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Liu S, Xia QY, Fu Y, Lu XF, Wang M, Guan WX. [Skip metastasis at the esophageal resection margin in radical gastrectomy: clinical characteristics of 30 cases]. Zhonghua Wei Chang Wai Ke Za Zhi 2023; 26:675-679. [PMID: 37583025 DOI: 10.3760/cma.j.cn441530-20221206-00508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Objective: To summarize the clinical characteristics of patients with skip metastasis at esophageal resection margin during radical gastrectomy. Methods: This is a descriptive study of case series. Relevant data from 2006 to 2022 were collected from two major gastric cancer consultation and treatment centers: Nanjing Drum Tower Hospital and Jinling Hospital.Characteristics, surgical approach, number of dissected lymph nodes, immunohistochemical staining, and pathological staging were summarized and analyzed. The distribution of residual tumor cells at the esophageal margins was further analyzed at the cellular and tissue levels. Skip metastasis at the esophageal resection margin was defined as a negative esophageal margin with a positive margin in the cephalad donut. Results: Thirty (0.33%, 30/8972) eligible patients, 24 (80.0%) of whom were male, were identified in the two centers. The mean age was 63.9±11.0 years. Seventeen (56.7%) of these patients had papillary or tubular adenocarcinomas, including 13 (43.3%) poorly- and four (13.3%) moderately-differentiated tumors; four (13.3%) had signet-ring cell carcinomas; four (13.3%) mucinous adenocarcinomas; three (10.0%) mixed adenocarcinomas, including two with poorly-differentiated tubular adenocarcinomas mixed with signet-ring cell carcinoma and mucinous adenocarcinoma; and one had a poorly differentiated tubular adenocarcinoma mixed with signet-ring cell carcinoma. Two patients (6.7%) had other types of cancer, namely adenosquamous carcinoma in one patient and undifferentiated carcinoma in the other one. The predominant tumor sites were the lesser curvature (n=26, 86.7%) and the cardia (n=24, 80.0%). The mean tumor diameter was 6.6 cm, mean distance between tumor and esophageal resection margin was 1.5 cm, and proportions of tumor invasion into the dentate line, nerves, and vessels were 80.0% (24/30), 86.7%(26/30), and 93.3% (28/30), respectively. The mean number of lymph nodes resected was 20.4±8.9. The pathological stage was mainly T4 (n=18, 60.0%) and N3 (n=21, 70.0%), the median Ki67 was 52.7%, and the rates of positivity for HER2, EGFR, VEGFR, E-cadherin and PD-L1 were 40.0% (12/30), 46.7% (14/30), 80.0% (24/30), 86.7% (26/30) and 16.7% (5/30), respectively. At the cellular level, cancer cells were mainly distributed in small focal areas, as cell masses, or as tumor thrombi; large numbers of widely distributed atypic cells were seldom observed. At the tissue level, cancer cells were located in the mucosal layer in seven patients (23.3%), in the submucosal layer in 18 (60.0%), and in the muscular layer in five (16.7%); no cancer cells were identified in the outer membrane. Five of the seven tumors were located in the lamina propria, two in the muscularis mucosae, and none in the mucosal epithelium. Conclusion: Patients with skip metastasis at the esophageal resection margin at radical gastrectomy have unfavorable tumor biology and a high proliferation index, are at a late pathological stage, and the residual cancer is mostly located in the submucosa.
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Affiliation(s)
- S Liu
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, Medical School of the Affiliated Hospital of Nanjing University, Nanjing 210000,China
| | - Q Y Xia
- Department of Pathology, Jinling Hospital, Nanjing 201101,China
| | - Y Fu
- Department of Pathology, Nanjing Drum Tower Hospital, Medical School of the Affiliated Hospital of Nanjing University, Nanjing 210000, China
| | - X F Lu
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, Medical School of the Affiliated Hospital of Nanjing University, Nanjing 210000,China
| | - M Wang
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, Medical School of the Affiliated Hospital of Nanjing University, Nanjing 210000,China
| | - W X Guan
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, Medical School of the Affiliated Hospital of Nanjing University, Nanjing 210000,China
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Guan WX, Ma Y, Peng XY. [Toxic retinopathy caused by veterinary antiparasitic closantel: a case report]. Zhonghua Yan Ke Za Zhi 2023; 59:570-573. [PMID: 37408429 DOI: 10.3760/cma.j.cn112142-20221127-00602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
A 32-year-old female patient presented with bilateral vision loss for 2 months following her intake of various antiparasitic drugs, including closantel, a veterinary drug, for a self-perceived intraocular parasitic infection. Swept-source optical coherence tomography revealed diffuse hyperreflectivity between the outer nuclear layer and the retinal pigment epithelium, as well as the largely indistinguishable outer retinal layers. This case was clinically diagnosed with veterinary closantel-induced toxic retinopathy and had a poor visual prognosis after nerve nutrition and circulation improvement therapy due to the long duration of the disease.
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Affiliation(s)
- W X Guan
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Beijing 100730, China
| | - Y Ma
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Beijing 100730, China
| | - X Y Peng
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Beijing 100730, China
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Fan SX, Wang J, Li Q, Li YS, Guan WX, Li JS. [Mechanism of gut-microbiota-liver axis in the pathogenesis of intestinal failure-associated liver disease]. Zhonghua Wei Chang Wai Ke Za Zhi 2021; 24:94-100. [PMID: 33461259 DOI: 10.3760/cma.j.cn.441530-20201009-00550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Intestinal failure (IF) is defined as the critical reduction of functional intestines below the minimum needed to absorb nutrients and fluids, so that intravenous supplementation with parenteral nutrition (PN) is required to maintain health and/or growth. Although the benefits are evident, patients receiving PN can suffer from serious cholestasis due to lack of enteral feeding and small intestinal bacterial overgrowth (SIBO). One such complication that may arise is intestinal failure-associated liver disease (IFALD). Evidences from recent studies suggest that alterations in the intestinal microbiota, as well as intraluminal bile acid driven signaling, may play a critical role in both hepatic and intestinal injury. Since Marshall first proposed the concept of the gut-liver axis in 1998, the role of gut-liver axis disorders in the development of IFALD has received considerable attention. The conversation between gut and liver is the key to maintain liver metabolism and intestinal homeostasis, which influences each other and is reciprocal causation. However, as a "forgotten organ" , intestinal microbiota on the pathogenesis of IFALD has not been well reflected. As such, we propose, for the first time, the concept of gut-microbiota-liver axis to emphasize the importance of intestinal microbiota in the interaction of gut-liver axis. Analysis and research on gut-microbiota-liver axis will be of great significance for understanding the pathogenesis of IFALD and improving the prevention and treatment measures.
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Affiliation(s)
- S X Fan
- Department of General Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - J Wang
- Department of General Surgery, Nanjing Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Q Li
- Department of General Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Y S Li
- Department of General Surgery, Shanghai Ninth People's Hospital, Medical School of Shanghai Jiaotong University, Shanghai 200011, China
| | - W X Guan
- Department of General Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - J S Li
- Department of General Surgery, Nanjing Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
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Qian WF, Guan WX, Gao Y, Tan JF, Qiao ZM, Huang H, Xia CL. Inhibition of STAT3 by RNA interference suppresses angiogenesis in colorectal carcinoma. Braz J Med Biol Res 2011; 44:1222-30. [PMID: 22030865 DOI: 10.1590/s0100-879x2011007500143] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Accepted: 10/13/2011] [Indexed: 12/13/2022] Open
Abstract
In order to investigate signal transduction and activation of transcription 3 (STAT3) signaling on angiogenesis in colorectal carcinoma (CRC) after inhibiting STAT3 expression, we constructed the HT-29-shSTAT3 cell line by lentivirus-mediated RNAi. Cell growth was assessed with MTT and the cell cycle distribution by flow cytometry. CRC nude mouse models were established and tumor growth was monitored periodically. On day 30, all mice were killed and tumor tissues were removed. Microvessel density (MVD) was determined according to CD34-positive staining. The expression of vascular endothelial growth factor A (VEGFA), matrix metalloproteinase-2 (MMP2) and basic fibroblast growth factor (FGF2) was monitored by quantitative real-time PCR and Western blot analysis. Knockdown of STAT3 expression significantly inhibited cell growth in HT-29 cells, with a significantly higher proportion of cells at G0/G1 (P < 0.01). Consistently, in vivo data also demonstrated that tumor growth was significantly inhibited in mice injected with HT-29-shSTAT3 cells. MVD was 9.80 ± 3.02 in the HT-29-shSTAT3 group, significantly less than that of the control group (P < 0.01). mRNA and protein levels of VEGFA and MMP2 in the HT-29-shSTAT3 group were significantly lower than in the control group (P < 0.05), but no significant difference was observed in the mRNA or protein level of FGF2 (P > 0.05). Taken together, these results demonstrate that STAT3 signaling is important to the growth of CRC and promotes angiogenesis by regulating VEGFA and MMP2 expression.
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Affiliation(s)
- W F Qian
- Department of General Surgery, Suzhou Hospital Affiliated to Nanjing Medical University, JS, China.
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Li FC, Guan WX. [Clinical application of the medial fasciocutaneous flap of arm]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2000; 14:350-1. [PMID: 12516436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVE To study the clinical application of the medial arm fasciocutaneous flap based on the medial septocutaneous branches of the brachial vessel. METHODS Since 1994, the medial arm fasciocutaneous flap based on the medial septocutaneous branches of the branchial vessel has been used to cure scar contracture of axillary and elbow joint, radiated ulcer of the chest wall. Eighteen clinical cases were reported. Among them, there were 14 males and 4 females, aged from 6 to 48 years old. The flaps, of which 3 were proximally based and 15 distally based, were designed 23 cm x 11 cm as maximal size and 10 cm x 6 cm as minimal size. RESULTS All the flaps survived and the excellent function and cosmetic result were achieved. CONCLUSION The medial arm fasciocutaneous flap is thin, soft and relatively hairless, so it is suitable for repairing the soft tissue defect of the axillary or elbow joint. There are consistently present perforators at both ends that allow one to rotate long flaps around pivoting points immediate to the areas needing coverage. Moreover, this flap is characterized by the simplicity of the surgical techniques and circulatory reliability.
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Affiliation(s)
- F C Li
- Department of Plastic Surgery, Affiliated Hospital of Xuzhou Medical College, Xuzhou Jiangsu, P. R. China 221002
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Li QF, Zhang DS, Guan WX. [Functional evaluation of electrical-injury nerve using somatosensory evoked potential technique]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2000; 14:332-5. [PMID: 12516430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVE To investigate the characteristics and the pathologic classification of electrical-injury nerve using somatosensory evoked potential(SEP) technique. METHODS SEP were detected and evaluated in 12 cases with electrical-injury nerve during operation, electrical stimulation was commenced from distal side of nerve where the structure of nerve looks normal under operating microscope, up to proximal side until evoking out a stable SEP predeterminate virtual value. Pathological examination and the following functional evaluation were compared with the values of SEP. RESULTS At the site of nerve looking normal under operating microscope, perineurium appears normal or slightly thicken. But there are obvious fibrosis and fibrotic proliferation between fascicular and intrafascicular. Vessel plexus is not seen. At SEP stabilizely evoked site, nervous construction is normal, there are visible interfascicular vessel plexus and connective tissue appears loose. Comparing SEP values with pathological section, amplitude and latency of SEP is positively correlative with the quality of nerve. Eight cases repaired with SEP technique to select the anastomosis site for nerve transplantation were followed up, two-point discrimination reached grade III (America hand surgery association criterion) within 62.5% cases. CONCLUSION SEP technique is valuable method for functional evaluation of electrical- injury nerve which has a complicated pathology. The pathology of electrical-injury nerve can be classified into 4 types, type A: fibrosis of nerve; type B: nerve looking normal under operation microscope, perineurium appears thicken, and there are obvious fibrosis and fibrotic proliferation between fascicular and intrafascicular, vessel plexus is rarely to see; type C: nerve looks normal, lymphocyte infiltration exists and it is obvious that there are many physalis-like, retrogressive construction in the section; type D: nervous construction is normal, there are visible interfascicular vessel plexus, and connective tissue appears loose, SEP always can be stably evoked.
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Affiliation(s)
- Q F Li
- Department of Plastics and Reconstructive Surgery, Shanghai Second Medical University, Shanghai, P. R. China 200011
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Fan ZH, Guan WX, Jin YT. [Silicone gel in the treatment of burn and prevention of hypertrophic scar]. Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi 1993; 9:385-7. [PMID: 8143216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Zhou S, Chang TS, Guan WX, Chen KX, Wang SL, Cao YL, Huang WY. Microsurgical replantation of the avulsed scalp: report of six cases. J Reconstr Microsurg 1993; 9:121-5; discussion 125-9. [PMID: 8468702 DOI: 10.1055/s-2007-1006660] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
This article reports the successful microsurgical replantation of six scalps avulsed for over 3 to 11 hr, after trauma and before repair, including five total and one partial avulsion. The authors believe that one key to successful replantation is effective vessel anastomoses. In the reported series, three scalps were reconstructed with two superficial temporal vessels and in five cases, with a 1:1 ratio between arteries and veins. The partially avulsed scalp was replanted successfully with only one artery and one vein. The management of postoperative complications is discussed.
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Affiliation(s)
- S Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, China
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Wang DM, Guan WX. Plastic surgery in China. Chin Med J (Engl) 1991; 104:355-7. [PMID: 1879204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- D M Wang
- Plastic Surgery Research Center, 3rd Clinical College, Beijing Medical University
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Guan WX. [Experiences in the treatment of postburn talipes equinus accompanied by ankle injury]. Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi 1991; 7:30-1. [PMID: 1674441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Guan WX. [Application of a free medial thigh flap to the treatment of late postburn cases (report of 6 cases)]. Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi 1988; 4:258-9, 317. [PMID: 3151675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
Postburn breast deformity is a sequelae of severe scar contraction of the burned chest. During the past four years, 6 female patients with such a deformity required reconstruction, and the surgery was performed in our department. Three different types of breast reconstruction were undertaken, each one achieving a satisfactory aesthetic result.
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Affiliation(s)
- W X Guan
- Plastic and Reconstructive Surgery Department, Ninth People's Hospital, Shanghai, China
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Guan WX, Qian YL, Cheng KX, Xu LG. Free medial thigh flap in treatment of advanced burn cases. Chin Med J (Engl) 1986; 99:187-90. [PMID: 3095042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Abstract
Postburn talipes equinovarus has long been a challenging problem for plastic surgeons, who usually replace the overlying scar in multistaged flap or tube transfer operations before lengthening the shortened Achilles tendon. This always requires long hospitalization and causes much discomfort for the patient because of postural immobilization. In 1975, I designed a new and simple procedure by Z-lengthening the scar tissue and the Achilles tendon as a whole in one stage. To date, the operative result in 10 cases has been excellent, without failure or recurrence.
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Affiliation(s)
- W X Guan
- Plastic Surgery Department, Shanghai People's Ninth Hospital, China
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Abstract
We present a technique using a reversed island forearm fascial flap based on the distal portion of the radial artery and veins, with a skin graft on top, to repair a soft tissue defect of the hand. Good results were obtained in a total of 18 operations in 17 postburn cases. The operation can be completed in one stage even when it involves the excision of scar tissue, correction of the secondary deformities of deep structures, and repair of the soft tissue defect of the hand. The advantages and disadvantages of the method and key points of the technique are discussed.
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Guan WX. [Frontal bone defect repaired with a composite ipsilateral island temporal flap]. Zhonghua Wai Ke Za Zhi 1984; 22:430-1, 446. [PMID: 6518901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Zhang DS, Guan WX, Huang WY, Ding ZX, Xu CY. Surgery in gigantic neurofibromas of the back. Report of 3 cases. Chin Med J (Engl) 1983; 96:893-6. [PMID: 6426882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Guan WX, Huang WY, Xu CY, Qian YL, Zhang DS. Dorsalis indicis flap for repair of thumb and first web space deformities. Report of 6 cases. Chin Med J (Engl) 1983; 96:159-63. [PMID: 6409522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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