AIM: To investigate gut barrier damage and intestinal bacteria translocation in severe acute pancreatitis (SAP), a simple rat model of SAP was induced and studied.METHODS: Pancreatitis was induced by uniformly distrib...AIM: To investigate gut barrier damage and intestinal bacteria translocation in severe acute pancreatitis (SAP), a simple rat model of SAP was induced and studied.METHODS: Pancreatitis was induced by uniformly distributed injection of 3.8% Na taurocholate (1 mL/kg) beneath the pancreatic capsule. Rats in the control group were injected with normal saline in the identical location. RESULTS: Serum amylase, plasma endotoxin, intestinal permeability, and pancreatitis pathology scores were all markedly higher in the pancreatitis group than in the control group (P < 0.01). The bacterial infection rate was signif icantly higher in the SAP group than in the control group (P < 0.01), observed in parallel by both bacterial culture and real-time polymerase chain reaction. Acute damage of the pancreas was observed histologically in SAP rats, showing interstitial edema, leukocyte infiltration, acinar cell necrosis and hemorrhage. The microstructure of the intestinal mucosa of SAP ratsappeared to be destroyed with loose, shortened microvilli and rupture of the intercellular junction, as shown by electron microscopy. CONCLUSION: Significant gut barrier damage and intestinal bacterial translocation were def initely observed with few potential study confounders in this SAP rat model, suggesting that it may be an appropriate animal model for study of gut barrier damage and bacterial translocation in SAP.展开更多
BACKGROUND Survival benefit of neoadjuvant chemotherapy(NAC)for advanced gastric cancer(AGC)is a debatable issue.Studies have shown that the survival benefit of NAC is dependent on the pathological response to chemoth...BACKGROUND Survival benefit of neoadjuvant chemotherapy(NAC)for advanced gastric cancer(AGC)is a debatable issue.Studies have shown that the survival benefit of NAC is dependent on the pathological response to chemotherapy drugs.For those who achieve pathological complete response(pCR),NAC significantly prolonged prolapsed-free survival and overall survival.For those with poor response,NAC yielded no survival benefit,only toxicity and increased risk for tumor progression during chemotherapy,which may hinder surgical resection.Thus,predicting pCR to NAC is of great clinical significance and can help achieve individualized treatment in AGC patients.AIM To establish a nomogram for predicting pCR to NAC for AGC patients.METHODS Two-hundred and eight patients diagnosed with AGC who received NAC followed by resection surgery from March 2012 to July 2019 were enrolled in this study.Their clinical data were retrospectively analyzed by logistic regression analysis to determine the possible predictors for pCR.Based on these predictors,a nomogram model was developed and internally validated using the bootstrap method.RESULTS pCR was confirmed in 27 patients(27/208,13.0%).Multivariate logistic regression analysis showed that higher carcinoembryonic antigen level,lymphocyte ratio,lower monocyte count and tumor differentiation grade were associated with higher pCR.Concordance statistic of the established nomogram was 0.767.CONCLUSION A nomogram predicting pCR to NAC was established.Since this nomogram exhibited satisfactory predictive power despite utilizing easily available pretreatment parameters,it can be inferred that this nomogram is practical for the development of personalized treatment strategy for AGC patients.展开更多
BACKGROUND Studies evaluating the characteristics of dual primary gastric and colorectal cancer(CRC)(DPGCC)are limited.AIM To analyze the clinicopathologic characteristics and prognosis of synchronous and metachronous...BACKGROUND Studies evaluating the characteristics of dual primary gastric and colorectal cancer(CRC)(DPGCC)are limited.AIM To analyze the clinicopathologic characteristics and prognosis of synchronous and metachronous cancers in patients with DPGCC.METHODS From October 2010 to August 2021,patients with DPGCC were retrospectively reviewed.The patients with DPGCC were divided into two groups(synchronous and metachronous).We compared the overall survival(OS)between the groups using Kaplan-Meier survival methods.Univariate and multivariate analyses were performed using Cox’s proportional hazards model to identify the independent prognostic factors for OS.RESULTS Of the 76 patients with DPGCC,46 and 30 had synchronous and metachronous cancers,respectively.The proportion of unresectable CRC in patients with synchronous cancers was higher than that in patients with metachronous cancers(28.3%vs 3.3%,P=0.015).The majority of the second primary cancers had occurred within 5 years.Kaplan-Meier survival analysis showed that the patients with metachronous cancers had a better prognosis than patients with synchronous cancers(P=0.010).The patients who had undergone gastrectomy(P<0.001)or CRC resection(P<0.001)had a better prognosis than those who had not.In the multivariate analysis,synchronous cancer[hazard ratio(HR)=6.8,95%confidence interval(95%CI):2.0-22.7,(P=0.002)]and stage III-IV gastric cancer(GC)[HR=10.0,95%CI:3.4-29.5,(P<0.001)]were risk prognostic factor for OS,while patients who underwent gastrectomy was a protective prognostic factor for OS[HR=0.2,95%CI:0.1-0.6,P=0.002].CONCLUSION Regular surveillance for metachronous cancer is necessary during postoperative follow-up.Surgical resection is the mainstay of therapy to improve the prognosis of DPGCC.The prognosis appears to be influenced by the stage of GC rather than the stage of CRC.Patients with synchronous cancer have a worse prognosis,and its treatment strategy is worth further exploration.展开更多
OBJECTIVE: To investigate the effect of FasL gene transfer to islet cells on pancreatic islet allografts. METHODS: A recombinant and replication-deficient type-5 adenovirus encoding murine FasL (AdV- FasL) was constru...OBJECTIVE: To investigate the effect of FasL gene transfer to islet cells on pancreatic islet allografts. METHODS: A recombinant and replication-deficient type-5 adenovirus encoding murine FasL (AdV- FasL) was constructed by the method of calcium phosphate precipitation. Pancreatic islets were infected with the recombinant adenovirus AdV-FasL, and transplanted into diabetic recipients. FasL expression was detected by RT-PCR and immunohistochemistry. The survival of allografts and the apoptosis of gene transferred islet allografts were analyzed. RESULTS: All animals receiving islet allograft alone returned to a diabetic state by several days (mean survival time 6.3±0.6 days). Compared with the control group, no delayed rejection and prolonged survival of allografts were observed in the group of FasL gene transfer. The rejection was accelerated and the allograft survival was shortened to 3.4±0.2 days (P<0.05). Pancreatic islets infected with AdV- FasL demonstrated positive staining of FasL at 24 h, with an increased intensity at 48 h, but not in AdV-5 infected or uninfected islets. TUNEL labeling of pancreatic islet allografts at 24, 48 h revealed apoptosis that was not in AdV-5 infected allografts. CONCLUSIONS: Though co-transplantation of FasL-expressing testicular cells can induce privilege of islet allografts and prolong allograft survival, direct expression of FasL on islet allografts infected with AdV-FasL may accelerate islets rejection by islet apoptosis and granulocyte infiltration.展开更多
Introduction Gastric cancer(GC)is the second most prevalent malignant tumor worldwide;it has a high mortality[1].The incidence of adenocarcinoma of the esophagogastric junction(AEG)is increasing in both Western and Ea...Introduction Gastric cancer(GC)is the second most prevalent malignant tumor worldwide;it has a high mortality[1].The incidence of adenocarcinoma of the esophagogastric junction(AEG)is increasing in both Western and Eastern countries[2–4].Total gastrectomy is considered the standard treatment of AEG.With the development of standard surgery and chemotherapy for GC,clinicians focus on not only survival outcomes,but also quality of life after comprehensive therapy.For patients undergoing gastrectomy,quality of life has always been affected by various symptoms,such as reflux and abdominal pain.展开更多
Background and aims:Mucosal healing is regarded as a clinical endpoint of Crohn’s disease(CD),and transmural healing is correlated to the concept of deep remission.Current therapies to induce mucosal and transmural h...Background and aims:Mucosal healing is regarded as a clinical endpoint of Crohn’s disease(CD),and transmural healing is correlated to the concept of deep remission.Current therapies to induce mucosal and transmural healing in CD are not satisfactory.Exclusive enteral nutrition(EEN)is underestimated therapy and its value has not been fully evaluated.Our aim was to investigate the efficacy of oral EEN for inducing mucosal and transmural healing in CD patients.Methods:This was a prospective,single-center,open-label study including diagnosed CD children and adults conducted between January 2015 and December 2016 in the Sixth Affiliated Hospital of Sun Yat-sen University.All patients were treated with oral EEN and underwent paired assessment at baseline and completion using C-reaction protein,erythrocyte sedimentation rate,platelets,hemoglobin,body mass index,CD activity index,simple endoscopic score for CD and bowel sonography.Azathioprine was combined to prevent relapse.Results:In this prospective observational study,29 CD patients with an average age of 28.9 years were identified.After oral EEN treatment,23 patients(79%)achieved complete mucosal healing,and the mean time to reach mucosal healing was 123 days(ranged from 50 to 212 days).Although only five patients(17%)achieved transmural healing,a significant reduction was observed in bowel-wall thickness(9.4163.06 vs 4.9761.76mm,P<0.001)and a significant improvement was observed in complications(including fistulas,abscess,ascites,stricture)assessed by bowel sonography(all P<0.05).Conclusions:Oral EEN therapy is highly effective for inducing mucosal healing in CD patients.Both CD patients at active stage and those at clinical remission show excellent clinical response to oral EEN.展开更多
基金Supported by The Natural Science Foundation of Guangdong Province, China, Grant No.2007A07001680
文摘AIM: To investigate gut barrier damage and intestinal bacteria translocation in severe acute pancreatitis (SAP), a simple rat model of SAP was induced and studied.METHODS: Pancreatitis was induced by uniformly distributed injection of 3.8% Na taurocholate (1 mL/kg) beneath the pancreatic capsule. Rats in the control group were injected with normal saline in the identical location. RESULTS: Serum amylase, plasma endotoxin, intestinal permeability, and pancreatitis pathology scores were all markedly higher in the pancreatitis group than in the control group (P < 0.01). The bacterial infection rate was signif icantly higher in the SAP group than in the control group (P < 0.01), observed in parallel by both bacterial culture and real-time polymerase chain reaction. Acute damage of the pancreas was observed histologically in SAP rats, showing interstitial edema, leukocyte infiltration, acinar cell necrosis and hemorrhage. The microstructure of the intestinal mucosa of SAP ratsappeared to be destroyed with loose, shortened microvilli and rupture of the intercellular junction, as shown by electron microscopy. CONCLUSION: Significant gut barrier damage and intestinal bacterial translocation were def initely observed with few potential study confounders in this SAP rat model, suggesting that it may be an appropriate animal model for study of gut barrier damage and bacterial translocation in SAP.
基金Supported by the Guangzhou Science and Technology Project,No.201803010040Natural Science Foundation of Guangdong Province,No.2016A030310187Nation Key Clinical Discipline。
文摘BACKGROUND Survival benefit of neoadjuvant chemotherapy(NAC)for advanced gastric cancer(AGC)is a debatable issue.Studies have shown that the survival benefit of NAC is dependent on the pathological response to chemotherapy drugs.For those who achieve pathological complete response(pCR),NAC significantly prolonged prolapsed-free survival and overall survival.For those with poor response,NAC yielded no survival benefit,only toxicity and increased risk for tumor progression during chemotherapy,which may hinder surgical resection.Thus,predicting pCR to NAC is of great clinical significance and can help achieve individualized treatment in AGC patients.AIM To establish a nomogram for predicting pCR to NAC for AGC patients.METHODS Two-hundred and eight patients diagnosed with AGC who received NAC followed by resection surgery from March 2012 to July 2019 were enrolled in this study.Their clinical data were retrospectively analyzed by logistic regression analysis to determine the possible predictors for pCR.Based on these predictors,a nomogram model was developed and internally validated using the bootstrap method.RESULTS pCR was confirmed in 27 patients(27/208,13.0%).Multivariate logistic regression analysis showed that higher carcinoembryonic antigen level,lymphocyte ratio,lower monocyte count and tumor differentiation grade were associated with higher pCR.Concordance statistic of the established nomogram was 0.767.CONCLUSION A nomogram predicting pCR to NAC was established.Since this nomogram exhibited satisfactory predictive power despite utilizing easily available pretreatment parameters,it can be inferred that this nomogram is practical for the development of personalized treatment strategy for AGC patients.
基金Supported by National Natural Science Foundation of China,No.82070684the Fundamental and Applied Basic Research Program of Guangdong Province,No.2020B151502005+3 种基金the Bethune Aixikang Distinguished Surgical Fund project,No.HZB-20190528-5China international medical foundation,No.Z-2017-24-2110the Program of Guangdong Provincial Clinical Research Center for Digestive Diseases,No.2020B1111170004the National Key Clinical Discipline.
文摘BACKGROUND Studies evaluating the characteristics of dual primary gastric and colorectal cancer(CRC)(DPGCC)are limited.AIM To analyze the clinicopathologic characteristics and prognosis of synchronous and metachronous cancers in patients with DPGCC.METHODS From October 2010 to August 2021,patients with DPGCC were retrospectively reviewed.The patients with DPGCC were divided into two groups(synchronous and metachronous).We compared the overall survival(OS)between the groups using Kaplan-Meier survival methods.Univariate and multivariate analyses were performed using Cox’s proportional hazards model to identify the independent prognostic factors for OS.RESULTS Of the 76 patients with DPGCC,46 and 30 had synchronous and metachronous cancers,respectively.The proportion of unresectable CRC in patients with synchronous cancers was higher than that in patients with metachronous cancers(28.3%vs 3.3%,P=0.015).The majority of the second primary cancers had occurred within 5 years.Kaplan-Meier survival analysis showed that the patients with metachronous cancers had a better prognosis than patients with synchronous cancers(P=0.010).The patients who had undergone gastrectomy(P<0.001)or CRC resection(P<0.001)had a better prognosis than those who had not.In the multivariate analysis,synchronous cancer[hazard ratio(HR)=6.8,95%confidence interval(95%CI):2.0-22.7,(P=0.002)]and stage III-IV gastric cancer(GC)[HR=10.0,95%CI:3.4-29.5,(P<0.001)]were risk prognostic factor for OS,while patients who underwent gastrectomy was a protective prognostic factor for OS[HR=0.2,95%CI:0.1-0.6,P=0.002].CONCLUSION Regular surveillance for metachronous cancer is necessary during postoperative follow-up.Surgical resection is the mainstay of therapy to improve the prognosis of DPGCC.The prognosis appears to be influenced by the stage of GC rather than the stage of CRC.Patients with synchronous cancer have a worse prognosis,and its treatment strategy is worth further exploration.
基金This study was supported by the National Natural Science Fundation of China (No. 39770726).
文摘OBJECTIVE: To investigate the effect of FasL gene transfer to islet cells on pancreatic islet allografts. METHODS: A recombinant and replication-deficient type-5 adenovirus encoding murine FasL (AdV- FasL) was constructed by the method of calcium phosphate precipitation. Pancreatic islets were infected with the recombinant adenovirus AdV-FasL, and transplanted into diabetic recipients. FasL expression was detected by RT-PCR and immunohistochemistry. The survival of allografts and the apoptosis of gene transferred islet allografts were analyzed. RESULTS: All animals receiving islet allograft alone returned to a diabetic state by several days (mean survival time 6.3±0.6 days). Compared with the control group, no delayed rejection and prolonged survival of allografts were observed in the group of FasL gene transfer. The rejection was accelerated and the allograft survival was shortened to 3.4±0.2 days (P<0.05). Pancreatic islets infected with AdV- FasL demonstrated positive staining of FasL at 24 h, with an increased intensity at 48 h, but not in AdV-5 infected or uninfected islets. TUNEL labeling of pancreatic islet allografts at 24, 48 h revealed apoptosis that was not in AdV-5 infected allografts. CONCLUSIONS: Though co-transplantation of FasL-expressing testicular cells can induce privilege of islet allografts and prolong allograft survival, direct expression of FasL on islet allografts infected with AdV-FasL may accelerate islets rejection by islet apoptosis and granulocyte infiltration.
基金supported by the Tianhe District Science and Technology Project,Guangzhou,China(No.201404KW020).
文摘Introduction Gastric cancer(GC)is the second most prevalent malignant tumor worldwide;it has a high mortality[1].The incidence of adenocarcinoma of the esophagogastric junction(AEG)is increasing in both Western and Eastern countries[2–4].Total gastrectomy is considered the standard treatment of AEG.With the development of standard surgery and chemotherapy for GC,clinicians focus on not only survival outcomes,but also quality of life after comprehensive therapy.For patients undergoing gastrectomy,quality of life has always been affected by various symptoms,such as reflux and abdominal pain.
基金supported by the National Natural Science Foundation of China(81470795)the Science and Technology Planning Project of Guangdong Province,China(2013B022000035).
文摘Background and aims:Mucosal healing is regarded as a clinical endpoint of Crohn’s disease(CD),and transmural healing is correlated to the concept of deep remission.Current therapies to induce mucosal and transmural healing in CD are not satisfactory.Exclusive enteral nutrition(EEN)is underestimated therapy and its value has not been fully evaluated.Our aim was to investigate the efficacy of oral EEN for inducing mucosal and transmural healing in CD patients.Methods:This was a prospective,single-center,open-label study including diagnosed CD children and adults conducted between January 2015 and December 2016 in the Sixth Affiliated Hospital of Sun Yat-sen University.All patients were treated with oral EEN and underwent paired assessment at baseline and completion using C-reaction protein,erythrocyte sedimentation rate,platelets,hemoglobin,body mass index,CD activity index,simple endoscopic score for CD and bowel sonography.Azathioprine was combined to prevent relapse.Results:In this prospective observational study,29 CD patients with an average age of 28.9 years were identified.After oral EEN treatment,23 patients(79%)achieved complete mucosal healing,and the mean time to reach mucosal healing was 123 days(ranged from 50 to 212 days).Although only five patients(17%)achieved transmural healing,a significant reduction was observed in bowel-wall thickness(9.4163.06 vs 4.9761.76mm,P<0.001)and a significant improvement was observed in complications(including fistulas,abscess,ascites,stricture)assessed by bowel sonography(all P<0.05).Conclusions:Oral EEN therapy is highly effective for inducing mucosal healing in CD patients.Both CD patients at active stage and those at clinical remission show excellent clinical response to oral EEN.
