ObjectiveTo investigate the feasibility and safety of the double cavity casing negative pressure drainage by inside and outside of the intestine in the primary resection and anastomosis of left colon cancer combined with acute obstruction. MethodsEighty-one cases of left colon cancer combined with acute obstruction who underwent surgeries in our hospital from January 2009 to December 2012 were collected prospectively, and were divided into one-stage surgery group (n=41) and control group (n=40). Cases of one-stage surgery group received double cavity casing negative pressure drainage by inside and outside of the intestine in the primary resection and anastomosis, and cases of control group underwent two-stage surgeries. Comparison of operation time, blood loss, time of anal exhaust after operation, hospital stay, hospital expense, and incidence of complication between the 2 groups was performed. ResultsThere were no significant difference in the operation time[(166±19) minutes vs. (173±23) minutes], blood loss[(253±42) mL vs. (273±50) mL], and time of anal exhaust after operation[(3.24±0.73) days vs. (3.50±0.95) days]beeween one-stage surgery group and control group, but hospital stay[(15.1±2.3) days vs. (23.1±4.1) days]and hospital expense[(3.70±0.68) ×105 yuan vs. (5.77±0.95) ×105 yuan]of one-stage surgery group were lower than those of control group (P<0.05). In addition, there were no significant difference in the incidences of wound infection[7.3% (3/41) vs. 10.0% (4/40)], intraabdominal infection[4.9% (2/41) vs. 10.0% (4/10)], pulmonary infection[12.2% (5/41) vs. 15.0% (6/40)], and anastomotic leakage[2.4% (1/41) vs. 5.0% (2/40)]beeween one-stage surgery group and control group (P>0.05). All of the cases were followed up for 1-36 months, and the median time were 22 months. There were no significant difference in the mortality[0 (0/41) vs. 2.5% (1/40)], recurrence rate[2.4% (1/41) vs. 5.0% (2/40)], and metastasis rate[7.3% (3/41) vs. 10.0% (4/40)]beeween one-stage surgery group and control group too (P>0.05). ConclusionIn the case of negative pressure drainage of double cavity casing, underwent decompression of the small bowel, and irrigation of colon, the primary resection and anastomosis of left colon cancer combined with acute obstruction was safe and feasible.
ObjectiveTo understand the function of long non-coding RNA (lncRNA) colon cancer associated transcript-1 (CCAT1) and summarize its relationship with gastric cancer.MethodThe published literatures on the studies of lncRNA CCAT1 function and its relationship with gastric cancer were reviewed and analyzed.ResultsThe lncRNA CCAT1 exerted the negative regulation on the genes by binding to microRNAs (miR) as a competitive endogenous RNA, mediating chromatin circulation between the c-MYC promoter and its upstream enhancer, and promoted the expression of c-MYC gene. The recent studies had found that the CCAT1 could bind to the miR-219-1 and miR-490, thereby promoting the progress of gastric cancer. The expression of lncRNA CCAT1 in the gastric cancer tissues increased, which was obviously different from that in the paracancer tissues and normal tissues. The high expression of lncRNA CCAT1 was related to the tumor size, lymphatic metastasis and TNM stage.ConclusionsThe specific mechanism, intracellular signal transduction pathway and interaction mechanism between CCAT1 and other molecules involved in the progress of gastric cancer still need to be further explored. With the in-depth study of lncRNA, especially CCAT1, it may provide a broader prospect for the diagnosis and treatment of gastric cancer as a target of CCAT1.
Urokinase plasminogen activator receptor (uPAR) is a membrane protein which is attached to the cellular external membrane. The uPAR expression can be observed both in tumor cells and in tumor-associated stromal cells. Thus, in the present study, the human amino-terminal fragment (hATF), as a targeting element to uPAR, is used to conjugate to the surface of superparamagnetic iron nanoparticle (SPIO). Flowcytometry was used to examine the uPAR expression in different tumor cell lines. The specificity of hATF-SPIO was verified by Prussian blue stain and cell phantom test. The imaging properties of hATF-SPIO were confirmed in vivo magnetic resonance imaging (MRI) of uPAR-elevated colon tumor. Finally, the distribution of hATF-SPIO in tumor tissue was confirmed by pathological staining. Results showed that the three cells in which we screened, presented different expression characteristics, i.e., Hela cells strongly expressed uPAR, HT29 cells moderately expressed uPAR, but Lovo cells didn't express uPAR. In vitro, after incubating with Hela cells, hATF-SPIO could specifically combined to and be subsequently internalized by uPAR positive cells, which could be observed via Prussian blue staining. Meanwhile T2WI signal intensity of Hela cells, after incubation with targeted probe, significantly decreased, and otherwise no obvious changes in Lovo cells both by Prussian blue staining and MRI scans. In vivo, hATF-SPIO could be systematically delivered to HT29 xenograft and accumulated in the tumor tissue which was confirmed by Prussian Blue stain compared to Lovo xenografts. Twenty-four hours after injection of targeting probe, the signal intensity of HT29 xenografts was lower than Lovo ones which was statistically significant. This targeting nanoparticles enabled not only in vitro specifically combining to uPAR positive cells but also in vivo imaging of uPAR moderately elevated colon cancer lesions.
ObjectiveTo develop an immune-related genes (IRGs) based prognostic signature and evaluate the value in predicting prognosis in patients with colon cancer.MethodsGene chip data sets of 452 colon cancer patients were collected from the TCGA database, and 2 498 IRGs data sets were obtained from the ImmPort database. After taking the intersection, univariate and multivariate Cox proportional hazards regression analysis were used to screen and construct the IRGs gene model. To evaluate the prognostic value of genetic models, Cox proportional hazards regression was used to analyze the correlation between IRGs model/clinicopathological features with prognosis of colon cancer. The relationship between risk score and immune cell infiltration was analyzed too.ResultsA total of 206 differentially expressed IRGs were identified in colon cancer tissues, and 11 kinds of IRGs were identified by univariate and multivariate Cox proportional hazards regression analysis: solute carrier family 10 member 2 (SLC10A2), C-X-C motif chemokine ligand 5 (CXCL5), C-C motif chemokine ligand 28 (CCL28), immunoglobulin kappa variable 1D-42 (IGKV1D-42), chromogranin A (CHGA), endothelial cell specific molecule 1 (ESM1), gastrin releasing peptide (GRP), stanniocalcin 2 (STC2), urocortin (UCN), oxytocin receptor (OXTR) and immunoglobulin heavy constant gamma 1 (IGHG1). Colon cancer patients were divided into high risk group and low risk group according to the median value of risk value of IRGs risk markers. Patients in the high risk group had shorter overall survival (OS) than that in the low risk group (P<0.001). The area of the time-dependent ROC curve (AUC) was 0.754, suggesting that IRGs model had a good ability to predict the prognosis of colon cancer patients. The higher the risk value of IRGs, the later T stage of colon cancer (T3–T4), the more lymph node metastasis (N1–N2) and the later clinical stage of colon cancer (Ⅲ–Ⅳ), P<0.05. Except for neutrophils, the infiltration density of B cells, CD4+ T cells, CD8+ T cells, dendritic cells and macrophages were significantly increased with the increased of the risk value (P<0.05).ConclusionThe risk values of the 11 kinds of IRGs gene models screened in this study can be used to predict the prognosis of colon cancer patients, and can be used as biomarkers to evaluate the prognosis of colon cancer patients.
Objective To explore the relationship between Epstein-Barr virus (EBV) infection with serum human kissin-1 (KISS-1) and matrix metalloproteinase 2 (MMP2) levels and prognosis in patients with colon cancer. Methods A total of 86 colon cancer patients who were hospitalized in our hospital from April 2015 to April 2016 were selected as the colon cancer group; in the same period, 84 cases of physical examination person in our hospital were selected as the control group. Real-time fluorescent quantitative PCR (qRT-PCR) was used to test colon cancer patients for EBV DNA, and divided the patients into EBV DNA negative group and EBV DNA positive group according to the test results. Enzyme-linked immunosorbent (ELISA) method was used to detect serum KISS-1 and MMP2 levels. Pearson method was used to analyze the correlation between serum KISS-1 and MMP2 levels in patients with colon cancer infected with EBV. The survival curve was drawn by Kaplan-Meier method, and the relationship between EBV infection and prognosis of colon cancer patients was analyzed by log-rank test. Multivariate Cox regression analysis were used to analyze the factors affecting the prognosis of colon cancer patients. Results Compared with the control group, the positive rate of EBV DNA in the colon cancer group was higher (χ2=21.854, P<0.001). The EBV DNA positive rate of patients with lymph node metastasis, TNM stage Ⅲ–Ⅳ, tumor low differentiation and tumor infiltration T3–T4 was higher than those without lymph node metastasis, TNM stage Ⅰ–Ⅱ, tumor high/medium differentiation and tumor infiltration T1–T2 (P<0.05). Compared with the EBV DNA negative group, the serum KISS-1 level of the EBV DNA positive group decreased, and the MMP2 level increased (P<0.001). There was a negative correlation between serum KISS-1 and MMP2 levels in colon cancer patients with EBV infection (r=–0.510, P<0.001). The 5-year survival rates of colon cancer patients in the EBV DNA-negative group and the EBV DNA-positive group were 52.94% (27/51) and 14.29% (5/35), respectively, the difference between the two groups was statistically significant (χ2=13.274, P<0.001). EBV infection, MMP2 high expression, and lymph node metastasis were independent risk factors affecting the prognosis of colon cancer patients (P<0.05), and KISS-1 low expression was a protective factor affecting the prognosis of colon cancer patients (P<0.05). Conclusions EBV infection is closely related to the progression and prognosis of colon cancer. The down-regulation of KISS-1 and the up-regulation of MMP2 may be related to EBV infection.
ObjectiveTo compare the short- and long-term effects of emergency surgery (ES) and self-expanding metal stent (SEMS) in treatment of malignant left-sided colonic obstruction.MethodsThe patients with malignant left-sided colonic obstruction who met the inclusion and exclusion criteria in the Third Affiliated Hospital of Soochow University from October 2010 to October 2020 were retrospectively collected and divided into ES group (n=43) and SEMS group (n=22). The baseline data, surgical data, postoperative data, and prognosis (overall survival and relapse free survival) were compared, and the risk factors of tumor recurrence after surgery were further analyzed by Cox proportional hazards regression model. ResultsIn this study, 65 cases of malignant left-sided colonic obstruction were included, including 43 cases in the ES group and 22 cases in the SEMS group. There were no statistical differences in the baseline data of the two groups (P>0.05). There were no significant differences in the incidence of postoperative complications [13.6% (3/22) vs. 23.3% (10/43), P=0.555], recurrence rate [40.9% (9/22) vs. 37.2% (16/43), P=0.772], and rate of receiving postoperative chemotherapy [68.2% (15/22) vs. 48.8% (21/43), P=0.138] between the SEMS group and ES group. Compared with the ES group, although the median hospitalization time was longer (20 d vs. 12 d, P=0.001), and the median hospitalization cost was higher (65 033 yuan vs. 40 045 yuan, P=0.001), the stoma rate of the SEMS group was lower [36.4% (8/22) vs. 88.4% (38/43), P=0.001], and the minimally invasive (laparoscopic) rate was higher [36.4% (8/22) vs. 7.0% (3/43), P=0.008]. There were no significant differences in the 4-year cumulative overall survival (46.9% vs. 48.4%, P=0.333) and 4-year cumulative relapse free survival (36.2% vs. 44.8%, P=0.724) between the SEMS group and ES group, but the overall survival of the SEMS group was better than that of the ES group for the patients with stage Ⅲ–Ⅳ (χ2=4.644, P=0.047). Multivariate analysis of Cox proportional hazards regression model showed that increased TNM stage increased the risk of postoperative tumor recurrence of patients with malignant left-sided colonic obstruction [HR=2.092, 95%CI (1.261, 3.469), P=0.004]. ConclusionsShort- and long-term effects of ES and SEMS in treatment of malignant left-sided colonic obstruction are equivalent. Although SEMS mode has a longer hospital stay and higher hospitalization costs, stoma rate is lower and laparoscopic surgery rate is higher. Overall survival of SEMS mode in treatment malignant left-sided colonic obstruction patients with stage Ⅲ–Ⅳ is better.
Objective To investigate the effects of recombinant adenovirus-mediated co-transfection of carcinoembryonic antigen (CEA) gene and erythropoietin (EPO) gene on promoting hematopoietic stem cells directly producing erythrocyte vaccine against colon cancer. Methods The expression adenovirus vectors carrying CEA and EPO or green fluorescent protein (GFP) gene were constructed respectively, and recombinant adenovirus carrying CEA, EPO or GFP were packaged and produced respectively. The bone marrow-derived mesenchymal stem cells (MSCs) of mice were isolated and cultured in vitro by anti-CD117 magnetic bead separation, and were transfected with CEA (CEA group), EPO (EPO group) or GFP (blank vector group), co-transfected with CEA and EPO (CEA-EPO group). The expressionsof CEA and EPO gene and its protein after transfection in supernatant fluid of culture were detected by realtime-PCR and Western blot method in each group. We had checked and obtained the vaccine with co-transfection of CEA gene and EPO gene by cell red line marker antibody CD71 and GPA, then we carried on experiments with the vaccine in vitro and in vivo. There were 4 groups in our trail: blank vector group, CEA group, EPO group, and CEA-EPO group. Results We had successfully gathered the hematopoietic stem cells, flow cytometry analysis result showed that there were significant differences before and after purification for positive selected samples (P<0.05). The expressions of double genes (CEA-EPO gene) and protein showed CEA-EPO gene were successfully transfected into the hematopoietic stem cells. We had confirmed erythrocyte vaccine with co-transfection of CEA and EPO gene by antibody CD71 and GPA with flow cytometry. The monocytes cytotoxicity on colon cancer cell line CT26 showed that lysis of target cells of CEA-EPO group were higher than those of other 3 groups when in proportion of 40∶1 (P<0.05). In the experimentation of neoplasma format, the volume of tumor and mortality were smaller or lower, but survival time was longer of CEA-EPO group in2 weeks after treatment (P<0.05). Conclusions The erythrocyte vaccine with co-transfection of CEA gene and EPO gene has efficient anti-tumor effects on colon cancer. Not only can promote hematopoietic stem cell directly producing erythrocyte vaccine, but also can produce tumor antigen vaccine against colon cancer.
ObjectiveTo evaluate safety and effectiveness of stent placement and emergency surgery in treatment of proximal colon cancer obstruction.MethodsThe PubMed, Embase, Cochrane Library, ClinicalTrials, CNKI, CBM, Wanfang Data, etc. were searched comprehensively. The literatures of Chinese and English randomized controlled trial and retrospective comparative study of stent placement and emergency surgery for the proximal colon cancer obstruction were retrieved. The RevMan 5.3 and Stata 12.0 softwares were used. The meta-analysis was made on the safety and effectiveness of these two treatments.ResultsA total of 9 literatures involving 636 patients were included, all of them were the retrospective studies, 4 of them only reported the clinical success rate and technical success rate. The technical success rate of stent placement was 0.94 [95% CI (0.91, 0.96)]. The clinical success rate was 0.90 [95% CI (0.87, 0.93)]. Compared with the emergency surgery group, the total complication rate and the temporary stoma rate were lower [OR=0.32, 95% CI (0.11, 0.94), P=0.04; OR=0.18, 95% CI (0.05, 0.65), P=0.009] and the hospital stay was shorter [MD=–2.97, 95% CI (–4.52, –1.41), P=0.000 2] in the stent placement group. The perioperative mortality rate, laparoscopic surgery rate, 5-year disease-free survival rate, and 5-year overall survival rate had no significant differences between these two groups (P>0.05).ConclusionCompared with emergency surgery, endoscopic stent placement for treatment of proximal colon cancer obstruction has a lower incidence of complications, temporary colostomy rate, shorter hospital stay, and it has no significant differences in mortality, laparoscopic surgery rate, and survival rate.
ObjectiveTo explore the relevant risk factors for postoperative delirium (POD) in elderly patients undergoing radical colon cancer surgery, and provide a basis for formulating postoperative prevention and treatment measures for POD. MethodsA total of 128 elderly patients diagnosed with colon cancer and underwent radical colon cancer surgery at Xindu District People’s Hospital in Chengdu from January 2018 to December 2021 were included as the study subjects. Patients were divided into two groups according to the score of Delirium Assessment Scale (4AT Scale). The basic data, main perioperative clinical data and laboratory indicators of the two groups were collected, and univariate and logistic regression analysis were carried out to determine the potential risk factors of POD in elderly patients with colon cancer after radical operation. ResultsAccording to the results of the 4AT scale score, a total score of ≥4 points was used as the threshold for determining patient POD. Among 128 patients, there were 29 patients (22.66%) with POD and 99 patients (77.34%) without POD. ① General data comparison: There was no significant difference between the two groups in gender, body mass index, years of education, hypertension, diabetes, smoking history and drinking history (P>0.05), but there was significant difference in age, preoperative mini-mental state examination (MMSE) score and American Society of Anesthesiologists (ASA) grade (P<0.05). ② Comparison of main clinical data during the perioperative period: There was no statistically significant difference between the two groups of patients in ICU treatment, nonsteroidal anti-inflammatory drug treatment, visual analogue scale, and intraoperative hypotension (P>0.05), but there was a statistically significant difference in operative time, anesthesia time, intraoperative blood loss, and dexmedetomidine treatment (P<0.05). ③ Comparison of preoperative laboratory indicators: There was no statistically significant difference between the two groups of patients in terms of hemoglobin, serum albumin, white blood cell count, prognostic nutritional index, neutrophil/lymphocyte ratio, D-dimer, and albumin to fibrinogen ratio (P>0.05). ④ The results of logistic regression analysis showed that low preoperative MMSE score [OR=0.397, 95%CI (0.234, 0.673)], long surgical time [OR=1.159, 95%CI (1.059, 1.267) ], and long anesthesia time [OR=1.138, 95%CI (1.057, 1.226) ] were independent risk factors for the occurrence of POD in elderly colon cancer patients undergoing radical surgery. ConclusionPreoperative MMSE score, operative time, and anesthesia time are closely related to the occurrence of POD in elderly colon cancer radical surgery, worth implementing key perioperative management in clinical practice to prevent and manage POD.
ObjectiveTo assess the effect of chewing gum on the recovery of postoperative gastrointestinal function in patients with colorectal cancer. MethodsA comprehensive search for relevant randomised controlled trials (RCTs) was conducted in domestic and international databases such as PubMed, The Cochrane Library, Web of Science, Chinese Science and Technology Journal Full-text Database, Chinese Periodicals Full-text Database, Wanfang data, and other databases, with a timeframe up to September 2023. The literature was screened according to the inclusion and exclusion criteria. Simultaneously, the literature quality evaluation and data extraction were performed. The continuous variables were described using mean difference (95% confidence interval) and the binary variables were described using odds ratio (95% confidence interval). Test level was α=0.05. ResultsA total of 28 RCTs covering 2 523 postoperative colorectal cancer patients were included. The meta-analysis results showed that the postoperative chewing gum could shorten the time of the first flatus [–11.99 (–14.45, –9.53)], the first defecation [–18.79 (–23.58, –14.00)], the first bowel sounds [–6.35 (–6.64, –6.06)] or the first starvation [–5.20 (–10.11, –0.28)], and the hospital stay [–1.35 (–1.99, –0.70)], as well as could increase the serum gastrin level [23.70 (14.88, 32.53)]. Furthermore, it also could decrease the incidence of postoperative complications, such as nausea [0.66 (0.48, 0.91)], abdominal distension [0.48 (0.35, 0.67)], and intestinal obstruction [0.34 (0.20, 0.59)]. However, there was a non-significant effect on vomiting [0.81 (0.60, 1.09)] or time of the first oral intake [–0.67 (–1.99, 0.65)]. ConclusionsFrom the results of this meta-analysis, postoperative gum chewing aids to promote the recovery of gastrointestinal function and reduce the risk of postoperative complications in colorectal cancer patients. Although further studies are needed to verify the long-term effects and the feasibility of clinical application, the results of this study provide an important empirical support for the utilize of chewing gum in the management of postoperative gastrointestinal function.