胃泌素和胆囊收缩素对胆管癌细胞凋亡阈值的影响

目的　探讨胃泌素和胆囊收缩素 (CCK)对胆管癌细胞凋亡阈值的调节作用。方法　以白僵菌素 (40 μmol/L× 1 2h)为凋亡诱导剂 ,末端标记 (TUNEL)技术检测胃泌素 (Gastrin) 1 7或CCK 8S(1 0 - 8mol/L× 48h)预处理后QBC939胆管癌细胞诱发性凋亡指数 (AI)的变化及反义bcl 2寡核苷酸转染 (1 .32mg/L)的影响。结果　Gastrin 1 7或CCK 8S预处理使AI显著降低 ,与对照组比较 ,差异有显著性 (P <0 .0 1 ) ,同时加入Gastrin/CCK B受体拮抗剂L365 ,2 60或转染反义bcl 2寡核苷酸可逆转 ,与相应Gastrin 1 7或CCK 8S组比较 ,差异有显著性 (P <0 .0 1 )。结论　胃泌素和CCK具有提高凋亡阈值、抑制胆管癌细胞凋亡的作用 ,其机制与上调bcl 2基因表达有关     

Einfluß der pankreasinnervation auf die exokrine sekretionsleistung der bauchspeicheldruse

Zusammenfassung In der vorliegenden Studic wurde der Einfluß des extrinsischen Nervensystems des Pankreas auf die exokrine Pankreassekretion nach Stimulation mit Sekretin, Zärulein, Tryptophan and Fett sowie die Aminosäure-und Fett-stimulierte Freisetzung von Neurotensin und CCK beim Hund untersucht. Die Denervation der Bauchspeicheldrüse führte zu keiner Veränderung der exokrinen Antwort auf Sekretin and Zärulein, dagegen bewirkte die Ausschaltung der extrinsischen Nerven eine signifikante Verminderung der Proteinantwort auf Tryptophan and Fett. Die Freisetzung von CCK wurde nicht verändert. Die Fett-stimulierten Neurotensinplasmaspiegel waren nach Denervation signifikant erhöht.

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Influence of pancreatic innervation on exocrine pancreatic

Summary In the present study we examined the influence of extrinsic pancreatic innervation on exocrine pancreatic response to secretin, caerulein, tryptophan and fat, and furthermore the amino acid- and fat-stimulated release of neurotensin and CCK in dogs. Denervation of the pancreas did not alter secretory response to secretin and caerulein, whereas transsection of the extrinsic nerves significantly diminished the protein response to tryptophan and fat. Release of CCK was not altered by pancreatic denervation. However, fat-evoked neurotensin plasma levels were significantly increased after denervation of the pancreas.

     

胃泌素受体在肝细胞肝癌中的表达

目的 探讨人肝细胞性肝癌(HCC)细胞株和组织中胃泌素受体(GR)的表达和临床病理学意义.方法 免疫组织化学染色方法 检测四种人HCC细胞株和25例人HCC组织中GR的表达.结果 显示在较高一抗浓度下,三种人HCC细胞株可见GR阳性表达,表达强弱为SMMC一7721>HepG2>QGY-7701,在人HCC组织中GR的阳性表达率为56%(14/25).但GR的表达与病人性别、年龄、临床分期、有否乙肝后肝硬化、肿瘤大小均无明显相关性.有脉管癌栓组与无脉管癌栓组显示出GR表达差异有统计学意义.结论 在肝细胞肝癌中存有胃泌素受体表达.是否具有内分泌治疗意义尚须进一步研究.     

Gastrointestinal surgical emergencies following kidney transplantation

This study reports major gastrointestinal complications in a group of 416 patients following kidney transplantation. Three hundred and ninety-nine patients received a cadaveric kidney while the other 17 received a living related organ. The immunosuppressive regimen changed somewhat during the course of the study but included azathioprine, prednisolone, antilymphocyte globulin, and cyclosporin. Perforations occurred in the colon (n=6), small bowel (n=4), duodenum (n=2), stomach (n=1), and esophagus (n=1). There were five cases of acute pancreatitis, four of upper gastrointestinal and two of lower intestinal hemorrhage, two of acute appendicitis, one of acute cholecystitis, one postoperative mesenteric infarction, and two small bowel obstructions. Fifty percent of the complications occurred while patients were being given high-dose immunosuppression to manage either the early postoperative period or episodes of acute rejection. Ten percent of the complications had an iatrogenic cause. Of the 31 patients affected, 10 (30%) died as a direct result of their gastrointestinal complication. This high mortality appears to be related to the effects of the immunosuppression and the associated response to sepsis. Reduction of these complications can be achieved by improved surgical management, preventive measures, prompt diagnosis, and a reduced immunosuppressive protocol.     

Gastrin、CCK对胆管癌细胞bcl-2、baX基因表达的调控

目的探讨Gastrin、CCK对胆管癌细胞bcl-2和bax基因表达的调控作用.方法用免疫组织化学、原位杂交、流式细胞术、逆转录-聚合酶链反应(RT-PCR)等技术,研究了Gastrin17肽(G-17)和CCK-8S肽(CCK-8 Sulfated)及CCK-A受体拮抗剂L364,718(L18)和Gastrin/CCK-B受体拮抗剂L365,260(L60)对QBC939胆管癌细胞bcl-2和bax mRNA、蛋白含量的影响.结果在正常情况下胆管癌细胞bcl-2和bax mRNA表达均为阳性,bax mRNA强于bcl-2 mRNA;G-17(1×10-10 mol/L、48 h)、CCK-8S(1×10-10mol/L)明显增强bcl-2 mRNA表达,而对bax mRNA表达无影响;同时加入L18和/或L60(1×10-10 mol/L)可明显抑制G-17和CCK-8S对bcl-2mRNA的促表达作用.经G-17或CCK-8S(1×10-8 mol/L)作用48 h,胆管癌细胞bcl-2蛋白表达明显增加,而bax蛋白表达无显著变化;L60或L18(1×10-8 mol/L)能明显抑制G-17和CCK-8S对bcl-2蛋白表达的促进作用.结论 Gastrin和CCK对bcl-2基因表达有上调作用,提示Gastrin和CCK对胆管癌细胞凋亡过程有抑制作用.     

Site-Specific Gene Expression Profiles and Novel Molecular Prognostic Factors in Patients with Lower Gastrointestinal Adenocarcinoma Diffusely Metastatic to Liver or Peritoneum

Background Generally, colorectal and high-grade appendiceal cancers are treated similarly; treatment approach is primarily based on tumor histology and stage of disease. Patients with adenocarcinoma of the lower gastrointestinal tract frequently experience diffuse metastases isolated to liver or peritoneum and have a poor survival. Identification of novel molecular pathways in metastases from these patients may identify novel targets and prognostic factors. Methods Microarray analyses of 20 metastatic tumors from patients with colorectal adenocarcinoma isolated to liver or peritoneum and eight high-grade appendiceal adenocarcinoma metastatic to peritoneum were performed using oligonucleotide microarray. Results In an unsupervised hierarchical cluster analysis of 2-fold upregulated or downregulated genes, there was a clear site-specific segregation of liver versus peritoneal metastases. Genes primarily involved in metastasis, angiogenesis, cell cycle regulation, cell proliferation, and cell adhesion were distinctly altered between these two metastatic sites. Among the metastasis genes, the average expression levels of LI-cadherin, ALCAM, CD2, and CD14 were significantly higher in both metastatic sites. TIMP1 was overexpressed in both sites where as TIMP-2, IGF-1, and HIF-1α were upregulated only in peritoneal metastases demonstrating the potential benefit of metastasis site-specific treatments. Subsets of genes significantly associated with poor survival were defined, a RET proto-oncogene interacting gene, GOLGA5, was highly predictive for survival in patients with colorectal adenocarcinoma. Conclusions These results demonstrate that liver and peritoneal metastases of lower GI adenocarcinoma have distinct gene expression patterns; these distinctions may help in the development of therapies based on site of metastases. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Gastrointestinal function in chronic renal failure

Feeding problems, anorexia and vomiting are common in infants and children with chronic renal failure (CRF), and play a major role in the growth failure often found in this condition. However, the gastroenterological and nutritional aspects of CRF in children have received little attention, hence therapeutic interventions are usually empirical and often ineffective. Gastritis, duodenitis and peptic ulcer are often found in adults with CRF on regular haemodialysis and following renal transplantation. Despite persistent hypergastrinaemia, gastric acid secretion is decreased rather than increased in most of these patients, and active peptic disease appears to be promoted by the removal of the acid output inhibition (neutralisation of gastric acid by ammonia) that follows active treatment.Helicobacter pylori, on the other hand, does not seem to play a significant role in the pathogenesis of peptic disease in CRF. Gastro-oesophageal reflux has been found in about 70% of infants and children with CRF suffering from vomiting and feeding problems, and thus appears to be a major problem in these patients. In a number of symptomatic patients with CRF, gastric dysrhythmias and delaved gastric emptying have also been found; hence there appears to be a complex disorder of gastrointestinal motility in CRF. Serum levels of several polypeptide hormones involved in the modulation of gastrointestinal motility [e.g. gastrin, cholecystokinin (CCK), neurotensin] and the regulation of hunger and satiety (e.g. glucagon, CCK) are significantly raised as a consequence of renal insufficiency, and can be reverted to normal by renal transplantation. Furthermore, several other humoral abnormalities (e.g. hypercalcaemia, hypokalaemia, acidosis, etc.) are not uncommon in CRF. By directly affecting the smooth muscle of the gut or stimulating particular areas within the central nervous system, all these humoral alterations may well play a major role in the gastrointestinal dysmotility, anorexia, nausea and vomiting in patients with CRF. Specific pharmacological and nutritional interventions should thus be considered for the treatment of vomiting and feeding problems in CRF.     

丙谷胺与生长抑素联合应用调控人胃癌MKN_(45)裸鼠移植瘤生长的研究

研究丙谷胺（ＰＧＬ）及其与生长抑素（ＳＳＴ）联合应用对人胃癌细胞株ＭＫＮ４５裸鼠移植瘤的抑制作用。方法建立人胃癌细胞株ＭＫＮ４５移植瘤的动物模型,观察ＰＧＬ（５００ｍｇ／ｋｇ体重）、ＳＳＴ（２００μｇ／ｋｇ体重）及两者联合应用对胃癌移植瘤的面积、重量、胃癌细胞ＤＮＡ的影响。结果ＰＧＬ组、ＰＧＬ＋ＳＳＴ组移植瘤的面积明显缩小,肿瘤重量明显减轻,胃癌细胞ＤＮＡ指数、平均ＤＮＡ含量及Ｓ期细胞比例明显降低（Ｐ＜０．０５）,ＰＧＬ＋ＳＳＴ组更为显著。结论ＰＧＬ能抑制胃癌细胞株ＭＫＮ４５移植瘤的生长,ＳＳＴ能明显增强ＰＧＬ对移植瘤的抑制作用。     

Sentinel Lymph Node Mapping of the Gastrointestinal Tract by Using Invisible Light

Background Because many gastrointestinal (GI) tumors spread by way of lymphatics, histological assessment of the first draining lymph nodes has both prognostic and therapeutic significance. However, sentinel lymph node mapping of the GI tract by using available techniques is limited by unpredictable drainage patterns, high background signal, and the inability to image lymphatic tracers relative to surgical anatomy in real time. Our goal was to develop a method for patient-specific intraoperative sentinel lymph node mapping of the GI tract by using invisible near-infrared light. Methods We developed an intraoperative near-infrared fluorescence imaging system that simultaneously displays surgical anatomy and otherwise invisible near-infrared fluorescence images of the surgical field. Near-infrared fluorescent quantum dots were injected intraparenchymally into the stomach, small bowel, and colon, and draining lymphatic channels and sentinel lymph nodes were visualized. Dissection was performed under real-time image guidance. Results In 10 adult pigs, we demonstrated that 200 pmol of quantum dots quickly and accurately map lymphatic drainage and sentinel lymph nodes. Injection into the mid jejunum and colon results in fluorescence of a single lymph node at the root of the bowel mesentery. Injection into the stomach resulted in identification of a retrogastric node. Histological analysis in all cases confirmed the presence of nodal tissue. Conclusions We report the use of invisible near-infrared light for intraoperative sentinel lymph node mapping of the GI tract. This technology overcomes the limitations of currently available methods, permits patient-specific imaging of lymphatic flow and sentinel nodes, and provides highly sensitive, real-time image-guided dissection.     

Minimally Invasive Surgery in Gastrointestinal Cancer: Benefits,Challenges, and Solutions for Underutilization

Background and Objectives:

After the widespread application of minimally invasive surgery for benign diseases and given its proven safety and efficacy, minimally invasive surgery for gastrointestinal cancer has gained substantial attention in the past several years. Despite the large number of publications on the topic and level I evidence to support its use in colon cancer, minimally invasive surgery for most gastrointestinal malignancies is still underused.

Methods:

We explore some of the challenges that face the fusion of minimally invasive surgery technology in the management of gastrointestinal malignancies and propose solutions that may help increase the utilization in the future. These solutions are based on extensive literature review, observation of current trends and practices in this field, and discussion made with experts in the field.

Results:

We propose 4 different solutions to increase the use of minimally invasive surgery in the treatment of gastrointestinal malignancies: collaboration between surgical oncologists/hepatopancreatobiliary surgeons and minimally invasive surgeons at the same institution; a single surgeon performing 2 fellowships in surgical oncology/hepatopancreatobiliary surgery and minimally invasive surgery; establishing centers of excellence in minimally invasive gastrointestinal cancer management; and finally, using robotic technology to help with complex laparoscopic skills.

Conclusions:

Multiple studies have confirmed the utility of minimally invasive surgery techniques in dealing with patients with gastrointestinal malignancies. However, training continues to be the most important challenge that faces the use of minimally invasive surgery in the management of gastrointestinal malignancy; implementation of our proposed solutions may help increase the rate of adoption in the future.     

胃泌素及其受体与胃癌关系的研究进展

胃泌素主要由胃窦及小肠上段黏膜的G细胞分泌,其受体分布在多种器官组织中.胃泌素及其受体具有调节细胞生长、分化,抑制细胞凋亡,促进细胞增生、侵袭、转移的功能.研究表明,胃泌素及其受体参与包括胃癌在内的多种肿瘤的发生、发展.胃泌素及其受体还可作为胃癌早期诊断的一个重要指标,同时也可能是胃癌治疗的潜在靶点.本文就胃泌素及其受体与胃癌的发生、发展关系作一综述.     

儿童胸腔镜心脏手术中奥美拉唑对胃肠道的保护作用

目的探讨奥美拉唑在婴幼儿胸腔镜体外循环(CPB)心脏手术中对胃肠道的保护作用。方法将127例先天性心脏病患者(年龄3～12岁)随机分为3组,实验组A和实验组B:行胸腔镜微创手术治疗,对照组:行常规手术治疗;实验组A在CPB预充液中给予奥美拉唑10mg,实验组B和对照组均注入等量生理盐水。3组均于术前、CPB30min、CPB结束、术后4h、24h进行胃液常规检查,并采集血液标本,用ELISA法测定血清促胃液素。结果与CPB前比较:实验组A胃液pH值较CPB结束后有明显升高(P<0.01),实验组B于术毕有明显降低(P<0.05),对照组于术后4h较术前有明显降低(P<0.05);3组胃液红细胞计数及血清促胃液素与CPB前比较均有明显上升(P<0.01)。与对照组比较:实验组A胃液pH于CPB结束后各时间点较对照组有明显上升,而胃液红细胞计数则有明显下降,血清促胃液素于CPB30min时即较其它两组有明显降低。实验组B胃液pH于术毕有明显降低,但术后24h恢复至术前水平,同时间点胃液红细胞计数与促胃液素则有明显降低。结论儿童胸腔镜心脏手术中CPB时间较常规手术时间长,需要在此期间进行胃肠道保护,术后各项指标恢复较常规手术时间短。     

复发性滋养细胞肿瘤预后因素分析

目的对影响滋养细胞肿瘤复发患者预后的因素进行分析,为临床复发患者的治疗及预后评估提供参考。方法回顾性分析1995年1月至2013年12月在北京协和医院接受治疗、至少复发1次且在本院随诊的滋养细胞肿瘤患者。采用SPSS 13.0软件,对复发患者的预后影响因素,包括年龄、末次妊娠性质、转移部位、FIGO分期、评分、首次术前β-HCG水平、首次术前化疗种类、化疗疗程、术后病理等进行分析。结果共纳入86例患者,复发患者的总完全缓解率为84.9%(73/86);单因素分析结果表明,初次于外院复发(P=0.038)及首次复发时间≤3个月(P=0.045)是影响复发患者的不良预后因素;多因素Cox回归模型的预后分析结果表明,首次复发发生于外院(P=0.025)、年龄≥31岁(P=0.048)是复发患者的不良预后因素。结论大多数复发患者能够通过化疗、手术与放疗的联合治疗治愈,对于有不良预后因素的患者仍期待有新的治疗方案。     

Gastrointestinal stromal tumors: analysis of clinical and pathologic factors

Gastrointestinal mesenchymal tumors have been classified as benign (leiomyoma) or malignant (leiomyosarcomas). More recently, these tumors have been termed gastrointestinal stromal tumors (GISTs). GISTs have a highly variable clinical course. This review analyzes the clinical presentation, pathologic examination, and long-term follow-up of patients with GIST. A retrospective analysis of the clinical course of patients with GIST at a single institution from 1986 to 1998 was performed. Nineteen patients with GIST (12 gastric, two duodenal, three jejunal, and two rectal) were treated. The most common clinical presentation was gastrointestinal bleed. CT scans, contrast studies, and endoscopy were used to identify a tumor mass. Diagnosis of GIST was made in only two patients preoperatively. Tumor size ranged from 0.8 to 23 cm. Histology of the tumors was variable. All patients underwent surgical resection with curative intent. Follow-up ranged from 2 to 55 months. There were two perioperative deaths. Local recurrence occurred in one patient. GISTs are uncommon. Preoperative diagnosis can be difficult, and often the diagnosis is made at the time of surgery. With complete resection of the tumor the clinical course is favorable with very few local recurrences. Therefore complete resection of the tumor is recommended.     

Analysis of potential risk factors in the survival of patients with primary retroperitoneal liposarcoma

IntroductionThe present work is an observational study of a series of variables regarding overall survival and disease-free survival in patients diagnosed with primary liposarcoma.MethodsThe study is prospective with retrolective data collection that includes all patients with primary liposarcoma referred to Hospital Son Espases University Hospital, Palma de Mallorca, Spain from January 1990 to December 2019.ResultsThe study includes 50 patients and the compartment surgery was performed in 18 patients (36%) of cases. The mean overall survival of the sample was 15.57 years (95% CI: 12.02–19.12) and the mean disease-free survival was 6.70 years (95% CI: 4.50–8.86).ConclusionCompartment surgery has not shown benefits in terms of overall survival and disease-free survival. The ASA classification (≥3) predicts a poor prognosis in both overall survival and disease-free survival. Resection with free margins, described on the pathological results and defined in this work as R0, show better disease-free survival.     

NO、CCK、VIP与Oddi括约肌的关系对胆管成石的影响

胆管结石是世界范围内的常见病、多发病,其发病率呈上升趋势.近些年来,人们认识到括约肌运动障碍在胆管结石发病过程中扮演重要角色.NO、CCK、VW及其相互作用对括约肌功能及胆汁排出起调节作用.有必要对这些因素进行深入研究,以探讨胆管结石的病因并对其治疗提供帮助.