Optimal Ligation Level of the Primary Feeding Artery and Bowel Resection Margin in Colon Cancer Surgery: The Influence of the Site of the Primary Feeding Artery

PURPOSE In colon cancer surgery, it is recommended that en bloc resection involving extended lymphadenectomy, characterized as a hemicolectomy, be performed by ligating the primary feeding artery at a high position and resecting proximal and distal with 5-cm to 10-cm bowel margins. However, there is little evidence to unequivocally support such extensive lymphovascular resection. METHODS The distribution of nodal metastases was obtained by the clearing method in 164 patients with colon cancer. RESULTS For pericolic spread, for pT1 tumors, the distance from the primary tumor to a diseased node was 2.5 cm; for pT2, the distance was less than 5 cm; for 97.0 percent of pT3 tumors and 93.3 percent of pT4 tumors with nodes involved, the distance was less than 7 cm. For central spread, for pT1 tumors, the rate of spread to central nodes was 0 percent; for pT2, the rate of spread was 20.0 percent to intermediate nodes (for tumors more than 5 cm from the feeding artery, the rate for central nodes was 0 percent); for pT3, the rate was 30.6 percent to intermediate nodes and 15.3 percent to main nodes; for pT4, the rate was 44.4 percent to intermediate nodes and 22.2 percent to main nodes. For curative resection cases with pT3 tumors more than 7 cm from the feeding artery, the rate to central nodes was 0 percent. CONCLUSIONS In T1 tumors, central node dissection is not required, but resection with proximal and distal 3-cm margins are required; in T2, central node dissection that includes the intermediate node should be performed in addition to resection with proximal and distal 5-cm margins. In T3 and T4, central node dissection that includes the main node should be performed in addition to resection with proximal and distal 7-cm margins. However, for T2 more than 5 cm from the primary feeding artery, and for T3 more than 7 cm from the primary feeding artery, proximal and distal resection alone may be adequate.     

烟酸对冠心病患者外周血单核细胞环一磷酸腺苷与三磷酸腺苷结合盒转运体A1表达的影响

目的以冠心病患者的外周血单核细胞为研究对象,观察烟酸对体外培养的单核细胞中环一磷酸腺苷及ATP结合盒转运体A1表达的影响,分析烟酸调节ATP结合盒转运体A1的表达与环一磷酸腺苷—蛋白激酶A途径的相关性。方法运用逆转录聚合酶链反应和Westernblot蛋白印迹分别检测ATP结合盒转运体A1mRNA与ATP结合盒转运体A1蛋白的表达,采用低pH值EIA法测定细胞内环磷酸腺苷水平。结果(1)各组外周血单核细胞中ATP结合盒转运体A1的表达及环一磷酸腺苷的水平在3h和48h的变化无明显差异(P>0.05);(2)冠心病高血脂患者单核细胞中ATP结合盒转运体A1的表达较正常人明显降低(P<0.05),而正常血脂组单核细胞中ATP结合盒转运体A1的表达较正常人无明显差异(P>0.05);(3)烟酸单独作用能明显增加冠心病人单核细胞中ATP结合盒转运体A1的表达(P<0.05),同时使单核细胞中环一磷酸腺苷的含量增加(P<0.05);(4)蛋白激酶A抑制剂Ro31-8220单独作用能明显降低冠心病人单核细胞中ATP结合盒转运体A1的表达(P<0.05),同时使单核细胞中环—磷酸腺苷的含量降低(P<0.05);(5)先用Ro31-8220作用30min后,再加入烟酸,则烟酸使单核细胞中ATP结合盒转运体A1表达上调及环一磷酸腺苷的含量增加的作用被完全抑制(P<0.05)。结论烟酸对单核细胞中ATP结合盒转运体A1表达的影响,是通过环一磷酸腺苷-蛋白激酶A途径发挥作用的,烟酸上调外周血单核细胞中ATP结合盒转运体A1表达的作用,与环一磷酸腺苷—蛋白激酶A途径存在明确的相关性。     

Abnormal cold perception in the lower limbs: A sensitive indicator for detection of polyneuropathy in patients with type 1 diabetes mellitus

Diabetic peripheral neuropathy differs in type 1 and type 2 diabetes. The aim of this study was to evaluate how signs and symptoms of neuropathy correlated with defects in motor and sensory nerve conduction velocity (MCV and SCV) and sensory perception thresholds in patients with type 1 diabetes. MCV and SCV in peroneal and sural nerves and vibratory, warm and cold perception thresholds (VPT, WPT, CPT) were evaluated in the lower limbs of 127 patients (42 ± 7.9 years old, duration of diabetes, 16 ± 11 years and HbA1c, 7.7 ± 1.4%). The results were compared with clinical findings (neuropathy impairment assessment, NIA) and sensory symptoms (neurological symptom assessment, NSA). Sensory symptoms were present in 24% of patients, 91% had at least one abnormal finding in the neurological examination and 84% had abnormal nerve conduction. The greatest deviation from normal was observed for CPT on the dorsum of the foot and peroneal MCV. NIA and NSA correlated with all electrophysiological measurements in the foot and big toe. It is concluded that clinical findings correlate well with electrophysiological abnormalities in patients with type 1 diabetic neuropathy. An elevated CPT for the foot was the most pronounced sensory defect.     

Expression of intercellular adhesion molecule (ICAM)-1 or ICAM-2 is critical in determining sensitivity of pancreatic cancer cells to cytolysis by human γδ-T cells: Implications in the design of γδ-T-cell-based immunotherapies for pancreatic cancer

Background and Aims:  γδ-T cells can recognize and kill malignant cells, particularly those of epithelial origin, through mechanisms which do not require the recognition of tumor-specific antigens (innate immune response). This natural ability of γδ-T cells to kill tumor cells in a tumor antigen-independent manner provides a strong rationale for developing clinical trials designed to exploit the innate antitumor properties of γδ-T cells.
Methods:  In vitro studies were carried out to asses the sensitivity of pancreatic cancer cells (MIA PaCa2, BxPC-3, PANC-1) to killing by ex vivo expanded human γδ-T cells.
Results:  The capacity of γδ-T cells to bind to as well as to kill pancreatic cancer cells correlated with the degree of surface expression of key intercellular adhesion molecules (ICAM) present on pancreatic cancer cells. Moreover, pancreatic cancer cells expressing neither ICAM-1 nor ICAM-2 were bound poorly by γδ-T cells and were found to be resistant to γδ-T-cell killing. However, upon transfection of resistant cells with ICAM-1 or ICAM-2, γδ-T cells were then able to bind to and subsequently kill these cells.
Conclusion:  In vitro , the expression of ICAM-1 or ICAM-2 on human pancreatic cancer cells is critically important in determining the extent to which these cells are sensitive to killing by human γδ-T cells. Accordingly, in ongoing and future clinical studies using γδ-T cells for the treatment of a variety of epithelial-derived solid tumors—including pancreatic cancer—interventions intended to modulate ICAM expression on tumor cells may become important adjuncts to γδ-T-cell-based immunotherapies.