Objective To explore the association of macrophages with carcinogenesis and development of gastric cancer. Method The related literatures at home and abroad were consulted and reviewed. Results The microenvironment of gastric cancer could induce the polarization of macrophages，and then the activated macrophages，especially the tumor associated macrophages，could in turn motivate the growth，invasion，and metastasis of tumor cells by secreting a series of active substances. Conclusions Macrophages，especially the tumor associated macrophages play an importantrole in the carcinogenesis and development of gastric cancer. Investigating the macrophages and their interaction with gastric cancer may lead to a profound understanding of carcinogenesis of gastric cancer as well as opening up a new prospectfor treatment.
The detection rate of benign and borderline/low-grade malignant tumors of pancreas has increased year by year. Most of the patients are middle-aged and young people, who have thirst for high quality of life in long-term. Pancreatic-duct-preserving partial pancreatectomy can meet the needs of reducing surgical trauma, preserving normal pancreatic function and improving patients’ quality of life. However, pancreatic-duct-preserving partial pancreatectomy often needs to face the problem of pancreatic duct defect. Repair of pancreatic duct needs to be applied ? according to different types of pancreatic duct defect. At the same time, the prevention and treatment of pancreatic fistula also require more patience, courage and creativity of pancreatic surgeons. Pancreatic-duct-preserving partial pancreatectomy can solve the current clinical problems. It is safe and feasible with carefully evaluate indications, characters of patients and the personal ability of surgeons.
Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) may provide more information in diagnosis of malignant tumor compared to conventional magnetic resonance imaging (MRI). Nowadays, in order to utilize the information expediently and efficiently, many researchers are aiming at the development of computer-aided diagnosis (CAD) of malignant tumor based on DCE-MRI. In this review, we survey the research in this field and summarize the literature in four parts, i.e. ① image preprocessing——noise reduction and image registration; ② region of interests (ROI) segmentation; ③ feature extraction——exploring the image characteristics by analyzing the ROI quantitatively; ④ tumor lesion recognition and classification——distinguishing and classifying tumor lesions by learning the features of ROI. We summarize the application of CAD techniques of DCE-MRI for cancer diagnosis and, finally, give some discussion on how to improve the efficiency of CAD in the future research.
This article reviews the development and progress in the field of limb salvage treatment, surgical techniques, and function reconstruction of pelvic malignant tumors in China in the past 30 years. Based on the surgical classification of pelvic tumor resection in different parts, the development of surgical techniques and bone defect repair and reconstruction methods were described in detail. In recent years, in view of the worldwide problem of biological reconstruction after pelvic tumor resection, Chinese researchers have systematically proposed the repair and reconstruction methods and prosthesis design for bone defects after resection of different parts for the first time in the world. In addition, a systematic surgical classification (Beijing classification) was first proposed for the difficult situation of pelvic tumors involving the sacrum, as well as the corresponding surgical plan and repair and reconstruction methods. Through unremitting efforts, the limb salvage rate of pelvic malignant tumors in China has reached more than 80%, which has preserved limbs and restored walking function for the majority of patients, greatly reduced surgical complications, and achieved internationally remarkable results.
ObjectiveTo investigate the experience in the treatment of splnic malignant tumors with laparoscopy. MethodsThe clinical data of 51 patients with splnic malignant tumor who underwent splenectomy between January 2009 and July 2015 were retrospectively reviewed. Patients were divided into two groups based on the surgical method: Open splenectomy (OS group, n=18) and laparoscopic splenectomy (LS group, n=33). The preoperative, intraoperative and postoperative data of the patients were collected and analysed, the differences of each index during perioperative period (general information), intraoperative data (operative time, estimated blood loss, the size of spleen, intraoperaive transfusion) and postoprative situation (hospital stays, the first oral intake, postoperative pancreatic fistula, rehaemorrhagia, abdominal infection or pulmonary infection and the like) were compared. ResultsLS group compared with OS group, the operative time of LS group was significantly shorter than that of OS group [(103.64±16.92) min vs. (144.44±31.10) min, P=0.000〕, the amount of bleeding of LS group [M (Q25, Q75): 60 (50, 100)〕was significantly less than the OS group [M (Q25, Q75): 150 (115, 210)〕, P=0.000. The hospitalization time of LS group was significantly shorter than the OS group [(13.61±9.91) d vs. (9.03±3.09) d, P=0.017〕, and the LS group has a lower indication of the postoprative complications of fever and pulmonary infection (P=0.010 and P=0.003). Conciusions Laparoscopic splenectomy is feasible in the treatment of splenic malignant tumors, the employment of laparoscopy can shorten the operative time, has the advantages of less bleeding, the shorten hospital stays, lower indication of postoprative complications, and being worthy of further popularization and application.
ObjectiveTo explore the effectiveness of free-style perforator pedicled propeller flap to repair the wound after extensive resection of skin malignant tumor on the thigh.MethodsBetween December 2016 and June 2019, 12 patients with skin malignant tumor on the thigh were treated. There were 9 males and 3 females, aged from 8 to 65 years (median, 38.5 years). The etiologies included basal cell carcinoma in 3 cases, squamous cell carcinoma in 7 cases, fibrosarcoma in 1 case, and malignant melanoma in 1 case. The disease duration ranged from 5 months to 10 years (median, 7.5 years). Color Doppler ultrasound was used to detect and mark at least one perforator vessel before operation. After extensive resection, the size of wound ranged from 5.0 cm×3.5 cm to 8.5 cm×6.5 cm. In the range of 1-3 cm from the edge of the lesion, the perforator vessels were explored again from the deep surface of the deep fascia to confirm and mark. The perforator vessel with diameter greater than 0.5 mm and closest to the edge of the lesion was taken as the rotation point of the flap. According to the wound size and shape, the free-style perforator pedicled propeller flap in size of 8.0 cm×3.5 cm to 12.5 cm×6.0 cm was designed. The wound was repaired with the big blade of the flap. The donor site was closed directly with the aid of the small blade.ResultsThe distal part of the skin flap was necrosis after operation, and healed after symptomatic treatment such as dressing change; the other flaps survived successfully and the wounds healed by first intention. All incisions at the donor site healed by first intention. All patients were followed up 5-24 months (mean, 10.2 months). During the follow-up, there was no recurrence of tumor. The flap had good elasticity and texture with no obvious swelling or scar hyperplasia, and the appearance was satisfactory; the hip and knee joint activities were normal.ConclusionBased on the extensive skin blood supply and abundant perforator vessels of the thigh, the free-style perforator pedicled propeller flap is an ideal flap for repairing small or medium wound after extensive resection of skin malignant tumor on the thigh.
Objective To evaluate the curative effectiveness and safety of transanal endoscopic microsurgery (TEM) vs. radical surgery (RS) for the patients with rectal malignant tumor, and to provide information for clinical research and practice. Methods Through computer searching The Cochrane Central Register of Controlled Trials, PubMed, OVID, CBM and CNKI from inception to April 2010, and hand searching relevant journals including Chinese Journal of Surgery and Chinese Journal of Evidence-Based Medicine, the randomized controlled trails (RCTs) and non-randomized controlled trails (NRCTs) comparing TEM with RS for rectal malignant tumor were collected. Data were extracted and evaluated by two reviewers independently according to the Cochrane Handbook for Systematic Reviews. Meta-analyses were conducted using the Cochrane collaboration’s software RevMan 5.0. Results One RCT and four NRCTs met the selection criteria, involving 929 patients. The methodological quality of all trials was low with possibility of bias. The meta-analyses showed that: a) Three studies reported local recurrence in T1 stage patients. There was a significant difference in local recurrence between the two groups (OR=12.61, 95%CI 2.59 to 61.29, P=0.002); b) Two studies reported disease-free survival in T1 stage patients. There was no significant difference between the two groups in disease-free survival (OR=1.12, 95%CI 0.31 to 4.12, P=0.86); c) Three studies reported overall survival in T1 stage patients. There was no significant difference between the two groups (OR=1.09, 95%CI 0.57 to 2.08, P=0.80); and d) Three studies reported postoperative complications in T1 stage patients. There was a significant difference between the two groups in terms of complications (OR=0.05, 95%CI 0.02 to 0.10, Plt;0.00001). Conclusion For T1 stage patients, TEM is associated with less injury of tissue, less operative bleeding, short duration of hospital stay, and low incidence of postoperative complications. The disease-free and overall survivals are comparable to those of RS, but the local recurrence rate is higher. The role of TEM in T2 stage patients is still under discussion. However, the trails available for this systematic review are of lower methodological quality, and bias may exist due to NRCTs. Therefore, more high quality RCTs are required.
ObjectiveTo evaluate the value of spectral CT monoenergetic imaging in optimizing the image quality of peripancreatic great vessels in patients with pancreatic malignant tumors. MethodsThe imaging data of 62 patients with pancreatic malignant tumors who underwent contrast-enhanced spectral CT at West China Hospital of Sichuan University from July 2018 to March 2021 were retrospectively analyzed. A total of 21 monoenergetic image sets (from 40 to 140 keV at 5 keV intervals) were reconstructed. The CT value, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) of the peripancreatic great vessels (including the celiac artery, common hepatic artery, superior mesenteric artery, portal vein, and superior mesenteric vein), as well as the tumor-to-parenchyma ratio (TPR) in the pancreatic parenchymal and portal venous phases, were compared between the mixed-energy images and the monoenergetic images. Additionally, subjective evaluations of vascular involvement in both the mixed-energy and optimal monoenergetic images were performed. ResultsThe overall differences in CT values, SNR, and CNR of the peripancreatic great vessels among mixed-energy and 21 monoenergetic image sets were all statistically significant (all P<0.001). In the monoenergetic images, as the energy level increased, the CT values, SNR, and CNR of the five peripancreatic great vessels showed consistent decreasing trends (all P<0.001). The 40 keV group exhibited the highest values for all indexes, indicating the best visualization. Regarding the TPR, both the pancreatic parenchymal and the portal venous phases showed a decrease as the energy level increased. The intergroup difference in TPR in the pancreatic parenchymal phase was statistically significant (P<0.001), while no significant difference was observed in the portal venous phase (P>0.05). The 40 keV monoenergetic images achieved the highest TPR, providing optimal lesion visualization. The subjective evaluations by two physicians on vascular involvement in 40 keV monoenergetic images and mixed-energy images showed good to excellent interobserver agreement (Kappa=0.775–1.000, all P<0.001). ConclusionThe 40 keV image from spectral CT can significantly optimize the imaging of peripancreatic great vessels, providing better subjective and objective image quality.
To evaluate effect of recombinant human growth hormone (rhGH) on immunologic function in patients with gastrointestinal malignant tumor (GIMT). Before and 3 weeks after surgical treatment and administration of rhGH, the amount of T lymphocyte subset (T-LS) and soluble interleukin 2 receptor (sIL-2R) level were measured in 12 patients with GIMT, which were compared with 20 cases of normal control and 18 cases of GIMT treated by surgery alone. Result: ①In all GIMT patients, the serum CD＋3, CD＋4 level and the ratio of CD＋4/CD＋8 were lower than normal control and the sIL2R level was much higher; ②After operation, the serum CD＋3, CD＋4 level and the ratio of CD＋4/CD＋8 of all patients increased, the serum sIL2R level decreased; ③In patients recieved rhGH, the serum CD＋3, CD＋4 level and the ratio of CD＋4/CD＋8 were much more increased and the serum sIL-2R level much more decreased than those of surgery alone group. Conclusion: rhGH can enhance the immunologic function of patients with GIMT.
Objective To summarize the effectiveness of the temporal island flap pedicled with the perforating branch of zygomatic orbital artery for repairing defects after periocular malignant tumor resection. Methods Between January 2015 and December 2020, 15 patients with periocular malignant tumors were treated. There were 5 males and 10 females with an average age of 62 years (range, 40-75 years). There were 12 cases of basal cell carcinoma and 3 cases of squamous carcinoma. The disease duration ranged from 5 months to 10 years (median, 2 years). The size of tumors ranged from 1.0 cm×0.8 cm to 2.5 cm×1.5 cm, without tarsal plate invasion. After extensive resection of the tumors, the left defects in size of 2.0 cm×1.5 cm to 3.5 cm×2.0 cm were repaired with the temporal island flap pedicled with the perforating branch of zygomatic orbital artery via subcutaneous tunnel. The size of the flaps ranged from 3.0 cm×1.5 cm to 5.0 cm×2.0 cm. The donor sites were separated subcutaneously and sutured directly. Results All flaps survived after operation and the wounds healed by first intention. The incisions at donor sites healed by first intention. All patients were followed up 6-24 months (median, 11 months). The flaps were not obviously bloated, the texture and color were basically the same as the surrounding normal skin, and the scars at recipient sites were not obviously. There was no complication such as ptosis, ectropion, or incomplete closure of the eyelids and recurrence of tumor during follow-up. Conclusion The temporal island flap pedicled with the perforating branch of zygomatic orbital artery can repair the defects after periorbital malignant tumors resection and has the advantages of reliable blood supply, flexible design, and good morphology and function.