To evaluate the surgical strategy for laparoscopic approach in recurrent inguinal hernia repair.Between January 2001 and December 2011, the clinical data of 213 patients with 225 recurrent inguinal hernias underwent laparoscopic repair were retrospectively analyzed. There were 202 male and 11 female patients and their average age were (67 ± 14) years old (range 22-97 years old). The surgical methods included laparoscopic transabdominal preperitoneal hernia repair (TAPP, n = 174), total extraperitoneal herniorrhaphy (TEP, n = 41) and intraperitoneal onlay mesh (IPOM, n = 10). The follow-up period ranged from 15 to 60 months (median 42 months). No patient lost to follow-up during the investigation.The 48 TAPP and 26 TEP were applied to 77 (32.9%) recurrent hernias after conventional suture repair; 23 TAPP and 15 TEP were utilized to 38 (16.9%) recurrent hernias after Lichtenstein repair; 90 TAPP and 1 IPOM were employed for 91 (40.4%) recurrent hernias after Patch and Plug repair; and the other 22 (9.8%) recurrent hernias after preperitoneal repair were repaired by using 13 TAPP and 9 IPOM techniques. No conversion to open surgery was observed. The average operative time was (39 ± 14) minutes (range 15-90 minutes). No patients required analgesia postoperatively. The postoperative average VAS score was 2.4 ± 1.1 (range 1.2-6.4). The average hospital stay was (1.7 ± 1.5) days (range 1-9 days), and the patients returned to unrestricted activities in 2 weeks was 99.6% (212 cases). No recurrence was observed during the follow-up. The accumulative postoperative complications rates was 11.1% (25 cases), with 1 severe complication (surgical intervention was needed) as intraabdominal infection (0.4%), as well as other 24 complications including 15 cases of seroma (6.7%), 5 cases of urinary retention (2.2%), 3 cases with transient paresthesia (1.3%) and 1 case with paralytic ileus (0.4%).TAPP and TEP are both feasible and efficacious techniques to treat recurrent hernias after suture repair and Lichtenstein repair, while the choice depends on surgeons' experience. Most recurrent hernias after Patch and Plug repair could be treated successfully by TAPP but TEP technique is not encouraged. For recurrences after preperitoneal repair, the TAPP repair should be recommended as first choice, while IPOM is a good technique to cope with the cases which TAPP failed.
Transmembrane protease/serine 4 (TMPRSS4) is a member of the type II transmembrane serine protease (TTSP) family and it was found highly expressed in several cancers. This study aims to evaluate the expression of TMPRSS4 in colorectal cancer (CRC) and investigate its role in proliferation and self-renewal of colon cancer cells. qRT-PCR and immunohistochemistry were used to detect the mRNA and protein expression level of TMRPSS4 in CRC samples respectively. Loss of function assay was conducted with RNAi technique. Cell proliferation was done with WST-8 assay; cell apoptosis and cell cycle analysis were performed with flow cytometry; invasion and migration were done with transwell assay. Plate and soft agarose clonogenic assays were used to detect clone-formation ability. CD44 and CD133 expressions were analyzed by flow cytometry and western blot. We found that TMPRSS4 was highly expressed in CRC tissues both at mRNA and protein level and correlated with pathological stage. Knockdown of TMPRSS4 in highly expressed colon cancer cell line HCT116 resulted in inhibition of cell proliferation, induction of cell apoptosis and suppression of invasion and migration; moreover, knockdown of TMPRSS4 suppressed the in vitro clone-formation ability of HCT116 and reduced the expressions of CD44 and CD133. The findings in this research showed that TMPRSS4 was associated with CRC stage and regulated the proliferation and self-renewal ability of colon cancer cells; TMRPSS4 was involved in the development and progression of CRC.
Additional file 1: Table S1. Summary of Polyamine Meatabolismrelated genes. Table S2. Samples clustering in CRC RNA-seq meta cohorts. Table S3. List of 10 major signaling pathway genes associated with cancer. Table S4. ssGSEA results for immune cells of meta cohort. Table S5. Differental PAM related genes for PAMcluster. Table S6. The gene of construction PAMscore. Table S7. Samples clustering in CRC RNA-seq meta cohorts. Table S8. The gene of construction PAMscore. PAMscore subgroup analysis by constructing a PAM scoring model. Table S9. Drug susceptibility results corresponding to PAMscore model genes. Table S10. Importance results of random forest screening. Table S11. Communication of immune cell based on PAMSscore model genes.
Laparoscopic colorectal surgery has been carried out in China for more than 30 years and has experienced a three-stage high-speed development of "exploring and designing,optimising and standardising, perfecting and re-innovating" at the technical level. Based on the support and assistance of laparoscopic technology, colorectal surgery has made rapid progress in sub-microscopic anatomy, surgical procedures, surgical concepts, instruments and equipment. Nowadays, the technology and efficacy of laparoscopic colorectal surgery have gradually reached the ceiling, and in view of the existing pain points and the future direction of development, where will we go? This article summarised the past three decades of experience and consolidate the results to guide the future practice and the way forward.
Cetuximab has been regularly added to the treatments for metastatic colorectal cancer worldwide. However, due to its therapeutic insensitivity and underlying mechanisms being largely unknown, the clinical implementation of cetuximab in colorectal cancer remains limited.The gene expression profile GSE56386 was retrieved from the Gene Expression Omnibus database. Differentially expressed genes were identified between cetuximab-responsive patients and nonresponders, annotated by gene ontology, Kyoto Encyclopedia of Genes and Genomes pathway analysis, and further analyzed by protein-protein interaction networks. The integrative prognostic analysis was based on The Cancer Genome Atlas and PrognoScan.1350 differentially expressed genes were identified with 298 upregulated and 1052 downregulated. Epidermis development, the cornified envelope, calcium ion binding, and amoebiasis were enriched in upregulated genes while digestion, the apical part of the cell, the 3',5'-cyclic-adenosine monophosphate phosphodiesterase activity and pancreatic secretion were found enriched in downregulated genes. The top 10 hub genes were identified, including epithermal growth factor, G-protein subunit β 5, G-protein subunit γ 4, fibroblast growth factor 2, B-cell lymphoma protein 2, acetyl-coenzyme A carboxylase β, KIT proto-oncogene receptor tyrosine kinase, adenylate cyclase 4, neuropeptide Y, and neurotensin. The hub genes exhibited distinct correlations in cetuximab-treated and untreated genomic profiles (GSE56386, GSE5851 and GSE82236). The highest correlation was found between B-cell lymphoma protein 2 and acetyl-coenzyme A carboxylase β in GSE56386. The mRNA expression of hub genes was further validated in the genomic profile GSE65021. Furthermore, B-cell lymphoma protein 2 and acetyl-coenzyme A carboxylase β also exhibited highest degrees among the hub genes correlation networks based on The Cancer Genome Atlas. Both B-cell lymphoma and acetyl-coenzyme A carboxylase β were not independent prognostic factors for colorectal cancer in univariate and multivariate Cox analysis. However, integrative survival analysis indicated that B-cell lymphoma protein 2 was associated with favorable prognosis (hazard ratio = 0.62, 95% confidence interval, 0.30-0.95, P = .024).This in silico analysis provided a feasible and reliable strategy for systematic exploration of insightful target genes, pathways and mechanisms underlying the cetuximab insensitivity in colorectal cancer. B-cell lymphoma protein 2 was associated with favorable prognosis.
Gastrointestinal tract reconstruction is a key procedure in laparoscopic surgery for gastrointestinal diseases. The reconstruction procedure in laparoscopic surgery is not superior to conventional surgery. Reconstruction procedures such as Billroth I , Billroth II and Roux-en-Y anastomosis are widely used in laparoscopic assisted distal gastrectomy,while esophagojejunostomy by Roux-en-Y reconstruction is a reasonable option for laparoscopic assisted total gastrectomy. The OrVilTM technique provides an easier alternative to complete the esophagojejunostomy. Esophagogastrostomy is mainly used in laparoscopic assisted proximal gastrectomy. Colorectal anastomosis with double stapling technique and coloanal anastomosis with hand-sewn technique are common reconstruction procedures in laparoscopic surgery for mid and low rectal diseases. In laparoscopic colectomy, a small incision is usually used to facilitate the reconstruction extracorporeally. It is believed that innovation of instrumentation in the near future could bring us safer reconstruction devices with better efficiency and quality for laparoscopic surgery.
Key words:
Gastrointestinal tract reconstruction; Laparoscopic surgery; Anastomosis
Laparoscopic surgery has got a brilliant progress in the past 30 years, especially in the field of gastrointestinal and colorectal surgery, which has a continuous increase in volume and frequency. However, for minimally invasive surgery, innovation is the only way to get further development. The innovation of minimally invasive gastrointestinal and colorectal surgery includes devices and techniques. The innovative devices include vision system of minimally invasive surgery such as 3D laparoscopy, 4K/6K high definition displayer or VR system, all dimensions surgical arms, robotic surgery system, and therapeutic endoscopy. The innovative techniques include new approaches of laparoscopic surgery for gastrointestinal and colorectal diseases, transanal total mesorectal excision and reconstruction of gastrointestinal tract in laparoscopic surgery. The rapid progress of innovation and development in devices and techniques implies more challenges and opportunities for the minimally invasive gastrointestinal and colorectal surgery in the near future.
Key words:
Gastrointestinal diseases; Minimally inva-sive surgery; Laparoscopy; Surgical procedures, operative; Innovation; Development
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