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    • br mtDNA mutation in human cancers Several

    2018-10-22


    mtDNA mutation in human cancers Several authors have evaluated not only the quantitative change in mtDNA copy number, but also the qualitative mtDNA D-loop mutations in human cancers. D-loop mutations, including the D310 region, have been reported in prostate cancer, head and neck cancer, lung cancer, breast cancer, etc. Furthermore, the D-loop mutations were reported to harbor clinicopathological significance in lung cancer and breast cancer. As the D310 region is located near the H-strand replication origin and binding side of TFAM, whether D310 mutation is related to the change of mtDNA copy number and mitochondrial biogenesis in human cancer remains obscured. However, several studies have demonstrated that D310 is a good marker to trace cancer cell clonal expansion. An analysis of 72 pairs of TESCC revealed a homoplasmic to heteroplasmic mtDNA D310 distribution from esophageal muscle to esophageal mucosa, and a heteroplasmic to homoplasmic mtDNA D310 redistribution from esophageal nontumor mucosa to TESCC, and then the metastatic order tranylcypromine node, combined with an increase of mtDNA copy number. This specific finding was compatible with the theory of cancer clonal expansion. As a consequence, the effect of D310 mutations on bioenergetic function of mitochondria in tumor tissues deserves to be further studied in the future.
    Circulating mtDNA in human cancers Recently, several investigators have also made great efforts to appraise the alteration of circulating plasma or serum mtDNA in several human cancers and evaluate their clinical implications. An elevation of circulating mtDNA copy number was noted in patients with urological malignancy, testicular germ cell cancer, and lung cancer after radiotherapy. On the contrary, a decrease of circulating mtDNA copy number was noted in breast cancer. At present, it is difficult to investigate the sources of these circulating mtDNA copies, and it is still unclear whether these alterations are related to the shifting of cancer metabolism.
    Introduction Indirect hernia sac high ligation is a time-honored surgical concept in the treatment of indirect inguinal hernia. Since 1978, however, nonligation treatment of the hernia sac has been proposed by several authors, without increasing indirect hernia recurrence. It has been shown that the peritoneum heals rapidly with a newly formed fibrotic tissue after a nonligation procedure. The procedure is safe in pediatric and young patients with nondilation of the internal rings. Male sex and age are significant risk factors for recurrent inguinal hernia disease, therefore, we decided to conduct this serial, prospective study to evaluate the efficiency and safety of nonligation of indirect hernia sac in senior male patients with dilated internal rings, defined as medium or large internal rings.
    Materials and methods From two regional hospitals, 117 consecutive male patients ranging from 54 years to 83 years in age, with indirect inguinal hernia and a distorted enlarged internal ring orifice were collected for this study from January 2005 to August 2008. The sizes of the internal ring orifices varied from medium (1.5–3 cm) to large (>3 cm). These 117 consecutive patients were divided into the ligation and nonligation groups. Patients from both groups were matched according to types of inguinal hernia (Table 1). A group of 15 patients with sliding hernia were grouped into the nonligation group as indirect hernia. Hernia surgery was performed under spinal or general anesthesia. In the ligation group, there were 62 hernia repairs in 60 patients. The indirect hernia sacs were ligated at the neck of the hernia sac prior to excision or division. Reinforcement of the posterior wall of the inguinal canal was performed using the Shouldice technique. In the nonligation group, there were 60 hernia repairs in 57 patients. The hernia sacs were inverted totally with smooth forceps into the preperitoneal space without resection in 21 hernia repairs. Another 24 hernia sacs in the nonligation group were amputated and the proximal stump of the hernia sac was closed, leaving the distal part in place, without ligation at its neck prior to reduction of the hernial sac into the preperitoneal space. In 15 sliding hernia repairs, high ligation of the hernial sac was not attempted, but the herniated sac was reperitonized or dissected gently and reduced into the preperitoneal space. All patients in the nonligation group also underwent a simultaneous Shouldice repair for the posterior wall reconstruction. The operative times, the postoperative complications including wound infection, hematoma, erythema, seroma, or retention of urine, were collected and analyzed. The intensity of pain was graded with a verbal pain scale as very mild, discomforting, tolerable, distressing, and very distressing at the first week outpatient visit. Statistical analyses were performed using the Pearson χ2 test. Follow-up was carried out at 1 week, 2 weeks, 1 year, and 3 years at the outpatient clinic or by telephone interview.