Utility of preoperative voice therapy on the voice recovery of vocal cord polyps patients undergoing the microsurgery / 临床耳鼻咽喉头颈外科杂志

OBJECTIVES@#To evaluate the therapeutic effect on the voice recovery of patients with vocal cord polyps undergoing the microsurgery of preoperative voice therapy.@*METHODS@#Twenty-six patients diagnosed with unilateral vocal cord polyp under stroboscope, who needed to undergo vocal cord loss resection under supportive laryngoscope, were randomly divided into control group (non-voice training) and treatment group (voice training), with each group of 13 patients. Patients in control group were just treated with surgical operation. Apart from surgical treatment, patients in treatment group received 6 hours intensive vocal therapy one week before the surgery. The therapy courses consist of the propaganda and education of voice care, postoperative vocal instruction and the patients' self-training under the guidance of voice therapists. The acoustic parameters (irregularity, breathiness, grade, jitter and shimmer) of the same patient were collected 24 to 48 hours before the surgery and 14 days after the surgery with Ling WAVES. The results were analyzed with SPSS 19.0.@*RESULTS@#The differences of all the five preoperative voice parameters between control group and treatment group are not significant; but postoperative breathiness and jitter in treatment group were significantly lower than that in control group, while the differences of irregularity, overall severity and shimmer were not significant between control group and treatment group. In control group, breathiness and jitter were significantly improved after surgery, while the differences of irregularity, breathiness and shimmer were not significant between preoperation and postoperation. In treatment group, all the five voice parameters were significantly improved after surgery. According to the laryngostroboscopic examination, the vocal fold polyps were excised completely in both groups.@*CONCLUSIONS@#Preoperative voice therapy contributes to the recovery of voice quality of the patients with vocal cord polyps. Combined intervention of surgery and voice therapy is an effective method to treat the patients with vocal cord polyps.

Anti-human 4-1BBL monoclonal antibody stimulates the nuclear translocation of NF-κB and the co-location of 4-1BBL/CD28 isoform in U937 cells / 中国实验血液学杂志

This study was purposed to investigate the molecular mechanism of 4-1BBL reverse signals in the human acute monocytic leukemia cell line of U937. The U937 cell line was used as target cells, and stimulated by the mouse anti-human 4-1BBL monoclonal antibody 1F1. The nuclear translocation of NF-κB and the co-location of 4-1BBL and CD28i molecules in U937 cells were observed with confocal laser scanning microscopy. The protein and m-RNA expression levels of 4-1BBL and CD28i were detected by flow cytometry and RT-PCR respectively. The results showed that the significant nuclear translocation of NF-κB and co-localization of 4-1BBL and CD28i on membrane of U937 cells appeared after being stimulated by mAb1F1. It is concluded that the 4-1BBL reverse signals transduction mediating the growth of U937 cells relates with the nuclear translocation of NF-κB. CD28i may be involved in intracellular 4-1BBL reverse signaling pathways.

Detection of serum neopterin in patients with hemophagocytic lymphohistiocytosis and its significance / 中国实验血液学杂志

This study was aimed to detect the peripheral blood serum neopterin (Npt) level in the patients with hemophagocytic lymphohistiocytosis (HLH) and to explore its significance in HLH. The enzyme-linked immunosorbent assay (ELISA) was applied to detect the serum Npt level and sCD25 level in 20 HLH patients before and after treatment and 15 healthy controls. The results indicated that the serum Npt and sCD25 levels in HLH patients were significantly higher than those in healthy controls (P < 0.0001). The serum Npt and sCD25 levels in the HLH group decreased significantly after treatment, respectively (P < 0.0001). The correlation analysis of Npt with sCD25 before and after treatment showed that they had significant correlation (r = 0.81, P < 0.05 before treatment; r = 0.65, P < 0.05 after treatment). Meanwhile, the level of serum Npt and ferritin had a significant correlation in newly diagnosed HLH patients (r = 0.55, P < 0.05). It is concluded that the serum Npt may play an important role in the HLH pathogenesis, the enhancement of Npt levels has an important significance for diagnosis and evaluation for HLH.

Analysis of associated factors of lymph node metastasis in intramucosal early gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To analyze the associated predictive factors of lymph node metastasis in intramucosal early gastric cancer, and to provide reference for individualized treatment protocol.</p><p><b>METHODS</b>Clinical data of 498 patients who were pathologically confirmed to be intramucosal early gastric cancer after radical resection of gastric cancer were retrospectively reviewed. Univariate and multivariate analyses were applied to evaluate the associated factors.</p><p><b>RESULTS</b>Forty-three out of 498 patients (8.6%) had lymph node metastasis. Tumor size (HR=1.525, 95%CI:1.040-2.236), depth of invasion (HR=1.656, 95%CI:1.158-2.368) and histological type (HR=8.149, 95%CI:1.770-37.513) were the independent risk factors for lymph node metastasis in intramucosal early gastric cancer.</p><p><b>CONCLUSIONS</b>Prediction and therapeutic guidance for lymph node metastasis in intramucosal early gastric cancer can be carried out according to clinicopathological risk factors.</p>

A multi-center, randomized, double-blind, placebo-controlled trial of glyceryl trinitrate ointment in the treatment of anal fissure / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical efficacy and safety of glyceryl trinitrate (GTN) ointment in the treatment of anal fissure.</p><p><b>METHODS</b>In this multi-center, randomized, double-blind and placebo-controlled trial, 240 chronic anal fissure patients from 7 clinical centers were randomized to receive eight-week treatment with GTN ointment (treatment group) or vaseline ointment (control group) respectively. Healing rate, visual analogue score (VAS), maximum anal resting pressure (MARP) and adverse reactions were recorded and compared.</p><p><b>RESULTS</b>A total of 221 patients (92.1%) finished the trial, including 114 patients in treatment group (95.0%, 114/120) and 107 in control group (89.2%, 107/120). At the endpoint of treatment (56 d), 90 patients in treatment group (78.9%, 90/114) healed completely compared to 31 patients in control group (29.0%, 31/107), and decrease rates of VAS in the two groups were (94.8±15.7)% and (61.2±35.7)% respectively, both differences were statistically significant (P<0.01). MARP after first administration was (20.2±18.5) mm Hg in treatment group (n=12) and (7.1±14.7) mm Hg in control group (n=6), which was not significantly different (P=0.152). Adverse reaction incidence was higher in treatment group (42.1% vs. 9.3%, P<0.05), while these adverse reactions were mainly headache and fullness in head, which were self-limiting.</p><p><b>CONCLUSION</b>GTN ointment can effectively promote healing and relieve pain in anal fissure with safety and tolerance.</p>

Narrow band imaging versus iodine staining for margin determination of early esophageal cancer during endoscopic submucosal dissection / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the clinical value of narrow band imaging (NBI) and iodine staining for margin determination of early esophageal cancer during endoscopic submucosal dissection (ESD).</p><p><b>METHODS</b>Clinical data of 87 patients with early esophageal cancers undergoing endoscopic submucosal dissection (ESD) were analyzed retrospectively. Patients were assigned to NBI group and iodine staining group according to the staining method before ESD operation. Clinicopathological features, esophageal spasm ratio, operation time, en bloc resection rate, complications, local recurrence, and distant metastases were compared between the two groups.</p><p><b>RESULTS</b>There were 37 patients in NBI group while 50 patients in iodine staining group. Location and size of the lesions between two groups were not significantly different. The ratio of moderate-severe esophageal spasm in NBI group was significantly lower as compared to iodine staining group [10.8%(4/37) vs. 32.0%(16/50), P<0.05]. The average operation time in NBI group was significantly shorter than that in iodine staining group [(42.2±19.5) min vs. (53.3±30.9) min, P<0.05). All the tumors were resected in an en bloc fashion and the R0 resection rate was 100%. Perforations in 2 patients and delayed bleeding in 1 patient were successfully treated by endoscopic methods. Esophageal strictures occurred in 3 patients of NBI group and 4 patients of iodine staining group, who were treated by endoscopic dilation and retrievable stents. During mean 13.2 months (range 4 to 20 months) follow-up periods, local recurrence occurred in 2 patients of NBI group and 2 patients of iodine staining group. These patients received ESD or other surgery.</p><p><b>CONCLUSION</b>Compared with iodine staining, using NBI for margin determination of early esophageal cancer during ESD is more convenient and fast because of distinctly lower degree of esophageal spasm.</p>

Membrane-covered self-expanding stents in the treatment of high-positioned esophageal stenosis or fistula / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy and safety of membrane-covered self-expanding metal stent in the treatment of high-positioned esophageal diseases, including esophageal stenosis, esophagotracheal fistula and anastomotic stricture.</p><p><b>METHODS</b>Clinical data of 84 patients who underwent stenting in our center from May 2005 to July 2013 were retrospectively analyzed. Of 84 patients, 31 were diagnosed as esophageal malignant stenosis, 2 compression stenosis, 10 radiation stenosis, 4 recurrent malignant stenosis, 27 anastomotic stricture, 1 esophageal stenosis after endoscopic submucosal dissection (ESD), 7 esophageal-tracheal fistula, 1 esophageal-mediastinal fistula, and 1 remnant stomach fistula. Distance from stenosis or fistula to central incisor was 15-20 cm in 48 cases, and more than 20 cm in 36 cases. All the patients were treated by 16 mm membrane-covered self-expanding metal stents. Main clinical manifestations and complications were evaluated.</p><p><b>RESULTS</b>A total of 100 stents were placed in 84 patients,with a success rate of 100%. There were no complications such as perforation and bleeding during operation. Dysphagia and cough were improved quickly with a success rate of 100%. After the placement of stents, the incidence of complication was 6.0% (5/84), of which 2 cases were severe retrosternal pain, 1 was tracheal collapse, and 2 were stent displacement. Seventy-six patients (90.5%) received complete follow-up of 1 to 36 months (mean 15 months). Re-stenosis occurred in 4 cases, new esophageal-tracheal fistula in 2 cases. Among these 6 cases, 5 cases underwent successfully stent placement once again, and another one case received Savary bougie and Argon-ion coagulation with good efficacy.</p><p><b>CONCLUSION</b>Endoscopic membrane-covered self-expanding metal stent placement is effective and safe for the relieve of dysphagia symptoms and the sealing of esophagotracheal fistula.</p>

Submucosal tunneling endoscopic resection in the treatment of rectal submucosal tumors originating from muscularis propria / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical value of submucosal tunneling endoscopic resection (STER) for rectal submucosal tumors (SMT) originating from muscularis propria.</p><p><b>METHODS</b>Clinicopathological data of 8 cases with rectal SMT originating from muscularis propria undergoing STER in our center from March 2011 to March 2013 were analyzed retrospectively.</p><p><b>RESULTS</b>En bloc STER was performed successfully in all the 8 cases. The tumors location was 5-15 cm from the edge of anus. The resected specimen size ranged from 1.0 to 3.5 cm (average 1.8 cm). The mean procedure time was 51 min (range, 40-70 min). One patient developed mucosa perforation and was repaired with metal clips. One patient developed subcutaneous emphysema in one leg, which was disappeared after two weeks. Postoperative pathological examination revealed schwannoma in 3 cases, leiomyoma in 2 cases, stromal tumor in 1 case, and proliferation of collagen fibers nodular degeneration in 2 cases. Postoperative follow-up ranged from 6 to 30 months and no residual lesion or recurrence was found.</p><p><b>CONCLUSION</b>STER is a safe and effective method for rectal SMT originating from muscularis propria in our initial experience.</p>

Therapeutic value of endoscopic submucosal dissection for gastrointestinal stromal tumor in the esophagogastric junction / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of endoscopic submucosal dissection (ESD) for gastrointestinal stromal tumor(GIST) in the esophagogastric junction(EGJ).</p><p><b>METHODS</b>Twenty patients with pathologically confirmed GIST in the EGJ were screened from all the patients undergoing ESD between November 2007 and June 2011. The clinicopathological and postoperative follow up data were analyzed.</p><p><b>RESULTS</b>There were 11 males and 9 females with the age ranging from 29 to 67 years(mean, 54.1 years). The maximum diameter of the lesions ranged from 8 to 20 mm(mean,14.8 mm). Fifteen patients underwent endoscopic submucosal excavation, 4 patients underwent endoscopic full-thickness resection, and 1 patient underwent submucosal tunneling endoscopic resection. The operative time ranged from 15 to 90 min(mean, 47.8 minutes). The estimated blood loss was 5 to 200 ml. The en bloc resection rate was 100%. Perforations occurred in 4 patients, pneumoperitoneum in 3 patients, cardia mucosal tear in 1 patient. All the complications were successfully managed with endoscopic intervention and conservative therapy. The post-operative follow up ranged from 3 to 36 months(mean, 13.2 months). No local recurrence or distant metastasis occurred.</p><p><b>CONCLUSION</b>ESD is a safe and effective procedure for GIST in the EGJ.</p>

How to improve the level of endoscopic diagnosis and treatment of early gastrointestinal cancer: private opinions / 中华胃肠外科杂志

At present, the level of diagnosis and treatment of early gastrointestinal cancer has a larger gap between China and developed countries. In recent years, the advent of new endoscopic imaging techniques has improved the detection rate of early gastrointestinal cancer. Along with this, endoscopic submucosal dissection(ESD) enables radical resection for early cancer. In this article, we discuss how to improve the level of endoscopic diagnosis and treatment of early gastrointestinal cancer.

Clinical value of different magnifying chromoendoscopy methods in screening gastric precancerous lesions and early cancers / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To prospectively evaluate the clinical value of different magnifying chromoendoscopy(MCE) methods in screening gastric precancerous lesions and early cancers.</p><p><b>METHODS</b>Between March 2010 and October 2011, among all the patients aged over 40 who received esophagogastroduodenoscopy at Zhongshan hospital, Fudan University, suspicious lesion was detected in 699 patients, who were randomly assigned to three groups: epinephrine dye(n=240), indigo carmine dye(n=246), and acetic acid-indigo carmine mixture dye(n=213). Diagnosis was made according to surface patterns and microvessels of the lesion. Pathological diagnosis was used as the gold standard. The concordance between endoscopic diagnosis and pathological diagnosis was evaluated through the agreement(Kappa) test. McNemar Paired chi-square test was used to compare the concordance of three MCE methods, regular white light, magnification alone, and NBI magnifier before and after MCE.</p><p><b>RESULTS</b>Pathological examination showed inflammatory lesions in 415 patients, intestinal metaplasia in 190, low grade intra-epithelial neoplasia in 17, and high grade intra-epithelial neoplasia or early cancer in 77. The percentage of patients with consistent endoscopic and pathological diagnosis was 77.1%(185/240) for epinephrine dye, 80.5%(198/246) for indigo carmine dye, and 81.2%(173/213) for acetic acid-indigo carmine mixture dye. Kappa values were 0.579, 0.502, and 0.667 respectively(all P<0.01). For the screening of high grade intra-epithelial neoplasia or early cancer, the diagnostic sensitivities were 84.0%, 83.3%, and 92.9%, respectively, and the specificities were 98.6%, 97.3%, and 98.4%. All the three chromoendoscopy methods improved the diagnostic accuracy for precancerous lesions compared with conventional gastroscopic observation with white light(all P<0.01). Indigo carmine and acid-indigo carmine mixture dye improved the diagnostic accuracy of magnification alone(both P<0.05). There was no significant difference in diagnostic accuracy between each MCE method and magnifying NBI observation(all P>0.05).</p><p><b>CONCLUSION</b>NBI magnification and all the three MCE methods may improve the diagnostic accuracy of early gastric cancer and precancerous lesions.</p>

Application and evaluation of submucosal tunneling endoscopic resection of gastric submucosal tumors originating from the muscularis propria layer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical value of submucosal tunneling endoscopic resection(STER) for gastric submucosal tumor(SMT) originating from the muscularis propria (MP) layer.</p><p><b>METHODS</b>Clinicopathological data of 23 cases with gastric SMT originating from the MP layer treated with STER from September 2010 to December 2011 were analyzed retrospectively.</p><p><b>RESULTS</b>There were 13 males and 10 females. The age ranged from 28 to 73(mean, 52.4) years old. Of the 23 SMTs, 11 were located in the cardia adjacent to the gastric body, 4 in the cardia adjacent to the fundus, 5 in the lesser curvature of gastric body and 3 in the gastric antrum of greater curvature. All the SMTs originating from the MP layer, 14 were located in the superficial MP layer and 9 in the deep MP layer(including 5 gastric SMTs close to serosa). En bloc STER was performed successfully in all the patients. The mean lesion size was 2.1 cm(range 1.5-3.2 cm). The mean procedure time was 54.8 min(range 30-125 min). Pathological examination showed that the lesions were leiomyomas(n=10), stromal tumors(n=8), glomus tumor(n=2), Schwannoma(n=2), and calcifying fibrous tumor(n=1). Both lateral and vertical margins were negative in all the cases. Three patients developed pneumothorax and subcutaneous emphysema and 5 pneumoperitoneum. One patient developed effusion under the left half of the diaphragm and secondary infection. All of them recovered uneventfully after conservative treatments. No delayed bleeding or GI tract leakage was noticed. None of the 23 cases encountered submucosal hematoma or infection. No tumor residual or recurrence was found during the follow up(range, 3-18 months).</p><p><b>CONCLUSIONS</b>STER is a safe, effective for appropriate lesions in the MP layer of the stomach. En bloc resection and accurate histopathological evaluations can be achieved.</p>

Selection and evaluation of endoscopic resection for submucosal tumors of the esophagogastric junction originating from muscularis propria / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical application and indication of endoscopic dissection technique for submucosal tumors (SMTs) of the esophagogastric junction (EGJ) originating from the muscularis propria.</p><p><b>METHODS</b>A total of 143 SMTs of the EGJ were treated by endoscopic resection in the Endoscopy Center of Zhongshan Hospital Affiliated to Fudan University between March 2007 and June 2011. The clinical and histopathologic feature, surgical approach, en bloc resection rate, complications, and postoperative follow up were evaluated.</p><p><b>RESULTS</b>There were 74 males and 69 females with a mean age of 49.1 years old. The en bloc resection rate was 94.4%(135/143). There were 126 patients who underwent endoscopic submucosal excavation in an en bloc fashion. Six patients underwent endoscopic full-thickness resection without laparoscopic assistance. Three patients underwent submucosal tunneling endoscopic resection. The other 8 SMTs were partially resected for histological evaluation and the residual tumors were further treated with nylon snare ligation. The mean lesion size was 17.6 mm. The mean procedure time was 45.1 minutes and the mean intraoperative bleeding was 50.0 ml. Perforations occurred in 6 patients and metal clips were used to close the defect. One patient with Mallory-Weiss syndrome was successfully treated with conservative treatment. Pathological examination showed that the lesions were leiomyoma (n=121), gastrointestinal stromal tumor (n=20), granulosa cell tumor (n=1), and intermuscular lipoma (n=1). No local recurrence and distant metastasis were noted during the follow-up (range, 3-48 months).</p><p><b>CONCLUSION</b>Endoscopic resection technique is safe and effective, and should be selected for each patient individually.</p>

Significance of soluble interleukin-2 receptor and NK cell activity in patients with hemophagocytic lymphohistiocytosis / 中国实验血液学杂志

This study was aimed to detect the level of soluble interleukin-2 receptor (sCD25) and cytotoxic activity of NK lymphocytes in patients with hemophagocytic lymphohistiocytosis (HLH), and to explore their clinical significance in HLH. The enzyme-linked immunosorbent assay was used to detect the sCD25 level in serum of 20 patients with HLH, 15 healthy controls, 20 cases of acute myeloid leukemia and 20 cases of systemic lupus erythematosus. The NK cell cytotoxicity in peripheral blood of patients with HLH and controls were detected by flow cytometry with CD107a antibody labeling and LDH release assay. The results indicated that the level of sCD25 in HLH patients was significantly higher than that in healthy controls and disease groups (P < 0.001). The NK cell cytotoxicity in peripheral blood detected by both methods in patients with HLH were lower than that in healthy controls (P < 0.05), and the results detected by flow cytometry correlated significantly with those by LDH release assay (r = 0.73, P < 0.05). It is concluded that detection of sCD25 levels and NK cell activity in peripheral blood in HLH is of great value. Using flow cytometry following CD107a antibody labeling to measure NK activity is a simple, stability, reproducibility method and can be used for clinical diagnosis of HLH.

Peroral endoscopic myotomy for esophageal achalasia: report of 42 cases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and the feasibility of peroral endoscopic myotomy (POEM) for esophageal achalasia (AC).</p><p><b>METHODS</b>The clinical data of 42 patients diagnosed as AC and received POEM in the Zhongshan Hospital of Fudan University between August 2010 and March 2011 were reviewed retrospectively. The key procedures of POEM included esophageal mucosal incision, submucosal "tunneling" by endoscopic submucosal dissection(ESD) technique, endoscopic myotomy of the circular muscle, and closure of mucosal incision by hemostatic clips.</p><p><b>RESULTS</b>The mean age of 42 cases was 43.9(range 10-70) years. The mean duration of disease was 8.7 years (range, 3 months to 50 years). The mean operative time was (68.5 ± 25.5) (range 23-180) minutes with a mean submucosal tunneling length of(10.5 ± 1.5)(range 8-15) cm. The average length of endoscopic myotomy of inner circular muscle was(9.5 ± 2.5)(range 7-13) cm. No serious complications related to POEM were encountered. The median follow-up period was 2.5(range 1-6) months. Dysphagia symptom was relieved significantly during the follow-up period in 41 patients; one patient had dysphagia and vomiting 15 days after the operation. Endoscopic observation showed a submucosal fistula which was managed by endoscopic incision.</p><p><b>CONCLUSIONS</b>As a novel minimally invasive therapy for AC, POEM appears to have definite short-term outcomes and can rapidly alleviate dysphagia symptom. Further observations and long follow-up are needed to evaluate long-term outcome and complications.</p>

Endoscopic therapy of adenomatous polyps and early-stage carcinomas of the colon and rectum / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the clinical efficacy of endoscopic treatment for colorectal adenomatous polyps and early-stage carcinomas.</p><p><b>METHODS</b>Between January 2006 and October 2007, 245 patients with colorectal adenomatous polyps and early-stage carcinomas with lifting sign(+) were treated by such endoscopic techniques as polypectomy, endoscopic mucosal resection (EMR), endoscopic piecemeal mucosal resection (EPMR) and endoscopic submucosal dissection (ESD).</p><p><b>RESULTS</b>Two hundred and fifty-three lesions ranged from 0.5 to 8.5 cm and the mean resected size was 2.3 cm, of which 157 were smaller than 2 cm and 96 larger than 2 cm. Confirmed pathologically, 249 lesions were successfully resected and the resection rate was 98.4% (249/253). None of patients had massive hemorrhage during the procedure and 2 had delayed bleeding. 1 had a little free air in abdominal cavity, 2 patients had subcutaneous emphysema due to deep tearing of the muscle layer, all 3 recovered after several days' conservative treatment. Visible perforation occurred in 4 cases during the dissection, of which 3 were typically closed with metallic endo-clip without surgical treatment, and 1 was managed surgically with obvious distention and much abdominal free air. The rate of resectional complication was judged to be 3.6% (9/253). Eight cases were transferred to surgery altogether after endoscopic procedure. Two hundred and thirty-one cases were followed up with confirmed healing of the large artificial ulcer after ESD except for local recurrence in 3 cases after EPMR.</p><p><b>CONCLUSIONS</b>Endoscopic resection appears to be an efficacious procedure to treat adenomatous polyp and early-stage carcinoma and provide pathological information about the whole lesion. Measures should be taken to reduce the complication rate of endoscopic resection in the future.</p>

Long-term efficacy of endoscopic excision of rectal carcinoids / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the long-term efficacy of endoscopic excision for rectal carcinoids.</p><p><b>METHODS</b>Clinical data of 91 patients with rectal carcinoids treated by endoscopic excision from 2000 to 2007 were analyzed retrospectively.</p><p><b>RESULTS</b>The average size of the primary tumor was 0.8 cm(range 0.3 to 2.3 cm). All the tumors were localized within the submucosal layer showing typical histology without lymphatic or vessel infiltration. Follow-up was available for 80 patients with mean 32.5 months (range 6 to 96 months). There was no recurrence in 65 patients with tumor size < 1.0 cm. Recurrence occurred in 3 cases among 25 patients with tumor size from 1.0 to 2.0 cm, and 1 died of hepatic metastasis. The 1-, 3-, and 5-year survival rates of the patients were 100%, 98.0%, and 91.4% respectively.</p><p><b>CONCLUSIONS</b>Tumor size and depth of invasion are two important prognostic factors of rectal carcinoids. Endoscopic excision is useful for rectal carcinoid patients with tumor size < 1.0 cm and located within the submucosal layer.</p>

Endoscopic submucosal dissection for rectal carcinoid tumors / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To assess the clinical value of endoscopic submucosal dissection(ESD)for rectal carcinoid tumors.</p><p><b>METHODS</b>Endoscopic miniprobe ultrasonography was performed in patients with rectal submucosal tumors under colonoscope. ESD was carried out with the needle knife for lesions diagnosed as rectal carcinoid as following: (1)Fluid was injected into the submucosal layer in the rectum to elevate the lesion from the muscle layer. (2)The surrounding mucosa of the lesion was pre-cut. (3)The connective tissue of the submucosa beneath the lesion was dissected.</p><p><b>RESULTS</b>Five rectal carcinoids ranged from 0.4 to 1.2 cm and the mean resected size was 1.1 cm. All rectal carcinoid tumors were verified by pathological examination with lateral and basal resection margins free of tumor. The mean ESD procedure time (from fluid injection to complete dissection) was 35 min (ranged from 20 to 45 min). Minor bleeding occurred in all of the tumors, and none of patients had massive hemorrhage requiring blood transfusion or emergency colonoscopy due to hematochezia after ESD. One patient had subserosal emphysema due to deep tearing of the muscle layer, and recovered after several days' conservative treatment. All patients were followed up with colonoscopy 1 month after ESD,which confirmed the healing of artificial ulcers.</p><p><b>CONCLUSIONS</b>ESD is a novel endoscopic treatment that makes it possible to resect the whole rectal carcinoids. Rectal carcinoid tumors can now be treated by ESD to achieve the same therapeutic effect as operation.</p>

Screening and analysis of genes encoding hepatocellular carcinoma associated tumor antigens / 中华肝脏病杂志

<p><b>OBJECTIVES</b>To screen and clone the genes encoding hepatocellular carcinoma associated tumor antigens.</p><p><b>METHODS</b>A hepatocellular carcinoma cDNA express library was constructed with ZAP vector and analyzed by serological analysis of recombinant cDNA expression library (SEREX) with sera from autologous and allogenous patients. Monoclonalized positive phage clones were converted into pBK-CMV phagemid forms by in vivo excision. The cDNA inserts were determined by restriction endonuclease digestion with EcoR I and Xho I. The cDNA inserts were sequenced and analyzed with bioinformatics. LIMS1 insert was cut from the clone HCL5-70 and constructed into pQE 31 express vector. The recombinant LIMS1 was expressed in M15 and analyzed with SDS-PAGE and Western blot.</p><p><b>RESULTS</b>Fourteen genes were cloned from autologous screening and eleven genes were obtained with allogeneous analysis. One gene, kinectin, was identified in both autologous and allogeneous screening. Eight of the total twenty-four genes were unknown for their functions; the other sixteen genes can be classified into eight groups according to their established or putative function. Recombinant LIMS1 was expressed in M15.</p><p><b>CONCLUSION</b>The identification of hepatocellular carcinoma associated tumor antigens provides potential targets for immunotherapy of hepatocellular carcinoma patients and will help in the understanding of the carcinogenesis of hepatocellular carcinoma.</p>

Clinical value of percutaneous endoscopic gastrostomy and jejunostomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility and safety of percutaneous endoscopic gastrostomy (PEG) and percutaneous endoscopic jejunostomy(PEJ).</p><p><b>METHODS</b>From June 1996 to April 2005, clinical data of 121 patients treated with PEG or PEJ were analyzed retrospectively.</p><p><b>RESULTS</b>A total of 121 patients experienced 134 times of PEG or PEG plus PEJ, including 90 cases (103 times) treated with PEG and 31 patients treated with PEG plus PEJ. Thirteen patients treated with PEG had fistula replacement 6-10 months after PEG. All patients had quick nutrition recovery after fistula tube insert,therefore parenteral nutrition was not required. No severe complications occurred in all patients after 10 months of following-up. Four patients had subcutaneous infection around fistula 4-10 days after PEG.</p><p><b>CONCLUSION</b>PEG and PEJ are safe and new methods for gastrointestinal decompression and enteral nutrition, which can be substitutes for nasogastric tube.</p>