ABSTRACT
Objective To investigate the clinical outcome of pancreatic pseudocyst(PPC)treated with non-surgical methods,and to compare the efficacy and safety between percutaneous drainage and endoscopic drainage in the management of PPC.Methods From February 2010 to July 2017,clinical data of patients with PPC,who received percutaneous drainage or endoscopic drainage,were retrospectively analyzed.The symptom relief rate,short-term and long-term radiologic remission rate,complication rate, recurrence rate and length of hospital stay were compared between patients treated by ultrasound guided percutaneous drainage(percutaneous group),by endoscopic ultrasonography-guided drainage(EUS group)and by endoscopic retrograde pancreatography guided transpapillary drainage(ERP group).Two independent samples t test,one-way analysis of variance,non-parametric test and Fisher′s exact test were performed for statistical analysis.Results A total of 153 patients were treated and the operation was successfully conducted in 148 patients(96.7%),of whom 39 were in percutaneous group,73 in EUS group and 36 in ERP group.The median follow-up time was 26 weeks(two weeks to 358 weeks).The symptom relief rate,long-term radiographic remission rate,complication rate,recurrence rate and retreatment rate of percutaneous group,EUS group and ERP group were 87.2%(34/39),79.5%(58/73),80.6%(29/36);81.5%(22/27),88.6%(39/44),66.7%(16/24);17.9%(7/39),28.8%(21/73),16.7%(6/36);15.0%(3/20),13.8%(8/58),10.0%(2/20);and 10.3%(4/39),8.2%(6/73),2.8%(1/36),respectively.There was no statistically significant difference among three groups (all P> 0.05).The short-term radiographic remission rate of ERP group was significantly lower than those of percutaneous group and EUS group(46.7%,14/30 vs 77.1%,27/35 and 87.7%,64/73),and the differences were statistically significant(χ2 =6.442 and 19.450,both P<0.01).The median hospital stay of percutaneous group was longer than those of EUS group and ERP group(14.0 days vs 9.0 days and 8.0 days),and the differences were statistically significant(Z= -3.687 and -2.630,both P<0.01).Conclusions The efficacies of percutaneous drainage and EUS-guided drainage are both better than ERP,and they are effective and safe methods especially for the patients with complication of pseudocysts and necrosis debris in pseudocysts.However,the hospitalization time of percutaneous drainage is longer. In addition,percutaneous drainage can be an alternative method after failed endoscopic drainage.
ABSTRACT
Objective To compare the effect of progressive teaching pattern with traditional long-term training on improvement of trainees ability of endoscopic ultrasonography ( EUS ) . Methods Ten learners who have achieved competence on routine endoscopic procedures but without any knowledge and skills on EUS procedures were enrolled in the study, and were randomly divided into two groups according to the sequence number. Learners with odd number received traditional long-term training, and the even number learners received progressive teaching. The proficiency of EUS knowledge and skills in the two groups were compared after one-year learning. Results At the final examination, the learners′ ability of mastering EUS was higher, and the study leave time was shorter in the progressive teaching group than that in the traditional long-term training group. however, we didn′t have a statistical comparison owing to the few numbers of trainees. Conclusion Progressive teaching pattern is superior to the traditional training, and it should be advocated when hospitals are relatively understaffed.
ABSTRACT
Objective To evaluate the diagnostic value of linked color imaging (LCI) technology on Helicobacter pylori (HP)-related gastritis. Methods Forty patients who were diagnosed as chronic gastritis using blue laser imaging endoscopy in Shenzhen Hospital of Southern Medical University during November 2016 to June 2017 were enrolled in this study. The appearance of gastric mucosa was observed using conventional white light imaging and LCI. Biopsies were taken under white light imaging according to biopsy pathological diagnosis consensus, and the ones from abnormal reddening area were taken under LCI. 13C-urea breath test (13C-UBT) was performed in all 40 patients. The consistency between the two observation methods and final pathological diagnosis was evaluated using Kappa test, and the diagnostic consistency of the two methods was compared using Mc Nemar paired Chi-square test.Results The positive predictive value of white light imaging and LCI for prediction of HP infection was 54. 5%(6/11) and 81. 5%(22/27), respectively.The consistency between white light imaging diagnosis and final pathological diagnosis was 0. 475 (19/40), Kappa＝0. 635; the consistency between LCI diagnosis and final pathological diagnosis was 0. 875 (35/40), Kappa＝0. 741. Mc Nemar paired Chi-square test showed that the consistency between the two methods had significant difference (P＜0. 01). 13C-UBT showed that 19 patients were positive and 21 negative. Among the 19 positive patients, 1 case was diagnosed as HP negative by pathology under LCI; and among the 21 negative patients, 4 cases were diagnosed as HP negative by pathology under LCI.The consistency between pathological diagnosis and 13C-UBT was good (Kappa＝0. 751). The red-white boundary and diffuse redness of gastric mucosa were observed in 15 and 11 cases under LCI, respectively, while unobserved under white light imaging.The Wilcoxon signed ranks test showed that there was a significant difference between white light imaging and LCI on the appearance of gastric mucosa (Z＝－4. 455, P＜0. 01). Conclusion LCI is more useful for diagnosis of HP-related chronic gastritis than white light imaging.
ABSTRACT
Objective To estimate the diagnostic value of cytology, DNA-ICM(DNA-image cytometry),cytology combined with DNA-ICM for pancreatic malignancy,and to explore the cut-off value for DNA-ICM. Methods Patients with suspicious pancreatic malignancy were retrospectively identified. In total,145 EUS-FNA specimens acquired from 140 separate patients were examined by cytology and DNA-ICM. Diagnostic values among cytology, DNA-ICM and the combination of the techniques in detecting pancreatic malignancy were compared. Results Compared with cytology, DNA-ICM had a lower sensitivity (63.0% VS 82.4%)and accuracy(69.7% VS 85.5%). After combining the techniques, the diagnostic value for pancreatic malignancy significantly improved compared with that by cytology(0.941 VS 0.912, P=0.007 0)or DNA-ICM only(0.941 VS 0.815, P<0.000 1). By using the Youden index, the cut-off value for DNA-ICM to detect pancreatic malignancy was one cell with DI(DNA index)≥2.5. Notably,with this standard, the sensitivity and accuracy of DNA-ICM significantly increased to 72.3% and 77.2%, and those of the combined techniques increased to 91.6% and 93.1%, respectively. Conclusion Automated DNA-ICM is an objective and effective method for pancreatic malignancy. Although DNA-ICM has a lower diagnostic value than that of conventional cytology, an improved value was obtained after combining the techniques.
ABSTRACT
Objective:To investigate the effects and mechanism of β-carotene on inflammatory factors (IL-1 β,IL-6,TNF-α) in LPS-induced RAW264.7 cells.Methods:Firstly,RAW264.7 cells of being induced by 4 (5 μg/ml)for 24 h were treated with different concentration of β-carotene (20,40,80,160 pmol/L)for 3 h.The cells viability was measured by MTIT,the mRNA relative expression of IL-1 β,IL-6,TNF-cα was detected by fluorescence quantitative PCR,the secretion capacity of IL-1 β,IL-6,TNF-α was detected by ELISA and the protein relative expression of NF-κB p65 protein was measured by Western blot.Secondly,RAW264.7 cells were induced by LPS(5 μg/ml) and different concentration of PDTC(1,5,10 μg/ml)for 24 h,NF-κB p65 protein was measured by Western blot and inflammatory factors were detected by fluorescence quantitative PCR and ELISA.Finally,compared the changes in the relative expression of inflammatory factors and NF-κB p65 protein between LPS+PDTC group and LPS+PDTC + β-carotene group.Results:Compared with the LPS-induced group,β-carotene could increase the cell viability of LPS-induced RAW264.7 cells and inhibied the relative expression of inflammatory factors and NF-κB p65 protein.Inhibited the relative expression of NF-κB p65 protein could reduce the relative expression of inflammatory factors.Compared with the LPS+PDTC group,LPS +PDTC + β-carotene group could inhibit the relative expression of inflammatory factors significantly (P＜0.05).But,there was little difference about the relative expression of NF-κB p65 protein between this two groups.Conclusion:β-carotene inhibits the relative expression of inflammatory factors(IL-1 β,IL-6,TNF-α) in LPS-induced RAW264.7 cells through inhibition of NF-κB p65 protein in NF-κB pathway,this pathway isn't unique.
ABSTRACT
Objective To compare the efficacy and safety of 5-fluorouracil and calcium folinatc combined with oxaliplatin (FOLFOX) program with capecitabine regimen combined oxaliplatin (XELOX) program as adjuvant chemotherapy in advanced colorectal cancer after surgery.Methods The postoperative clinical data of 286 advanced colorectal cancer patients were retrospectively analyzed.Of which,204 patients received FOLFOX4/6 adjuvant chemotherapy and 82 patients received XELOX adjuvant chemotherapy.The three-years disease-free survival (DFS) time,three-years overall survival (OS) time and adverse reactions of the two groups were compared.Count data of the two groups' were compared by chi-square test,and measurement data were analyzed by t-test.Results In the FOLFOX4/6 group,153 patients (75 ％) completed 12 cycles of chemotherapy,and in the XELOX group,66 patients (80 ％) finished eight cycles of chemotherapy.There was no statistical difference in three-year DFS incidence (FOLFOX4/6 stage Ⅱ 87％,Ⅲ 82％; XELOX stage Ⅱ 83％,Ⅲ 80％) and three-year OS incidence (FOLFOX4/6 stage Ⅱ 92％,Ⅲ 88％; XELOX stage Ⅱ 89％,Ⅲ 86％) between two groups (all P＞0.05).There was no statistical difference in the incidence of common adverse reactions between FOLFOX4/6 and XELOX group (all P＞0.05).Adverse reactions of degree Ⅰ and Ⅱ were more common,while degree Ⅲ and Ⅳ were seldom.Of the adverse reactions of degree Ⅲ and Ⅳ,the incidence of neutropenia in patients of FOLFOX group was a little higher than in those of XELOX group,and the incidence of hand-foot syndrome was a litter higher in XELOX group than in FOLFOX group.However,there was no significant difference (x2 =0.060,0.928,both P＞0.05).Conclusion There was no statistical significance between FOLFOX4/6 and XELOX as postoperative auxiliary chemical therapy for advanced colorectal cancer,and both therapies possess good tolerance and safety.
ABSTRACT
<p><b>OBJECTIVE</b>To study the characteristics of host immune response against human gastric carcinoma of different histological types.</p><p><b>METHODS</b>The expression of 24 families of T cell receptor beta chain variable region (TCRVbeta) and cytokine profiles in isolated CD4(+) and CD8(+) subsets, as well as the cytokine profiles in purified epithelial cells from the tumor tissue and the residual benign tissue of patients with gastric carcinoma, was detected by a highly sensitive radioactivity labeled semi-quantitative RT-PCR technique.</p><p><b>RESULTS</b>The number of expanded T cell clones in CD8(+) subset from tumor tissue of the intestinal-type carcinoma was larger than that of diffuse-type (P = 0.046). The mRNA levels of IL-6, IL-8 in CD8(+) T subset, as well as the level of TNF-alpha in CD4(+) T subset from the tumor tissue of the diffuse type (0.61 +/- 0.29, 0.56 +/- 0.22, 0.09 +/- 0.03) were significantly higher than that from the residual benign tissue (0.14 +/- 0.05, 0.27 +/- 0.09, 0.04 +/- 0.02; P = 0.028, P = 0.043, P = 0.046). However, the mRNA level of IL-8 in CD8(+) subset and epithelial tumor cells of the intestinal-type (0.57 +/- 0.25, 0.27 +/- 0.07) was significantly higher than that from the residual benign tissue (0.21 +/- 0.07, 0.14 +/- 0.06; P = 0.028, P = 0.028).</p><p><b>CONCLUSIONS</b>The characteristics of host immune response against tumor are different between intestinal-type and diffuse-type gastric carcinoma. Both fewer expanded T cell clones and more suppressive cytokines suggest a more suppressive immune status in the local tumor lesion of diffuse-type than in the intestinal-type of the gastric carcinoma.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , CD4-Positive T-Lymphocytes , Metabolism , Pathology , CD8-Positive T-Lymphocytes , Metabolism , Pathology , Clone Cells , Cytokines , Genetics , Gene Expression Regulation, Neoplastic , Interferon-gamma , Genetics , Interleukin-10 , Genetics , Interleukin-2 , Genetics , Interleukin-4 , Genetics , Interleukin-6 , Genetics , Interleukin-8 , Genetics , Interleukins , RNA, Messenger , Genetics , Metabolism , Receptors, Antigen, T-Cell, alpha-beta , Genetics , Stomach Neoplasms , Genetics , Allergy and Immunology , Pathology , T-Lymphocytes , Metabolism , Pathology , Transforming Growth Factor beta , Genetics , Tumor Necrosis Factor-alpha , GeneticsABSTRACT
<p><b>OBJECTIVE</b>To study the characteristics of local cytokines profile in human gastric cancer lesions and offer guides for immunotherapy of gastric cancer.</p><p><b>METHODS</b>The cytokines profile in isolated CD4+, CD8+ T subsets and epithelial cells from cancer tissue, contrasted with benign gastric mucosa of 15 gastric cancer patients were analyzed by a highly sensitive radioactivity labeled semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) technique.</p><p><b>RESULTS</b>The predominance of increased Th2 and reduced Th1 immune response in both CD4+ and CD8+ T subsets from cancer tissue, compared with benign gastric mucosa, were observed. IL-6, IL-8 and TNF-alpha in CD8+ T cells from cancer tissue showed statistical higher levels than those from benign gastric mucosa (P = 0.029, P = 0.022, P = 0.002), so did IL-10, TGF-beta, TNF-alpha in T cells and epithelial cells.</p><p><b>CONCLUSION</b>A shift of Th1/Th2 cytokines to Th2 is found in T cells from local tumor lesion of gastric cancer, which suggests an immune suppressive status in local tumor lesion. The obvious change of cytokine profile in CD8+ T cell suggests they play a main role in immune suppression. To study the cytokine expression of different cell subsets, we are able to offer guides for immunotherapy for patients with gastric cancer.</p>