Treatment of postprandial discomfort syndrome in the elderly: a multi-centered prospective randomized controlled clinical study / 中华内科杂志

Objective@#To evaluate the efficacy and safety of Oryz-Aspergillus enzyme and pancreatin tablets (Combizym®) in the treatment of postprandial distress syndrome (PDS) in the elderly, compared with gastrointestinal motility drugs.@*Methods@#A prospective randomized controlled trial was designed and registered in the China Clinical Trials Registry (ChiCTR-IPR-16008185). The elderly patients with PDS were randomly divided into three groups, including Mosapride group with Mosapride citrate tablets 5 mg 3 times per day for 2 weeks; Combizym® group with Combizym tablets 244 mg 3 times per day for 2 weeks; combined treatment group with both drugs and same doses for 2 weeks. The modified Nepean dyspepsia index (NDSI) score, discomfort intensity score and PDS score were calculated on patients before treatment, at the end of first and second week of treatment, as well as 4 weeks after treatment finished, respectively. Adverse effects were evaluated.@*Results@#A total of 323 patients from 16 tertiary hospitals in China were enrolled in this study. Among them, 105 patients were in Mosapride group, 109 in Combizym® group and 109 in combined treatment group. There were 148 males (45.8%) and 175 females (54.2%) with median age 71.4±9.0 years (60-100 years). Baseline characteristics of three groups were comparable. After treatment, the NDSI scores in three groups all decreased significantly (P<0.001), while they were similar between groups (P>0.05). The discomfort intensity score and PDS score in three groups showed a significant reduction after treatment (P<0.001), especially in the combined treatment group. Compared with Mosapride group, the scores in Combizym® group decreased significantly after one or two weeks [discomfort intensity score: after one week, 4.0(2.5, 8.0) vs. 6.0(3.0, 10.0); after two weeks, 3.0(0.0, 5.0) vs. 4.0(2.0, 6.0); all P<0.05. PDS score: after one week, 6.0(3.0, 9.0) vs. 7.0(3.5, 10.5); after two weeks, 3.0(0.0, 5.0) vs. 4.0(2.0, 7.0); all P<0.05]. The efficacy rate in all patients after first week of treatment was over 15.0%. The efficacy rates after two weeks were 55.2%, 68.8% and 73.4% in Mosapride group, Combizym® group and combined treatment group, respectively. After two week treatment, the efficacy rates in Combizym® group (P=0.041) and combined group (P=0.006) were higher than that of Mosapride group. The recurrence rate of Mosapride group was 9.5%, which was significantly higher than that of Combizym® group (1.8%, P<0.05) and combined treatment group (1.8%, P<0.05). There were no serious adverse effects in the three groups.@*Conclusions@#The efficacy of Oryz-Aspergillus enzyme and pancreatin tablets is comparable with that of Mosapride in elderly PDS patients, with fewer adverse effects and low recurrence rate. Combination regimen indicates better efficacy than that of Oryz-Aspergillus enzyme and pancreatin tablets or Mosapride alone.

Treatment of postprandial discomfort syndrome in the elderly: a multi-centered prospective randomized controlled clinical study / 中华内科杂志

Objective:To evaluate the efficacy and safety of Oryz-Aspergillus enzyme and pancreatin tablets (Combizym ?) in the treatment of postprandial distress syndrome (PDS) in the elderly, compared with gastrointestinal motility drugs. Methods:A prospective randomized controlled trial was designed and registered in the China Clinical Trials Registry (ChiCTR-IPR-16008185). The elderly patients with PDS were randomly divided into three groups, including Mosapride group with Mosapride citrate tablets 5 mg 3 times per day for 2 weeks; Combizym ? group with Combizym tablets 244 mg 3 times per day for 2 weeks; combined treatment group with both drugs and same doses for 2 weeks. The modified Nepean dyspepsia index (NDSI) score, discomfort intensity score and PDS score were calculated on patients before treatment, at the end of first and second week of treatment, as well as 4 weeks after treatment finished, respectively. Adverse effects were evaluated. Results:A total of 323 patients from 16 tertiary hospitals in China were enrolled in this study. Among them, 105 patients were in Mosapride group, 109 in Combizym ? group and 109 in combined treatment group. There were 148 males (45.8%) and 175 females (54.2%) with median age 71.4±9.0 years (60-100 years). Baseline characteristics of three groups were comparable. After treatment, the NDSI scores in three groups all decreased significantly ( P<0.001), while they were similar between groups ( P>0.05). The discomfort intensity score and PDS score in three groups showed a significant reduction after treatment ( P<0.001), especially in the combined treatment group. Compared with Mosapride group, the scores in Combizym ? group decreased significantly after one or two weeks [discomfort intensity score: after one week, 4.0(2.5, 8.0) vs. 6.0(3.0, 10.0); after two weeks, 3.0(0.0, 5.0) vs. 4.0(2.0, 6.0); all P<0.05. PDS score: after one week, 6.0(3.0, 9.0) vs. 7.0(3.5, 10.5); after two weeks, 3.0(0.0, 5.0) vs. 4.0(2.0, 7.0); all P<0.05]. The efficacy rate in all patients after first week of treatment was over 15.0%. The efficacy rates after two weeks were 55.2%, 68.8% and 73.4% in Mosapride group, Combizym ? group and combined treatment group, respectively. After two week treatment, the efficacy rates in Combizym ? group ( P=0.041) and combined group ( P=0.006) were higher than that of Mosapride group. The recurrence rate of Mosapride group was 9.5%, which was significantly higher than that of Combizym ? group (1.8%, P<0.05) and combined treatment group (1.8%, P<0.05). There were no serious adverse effects in the three groups. Conclusions:The efficacy of Oryz-Aspergillus enzyme and pancreatin tablets is comparable with that of Mosapride in elderly PDS patients, with fewer adverse effects and low recurrence rate. Combination regimen indicates better efficacy than that of Oryz-Aspergillus enzyme and pancreatin tablets or Mosapride alone.

Clinical Features and Management of Ischemic Colitis in Elderly Patients / 胃肠病学

Ischemic colitis (IC)is one of the major causes of acute lower gastrointestinal bleeding and usually occurs in the elderly. Hypoperfusion of the mesenteric microvasculature,even induced by constipation in the elderly,is by far the approximate mechanism. The clinical manifestations of IC vary depending on the extent and duration of ischemia. The presenting symptoms include sudden cramping abdominal pain;an urgent desire to defecate;and passage within 24 hours of bright red or maroon blood or bloody diarrhea. CT scan should be the first imaging modality of choice for patients with suspected IC to assess the distribution and phase of colitis. Early colonoscopy (within 48 hours of presentation)should be performed to confirm the diagnosis if without gangrene and perforation. Nonsurgical treatment approach usually includes bowel rest,intravenous fluid,electrolyte repletion,correction of precipitating conditions and antibiotic usage,occasionally with administration of total parenteral nutrition. It has been shown that isolated right colonic ischemia (IRCI)has a worse outcome than ischemia affecting other regions of the colon. Surgical intervention should be considered in the presence of IRCI or pan-colonic ischemia and in the presence of gangrene.

Effect of miR-92b on migration, adhesion and invasion of human gastric cancer cell line SGC7901 / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of miR-92b on the migration, adhesion and invasion of gastric cancer cell line SGC7901.</p><p><b>METHODS</b>The miR-92b inhibitor and mimics were transiently transfected in SGC7901 cells. The changes in the migration, adhesion and invasion of the transfected cells were tested with wound healing assay, Transwell migration assay, matrigel adhesion and Transwell invasion assay. The cellular expression of E-cadherin, vimentin, Akt and p-Akt were analyzed by Western blotting.</p><p><b>RESULTS</b>The migration, adhesion and invasion assays showed that transfection with the inhibitor of miR-92b obviously decreased the numbers of gastric cancer cells. The expression of E-cadherin, AKT, and pAKT increased and vimentin decreased significantly in the cells transfected with the inhibitor of miR-92b. Transfection with the mimics of miR-92b produced opposite effects in SGC7901 cells.</p><p><b>CONCLUSION</b>miR-92b promotes the migration, adhesion and invasion of human gastric cancer cell line SGC7901 by mediating epithelial-mesenchymal transition, and may accelerate tumor cell metastasis via signaling pathways other than PI3K/Akt pathway.</p>

An analysis of clinical characteristics and risk factors for ulceration in ischemic colitis / 中华内科杂志

Objective To investigate the clinical manifestations and risk factors related to ulcer in patients with ischemic colitis(IC).Methods Clinical data of sixty-three IC patients with definite diagnosis from June 2002 to June 2012 in the PLA General Hospital were retrospectively analyzed.All patients were classified into ulcer group (23 cases) and non-ulcer group (40 cases) according to the presence of ulcer or not.Clinical manifestations and risk factors related to ulcer lesions were compared in the two groups.Logistic regression model was used for statistical analysis.Results There were 50 men and 13 women enrolled,with an average age of 70 years old.The main clinical manifestations included abdominal pain [85.7％ (54/63)],diarrhea [54.0％ (34/63)],hematochezia [41.3％ (26/63)].In comparison with non-ulcer group,the ulcer group showed higher incidences of chronic constipation[34.8％ (8/23)vs 12.5％ (5/40),P =0.03],enteric-coated aspirin intake [52.2％ (12/23) vs 25.0％ (10/40),P =0.03] and abdomen tenderness[82.6％ (19/23) vs 52.5％ (21/40),P =0.02].Chronic constipation and entericcoated aspirin intake were independent risk factors related to ulcer lesions (OR =3.38,P =0.04 ; OR =5.91,P =0.03).Patients with abdomen tenderness had higher incidence of ulcer lesion(OR =3.12,P =0.04).The most common location of IC was left colon[69.8％ (44/63)].No difference of site distribution was found in ulcer and non-ulcer group(P =0.066).Splanchnic atherosclerosis in the ulcer group was more common than in non-ulcer group [88.2％ (15/17) vs 58.3％ (14/24),P =0.038].The duration of hospitalization was significantly longer in ulcer group [(14.3 ± 7.1) d vs (6.2 ± 4.1) d,P ＜ 0.01].Higher white blood cell (WBC) count and lower hemoglobin (Hb) were seen in ulcer group than those in non-ulcer group [(10.17 ±3.32) × 109/L vs (7.25 ±3.15) × 109/L,P =0.018; (98 ±27)g/L vs (126 ±35)g/L,P=0.041].Conclusions Chronic constipation,enteric-coated aspirin intake and splanchnic atherosclerosis are risk factors related to ulcer in IC patients.Abdomen tenderness,high WBC and low Hb strongly indicate possible IC with ulcer.

The clinical analysis for 43 cases of acute superior mesenteric artery thrombosis confirmed by angiography and surgery / 中华内科杂志

Objective To investigate the clinical manifestations and mortality related risk factors in patients with acute superior mesenteric artery embolism (ASMAE).Methods Clinical data of forty-three confirmed ASMAE patients in the PLA General Hospital from June 2002 to June 2012 were retrospectively analyzed.All patients were classified into the survival group (28 cases) and the death group (15 cases)according to the prognosis.The prognosis associated factors were further analyzed.Results The study group consisted of 31 men (72.1％)and 12 women (27.9％),with average age of (63 ± 11) years.The majority patients with ASMAE in our study had history of atherosclerotic diseases.The main clinical manifestationsincluded abdominal pain [100％ (43/43)],nausea and vomitting [55.8％ (24/43)],hematochezia [32.6％ (14/43)].Abdominal CT scan was performed in 74.4％ (32/43) patients with a high positive result of 96.9％ (31/32).Weight loss occurred more frequently in survival group than in death group [32.1％ (9/28) vs 6.7％ (1/15),P =0.001].Moreover,weight loss has been shown as a protective factor for ASMAE survival (OR =0.75,P =0.038) by logistic analysis.Compared with the death group,the incidence of either peritoneal irritation sign or ascites was significantly lower in survival group [respectively 7.1％(2/28) vs 66.7％ (10/15),14.3％ (4/28) vs 73.3％ (11/15),P ＜0.05],which were two independent risk factors of mortality(OR =8.51,P =0.014 ; OR =3.07,P =0.028).The incidence of main artery embolism of superior mesentery artery (SMA) in death group was higher than that in survival group [93.3％ (14/15) vs 60.7％ (17/28),P =0.023].Main artery embolism of SMA was also an independent mortality risk factor of ASMAE patients (OR =5.05,P =0.039).A total of 18 patients were treated with enterectomy.Intestine excision length was shorter in survival group than in death group [(82.8 ± 25.2) cm vs (141.0 ± 18.1)cm,P =0.017].The time from onset to operation in survival group was shorter than that in death group [(44.8 ±29.7) h vs (69.1 ±28.0) h,P =0.013].Conclusions Patients with ASMAE based on chronic ischemia have a relative good prognosis for survival.Peritoneal irritation sign,ascites and main artery embolism of SMA were independent risk factors for death in ASMAE.Intestine excision length and the interval from onset to operation may affect the mortality of ASMAE patients.

Lgr5 and CD44 expressions in different types of intestinal polyps and colorectal cancer / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the expression of tumorigenesis-related stem cell markers Lgr5 and CD44 in different pathological types of intestinal polyps and their clinical significance in predicting tumorigenesis.</p><p><b>METHODS</b>A total of 145 cases of colorectal polyps, adenomas and cancer tissues were obtained by colonoscopy biopsy. Immunohistochemistry was employed to detect the expression of Lgr5 and CD44 to analyze their relationship with the occurrence and prognosis of colon and rectal cancer.</p><p><b>RESULTS</b>The expression of CD44 in colon cancer tissue was 95.65%, significantly higher than that in normal mucosa (5%), inflammatory hyperplastic polyps (22.58%), tubular adenomatous polyps (55.26%) and villous polyps (75.76%) (P<0.05). The expression of Lgr5 in colorectal cancer was up to 95.65% while negative in normal colorectal tissue and was 16.12% in inflammatory hyperplastic tissues (P<0.05). The expression rate of Lgr5 was 86.84% in tubular adenoma and 93.94% in villous polyps, both comparable with that in colon cancer (P>0.05). Correlation analysis indicated that the expression of CD44 and Lgr5 were positively correlated with the progression of intestinal polyp tumorigenesis (rs=0.69377, P<0.0001; rs=0.81637, P<0.0001).</p><p><b>CONCLUSION</b>Lgr5 and CD44 are highly expressed in colorectal cancer tissues in close correlation with the clinical and pathological features. The expression profiles of Lgr5 and CD44 represent a distinct feature to differentiate colorectal cancer from normal intestinal mucosa. Lgr5 is more closely correlated with tumor progression of polyps than CD44. This means detecting of the expression of Lgr 5 together with CD44 is important and necessary in clinical diagnosis of patients with early stage colorectal diseases such as polyps and their canceration.</p>

The value of serum intestinal fatty acid binding protein measurement in discriminating intestinal ischemia in patients with acute abdomen / 中华内科杂志

ObjectiveTo assess the differential diagnostic value of serum intestinal fatty acid binding protein (I-FABP)in distinguishing intestinal ischemia patients from acute abdomen patients.MethodsA total of 151 patients with acute abdomen and 17 healthy controls from the PLA General Hospital were enrolled from November,2009 to August,2011. Serum I-FABP levels were measured by ELISA.According to the ROC curve,the cut-off value,sensitivity,specificity,positive likelihood ratio (PLR),negative likelihood ratio ( NLR),positive predietive value (PPV) and negative predictive value (NPV) were calculated. ResultsOf the 151 acute abdomen patients,there were 24 intestinal ischemia patients and 127 without intestinal ischemia.Serum I-FABP level in intestinal ischemia group [( 109.67 ±48.82) μg/L]was significantly higher than those in patients without intestinal ischemia [(36.78 ± 11.25) μg/L]and healthy controls[(8.33 ±6.25) μg/L]( all P values ＜0.01 ).The serum I-FABP cut-off value for the diagnosis of intestinal ischemia was 87.52 μg/L.Serum I-FABP was efficient in terms of sensitivity (0.762),NPV(0.963),PLR(3.05) and NLR (0.24) in the diagnosis of intestinal ischemia.ConclusionI-FABP is potentially useful for discriminating intestinal ischemia from acute abdomen.

A retrospective analysis of clinical characteristics and mortality of gastrointestinal bleeding in 414 elderly patients / 中华内科杂志

Objective To analyze clinical characteristics of patients with gastrointestinal bleeding (GIB)and the death-related risk factors.Methods A retrospective analysis Was conducted in 414 patients hospitalized for GIB during a 16-year period of 1994 to 2009.Logistic regression analysis identified predictors of mortality.Results The mean age of the 414 patients is 83.5 years old,ranging from 65 to 96years old.The main causes of GIB were peptic ulcer(33.1%,137/414),gastroduodenal mucosal erosion (28.5%,118/414)and tumor(21.0%,87/414).The main symptom was melena(71.0%,294/414).Drugs that induced GIB were mainly non-steroidal anti-inflammatory drugs,including aspirin(11.1%,46/414),acetaminophen(8.9%,37/414)and indomethacin(1.9%,8/414).14%of patients(58/414) died of GIB in 30 days.The proportion of drug-induced GIB and gastroduodenal mucosal erosion caused GIB had increased significantly during the period of 2004 to 2009(P<0.05).Analysis of 30-day mortality risk showed advanced age,low diastolic blood pressure,high heart rate,low hemoglobin levels at presentation and hemorrhage volume in dead GIB elderly patients were significantly different compared with GIB elderly patients alive.Presence of severe comorbidity(heart failure and renal failure)and caused by cirrhosis and portal hypertension in GIB elderly patients were the only independent predictors of 30-day mortality (P<0.001).Conclusion Death of GIB patients occurred predominantly in elderly patients with severe comorbidities and systemic conditions at presentation.

Factors for the recurrence after endoscopic resection of early gastric cancer / 中华内科杂志

Objective To investigate the related factors of recurrence of early gastric cancer (EGC) after endoscopic resection. Methods Clinicopathologic data of 169 patients with EGC who underwent endoscopic resection and periodically followed up by the Chinese PLA General hospital were analyzed retrospectively. Results During a follow-up of 13-57 months (median time 24. 5 months), 12patients had gastric cancer again and the recurrence rate was 7. 1% (12/169). The recurrence time varied from 3 to 36 (28 ± 23)months and the median time was 18 months. The recurrence rates of 0.5 year, 1st year, 2nd year and 3rd year were 1.18% (2/169), 3.55% (6/169), 9.91% (11/111) and 12.24%(12/98), respectively. Eleven patients had gastric cancer again within 2 years after resection.Undifferentiated histology (including poorly differentiated carcinoma and signet ring cell carcinoma),submucosal infiltration and lymphovascular invasion of the primary lesion of EGC were related to thepostsurgical recurrence ( all P ＜ 0. 05). Conclusion Most recurrence of EGC occurred within 2 years afterendoscopic resecton and is related with undifferentiated histology, submucosal infiltration andlymphovascular invasion. It is important for these patients to receive endoscopy follow up.

A control study on selective biliary cannulation technique reducing incidence of post-ERCP pancreatitis / 中华肝胆外科杂志

Objective To determine if using a soft-tipped guidewire to cannulate the common bile duct may ameliorate development of PEP(post-ERCP pancreatitis)and facilitate cannulation of the CBD(common bile duct).Methods A total of 78 patients treated treateed in our hospital underwent ERCP through conventional direct cannulation(52 diagnostic ERCPs,26 therapeutics ERCPs)from 1998 to 2001 were randomly selected as group A while 112 patients underwent ERCP through guide wire-directed cannulation(21 diagnostic ERCPs,91 therapeutics ERCPs)from 2007 to 2008 as group B.Then we retrospectively studied and compared the following parameters between the two groups:1)Success rate of biliary access;2)visualization rate of pancreatic duct;3)the level of serum amylase,severity of abdominal pain and the rate of PEP.Meanwhile,the correlation between grading of pancreatic duct visualization and PEP was analyzed.Results The success rate of biliary access of the guidewire group(106/112 cases)was significantly greater than the conventional group(33/78 cases)(94.64%vs.42.30%,P<0.01).In group A,about61.53%(16/26)of the 26 cases could not continue the next therapeutics ERCP because of unsucceasful carmulation. The visualization rate of pancreatic duct of group A and B were 58.97%(46/78 cases)and 8.04%(9/112 cases)(P<0.01) respectively.On occurrence rate of PEP,group A(17/78 cases)was significantly higher than group B(4/112 cases)(21.79% vs.3.57%,P<0.01),and severe pancreatitis occurred in 3 patients in conventional group.However,there was no severe pancreatitis in the guide wire group.There were no significant differences (P>0.05) in terms of the rate of hyperamylasemia between the two groups.The significant correlation was found between the grading of pancreatic duct visualization and the occurrence of PEP.Condusion Guidewire-directed selective access to the bile duct lowers likdihood of PEP by facilitating cannulation and lowering the visualization rate of pancreatic duct.The occurrence of PEP could be predicted by the grading of pancreatic duct visualization,which is a very important but not the unique factor leading to PEP.

Clinical analysis of short- and long-term complications after endoscopic Oddi's sphincterotomy in 95 patients / 中华肝胆外科杂志

Objective To investigate the short- and long-term complications after endoscopic Oddi's sphincterotomy (EST) upon endoscopic retrograde cholangiopancreatography (ERCP) procedure and determine whether the size of EST correlates to the occurrence of EST complications.Methods 95 cases receiving EST in the process of ERCP in our hospital were studied and followed up. The patients were divided into large, moderate and small incision groups according to the size of EST and the states of short-term and long-term EST complications were statistically analyzed.Results The incidence of short-term complications of EST was 18. 94% (18/95). They included bleeding in the process of ERCP in 11 cases, delayed bleeding in 3, acute pancreatitis in 1, acute cholangitis in 2 and duodenal perforation in 1. All these patients but 1 with duodenal perforation were discharged after undergoing symptomatic treatments. Eleven out of the 95 patients had long-term complications (11.57 % ). These included biliary system infection in 5 cases, recurrent calculus of bile duct in 3, papilla stricture in 1 and chronic relapsing pancreatitis in 2. All 11 patients recovered after therapeutic ERCP again or symptomatic drug treatments. There was no significant difference in incidence of short-term (χ2 =2.433, P=0.296) or long-term complications (χ2 = 1.151, P=0.562) among the 3 groups. Furthermore, there was no statistical correlation between the incision size of Oddi and complications including operative bleeding (P=0.109), short-term complications (P=0.124) and longterm complications(P=0.402). Conclusion There are many short-term and long-term complications after EST, but there is no correlation between the complications and the incision size of Oddi. The occurring rate of complications might be reduced through accurate direction of papilla incision, avoidance from injury of blood vessel, keeping bile drainage unobstructed and protection of the function of Oddi sphincter as far as possible in the process of ERCP.

Feasibility of hypocaloric nutrition support in elderly patients / 中华临床营养杂志

Objective　To investigate the feasibility of hypocaloric nutrition support in elderly patients.Methods　Sixteen elderly patients ( ＞ 85 years) were treated with hypocaloric nutrition for 4 weeks. The calorie intake was 75-96 kJ·kg-1·d -1 , including 44％ -59％ of carbohydrates ( 137-207 g·d -1 ) , 26％ -42％ of lipids (40-67 g·d-1) , and 14％-16％ of proteins (0.7-0.9 g·kg-1·d-1). Nonprotein calorie-to-nitrogen ratio was 131∶1-150∶1. After 4 weeks of treatment, changes in blood routine test, biochemistry, and clotting function were compared with those before hypocaloric nutrition support. Results　After hypocaloric nutrition support, the plasma proteins, blood fats, and lymphocytes in these 16 elderly patients were well maintained, and no obvious adverse effect on clotting function or liver/kidney functions was observed. Conclusion　Hypocaloric nutrition support is safe and effective for elderly patients who are older than 85 years.

Changes of tissue structure of gastric mucosa with aging in rats / 中华老年医学杂志

Objective To observe the changes of tissue structure of gastric mucosa with aging in rats. Methods Twelve healthy Wistar rats were divided into two groups: aged (12 months,n=6) and non-aged rats (3 months,n=6). The thickness of gastric gland and muscular layer of mucosa were observed under the light microscopy. Pepsin activity and the expression of proliferating cell nuclear antigen (PCNA) were detected by biochemical method and immunohistochemical method respectively. Results Intestinal metaplasia, dysplasia and adenoma were not found in gastric mucosa in two groups. In aged versus non-aged rat group, the thickness of gastric gland was decreased [(271.5±47.4) μm vs. (350.9±53.3) μm, t=2.731, P<0.05], while the thickness of muscular layer of mucosa was increased [(98.1±13.1) μm vs. (62.4±10.6)μm, t=5.174, P<0.01]. The content of pepsin in aged rats were lower than in non-aged rats[(3. 011±1. 222) U vs. (4.733±1.304) U, t= 2.361, P<0.05]. Immunohistochemistry results showed that the positive cells of PCNA were located in gastric stem cells in cervical part, and the thickness of the gastric stem cells was decreased in aged rats. Conclusions The incidences of gastric gland atrophy and muscular layer hypertrophy are increased, and the secretion of pepsinogen and the proliferation ability of gastric stem cells are decreased in aged rats.

The relationship of gastric acid with intragastric bacterium and pulmonary infection in rats at different ages / 中华老年医学杂志

Objective To investigate the relationship of gastric pH value with intragastric bacterium and pulmonary infection in rats at different ages.Methods Thirty Wister rats were divided into three groups: young control group, senile group garaged with saline and young omeprazole group garaged with omeprazole (30mg/kg/d). The gastric pH value was measured after two weeks, and bacterial culture of gastric and lung tissues were done and the pathological sections of lung tissues were made.Results The gastric pH (2. 450±1. 344), number of intragastric bacterium (5. 579±4. 316) cfu/g and number of pulmonary bacterium (1. 617±3. 509) cfu/g in senile group had no differences compared with young control group [(2. 010±0. 507), (1. 505±3. 259)cfu/ g, (0. 475±1. 503)cfu/g, respectively, all P>0. 05]. The differences in gastric pH value, number of intragastric bacterium and number of pulmonary bacterium had statistical significances between young omeprazole group and young control group [(5. 560±1. 007)vs. (2. 010±0. 507), (9. 942±1. 663) cfu/g vs. (1. 505±3. 259)cfu/g, (6. 272±3. 830) cfu/g vs. (0. 475±1. 503)cfu/g, all P<0. 01]. The lung tissues were slightly infiltrated with lymphocytes both in young control group and senile group, and 30% of rats in young omeprazole group had pulmonary infection.Conclusions The number of intragastric bacterium and pulmonary bacterium is increased with the increasing of the gastric pH value, and the pulmonary infection becomes heavier in these rats. But the number of intragastric bacterium and pulmonary bacterium and the pulmonary inflammation have no changes with the increasing of age.

A lamin-like protein gene is down-regulated in human gastric cancer / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To clone human gastric cancer related gene and to analyze its expression profile in gastric mucosal tissues.</p><p><b>METHODS</b>Paired tumor, paratumor and non-tumor specimens from 7 gastric adenocarcinoma patients (male 4, female 3, with average age 51 +/- 18 years) were studied by means of fluorescent differential display reverse transcription polymerase chain reaction (DDRT-PCR). The differentially expressed cDNA bands of interest were cloned and analyzed by Northern blot and in situ hybridization. Thirty cases (male 23 female 7 with average age 59 +/- 8 years) of paired paraffin-embedded gastric tumor and non-tumor tissues were used in in situ hybridization analysis.</p><p><b>RESULTS</b>A gene expressed much lower in 6 out of 7 tested tumor samples than in their normal and paratumor counterparts was identified. It was named GCRG123. Northern blot analysis confirmed the differential expression. Human multiple tissue Northern blot analysis showed that GCRG123 expressed in various adult human tissues including thymus, prostate, testis, ovary, small intestine, colon and peripheral blood leukocyte. Sequence analysis revealed that GCRG123 (GenBank accession number AF454554) was a lamin like protein gene. It had one open reading frame which consisted of 49 amino acids (GenBank accession number AAL61668.1). In situ hybridization analysis showed a high GCRG123 expression level in normal gastric epithelium and pylori glands, but low expression level in tumor as well as dysplasia and most intestinal metaplasia at the paratumor regions.</p><p><b>CONCLUSION</b>A lamin-like protein gene was identified in human gastric mucosa, it is down-regulated in gastric cancer and its precancerous leisions.</p>

Direct gastroscopy for detecting gastric cancer in the elderly / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the safety and effectiveness of direct gastroscopy for detecting gastric cancer.</p><p><b>METHODS</b>Clinical screening by direct gastroscopy was performed for gastric cancer (GC) from September 1985 to July 1998. 3048 elderly people were screened. Their age ranged from 60 to 93 years, and 2034 of the 3084 were followed up.</p><p><b>RESULTS</b>Ninety-two patients with gastric cancer were discovered by gastroscopy, representing 3.02% of the screened population. The rate of early gastric cancer (EGC) was 63.04% (58/92) of all gastric cancers detected. The rate was up to 79.59% (39/49) on follow-up, and was 74.14% (43/51) in asymptomatic patients with gastric cancer. The excision rate was 88.89% for patients with gastric cancer, and 100% for patients with early gastric cancer. The 5-year survival rate was 91.89% for patients with gastric cancer, and 96.30% for patients with early gastric cancer.</p><p><b>CONCLUSION</b>Clinical screening and follow-up by direct gastroscopy in persons over 60 years of age are a safe and effective method for raising the 5-year survival and detection rate of gastric cancer, especially early gastric cancer.</p>

Clinical analysis of recurrence after gastrectomy for early gastric cancer / 解放军医学杂志

Objective To analyze clinicopathological characteristics of recurrence after gastrectomy for early gastric cancer. Methods 308 patients were treated surgically for early gastric cancer from 1983 to 2005. 245 patients were followed up after gastric resection.Clinicopathologic factors were investigated by using univariate methods and multivariate analysis for the possible relationship to recurrence. Results 30 patients developed recurrent disease (median 28 months). The 1-year, 3-year, 5-year, 7-year, 10-year and 15-year recurrent rates were 5.49%, 8.44%, 11.27%, 14.83%, 16.39% and 37.79%, respectively. 13 patients with mucosal gastric cancer developed recurrent disease (median 24 months). The 1-year, 3-year, 5-year, 7-year, 10-year and 15-year recurrent rates were 4.23%, 6.68%, 7.75%, 9.34%, 9.34% and 28.24%, respectively. 17 patients with submucosal gastric cancer developed recurrent disease (median 31 months). The 1-year, 3-year, 5-year, 7-year, 10-year and 15-year recurrent rates were 7.39%, 11.14%, 16.54%, 24.49%, 29.69% and 64.85%, respectively. Cox multivariate analysis showed that submucosal invasion (P=0.044, OR=2.172) was a positive independent risk factor and paracarcinomatous mucosal medium-severe intestinal metaplasia (P=0.047, OR=0.460) was a negative independent risk factor for recurrence. 76.7% (23/30) patients with recurrence did not have indication of resection for a cure, and they did not undergo surgery again. 23.3% (7/30) patients with recurrence had indication for curative resection, and 4 of whom underwent curative resection, but 3 did not because of poor health. Pathological examination after surgery showed that in 3 patients there was early gastric cancer in the remnant stomach without lymph node metastasis, and in one patient there was advanced gastric cancer in remnant stomach with regional lymph node metastasis. The patient with advanced gastric cancer survived for 28 month without detectable tumor. Logistic regression analysis showed paracarcinomatous mucosal medium-severe intestinal metaplasia (P=0.016, OR=17.000) was a positive independent predictor for second radical surgery. The follow-up examinations including endoscopy were performed in 86.7% (26/30) of patients after operation at least every 1-2 years. Conclusion Early gastric cancer patients with submucosal invasion have a high risk of recurrence, and those with paracarcinomatous mucosal medium-severe intestinal metaplasia have a low risk of recurrence. The patients with paracarcinomatous mucosal medium-severe intestinal metaplasia and cancer recurrence are feasible for a curative resection. The follow-up examinations including endoscopy every 1 or 2 years contributed highly to finding an early recurrent cancer in the remnant stomach. But it is not so helpful to increase the possibility of a curative surgery in patients with recurrence and metastasis after gastrectomy.

Multivariate analysis of lymph node metastasis in patients with early gastric cancer / 解放军医学杂志

2cm) and undifferentiated type were significantly related to lymph node metastasis in submucosal cancer. No lymph node metastasis was observed in 25 patients with submucosal invasion who showed none of the three risk factors, whereas 72.7% (8/11) of patients with all the three factors had lymph node metastasis. Conclusion The tumor size and lymphatic vessel involvement are related with lymph node metastasis in mucosal cancer. Poor differentiation, tumor size and lymphatic vessel involvement are related with lymph node metastasis in submucosal cancer.

Preparation of gastric adenocarcinoma related cDNA microarray / 解放军医学杂志

Objectives To prepare the gastric adenocarcinoma related cDNA microarray and to screen differentially expressed genes between human gastric adenocarcinoma and normal gastric mucosa. Methods A set of cDNA microarray slides containing a duplicate set of 576 cDNA spots. These selected clones have been verified in sequence. The PCR products of human genes were spotted onto a chemical-material-coated glass plates in array. DNAs were fixed on the glass plate after series of treatment. Both RNAs from the gastric adenocarcinoma and normal gastric mucosa were reversely transcribed to the cDNAs with the incorporation of fluorescent dUTP to prepare the hybridization probes. The mixed probes were hybridized to the cDNA microarray. After high-stringent washing, the cDNA microarray was scanned for fluorescent signals to display differences between two tissues. Results Gastric adenocarcinoma related cDNA microarray slides contained 111 differentially expressed genes of gastric adenocarcinoma, 37 known genes related to gastric carcinogenesis (such as p21ras, p53, etc.) and control genes. The results of 10 couples of hybridizations to the gastric adenocarcinoma related cDNA microarray slides with Cy3-labeled cDNA probe from normal gastric tissue and Cy5-labeled cDNA probe from gastric adenocarcinoma showed analyzed spots uniformity background and clear signal. Among the 576 target genes, the expression level of 48 genes differed between gastric adenocarcinoma and normal mucosa in 5 or more samples (eight genes differed in all samples). There were 39 down-regulated and 9 up-regulated genes in gastric adenocarcinoma. Conclusion Gastric adenocarcinoma related cDNA microarray slides were successfully developed. The results of the experiments showed that gastric adenocarcinoma related cDNA microarray slides are reliable, sensitive and reproducible.