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Objective To analyze the core genes of lung ischemia-reperfusion injury and construct a competitive endogenous RNA (ceRNA) network. Methods Original data of GSE145989 were downloaded from the Gene Expression Omnibus (GEO) database as the training set, and the GSE172222 and GSE9634 datasets were used as the validation sets, and the differentially-expressed genes (DEG) were identified. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were performed. Protein-protein interaction (PPI) network was constructed, and the core genes were screened, and the diagnostic values of these core genes and the immune infiltration levels of immune cells were evaluated. The ceRNA network was constructed and validated. The targeted drugs based on ceRNA network were assessed. Results A total of 179 DEG were identified, including 61 down-regulated and 118 up-regulated genes. GO analysis showed that DEGs were associated with multiple biological processes, such as cell migration, differentiation and regulation, etc. They were correlated with cell components, such as vesicle membrane, serosa and membrane raft, etc. They were also associated with multiple molecular functions, such as chemokine receptor, G protein-coupled receptor, immune receptor activity and antigen binding, etc. KEGG pathway enrichment analysis revealed that DEG were involved in tumor necrosis factor (TNF), Wnt, interleukin (IL)-17 and nuclear factor (NF)-κB signaling pathways, etc. PPI network suggested that CD8A, IL2RG, STAT1, CD3G and SYK were the core genes of lung ischemia-reperfusion injury. The ceRNA network prompted that miR-146a-3p, miR-28-5p and miR-593-3p were related to the expression level of CD3G. The miR-149-3p, miR-342-5p, miR-873-5p and miR-491-5p were correlated with the expression level of IL-2RG. The miR-194-3p, miR-512-3p, miR-377-3p and miR-590-3p were associated with the expression level of SYK. The miR-590-3p and miR-875-3p were related to the expression level of CD8A. The miR-143-5p, miR-1231, miR-590-3p and miR-875-3p were associated with the expression level of STAT1. There were 13 targeted drugs for CD3G, 4 targeted drugs for IL-2RG, 28 targeted drugs for SYK and 3 targeted drugs for lncRNA MUC2. No targeted drugs were identified for CD8A, STAT1 and other ceRNA network genes. Conclusions CD8A, IL2RG, STAT1, CD3G and SYK are the core genes of lung ischemia-reperfusion injury. The research and analysis of these core genes probably contribute to the diagnosis of lung ischemia-reperfusion injury and providing novel research ideas and therapeutic targets.
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Renal ischemia-reperfusion injury (RIRI) is the main cause of acute kidney injury (AKI), which commonly occurs in surgery, severe trauma, shock and drug-induced kidney injury. At present, effective treatment for RIRI is still lacking. Oxidative stress is the major pathological injury mechanism of RIRI. Nuclear factor E2-related factor 2 (Nrf2) is the key transcription factor of anti-oxidative stress response, which may activate various cytoprotective genes related to redox and detoxification. Recent studies have shown that Nrf2 may play a protective role in the protection and treatment of RIRI by regulating oxidative stress, inflammation, cell apoptosis and autophagy, etc. Consequently, the structure and biological function of Nrf2, related signaling pathways, its role in the incidence and development of RIRI and potential mechanism were reviewed in this article, aiming to provide novel ideas for the prevention and treatment of RIRI.
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ObjectiveTo evaluate the intervention effect of dihydroartemisinin （DHA） on hippocampal nerve injury in L5 spinal nerve ligation （SNL） model and tumor necrosis factor-α （TNF-α） hippocampal continuous injection model. In primary cultured microglia-hippocampal neurons， the regulatory pattern of DHA on microglia-hippocampal neuronal interactions was confirmed. MethodThe experimental animals were divided into Sham group， SNL group， and DHA group （16 mg·kg-1）， with 3 mice in each group. The hippocampal CA3 glutamatergic neurons were labeled with adeno-associated virus ［Calmodulin-dependent protein kinase Ⅱ（CaMKⅡ） dTomato AAV］， and their contributions to the hippocampal CA1， prefrontal cortex （Frc）， anterior cortex （ACC）， projections of nucleus accumbens （Nac）， and Basolateral Amygdala （BLA） were traced by immunofluorescence staining. The experimental animals were divided into a Sham group， a TNF-α hippocampus continuous injection model group， DHA-L， DHA-M， and DHA-H groups （4， 8， 16 mg·kg-1）， and pregabalin group （25 mg·kg-1）， with 4 mice in each group. The morphology of pyramidal neurons in the hippocampal CA1 and CA3 regions was counted by Golgi staining. The continuous activation of hippocampal primary neurons and microglia was induced， DHA intervention was given by co-culture， and the cell soma area and the expression of postsynaptic density protein 95 （PSD95） inside and outside the primary and secondary dendritic spines of neurons were counted by immunofluorescence. ResultCompared with the Sham group， the projection of CA3 glutamatergic neurons to CA1 region， Frc， and ACC in the SNL group was significantly reduced （P<0.01）， while the projection to Nac and BLA was significantly increased （P<0.01）. As compared with the SNL group， the projection of hippocampal CA3 glutamatergic neurons to CA1 region， Frc， and ACC was significantly increased in the DHA group （P<0.01）， while the projection to Nac and BLA was significantly reduced （P<0.01）. Golgi staining results showed that as compared with the Sham group， the density of dendritic spines and the number of dendritic branches in the CA1 and CA3 pyramidal neurons in the TNF-α hippocampal continuous injection model group were significantly reduced （P<0.01）. As compared with the TNF-α hippocampal continuous injection model， the density of dendritic spines and the number of dendritic branches in hippocampal CA1 and CA3 pyramidal neurons in the DHA-M and DHA-H groups were significantly increased （P<0.05， P<0.01）. Compared with DHA-M group， the total dendrite length of CA1 pyramidal neurons in hippocampus in DHA-H group was significantly increased （P<0.01）， while the total dendrite length of CA1 neurons and the total dendrite base length of CA3 neurons in DHA-L group was significantly decreased （P<0.01）. Compared with the blank control group， the cell soma area of the glycine group and glutamate group increased significantly （P<0.01）. As compared with the glycine group and glutamate group， the cell area of the glycine + glutamate group was significantly increased （P<0.01）， and as compared with the glutamate group， the cell soma area of the glutamate + DHA group was significantly reduced （P<0.01）. As compared with the glycine acid + glutamate group， the cell soma area of the glycine + glutamate + DHA group was significantly reduced （P<0.01）， and as compared with the glutamate + DHA group， the cell soma area of the glycine + glutamate + DHA group was also significantly reduced （P<0.05）. Compared with the blank control group， the cell soma area of the glutamate group was significantly increased （P<0.01）. As compared with the glutamate group， the cell soma area of the glutamate + DHA-L， glutamate + DHA-M， and glutamate + DHA-H groups was significantly reduced （P<0.01）. As compared with the blank control group， the expression of the resting primary microglia + glycine group in primary and secondary dendritic internal and external postsynaptic density protein 95 （PSD95） was significantly increased （P<0.01）. As compared with the resting primary microglia + glycine group， the expression of PSD95 in the primary and secondary dendritic spinous and external neurons of the activated primary microglia + glycine group was significantly reduced （P<0.01）. As compared with the activated primary microglia + glycine group， the expression of PSD95 in the primary and secondary dendritic spinous and external neurons in the activated primary microglia + glycine + DHA group was significantly increased （P<0.01）. As compared with the activated primary microglia + DHA group， the expression of PSD95 in the primary and secondary dendritic spines and outside neurons in the activated primary microglia + glycine + DHA group was significantly increased （P<0.01）. ConclusionDHA has a significant repair effect on vertebral neuronal damage caused by hippocampal microglia and TNF-α overexpression in NP pathology， and this repair is closely related to the dual inhibition of neuronal-microglia by DHA.
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Objective:To evaluate the safety and clinical efficacy of the novel double disc-shaped gastrointestinal occluder (hereinafter referred to as occluder) in treatment of refractory tracheoesophageal fistula (TEF).Methods:From July 1, 2020 to January 31, 2021, 10 patients with refractory TEF treated with occluder at Department of Gastroenterology, the First Affiliated Hospital with Nanjing Medical University were collected. The patients′ clinical data such as gender, age, body mass index and fistula diameter were recorded. The success rate of operation, intraoperative and postoperative complications, operation time, postoperative hospital stay, efficacy of fistula closure and postoperative recovery were analyzed. The Karnofsky score and body mass index of patients 1 month and 3 months after operation were compared with those before operation for curative effect evaluation. Paired t test was used for statistical analysis. Results:Among the 10 TEF patients, there were 7 males and 3 females, the median age was 64.5 years old (ranged from 49.0 to 78.0 years old), the body mass index was (18.0±2.5) kg/m 2 and the diameter of the fistula was (1.2±0.6) cm. Occluder placement was successful in all patients. The operation time was (17.6±7.8) min (ranged from 7.0 to 30.0 min). Two cases had little bleeding during the operation, and there was no bleeding after the operation. The postoperative hospital stay was (5.9±4.0) d (ranged from 1.0 to 12.0 d). Among the 10 TEF patients, fistula of 5 patients were completely blocked, 4 cases were partially blocked and 1 case was ineffectively blocked, the effective rate of blocking was 9/10. One month follow-up after operation showed that the symptoms of choking and coughing during eating were significantly improved in 9 patients, and the symptoms of choking and coughing during eating were significantly improved in 1 patient after waist diameter of 12 mm occluder was replaced with the occluder of 15 mm. The 3-month follow-up after operation showed that the occluders were in the right place in 8 patients, the occluder was displaced in 1 patient and the occluder was removed and treated with enteral nutrition. One patient died due to the recurrence of esophageal cancer. The Karnofsky score of TEF patients 3 months after operation and the body mass index of TEF patients 1 month and 3 months after operation were higher than those before operation (70.0±34.0 vs. 46.0±10.7, (19.32±2.59) and (19.73±2.92) kg/m 2 vs. (18.03±2.50) kg/m 2), and the differences were statistically significant ( t=-3.09, -2.37 and -2.82, all P<0.05). Conclusions:Gastrointestinal occluder is safe and effective in the treatment of refractory TEF.
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Objective:To compare the efficacy of oral sulfate solution (OSS) and polyethylene glycol (PEG) electrolyte powder for colonoscopy bowel preparation.Methods:A total of 283 randomized patients from 9 centers in China taking OSS ( n=143) or PEG ( n=140) using two-day split bowel preparation regimen received colonoscopy and assessment. The primary index was the bowel preparation success rate [global Boston bowel preparation scale (BBPS)≥ 6 by independent assessment center]. Secondary indices included BBPS global and segmental scores, investigator satisfaction (5-point Likert scale) with the quality of bowel preparation, patient satisfaction assessed by questionnaires, and patient tolerance assessed by Sharma scale. Compliance and safety were compared between the two groups. Results:The bowel preparation success rates were 100.0% for OSS and 99.3% for PEG [adjusted difference 0.7% (95% CI: -5.3% - 6.7%), P<0.001 for non-inferiority]. The BBPS global score in OSS group was significantly higher than that in PEG group (8.1 VS 7.7, P<0.001). The segment BBPS scores were also higher in OSS group than those in PEG group for all 3 segments (right colon: 2.4 VS 2.3, P=0.002; transverse colon: 2.8 VS 2.7, P=0.018; left colon: 2.8 VS 2.7, P=0.007). Investigator Likert score in the OSS group was significantly higher than that in the PEG group (2.6 VS 2.3, P<0.001). There was no significant difference in compliance between OSS and PEG, except for the second dose (90.9% VS 82.6%, P=0.039). There was no significant difference in patient satisfaction, Sharma score or proportion of patients with tolerance-related symptoms between the two groups. Safety was comparable between the two groups, and all adverse events were mild to moderate. Conclusion:OSS has comparable efficacy with PEG, with higher BBPS scores in all segments, better investigator satisfaction, better compliance in split dose, and comparable patient tolerance and safety.
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Objective:To evaluate the long-term efficacy of double-tunnel peroral endoscopic myotomy (POEM) and traditional POEM in the treatment of achalasia cardia.Methods:A randomized controlled trial was performed on the data of 30 patients with achalasia cardia, who underwent POEM in the First Affiliated Hospital of Nanjing Medical University from June 2018 to June 2019. The 30 consecutive patients were randomly assigned to double-tunnel POEM group (15 cases, a second tunnel was established opposite to the traditional one) and traditional POEM group (15 cases). Intraoperative information was recorded, and patients were followed up regularly to compare the efficacy and complications between the two groups.Results:Double-tunnel POEM and traditional POEM were all completed with technical success. There were no significant differences in the intraoperative complications (5/15 VS 4/15, P=1.000), hospitalization time or cost between the two groups. The follow-up time was 17.20±4.83 months and 15.33±4.67 months in the traditional POEM group and the double-tunnel POEM group, respectively. The Eckardt scores after surgery between the two groups had no significant difference [1.53 (2.00) VS 1.60 (3.00), Z=-0.363, P=0.744]. The symptom relief cases were both 14 in the two groups. The postoperative 4-second integrated relaxation pressure (4 s IRP) of the double-tunnel group (11.27±3.14 mmHg) was significantly lower than that of the traditional group (15.05±4.21 mmHg, t=2.794, P=0.009). There was no significant difference in postoperative gastroesophageal reflux disease questionnaire scores between the two groups (4.40±1.64 VS 4.20±1.42, t=0.357, P=0.724). Conclusion:Double-tunnel POEM has almost the same efficacy as the traditional POEM except for a lower post-POEM 4 sIRP.
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ObjectiveTo establish a neuroinflammation-based obesity and depression comorbidity （COM） model in mice and explore the pharmacodynamics and preliminary pharmacological mechanism of tripterine on COM mice. MethodC57BL/6J mice were randomly divided into a normal group （Chow）， a diet-induced obesity group （DIO）， and a COM group. The mice in the COM group were fed on a high-fat diet and chronically stressed with moist litter for 12 weeks to establish the COM model. C57BL/6J mice were randomly divided into a Chow group， a COM group， and a tumor necrosis factor-α（TNF-α） knock-down group. In the TNF-α knock-down group， TNF-α shRNA adeno-associated virus was injected into the amygdala through brain stereotaxis， and the expression of TNF-α in the amygdala was down-regulated. C57BL/6J mice were randomly divided into a Chow group， a DIO group， a DIO + low-dose tripterine group （0.5 mg·kg-1）， a DIO + high-dose tripterine group （1.0 mg·kg-1）， a COM group， a COM + low-dose tripterine group （0.5 mg·kg-1）， and a COM + high-dose tripterine group （1.0 mg·kg-1）. The body weight， food intake， glucose tolerance， white/brown fat ratio， serum total cholesterol （TC）， triglyceride （TG）， and high-/low-density lipoprotein cholesterol （HDL-C and LDL-C） content were recorded， and obesity of mice in each group was evaluated. Forced swimming test （FST）， tail suspension test （TST）， and open field test were used to evaluate the degree of depression of mice in each group. Immunofluorescence staining was used to detect the protein expression levels of neuropeptide Y， tryptophan hydroxylase 2 （TPH2）， and brain-derived neurotrophic factor （BDNF） in various brain nuclei of mice. Correlation analysis was used to detect the correlation of obesity and depression indexes. ResultThe comparison of the Chow group and the DIO group indicated that COM mice showed obesity and depression. To be specific， obesity was manifested as increased body weight and food intake （P<0.05， P<0.01）， as well as increased NPY expression in the central amygdala， and depression was manifested as prolonged immobility time in FST and TST （P<0.01）， and reduced TPH2-positive 5-hydroxytryptamine neurons in the dorsal raphe nucleus （DRN） and basolateral nucleus of the amygdala （BLA）. The down-regulation of TNF-α protein in BLA of COM mice shortened the immobility time in FST and TST （P<0.05， P<0.01）， increased TPH2/BDNF-positive neurons in BLA， and showed no significant changes in obesity. In DIO mice， the administration of 0.5 mg·kg-1 tripterine for 9 days significantly decreased the 60 min blood glucose in glucose tolerance （P<0.01） and food intake （P<0.05）. In COM mice， 1.0 mg·kg-1 tripterine was administered for 14 days to significantly decrease 30 min blood glucose in glucose tolerance （P<0.01）， and food intake （P<0.05）， and immobility time in TST （P<0.01）， increase TPH2-BDNF double-labeled cells in BLA and DRN， and reduce the area of TMEM119-stained cells. ConclusionThe model of obesity and depression comorbidity can be properly induced in mice under the condition of dual stress of energy environment. Tripterine can effectively interfere with obesity-depression comorbidity， and its mechanism may be related to the inhibition of central nervous system inflammation.
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Objective:To evaluate the safety and efficacy of combination of submucosal tunneling endoscopic septum division (STESD) and peroral endoscopic myotomy (POEM) for the treatment of esophageal epiphrenic diverticulum with esophagogastric junction (EGJ) outflow tract disorder.Methods:From October 2017 to August 2021, 6 patients with esophageal epiphrenic diverticulum complicated with EGJ outflow tract disorder receiving combination of STESD and POEM in the Endoscopic Center of the First Affiliated Hospital of Nanjing Medical University were enrolled. The clinical characteristics of the patients were retrospectively analyzed, which included the ratio of male to female, age, course of disease, length of diverticula, location, whether with multiple diverticula, type of EGJ outflow tract disorders, whether the endoscopic technique was successful (the completion of all steps under endoscopy, including tunnel establishment and diverticulum cristae, lower esophageal sphincter and cardia muscularis propria incision); operation time, changes in the severity of clinical symptoms before and after operation (including weight loss, dysphagia, retrosternal pain, and reflux assessed using the Eckardt score), intraoperative and postoperative complications, and follow-up, including whether achieved clinical success (complete or nearly complete improvement of dysphagia, vomiting after eating, retrosternal pain, regurgitation, weight loss, no need for repeat endoscopic intervention during follow-up) and adverse events. Descriptive methods were used for statistical analysis.Results:The male to female ratio of the 6 patients was 3 to 3, the median age was 69.2 years old, and the median disease course was 92.3 months. The median length of the diverticula was 47.5 mm. Diverticulum was located in the right wall of esophagus in 4 cases and in the left wall of esophagus in 2 cases, of which 1 patient was multiple diverticulum of esophagus. Achalasia was found in 5 cases, and EGJ outflow obstruction was found in 1 case. All the 6 patients successfully completed combination of STESD and POEM, and all achieved successful edoscopic technique. The operation time (range) was 55 min (40 to 70 min). Clinical symptom Eckardt score (range) before and after operation was 9.0 (7.0 to 11.0) and 1.3 (1.0 to 2.0), respectively. After operation the clinical symptom improved compared with that before operation. There were no delayed bleeding, perforation, infection, subcutaneous emphysema and other complications and severe adverse events. Six patients were all cured and discharged. Follow-up period was 1 to 50 months. The symptoms of dysphagia, vomiting after eating, retrosternal pain, regurgitation and weight loss were all significantly improved compared with those before operation. There were no severe adverse events and all achieved clinical success.Conclusions:Combination of STESD and POEM is safe and effective in the treatment of esophageal epiphrenic diverticulum with EGJ outflow tract disorder, and has good short-term and long-term effects.
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To evaluate the therapeutic effectiveness and safety of a novel gastrointestinal occluder device for gastrobronchial fistula. Data of 5 patients diagnosed as having gastrobronchial fistula who received treatment by a novel gastrointestinal occluder device at the First Affiliated Hospital of Nanjing Medical University from July to August 2020 were retrospectively analyzed. The total operation time, occluding time, intraoperative and postoperative complications, postoperative hospital stay and patients′ satisfaction were reviewed. Regular follow-up was conducted, and the short-term curative effect of occluding was evaluated 1 month after operation.All patients were males with age of 58-69 years. The course of fistula ranged 3-16 months and the diameter ranged 0.3-1.0 cm. All 5 patients achieved technical success with operation time of 38-88 minutes and occluding time of 8-24 minutes. The postoperative hospital stay ranged 3-5 days and the patients′ satisfaction score was 10. No severe complications occurred during or after operation. One month after endoscopic therapy, fistula was completely occluded in 4 patients. One patient died due to severe pulmonary infection and multiple organ failure although the bucking symptom after drinking and eating recovered before. Endoscopic closure of gastrointestinal fistula by means of the novel gastrointestinal occluder device is safe and effective.
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Objective:To investigate the value of atropine administration before tracheal intubation under general anesthesia in the elderly patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)biopsy.Methods:This was a case-control study.A total of 87 elderly hospitalized patients receiving chest enhanced CT test suggesting the risk of lung cancer with enlargement of mediastinal lymph nodes in 7 regions were scheduled to undergo endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)biopsy under general anesthesia.The patients were randomly divided into two groups by flipping a coin: the atropine group(n=40)and the control group(n=47). The indicators for evaluating the application values of atropine included preoperative, intra-operative and postoperative systolic blood pressure(SBP), diastolic blood pressure(DBP), heart rate, oropharyngeal and airway secretion volume, oxygen saturation, operation time, positive diagnosis rate and postoperative adverse reactions.Results:SBP and DBP were lower in the atropine group than in the control group before endotracheal intubation(131.7±15.3 mmHg vs.140.7±13.7 mmHg, 79.1±7.6 mmHg vs.85.6±7.4 mmHg, t=2.885 and 4.061, P<0.05). There was no significant difference in SBP and DBP 10 min after endoscopic operation and 10 min after tracheal extubation between the atropine group versus the control group(SBP: 109.1±11.2 mmHg vs.105.0±12.2 mmHg, 136.9±23.0 mmHg vs.129.9±11.2 mmHg, DBP: 66.9±7.5 mmHg vs.68.0±8.3 mmHg, 77.6±10.9 mmHg vs.78.5±6.4 mmHg, t=-1.617, 0.687, -1.751 and 0.448, P>0.05). There was no significant difference in HR between the two groups before endotracheal intubation( t=1.416, P>0.05), while HR was higher in the atropine group than in the control group 10 min after endoscopic operation and 10 min after tracheal extubation( t=-3.323 and -2.181, P<0.01 and P<0.05). The change rates of SBP and DBP were lower in the atropine group than in the control group 10 min after endoscopic operation and 10 min after tracheal extubation( t=7.947, -6.962, -3.187 and -3.232, P<0.01). The change rate of HR was lower in the atropine group 10 min after endoscopic operation and was higher 10 min after tracheal extubation than in the control group( t=-6.467 and -4.131, P<0.01). There were significant differences in the volume of oropharyngeal and airway secretions and fingertip oxygen saturation between the two groups before endotracheal intubation and 10 min after tracheal extubation( t=-2.334, 2.759, -3.314 and -2.767, P<0.01). The endoscopic operation time was less in the atropine group than in the control group with no statistically significant difference[(25.9±5.7)min vs.(26.4±4.7)min, t=0.391, P>0.05]. There was no significant difference in postoperative adverse reactions between the atropine group versus the control group(34 patients or 85.0% vs.43 patients or 91.5%, χ2=1.247, P>0.05). Conclusions:The application of atropine before tracheal intubation under general anesthesia is beneficial to stabilizing the intraoperative blood pressure and heart rate, and can reduce the production of postoperative oropharyngeal and airway secretions in elderly patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration biopsy.
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Objective To investigate the risk factors for non-curative resection after endoscopic submucosal dissection ( ESD ) for early esophageal cancer and high-grade intraepithelial neoplasia .Methods The clinicopathological data of 427 cases of early esophageal cancer and high-grade intraepithelial neoplasia who underwent ESD was performed from January 2013 to December 2016 in the Department of Gastroenterology , First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed .According to the results of postoperative pathology and immunohistochemistry ,339 patients were defined as curative resection group and 88 patients were defined as non-curative resection group .Chi-square test , univariate analysis and multivariate logistic regression analysis were used for statistical analysis .Results A total of 427 patients were enrolled in this study, with an average age of (63.2 ±7.7) years, including 96 cases of early esophageal cancer and 331 cases of high-grade intraepithelial neoplasia .The enbloc resection rate of ESD was 94.8％(405/427), 88 of them were non-curative resected, and the non-curative resection rate was 20.6％.Univariate analysis showed that early esophageal cancer (odds ratio (OR)=3.682, 95％confidence interval (CI) 2.216 to 6.118, P<0.01), submucosal infiltration (OR=10.220, 95％CI 4.861 to 21.481, P<0.01), ESD indications (OR=6.005, 95％CI 3.545 to 10.172, P<0.01) and lifting sign after injecting at the base of lesions (OR=2.508, 95％CI 1.005 to 6.255, P=0.042) were statistically significant between non-curative resection group and curative resection group . Multivariate unconditional logistic regression analysis revealed that submucosal infiltration (OR =4.329, 95％CI 1.758 to 10.661,P =0.001), not absolute indications of ESD (OR =6.484, 95％CI 2.205 to 19.068, P=0.001) and negative lifting sign (OR=3.182, 95％CI 1.171 to 8.651, P=0.023) were independent risk factors for non-curative resection.Conclusions Patients with early esophageal cancer , submucosal infiltration , not absolute indications for ESD and negative lifting signs are prone to non-curative resection .Moreover , submucosal infiltration , not absolute indications for ESD , and negative lifting signs are the independent risk factors for non-curative resection .
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Objective To investigate the screening results and risk factors for precancerosis and early gastric cancer in southern Jiangsu province. Methods A total of 8 647 participants aged over 40 years were randomly sampled from 7 of 35 counties in Shengze District.Initial screening was performed with antibody testing to determine the pepsinogen Ⅰ/Ⅱratio(PGR),gastrin-17(G-17)level,and prevalence of Helicobacter pylori (Hp) infection, in addition to a questionnaire survey. Based on blood test results, participants were assigned to a low-,moderate,or high-risk group.Those assigned to moderate and high-risk groups were referred for endoscopy. In the low-risk group, 210 participants (30/county) were randomly selected for endoscopy.Results The overall prevalence of Hp infection was 51.2%.Female sex,body mass index,number of family members,and smoking were identified as risk factors based on the results of logistic regression, while educational level, drinking, and history of gastric cancer and digestive diseases were identified as protective factors.Based on the results of gastric functional testing, 2 391 participants(210 of 6 466 in the low-risk group and all participants in the moderate and high-risk groups) were referred for endoscopy.Of 2 381 participants,1 290 underwent endoscopy,with a response rate of 54.0%.According to the endoscopic and pathological findings, 925 participants were diagnosed with gastritis, 233 with atrophic gastritis and intestinal metaplasia,136 with intestinal metaplasia,32 with hyperplastic polyps,26 with mild dysplasia, 3 with moderate dysplasia, 6 with early gastric cancer,and 2 with advanced gastric cancer.The relevance ratio for gastric cancer was 92.5/100 000 in this specific region.Age,history of gastric cancer,Hp infection, over-/under-expression of PGI, PGR, and G-17 level were identified as risk factors for precancerous lesions. In the moderate and high risk groups, the prevalence of precancerous lesions was 24.6% in males and 24.4% in females,with adjustment using propensity score modeling.Conclusion The relevance ratio for early gastric cancer and precancerous lesions was slightly higher in those aged over 40 years in southern Jiangsu Province.It is essential to provide specific intervention and long-term follow-up for those screened for gastric cancer and precancerous lesions.
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Objective To investigate the clinicopathological features and correlation between synchronous multiple early gastric cancer (SMEGC)and single early gastric cancer (EGC).Methods From January 2008 to December 2016,the clinical data of 994 patients with EGC who underwent open or laparoscopic gastrectomy surgery were collected from the electronic medical data base of the First Affiliated Hospital of Nanjing Medical University and Xuzhou No.1 People's Hospital.The data of patients including gender,age,tumor morphologys,tumor location,tumor size,histological type,depth of invasion,lymph nodes metastasis,lymphovascular metastasis,peripheral nerve invasion,and blood types were analyzed.T test and Chi square test were used for statistical analysis.Results Among 994 EGC patients,27 cases (2.7％) were SMEGC,and 967 cases (97.3％) were single EGC.The percentage of male and female of single EGC were 71.4％ (690/967) and 28.6％ (277/967),respectively;the percentage of male and female of SMEGC were 88.9％ (24/27) and 11.1％ (3/27),respectively,and there was statistically significant difference in the gender composition ratio between single EGC and SMEGC (x2 =3.975,P=0.046).The incidence of ulcer in single EGC and SMEGC were 50.6％ (489/ 967) and 29.6 ％ (8/27),respectively,and the difference in the incidence of ulcers between single EGC and SMEGC was statistically significant (x2 =4.653,P=0.031).There were no statistically significant differences between single EGC and SMEGC in gross morphology,depth of invasion,lymph nodes metastasis,lymphovascular metastasis,peripheral nerve invasion,tumor location,pathological type and blood types (all P＞0.05).In the SMEGC patients,the incidence of main lesions invading the mucosa was 48.1％ (13/27) and submucosa invasion was 51.9％ (14/27);and for minor lesions,the corresponding incidences were 77.8％ (21/27) and 22.2％ (6/27),respectively,and the difference was statistically significant (x2 =5.063,P＜0.05).There were no statistically significant differences between the main lesions and minor lesions in tumor size,pathological type,with or without ulcers,gross morphology and tumor location (all P＞0.05).Conclusions The main risk factors of SMEGC are male and no ulcerative lesions.The clinicopathological features are similar between main lesions and minor lesions in SMEGC.
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Objective To investigate the risk factors of lymph node metastasis (LNM) in patients with superficial esophageal cancer (SEC) and to evaluate its clinical application.Methods From January 2010 to December 2016,769 SEC patients,who received surgery in the First Affiliated Hospital of Nanjing Medical University,were enrolled,and their clinical data were retrospectively analyzed.Chisquare test and logistic regression analysis were performed for statistical analysis.The sensitivity,specificity,and overall positive accuracy of pathological type and depth of invasion before operation were evaluated.Results The rate of LNM in patients with SEC was 15.34％ (118/769).There were significant differences in alcohol consumption,maximum tumor diameter,histological type,differentiation degree,depth of invasion and vascular invasion between patients with LNM (118 cases) and patients withoutLNM (651 cases) (x2=5.66,13.71,40.65,20.04,36.70 and 61.51;all P＜0.05).The results of multivariate analysis showed that maximum tumor diameter＞2 cm(odd ratio (OR) 1.76,95％ confidence interval (CI) 1.12 to 2.77),poor differentiation(OR 1.92,95％CI 1.23 to 3.01),submucosal invasion(OR 2.67,95％CI 1.28 to 5.56) and vascular invasion (OR 5.28,95％CI 2.75 to 10.13) were independent risk factors of LNM in patients with SEC.The tumor location was significantly correlated with the site of LNM (x2=107.05,P＜0.01).The sensitivity and specificity of preoperative assessment of LNM were 58 ％ (51/88) and 59 ％ (301/510),respectively.The overall positive accuracy of histological type before operation was 66.7％ (440/660).The overall positive accuracy of depth of invasion evaluated by endoscopic ultrasound before operation was 27.9％ (19/68).Conclusion Endoscopic treatment is recommended for SEC patients with maximum tumor diameter ≤ 2 cm,high ormoderate degree of differentiation,tumor confined to the mucosal layer and without vascular metastasis for the relatively low risk of LNM.
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Objective To investigate the value of endoscopic retrograde appendicitis therapy ( ERAT) in the diagnosis and treatment of atypical acute appendicitis. Methods All the 48 patients suspected of atypical acute appendicitis in Jiangsu Province Hospital from January 2015 to December 2016 were randomly divided into ERAT group and conservative treatment group according to the treatment method. The final appendectomy rate of the two groups was analyzed. Results Only 17 of the 24 patients in the ERAT group received endoscopic treatment because of complex conditions or personal wishes, and 16 cases were diagnosed as acute appendicitis. Surgical resection was performed in 5 cases because of recurrence of the disease after ERAT, and the appendectomy rate was 31. 2％ ( 5/16 ) . In the conservative treatment group, all 24 patients were treated with antibiotics. Twenty of them underwent surgical resection with appendectomy rate of 83. 3％ ( 20/24) , and 1 of them had appendiceal perforation. The appendectomy rate of the ERAT group was significantly lower than that of the conservative treatment group (χ2=11. 111, P<0. 05) . Conclusion ERAT has a high diagnostic and therapeutic value for atypical acute appendicitis.
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Objective To explore the effect of regional synergistic treatment system on the treatment time and short-term prognosis of patients with ST-segment elevation myocardial infarction (STEMI).Methods A retrospective analysis of the clinical data of STEMI patients who admitted to emergency center of Suzhou Kowloon Hospital Affiliated to Shanghai Jiaotong University School of Medicine and underwent primary percutaneous coronary intervention (PPCI) from January 2013 to January 2017 were conducted. All patients were divided into two groups, group A was the patients who underwent the PPCI before the establishment of the acute chest pain area co-treatment system (from January 2013 to December 2014), and group B was the patients who received the treatment after the establishment of the area co-treatment system (from January 2015 to January 2017). The length of time from onset of symptoms to the balloon dilatation (S2B), the length of time from the first medical contact to the balloon dilatation (FMC2B), the length of time from entering the gate of hospital to the balloon dilatation (D2B), and the incidence of 90-day end point events (including heart failure, all-cause death, and other related adverse events) were collected. The relations of the establishment of the acute chest pain area co-treatment system and the incidence of 90-day end point events were analyzed by multivariable Logistic regression analysis.Results Among the 221 enrolled patients with STEMI, 83 patients were in group A and 138 patients were in group B respectively. Compared with group A, S2B time [minutes: 180 (140, 210) vs. 201 (154, 225)], FMC2B time [minutes: 89 (78, 100) vs. 94 (83, 107)] and D2B time [minutes: 66 (62, 70) vs. 85 (72, 99)] were significantly shortened in group B (allP < 0.05), the incidence of 90-day end point events were significantly decreased (heart failure:20.3％ vs. 32.5％, all-cause death: 1.4％ vs. 7.2％, other related adverse events: 23.2％ vs. 36.1％, allP < 0.05). It was shown by multivariable Logistic regression analysis that the establishment of the acute chest pain area co-treatment system could lower the incidence of 90-day end point events [heart failure: odds ratio (OR) = 1.904, 95％ confidence interval (95％CI) = 0.968-1.004, P = 0.048; all-cause death:OR = 11.724, 95％CI = 0.955-1.048,P = 0.013; other related adverse events:OR = 1.925, 95％CI = 1.049-3.530,P = 0.034].Conclusion The construction of regional synergistic treatment system can shorten the emergency treatment time of STEMI patients and reduce the incidence of 90-day end point events including heart failure and death.
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Objective To explore the effect of regional synergistic treatment system on the treatment time and short-term prognosis of patients with ST-segment elevation myocardial infarction (STEMI).Methods A retrospective analysis of the clinical data of STEMI patients who admitted to emergency center of Suzhou Kowloon Hospital Affiliated to Shanghai Jiaotong University School of Medicine and underwent primary percutaneous coronary intervention (PPCI) from January 2013 to January 2017 were conducted. All patients were divided into two groups, group A was the patients who underwent the PPCI before the establishment of the acute chest pain area co-treatment system (from January 2013 to December 2014), and group B was the patients who received the treatment after the establishment of the area co-treatment system (from January 2015 to January 2017). The length of time from onset of symptoms to the balloon dilatation (S2B), the length of time from the first medical contact to the balloon dilatation (FMC2B), the length of time from entering the gate of hospital to the balloon dilatation (D2B), and the incidence of 90-day end point events (including heart failure, all-cause death, and other related adverse events) were collected. The relations of the establishment of the acute chest pain area co-treatment system and the incidence of 90-day end point events were analyzed by multivariable Logistic regression analysis.Results Among the 221 enrolled patients with STEMI, 83 patients were in group A and 138 patients were in group B respectively. Compared with group A, S2B time [minutes: 180 (140, 210) vs. 201 (154, 225)], FMC2B time [minutes: 89 (78, 100) vs. 94 (83, 107)] and D2B time [minutes: 66 (62, 70) vs. 85 (72, 99)] were significantly shortened in group B (allP < 0.05), the incidence of 90-day end point events were significantly decreased (heart failure:20.3％ vs. 32.5％, all-cause death: 1.4％ vs. 7.2％, other related adverse events: 23.2％ vs. 36.1％, allP < 0.05). It was shown by multivariable Logistic regression analysis that the establishment of the acute chest pain area co-treatment system could lower the incidence of 90-day end point events [heart failure: odds ratio (OR) = 1.904, 95％ confidence interval (95％CI) = 0.968-1.004, P = 0.048; all-cause death:OR = 11.724, 95％CI = 0.955-1.048,P = 0.013; other related adverse events:OR = 1.925, 95％CI = 1.049-3.530,P = 0.034].Conclusion The construction of regional synergistic treatment system can shorten the emergency treatment time of STEMI patients and reduce the incidence of 90-day end point events including heart failure and death.
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Objective@#To study the expression status and clinical significance of PTEN and NDRG1 in colorectal carcinoma.@*Methods@#Tissue samples of 91 colorectal cancers, 30 colorectal adenomas and 21 colorectal normal mucosa tissues were collected. Postoperative specimens were examined by immunohistochemistry for PTEN and NDRG1 expression. The expression of PTEN and NDRG1 was correlated with clinicopathological feature.@*Results@#The expression of PTEN and NDRG1 in the studied cases was detected in 55.0%(50/91) and 76.9%(70/91), respectively. Their expression was significantly different from that of colorectal adenomas and normal colorectal mucosa tissues(P<0.05). Decreased expression of PTEN and over expression of NDRG1 were significantly related to the lymph node metastasis (P<0.05). The expression of PTEN was negatively related to that of NDRG1 in colorectal carcinoma(rs′=-0.251, P=0.016). The patients with negative expression of PTEN showed a lower disease free survival and overall survival(P<0.05).@*Conclusions@#Loss of expression of PTEN protein may be an important molecular marker in predicting the occurrence and PTEN may be useful as a prognostic marker of colorectal carcinoma. NDRG1 plays a role in the development of colorectal carcinoma, although not a prognostic indicator.The ancillary study with combined detection of PTEN and NDRG1 may be useful in difficult cases.
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Objective To evaluate the clinical efficacy and safety of endoscopic submucosal dissection (ESD) guided with endoscopic ultrasonography (EUS) for rectal neuroendocrine neoplasms(NENs).Methods A retrospective analysis was performed on 58 patients with rectal ENEs who underwent ESD from January 2011 to December 2015 in JiangSu Province Hospital.Manifestations of EUS, clinicopathological characteristics, proliferation activity grade, complete resection rate, complications and follow-up results of lesion were studied.Results Those treated by ESD included 58 patients with 64 lesions of rectal NENs.EUS results showed that 3 lesions originated from mucosa, 3 from muscularis mucosa and 58 from submucosa.A total of 34 lesions located within 5 cm from anus, 26 in 6-10 cm from anus and 4 more than 10 cm from anus.All 64 lesions were successfully treated by ESD.The mean maximum diameter of the lesions was 0.8 cm(0.2-3.5 cm), and the mean procedure time was 31 min(10-60 min).The complete resection rate was 93.8% (60/64).There were 4 patients with positive basal surgical margin, and two of them underwent additional surgery and two others were treated with argon plasma coagulation after rejecting surgery and ESD.Histological examination determined that 59 lesions were pathologic grade 1(G1) and 5 were pathologic grade 2(G2).Delayed bleeding occurred in 4 cases after ESD,which was managed by medicine in 1 case and endoscopic treatment in 3 cases.No perforation occurred after ESD.During a mean follow-up period of 22.9 months(3-48 months), no lymph node metastasis or distant metastasis was observed.Conclusion EUS is able to distinguish the origin of rectal NENs and aid determining the range and depth of ESD.ESD appears to be a safe, feasible and effective procedure for providing accurate histopathologica1 evaluations as well as curative treatments for rectal NENs limited to submucosa.
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Objective To investigate the intermediate and long-term efficacy of endoscopic submucosal dissection (ESD) for early esophageal cancer(EEC).Methods A total of 56 patients with EEC underwent ESD at Jiangsu Province People's Hospital between April 2010 and June 2015.Among the 56 cases,there were 39 cases of intramucosal cancer,17 cases of submucosal cancer.Intravascular cancer embolus was found in 2 patients.The en bloc and complete resection rates,the residual,local tumor recurrence and new occurrence rates of EEC after ESD were evaluated.The average follow-up time was 24.4 months,ranging from 1 to 62 months.Results The en bloc and complete resection rates were 92.9％(52) and 87.5％ (49),respectively.Four patients were treated by additional esophagectomy.The cases of residual lesions,local tumor recurrence,new occurrence and second primary extra-esophageal cancer (gastric cancer) was 1 (1.8％),2 (3.6％),2 (3.6％) and 2 (3.6％),respectively.No additional surgical operations were performed in the 7 patients or no recurrence was found,and there was no death during the follow-up period.Conclusion ESD has the advantage of high complete resection rate,low residual and local tumor recurrence rate in treatment of EEC,and the intermediate and long-term outcomes are satisfactory.