Influence of digestive tract reconstruction techniques on plasma ghrelin level and body mass index after subtotal gastrectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the impact of digestive tract reconstruction techniques on plasma ghrelin level and body mass index (BMI) after subtotal gastrectomy.</p><p><b>METHODS</b>Eighty-one patients undergoing subtotal gastrectomy for T1-3N0M0 gastric cancer were divided into three groups according to digestive tract reconstruction techniques, which included Billroth I group (n=30), Billroth II group (n=25) and Roux-en-Y group(n=26). Plasma ghrelin level was determined by radioimmunoassay preoperatively and one day, one week, half a year, and one year after gastrectomy. BMI was similarly recorded.</p><p><b>RESULTS</b>Plasma ghrelin levels of three groups decreased sharply to nadir one day after operation, which were (34.2±5.2)%, (37.7±4.7)% and (36.5±4.9)% respectively. A week after operation they were (52.6±6.5)%, (48.3±5.7)% and (48.1±6.0)%. There were no statistical difference between groups (P=0.075). Half a year postoperatively, they were (91.7±7.5)%, (80.4±8.1)% and (75.3±8.3)% and a year postoperatively(95.3±5.1)%, (84.5±6.3)% and (79.9±6.7)%, showing that Billroth I group was obviously higher than the other two groups (P<0.01) and Billroth II group was higher than Roux-en-Y group (P<0.05). BMI of three groups at a year after surgery descended by (2.1±1.1)%, (4.5±1.9)% and (5.7±1.8)% respectively, demonstrating statistical difference. Linear regression correlation existed in the three groups between decreasing amplitude of ghrelin and BMI (P<0.01).</p><p><b>CONCLUSIONS</b>Billroth I digestive tract reconstruction takes on the normal anatomy and physiology and therefore promotes compensatory ghrelin secretion. Falling of ghrelin level greatly contributes to the weight loss after subtotal gastrectomy.</p>

Role of duodenum in regulation of plasma ghrelin level and body mass index after subtotal gastrectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the role of duodenum in regulation of ghrelin and body mass index (BMI) and the correlation between ghrelin and BMI after subtotal gastrectomy.</p><p><b>METHODS</b>Forty-two patients with T(0-1)N(0-1)M(0) gastric cancer were divided into two groups after gastrectomy according to digestive reconstruction pattern, Billroth I group (n=23) and Billroth II group (n=19) respectively. Plasma ghrelin levels were determined by radioimmunoassay (RIA) before and at day 1, 7, 30 and 360 after gastrectomy,and BMIs were also measured.</p><p><b>RESULTS</b>Two groups had identical postoperative trends in ghrelin alterations during the early stage, both dropping to nadir at day 1 (36.7% vs 35.7%), then markedly increasing at day 7 (51.0% vs 51.1%). At day 30, ghrelin level of Billroth I group was slightly higher than that of Billroth II group. At day 360, ghrelin level of Billroth I group recovered to 93.6%, approaching though lower than preoperative level and no significant difference was displayed, while ghrelin level of Billroth II group recovered only to 81.6% of preoperational level and significant difference existed (P=0.033). Compared with preoperative levels, ghrelin of two groups decreased by 6.9% and 18.4% while BMI by 3.3% and 6.4% respectively, liner regression correlations were revealed in both groups between decrease magnitudes(R(1)(2)=0.297,P=0.00;R(2)(2)=0.559,P<0.001).</p><p><b>CONCLUSIONS</b>Anatomico-physiological duodenum compensatively promotes ghrelin recovery, accordingly enhances BMI after gastrectomy. Regarding patients with insufficient ghrelin secretion, ghrelin is positively correlated with BMI.</p>

Expression and clinical significance of costimulatory molecule B7-H3 mRNA and B7-H3 protein in gastric carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the expression of B7-H3 mRNA and B7-H3 protein in gastric carcinoma and their clinical significance.</p><p><b>METHODS</b>The expression of B7-H3 mRNA and B7-H3 protein in gastric carcinoma and the nearby normal tissue of 38 patients was detected by real-time RT-PCR and immunohistochemical assay respectively.</p><p><b>RESULTS</b>B7-H3 mRNA was expressed both in gastric carcinoma and nearby normal tissue, but the expression level in gastric carcinoma was much lower than that in nearby normal tissue. There were no significant differences of B7-H3 mRNA expression among gender, age, histological type, tumor size, lymph node metastasis and invasive depth (all P >0.05). The positive rate of B7-H3 protein expressed in gastric carcinoma was 39.5%. There were no significant differences of B7-H3 protein expression among gender, age, histological type, tumor size, lymph node metastasis and invasive depth (all P >0.05), but there were significant differences among groups of clinical stage (P=0.022) and pathological grade (P=0.039). Kaplan-Meier analysis revealed that disease-free survival or overall survival of the patients with positive B7-H3 expression were significantly longer than those with negative B7-H3 expression (P=0.009 and P=0.010 respectively).</p><p><b>CONCLUSION</b>Detection of B7-H3 expression in gastric carcinoma will be beneficial to the judgment of the prognosis of gastric carcinoma and the choice of individualized treatment.</p>