Survey and analysis of the current status of conventional diagnostic/therapeutic gastrointestinal endoscopy: an investigation from 169 hospitals in mainland China / 中华消化杂志

Objective To investigate the current status of conventionai diagnostic/therapeutic gastrointestinal (GI) endoscopy (conventional gastroscopy/colonoscopy and endoscopic polypectomy,et al.) in mainland China.Methods The survey was conducted by a questionnaire sent via e-mail or telephone to the hospital-based GI endoscopy units,including three levels of hospitals (Third-Grade Hospital Classification in China).Results From May 2010 to November 2010,169/279 (60.6％)units were enrolled,which covered 28 provinces (90.3％) in mainland China.Among the 169hospitals,147(87.0％ ) hospitals performed GI endoscopy,and all the hospitals performed gastroscopy (100％).Furthermore,100％ of the tertiary hospitals,and 93.9％ (138/147) of the second-level hospitals performed colonoscopy,significantly higher than that of the first-level hospitals (25.0％)(x2 =60.9,P＜0.01).All the tertiary hospitals (100％),and 79.8％ (71/89) of the second-level hospitals perform endoscopic polypectomy,significantly higher than that of the first-level hospitals (16.7％,x2 =20.0,P＜0.01,P＜0.05).Among the 147 hospitals with the ability to perform GI endoscopy,74 hospitals (50.3％) performed endoscopic retrograde cholangiopancreatography (ERCP).Furthermore,76.1％ (35/46) of the tertiary hospitals performed ERCP,significantly higher than that of the second-level hospitals (43.8 ％,39/89) (x2 =12.7,P＜0.01),and none of the 12 first-level hospitals performed ERCP,endoscopic ultrosonography (EUS) or EVL/EVS(endoscopic oesophageal varices ligation/sclerotherapy).Conclusions The conventional diagnostic GI endoscopy (routine gastroscopy and colonoscopy) was popularized in the tertiary and the second-level hospitals,and there was still much to improve for the first-level hospitals.With regard to the conventional therapeutic endoscopics,ERCP and EVL/EVS were more popular in the tertiary hospitals,while the second-level hospitals have much to improve.

Biliary passage dilator assisted percutaneous endoscopic gastostomy in natural orifice translumenal endoscopic surgery / 中华消化内镜杂志

Objective To explore the feasibility and safety of the biliary passage dilator assisted percutaneous endoscopic gastostomy(PEG)in natural orifice translumenal endoscopic surgery(NOTES).Methods Eleven hybrid dogs were recruited to the study.One dog was used for pilot study of biliary passage dilator assisted PEG.The rest ten were divied into 2 groups randomly(5 per group), receiving conventional PEG and biliary passage dilator assisted PEG, respectively.The efficacy and safety of these 2 methods in NOTES were compared.Two weeks later, routine gastroscopy was performed to detect the healing of luminal incision and all animals were sacrificed to explore the possible complications in the abdominal cavity.Results With the assistance of the biliary passage dilator, successful transgastric access to the peritoneal cavity was achieved in the pilot study.Biliary passage dilator assisted PEG was completed in all the 5 dogs of the experimetal group, while tradional PEG succeded in only 4.The average transgastric puncture time in the biliary passage dilator assisted PEG(7.0 ± 1.7 min)was significantly shorter than that of conventional PEG (11.0 ± 3.2 min, P ＜ 0.05).Nine dogs survived for 2 weeks postoperatively without loss of weight or peritonitis.Endoscopy showed transgastric puncture healed well.Autopsy revealed no gross adhering zone,bleeding, injury of adjacent organs or abcasses.Conclusion Compared with the conventional PEG, the biliary passage dilator assisted PEG shows the advantages of reduced difficulty and shoter time of puncture without any apparent complications.There is a good prospect of its application in NOTES.

Empirical study and treatment analysis of corrosive gastritis by toilet cleaner / 中华急诊医学杂志

Objective To study the gastrointestinal tract damage induced by acid detergent toilet cleaner and treatment methods.Method Acute toxicity of toilet cleaner was studied using big white rabbits.Subacute and chronic toxicity and treatment methods were studied by hospital patients.Results After falling 15 ml toilet cleaner into stomach through mouth in 2 rabbits,both died of gastric perforation.After one patient misapplied with 50 ml to//et cleaner,gastric corrosive ulcer was found by gastroscopy after treatment 7 d,gastric constrictive inflammation was found by upper gastrointestinal barium meal at 14 d after treatment,and gastric scarring was found by gastroscopy after treatment 51 d.Conchusions Acid detergent toilet cleaner mainly harm gastric mucosa,gastric perforation is easily induced in acute stage,gastric ulcer induced in subacute stage,and scarring induced in chronic stage.Taking orally pure milk,inhibiting gasuic acid secretion and haemostasis are mainly treatment methods.Examination of gastroscopy and upper gastrintesinal barium meal may be carried out in subaeute and chronic stages.

Thoracoscopy and thoracotomy for lung biopsy and wedge resection in solitary pulmonary nodule / 中国肺癌杂志

<p><b>BACKGROUND</b>Lung wedge resections and biopsies are frequently needed to diagnose and treat benign or malignant lung lesions. This study aims to compare thoracoscopy with thoracotomy for lung biopsy and wedge resection in solitary pulmonary nodule (SPN).</p><p><b>METHODS</b>A controlled retrospective study was performed in this hospital. Patients with clinical diagnosis of SPN were undergone thoracoscopy or thoracotomy. Data of operation time, hours of stay in recover room, duration and volume of chest tube drainage, accuracy of biopsies, days of hospitalization and the whole cost of hospitalization were evaluated.</p><p><b>RESULTS</b>All patients were received lung biopsies and wedge resections (thoracoscopy 26,thoracotomy 47), and they were diagnosed pathologically. The days of hospitalization were similar in the two groups. The minutes of operation had no significant difference (thoracoscopy: 103.9±29.4 minutes, thoracotomy: 94.7±33.9 minutes). Both groups had equivalent duration of chest tube drainage (thoracoscopy: 60.3±25.0 hours, thoracotomy: 62.5±20.1 hours, P =0.687) . The total volume of chest tube drainage showed no difference in both groups. The hours of stay in recover room (thoracoscopy: 75.4±21.6 hours, thoracotomy: 80.4±17.7 hours, P =0.287) and days of hospitalization after operation (thoracoscopy: 11.3±3.4 days, thoracotomy: 10.6±2.4 days, P = 0.304 ) were not different significantly. The whole cost of thoracoscopy was 17 800.2±6 038.9 CNY and thoracotomy was 17 677.4±6 327.8 CNY ( P = 0.936 ).</p><p><b>CONCLUSIONS</b>There is no significant difference in outcomes for thoracoscopy and thoracotomy approaches. Both thoracoscopy and thoracotomy are acceptable procedures for lung biopsy and wedge resection in solitary pulmonary nodules.</p>

Methylation status and mRNA expression of caspase-8 in human hepatocellular carcinoma cells resistant to tumor necrosis factor-related apoptosis-inducing ligand / 第三军医大学学报

Objective To study the association of methylation status of C5 of the cytosine in the CpG di-nucleotide of caspase-8 promoter and expression of caspase-8 mRNA with the resistance to tumor necrosis factor-related apoptosis-inducing ligand(TRAIL) in human hepatocellular carcinoma cell lines,and to evaluate the effect of demethylation agent 5-Aza-2′-deoxycytidine(5-Aza-CdR) on the resistance to TRAIL of human hepatocellular carcinoma cell lines.Methods Methylation status of caspase-8 promoter was measured with methylation-specific PCR method(MSP).Expression of caspase-8 mRNA was detected with RT-PCR.Apoptosis induced by TRAIL was observed by Acridine Orange/Ethidium Bromide(AO/EB) staining.Results Unmethylated status of caspase-8 promoter was found in both HepG2 and SMMC 7721 hepatocellular carcinoma cells.5-Aza-CdR neither up-regulated caspase-8 mRNA expression nor increased the sensitivity of hepatocellular carcinoma cells to TRAIL.Conclusion caspase-8 promoter methylation status and caspase-8 mRNA expression are not related to the resistance to TRAIL.5-Aza-CdR can not increase the sensitivity of hepatocellular carcinoma cells to TRAIL.

Diagnosis and surgical treatment of esophageal leiomyoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the characteristics of diagnosis and surgical treatment of esophageal leiomyoma.</p><p><b>METHODS</b>Preoperative radiology, esophagoscopy and results of surgical treatment were retrospectively analyzed in 141 patients with esophageal leiomyoma.</p><p><b>RESULTS</b>Dysphagia (64.5%) and chest or epigastric pain (20.6%) were the most common presenting symptoms with a mean duration of 15.7 months. Eleven patients had been misdiagnosed as malignant esophageal disease, mediastinal or retroperitoneal tumor before operation. Thirteen patents received partial esophageal resection, including 2 patients with gigantic tumor, 3 still misdiagnosed as malignancy in the operation theater and 8 accompanied with esophageal or gastric cardiac carcinoma. 128 patients were treated with tumor removal only, among whom the esophageal mucosa was ruptured and sutured in 13 patents. The tumor was single in 130 patients and multiple in 11 patients. The tumor shape was either oval, horseshoe-or ginger-like. Tumor surrounded the esophagus less than half circumference in 75 patients, more than half in 59 patients and involved the whole circumference in 7 patients. The tumor was polypoid and intraluminal in one patient. It was extraluminal in 2 patients and was intramural in all the others. The morbidity and 30-day mortality rates were 3.6% and 0%.</p><p><b>CONCLUSION</b>Preoperative differentiation of esophageal leiomyoma is important for it may be misdiagnosed as esophageal malignant disease or mediastinal tumor. Tumor removal only is indicated if possible. Biopsy is inadvisable if leiomyoma has been suspected by esophagoscopy. The incidence of esophageal carcinoma complicating esophageal leiomyoma is high, of which the reason needs further study.</p>

99mTc-Pingyangmycin imaging in the diagnosis of primary lung cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the clinical value of (99m)Tc-Pingyangmycin (PYM) imaging for the diagnosis of primary lung cancer.</p><p><b>METHODS</b>Radionuclide (99m)Tc-Pingyangmycin (PYM) imaging was performed in 56 patients with pulmonary lesions.</p><p><b>RESULTS</b>The uptake ratio and retention index (RI) were different in malignant and benign lesions. With the delayed ratio regarded as the threshold for lung cancer, the overall accuracy, sensitivity and specificity of (99m)Tc-PYM in the diagnosis of lung cancer were 82.1%, 82.7% and 80%, respectively. If RI was regarded as the threshold, the overall accuracy, sensitivity and specificity were 94.6%, 93% and 100%, respectively. There was no significant difference among different histological types of the lung carcinoma.</p><p><b>CONCLUSION</b>(99m)Tc-PYM, as a good imaging agent, is useful in differentiating malignant lung lesions from benign ones.</p>

Surgical treatment for lung cancer patients with poor pulmonary function / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To summarize surgical treatment of lung cancer patients with poor pulmonary function.</p><p><b>METHODS</b>From 1991 to 1999, 181 lung cancer patients with poor pulmonary function underwent operation. The correlation between the results of preoperative pulmonary functional tests and the postoperative cardiopulmonary complications was analyzed by Chi-square test (chi(2)).</p><p><b>RESULTS</b>In 181 patients, pneumonectomy was done in 43, lobectomy in 118, partial lung resection in 16 and exploration in 4. The postoperative complication and mortality rates of the resection group were 42.3% (75/177) and 7.9% (14/177). The cardiopulmonary complication rates were 25.6%, 48.3%, 31.3% in pneumonectomy, lobectomy and partial lung resection. The morbidity and mortality rates of 8 patients who received preoperative chemotherapy and/or radiotherapy were 75.0% and 37.5%. The morbidity and mortality rates of 12 patients who had had a previous history of thoracotomy were 66.7% and 33.3%. In the present series, the 1-, 3- and 5-year survival rates were 71.1%, 42.2% and 31.1%. The 5-year survival rates of patients with stage I, II and III lesions were 55.0%, 25.0% and 0.</p><p><b>CONCLUSION</b>Preoperative spirometry is an important evaluation test for lung cancer patients with poor pulmonary function. It should be evaluated in combination with other pulmonary function tests such as CO(2) diffusion and cardiopulmonary excise tests, etc whenever possible. Patients with a history of thoracotomy, chemotherapy and radiotherapy should be carefully evaluated before operation to avoid high morbidity and mortality. Stage I and II lung cancer patients with poor pulmonary function can undergo operation if they have been well managed preoperatively and well taken care of with nursing care perioperatively.</p>

Clinical value of prophylactic radiotherapy after curative resection of esophageal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the clinical value of prophylactic radiotherapy for esophageal carcinoma after curative operation.</p><p><b>METHODS</b>495 esophageal squamous cell cancer patients who had undergone radical resection were randomized by the envelope method into a surgery alone group (S, 275) and a surgery plus radiotherapy group (S + R, 220). Radiation treatment was started 3 - 4 weeks after operation. The portals encompassed the whole mediastinum and bilateral supraclavicular areas. A mid-plane dose of 50 approximately 60 Gy in 20 approximately 30 fractions over 5 approximately 6 weeks was delivered.</p><p><b>RESULTS</b>1. Survival rate: the overall 5-year survival rate was 39.4%. Those of S alone and S + R groups were 37.1% and 41.3% (P = 0.447 4). The 5-year survival rate for Stage III patients were 13.1% in S alone group and 35.1% in R + S group (P = 0.002 7), 2. Pattern of failure: The incidence of local recurrence intra-thoracic lymph node metastasis, anastomotic recurrence and extra-thoracic lymph node metastasis in S + R group (16.2%, 0.5% and 3.1%) were lower than those (25.9%, 5.8% and 13.2%) (P < 0.05) in S alone group and 3.</p><p><b>COMPLICATIONS</b>the anastomotic stricture frequencies were similar in the two groups (S 1.8%; S + R 4.1%).</p><p><b>CONCLUSION</b>1. Prophylactic radiotherapy is able to improve the survival rate of stage III patients treated by radical resection, 2. Postoperative radiotherapy is able to reduce the incidence of failure by recurrence in the intra-thoracic lymph nodes and anastomotic recurrence to where radiation therapy had been given, 3. Postoperative radiotherapy does not increase the incidence of anastomotic stricture.</p>

Management of perioperative respiratory problems in patients with tumor of trachea or carina / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To summarise and analyse the experience and methods of managing the perioperative respiratory problems in patients with tumor of trachea or carina surgically treated during the last decade, and the ways of preventing severe postoperative respiratory complications in the future.</p><p><b>METHODS</b>Thirty-eight patients with tumor of trachea or carina surgically treated from 1991 to 2000 by different modes of tracheobronchial plastic surgery were retrospectively studied to summarise and analyse the changes in preoperative pulmonary function, postoperative complications and the management of perioperative respiratory problems.</p><p><b>RESULTS</b>Out of 38 patients, 29 (76.3%) gave abnormal results to preoperative pulmonary function tests. 55.3% (21/38) of the whole series developed 45 postoperative complications with respiratory complications as the major one (80.0%). Seventeen patients who had undergone carinal pneumonectomy or carinal resection plus reconstruction gave far more complications (28 complications) than the remaining 21 patients treated by other modes of surgery (17 complications). Four patients died of postoperative complications with a mortality rate of 10.5%.</p><p><b>CONCLUSION</b>Patients treated with carinal pneumonectomy or carinal resection plus reconstruction give much more complications than patients treated by any other modes of large airway surgery. Fiberoptic bronchoscopic (FOB) guided intubation, precise surgical treatment, postoperative mechanical ventilation support, use of effective antibiotics and sufficient nutritional support are important for a successful management of these patients.</p>

Hepatocarcinoma HepG2 cell apoptosis promoted by hTERT RNAi through cytochrome C dependent mitochondrial pathway / 解放军医学杂志

Objective To probe the mechanism of hepatocarcinoma cell apoptosis promoted by human telomerase reverse transcriptase (hTERT) RNA interference (RNAi) by mitochondrial pathway in vitro. Methods Westernblot was employed to detect the intracellular expressions of caspase-9, hTERT, Bcl-2 and Bax, and mitochondrial and cytoplastic cytochrome C (cyt C) in HepG2 cells transfected by pSliencer 3.1-H1 neo-shTERT (small hairpin RNA hTERT). Result In the HepG2 cells transfected by pSliencer 3.1-H1 neo-shTERT, expressions of hTERT, Bcl-2 and mitochondrial cyt C were significantly down-regulated, while Bax and cytoplastic cyt C were obviously up-regulated, and active caspase-9 was found in addition to procaspase-9 compared with that in negative control cells and untransfected cells. Conculsion hTERT RNAi may suppress hTERT expression to result in reduction of Bcl-2 and increase of Bax, and then induce hepatocarcinoma HepG2 cell apoptosis by mitochondrial pathway subsequent to cyt C release from mitochondria to cytoplast.

EUS in preoperative TNM staging of esophageal carcinoma / 中华消化内镜杂志

Objective To study preoperatively on TNM staging of esophageal carcinoma by endo-scopes ultrasonography ( EUS). Methods Sixty-one patients with esophageal carcinoma were preoperatively staged by EUS. The results were compared with the postoperative histopathological staging according to the new (1997) TNM classification. Results Clinical staging of T subsets by EUS was reliable with an overall accuracy rate of 86. 9% , while that of N subsets was relatively more difficult with an overall accuracy rate of 52. 5% ; sensitivity and specificity of regional lymph nodal metastases were 88. 9% and 23. 5% respectively. Conclusion EUS is relatively an accurate measure in assessing the depth of tumor infiltration, whereas further efforts are needed to improve the accuracy in N staging. EUS will be helpful in choice of the appropriate therapeutic procedure and predicting the possibility of surgical resection.

Sensitivity of human gastric cancer cells to TRAIL is not associated with caspase-8 promoter methylation status / 第三军医大学学报

Objective To study the effect of methylation state of C5 of the cytosine in the CpG di nucleotide of caspase 8 promoter on tumor necrosis factor related apoptosis inducing ligand (TRAIL) antitumor activity in gastric carcinomas. Methods The methylation states of the caspase 8 promoter region of 5 kinds of gastric carcinoma strains were measured by methylation specific PCR method. The antitumor activity of TRAIL protein was measured by MTT method. Results No methylation of caspase 8 promoter was found in gastric carcinoma cells. Treatment with demethylation agent 5 Aza 2′ deoxycytidine (5 Aza CdR) increased sensitivity of gastric cancer cells to TRAIL, but did not change methylation status of caspase 8 promoter in gastric carcinoma cells. Conclusion Caspase 8 promoter methylation status is not associated with TRAIL antitumor activity.

Enhanced TRAIL antitumor activity on human gastric cancer cells induced by 5-Aza-CdR is involved in up-regulation of caspase-8 / 第三军医大学学报

Objective To study the effects of demethylation agent 5-Aza-2′-deoxycytidine (5-Aza-CdR) on the antitumor activity of tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) against gastric carcinoma. Methods Expression of caspase-8 mRNA was examined by RT-PCR. Antitumor activity of TRAIL protein was measured by MTT method. Results The inhibition rates of treatment with 200 ng/ml TRAIL for 72 h on gastric cell lines SGc 7901, Kato 3, and AGS were 9.83%, 11.94%, and 4.04%. After treatment with 5-Aza-CdR, the inhibition rates of 200 ng/ml TRAIL on gastric cell lines increased to 38.98%, 52.42%, and 30.72%. Before exposure to 5-Aza-CdR, expression of caspase-8 mRNA was low and an increased expression of the caspase-8 was found in the three gastric cancer cells after treatment with 5-Aza-CdR. Conclusion Treatment with 5-Aza-CdR can increase TRAIL antitumor activity on human gastric cancer and its mechanisms might be involved in the up-regulation of caspase-8 gene.