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Gastrointestinal cancers are the common malignant tumors of the digestive system, and their morbidity and mortality are in the forefront of malignant tumors. Currently, cancer immunotherapy is the hottest topic in cancer research field. Although cancer immunotherapy has achieved some results in the fundamental research and clinical application of gastrointestinal tumors, there are still a series of problems that need to be resolved. In this article, we review the fundamental and clinical research progress of several common methods of cancer immunotherapy in the field of gastrointestinal tumors.
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Objective:To explore the detection rate of non-caseating granuloma under endoscopy in patients with Crohn′s disease and its influencing factors, in order to improve the pathological diagnosis rate of Crohn′s disease.Methods:From July 2016 to April 2021, at the First Affiliated Hospital of Soochow University, 199 patients who met the clinical diagnostic criteria for Crohn′s disease and underwent endoscopic biopsy were collected. The detection rates of non-caseating granulomas in all patients with Crohn′s disease, in different types (primary and recurrent) and whether the biopsy site included the colon were analyzed. According to whether non-caseating granulomas were detected by endoscopic biopsy, the patients were divided into the detected group and the undetected group. The clinical data of the two groups of patients were compared, which included gender, age, course of disease, body mass index, smoking status, clinical manifestations (abdominal pain, diarrhea, gastrointestinal bleeding, perianal lesions, weight loss, fever, intestinal obstruction), therapeutic medication (5-aminosalicylic acid, immunosuppressants, glucocorticoid, biological agents, exclusive enteral nutrition), history of bowel surgery, laboratory examination results (hemoglobin, platelet count, neutrophil count, C-reactive protein, erythrocyte sedimentation rate, albumin), endoscopic manifestation (ulcer, fistula, stricture), simplified Crohn′s disease activity index (CDAI), total number of biopsy samples, and site of biopsy. Chi-square test, continuity correction chi-square test, Mann-Whitney U test and Fisher exact test were used for statistical analysis, and logistic regression analysis was used to analyzed the influencing factors of detection of non-caseating granulomas under endoscopy. Results:Among the 199 patients with Crohn′s disease, 67 cases were detected with non-caseating granuloma (detected group), and the overall detection rate was 33.7% (67/199); 132 cases were not detected with non-caseating granuloma (undetected group). The detection rate of non-caseating granulomas in patients with primary Crohn′s disease was higher than that of recurrent patients (39.9%, 59/148 vs. 15.7%, 8/51), and the detection rate of non-caseating granulomas in patients with Crohn′s disease whose biopsy site included the colon was higher than that of patients whose biopsy site did not include colon (64.1%, 25/39 vs. 26.3%, 42/160), and the differences were statistically significant ( χ2=9.93 and 20.12 , P=0.002 and <0.001). The age of patients in the detected group was younger than that of the undetected group; the course of disease of the detected group was shorter than that of the undetected group; the proportions of patients with abdominal pain and history of biological treatment in the detected group were lower than those of the undetected group; the simplified CDAI score of the detected group was higher than that of the undetected group; and the total number of biopsy samples of the detected group was more than that of the undetected group (30.0 years old (25.0 years old, 37.00 years old) vs. 32.0 years old (28.0 years old, 41.0 years old); 1.0 year (0.0 year, 3.0 years) vs. 2.0 years (0.0 year, 5.0 years), 61.2%, 41/67 vs. 75.8%, 100/132; 0, 0/67 vs. 10.6%, 14/132; 5.00 (2.00, 7.00) vs. 4.00 (2.00, 6.00); 10 (8, 12) vs. 6 (3, 9)), and the differences were statistically significant ( Z=-2.29, -1.99, χ2=4.56, corrected χ2=6.11, Z=-2.05, -5.64, all P<0.05). The case number of biopsy location in terminal ileum, colon, ileocolon, upper gastrointestinal tract, terminal ileum+ upper gastrointestinal tract, ileocolon+ upper gastrointestinal tract in the detected group was 36, 4, 18, 1, 5 and 3, respectively, compared with those of undetected group (94, 4, 8, 11, 13 and 2), the difference was statistically significant (Fisher′s exact test, P<0.001). The results of multivariate logistic regression analysis suggested that the total number of biopsy samples, whether the biopsy site included the colon and disease type were independent influencing factors for the detection of non-caseating granulomas under endoscopy in patients with Crohn′s disease (regression coefficients=0.157, 0.979 and -0.960, OR=1.171, 2.662 and 0.383; 95% confidence interval 1.067 to 1.284, 1.140 to 6.214, 0.158 to 0.929; P=0.001, 0.024 and 0.034). Conclusions:For endoscopic examination in patients with suspected Crohn′s disease, the total number of biopsy samles should be increased as much as possible, and biopsy should be performed at the colonic lesions, in order to improve the detection rate of non-caseating granulomas under endoscopy thereby providing more pathological evidence for the diagnosis of Crohn′s disease.
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To evaluate the psychological symptoms of patients with Crohn disease (CD), and to explore the risk factors affecting quality of life (QOL) in CD patients, 50 adult patients with CD, and 50 healthy controls were enrolled. Psychological questionnaires including self-rating anxiety scale (SAS), self-rating depression scale (SDS), the inflammatory bowel disease questionnaire (IBDQ) and the short form-36 health survey (SF-36) were completed. The results showed both the SAS (40.3±8.5 VS 37.6±7.0) and the SDS (47.1±11.1 VS 41.8±9.6) in CD patients were significantly higher than those in the healthy controls ( t=5.4, P<0.05; t=10.6, P<0.05). The IBDQ scores revealed the physical symptoms scores were 49.50±7.62, systemic symptoms scores 23.92±5.07, emotional functions scores 57.13±15.62, and social function scores 22.15±9.08 in CD active phase. However, the above scores were 60.12±4.01, 26.24±3.97, 67.34±15.17, and 25.44±2.03 respectively in the remission phase. Four subscale items of IBDQ in CD active phase were significant lower than those in the remission phase (all P<0.05). The subscale items of SF-36 scores (PF, RP, BP, GH, VT, SF, RE, MH) in CD patients were significant lower than those in healthy controls (all P<0.05). The SF-36 items scores of PF,RP and MH in the remission phase were significant higher than those in the active phase (all P<0.05). The SF-36 items scores of GH and VT in patients with malnutrition were significant lower than those with nutrition (both P<0.05). Multivariate regression analysis showed that disease status and nutritional risk ( P<0.05) significantly affected the patients' IBDQ scores. Factors including sex, age, marital status, education background, medical insurance, use of biologicals, surgery treatment had little influence on the total score of IBDQ ( P>0.05). Psychological conseling and treatment in the active phase may improve QOL of CD patients.
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Objective:To compare the efficiency and safety of T knife and Dual knife in endoscopic submucosal dissection (ESD) in the treatment of esophageal lesios.Methods:A total of 59 hospitalized patients with esophageal lesions who underwent ESD in the First Affiliated Hospital of Soochow University from June 2018 to January 2019 were enrolled in the study, and the patients were randomly divided into T knife group ( n=29) and Dual knife group ( n=30). The operation time, resection speed, complete resection rate, and complications of the two groups were compared. Results:There were no significant differences in gender, age and comorbidity between the T knife group and the Dual knife group (all P > 0.05). The operation time of T knife group and Dual knife group was 57.86±24.62 min and 66.28±29.48 min, respectively, and the difference was statistically significant ( t=1.189, P=0.024). The resection speed of the two groups was 22.80±7.31 mm 2/min and 16.20±7.24 mm 2/min, respectively, with significant difference ( t=3.484, P=0.001). The complete resection rate of the two group was 86.2% (25/29) and 86.7% (26/30), respectively, with no significant difference ( χ2 =0.108, P=0.742). There were 2 (6.9%) cases of complications in the T knife group, while 5 (16.7%) cases in the Dual knife group, the incidence of complications was no significant difference ( χ2=0.574, P=0.449). There was no perforation or bleeding in the both groups. Conclusion:In the treatment of esophageal lesions, T knife in ESD has the advantages of short operation time and high resection speed compared with Dual knife, and is worthy of clinical application.
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Objective:To evaluate the efficacy of hemostatic powder on preventing delayed bleeding after endoscopic submucosal dissection (ESD).Methods:Patients who received ESD in the First Affiliated Hospital of Soochow University and Yulin No.2 Hospital from June 2017 to August 2018 were enrolled with informed consents, and randomly divided into the study group and the control group. Hemostatic powder was applied on post-ESD ulcer after routine hemostasis method in the study group, and the control group was given routine hemostasis method only. The time and dosage of hemostatic powder spraying and its adverse events were observed in the study group. The operation time, rate of delayed bleeding (within 30 days after operation) and early delayed bleeding (within 48 hours after operation), and postoperative hospital stay were compared between the two groups.Results:A total of 196 patients were enrolled including 97 in the study group and 99 in the control group. The baseline data were comparable between the two groups (all P>0.05). In the study group, the time to spray powder was 68.78±19.75 s, dosage was 2.51±0.93 g. Powder delivery catheter was blocked in one case (1.03%, 1/97). No adverse event was reported during 30 days of follow-up. The operation time was not statistically different in the study group and the control group (61.92±11.71 min VS 59.76±11.01 min, t=1.330, P=0.185). The delayed bleeding rate of the study group was significantly lower than that of the control group [1.03% (1/97) VS 8.08% (8/99), P=0.035]. There was no case of early delayed bleeding occurred in the study group, while 6 cases (6.06%, 6/99) in the control group ( P=0.029). The postoperative hospital stay was not statistically different between the study group and the control group (4.57±0.85 d VS 4.86±1.37 d, t=1.778, P=0.077). Conclusion:Although capacity of hemostatic system remains to be improved, hemostatic powder is an effective, safe and simple method to reduce delayed bleeding rate after ESD, especially on early delayed bleeding.
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Objective To detect whether patients with gastric cancer had unique serum metabolomic characteristics by liquid chromatography-mass spectrometry (LC-MS) metabolomic analysis,and to screen potential markers for early gastric cancer and to preliminarily explore the related metabolic pathways.Methods At the First Affiliated Hospital of Soochow University,66 patients with gastric cancer and 44 patients with benign gastric disease from July,2017 to January,2018 were enrolled,and 50 healthy subjects served as controls.Twenty-five patients with gastric cancer at stage Ⅰ and Ⅱ and 25 patients with gastric cancer at stage Ⅲ and Ⅳ were selected from the 66 patients with gastric cancer,and 25 subjects were also selected from 50 healthy controls.The plasma small molecule metabolites of patients with gastric cancer and benign gastric disease and healthy controls were detected by LC-MS method.Multivariate logistic regression analysis was used to establish and validate the principal component analysis (PCA) model and partial least squares-discriminant analysis (PLS-DA) model and screen the differential metabolites.The receiver operating characteristic curve analysis was used to evaluated the clinical efficacy of differential metabolites.Results PCA and PLS-DA models showed that gastric cancer had a obviously specific metabolites profile,the profile of benign gastric disease overlapped with that of gastric cancer and healthy controls.The results of multivariate logistic regression analysis confirmed that four metabolites including isoleucine,benzophenone,sphingosine-1-phosphate and galactopyranose set could be used to establish an optimal diagnostic model.The area under the curve (AUC)(95％ confidence interval (CI)) was 0.963 (0.930 to 0.997),and the best cut off value,sensitivity and specificity were 0.871,93.1％ and 94.0％,respectively.Meanwhile,patients with gastric cancer at stage Ⅰ + Ⅱ and stage Ⅲ + Ⅳ had a distinct clustering trend compared with the control group.In the serum of patients with gastric cancer at stage Ⅰ + Ⅱ and stage Ⅲ + Ⅳ,a total of 24 differential metabolites were identified,theconcentration of five of which including lysine,carnitine,benzenesulfonamide,arginine and docosahexaenoic acid ethyl ester,increased along with the progression of gastric cancer.Pipecolic acid and kynurenine might served as biomarkers for early and mid gastric cancer (stage [+ Ⅱ) screening.Conclusions LC-MS metabolomic effectively confirm the unique changes of serum metabolites in patients with gastric cancer.The screened differential metabolites have potential clinical application value for predicting the risk of gastric cancer.
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Objective To evaluate the therapeutic value of endoscopic jejunal tube placement, endoscopic clipping, and over the scope clip ( OTSC) for digestive fistula. Methods Data of 38 patients with digestive fistulas at the First Affiliated Hospital of Soochow University admitted from July 2015 to July 2017 were retrospectively analyzed. Treatments were chosen according to the size and the site of the fistulas. Thirteen patients underwent jejunal tube placement ( the jejunal tube group ) , 20 underwent endoscopic clipping( the endoscopic clipping group) , and 5 underwent OTSC( the OTSC group) . The technical success rate, clinical cure rate and postoperative hospital stay were analyzed. Results All patients received the endoscopic operation successfully with no significant complications. In the jejunal tube group, 4 patients′fistulas fully healed, lesion was smaller after treatment in 3 patients, lesion didn′t change in 5 patients, and 1 patient died. The complete cure rate was 30. 8％ (4/13), and the postoperative hospital stay was 47. 4± 14. 1 days. For the endoscopic clipping group, 16 patients′ fistulas fully healed, lesion was no smaller compared with that before treatment in 3 cases, and 1 patient died. The complete cure rate was 80. 0％ ( 16/20) , and the postoperative hospital stay was 17. 9 ± 8. 9 days. Total patients in the OTSC group were completely cured, with 100. 0％( 5/5) of complete cure rate. One patient with refractory esophageal fistula underwent OTSC repeatedly with endoscopic clipping, and the healing time of fistula was 102 days. The postoperative hospital stay of 4 others was 5. 3±1. 7 days. The cure rate of fistula was higher (P=0. 03, P<0. 001) and the postoperative hospital stay was shorter ( P=0. 04, P<0. 001) in the OTSC group compared with the clipping group and the jejunal tube group. Conclusion Endoscopic management is safe and effective for digestive fistulas with less trauma, easy performance and short time of healing.
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Objective To evaluate the clinical value of endoscopic submucosal tunnel dissection ( ESTD) for treatment of large gastric angle superficial neoplasms. Methods A retrospective analysis was performed on data of 87 patients with superfical neoplasms in gastric angle, including 32 cases undergoing ESTD and 55 cases undergoing endoscopic submucosal dissection ( ESD) in 6 institutions between July 2014 and July 2016. The dissection time, dissection speed, en bloc resection rate, curative resection rate, adverse events, and prognosis were compared between the two groups. Results The ESTD group showed a shorter dissection time ( 87. 3 ± 32. 6 min VS 136. 7 ± 64. 5 min, P<0. 01 ) , a higher dissection speed ( 0. 18 ± 0. 07 cm2/min VS 0. 08±0. 05 cm2/min, P<0. 01), a higher en bloc resection rate[100％ (32/32) VS 87. 3％ (48/55), P=0. 035], and a higher curative resection rate[100％ (32/32) VS 85. 5％ (47/55), P=0. 024] compared with the ESD group. The intraoperative bleeding rate[59. 4％ (19/32) VS 100. 0％( 55/55) , P<0. 01] and muscular injury rate[ 0 ( 0/32) VS 14. 5％ ( 8/55) , P=0. 024] were lower in the ESTD group than those of the ESD group. There was no statistical difference on recurrence rate between the two groups[0 (0/32) VS 1. 9％ (1/54), P=0. 443]. Conclusion ESTD has a higher dissection speed and greater security on treatment of large gastric angle superficial neoplasms, and is worthy to be generalized.
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Objective To analyze the clinical characteristics and prognosis of patients with rectal gastrointestinal stromal tumor ( GIST) . Methods We collected the data of 31 rectal GIST patients definitely demonstrated by pathology and immunohistochemistry in the First Affiliated Hospital of Soochow University, the Second Affiliated Hospital of Soochow University, and Suzhou Wuzhong People′s Hospital from January 2008 to December 2016. The clinical characteristics, therapeutic modalities, and prognoses were retrospectively analyzed. Results Among the 31 rectal GIST patients, 16 underwent local resection and 15 underwent radical surgery. There was no significant difference on the three-year survival rate between the two groups [ 93. 8％ ( 15/16 ) VS 73. 3％ ( 11/15 ) , P=0. 135 ] . There was no significant difference on the survival rate between the oral imatinib patients and non-oral imatinib patients in the local resection group [ 75. 0％ ( 3/4) VS 100. 0％ ( 12/12) , P=0. 083] and the radical surgery group[ 77. 8％ ( 7/9) VS 66. 7％(4/6), P=0. 579]. The postoperative recurrence and metastasis rate of the two groups was no significantly different[31. 3％ (5/16) VS 53. 3％ (8/15), P=0. 213]. Conclusion The choice of surgical procedure has no significant effects on the survival rate and postoperative recurrence for rectal GIST patients, and whether oral imatinib or not has no significant effects on the survival of patients.
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Objective To compare the diagnostic value of the old "ABC" method [serum pepsinogen(PG) combined with Helicobacter pylori (Hp) IgG antibody] and the new "ABC" method [serum pepsinogen plus gastrin-17(G-17)] in screening gastric cancer and its precancerous condition. Methods Serum PG, G-17 and Hp-IgG were quantified by enzyme-linked immunosorbent assay (ELISA) in 278 subjects. Subjects were grouped according to the criteria of two methods. The gastroscopy and pathological biopsy were gold standard. Results The positive rate of old "ABC" method was 74.46% (207/278), which was 54.68% of new "ABC" method (151/278). For the diagnosis of gastric cancer, the sensitivity and specificity of the old "ABC" method were 90.74% and 29.46% respectively, with diagnostic coincidence rate 41.37%. The sensitivity and specificity of the new "ABC" method were 92.59% and 54.46% respectively, with diagnostic coincidence rate 61.87%. As to the diagnosis of pre-cancerous state, the sensitivity and specificity of the old "ABC" method were 75.81% and 36.00%, with diagnostic coincidence rate 58.03%. The sensitivity and specificity of the new "ABC" method were 62.10% and 75.00%, with diagnostic coincidence rate 67.86%. Conclusions Compared with the old "ABC" method, the new "ABC" method has higher sensitivity, specificity and diagnostic coincidence rate for the diagnosis of gastric cancer, yet higher specificity and lower sensitivity for the diagnosis of precancerous conditions.
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Primary duodenal adenocarcinoma (PDA)is a rare but aggressive digestive tract malignancy,and its incidence is increasing in recent years. Early diagnosis of PDA is challenging due to nonspecific symptoms. Hence,it is often detected at an advanced stage. Treatment strategies tends to favor aggressive surgical resection. Adjuvant chemotherapy and radiation are important components of multi-modality treatment for patients with high risk of recurrence, and molecular targeted therapy is still in the exploratory stage. The best adjuvant therapy after operation is not yet clear. Early diagnosis and treatment is of great significance for prognosis. This article reviewed advances in epidemiology,risk factors,diagnosis,treatment and prognosis of PDA.
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Vasculitis is a group of autoimmune diseases characterized by vascular wall inflammation and necrosis,and often involving multiple organs,including the digestive system,such as gastrointestinal tract,hepatic and biliary system,as well as pancreas. The gastrointestinal manifestations of vasculitis are varied and usually non-specific. Misdiagnosis is frequent especially when gastrointestinal symptoms are the presenting manifestations. In this review,we summarized the gastrointestinal manifestations of vasculitis for facilitating the recognition of these diseases by clinicians.
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The early detection and diagnosis of colorectal cancer (CRC)is of great clinical importance. Peripheral blood methylated SEPT9 gene was found to be a sensitive and specific biomarker for CRC and was superior to other commonly used screening methods such as fecal occult blood test,serum tumor markers and colonoscopy in a variety of studies. But it is of limited value in screening of adenomas,polyps and other precursors of CRC,and its capacities for assessment of cancer recurrence and therapeutic effects of radiotherapy and chemotherapy need further clinical validation. This article reviewed the progress in application of peripheral blood methylated SEPT9 gene assay for CRC screening.
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The early detection and diagnosis of colorectal cancer (CRC)is of great clinical importance. Peripheral blood methylated SEPT9 gene was found to be a sensitive and specific biomarker for CRC and was superior to other commonly used screening methods such as fecal occult blood test,serum tumor markers and colonoscopy in a variety of studies. But it is of limited value in screening of adenomas,polyps and other precursors of CRC,and its capacities for assessment of cancer recurrence and therapeutic effects of radiotherapy and chemotherapy need further clinical validation. This article reviewed the progress in application of peripheral blood methylated SEPT9 gene assay for CRC screening.
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Objective To analyze the clinical features and risk factors of recurrent acute pancreatitis (RAP).Methods From September 2012 to September 2014,the clinical data of 411 patients with primary acute pancreatitis (AP) were collected.From March to June 2016,patients were followed up.The clinical features of patients with RAP were analyzed.Univariate and multivariate regression analysis were performed to analyze the risk factors of RAP.Results Among the 411 patients with AP,those caused by biliary disease,hyperlipidemia,alcohol,other known causes and idiopathic AP were 265 cases (64.5％),61 cases (14.8％),19 cases (4.6％),21 cases (5.1％) and 45 cases (10.9％),respectively.In two weeks of AP onset,the recurrent rate of biliary AP in cholecystectomy group was 7.1％ (5/70),which was lower than that of non-cholecystectomy group (30.2％,42/139),and the difference was statistically significant (xz =14.218,P＜0.01).The results of univariate regression analysis suggested that gender,body mass index (BMI),complicated with diabetes,etiology,history of smoking,history of drinking and pancreatic necrosis were correlated with RAP (all P＜0.05).The results of multivariate regression analysis indicated that complicated with diabetes (odd ratios (OR) =3.417,95 ％ confidence interval (CI) 1.979 to 5.900,P＜0.01),hyperlipidemic pancreatitis (OR=2.247,95％CI 1.077 to 4.688,P=0.023),history of smoking (OR=4.023,95％CI 2.377 to 6.809,P＜0.01),complicated with pancreatic necrosis (OR=3.312,95％ CI 1.675 to 6.546,P＜0.01) were independent risk factors of RAP.Conclusions Hypertriglyceridemia,smoking,complicated with pancreatic necrosis and diabetes are independent risk factors of RAP.Patients with biliary AP should receive cholecystectomy as early as possible,which could reduce RAP.
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Background:China is an area with high incidence of gastric cancer,studies have shown that serum pepsinogen (PG) and gastrin-17 (G-17)levels can be used for gastric cancer screening. Aims:To investigate the values of serum PG and G-17 levels in screening gastric precancerous lesion and gastric cancer. Methods:A total of 211 patients with gastroduodenal disease diagnosed by endoscopy and biopsy from March 2016 to October 2016 at the First Affiliated Hospital of Soochow University were enrolled,and 67 healthy subjects were served as controls. Serum levels of PGⅠ,PGⅡ,G-17 and Hp-IgG antibodies were determined by ELISA. Results:Compared with control group,PGⅠ level and PGR were significantly decreased in atrophic gastritis group (P < 0. 01);serum PGⅠ level and PGR were significantly decreased, and G-17 level was significantly increased in low grade intraepithelial neoplasia group,high grade intraepithelial neoplasia group and gastric cancer group (P < 0. 01). ROC curve showed that the best cutoff values of PGⅠ,PGR and G-17 for diagnosing gastric cancer and gastric precancerous lesion were 74. 74 ng/ mL (sensitivity 88. 3％,specificity 78. 0％), 6. 59 (sensitivity 87. 0％,specificity 73. 8％),13. 02 pmol/ L (sensitivity 54. 2％,specificity 84. 4％),respectively. PGR and G-17 were the independent predictors of gastric cancer and gastric precancerous lesion. The sensitivity and specificity of combined detection of PGⅠ,PGR and G-17 for diagnosing gastric precancerous lesion and gastric cancer were 89. 9％ and 84. 4％,respectively. Conclusions:Serum PGⅠ,PGR and G-17 may be used as indicators of gastric cancer and gastric precancerous lesion screening. PG combined with G-17 for diagnosing gastric cancer and gastric precancerous lesion is more sensitive and specific than using serum PG or G-17 alone.
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Objective To evaluate the feasibility and safety of endoscopic treatment for gastric stromal tumors with maximum diameter of 3 to 5 cm. Methods From April 2010 to April 2016, a retrospective analysis was performed on the data of patients with gastric stromal tumors undergoing endoscopic (29 cases)or laparoscopic(26 cases)resection in the First Affiliated Hospital of Soochow University. Baseline data, perioperative data and follow-up data were collected and analyzed. Results There was significant difference on tumor location between the two groups(χ2=12.173, P=0.007). Tumors mainly located at gastric fundus in the endoscopic group(65.5%,19/29),while at gastric body in the laparoscopic group(61.5%, 16/26). Compared with the laparoscopic group, patients in the endoscopic group had shorter operation time[45(35, 60)min VS 70(60, 85)min, U = 686.000, P<0.05], lesser intraoperative blood loss[15(10,15)mL VS 20(10, 20)mL, U=513.000, P=0.017], and earlier recovery time of gastrointestinal function[12(6, 24)h VS 20(18, 24)h, U=585.500, P<0.001]. Compared with the laparoscopic group, the patients in the endoscopic group had a higher complication rate[55.2%(16/29)VS 11.5%(3/26), χ2=11.543, P<0.001]and a lower intact tumor removal rate [89.7%(26/29)VS 100.0%(26/26),χ2=23.989,P<0.001]. The other perioperative parameters such as the incidence of intraoperative major bleeding, postoperative peritonitis, postoperative fasting time, hospitalization time and total hospitalization expenses showed no statistical different(all P>0.05). The postoperative follow-up time was 30.0(17.5,50.0)and 38.5(26.0,49.8)months in the endoscopic and laparoscopic group,respectively. There was no significant difference in the recurrence rate between the two group[3.4%(1/29)VS 7.7%(2/26),χ2=0.009,P=0.922]. Conclusion Endoscopic resection may be an alternative therapeutic approach for large gastric stromal tumors with shorter operation time, less intraoperative blood loss,and earlier recovery time of gastrointestinal function.
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Objective To study the impacts of B7-H3 molecule on the proliferation of T lymphocytes in different activation conditions and on the secretion of relevant cytokines.Methods Peripheral blood samples were collected from healthy subjects to separate peripheral blood mononuclear cells (PBMC) by Ficoll density gradient centrifugation.T lymphocytes were isolated from some of the PBMCs and purified with T Cell Enrichment Kit.PBMC and purified T lymphocytes were activated by anti-CD3/CD28 monoclonal antibodies (McAb) in vitro.Flow cytometry analysis was used to detect the expression of CD28 and CTLA-4 on T lymphocytes at different time points for further analyzing the activation states of T lymphocytes.On this basis, human B7-H3-Fc fusion protein was added into the mixed co-cultivation system on days 0, 1, 2, 3 and 4, and Hu-Fc fusion protein was used as isotype control.CCK-8 method was performed to detect the proliferation of T lymphocytes in each group.ELISA method was used to detect the secretion of cytokines (IL-2, IL-10 and IFN-γ) and to analyze the immune responses induced by stimulating T lymphocytes at different states of activation with B7-H3.Results B7-H3 molecule significantly inhibited the quiescent T lymphocytes from secreting IL-2 and IL-10, but had no significant impact on IFN-γ secretion.Moreover, it significantly promoted the activated T lymphocytes to secret IL-2 and IFN-γ, but had no obvious impact on IL-10 secretion.Results of the cell proliferation assay showed that B7-H3 molecule inhibited the in vitro proliferation of T lymphocytes in the PBMC, but had no obvious impact on purified T lymphocytes.ConclusionThe regulatory effects of B7-H3 molecule on the immune functions of T lymphocytes vary with the activation states of T lymphocytes.
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Objective To study on the expression and clinical significance of programmed death ligant 1 (PD-1) in the development of colorectal cancer.Methods Flow cytometry (FCM) was used to detect and analyse the positive expression rate of PD-1 on CD3+ T cells in peripheral blood samples of 88 colorectal cancer patients and 74 healthy volunteers,and in sixpairs of tissue specimens (colorectal cancer tumor and adjacent normal tissues).Colon cancer tumor-bearing mice models were constructed by subcutaneous implantation of murine colon cancer cell line CT26,and the changes of positive expression rate of PD-1 on CD3+ T cells in spleens and transplanted tumor tissues were also detected by FCM in different time points during five,eight,11,14,17,20 days after the model was constructed.Finally,the experimental results were analyzed by t test or variance analysis.Results The positive expression rate of PD-1 on CD3+ T cells in peripheral blood of colorectal cancer patients was significantly higher than that in healthy volunteers ((29.25 ± 9.37) ％ vs (19.35 ± 7.37) ％,t =7.375,P＜ 0.01),and the positive expression rates were significantly increased in colorectal cancer patients with lower degree of differentiation,lymph node metastasis and higher Duke's stage.The positive expression rate of PD-1 on CD3+T cells was significantly higher in colorectal cancer tissues compared to adjacent normal tissues ((52.38±12.28)％ vs (24.72±4.78)％,t=5.143,P＜0.01).In the colon cancer tumor-bearing mice models,along with the growth of transplanted tumors,PD-1 positive expression rates on the CD3+T cells of tumor-bearing mice spleens and transplanted tumors showed a gradually rising tendency.From the eighth day to the 20th day after subcutaneous transplanted colon cancer cells,the average positive expression rate of PD-1 on the CD3+T cells of tumor-bearing mice spleens rose from (52.83±6.17)％ to (77.30± 6.84) ％,and the average positive expression rate of transplanted tumors rose from (60.43 ± 2.77)％ to (90.47±4.31) ％.Conclusion There is a correlation between the expression of PD-1 on mature T cell surface and the development of colorectal cancer,and the high specific expression of PD-1 may promote the invasion and metastasis of colorectal cancer.
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After the initial episode of acute pancreatitis (AP), some patients have a tendency to relapse.With the development of imaging technologies and genetic tests, the diagnostic accuracy of the etiological factors of recurrent acute pancreatitis (RAP) such as dysfunction of sphincter of Oddi, pancreas divisum, and genetic mutations are improved.Clinical studies indicate that etiological treatment by endoscopic approaches may reduce recurrence in some RAP patients.In this article, the progress in etiology, diagnosis and treatment of RAP was reviewed.