Clinical efficacy and prognostic influencing factors of radical surgery for duodenal gastro-intestinal stromal tumor: a multicenter retrospective study / 中华消化外科杂志

Objective:To investigate the clinical efficacy and prognostic influencing factors of radical surgery for duodenal gastrointestinal stromal tumor (GIST).Methods:The retrospective cohort study was conducted. The clinicopathological data of 741 duodenal GIST patients who under-went radical surgery in 17 medical centers, including 121 cases in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 121 cases in Chinese PLA General Hospital, 116 cases in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 77 cases in Fudan University Shanghai Cancer Center, 77 cases in West China Hospital, Sichuan University, 31 cases in Guangdong Provincial People′s Hospital, 24 cases in Fujian Cancer Hospital, 22 cases in Fujian Medical University Union Hospital, 25 cases in Shengjing Hospital of China Medical University, 19 cases in Xiangya Hospital, Central South University, 23 cases in Zhejiang Cancer Hospital, 17 cases in Liaoning Cancer Hospital＆Institute, 17 cases in the First Affiliated Hospital of Xiamen University, 15 cases in Sun Yat-sen University Cancer Center, 14 cases in the First Affiliated Hospital of Nanjing Medical University, 14 cases in Zhongshan Hospital Affiliated to Xiamen University and 8 cases in General Hospital of Chinese People′s Liberation Army Air Force, from January 2010 to April 2020 were collected. There were 346 males and 395 females, aged 55(range, 17?86)years. Observation indicators: (1) neoadjuvant treatment; (2) surgical and postoperative situations; (3) follow-up; (4) stratified analysis. Follow-up was conducted using outpatient examination or telephone interview. Patients were followed up once every 3?6 months during neoadjuvant therapy and once every 6?12 months after radical surgery to detect tumor recurrence and survival of patient up to April 2022. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using chi-square test or Fisher exact probability. The Kaplan-Meier method was used to draw survival curves and calculate survival rates. Log-rank test was used for survival analysis. The COX regression model was used for univariate and multivariate analyses. Propensity score matching was done by the 1∶1 nearest neighbor matching method, and the matching tolerance was 0.02. Results:(1) Neoadjuvant therapy. Of the 741 patients, 34 cases received neoadjuvant therapy for 8(range, 3?44)months. Cases assessed as partial response, stable disease and progressive disease before the radical surgery of the 34 cases were 21, 9, 4, respectively. The tumor diameter of the 34 patients before the neoadjuvant therapy and before the radical surgery were 8.0(range, 3.0?26.0)cm and 5.3(range, 3.0?18.0)cm, with the regression rate as 31.9%(range, ?166.7% to 58.3%). (2) Surgical and postoperative situations. Of the 741 patients, 34 cases underwent radical surgery after receiving neoadjuvant therapy, and 707 cases underwent radical surgery directly. All the 741 patients underwent radical surgery successfully, in which 633, 102 and 6 cases received open surgery, laparoscopic surgery and endoscopic treatment, respectively. Of the 633 cases receiving open surgery and the 102 cases receiving laparoscopic surgery, cases with surgical resection range as pancreatoduodenectomy (PD) was 238, and cases with surgical resection range as duodenal limited resection, including duodenal wedge resection, distal gastrectomy, segmental duodenal resection, local resection of duodenal tumor or segmental duodenum combined with subtotal gastrectomy, was 497, 226, 55, 204, 12. Of the 741 patients, 131 cases had post-operative complications including 113 cases with grade Ⅰ?Ⅱ complications and 18 cases with ≥ grade Ⅲ complications of the Clavien-Dindo classification. The duration of postoperative hospital stay of the 741 patients was 13(range, 4?120)days. Of the 707 patients receiving direct radical surgery, 371 cases were evaluated as extremely low risk, low risk, medium risk of the modified National Institutes of Health (NIH) risk classification after surgery, and 336 cases were evaluated as high risk in which 205 cases receive postoperative adjuvant imatinib therapy with the treatment time as 24(range, 6?110)months. (3) Follow-up. All the 741 patients were followed up for 58(range, 7?150)months. During the follow-up, 110 patients had tumor recurrence and metastasis. The 1-, 3-, 5-year overall survival rates and 1-, 3-, 5-year disease-free survival rates of the 741 patients were 100.0%, 98.6%, 94.5% and 98.4%, 90.9%, 84.9%, respectively. The 1-, 3-, 5-year overall survival rates and 1-, 3-, 5-year disease-free survival rates of the 707 patients receiving direct radical surgery were 100.0%, 98.5%, 94.3% and 98.4%, 91.1%, 85.4%, respectively. (4) Stratified analysis. ① Analysis of prognostic factors in patients undergoing radical surgery directly. Results of univariate analysis showed that primary tumor location, tumor diameter, mitotic count, modified NIH risk classification and tumor gene information were related factors affecting the overall survival of 707 patients with primary duodenal GIST who underwent direct radical surgery ( hazard ratio=0.43, 0.18, 0.22, 0.06, 0.29, 95% confidence intervals as 0.20?0.93, 0.09?0.35, 0.10?0.50, 0.03?0.12, 0.09?0.95, P<0.05). The primary tumor location, tumor diameter, mitotic count, modified NIH risk classification were related factors affecting the disease-free survival of 707 patients with primary duodenal GIST who underwent direct radical surgery ( hazard ratio=0.65, 0.25, 0.25, 0.10, 95% confidence intervals as 0.41?1.03, 0.17?0.37, 0.15?0.42, 0.07?0.15, P<0.05). Results of multivariate analysis showed that primary tumor located at the horizontal segment of duodenum, mitotic count >5/50 high power field, tumor gene KIT exon 9 mutation were independent risk factors affecting the overall survival of 365 patients with primary duodenal GIST after removing 342 patients without tumor gene information who underwent direct radical surgery ( hazard ratio=2.85, 2.73, 3.13, 95% confidence intervals as 1.12?7.20, 1.07?6.94, 1.23?7.93, P<0.05). Tumor diameter >5 cm and mitotic count >5/50 high power field were independent risk factors affecting the disease-free survival of 707 patients with primary duodenal GIST who underwent direct radical surgery ( hazard ratio=3.19, 2.98, 95% confidence intervals as 2.05?4.97, 1.99?4.45, P<0.05). ② Effect of postoperative adjuvant therapy on prognosis of high-risk patients of modified NIH risk classification. Of the 336 patients evaluated as high risk of the modified NIH risk classification, the 5-year overall survival rate and 5-year disease-free survival rate were 94.6% and 77.3% in the 205 cases with postoperative adjuvant therapy, versus 83.2% and 64.4% in the 131 cases without postoperative adjuvant therapy, showing significant differences between them ( χ2=8.39, 4.44, P<0.05). Of the 205 patients evaluated as high risk of the modified NIH risk classification who received postoperative adjuvant therapy, there were 106 cases receiving postoperative adjuvant therapy <36 months, with the 5-year overall survival rate and 5-year disease-free survival rate were 87.1% and 58.7%, and there were 99 cases receiving post-operative adjuvant therapy ≥36 months, with the 5-year overall survival rate and 5-year disease-free survival rate were 100.0% and 91.5%. There were significant differences in the 5-year overall survival rate and 5-year disease-free survival rate between the 106 patients and the 99 patients ( χ2=13.92, 29.61, P<0.05). ③ Comparison of clinical efficacy of patients with different surgical methods. Before propensity score matching, cases with primary tumor located at bulb, descending, horizontal, ascending segment of duodenum, cases with tumor diameter ≤5 cm and >5 cm were 95, 307, 147, 34, 331, 252, in the 583 patients receiving open surgery with complete clinical data, versus 15, 46, 17, 5, 67, 16 in the 83 patients receiving laparoscopic surgery with complete clinical data, showing no significant difference in the primary tumor location ( χ2=0.94, P>0.05), and a significant difference in the tumor diameter ( χ2=17.33, P<0.05) between them. After propensity score matching, the above indicator were 16, 39, 20, 8, 67, 16 in the 83 patients receiving open surgery, versus 15, 46, 17, 5, 67, 16 in the 83 patients receiving laparoscopic surgery, showing no significant difference between them ( χ2=1.54, 0.00, P>0.05). Cases with postoperative complications, cases with grade Ⅰ?Ⅱ complica-tions and ≥grade Ⅲ complications of the Clavien-Dindo classification, duration of postoperative hospital stay, the 5-year overall survival rate and 5-year disease-free survival rate were 17, 12, 5, 11(range, 5?120)days, 92.0%, 100.0% in the 83 patients receiving open surgery, versus 9, 7, 2, 11(range, 5?41)days, 91.6%, 97.3% in the 83 patients receiving laparoscopic surgery, showing no signi-ficant difference in postoperative complications, duration of postoperative hospital stay, the 5-year overall survival rate and 5-year disease-free survival rate ( χ2=2.91, Z=3 365.50, χ2=3.02, 1.49, P>0.05) between them. There was no significant difference in complications of the Clavien-Dindo classification between them ( P>0.05). ④ Comparison of clinical efficacy of patients with primary tumor located at the descending segment of duodenum who underwent surgery with different surgical resection scopes. Before propensity score matching, cases with tumor diameter ≤5 cm and >5 cm, cases with tumor located at opposite side of mesangium and mesangium were 71, 85, 28, 128 in the 156 patients with primary tumor located at the descending segment of duodenum who underwent PD with complete clinical data, versus 92, 41, 120, 13 in the 133 patients with primary tumor located at the descending segment of duodenum who underwent duodenal limited resection with complete clinical data, showing significant differences between them ( χ2=16.34, 150.10, P<0.05). After propensity score matching, the above indicator were 28, 13, 16, 25 in the 41 patients with primary tumor located at the descending segment of duodenum who underwent PD with complete clinical data, versus 28, 13, 16, 25 in the 41 patients with primary tumor located at the descending segment of duodenum who underwent duodenal limited resection with complete clinical data, showing no significant difference between them ( χ2=0.00, 0.00, P>0.05). Cases with postopera-tive complications, cases with grade Ⅰ?Ⅱ complications and ≥grade Ⅲ compli-cations of the Clavien-Dindo classification, duration of postoperative hospital stay, the 5-year overall survival rate and 5-year disease-free survival rate were 13, 11, 2, 15(range, 9?62)days, 94.2%, 64.3% in the 41 patients with primary tumor located at the descending segment of duodenum who underwent PD with complete clinical data, versus 9, 8, 0, 15(range, 7?40)days, 100.0%, 78.8% in the 41 patients with primary tumor located at the descending segment of duodenum who underwent duodenal limited resection with complete clinical data, showing no significant difference in post-operative complica-tions, the 5-year overall survival rate and 5-year disease-free survival rate ( χ2=0.99, 0.34, 1.86, P>0.05) between them. There was no significant difference in complications of the Clavien-Dindo classification ( P>0.05) and there was a significant difference in duration of postopera-tive hospital stay ( Z=614.50, P<0.05) between them. Conclusions:The clinical efficacy of radical surgery for duodenal GIST are ideal. Primary tumor located at the horizontal segment of duodenum, mitotic count >5/50 high power field, tumor gene KIT exon 9 mutation are independent risk factors affec-ting the overall survival of patients undergoing direct radical surgery and tumor diameter >5 cm and mitotic count >5/50 high power field are independent risk factors affecting the disease-free survival of patients. There is no significant difference in the short-term efficacy and long-term prognosis between patients undergoing open surgery and laparoscopic surgery. For patients with primary tumor located at the descending segment of duodenum, the duration of postoperative hospital stay is longer in patients undergoing PD compared with patients undergoing duodenal limited resection. For patients evaluated as high risk of the modified NIH risk classification, posto-perative adjuvant therapy and treatment time ≥36 months are conducive to improving the prognosis of patients.

Uncontrolled preliminary study on the clinical efficacy of fecal microbiota transplantation in irritable bowel syndrome and its influence on gut microbiota / 中华消化杂志

Objective:To investigate the efficacy and safety of fecal microbiota transplantation (FMT) in the treatment of irritable bowel syndrome (IBS), and to explore the effects of FMT on the gut microbiota of IBS patients.Methods:From September 2016 to August 2017, at Guangzhou First People′s Hospital, 28 hospitalized IBS patients who underwent FMT treatment were enrolled. Before FMT, four and 12 weeks after FMT, all the IBS patients completed the irritable bowel syndrome quality of life scale (IBS-QOL), irritable bowel syndrome severity scoring system (IBS-SSS) and gastrointestinal symptom rating scale (GSRS). 16S rDNA sequencing was performed before FMT and four weeks after FMT. The effects of FMT on gut microbiota diversity and microbiota structure of IBS patients were analyzed respectively from the level of phylum, family and genus, and linear discriminant analysis effect size (LEfSe) was further used to screen the different bacteria. Paired t test and paired rank sum test were used for statistical analysis. Results:Twelve weeks after FMT, the scores of the six dimensions of IBS-QOL including dysthymia, behavioral disorder, auto imagery, health concerns, eating avoidance, and relationship expansion were all lower than those before FMT (43.750, 22.656 to 56.250 vs. 48.438, 32.031 to 60.938; 37.500, 18.750 to 56.250 vs. 46.429, 21.429 to 62.500; 31.250, 14.063 to 42.188 vs. 31.250, 18.750 to 50.000; 41.667, 27.083 to 56.250 vs. 50.000, 41.667 to 66.667; 54.167, 43.750 to 72.917 vs. 66.667, 58.333 to 83.333; 8.333, 0.000 to 33.333 vs. 16.667, 8.333 to 33.333, respectively), and the differences were statistically significant ( Z=-2.157, -3.429, -2.274, -3.197, -3.042 and -2.329, all P<0.05). Twelve weeks after FMT, the scores of the two dimensions of IBS-QOL including behavioral disorder and relationship expansion were both lower than those of four weeks after FMT (37.500, 18.750 to 56.250 vs. 39.286, 19.643 to 62.500 and 8.333, 0.000 to 33.333 vs. 16.670, 2.083 to 41.667, respectively), and the differences were statistically significant ( Z=-1.998 and -2.110, both P<0.05). Four and 12 weeks after FMT, the scores of IBS-SSS and GSRS were both lower than those before FMT ((190.32±106.51), (201.43±102.48) vs. (245.93±86.10) and 5.50, 4.00 to 9.00 and 5.50, 4.00 to 8.75 vs. 7.00, 6.00 to 9.75), and the differences were statistically significant ( t=4.402 and 3.848, Z=-3.081 and -3.609; all P<0.01). No serious adverse reactions occurred in the patients after FMT. At the phylum level, after FMT the abundance of Verrucomicrobia in the feces of IBS patients was richer than that before FMT (6.74% vs. 0.37%); at the family level, after FMT the abundance of Verrucomicrobiaceae in the feces of IBS patients was richer than that before FMT (6.74% vs. 0.37%); at the genus level, after FMT the abundance of Akkermansia was richer than that before FMT (6.74% vs. 0.37%); and the differences were statistically significant (all Z=-2.589, all P=0.010). The results of LEfSe method indicated that four weeks after FMT the abundance of Akkermansia in the gut microbiota of IBS patients was richer than that before FMT (6.74% vs. 0.37%), and the difference was statistically significant (linear discriminant analysis value=4.5, P=0.049). Conclusions:FMT is safe and effective in the treatment of IBS. The mechanism may be through upregulating the diversity of gut microbiota and changing the structure of gut microbiota of IBS patients.

Acute kidney injury and hepatorenal syndrome in end-stage liver disease / 临床肝胆病杂志

Acute kidney injury (AKI) and hepatorenal syndrome (HRS) are serious complications in patients with end-stage liver disease, with renal injury as the main manifestation. They are interrelated, but also different from each other. There are several types of AKI, i.e., prerenal AKI, intrarenal or intrinsic AKI, and post-renal AKI, and type 1 HRS is considered a special type of AKI. There are different therapies for different types of AKI. With the improvement in the diagnostic criteria for AKI and chronic kidney disease in recent years, the diagnostic criteria and classification of HRS have also been updated. As for pathogenesis, systemic inflammation caused by intestinal bacterial translocation is attracting more and more attention. HRS was considered functional renal injury in the past, but recent evidence suggests the existence of structural injury. Vasoconstrictor combined with albumin is the main therapeutic drug for HRS. This article reviews the diagnosis and treatment of AKI in end-stage liver disease and the recent advances in the diagnostic criteria, classification, pathology, pathogenesis, and treatment of HRS.

Correlation between the severity of peptic ulcer bleeding and Helicobacter pylori type / 中华消化杂志

Objective@#To investigate the correlation between the severity of peptic ulcer bleeding (PUB) and the serum antibody typing of Helicobacter pylori (H.pylori).@*Methods@#From January 1, 2009 to December 31, 2018, at Guangzhou First People′s Hospital, 1 444 patients diagnosed with PUB and received H. pylori serum antibody test at the same time were enrolled and divided into high-risk group (324 cases) and low-risk group (1 120 cases) according to Forrest classification, and according to recurrent bleeding, the patients were divided into recurrent bleeding group (32 cases) and non-rebleeding group (1 412 cases). Serum H. pylori specific antibodies cytotoxin-associated gene A (CagA), vacuolating cytotoxin A (VacA) and urease were detected by protein array. The correlation between H. pylori positive rate, H. pylori type, PUB and rebleeding were analyzed. Chi-square test and logistic regression analysis were used for statistical analysis.@*Results@#Among 1 444 PUB patients, there were 709 patients with gastric ulcer bleeding (GUB) and 735 patients with duodenal ulcer bleeding (DUB). Previous history of peptic ulcer disease (odds ratio (OR)=1.501, P=0.006), the maximum diameter of ulcer over 2 cm (OR=2.484, P<0.01) and H. pylori infection (OR=1.508, P=0.005) were independent risk factors of the severity of PUB. The total H. pylori positive rate was 68.49% (989/1 444), H. pylori type Ⅰ was the main type. Of which, 61.34% (549/895) were CagA and VacA double positive strains, 31.73% (284/895) were VacA single positive bacteria and CagA single positive bacteria was only 6.93% (62/895). The positive rate of H. pylori of high-risk group was higher than that of low-risk group (75.31%, 244/324 vs. 66.52%, 745/1 120), and the difference was statistically significant (χ2=8.999, P=0.004). In addition, the more serious Forrest classification, the higher the detection rate of H. pylori, and the difference was statistically significant (χ2=11.840, P=0.037). There was no significant difference in the positive rate of H. pylori between recurrent bleeding group and non-rebleeding group (81.25%, 26/32 vs. 68.20%, 963/1 412; χ2=2.469, P>0.05). According to H. pylori antibody type, H. pylori type Ⅰ infection was mainly in both high-risk group and low-risk group. The positive rate of H. pylori type Ⅰ strain of high-risk group was higher than that of low-risk group (67.28%, 218/324 vs. 60.45%, 677/1 120), and the difference was statistically significant (χ2=4.986, P=0.026). There was no statistically significant difference in the positive rate of H. pylori between GUB group and DUB group (68.41%, 485/709 vs. 68.57%, 504/735; χ2=0.005, P>0.05).@*Conclusions@#The infection of H. pylori is positively correlated with the severity of PUB, but not correlated with early ulcer rebleeding. H. pylori type Ⅰ is the main pathogenic strain of GUB and DUB, and CagA and VacA double positive strain is the most common strain.

Correlation between the severity of peptic ulcer bleeding and Helicobacter pylori type / 中华消化杂志

Objective To investigate the correlation between the severity of peptic ulcer bleeding (PUB) and the serum antibody typing of Helicobacter pylori (H.pylori).Methods From January 1, 2009 to December 31, 2018, at Guangzhou First People's Hospital, 1 444 patients diagnosed with PUB and received H.pylori serum antibody test at the same time were enrolled and divided into high-risk group (324 cases) and low-risk group ( 1 120 cases ) according to Forrest classification , and according to recurrent bleeding , the patients were divided into recurrent bleeding group (32 cases) and non-rebleeding group (1 412 cases).Serum H.pylori specific antibodies cytotoxin-associated gene A (CagA), vacuolating cytotoxin A (VacA) and urease were detected by protein array .The correlation between H.pylori positive rate, H.pylori type, PUB and rebleeding were analyzed .Chi-square test and logistic regression analysis were used for statistical analysis . Results Among 1 444 PUB patients, there were 709 patients with gastric ulcer bleeding ( GUB) and 735 patients with duodenal ulcer bleeding ( DUB).Previous history of peptic ulcer disease ( odds ratio (OR)＝ 1.501, P＝0.006), the maximum diameter of ulcer over 2 cm (OR＝2.484, P?0.01) and H.pylori infection (OR＝1.508, P＝0.005) were independent risk factors of the severity of PUB .The total H.pylori positive rate was 68.49%(989/1 444), H.pylori type Ⅰwas the main type.Of which, 61.34%(549/895) were CagA and VacA double positive strains , 31.73%(284/895) were VacA single positive bacteria and CagA single positive bacteria was only 6.93%(62/895).The positive rate of H.pylori of high-risk group was higher than that of low-risk group (75.31%, 244/324 vs.66.52%, 745/1 120), and the difference was statistically significant (χ2 ＝8.999, P ＝0.004).In addition, the more serious Forrest classification , the higher the detection rate of H.pylori, and the difference was statistically significant (χ2 ＝11.840, P＝0.037).There was no significant difference in the positive rate of H.pylori between recurrent bleeding group and non-rebleeding group (81.25%, 26/32 vs.68.20%, 963/1 412; χ2 ＝2.469, P＞0.05).According to H.pylori antibody type, H.pylori typeⅠinfection was mainly in both high-risk group and low-risk group.The positive rate of H.pylori typeⅠstrain of high-risk group was higher than that of low-risk group (67.28%, 218/324 vs.60.45%, 677/1 120), and the difference was statistically significant ( χ2 ＝4.986, P ＝0.026).There was no statistically significant difference in the positive rate of H.pylori between GUB group and DUB group (68.41%, 485/709 vs. 68.57%, 504/735; χ2 ＝0.005, P＞0.05).Conclusions The infection of H.pylori is positively correlated with the severity of PUB, but not correlated with early ulcer rebleeding .H.pylori typeⅠis the main pathogenic strain of GUB and DUB, and CagA and VacA double positive strain is the most common strain .

Analysis of clinicopathological characteristics and changing trend of 77 978 cases of colorectal polyps and colorectal cancer detected by colonoscopy in the past 27 years / 中华消化杂志

Objective To explore the detection rate of colorectal polyps and colorectal cancer under colonoscopy,and their clinicopathological characteristics and changing trend.Methods From January 1,1991 to December 31,2017,at Guangzhou First People's Hospital,the colorectal polyps and colorectal cancer diagnosed by colonoscopy were collected.The gender,age,location of colorectal polyps and colorectal cancer and pathological type were retrospectively analyzed.Chi-square test was performed for statistical analysis.Results Among 77 978 patients underwent routine colonoscope examination,male and female accounted for 50.18％ (39 132/77 978) and 49.82％ (38 846/77 978),respectively;and the age was (52.8 ± 15.7)years.A total of 23 240 patients with colorectal polyps were detected,and the total detection rate was 29.80％.The detection rate of colorectal polyps of male patients was higher than that of female patients (35.11％,13 741/39 132 vs.24.45％,9 499/38 846),and the difference was statistically significant (x2 =1 059.16,P ＜0.01),the age was (59.2 ± 14.6) years.The most common location of polyps was left colon,accounted for 48.56％ (11 286/23 240).The pathological type was adenoma (60.99％,13 726/22 504).Totally 5 204 patients with colorectal cancer were detected,the detection rate of 6.67％;the detection rate of male was higher than that of female (7.71％,3 018/39 132 vs.5.63％,2 186/38 846),and the difference was statistically significant (x2 =136.07,P ＜0.01),the age was (63.5 ± 12.5) years.The colorectal cancer was predominantly located in the left colon (73.71％,3 836/5 204).And the common pathological type was moderately differentiated adenocarcinoma (83.61％,4 351/5 204).Based on a nine-year as a time period,the detection rate of eolorectal polyps was 12.91％ (599/4 639) from 1991 to 1999,22.74％ (3 784/16 642) from 2000 to 2008,and 33.26％ (18 857/56 697) from 2009 to 2017,showing a significant upward trend (x2 =1 353.45,P ＜0.01).The detection rate of colorectal cancer was 9.03％ (419/4 639) from 1991 to 1999,8.59％ (1 430/ 16 642) from 2000 to 2008,and 5.92％ (3 355/56 697) from 2009 to 2017,showing a significant downward trend (x2 =191.89,P ＜ 0.01).There was no significant change in pathological types of colorectal polyps in 27 years (x2 =201.08,P ＞ 0.05);while moderately differentiated adenocarcinoma increased,however,the highly and poorly differentiated type decreased (x2 =249.27,P ＜ 0.01).No significant changes in lesion location was found (x2 =117.11 and 134.82,both P ＞ 0.05).Conclusions The detection rate of colorectal polyps increased in the past 27 years,while colorectal cancer decreased.The elderly men are susceptible populations.The most common location of colorectal polyps and cancer are left colon,which should be carefully examined during colonoscope examination.

Expression and Clinical Significance of Pin1 and CyclinD1 in Gastrointestinal Stromal Tumor / 中国医科大学学报

Objective To investigate the relationship between Pin1 and CyclinD1 expression and the development of gastrointestinal stromal tu?mor(GIST). Methods The protein and mRNA expression of Pin1 and CyclinD1 in 85 samples of GIST and adjacent non?cancerous tissues were detected by immunohistochemistry and real?time quantitative polymerase chain reaction. Results The expression rate of Pin1 protein in GIST tis?sues(64.7%;55/85)was higher than that in adjacent non?cancerous tissues(26.7%;4/15). Similarly,the expression rate of CyclinD1 protein in GIST tissues(42.3%;36/85)was higher than that in adjacent non?cancerous tissues(6.7%;1/15). The expression of Pin1 and CyclinD1 mRNA in GIST tissues was 7.03 and 5.53 times that in adjacent non?cancerous tissues ,respectively. There was no obvious correlation between the expres?sion of Pin1 and clinicopathological parameters. The expression of CyclinD1 was positively correlated with the grade of NIH and tumor diameter (P<0.05). There was a significant correlation between the expression of Pin1 and CyclinD1 in GIST tissues. Conclusion The expression of both Pin1 and CyclinD1 was up?regulated in GIST tissues. The significant correlation between the expression of Pin1 and CyclinD1 in GIST tissues sug?gests that their synergistic effect promotes carcinogenesis and the development of GIST.

Current status of surgical treatment of gastric gastrointestinal tumors: a national multi-center retrospective study / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To retrospectively analyze the clinicopathology of patients with gastric gastrointestinal stromal tumor(gGIST) who underwent radical excision within 18 years in 10 domestic medical centers in order to understand the status of domestic surgical treatment of gGIST.</p><p><b>METHODS</b>Clinicopathological data of gGIST patients undergoing radical excision in 10 medical centers from January 1998 to January 2016 were collected, and their operational conditions, postoperative adjuvant therapy, gene detection and survival were analyzed retrospectively.</p><p><b>RESULTS</b>A total of 1 846 cases were recruited in this study, including 246 cases from Guangdong General Hospital, 331 cases from Sun Yat-sen University Cancer Center, 374 cases from Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, 342 cases from Nanfang Hospital of Southern Medical University, 265 cases from Fujian Medical University Union Hospital, 148 cases from Fudan University Shanghai Cancer Center, 49 cases from West China Hospital of Sichuan University, 43 cases from Peking University Cancer Hospital and Institute, 28 cases from the 81st Hospital of Pepole's Liberation Army(PLA), 20 cases from Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute. There were 918 male (49.7%) and 928 female patients (50.3%) with median onset age of 59(18 to 95) years old. Fundus(735 cases, 39.8%) and body (781 cases, 42.3%) of stomach were the common sites of lesions. The average size of tumor was (5.3±4.6) cm. There were 1 421 cases with mitotic count ≤5(77.0%). According to the operation procedure, 924 cases (50.1%) underwent laparoscopic surgery, 759 cases (41.1%) laparotomy, 120 cases (6.5%) endoscopic surgery, and 20 cases (1.1%) laparoscopic combined with endoscopic surgery, 6 cases (0.3%) laparoscopic excision surgery through gastric wall and cavity, and 17 cases (0.9%) laparoscopy and then were transferred to laparotomy. Wedge excision were performed in 1 308 cases (70.9%), proximal gastric excision in 226 cases(12.2%), distal gastric excision in 92 cases (5.0%), total gastrectomy in 94 cases (5.1%), and local gastrectomy in 126 cases(6.8%). Multi-visceral excision was performed in 138 cases, and the splenectomy was performed in 83 cases(60.1%)with the highest ratio. According to modified NIH classification, 399 cases(21.6%) were extreme low risk, 580 cases(31.4%) were low risk, 424 cases(23.0%) were moderate risk, 443 cases (24.0%) were high risk. A total of 461 cases received postoperative imatinib adjuvant therapy, accounting for 53.2%(461/867) of patients with moderate and high risk. Among 1 846 cases, 1 402 cases (75.9%) had complete follow-up data and the median follow-up time was 33.6 (0.1 to 158) months. The 5-year survival rates of extreme low risk, low risk, moderate risk and high risk were 100%, 98.5%, 92.5%, and 79.2% with significant difference(P=0.000).</p><p><b>CONCLUSIONS</b>Gastric GIST occurs mostly in fundus and body of stomach in China. Wedge excision is the main operational procedure and laparoscopic operation is over 50%. General prognosis of gastric GIST is quite good.</p>

Efficacy of Hydrochloride Phenazopyridine on Postoperative Pain of Cystoscopy / 中国康复理论与实践

Objective To explore the clinical effect of hydrochloride phenazopyridine on relieving the pain after cystoscopy. Methods 60 male patients undergoing cystoscopy were divided into observation group and control group according to the block randomization meth-od with 30 patients in each group. 1 h after cystoscopy, the observation group was given orally hydrochloride phenazopyridine 0.2 g, 3 times a day for 0.6 g totally. The control group was not treated with oral medication for pain. The pain degree was evaluated with Numerical Rat-ing Scale (NRS), and the side effects were recorded. Results There was no significant difference in NRS score immediately after cystoscopy between 2 groups (P=0.725). The NRS score was lower in the observation group than in the control group 24 h after cystoscopy (P=0.002). Conclusion Hydrochloride phenazopyridine can effectively relieve the postoperative pain of cystoscopy.

Predictive Value of Microvessel Density and Blood Vessel Invasion in Hepatic Metastasis from Early-stage Rectal Cancer / 中国医科大学学报

Objective To explore the predictive value of microvessel density(MVD)and blood vessel invasion(BVI)in hepatic metastasis from early-stage rectal cancer.Methods MVD and BVI in the tumor tissue from 380 patients with stage I and II rectal cancer was determined by immunohistochemical S-P method with anti-CDIOS antibody and anti-CD34 antibody,respectively.Multinomial logistic regression was performed to analyze the predictive value of MVD and BVI in hepatic metastasis from early-stage rectal cancer.Results CD105 was expressed in newborn blood vessels,not in normal blood veseels.in the rectal cancer tissue.MVD was correlated with histological type and infiltration depth(P＜0.05).Besides histological type and infiltration depth,BVI was also correlated with histological grade.Multivariate analysis revealed that histological type,tumor infiltration depth,BVI,adjuvant therapy,and MDV were independent predictors of hepatic metastasis from rectal cancer.The risk of hepatic metastasis in patients with postive expression of either MVD or BVI or both were significant higher than that in patients with low expression of MVD and those without BVI expression[hazard ratio(95%CI),4.210(2.182-11.214)].Conclusion BVI and MVD are independent predictors of hepatic metastasis from stage I and II rectal cancer.Combined detection of MVD and BVI may help to predict the clinical outcome of patients with early-stage rectal cancer.

Association between the polymorphism of A9570G in angiotensin I converting enzyme 2 gene and cardiac dysfunction and ventricular remodeling after myocardial infarction / 中国医师杂志

Objective To determine the effects of polymorphism of A9570G in angiotensin I converting enzyme 2 gene ( ACE2) gene on cardiac dysfunction and ventricular remodeling after myocardial infarction. Methods 252 patients with old myccardial infarction were included in this study. They were classified according to their polymorphisms of ACE 2 gene analyzed by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). Echocardiograms were used to determine left ventricular end diastolic diameters (LVEDd) , Left ventricular mass index (LVMI) , mitral flow pattern early diastolic and late diastolic peak flow ratio (E/A) and left ventricular ejection fraction ( LVEF). Results In male, LVEDd, LVMI, and LVEF had significant difference among ACE2 genotypes ( t = 2. 609,3.527and 2.063, P =0.010,0.001 and 0.041), and no significant differences in E/A( t =0.689,P =0.492). In female,LVEDd, LVMI, E/A and LVEF had no significant difference among ACE2 genotypes( F =0. 848, 0.077,0. 985 and 1.611, P = 0. 432,0. 926,0. 377 and 0. 205 ). Conclusion The polymorphism of A9570G in ACE2 gene may be associated with cardiac dysfunction and ventricular remodeling after myocardial infarction in male. ACE 2 gene polymorphism may be a genetic factor on cardiac dysfunction and ventricular remodeling after myocardial infarction.

Epidemiology of nonalcoholic fatty liver disease: a follow-up study for 4 years / 中华消化杂志

Objective To investigate the prevalence,incidence,death causes and natural course of nonalcoholic fatty liver disease (NAFLD) as well as the risk factors of NAFLD development in population of Guangdong province.Methods On the basis of previous epidemiological survey in 2005,3545 subjects were followed up (medium 4 years) for death causes.Of which,624 subjects (re-survey group) received interview,physical examinations,biochemical tests and ultrasonography again.The natural course and the risk factors of the NAFLD were analyzed.Results Of 3543 subjects,219subjects were failed to followed up and 4 out of 467 NAFLD patients (8.6‰) died of cardiovascular and cerebrovascular diseases during follow-up period.In rest 2857 subjects,22 (7.7‰) died of cardiovascular/cerebrovascular diseases and cancers.However,there were 117 NAFLD patients in resurvey group at the baseline.The NAFLD remained in 51 (43.6%) patients,aggravated in 26 (22.2%),alleviated in 21 (18.0%) and regressed in 19 (16.2%) at the endpoint.Meanwhile 185(36.5 %) out of 507 normal subjects developed NAFLD at the endpoint.The standard prevalence of NAFLD increased from 10.5% (2005) to 22.6% (2009,P<0.05).The standard incidence was 4.9% per year with male (5.1%) being higher than female (4.7%,P<0.05).The cumulative incidence was significantly higher in urban cities (43.1%) than in rural areas (27.4%,P<0.05).Cox proportional hazards regression showed that the age (OR= 1.893),waist circumference (OR=2.512),waist-to-hip ratio (WHR,OR= 1.400),body mass index (BMI,OR=2.581) and serum cholesterol levels (OR = 1.587) were associated with the development of NAFLD (P < 0.05).Multivariate regression logistic analysis revealed that age and BMI were associated factors for NAFLD.Decreased waist circumference was prone to remission.Conclusions The higher prevalence and incidence of NAFLD were noted in population of Guangdong province.The NAFLD patients mainly died of cardiovascular/cerebrovascular diseases,but not liver disease.Obesity,aging and dyslipidemia are high risk factors for NAFLD development.

A nested case-control study on genetic polymorphisms for patients with non-alcoholic fatty liver disease / 中华消化杂志

Objective To investigate the relationship between the genetic polymorphisms, which played roles in the pathogenesis of metabolic syndrome (MS), and susceptibility of non-alcoholic fatty liver disease (NAFLD) in Han people in Guangdong province. Methods The subjects were selected from an epidemiologie survey in Guangdong province. Fifty to 117 adult NAFLD patients, who met the criteria of Chinese guideline for diagnosis of NAFLD and had typically clinical, biochemical signs and abdominal ultrasonography, were recruited in the study. By using 1 : 1 matched method of nested case-control study, same numbers of people without NAFLD were included as controls. The genetic analyses was performed by using genomic DNA extracted from peripheral blood. Polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) was applied to detect the single nucleotide polymorphisms (SNPs) at 9 sites in 7 candidate genes. Results Most SNPs of the genes were related to the susceptibility of NAFLD. Some of them had positive relation (increasing the risk) such as tumor necrosis factor (TNF)-α-238, adiponectin-45, leptin-2548, peroxisome proliferator-activated receptors (PPAR) γ-161 and phosphatidylethanolamine N-methyltransferase (PEMT)-175. Some had negative relation (decreasing the risk) including adiponectin-276 and hepatic lipase-514. And some had no relation (TNF-α-380 and PPAR g coactivator-1α-482). Conclusion Most cytokines' SNPs of candidate genes discovered in MS patients are related to the susceptibility of NAFLD.

Factors analysis on liver metastasis from rectal cancer / 中国医师进修杂志

Objective To detect the clinical factors related with liver metastasis in young patients with rectal cancer.Methods Three hundred and fifty young patients with rectal cancer were collected to set up the database.Single and multi-factor Logistic regression was applied to indicate the independent factors relating to liver metastasis.The regression equation to predict probability of liver metastasis from rectal cancer was established.Results Liver metastasis was 120 cases (34.3%).Single-factor analysis revealed that patho-organization type,pathologytype,infiltration extent,blood vessel invasion (BVI),TNM stage,operation character,the preoperative level of carcino-embryonic antigen,histology grading were related with liver metastasis.Multi-factor analysis revealed that only BVI (P=0.001),TNM stage (P=0.001),pathoorganization type (P=0.005),the preoperative level of CEA (P=0.008) and operation character (P=0.032) were independent factors to predict probability of liver metastasis.Conclusions Rectal cancer of young patients who being with BVI,advanced phase,high preoperative level of CEA,radical operation or poor differentiation degree,are apt to develop liver metastasis.They should be given further individualized intensive adjuvant treatment.

A method of medical image registration based on frequency domain and time domain / 中国组织工程研究

To resolve the problems of relativity translation variant and relativity rotation variant existed in the two medical images, combining the removing characteristics and rotating characteristics in image signal Fourier transform, a method of medical image registration combining with frequency domain and time domain is put forward based on the well-known Fourier property. The method decouples the estimation of rotation and translation. It determines rotation parameters based on amplitude spectrum correlation in frequency domain and estimation translation parameters based on intensity value correlation in time domain. The experimental results of nuclear medical image registration and multi-modality medical image registration show that this method is a very robust and fast registration method with high accuracy.

Stem cells transplantation for experimental colitis in rats / 中华消化杂志

Objective To investigate the effect of transplantation of allogeneic bone marrow hematopoietic cells(HCs)and mesenchymal stem cells(MSCs)on experimental colitis(EC)in rats.Methods The HCs and MSCs obtained from SD male rats were cultured and expanded in vitro.In experiment 1 and 2 groups,HCs were labeled with bromodeoxyuridine(BrdU)and MSCs were obtained using the tube wall attach technique,respectively.Seventy-two female rats were infused with trinitrobenzene sulfonic acid(TNBS)to induce EC models.After 24 hours,HC or MSC suspensions were injected into the rats in experimental 1(n=18)and 2(n=18)groups via caudal veins,respectively.Control animals were injected with isotonic saline.The whole colon was removed on day 7,14 and 21 after transplantation and examined histopathologically.BrdU labeled HCs were tested with immunohistochemical staining and MSCs were detected for sex-determining gene(sry)by PCR.Results EC models were successfully established.The HCs or MSCs grew rapidly in the culture suspension.On day 7,14 and 21 after transplantation,the BrdU immunoreactive cells were detected in the colon(6/6),and the positive expression of the sry gene was found in 1/6,2/6 and 3/6,respectively.No positive labeled cell was found in controls.There was no significant improvement in histopathological scores on the colon in two experimental groups compared with the controls.Conclusions Allogeneic HCs and MSCs may localize in the colon of EC models.The ability of localization is higher in HCs than MSCs.The transplantation of HCs and MSCs can not obviously improve histopathologically.

Smoking, Alcohol Drinking and Gallstone Disease in General Male Population / 中国慢性病预防与控制

Objective To explore the relationship between smoking, alcohol drinking and gallstone disease in general male population in Guangdong. Methods Each subject received a questionnaire and took an upper abdominal ultrasound examination in a cross-sectional study. Results The prevalence of gallstone disease became higher with the increase of amount of cigarette smoking per day (trend test ?2=5.542, P=0.019) and with the total amount of cigarette smoking in their life (trend test ?2=7.302, P=0.007), these significance remained after controlling well-known risk factors for gallstone disease such as age and body mass index (BMI) (OR=1.269,95%CI: 1.018~1.580 for cigarette smoking per day and OR=1.295, 95%CI: 1.020~1.646 for total ). Little to moderate alcohol drinking (

Endoscopic ultrasonography in the diagnosis and staging of gastric cancer / 中华消化内镜杂志

Objective To assess the clinical significance of endoscopic ultrasonography (EUS) in the diagnosis and preoperative staging of gastric cancer. Methods EUS was carried out in 22 patients inclu-ding 17 gastric cancer patients and 5 patients in suspicion. Helical CT scanning was performed in all of the patients and fine needle aspiration biopsies ( FNAB) were administrated to 5 suspicious patients. Compared the results of operation and pathology with those of tumor staging by estimating the depth of tumor invasion ( T) , local lymph node metastasis ( N) and metastasis to neighboring or remote organs ( M) in order to esti-mate the accuracy of diagnosis and TNM staging. The sensitivity and specificity of tumor-node-metastasis staging of gastric cancer by EUS were compared with those of the spiral CT according to the final histopatho-logical results. Results In 5 suspicious patients specimens were successfully obtained by FNAB under the guide of EUS with the pathological diagnosis of adenocarcinoma in 4 cases and signet ring cell carcinoma, 1 case. All patients underwent radical gastrectomy except one in T1N0M0, staging was treated by endoscopic mucosal resection (EMR). The sensitivity and specificity of EUS in T, N, and M stage were 84.9% and 74. 2% , 92. 1% and 77. 1% , 63. 4% and 87. 5% respectively; whereas those of CT in T, N, and M stage were 27. 3% and 75% , 31.5% and 100% , 50% and 100% respectively. The sensitivity of EUS in T and N staging were higher than those of CT with significant statistical difference (P