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Objective:To explore the effect of spontaneous breathing during induction of general anesthesia on atelectasis in patients undergoing laparoscopic resection of gastrointestinal tumors.Methods:A total of 60 patients aged 18-60 years scheduled for laparoscopic resection of gastrointestinal tumors under general anesthesia in the First Hospital of Shanxi Medical University from October 2021 to August 2022 were selected. The body mass index was 18.5-28.0 kg/m 2 and the American Society of Anesthesiology grade wasⅠ-Ⅱ. All patients were divided into the spontaneous breathing group (group S, 30 cases) and the controlled breathing group (group C, 30 cases) according to the random number table method. Patients in group S received 0.2-0.3 mg/kg etomidate (pumping at the speed of 200 ml/h) and 2 μg/kg remifentanil (slowly injected more than 30 s) for anesthesia induction; patients in group C received 0.2-0.3 mg/kg etomidate and 2 μg/kg remifentanil (slowly injected more than 30 s) and 0.2 mg/kg cisatracurium. After bispectral index (BIS) decreased to 80, the patients had no response to the language stimulation; and then the mask was used to closely fit the face and maintain spontaneous breathing in group S; patients in group C received manual positive pressure ventilation. Atelectasis scores were collected immediately after endotracheal intubation (T 1) and 15 min after transferring to the recovery room (T 3), and oxygenation index (OI) was collected 5 min after endotracheal intubation (T 2) and at T 3. The postoperative pulmonary complication (PPC) on the 3rd day after the operation was recorded. Results:A total of 56 patients were finally enrolled, 27 cases in group S and 29 cases in groups C. Compared with group C, the atelectasis score of group S at T 1 and T 3 decreased [T 1: (2.4±0.8) scores vs. (4.2±0.7) scores, t = -9.12, P < 0.001; T 3: (8.2±1.8) scores vs. (10.5±1.6) scores, t = -4.96, P < 0.001]. The OI increased at T 2 and T 3 in group S [T 2: (334±11) mmHg (1 mmHg = 0.133 kPa) vs. (323±13) mmHg, t = 3.45, P = 0.001; T 3: (362±23) mmHg vs. (347±25) mmHg, t = 2.31, P = 0.025]. The incidence of PPC was 20.7% (6/29) and 18.5% (5/27), respectively in group C and group S on the 3rd day after the operation, and the difference was statistically significant ( χ2 = 0.04, P = 0.838). Conclusions:Maintaining spontaneous breathing during induction of general anesthesia can reduce atelectasis caused by general anesthesia and improve oxygenation for patients undergoing laparoscopic resection of gastrointestinal tumors.
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In order to evaluate the efficacy and safety of submucosal tunneling endoscopic resection (STER) for the treatment of multiple submucosal tumors (SMT) in the upper gastrointestinal tract, data of 24 cases with upper gastrointestinal SMT (including 56 SMT lesions) treated at Taizhou Municipal Hospital and Shanghai East Hospital from January 2016 to June 2021 were collected for retrospective observation. The treatment effect, occurrence of major adverse events and follow-up results were analyzed. The results showed that 19 cases (79.2%) underwent tumor resection through one tunnel, and 5 cases (20.8%) underwent tumor resection through two tunnels. The length of the tunnel was 3-12 cm, with an average of 6.2 cm. The surgical time ranged from 19 to 130 minutes, with an average of 55.6 minutes. The overall resection rate was 89.29% (50/56). The hospitalization time was 2-7 days, with an average of 3.5 days. Major adverse events occurred in 2 cases (8.3%), all of which were mucosal injuries, and were cured with titanium clips and self expanding metal sealing stents. During a follow-up period of 6-64 months, with an average of 32.0 months, there was no residual tumor, tumor implantation tunnel, local recurrence, distant metastasis or death. To sum up, STER is safe and feasible for the treatment of multiple SMT in the upper gastrointestinal tract. The main resection method is single tunnel, and double tunnel is required for multiple SMT far apart.
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Gastrointestinal tumors(GT)are characterized by both high malignancy and high mortality and have become the major diseases for prevention in the elderly.GT often present detectable changes, including bleeding and abnormal mucosal morphology.However, many technical difficulties remain in accurately monitoring the tumor itself and related abnormal lesions mentioned above, which are the key factors affecting the early detection rate of gastrointestinal tumors.In recent years, with progresses in artificial intelligence(AI)applications for digestive endoscopy image analysis, biosensors, new biomarkers and other areas, AI holds promise for the detection of bleeding, morphological and structural abnormalities of the mucosa, tumors and other major disorders.Here we review the progress of AI applications in geriatric digestive diseases affecting digestive organs and the mucosa in light of morphology and function, to provide a reference for reducing the incidence of both geriatric emergencies and GT.
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Objective:To investigate the clinicopathological features of metastatic ovarian tumors from digestive system.Methods:The clinicopathological and follow-up data of 21 patients with metastatic ovarian tumor from digestive system were collected from April 2006 to January 2020 in the Maternity Hospital of Dalian Women and Children′s Medical Group. The pathological slides were reviewed, immunostained by EnVision method, and the clinicopathological features were summarized.Results:Twenty-one cases, aging from 26 to 66 years (average 41.5 years), were treated with chief complaint of abdominal pain, menstrual disorder or pelvic mass. The incidence of bilateral ovarian tumor was 81.0% (17/21), with a diameter of 0.2 to 20.0 cm. Most of tumors were solid and cystic, nodular or lobulated. Microscopically, tumor cells diffusely infiltrated ovarian stroma, accompanied with stromal proliferation and luteinization obviously. Metastatic gastric cancers were mainly signet-ring cell carcinomas, with cytokeratin 7 (CK7) positive, tail homeobox transcription factor 2 (CDX2) and cytokeratin 20 (CK20) partially positive, paired-box gene 8 (PAX8) and special AT-rich sequence binding protein 2 (SATB2) negative; metastatic colorectal cancers were mainly characterized by atypical glands, forming single cells or cribriform structure; metastatic appendix tumors were mostly low-grade tumor cells similar to ovarian borderline tumors and abundant extracellular mucinous, accompanied by peritoneal pseudomyxoma. The CK7 and PAX8 were negative, while the CK20, CDX2 and SATB2 were positive in patients with metastatic ovarian tumor from colorectal cancer and appendix tumor. The average follow-up time was 36 months, 18 patients relapsed within 5 years, 15 patients died; 3 patients were lost to follow-up.Conclusions:The ovarian metastatic tumors from digestive system are mostly bilateral, mainly solid and cystic. Microscopically, they show diffuse interstitial infiltration of tumor cells. The diagnosis should be combined with medical history, clinical symptoms, gross and histological features of tumor and immunohistochemistry, which should be mainly differentiated from primary mucinous ovarian tumor. The overall prognosis is poor.
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Tumor-associated inflammation is closely related to the development of tumors. The ratio of lymphocytes to C-reactive protein (LCR) is a new marker reflecting the inflammatory state of the body, which plays an important role in predicting the prognosis of digestive system neoplasms. Compared with the detection of lymphocytes or C-reactive protein alone, this marker has higher sensitivity and accuracy, and can provide a new direction for clinical diagnosis and treatment of digestive system neoplasms.
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Objective:To study the clinical efficacy of acupuncture at Zusanli (ST 36)combined with Traditional Chinese Medicine (TCM) enema in the treatment of gastroparesis syndrome after gastrointestinal tumor operation.Methods:A total of 96 patients with gastroparesis syndrome after gastrointestinal tumor surgery in our hospital from June 2016 to May 2021, who met the inclusion criteria, were randomly divided into three groups by random drawing, with 32 in each group. The control group took mosapride citrate tablets orally, the TCM enema group added TCM enema on the basis of the control group, and the combined group added acupuncture Zusanli (ST 36)on the basis of the TCM enema group. All three groups were treated continuously for 4 weeks. The main syndromes were scored before and after treatment. The levels of serum gastrin (GAS), motilin (MTL) and somatostatin (SS) were detected by radioimmunoassay. The gastric electrophysiological parameters (waveform response area, waveform frequency and average amplitude) were detected by intelligent dual channel gastrointestinal electrograph, the adverse reactions during treatment were recorded, and the clinical efficacy was evaluated.Results:The total effective rate was 96.9% (31/32) in the combined group, 81.3% (26/32) in the TCM enema group and 68.8% (22/32) in the control group. There was significant difference among the three groups ( χ2=8.72, P=0.013). The scores of abdominal fullness and distention, fatigue, belching acid reflux, dry mouth and bitter mouth in the combined group were significantly lower than those in the TCM enema group and the control group ( F values were 16.39, 13.21, 11.28 and 10.23, respectively, P<0.001). After treatment, the levels of GAS [(140.62±15.19) ng/L vs. (128.79±14.34) ng/L, (115.98±12.40) ng/L, F=21.09], MTL [(268.66±28.21) ng/L vs. (245.89±25.24) ng/L, (230.78±22.43) ng/L, F=30.29] and SS [(70.58±8.17) ng/L vs. (65.50±7.76) ng/L, (59.73±7.05) ng/L, F=33.19] in the combined group were significantly higher than those in the TCM enema group and the control group ( P<0.01). The waveform response area [(172.62±17.14) μV/s vs. (158.56± 15.32) μV/s, (145.48±14.13) μV/s, F=20.24], waveform frequency [(3.86±0.61) cpm vs. (3.29±0.50) cpm, (3.01±0.63) cpm, F=13.17] and average amplitude [(86.51±8.98) μV vs. (75.70±7.93) μV, (68.65±7.46) μV, F=28.11] were significantly higher than those in TCM enema group and control group ( P<0.01). During the treatment period, the incidence of adverse reactions was 18.8% (6/32) in the combined group, 15.6% (5/32) in the TCM enema group and 12.5% (4/32) in the control group. There was no significant difference between the three groups ( χ2=0.47, P=0.789). Conclusion:Acupuncture at Zusanli (ST 36) combined with TCM enema can improve the TCM syndrome scores, gastrointestinal hormone level and gastric electrophysiological parameters of patients with gastroparesis syndrome after gastrointestinal tumor operation, improve the curative effect with safety.
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Objective To investigate the association of biliary, pancreatic, and ampullary tumors with the onset of acute pancreatitis (AP) and the clinical features of tumor-induced AP by retrospectively analyzing the clinical data of patients with tumor-induced AP. Methods Related clinical data were collected from the patients with AP who were admitted to The First Affiliated Hospital of Zhengzhou University from January 2013 to August 2021. The etiological composition of AP was analyzed, as well as the change in the incidence rate of tumor-induced AP; the clinical features of AP were compared between tumor-induced and non-tumor-induced AP and between the tumors at different locations to explore the pathogenesis of tumor-induced AP. For normally distributed continuous data, the t -test was used for comparison between two groups; a one-way analysis of variance was used for comparison between multiple groups, and the SNK- q test was used for further comparison between two groups. For non-normally distributed continuous data, the Mann-Whitney U test was used for comparison between two groups; the Kruskal-Wallis H test was used for comparison between multiple groups, and the Wilcoxon rank-sum test was used for further comparison between two groups. The chi-square test or the Fisher's exact test was used for comparison of dichotomous categorical data between groups, and the goodness-of-fit test was used for comparison of polytomous categorical data between groups. The receiver operating characteristic (ROC) curve was used to evaluate the differential factors for pancreatic tumor-induced AP, and a multivariate logistic regression analysis was used to investigate the independent predictive factors for tumor-induced AP. Results A total of 8106 patients with AP were enrolled, among whom 84 patients (1.04%) had tumor-induced AP (tumor group). The tumor group had a significantly higher mean age than the non-tumor group ( t =6.050, P < 0.001). The mean time from initial onset of AP to tumor diagnosis was 7.38 months. Among the 84 patients with tumor-induced AP, 75 (89.2%) had mild AP (MAP), 8 (9.5%) had moderate severe AP, and 1(1.2%) had severe AP; as for the origin of tumor, 11(13.1%) had tumor originating from the lower biliary tract, 13(15.5%) had tumor originating from the ampulla, and 60(71.4%) had tumor originating from the pancreas. Recurrence of AP (risk ratio [ RR ]=8.362, 95% confidence interval [ CI ]: 3.162-22.115, P < 0.001), pancreatic duct dilatation ( RR =10.996, 95% CI : 3.871-31.236, P < 0.001), bile duct dilatation ( RR =7.738, 95% CI : 2.521-23.752, P < 0.001), and leukocyte count ( RR =0.766, 95% CI : 0.666-0.881, P < 0.001) were independent predictive factors for tumor-induced AP. Conclusion Tumor-induced AP is common in middle-aged and elderly men, with the clinical manifestations of MAP, easy recurrence, pancreatic duct dilatation/bile duct dilatation, and a persistent increase in the tumor marker CA19-9. Imaging examination of the biliary, pancreatic, and ampullary regions should be enhanced for AP with the above characteristics and no apparent trigger, and follow-up should be strengthened to avoid the missed diagnosis of tumor and the influence on prognosis.
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To evaluate the diagnostic value of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for portal vein tumor thrombus, data of patients with digestive system malignant tumors combined with portal vein tumor thrombus diagnosed by CT or magnetic resonance imaging who underwent EUS-FNA from April 2015 to July 2020 in the Second Affiliated Hospital of Soochow University were collected. A total of 7 patients were included, with 2 cases of primary hepatocellular carcinoma, 3 cases of primary pancreatic carcinoma and 2 cases of primary gastric cancer. EUS-FNA was successfully performed in 7 patients with portal vein embolus. Pathological examination of portal vein embolus showed 5 cases of malignant tumor. No tumor cell was found in 2 cases. There were no complications such as local hematoma, abdominal hemorrhage or infection in all patients. EUS-FNA is safe and effective for patients diagnosed as having malignant tumors with portal vein embolus.
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Objective:To identify the potential pathogenic genes for perioperative neurocognitive disorder (PND) in the patients with digestive system tumors.Methods:The gene expression data of esophageal cancer, gastric cancer, colon cancer, rectal cancer and liver cancer in The Cancer Genome Atlas database were analyzed by bioinformatics analysis method, and the differentially expressed genes in tumor tissues in above-mentioned disease samples were identified compared with para-carcinoma tissues.Secretory proteome differential genes with the same expression trend in digestive system tumors were obtained by comparing with human secretory proteome genes.The correlation between secretomics and PND was determined by comparing with the GeneCards database.Hub genes were identified through PPI network construction and calculation, and the functions and signaling pathways of the above-mentioned differential genes were identified through GO and KEGG enrichment analysis.Results:Compared with para-carcinoma tissues, the expression of 2 640 genes was significantly up-regulated and the expression of 1 423 genes was down-regulated in esophageal cancer tissues; the expression of 3 748 genes was up-regulated and the expression of 908 genes was down-regulated in gastric cancer samples; the expression of 2 684 genes was up-regulated and the expression of 2 678 genes was down-regulated in colon cancer samples; the expression of 2 876 genes was up-regulated and the expression of 2 945 genes was down-regulated in rectal cancer samples; the expression of 1 484 genes was up-regulated and the expression of 723 genes was down-regulated in hepatocellular carcinoma samples.Among them, the expression of the encoding genes of 53 secreted proteins was uniformly up-regulated and the expression of the encoding genes of 20 secreted proteins was uniformly down-regulated in the above tumors.Twenty up-regulated genes and 3 down-regulated genes were associated with PND.PPI network analysis showed that MMP9 was the hub gene.The results of GO and KEGG analysis suggested that differentially expressed genes were mainly related to receptor-ligand activity, cytokine activity and chemokine activity, and were mainly enriched in signaling pathways related to cell cycle and cellular senescence.Conclusions:About 23 differentially expressed genes in digestive system tumors are potentially related to PND, of which MMP9 and other genes may be the hub genes, mainly acting on receptor-ligand binding, regulation of cytokine and chemokine activity, cell cycle, cellular senescence and other related signaling pathways.
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Introducción: En el proceso de formación del residente en Gastroenterología se perciben limitaciones en la atención a pacientes con neoplasias digestivas, las cuales tienen su base en una insuficiente dinámica, en tanto se revela una visible polarización médico-instrumental de la práctica asistencial, orientada más hacia la endoscopia digestiva diagnóstica y terapéutica, en detrimento de lo preventivo, como parte indisoluble de esa formación. Objetivo: Proponer una estrategia para la formación del residente en gastroenterología en la atención holística endoscópica a pacientes con neoplasias del sistema digestivo. Desarrollo: Se propone una estrategia pedagógica para sistematizar la atención holística preventivo-diagnóstico-terapéutica en la formación del residente en gastroenterología, que deviene un instrumento práctico y flexible, contentivo de etapas, subetapas, orientaciones metodológicas y un sistema de evaluación que permite articular los contenidos clínico-endoscópicos, en un movimiento integrador, a través del diagnóstico, elaboración, implementación y evaluación de acciones para la formación del futuro especialista. Conclusiones: Este instrumento práctico se encamina a sistematizar la formación praxiológico-endoscópico-asistencial de este especialista en la atención holística preventivo-diagnóstico-terapéutica a pacientes con neoplasias digestivas, para el desarrollo de la excelencia en la profesión.
Introduction: In the process of the Gastroenterology resident training there are limitations in the care to patients with digestive neoplasms, which have their base in an scarce dynamics, while a visible polarization doctor-tools in the healthcare practice is observed, which is addressed towards the diagnostic and therapeutical digestive endoscopy more than to the preventive digestive endoscopy, as an indispensable part of the training process. Objective: To propose a pedagogical strategy, for the training of the Gastroenterology resident in the holistic and endoscopic care to patients with neoplasms of the digestive system. Development: A pedagogical strategy is proposed to systematize the preventive-diagnostic-therapeutical and holistic care in the training of the gastroenterology resident, which becomes a practical and flexible instrument, that includes stages and substages, methodological orientations and an evaluation system which allows to articulate the clinical and endoscopic contents, in an comprehensive movement, through the diagnosis, elaboration, implementation and evaluation of actions for the training of the future specialist. Conclusions: This practical instrument proposed is aimed at systematizing the praxiological-endoscopic training of these specialists in the holistic, preventive-diagnostic-therapeutic treatment to patients with digestive neoplasms, so as to reach professional excellence in the profession.
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Education, Continuing/methods , Professional Training , Gastroenterology , Digestive System , Digestive System Neoplasms/diagnosisABSTRACT
RNA N6-methyladenosine (m6A) modification is an important gene expression regulation mechanism of eukaryotes. The m6A modification mainly mediates the methylation of adenosine N6. It is a reversible epigenetic modification that not only occurs in messenger RNA (mRNA), but also occurs in non-coding RNA (ncRNA). In addition, RNA m6A modification participates in many physiological and pathological processes, and also plays an important role in the occurrence and development of tumors. This article reviews the role of RNA m6A modification in malignant tumors of the digestive system.
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N 6-methyladenosine (m 6A) methylation modification is defined as the methylation at the N 6 position of adenosine. This dynamic process is regulated by writer, eraser and reader. Accumulating evidence indicates that m 6A methylation modification is involved in the initiation and development of various digestive system neoplasms including proliferation, invasion, metastasis and chemoresistance. A further understanding about the role of m 6A methylation modification in digestive system neoplasms will benefit the development of a novel precise diagnostic and therapeutic strategy and finally improve the overall prognosis of patients.
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Caudal type homeobox transcription factor 2 (CDX2) is an enteric-specific nuclear transcription factor, which is mainly expressed in the small intestine and colorectum and not expressed in normal gastric mucosa. CDX2 is involved in the occurrence, development, invasion and metastasis of gastrointestinal tumors, and its expression state is related to the clinicopathological characteristics and prognosis of patients with gastrointestinal tumors. It is expected to provide a new idea for the diagnosis and treatment of gastrointestinal tumors by further studying the mechanism of CDX2 involvement in tumor genesis and development and its relationship with clinicopathological features and prognosis.
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Mammalian target of rapamycin (mTOR) is involved in a variety of cellular signaling pathways, which is related to cell growth, proliferation, autophagy, apoptosis and cell cycle progression.mTOR signaling pathway is usually activated in tumors and is closely related to the occurrence, progression and metabolism of tumors.Therefore, mTOR signaling pathway is a hot spot in anti-tumor therapy research.In recent years, with the research of the mechanism of mTOR signaling pathway in digestive system tumors and the exploration of inhibitors, new ideas have been provided for clinical diagnosis and treatment, prognosis assessment and targeted drug development.
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Introducción: En la formación del residente de Gastroenterología todavía se perciben limitaciones en cuanto al tratamiento, la prevención y la pesquisa de neoplasias del sistema digestivo, lo que indica la necesidad de un proceso pedagógico que tipifique y eleve la importancia de una praxis asistencial más coherente y comprometida con las necesidades de salud de la población. Desarrollo: Los referentes epistemológicos sobre este tema revelan una limitada sistematización de la dimensión asistencial respecto a la atención a pacientes con tumores digestivos, pues no se ha logrado integrar el diagnóstico, la prevención y la terapéutica en la intervención holística endoscópica de los especialistas de esta rama de la medicina. Conclusiones: La dinámica praxiológica, endoscópica y asistencial que se propone en esta investigación deviene lógica de sistematización formativa que favorece el perfeccionamiento de la práctica clinicoendoscópico-asistencial de este especialista en la atención holística a pacientes con neoplasias del tracto gastrointestinal.
Introduction: In the training of the Gastroenterology resident are still limitations perceived as for the treatment, prevention and investigation of the digestive system neoplasms, what indicates the necessity of a pedagogic process that typifies and elevate the importance of a more coherent and committed assistance practice with the population's health needs. Development: The epistemological referents on this topic reveal a limited systematization of the assistance dimension regarding care to patients with digestive tumors, because it has not been possible to integrate the diagnosis, prevention and therapy in the holistic endoscopic intervention of the specialists of this branch of medicine. Conclusions: The praxiologic, endoscopic and assistance dynamic that is suggested in this investigation becomes logic of training systematizing that favors the improvement of this specialist's clinicoendoscopic-assistance practice in the holistic care to patients with gastrointestinal tract neoplasms.
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Professional Training , Gastroenterology/education , Digestive System Neoplasms , Medical Staff, HospitalABSTRACT
Farnesoid X receptor (FXR) is the first discovered bile acid receptor. In recent years, more and more studies have shown that there are disorders of FXR expression in malignant tumors of digestive system. This article reviewed the advances in study on FXR in the digestive system tumors.
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KIAA1199 gene is an important member of the HUGE database, and is involved in the transduction of intracellular signaling pathway through epigenetic mechanism, regulating the cell growth, differentiation, apoptosis and migration. Recent studies showed that KIAA1199 gene is closely related to tumorigenesis and tumor development. The expression of KIAA1199 gene is highly upregulated in many types of tumor, especially in digestive system neoplasms, and having the effects of promoting proliferation, adhesion, invasion and migration of tumor cells. This article reviewed the role of KIAA1199 gene in digestive system neoplasms.
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Polyphylla saponin is the major effective ingredient of polyphylla. Pharmacology research showed that polyphylla saponin could effectively inhibit the occurrence and development of malignant tumor of digestive system via inhibiting tumor cell proliferation, promoting tumor cell apoptosis, inhibiting tumor neovascularization, inhibiting tumor cell migration, regulating tumor cell immune function, regulating tumor cell resistance to chemotherapeutic drugs. This article reviewed the role and mechanism of polyphylla saponin in digestive system tumors.
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The early diagnosis, efficacy and prognosis evaluation of digestive malignant neoplasms are still difficult problems in the medical field. CT texture analysis (CTTA) is a new imaging post-processing technique, also an emerging area of radiomics. In recent years, CTTA has been widely used in digestive system neoplasms' classification, treatment efficacy evaluation, survival assessment and so on, having more advantages than conventional morphological evaluation. The application progresses of CTTA in diagnosis of digestive malignant neoplasms were reviewed in this article.
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Objective@#To evaluate the recent efficacy and safety of gemcitabine combined with S-1 in the treatment of advanced biliary tract cancer.@*Methods@#From August 2014 to May 2017, 27 patients with advanced biliary tract cancer confirmed by pathology in the First People's Hospital of Zhengzhou received gemcitabine(1 000mg/m2, day 1 and 8) and S-1(80mg/m2, day 1-14) every three weeks.The recent efficacy and toxicities were observed after two cycles of chemotherapy.@*Results@#All of the 27 patients were evaluated, 1 patient(3.7%) achieved CR, 6 patients(22.2%) with PR, 12 patients(44.4%) with SD, 8 patients(29.6%) with PD.The total response rate was 25.9%(7/27), the disease control rate was 70.4%(19/27). The main toxicities were gastrointestinal reactions and myelosuppression, no chemotherapy-related death was observed.@*Conclusion@#Gemcitabine combined with S-1 in the treatment of advanced biliary tract cancer is safe and effect.