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Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by abdominal pain and changes in bowel habits. IBS is a multifactorial, stress-sensitive disease. Epigenetic changes include DNA methylation change, histone modification, and differential expressions of microRNA and long non-coding RNA. Explaining the changes in IBS from the perspective of epigenetics could bring new insights for the pathogenesis and treatment of the disease. This article reviewed the progress in research on the epigenetics of IBS.
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Objective To investigate the clinical effects and prognostic factors of radical surgery for primary gallbladder cancer (GBC).Methods The retrospective case-control study was conducted.The clinicopathological data of 305 patients with primary GBC who underwent radical Ro resection in the First Affiliated Hospital of Xi'an Jiaotong University from 2013 to 2017 were collected,including 108 males and 197 females,aged from 30 to 88 years,with a median age of 62 years.According to the different tumor staging,patients underwent corresponding operation and adjuvant treatment based on the postoperative indication of chemotherapy.Observation indicators:(1) results of imaging and laboratory examinations;(2) treatment situations:① surgical situations,② postoperative adjuvant treatment;(3) results of postoperative pathological examination;(4) followup;(5) prognostic factors analysis.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to December 5,2018,and death was used as the end point.Measurement data with normal distribution were represented as Mean±SD.Measurement data with skewed distribution were described as M (range).Count data were represented as percentage.The survival curve and survival rate were respectively drawn and calculated using the Kaplan-Meier method.The univariate analysis and multivariate analysis were respectively done using the Log-rank test and COX regression model.Results (1) Results of imaging and laboratory examinations:results of imaging examination showed that diagnostic rates of ultrasound,CT and MRI examination were respectively 84.06％ (174/207),85.71％ (168/196) and 63.11％ (65/103).Results of laboratory examination showed that the positive rates of CA19-9,CA125 and carcinoembryonic antigen (CEA) were respectively 55.34％ (145/262),48.06％ (124/258) and 46.15％ (126/273).(2) Treatment situations:① surgical situations:305 patients underwent radical R0 resection for primary GBC,including 145 undergoing liver wedge resection + D2 lymph node dissection,61 undergoing liver wedge resection + D1 lymph node dissection,55 undergoing liver Ⅳ B and Ⅴ segmentectomy + D2 lymph node dissection,11 undergoing liver Ⅳ B and Ⅴ segrnentectomy + D1 lymph node dissection,9 undergoing right hepatectomy + D2 lymph node dissection,5 undergoing liver wedge resection + D2 lymph node dissection + partial colectomy,4 undergoing pancreaticoduodenectomy,3 undergoing simple cholecystectomy in Tis stage,3 undergoing right hepatectomy + D1 lymph node dissection,2 undergoing liver ⅣB and Ⅴ segmentectomy + D2 lymph node dissection + partial colectomy,1 undergoing liver Ⅳ B and Ⅴ segmentectomy + resection and reconstruction of portal vein + D2 lymph node dissection,1 undergoing liver ⅣB and Ⅴ segmentectomy + D2 lymph node dissection + partial resection of the stomach or duodenum,1 undergoing pancreaticoduodenectomy + resection and reconstruction of portal vein,1 undergoing right hepatectomy + pancreaticoduodenectomy,1 undergoing right hepatic lobectomy + partial gastrectomy + D2 lymph node dissection,1 undergoing right hepatic lobectomy + D1 lymph node dissection and 1 undergoing right hepatic trilobectomy + D2 lymph node dissection.Of 94 patients with unsuspected GBC,78 who were diagnosed in the other hospitals received salvage surgery in the authors' center.Twenty-one patients had postoperative surgery-related complications,including 11 with bile leakage,8 with pulmonary infection and 2 with abdominal bleeding.Two patients died in the perioperative period.② Postoperative adjuvant treatment:26 patients underwent postoperative adjuvant chemotherapy.Chemotherapy regimen:gemcitabine + oxaliplatin were used in 12 patients,gemcitabine + tegafur in 7 patients,gemcitabine + cisplatin in 6 patients,oxaliplatin + tegafur in 1 patient.(3) Results of postoperative pathological examination.The postoperative pathological type of 305 patients:257,23,6,5,4,3,3,2,1 and 1 patients were respectively confirmed as pure adenocarcinoma,adenocarcinoma combined with squamous cell carcinoma,adenocarcinoma combined with neuroendocrine carcinoma,mucinous adenocarcinoma,neuroendocrine carcinoma,adenocarcinoma combined with mucinous carcinoma,squamous cell carcinoma,sarcomatoid carcinoma,adenocarcinoma combined with sarcomatoid carcinoma,adenocarcinoma combined with signet-ring cell carcinoma.Degree of tumor differentiation:highdifferentiated,moderate-differentiated and low-differentiated tumors were detected in 37,130 and 121 patients,respectively,17 with unknown differentiated degree.Of 305 patients,16 and 32 patients had respectively vascular invasion and nerve invasion.The number of lymph node dissected of 305 patients was 8±5,with positive lymph node of 0 (range,0-9),including 121 with lymphatic metastasis (26 with jumping lymphatic metastasis).TNM staging of 305 patients:stage 0,Ⅰ,Ⅱ,ⅢA,ⅢB,ⅣA and ⅣB were detected in 7,18,13,137,57,11 and 62 patients,respectively.(4) Follow-up:245 of 305 patients were followed up for 18.0 months (range,6.0-70.0 months).The survival time,1-and 3-year survival rates were respectively 29.5 months (range,0.5-69.9 months),71.6％ and 45.8％.One hundred and twenty-two patients died during the follow-up.(5) Prognostic factors analysis:the results of univariate analysis showed that preoperative level of bilirubin,pathological type,degree of tumor differentiation,liver invasion,vascular invasion,nerve invasion,T staging,N staging and postoperative chemotherapy were factors affecting prognosis of patients with primary GBC (x2 =10.26,3.96,45.89,34.64,12.75,27.05,35.09,39.44,4.40,P＜0.05).The results of multivariate analysis showed that low-differentiated tumor,liver invasion and N2 staging were independent risk factors affecting prognosis of patients with primary GBC [odds ratio (OR)=1.90,1.71,1.46,95％ confidence interval (CI):1.34-2.70,1.15-2.52,1.17-1.82,P＜0.05],and postoperative chemotherapy was a protective factor affecting prognosis of patients with primary GBC (OR=0.35,95％ CI:0.15-0.82,P＜0.05).Conclusions For patients with primary GBC undergoing radical resection,D2 lymph node dissection should be performed routinely.The low-differentiated tumor,liver invasion and N2 staging are independent risk factors affecting prognosis of patients,and postoperative chemotherapy is a protective factor.
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Objective To investigate the application value of the anatomical location of positive nodes (N staging) from TNM staging systems published by American Joint Committee on Cancer (AJCC) (7th edition),number of metastatic lymph nodes (NMLN),lymph node ratio (LNR) and log odds of metastatic lymph nodes (LODDS) as prognostic predictors in advanced gallbladder carcinoma(GBC).Methods The retrospective crosssectional study was conducted.The clinicopathological data of 176 patients who underwent radical resection of advanced GBC in the First Affiliated Hospital of Xi'an Jiaotong University between January 2008 and December 2014 were collected.According to preoperative assessment,intraoperative exploration and frozen section biopsy,staging and surgical procedure were confirmed.Observation indicators and evaluation criteria:(1) surgical and postoperative situations;(2) follow-up and survival situations;(3) N staging related indicators based on TNM staging systems of AJCC (7th edition):LNR =NMLN / total number of lymph node dissection,LODDS =Log (NMLN+0.5) / (total number of lymph node dissection-NMLN+0.5);(4) lymph node staging based on NMLN,LNR and LODDS:LODDS ＜-1.0 as LODDS 1 staging,-1.0 ≤ LODDS ＜ 0 as LODDS 2 staging,LODDS ≥0 as LODDS 3 staging;(5) prognostic comparisons of patients with different lymph node staging;(6) accuracy of 4 different types of lymph node staging predicting the prognosis of patients.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to December 31,2017.Measurement data with normal distribution were represented as x-±s.Measurement data with skewed distribution were described as M (range),and comparisons were done using the nonparametric test.The survival rate was calculated by the Kaplan-Meier method,and the Log-rank test was used for survival comparison.Correlation analysis was done using the Spearman correlation analysis,r ≥ 0.800 as a high correlation,0.500 ≤ r ＜ 0.800 as a moderate correlation and 0.300 ≤ r ＜ 0.500 as a low correlation.The receiver operating characteristic (ROC) curve and area under the curve (AUC) were respectively drawn and calculated based on 4 kinds of binary logistic regression model.Akaike information criterion (AIC) and Harrell concordance index (Harrell c-index) were respectively calculated based on 4 kinds of COX proportional hazard regression model.The larger values of AUC and Harrell c-index caused a smaller value of AIC,but a lymph node staging standard correlated with greater prognostic accuracy.Harrell c-index ＜ 0.50 was no prediction,and 0.50 ≤ Harrell c-index ≤ 1.00 was an obvious prediction.Results (1) Surgical and postoperative situations:176 patients underwent successful radical resection of GBC,including 161 in R0 resection and 15 in R1 resection,99 with D1 lymph node dissection and 77 with D2 lymph node dissection.Of 176 patients,9 with postoperative complications were improved by symptomatic treatment,including 6 with bile leakage,2 with hepatic dysfunction and 1 with intra-abdominal hemorrhage.Results of postoperative pathological examination:total number of lymph node dissection,NMLN and LNR were respectively 6.7±4.4,0 (range,0-12.0) and 0 (range,0-1.00);high-differentiated,moderate-differentiated and low-differentiated tumors were respectively detected in 16,81 and 79 patients;162 and 14 patients were in T3 and T4 stages;60 patients were combined with infiltration of the liver.(2) Follow-up and survival situations:176 patients were followed up for l-118 months,with a median time of 33 months.The 1-,3-and 5-year overall survival rates were respectively 63.1％,42.0％ and 32.0％.(3) N staging related indicators based on TNM staging systems ofAJCC (7th edition):95,45 and 36 patients were respectively detected in staging N0,N1 and N2.NMLN,LNR and LODDS were respectively 2.0 (range,1.0-7.0),0.40 (range,0.08-1.00),-0.15 (range,-0.99-1.04) in staging N1 and 4.0 (range,1.0-12.0),0.57 (range,0.13-1.00),0.11 (range,-0.70-1.04) in staging N2,with a statistically significant difference in NMLN (Z=-3.888,P＜0.05) and with no statistically significant difference in LNR and LODDS (Z=-1.492,-1.689,P＞0.05).(4) Lymph node staging based on NMLN,LNR and LODDS:NMLN and LNR as a cut-off point were respectively 4.0 and 0.70,NMLN 1 staging (NMLN=0) was detected in 95 patients,NMLN 2 staging (1.0 ≤ NMLN ≤ 4.0) in 61 patients and NMLN 3 staging (NMLN＞4.0) in 20 patients;LNR 1 staging (LNR=0) was detected in 95 patients,LNR 2 staging (0 ＜ LNR ≤ 0.70) in 58 patients and LNR 3 staging (LNR＞0.70) in 23 patients.LODDS 1,2 and 3 stagings was detected in 61,70 and 45 patients,respectively.The lymph node staging based on NMLN and LNR was significantly correlated with based on N staging of TNM staging systems of AJCC (7th edition) (r =0.949,0.922,P＜0.05);the lymph node staging based on LODDS was moderately correlated with based on N staging of TNM staging systems of AJCC (7th edition) (r =0.758,P＜ 0.05).(5) Prognostic comparisons of patients with different lymph node staging:1-,3-and 5-year overall survival rates were respectively 86.3％,65.3％,52.2％ in N0 staging patients and 44.4％,22.2％,13.3％ in N1 staging patients and 25.0％,5.6％,2.8％ in N2 staging patients,with a statistically significant difference (x2=88.895,P＜0.05).The 1-,3-and 5-year overall survival rates were respectively 86.3％,65.3％,52.2％ in NMLN 1 staging patients and 47.5％,19.7％,11.1％ in NMLN 2 staging patients and 0,0,0 in NMLN 3 staging patients,with a statistically significant difference (x2=121.086,P＜0.05).The 1-,3-and 5-year overall survival rates were respectively 86.3％,65.3％,52.2％ in LNR 1 staging patients and 41.4％,17.2％,11.8％ in LNR 2 staging patients and 17.4％,8.7％,0 in LNR 3 staging patients,with a statistically significant difference (x2 =86.503,P＜ 0.05).The 1-,3-and 5-year overall survival rates were respectively 85.2％,65.5％,51.8％ in LODDS 1 staging patients and 65.7％,40.0％,31.3％ in LODDS 2 staging patients and 28.9％,13.3％,5.9％ in LODDS 3 staging patients,with a statistically significant difference (x2=59.195,P＜0.05).(6) Accuracy of 4 different types of lymph node staging predicting the prognosis of patients:according to N staging of TNM staging systems of AJCC (7th edition),NMLN,LNR and LODDS,AUC,AIC and Harrell c-index of lymph node staging were respectively 0.878,0.881,0.870,0.864 and 1 047.5,1 026.4,1 044.2,1 063.6 and 0.77,0.78,0.77,0.76.AIC value was smaller with increased values of AUC and Harrell c-index based on NMLN,showing a greatest accuracy predicting the prognosis of patients.Conclusion Among N staging of TNM staging system of AJCC (7 edition),NMLN,LNR and LODDS as prognostic predictors,NMLN can more precisely predict radical resection of advanced GBC.
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Objective To investigate the difference of iNOS and NQO1 in breast cancer with different mo-lecular subtypes and the correlation between clinical parameters,and to explore the clinical treatment of breast can-cer. Methods The data on 100 patients with breast cancer who had undergone modified radical mastectomy was retrospectively reviewed.Expressions of iNOS and NQO1 were detected by immunohistochemistry.Numeration data was processed using χ2test or Fisher′s exact test.Spearman correlation was applied to analyze different clinical mo-lecular pathological features.Results NQO1 expression was correlated with TNM staging and lymph node metasta-sis(χ2=6.603,4.938,P<0.05),and the expression rate of NQO1 in overexpressing of HER-2 was higher than that in type luminal A(χ2=8.341,P < 0.008). Expression of iNOS was related to expression of Ki-67,stage of TNM and lymph node metastasis(χ2=5.243,8.157,and 5.929,P<0.05),the expression rate of iNOS in lumi-nal A was significantly lower than that in type luminal B(χ2=7.990,P<0.008).Conclusions The expression of NQO1 and iNOS may be involved the process of oxidative stress associated with breast cancer,and it plays an im-portant role in the development of breast cancer. Different molecular level of oxidative stress between the types of breast cancer may be different,whose molecular mechanism needs to be further studied.
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Objective To investigate the relationship between axillary lymph node status and molecular pathological features in breast cancer and its clinical significance. Methods A retrospective analysis was performed to study the relationship of axillary lymph node metastasis (LNM), positive lymph node (PLN), and lymph node ratio (LNR) with clinical and molecular pathology features in 300 patients with breast cancer. Results Of 300 cases of breast cancer, the positive rate of axillary LNM was 31.0% (13/42) in the Luminal A subtype of breast cancer, yielding a statistically significant difference (P 0.05). PLN and LNR were all negatively correlated with E-cadherin expression in breast cancer (P 0.05). Conclusion The combined phenotype expression of ER, PR, HER-2, and Ki67 (molecular subtypes) are associated with the incidence of axillary lymph node metastases , and E-cadherin expression deficiency and tumor size growth promote the progression of lymph node metastases in breast cancer.
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Objective To investigate the roles of aberrant expression of c-myc,c-myb,and c-erbB-2 in the development of breast cancer and its clinical significance.Methods Immunohistochimical technique (S-P method)was used to detect the expression of c-myb,c-myc and c-erbB-2 protein in 150 cases of breast cancer and 30 cases of benign proliferative lesions.heir relation to clinical pathological parameters were analyzed.Results The protein expression levels of c-myc,c-myb,and c-erbB-2 in breast cancer were higher than those in benign proliferative lesions and the difference was significant(all P ＜0.05).Expression of c-myc protein had obvious relationship to histological grade,lymph nodes metastasis and pathological types(all P ＜ 0.05).Expression of c-myb protein related significantly to histological grade (P ＜ 0.05).c-erbB-2 was associated with the tumor size,grading,PR expression (all P ＜ 0.05).The association among the three kinds of genetic proteins was observed.Conclusion Expressions of oncogenes c-myc,c-myb,and c-erbB-2 proteins are higher in breast cancer and lower in benign proliferative lesions.The difference is significant.They are related to the grading and some other prognostic factors such as tumor size,pathologic types,PR expression and lymph node metastasis.The results suggest that these oncogenes are activated in the development of breast cancer and provoke cancerous cells multiplication.Expressions of oncogenes c-myc,c-myb and c-erbB-2 mightbe considered to be the prognostic indicators of breast cancer.
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Objective To investigate changes of esophagogastric varicosis,and portal hemodynamics in cirrhotic portal hypertensive patients after Hassab surgical operation. Method The changes of esophageal varicosis and gastric varices incidences at different phases of cirrhotic patients after the Hassab surgical operation were examined by electric endoscope.Hemodynamics of portal vein system was measured by Doppler color imaging and color Doppler ultrasound after operation. Results Mild esophageal varicosis incidences on the 6th,12th and 18th month after the Hassab surgical operation were respectively 44.1%,34.7% and 28.4%,higher than that before operation (7.5%) (P＜0.05).Severe esophageal varicosis incidences on the 6th,12th and 18th month were respectively 25.1%,30.0% and 35.0%,lower than that before operation (65.2%) (P ＜ 0.05).Mild esophageal varicosis with gastric varices incidences on the 6th,12th,18th and 24th month before and after operation were respectively 16.6%,and 7.4%,9.2%,9.1%,10.3% respectively.Severe esophageal varicosis with gastric varices incidences in the 6th,12th,18th and 24th month were respectively 43.8%,and 45.8%,45.2%,47.4%,48.8% (P＜0.05).Inner diameter of portal vein and the right branch of portal vein on the 6th and 12th month before and after operation were respectively (13.5±1.7) mm,(9.8±2.0) mm,(10.5±2.2) mm,(11.2±1.2) mm,(8.1 ± 1.3) mm and (8.2 ± 2.2) mm (P ＜ 0.05).Maximum flow rate and blood flow of portal vein,velocity of the left of portal vein in the 6th and 12th month were respectively (13.6 ±2.6) cm/s,(1095 ±290) ml/min,(13.3±2.6) cm/s,(11.5 ±1.6) cm/s,(11.8 ±1.8) cm/s,(847 ±249) ml/min,(907 ± 310) ml/min,(11.0 ± 1.9) cm/s and 11.1 ± 1.9 cm/s (P ＜ 0.05).Velocity of the right of portal vein in the sixth month were (11.6 ± 2.6) cm/s,which was significantly slower than preoperative level of (13.2 ± 2.9) cm/s. Conclusion After the Hassab surgical operation the degree of esophageal varices lightens during 18 months and aggravates after 18 months.There is obvious relation between gastric varices and the degree of esophageal varices.Velocity of portal blood flow becomes slow,blood flow diminishes and inner diameter reduces after the Hassab surgical operation.
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Objective: To investigate the efficacy of specific point acupuncture and manipulative adjustment on muscle strength of the knee osteoarthritis. Method: One hundred and five patients were randomly allocated to two groups. Sixty-eight cases in the treatment group were treated by specific point acupuncture and manipulative adjustment on muscle strength of the knee joint. While 37 cases in the control group were treated with specific point acupuncture alone. Result: The total effective rate was significantly higher in the treatment group than in the control group (P＜0.05). Conclusion: Specific point acupuncture and manipulative adjustment on muscle strength of the knee joint has a satisfactory curative effect on knee osteoarthritis.
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Objective To understand the incidence and the clinicopathological characteristics of breast cancer in Bengbu area.Methods The clinicopathological datas of 446 cases of breast cancer were analyzed retrospectively,which included the clinical profile,tumor size,pathological grading,lymphatic metastasis,pTNM staging,hormonal receptor status and oncogene C-erbB-2 protein expression of some cases.Results Female was found in 99.6% of the patients.The average age was 49.76 years old.Most patients presented firstly by breast masses.The average time was 11.58 months from discovering the mass to final pathological diagnosis.The average longest diameter was 3.06cm.Invasive ductal carcinoma was found in 92.8%.Metastasis was found in 58.8%.Lymphatic metastasis rate was higher in extrinstic and posterior pectoralis monor.ER expression rate was 45.3% and PR,44.2%.The positive rate of C-erbB-2 was 81.4%.C-erbB-2 protein expression was found to be related to the status of ER and PR.Conclusion Breast cancer is more commonly found in middle and old women.Early discovery rate is lower and invasive carcinoma is diagnosed in most cases while metastasis is found in halof the cases.Carrying out breast cancer census is of important significance for prevention and treatment of breast cancer.
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Objective To explore the diagnosis and differential diagnosis of tricholemmal carcinoma and the significance of expression of cytokeratin(CK)and oncogene protein(c-erbB-2)in it.Method Twenty-two cases of tricholemmal carcinoma were studied with histologic and immunohistochemical tech-niques,and compared with those in squamous cell carcinoma.The neoplastic cells were stained with cytok-eratin-H,cytokeratin-L and c-erbB-2immunohistochemically(S-P method).Results The morphological characteristics of the tricholemmal carcinoma were the lobular structure and sudden keratinization in the cen-ter of the lobule,which were the key points to be differentiated with squamous cell carcinoma.The positive rate of cytokeratin-H of tricholemmal carcinoma was81.8%(18/22),and the positive cells distributed in the middle zone between the keratinized lobular center and tumor cells in the peripheral area,which differed from squamous cell carcinoma.Cytokeratin-L expression was not found in tricholemmal carcinoma.The posi-tive rate of c-erbB-2was50%(11/22)in tricholemmal carcinoma,with positive cells distributed to the mar-gin of the carcinoma cell nests,and increased with the poor differentiation.Conclusions The particular dis-tribution of cytokeratin-H suggests the tricholemmal origin of tricholemmal carcinoma.C-erbB-2may take part in the activation and differentiation of this tumor.
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Medical examination is an important measurement of evaluating the teaching effect and studying results,and also is the main method and content of teaching quality evaluation in universities and colleges.During the teaching evaluation we found that many problems of medical examination need to be solved and improved.This paper deals with three major aspects closely related to teachers including the standardization of programming test paper,rating the test scores,and statistical analysis of the examination papers.
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Purpose To study the main points of the diagnosis and differential diagnosis of the lymphadenitis in CSD. Methods Expression of CD45, CD3 and CD68 were evaluated immunohistochemically (S-P method). Results Five cases of microabscess in early stage and 21 cases of microabscess-granuloma were found. The histologic features were the formation of microabscess and granuloma. The early microabscess in the lymphnodes were surounded by B lymphocytes (CD20+) and macrophages (CD68+). The typial microabscess granuloma were surrounded by epitheloid cells (CD68+) and CD3 positive T lymphocytes. Conclusion The main characteristic of the lymphadenitis of cat scratch disease is the formation of granuloma with microabscess. The immumohistochemical markers are useful to distinguish the proliferative cell types. This lesion may result from bacterial infection which induces the cell immune reaction.