Anticoagulation status and adherence in patients with atrial fibrillation hospitalized for ACS and the impact on 1-year prognosis: a multicenter cohort study / 中华心血管病杂志

Objective: For patients with atrial fibrillation (AF) complicated with acute coronary syndrome (ACS), both anticoagulant and antiplatelet therapy should be applied, but the use of anticoagulation therapy is still poor in these patients in China. The purpose of this study was to explore the status and adherence of antithrombotic therapy in AF patients with ACS and the impact on 1 year clinical outcomes. Methods: Patients with AF hospitalized for ACS were retrospectively included from 6 tertiary hospitals in China between July 2015 and December 2020. According to the use of anticoagulant drugs at discharge, patients were divided into two groups: anticoagulant treatment group and non-anticoagulant treatment group. Logistic regression model was used to analyze the main factors influencing the use of anticoagulant drugs in patients with atrial fibrillation complicated with ACS. Major adverse cardiac events (MACEs) were defined as all-cause death, non-fatal myocardial infarction or coronary revascularization, and ischemic stroke and Bleeding Academic Research Consortium (BARC) 3 bleeding events were also collected at 1 year after discharge. After propensity score matching, Cox proportional hazards models and Kaplan-Meier analysis were used to evaluate the effect of anticoagulant treatment and non-anticoagulant treatment on 1-year prognosis. The patients were divided into different groups according to whether anticoagulation was performed at discharge and follow-up, and the sensitivity of the results was analyzed. Results: A total of 664 patients were enrolled, and 273 (41.1%) were treated with anticoagulant therapy, of whom 84 (30.8%) received triple antithrombotic therapy, 91 (33.3%) received double antithrombotic therapy (single antiplatelet combined with anticoagulant), and 98 (35.9%) received single anticoagulant therapy. Three hundred and ninety-one (58.9%) patients were treated with antiplatelet therapy, including 253 (64.7%) with dual antiplatelet therapy and 138 (35.3%) with single antiplatelet therapy. After 1∶1 propensity score matching between the anticoagulant group and the non-anticoagulant group, a total of 218 pairs were matched. Multivariate logistic regression analysis showed that history of diabetes, HAS-BLED score≥3, and percutaneous coronary intervention were predictors of the absence of anticoagulant therapy, while history of ischemic stroke and persistent atrial fibrillation were predictors of anticoagulant therapy. At 1-year follow-up, 218 patients (79.9%) in the anticoagulant group continued to receive anticoagulant therapy, and 333 patients (85.2%) in the antiplatelet group continued to receive antiplatelet therapy. At 1-year follow-up, 36 MACEs events (13.2%) occurred in the anticoagulant group, and 81 MACEs events (20.7%) in the non-anticoagulant group. HR values and confidence intervals were calculated by Cox proportional risk model. Patients in the non-anticoagulant group faced a higher risk of MACEs (HR=1.802, 95%CI 1.112-2.921, P=0.017), and the risk of bleeding events was similar between the two group (HR=0.825,95%CI 0.397-1.715, P=0.607). Conclusions: History of diabetes, HAS-BLED score≥3, and percutaneous coronary intervention are independent factors for the absence of anticoagulant therapy in patients with AF complicated with ACS. The incidence of MACEs, death and myocardial infarction is lower in the anticoagulant group, and the incidence of bleeding events is similar between the two groups. The risk of bleeding and ischemia/thrombosis should be dynamically assessed during follow-up and antithrombotic regiments should be adjusted accordingly.

Chinese consensus on the use of antiarrhythmic drugs for rhythm control in atrial fibrillation / 中华内科杂志

Rhythm control is crucial part of comprehensive management of atrial fibrillation (AF). Rhythm control can reduce the burden of AF effectively, reduce symptoms, and improve the prognosis in early AF. Antiarrhythmic drugs (AADs) are the first-line treatment for rhythm-control strategies. This consensus focuses on the principle of rhythm control in AF, the characteristics of AADs, and the medication recommendations for patients in different populations suffering from AF. Hence, this consensus aims to support clinical decision-making for AF therapy.

Impact of empagliflozin on peak oxygen uptake in HFmrEF patients: a randomized controlled trial / 中华心血管病杂志

Objective: To evaluate the impact of empagliflozin on peak oxygen uptake (VO2peak) in patients with heart failure with mildly reduced ejection fraction (HFmrEF). Methods: In this randomized controlled trial, consecutive HFmrEF patients admitted to the Department of Cardiology of China-Japan Friendship Hospital from September 2019 to October 2020 were screened, and randomly assigned to empagliflozin group (EG) or conventional group (CG) using a random number table. The enrolled patients were treated according to the guidelines, and patients in the empagliflozin group received additional empagliflozin (10 mg, once a day, orally) on top of the conventional treatment. The primary end points were VO2peak at 6 months after treatment, and the secondary end points included other parameters of cardiopulmonary exercise test (CPET), 6-minute walking distance, N-terminal B-type pro-natriuretic peptide (NT-proBNP) level, and Kansas City Cardiomyopathy Questionnaire (KCCQ) score. Results: A total of 112 patients were included (mean age 69 (57, 78) years, 84 male (75.0%)). There were 55 cases in CG group and 57 cases in EG group. There were no significant differences in baseline data including age, sex, body mass index, left ventricular ejection fraction, systolic blood pressure, heart rate, estimated glomerular filtration rate, glycosylated hemoglobin, hemoglobin, NT-proBNP, daily dose of tolasemi, combined medication, CPET parameters, the proportion of New York Heart Association heart function Ⅲ/Ⅳ, history of coronary heart disease, history of hypertension, history of diabetes (all P>0.05). At 6 months after treatment, VO2peak was significantly higher in EG group than in CG group(P=0.023). VE/VCO2 slope was significantly lower in EG group than in CG group(P=0.034). Oxygen uptake efficiency slope was significantly higher in EG group than in CG group(P=0.038). The level of NT-proBNP was significantly lower in EG group than in CG group(P=0.020). Six-minute walking distance was significantly higher in EG group than in CG group(P=0.037). KCCQ score was significantly higher in EG group than in CG group(P=0.048). Exercise oscillatory ventilation decreased in both groups (1 case in each group, P>0.05). Conclusion: Empagliflozin can significantly improve VO2peak in patients with HFmrEF.

Challenges in the diagnosis and management of acute bowel obstruction: Focus on the standard of practice / 中国实用外科杂志

Acute bowel obstruction(ABO)is one of the most common acute abdomen with complicated etiology and critical conditions.Insufficient recognition of the clinicopathologic features for different types and the urgency for special types of ABO,over-reliance on imaging diagnosis,and less standard for practice are the major limitations in the management of ABO. Basically,a qualified clinical training program,including history collection, physical examination and thorough comprehension of the pathological mechanisms,is needed to be established. Furthermore,application and interpretation of imaging examinations should be standardized,in order to achieve precise qualitative,topical and etiological diagnosis. Specifically,strangulated and closed loop ABO should be identified and treated very soon due to critical outcome. Finally,the strategy of surgery should be made based on the strict indications and damage control principle.

Progress of CLASS-02 trial of laparoscopic and open total gastrectomy for early gastric cancer / 中国实用外科杂志

CLASS-02 was the second study since the estab-lishment of Chinese Laparoscopic Gastrointestinal SurgeryStudy Group(CLASS). Till now, the enrollment and data verifi-cation had been nearly completed, and it was expected to fin-ish the data analysis in June 2019. Under strict quality control,each of the process included medical ethics, baseline assess-ment, surgical standardization,evaluation of morbidity, follow-up, and data management was well considered during thestudy. The results of CLASS-02 study will set a solid founda-tion for the subsequent phase III clinical trial on efficacy oflaparoscopic total gastrectomy. We hope that the CLASS seriesstudies will facilitate the release of high-quality clinical re-search data and surgical innovation forgastriccancerin China.

Impact of therapy options on in-hospital and three-year outcome of patients with ST-elevation myocardial infarction in Beijing / 中华心血管病杂志

<p><b>OBJECTIVES</b>To evaluate the clinical characteristics, in-hospital and three-year outcome in ST-elevation myocardial Infraction (STEMI) patients receiving conservative treatment (CT), thrombolytic treatment (TT) and primary percutaneous coronary intervention (PCI) in Beijing.</p><p><b>METHODS</b>This 12-month prospective, multicenter registry study was conducted in 19 hospitals with 808 patients with STEMI in Beijing between Jan. 2006 and Dec. 2006, 518 (64%) received PCI, 106 (16.1%) received TT and 184 (22.8%) received CT therapy. Patients were followed up for 3 years.</p><p><b>RESULTS</b>At baseline, the age of patients in CT group [(64.5 ± 13.5) years] was significantly higher than those in TT group p(57.9 ± 11.0) years] and in PCI group [ (60.4 ± 12.3) years, all P<0.01]; and the median time from symptom onset to hospital in CT group (207 min) was significantly longer than those in TT group (130 min) and PCI group (130 min, all P<0.01). Emergency Medical Service (EMS) use was significantly higher in PCI group (184/518, 35.5%) than in CT group (46/184, 27.3%) and TT group (29/107, 25.0%, all P<0.05). Health insurance holder was the highest in PCI group (P<0.01). PCI was performed less frequently than thrombolytic therapy [66.6% (345/518) vs. 80.2% (85/106)m P=0.02] during off-hours and more frequently performed in tertiary hospitals than in secondary hospitals[66.8%(437/651) vs. 52.6% (81/154, P<0.01)]. The in-hospital mortality and the cardiovascular mortality at 3 year after hospital discharge was significantly higher in CT group [9.2% (17/185) and 9.4% (15/159)] than in PCI group [3.5% (18/518), 4.5% (20/446)] and TT group [6.6% (7/106), 2.3% (2/86), all P<0.01]. Patients in PCI group had the highest adherence level of aspirin, β-blocker, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers or statins at 3-years follow-up (all P<0.05). Multivariable Cox proportional hazards regression analysis showed that only PCI was associated with lower risk of cardiovascular death (HR-0.40, 95% CI:0.21-0.73, P<0.01).</p><p><b>CONCLUSIONS</b>Social and clinical setting may affect the physician's decision to provide reperfusion therapy in Beijing for STEMI patients. Better adherence of secondary preventive drugs and lower cardiovascular death are observed in STEMI patients receiving PCI during the 3-year follow-up</p>

Efficacy of neoadjuvant chemotherpy in patients with locally advanced gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of neoadjuvant chemotherapy in patients with locally advanced gastric cancer, and to analyze the relevant factors of recurrent death of gastric cancer after adjuvant chemotherapy.</p><p><b>METHODS</b>Clinical data of 49 patients who underwent neoadjuvant chemotherapy for locally advanced gastric cancer between July 2007 and June 2011 were reviewed. Preoperative staging was determined by endoscopic ultrasonography and abdominal computer tomography (CT) or magnetic resonance imaging (MRI). Chemotherapy was administered for regimen of two or three drugs. Prognostic factors were analyzed by univariate and multivariate analysis with Cox proportional hazard model.</p><p><b>RESULTS</b>The response rate was 33.3% (16/48) and disease control rate was 93.8% (45/48). Forty-four (89.8%, 44/49) patients received curative resection after neoadjuvant chemotherapy, among whom 90.9% (40/44) underwent D2 lymphadenctomy. Thirty-two cases had pathological response and 2 patients had pathological complete response. The average hospital stay was 11.6 days and 2 patients had longer hospitalization because of postoperative pancreatic complications. The toxicities were most in grade 1-2. All the patients were followed up postoperatively and the median follow-up was 21.6 months. Median progression-free survival was 29.6 (95%CI:24.0-35.2) months and median overall survival was 34.6 months (95%CI:29.8-39.4). Imaging response (P=0.038, RR=0.168, 95%CI:0.031-0.904) and pathological response (P=0.007, RR=0.203, 95%CI:0.064-0.642) were identified as independent prognostic factors with COX multivariate analysis.</p><p><b>CONCLUSIONS</b>Neoadjuvant chemotherapy has quite high disease control rate and R0 resecting rate for patients with locally advanced gastric cancer. Imaging response and pathological response are most important prognostic factors in those patients.</p>

Clinicopathological features and prognosis of chronic gastric ulcer with early canceration / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinicopathological features and prognosis of chronic gastric ulcer with early canceration in order to provide useful information for diagnosis and treatment strategies.</p><p><b>METHODS</b>A retrospective review of clinical data and prognosis from 43 patients of chronic gastric ulcer with early canceration from 2003 to 2010 was conducted. These data were compared with those with primary intra-mucosa gastric cancer (type I and II 275 cases, type III 68 cases).</p><p><b>RESULTS</b>In 43 cases of chronic gastric ulcer with early canceration, 30 cases (69.8%) were male, 22 cases (51.2%) were younger than 60 years old. Lesions located in the body or antrum of the stomach in 39 cases (90.7%), were less than 2 cm in 26 cases (60.5%), were undifferentiated type in 23 cases (53.5%), and developed lymph node metastasis in 4 cases (9.3%). Lesions of 4 cases of chronic gastric ulcer with early canceration located in the upper third of the stomach, while those of type III primary intra-mucosal gastric cancer all located in the lower two thirds, and the difference was statistically significant (P<0.01). Compared to type III and type I and II primary intra-mucosal gastric cancer, chronic gastric ulcer with early canceration did not differ in clinicopathological characteristics such as histological type, vascular or lymphatic invasion, and lymph nodes metastasis (all P>0.05). The median follow-up time was 57 months (range 16 to 98 months). The 5-year overall survival was 95.3% in chronic gastric ulcer with early canceration group, similar to that of type I, II (97.4%) or type III (94.5%) primary intra-mucosal gastric cancer group (P>0.05).</p><p><b>CONCLUSIONS</b>The clinicopathological features of chronic gastric ulcer with early canceration are similar to those of primary intra-mucosal gastric cancer. The prognosis is promising for those patients undergoing surgical treatment.</p>

Association of T helper cell 1 cytokines expressions with prognosis of gastric cancer patients / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the association of the expressions of Th1 cytokines in gastric cancer tissue and the prognosis of patients with gastric cancer after radical resection.</p><p><b>METHODS</b>Fifty-eight patients with gastric cancer treated at the Zhongshan Hospital of Fudan University were retrospectively analyzed. The expressions of Th1 cytokines mRNA were detected in tumor tissues by real-time polymerase chain reaction(RT-PCR) method in Th1 cells including TRAV10, IRF1, TBX21, CD3Z, GZMB, GATA3, and IFNG. Association of Th1 cytokines mRNA expressions and prognosis was evaluated.</p><p><b>RESULTS</b>The median follow up was 42.5(1-64) months. The 1-year survival rate was 84.5% and the 3-year survival rate was 72.4%. Univariate Cox regression analysis showed that lymph node metastasis, distant metastasis, TNM staging, lymphovascular invasion, GNLY mRNA expression, and the overall expression level of the 8 types of Th1 cells were associated with the prognosis of patients with gastric cancer(all P<0.05). The 3-year survival was 86.2% in patients with increased expression of mRNA and 58.6% in those with decreased expression. The 3-year survival was 79.6% in patients with any increase in the 8 Th1 cytokines and 33.3% in those with consistent downregulation of the 8 cytokines. Multivariate Cox analysis showed that lymph node metastasis and the overall expression level of 8 Th1 cytokines were independent risk factors associated with the prognosis of patients with gastric cancer in this cohort(both P<0.05).</p><p><b>CONCLUSIONS</b>The mRNA expression of GNLY is associated with the prognosis of patients with gastric cancer but is not an independent risk factor. The combination of mRNA expressions of the eight cytokines is an independent prognostic factor.</p>

Association of transcriptional repressor Snail with Lauren classification of gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the association of Snail expression and Lauren classification of gastric cancer.</p><p><b>METHODS</b>The protein levels of Snail and E-cadherin were detected by Western blot in N87 (intestinal-type gastric cancer cell line) and AGS(diffuse-type gastric cancer cell line) cell lines and those after transfection of GSK-3β plasmid. The study included a total of 77 patients with primary gastric cancer who underwent curative gastrectomy in the Zhongshan Hospital from February 2000 to December 2005 without any chemotherapy or radiation therapy before surgery. Tissues of gastric cancer specimens were stained using immunohistochemistry to determine Snail expression.</p><p><b>RESULTS</b>Snail expression was low in N78 and high in AGS. E-cadherin expression showed reverse expression pattern. After transfection with GSK-3β, the expression of Snail was significantly suppressed and that of E-cadherin elevated (P<0.01). Different concentrations of GSK-3β inhibitor lithion chloride were used to treat the cell lines and Snail expression was significantly up-regulated in a dose-dependent manner (P<0.01). Snail expression was elevated in 16 out of 21 N78 cell lines, and in 21 out of 56 AGS cell lines, and the difference was statistically significant (P<0.01).</p><p><b>CONCLUSION</b>The expression of Snail is closely associated with the Lauren classification of gastric cancer, and it may be a potential marker of the gastric cancer classification.</p>

Relationship and interactions between elevated fasting glucose and hypertension for cardiocerebral vascular disease / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the relationship and interaction of elevated fasting glucose and hypertension on cardiocerebral vascular disease.</p><p><b>METHODS</b>10 054 males and females were recruited for our cross-sectional study during May 2007 to August 2007. Unconditional logistic regression was used to analysis the relationship between fasting glucose and hypertension on cardiocerebral vascular disease. A product of fasting glucose and hypertension was added to the logistic regression model to evaluate the multiplicative interaction and relative excess risk of interaction (RERI), attributable proportion (AP) of interaction and synergy index (S) was applied to evaluate the additive interaction of the two factors. Bootstrap was used to calculate 95% confidence intervals (CI) of RERI, AP and S.</p><p><b>RESULTS</b>After adjusting age, gender, smoking, drinking, body mass index (BMI) and region, the product of fasting glucose and hypertension was not statistically significant, which means there was no multiplicative interaction between the two. But the additive indexes RERI, AP and S with 95%CI of diabetes and hypertension were 0.64 (0.03, 1.25), 0.27 (0.01, 0.47) and 1.83 (1.02, 5.13) respectively, which means significant additive interaction was shown between the two on cardiovascular disease but not no stroke. And there were no additive interaction between impaired fasting glucose on cardiovascular disease or stroke.</p><p><b>CONCLUSIONS</b>Hypertension was independently related to cardiovascular disease and stroke in Beijing citizens, and diabetes were independently related to stroke. There was additive interaction between diabetes and hypertension on cardiovascular disease.</p>

Quality of life change and its influencing factors in patients with acute coronary syndrome after drug-eluting stent implantation / 中华心血管病杂志

<p><b>OBJECTIVE</b>To prospectively evaluate the change of quality of life in patients with acute coronary syndrome following percutaneous coronary intervention (PCI) with drug-eluting stents and explore the influencing factors of quality of life.</p><p><b>METHODS</b>There hundred and thirty four consecutive patients with acute coronary syndrome receiving drug-eluting stents implantation between September 2008 and December 2009 were enrolled. Of them, two hundred and ninety three patients completed 36-item short form health survey at baseline and 6 months after PCI procedure. Change of quality of life and influencing factors on quality of life were analyzed.</p><p><b>RESULTS</b>Compared with baseline, quality of life improved significantly after PCI in terms of both physical component summary and mental component summary [ (51.07 ± 20.39) scores vs. (61.69 ± 19.73) scores and (63.27 ± 20.00) scores vs. (68.81 ± 18.71) scores, respectively; all P < 0.01]. Multiple linear regression analysis showed that female, diabetes and ST-segment elevation myocardial infarction were independent predictors of physical component summary improvements post PCI (β values were -0.310, -3.880 and 1.302, respectively; P < 0.05 or P < 0.01). Previous PCI and diabetes were independent predictors of mental component summary improvements post PCI (β values were -1.483 and -2.790, respectively; all P < 0.01).</p><p><b>CONCLUSIONS</b>Quality of life of acute coronary syndrome patients is significantly improved at 6 months after drug-eluting stents implantation. The predictors of physical quality of life improvement are female, diabetes, and ST-segment elevation myocardial infarction. Predictors of mental quality of life improvement are previous PCI and diabetes.</p>

Endoscopic management of early postoperative anastomotic hemorrhage / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>The study aimed to evaluate the efficacy of endoscopic therapy for early postoperative anastomotic hemorrhage.</p><p><b>METHODS</b>Fourteen patients experienced an episode of early postoperative anastomotic hemorrhage and were treated endoscopically from January 2005 to June 2010. The clinical data was analyzed retrospectively.</p><p><b>RESULTS</b>Fourteen patients(9 males and 5 females, median age 57.5 years, range 26-74 years) were diagnosed with postoperative hemorrhage between 6 hours to 14 days after surgery. The blood loss ranged from 500 to 1500 ml. Sclerosing agent injection, electrocoagulation, and hemoclips were attempted to control the bleeding. Endoscopic approach to control early postoperative anastomotic hemorrhage was successful in all the patients. No recurrent bleeding was observed during the follow-up. No complications associated with endoscopic therapy.</p><p><b>CONCLUSION</b>Endoscopic approach for the management of early postoperative anastomotic hemorrhage is feasible with high success rate and associated with no complications.</p>

Clinicopathological features and prognosis of cystic gastrointestinal stromal tumor / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathological and molecular genetic characteristics of gastrointestinal stromal tumor (GISTs) with significant cystic changes, and to assess their biological behavior.</p><p><b>METHODS</b>Clinicopathological features of 7 patients with cystic GISTs treated at the Zhongshan Hospital of Fudan University from February 2005 to January 2010 were summarized retrospectively. The mutations status of c-kit and PDGFR-α were analyzed.</p><p><b>RESULTS</b>There were 2 males and 5 females aged from 46 to 76 years old. Primary site of GISTs included stomach(n=4), duodenum(n=1), and small intestinal(n=2). Tumor size ranged from 6 to 16 cm with obviously cystic changes. Tumor cells were found in the solid components under microscope, of which epithelioid cell type were found in 4 case and spindle cell type in 3 cases. The mitotic figures were no more than 3/50 HPF in all the patients. According to the NIH criteria, 4 were high-risk and 3 were low-risk. Based on morphological characteristics, 3 cases were as borderline tumor, 3 moderate-risk, and 1 moderate-risk. Gene mutation of exon 11 of c-kit were identified in 3 cases. During the follow up ranging from 9 to 80 months, all the 7 patients had cancer-free survival.</p><p><b>CONCLUSION</b>The biological behavior of cystic GIST is indolent with a low risk of malignancy and favorable prognosis.</p>

Impact of acute smoking on artery function in healthy chronic smokers / 中华心血管病杂志

<p><b>OBJECTIVES</b>To explore the effect of acute smoking on vascular endothelial function, arterial stiffness and the possible underlying mechanisms.</p><p><b>METHODS</b>We measured the endothelial function and arterial stiffness in 50 healthy chronic smokers before and after acute smoking with EndoPAT2000. The test was carried out on two separate finger tips. The endothelial function was evaluated by PAT ratio of the finger tip and systemic arterial stiffness was evaluated by augmentation index (AI). Plasma soluble intercellular adhesion molecule-1 (sICAM-1) and tissue plasminogen activator (tPA) before and 20 min after acute smoking were measured with enzyme linked immuno sorbent assay.</p><p><b>RESULTS</b>The PAT ratio was decreased (1.87 ± 0.40 vs. 1.73 ± 0.28, P = 0.004) while AI was significantly increased after acute smoking (2.94% ± 21.77% vs. 7.11% ± 20.65%, P = 0.01). There was no significant changes in sICAM [(306.5 ± 76.1) µg/L vs. (315.7 ± 90.9) µg/L, P = 0.402], but tPA [7.87 (5.41 - 10.08) µg/L vs. 5.77 (3.77 - 9.68) µg/L, P < 0.01] was significantly decreased after smoking.</p><p><b>CONCLUSIONS</b>Smoking could acutely affect endothelia function, arterial stiffness and deteriorate the activity of fibrinolytic system which could lead to coronary thrombosis in smokers.</p>

Application of robotic system in gastrointestinal surgery / 中华胃肠外科杂志

Robotic system helps surgeons in performing surgery. Currently Da Vinci system is the most popular. Da Vinci system has been used for the stomach and bowel diseases in 27 cases(18 cases of stomach and 9 cases of colon and rectum) in the Zhongshan Hospital, Fudan University. Accurate preoperative staging is crucial, and Da Vinci system is advantageous in lymph node dissection, preservation of nerve plexus, and complete resection of mesorectum. Adoption of gastrointestinal tract reconstruction technique should depend on the operation and experience in surgery. Though Da Vinci system has limitations and the cost is high, it is believed to be the future trend.

Expression and prognostic value of M2 macrophages and regulatory T cells in gastric carcinoma tissue / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the prognostic value of M2 macrophages and regulatory T cells(Tregs) in gastric carcinoma.</p><p><b>METHODS</b>Clinicopathological characteristics and follow up data of 135 patients with gastric carcinoma were collected. Patients included were those who underwent D2 radical resection(R0) at Zhongshan Hospital of Fudan University from February 1999 to December 2005. Tissue chips of gastric carcinoma specimen were stained using immunohistochemistry to determine the cells density and number of M2(CD163 positive) and Tregs(Foxp3 positive).</p><p><b>RESULTS</b>The median positive cells density of M2 macrophages and Tregs in tumor tissue were 7.48/HP and 6.33/HP, respectively, higher than that in adjacent tissues(1.37/HP and 2.92/HP, P<0.001). The density of M2 macrophages was positively correlated with that of Treg cells(r=0.415, P<0.001) in tumor tissue. The median survival of patients with low expression of M2 and Tregs(n=43) was significantly longer than those with high expression of the 2 cells(n=45) (99.0 vs. 72.3 months, P<0.05).</p><p><b>CONCLUSION</b>Combined detection of M2 macrophages and Tregs may predict the prognosis of gastric carcinoma.</p>

Adjuvant chemotherapy for gastric cancer: more drugs do not mean better efficacy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare oncologic outcomes between doublet and triplet adjuvant chemotherapy for gastric cancer patients undergoing radical resection.</p><p><b>METHODS</b>Patients with gastric cancer receiving adjuvant chemotherapy after radical resection from January 2004 to December 2008 were included. Doublet was defined as 5-FU 750 mg/m² (days 1-5) or capecitabine 1000 mg/m² (days 1-14) plus cisplatin 60 mg/m² (day 1) or oxaliplatin 130 mg/m² (day 1), while triplets had epirubicin 50 mg/m² (day 1) added. Chemotherapy was initiated 4-6 weeks after surgery, repeated every three weeks for 6 cycles. Patients were followed-up in the outpatient clinic until death or the most recent follow up(April 30, 2010). Cox proportional- hazard model and Chi-square test were used to test statistical difference.</p><p><b>RESULTS</b>A total of 316 patients (210 received doublets, 106 received triplets) had a median follow-up time of 47 months. Seventy-seven patients died at the end of the follow-up. Two groups were comparable except for age (median age of 57 in doublets, 51 in triplets, P<0.01). The two groups had similar disease-free survival (16 months vs. 23 months, P=0.656) and 3-year overall survival(59.6% vs. 64.8%, P=0.293). There was no significant difference in severe adverse side effects between the two groups (21.9% vs. 30.2%, P=0.107).</p><p><b>CONCLUSION</b>Triplet adjuvant chemotherapy appears not to be associated with superior efficacy than doublet regimen for patients with gastric cancer after radical resection.</p>

Novel mutations of cardiac troponin T in Chinese patients with hypertrophic cardiomyopathy / 中华心血管病杂志

<p><b>OBJECTIVE</b>To screen the cardiac troponin T (TNNT2) mutations in Chinese patients with hypertrophic cardiomyopathy (HCM) and to analyze the potential link between the genotype and the phenotype.</p><p><b>METHODS</b>Clinical features of 100 probands with HCM and some family members were evaluated, 200 unrelated normal subjects served as control. The exons and flanking introns of TNNT2 were amplified with PCR and direct sequencing was used to screen TNNT2 mutations/polymorphisms.</p><p><b>RESULTS</b>Two novel missense mutations were detected in 2 HCM patients: R92W and R286H. These 2 mutations were not found in 200 non-HCM controls. A five-basepair insertion/deletion polymorphism in intron 3 of TNNT2 was identified in this HCM cohort but was not related to the phenotype.</p><p><b>CONCLUSIONS</b>Two missense mutations, R92W and R286H, were found in 2/100 patients with HCM, TNNT 2 mutation is relatively low in Chinese patients with HCM.</p>

Association between systemic inflammation and autoimmunity parameters and plasma lipid in patients with rheumatoid arthritis / 中华心血管病杂志

<p><b>OBJECTIVE</b>The purpose of this study was to observe the association between inflammation status/autoimmune antibodies and plasma lipid in patients with rheumatoid arthritis (RA).</p><p><b>METHODS</b>A total of 402 RA patients were admitted into our hospital during January 2008 to March 2009 and 225 RA patients who met the inclusion criteria were selected to perform a full lipid profile examination including total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG). Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), anti-keratin antibody (AKA), anti-perinuclear factor autoantibody (APF) and complement (C) were also evaluated. Atherogenic index of plasma (AIP) was calculate by the formula Log (TG/HDL-C).</p><p><b>RESULTS</b>(1) There were 12.9%, 10.2% and 14.2% patients with elevated TC, LDL-C and TC respectively, patients with reduced HDL-C accounted for 43.6%. (2) C(3) was higher in elevated TC group than normal TC group (P < 0.05). ESR and CRP were significantly higher in decreased HDL-C group than in normal HDL-C group (P < 0.05). CRP, C(3) and C(4) were significantly higher in elevated LDL-C group than in normal LDL-C group (P < 0.05). (3) Multiple stepwise regression analysis showed that C(3) was positively correlated with TC (R(2) = 0.067, P < 0.05). Both ESR and CRP were negative correlated with HDL-C (R(2) = 0.202, P < 0.05). CRP and anti-CCP were positively correlated with LDL-C (R(2) = 0.129, P < 0.05). ESR and C(4) were positively correlated with AIP (R(2) = 0.046, P < 0.05).</p><p><b>CONCLUSION</b>This study showed that rheumatoid arthritis is associated with an abnormal lipid profile, especially in patients with increased inflammation markers and autoimmune antibodies. Moreover, ESR and C(4) were predictors of increased AIP in this cohort.</p>