Qualitative Insights on the Caregiving of Gastrointestinal Cancer Patients with Low Quality of Life Scores

@#Introduction: Caring for gastrointestinal cancer patients can be demanding and to some, caregivers, burdensome; resulting in them having low quality of life (QOL) and thus they may become the next potential patients. Hence, true heartfelt experiences need to be captured to highlight issues and preventive measures that are not voiced out as most often caregiving is done in silence and out of responsibility. Therefore, this study aimed to explore on the caregivers’ insights on how caregiving experience has resulted in their low QOL. Methods: Seven family caregivers were purposively selected from two oncology centres in the Klang Valley, Malaysia for this qualitative case study. The selection was based on the low scores obtained from Malay Caregiver Quality of Life Cancer (MCQOL) questionnaire during an initial cross-sectional study. Following that, in-depth interviews were performed on those selected caregivers. Interview data were triangulated with the questionnaire and observations for validity. Member and expert checking were conducted to ensure credibility and trustworthiness. A thematic content analysis was later performed. Results: Thematic analysis revealed four distinct contributors to the caregivers’ QOL; namely, patients’ financial and stress management; impact towards physical, psychological, social (including relationship) wellbeing, communication; and support from families, organisation and community. Conclusion: The qualitative study discovered evidence for collaborative support needed to ensure better QOL for the caregivers.

Practice and thinking of standardized training on the diagnosis of early upper gastrointestinal cancer in gastroscopy teaching / 中华医学教育探索杂志

Early upper gastrointestinal cancer screening skills teaching is the vacancy and difficulty of endoscopic teaching and training. In this study, a standardized training program was set up for endoscopic physicians who had mastered the basic gastroscopy techniques. The training period was 12 weeks, including theoretical training, early cancer awareness training, standardized gastroscopy operation technology, endoscopic diagnosis of early esophageal and gastric cancer, and theoretical and skill examination. After passing the examination, trainees can participate in early cancer case competition. According to questionnaire survey, 100%(15/15) of trainees thought that standardized training was necessary for improving the detection rate of early upper gastrointestinal cancer, and it could significantly improve the trainees' diagnosis level. Therefore, the overall setting of the standardized training process for the diagnosis of early upper gastrointestinal cancer in our center is generally reasonable, which is worthy of further promotion.

Qualidade de vida de pacientes com câncer do trato gastrointestinal em um hospital oncológico / Quality of life of patients with cancer of the gastrointestinal tract in an oncological hospital / Calidad de vida de pacientes con cáncer del tracto gastrointestinal en un hospital oncológico

O objetivo deste estudo foi avaliar a qualidade de vida de pacientes com câncer do trato gastrointestinal em um hospital oncológico no Maranhão. Trata-se de um estudo transversal de abordagem quantitativa realizado em um serviço oncológico com pacientes em tratamento, aplicando-se o European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire (EORTC QLQ-C30) para avaliação da qualidade de vida. Os dados foram analisados por meio de estatística descritiva e do teste t, considerando nível de significância de 5%. A maior parte dos participantes eram do sexo masculino (62,7%), na faixa etária de 50 a 79 anos (74,5%), de raça/cor parda (86,2%), casados/em união estável (47,0%), católicos (52,9%), com ensino fundamental (58,8%) e renda de um a dois salários-mínimos (58,8%). Com relação às variáveis clínicas, a neoplasia de estômago predominou em 58,8%, sendo diagnosticados entre seis meses e dois anos (52,9%). Quanto ao tratamento, 47,0% iniciaram-no em até três meses, além disso, havia aqueles que estavam no segundo tratamento (72,5%). O tratamento quimioterápico representou 94,1% dos pacientes e, quanto aos fatores de risco, não fumantes representavam 54,9%, etilistas 60,7%, e sem histórico familiar de câncer 49,0%. Em relação aos escores de saúde global, a média foi de 64,5%, o sintoma da insônia de 39,2%. Já em escala funcional, o comprometimento físico foi de 78,8% dos pacientes. A qualidade de vida foi considerada satisfatória pelos pacientes. Apesar disso, o funcionamento físico apresentou menor impacto que o emocional, o que representa melhores tratamentos com menores efeitos físicos, visto que os pacientes oncológicos tendem a apresentar mais limitações na função física, o que torna inferior sua qualidade de vida.

This study aimed to evaluate the quality of life of patients with cancer of the gastrointestinal tract in an oncology hospital in Maranhão (Brazil). This is a cross-sectional study with a quantitative approach, carried out in an oncology service with patients undergoing treatment, applying the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire (EORTC QLQ-C30) to assess the quality of life, the data were analyzed by using descriptive statistics and T test considering a significance level of 5%. 51 male patients participated (62.7%), in the age group from 50 to 79 years old (74.5%), of brown color (86.2%), married/in stable union (47.0%), Catholics (52.9%), having elementary schooling (58.8%), and income of 1 to 2 minimum wages (58.8%). Regarding the clinical variables, stomach neoplasms predominated in 58.8%, they were diagnosed between six months and two years (52.9%). As for treatment, 47.0% started with up to three months, were in the second treatment (72.5%), 94.1% had chemotherapy, and as for risk factors, non-smokers were 54.9%, alcoholics were 60.7%, and those without family history of cancer were 49.0%. Regarding the global health scores, the average was 64.5%, insomnia symptom was 39.2%, and in the functional scale, physical impairment was 78.8%. The quality of life was considered satisfactory by the patients. Despite this, physical functioning had less impact than emotional functioning, which represents better treatments with less physical effects, since cancer patients tend to have more limitations in physical function, which worsens their quality of life.

Este estudio tuvo por objetivo evaluar la calidad de vida de pacientes con cáncer del tracto gastrointestinal en un hospital oncológico de Maranhão (Brasil). Se trata de un estudio transversal con enfoque cuantitativo, realizado en un servicio de oncología con pacientes en tratamiento, aplicando el European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire (EORTC QLQ-C30) para evaluar la calidad de vida, los datos se analizaron mediante estadística descriptiva y prueba T considerando un nivel de significación del 5%. Participaron 51 pacientes del sexo masculino (62,7%), del grupo etario de 50 a 79 años (74,5%), el color pardo (86,2%), casado/unión estable (47,0%), católicos (52,9%), nivel de estudios primaria (58,8%) e ingresos de 1 a 2 salarios (58,8%). En cuanto a las variables clínicas, predominó el cáncer de estómago en el 58,8%, se diagnosticaron entre los seis meses y los dos años (52,9%). En cuanto al tratamiento, el 47,0% lo inició con hasta tres meses, el 72,5% estaba en el segundo tratamiento, el 94,1% realizaba quimioterapia, y en cuanto a los factores de riesgo, el 54,9% eran no fumadores, el 60,7% alcohólicos y el 49,0% no tenía antecedentes familiares de cáncer. En cuanto a los puntajes globales de salud, el promedio fue del 64,5%, el síntoma de insomnio del 39,2%, y en la escala funcional, el deterioro físico fue del 78,8%. La calidad de vida fue considerada satisfactoria por los pacientes. A pesar de esto, el funcionamiento físico tuvo un impacto menor que el funcionamiento emocional, lo que representa mejores tratamientos con menos efectos físicos, ya que los pacientes con cáncer tienden a presentar más limitaciones en la función física, lo que empeora su calidad de vida.

Progress on Immunotherapy of Gastrointestinal Cancer / 肿瘤防治研究

Gastrointestinal cancers are the common malignant tumors of the digestive system, and their morbidity and mortality are in the forefront of malignant tumors. Currently, cancer immunotherapy is the hottest topic in cancer research field. Although cancer immunotherapy has achieved some results in the fundamental research and clinical application of gastrointestinal tumors, there are still a series of problems that need to be resolved. In this article, we review the fundamental and clinical research progress of several common methods of cancer immunotherapy in the field of gastrointestinal tumors.

Development of Non-invasive Endoscope System with Magnetic Anchored Ablation Electrode for Early Cancer of Digestive Tract / 中国医疗器械杂志

This study introduces a non-invasive gastrointestinal early cancer magnetic anchor ablation electrode endoscopy system, including a magnetic anchor module and ablation electrode module. The magnetic anchoring module is composed of an external guide magnet and an internal magnet, made of permanent magnet material NdFeB; the ablation electrode module is based on the modification of the front end lens hood of the existing endoscope (CMD-90D LED electronic upper gastrointestinal endoscope). The new endoscope system not only includes all the functions of the original endoscope, but also introduces magnetic anchoring to enable the ablation electrode to be accurately positioned and controllable in the process of treating tumors, avoiding the phenomenon of gastric perforation; the introduction of steep pulse electric field ablation electrodes realizes the purpose of non-invasive treatment. Its clinical application will become a new method to treat early cancer of the digestive tract.

Research Advances in the Role of Keratins in Gastrointestinal Cancer / 中国医学科学杂志(英文版)

The incidence and mortality rates of gastrointestinal (GI) cancer remain high. Despite constant improvements in diagnostic and therapeutic techniques, the early diagnosis, mid- and late-stage treatment, drug tolerance, and cancer recurrence and metastasis in GI cancer remain challenging. In this review article we summarize the recent research advance in the roles of keratins in GI cancer, with the hope that they will become efficient biomarkers for the prediction, diagnosis, or treatment of these malignancies.

Unsupervised deep learning for identifying the O 6-carboxymethyl guanine by nanopore sequencing / 生物医学工程学杂志

O 6-carboxymethyl guanine(O 6-CMG) is a highly mutagenic alkylation product of DNA that causes gastrointestinal cancer in organisms. Existing studies used mutant Mycobacterium smegmatis porin A (MspA) nanopore assisted by Phi29 DNA polymerase to localize it. Recently, machine learning technology has been widely used in the analysis of nanopore sequencing data. But the machine learning always need a large number of data labels that have brought extra work burden to researchers, which greatly affects its practicability. Accordingly, this paper proposes a nano-Unsupervised-Deep-Learning method (nano-UDL) based on an unsupervised clustering algorithm to identify methylation events in nanopore data automatically. Specially, nano-UDL first uses the deep AutoEncoder to extract features from the nanopore dataset and then applies the MeanShift clustering algorithm to classify data. Besides, nano-UDL can extract the optimal features for clustering by joint optimizing the clustering loss and reconstruction loss. Experimental results demonstrate that nano-UDL has relatively accurate recognition accuracy on the O 6-CMG dataset and can accurately identify all sequence segments containing O 6-CMG. In order to further verify the robustness of nano-UDL, hyperparameter sensitivity verification and ablation experiments were carried out in this paper. Using machine learning to analyze nanopore data can effectively reduce the additional cost of manual data analysis, which is significant for many biological studies, including genome sequencing.

Postoperative ileus after laparotomy for gastrointestinal cancer treated with electroacupuncture: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the effect of electroacupuncture (EA) on postoperative ileus after laparotomy for gastrointestinal cancer.@*METHODS@#A total of 90 patients with postoperative ileus after laparotomy for gastrointestinal cancer were randomized into an EA group and a conventional treatment group, 45 cases in each one. In the conventional treatment group, the postoperative fast track surgical regimen was accepted. In the EA group, on the base of the treatment as the conventional treatment group, acupuncture was applied to Zusanli (ST 36), Shangjuxu (ST 37), Yinlingquan (SP 9) and Taichong (LR 3) and electric stimulation was attached on Zusanli (ST 36) and Yinlingquan (SP 9), with continuous wave, 2 Hz in frequency and 3-5 mA in intensity. Acupuncture was provided once daily till the onset of postoperative exhaust and defecation. The first postoperative exhaust time, the first postoperative defecation time, the postoperative hospital stay and the wound pain under standing on the next morning after entering group were compared in the patients between the two groups. The impact of the EA expectation was analyzed on the first postoperative exhaust time, the first postoperative defecation time and the postoperative hospital stay separately.@*RESULTS@#The first postoperative exhaust time and the first postoperative defecation time in the EA group were earlier than the conventional treatment group (P<0.05), the postoperative hospital stay was shorter than the conventional treatment group (P<0.05), and the rate of wound pain in the postoperative standing was lower than the conventional treatment group (P<0.05). EA expectation had no obvious correlation with the clinical therapeutic effect (P>0.05).@*CONCLUSION@#EA can relieve postoperative ileus symptoms, alleviate pain and shorten hospital stay in the patients after laparotomy for gastrointestinal cancer.

A meta-analysis of the value of intelligence-assisted endoscopic diagnosis system based on deep learning for early upper gastrointestinal cancer / 中华消化内镜杂志

Objective:To systematically evaluate the intelligence-assisted endoscopic diagnosis system based on deep learning (DL-IEDS) for early cancer of the upper digestive tract.Methods:Literature on the value of DL-IEDS for diagnosis of early cancer of the upper digestive tract was searched in English (PubMed, Embase, Web of Science and Cochrane Library)and Chinese databases (Sinomed, CNKI, Wanfang and VIP). The quality of literatures was evaluated according to Quality Assessment of Diagnostic Accuracy Studies-2. The Rev Man 5.3, Meta-Disc 1.4 and Stata 15.1 were used for the meta-analysis.Results:Eight studies were included with a total of 9 675 images (including 2 748 images of early cancer). Meta-analysis results showed that the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and comprehensive diagnostic ratio of DL-IEDS in the diagnosis of early cancer of the upper digestive tract were 0.920, 0.874, 6.824, 0.103 and 71.109, respectively. The area under the curve (AUC) of summary receiver operating characteristics was 0.958 7. Five studies reported the results of DL-IEDS in the diagnosis of early gastric cancer, and the combined analysis showed that the pooled sensitivity and specificity were 0.840 and 0.845 respectively, and the AUC was 0.919. Four studies reported the accuracy rate of endoscopic experts and endoscopic novices in diagnosing early upper gastrointestinal cancer, and results showed that the pooled sensitivity, specificity and AUC were 0.693, 0.892 and 0.892 3, and 0.586, 0.860 and 0.754 5, respectively. Compared with endoscopy experts, the AUC of DL-IEDS in diagnosis of early upper gastrointestinal cancer showed no statistically significant difference ( Z=1.510, P=0.131), while compared with endoscopy novices, the difference was statistically significant ( Z=6.841, P<0.001). Conclusion:The DL-IEDS has high diagnostic accuracy for early upper digestive tract cancer, and can significantly improve the diagnostic ability of endoscopy novices.

Is perioperative fasting associated with complications, length of hospital stay and mortality among gastric and colorectal cancer patients? A cohort study

ABSTRACT BACKGROUND: During a surgical procedure, patients are often subjected to fasting for times that are more prolonged than the ideal, which may lead to complications. OBJECTIVE: To evaluate the duration of perioperative fasting and its association with postoperative complications, length of hospital stay (LOS) and mortality among gastric and colorectal cancer patients. DESIGN AND SETTING: Cohort study developed in a surgical oncology hospital in the city of Natal (Rio Grande do Norte, Brazil). METHODS: Patients aged over 18 years were included. The Clavien-Dindo surgical complication scale was used to evaluate occurrences of postoperative complications. LOS was defined as the number of days for which patients stayed in the hospital after surgery, or until the day of death. RESULTS: Seventy-seven patients participated (59.8 ± 11.8 years; 54.5% females; 70.1% with bowel tumor). The incidences of postoperative complications and death were 59.7% and 3.9%, respectively. The duration of perioperative fasting was 59.0 ± 21.4 hours, and it was higher among non-survivors and among patients with prolonged hospital stay (≥ 6 days). For each one-hour increase in the durations of perioperative and postoperative fasting, the odds of prolonged hospitalization increased by 12% (odds ratio, OR = 1.12; 95% confidence interval, CI 1.04-1.20) and 5% (OR = 1.05; 95% CI 1.02-1.08), respectively. CONCLUSION: Prolonged perioperative fasting, especially in the postoperative period, was observed in a sample of patients with gastric and colorectal cancer, and this was an independent predictor of LOS.

Trends of upper gastrointestinal cancer mortality from 1983 to 2015 in Cixian County, Hebei Province / 中国肿瘤临床

Objective: To analyze the mortality of upper gastrointestinal cancer in Cixian County, Hebei Province, China, over the past 33 years, and provide evidence for the prevention and treatment of such cancer. Methods: According to the cancer registration regulations, changes in the mortality of upper gastrointestinal cancer were collected, sorted and evaluated, and the trends in the mortality of upper gastrointestinal cancer were analyzed using the cancer registration data accumulated by the Cixian cancer Registration Office between January 1, 1983, and December 31, 2015. The percentage changes in crude mortality, standardized mortality in China, and the standardized worldwide mortality were calculated. The annual percent change of mortality was estimated using a linear regression model of the adjustment rate. Results: Over the 33-year period in Cixian County, the average crude mortality of upper gastrointestinal cancer was 119.31/100,000, including 149.21/100,000 for males and 88.40/100,000 for females. The standardized mortality rate in China was 160.85/100,000, including 227.00/100,000 males and 108.07/100,000 females. The worldwide standardized mortality rate was 162.39/100,000, including 228.52/100,000 males and 109.30/100,000 females. Conclusions: The mortality of upper gastrointestinal cancer displayed a decreasing trend, but it still had the highest mortality rate of malignant tumors in Cixian County. Age-specific mortalities were increasing along with the rise of age.

Research progress of exosome-derived microRNA in gastrointestinal tumors / 医学研究生学报

Exosome are nano-scale vesicles with a phospholipid bilayer membrane structure. They are widely distributed in body fluids such as serum, urine, and saliva, containing various biologically active substances such as RNA, DNA fragment and protein. Exosomes contain miRNAs called exosomal-derived miRNAs. Gastrointestinal tumors are one of the common malignant tumors. Effective screening and early diagnosis are clinical priorities and difficulties. Exosome-derived miRNAs in human circulation can be used as potential biomarkers for early diagnosis of digestive tract tumors. This article reviews the concepts and biological characteristics of exosomal-derived miRNAs, the detection of exosome-derived miRNAs and the relationship between exosome-derived miRNAs and digestive tract tumors.

Quality improvement of diagnosis and treatment of gastrointestinal cancer: establishment and implementation of the China Gastrointestinal Cancer Surgery Union Database / 中华胃肠外科杂志

Since the China Gastrointestinal Cancer Surgery Union was established, it has continuously collected the annual reports of 95 gastrointestinal surgery centers nationwide from 2014 to 2017, and collected data on more than 130 000 cases of gastric cancer. This article combines the experience of associated databases at home and abroad to analyze the construction of the China Gastrointestinal Cancer Surgery Union Database, and explore the role of multi-center cooperation and big data analysis in the promotion of gastrointestinal surgery. For a complete database to successfully achieve its ultimate goal, it needs clear goals, continuous funding, a qualified management team, consensus on data content, a high completion rate, and the support and cooperation of an advanced processing system. As a high-quality database with clear construction goals and database project construction based on the goals, while promoting the level of clinical diagnosis and treatment, it is also widely used in risk prediction model development, audit supervision, epidemiological research, health service research, and clinical hypothesis testing, etc. How to build a high-quality database to give a full promotion in clinical diagnosis and treatment is a huge challenge. Although the construction of medical databases in China has just started, we believe that with the further improvement in understanding, management and analysis capabilities for surgical databases, more databases including the China Gastrointestinal Cancer Surgery Union Database will make greater contributions in promoting the development of diagnosis and treatment of gastrointestinal cancer in China and the world.

Gastric and rectal cancers in workers exposed to asbestos: a case series

Analysis of Prognosis according to Type of Health Insurance in Five Major Gastrointestinal Cancer Patients in Public Hospitals: Single-institution Retrospective Study / 대한소화기학회지

BACKGROUND/AIMS: Public hospitals were established to provide high quality medical services to low socioeconomic status patients. This study examined the effects of public hospitals on the treatment and prognosis of patients with five-major gastrointestinal (GI) cancers (stomach cancer, colon cancer, liver cancer, bile duct cancer, and pancreatic cancer).METHODS: Among the 1,268 patients treated at Seoul National University Boramae Medical Center from January 2010 to December 2017, 164 (13%) were in the medicare group. The data were analyzed to identify and compare the clinical manifestations, treatment modality, and clinical outcomes between the groups.RESULTS: No statistically significant differences in the clinical data (age, sex), treatment method, and five-year survival rate were observed between the health insurance group and medicare group in the five major GI cancer patients. On the other hand, some medicare group patients tended more comorbidities and fewer treatment options than health insurance patients.CONCLUSIONS: Public hospitals have a positive effect on the treatment and prognosis in medicare group patients with the five-major GI cancers.

Epidemiology of gastrointestinal cancers in the hospital of Tambohobe Fianarantsoa, Madagascar

Background: Gastrointestinal cancers are among the top 10 cancers and causes of cancer death worldwide. Given the absence of cancer registry in Madagascar and absence of epidemiological study of gastrointestinal cancer in the province of Fianarantsoa, our aim was to describe the epidemiological aspect of gastrointestinal cancers at the University Hospital of Tambohobe Fianarantsoa.Methods: Authors have conducted a descriptive retrospective study over a three-year period from January 1, 2015 to December 31, 2017 at the University Hospital of Tambohobe Fianarantsoa (in oncology, internal medicine and visceral surgery departments). The variables analyzed were age, gender, tumor location.Results: Authors have collected 74 cases of gastrointestinal cancers. There were 46 males 62.16% and 28 females 37.84%. The mean age was 56.30±12.10 years old. The predominant age groups were 45-55 years. Authors found colorectal cancer in 43%, followed by liver carcinoma in 19%, then pancreatic cancer 14%, esophageal cancer 13%, gastric cancer 8%, duodenum cancer 3%.Conclusions: Gastrointestinal cancers at the hospital of Tambohobe Fianarantsoa affect young people, especially the male gender with a predominance of colorectal and liver cancer.So, it is important to continue the vaccination against hepatitis viral B infection and to implement a colorectal cancer screening program.

Risk factors of postoperative bleeding of endoscopic submucosal dissection for early gastrointestinal cancer / 中华消化内镜杂志

Objective@#To analysis the risk factors of postoperative bleeding of endoscopic submucosal dissection (ESD) for early gastrointestinal cancer.@*Methods@#A retrospective study was performed on the data of 430 patients (449 lesions) with early gastrointestinal cancer undergoing ESD in Fujian Provincial Hospital Digestive Endoscopic Center from June 2008 to February 2015 and in Fujian Provincial Hospital South Branch Digestive Endoscopic Center from May 2015 to April 2018. Patients with postoperative bleeding were compared with those without postoperative bleeding on the basis of general conditions, endoscopic performance, postoperative pathology and so on to analysis the risk factors for postoperative bleeding of ESD.@*Results@#Among the 430 cases (449 lesions)of early gastrointestinal cancer undergoing ESD, 16 cases (3.7%) had postoperative bleeding. According to whether the occurrence of postoperative hemorrhage, patients were divided into bleeding group (n=16) and not bleeding group (n=433). Univariate analysis suggested that whether had hypertension was statistically significant between the two groups (χ2=4.793, P=0.029), while patients age (t=0.465, P=0.642), gender (χ2=0.035, P=0.642), whether to have diabetes (χ2=0.647, P=0.421), whether to have coronary heart disease (P=1.000), lesion size (t=1.598, P=0.111), whether two or more lesions (P=1.000), lesion site (χ2=6.183, P=0.289), operation time (t=1.335, P=0.201), pathological grading (χ2=0.687, P=0.709), and lesion infiltration depth (χ2=0.134, P=0.714) were not statistically significant between the two groups. Logistic regression analysis showed that hypertension (OR=3.358, 95%CI: 1.227-9.186, P=0.018) was an independent risk factor of bleeding after ESD for early gastrointestinal cancer.@*Conclusion@#Hypertension is closely related to postoperative bleeding following ESD for early gastrointestinal cancer.Patients with hypertension are at a greater risk of bleeding after ESD.

Risk factors of postoperative bleeding of endoscopic submucosal dissection for early gastrointestinal cancer / 中华消化内镜杂志

Objective To analysis the risk factors of postoperative bleeding of endoscopic submucosal dissection (ESD) for early gastrointestinal cancer. Methods A retrospective study was performed on the data of 430 patients ( 449 lesions ) with early gastrointestinal cancer undergoing ESD in Fujian Provincial Hospital Digestive Endoscopic Center from June 2008 to February 2015 and in Fujian Provincial Hospital South Branch Digestive Endoscopic Center from May 2015 to April 2018. Patients with postoperative bleeding were compared with those without postoperative bleeding on the basis of general conditions, endoscopic performance, postoperative pathology and so on to analysis the risk factors for postoperative bleeding of ESD. Results Among the 430 cases (449 lesions)of early gastrointestinal cancer undergoing ESD, 16 cases ( 3. 7％) had postoperative bleeding. According to whether the occurrence of postoperative hemorrhage, patients were divided into bleeding group ( n = 16 ) and not bleeding group ( n=433) . Univariate analysis suggested that whether had hypertension was statistically significant between the two groups (χ2=4. 793, P=0. 029) , while patients age ( t=0. 465, P=0. 642) , gender (χ2=0. 035, P=0. 642), whether to have diabetes (χ2=0. 647, P=0. 421),whether to have coronary heart disease (P=1. 000), lesion size (t=1. 598, P=0. 111),whether two or more lesions (P=1. 000), lesion site (χ2=6. 183, P= 0. 289 ) , operation time ( t= 1. 335, P= 0. 201 ) , pathological grading (χ2 = 0. 687, P=0. 709),and lesion infiltration depth (χ2=0. 134, P=0. 714) were not statistically significant between the two groups. Logistic regression analysis showed that hypertension ( OR=3. 358, 95％CI:1. 227-9. 186, P=0. 018) was an independent risk factor of bleeding after ESD for early gastrointestinal cancer. Conclusion Hypertension is closely related to postoperative bleeding following ESD for early gastrointestinal cancer. Patients with hypertension are at a greater risk of bleeding after ESD.

Current treatment status and trends of early gastric cancer in China: analyzed based on the data of China Gastrointestinal Cancer Surgery Union / 中国实用外科杂志

Gastric cancer is one of the most common cancersin China. The proportion of early gastric cancer(EGC) is stillrelatively low in China. The data of China Gastrointestinal Can-cer Surgery Union from 2014 to 2017 can reflect the currentstatus and trends of diagnose and treatment of EGC in China.The union collected data of 134,111 cases of gastric cancer in95 centers in China. The trend analysis was performed with da-ta from centers with at least 3 years data collected. Within allthe patients, the proportion of EGC was 19.7%. The propor-tions of EGC were higher in Zhejiang, Beijing, Jiangsu, Tian-jin, and Shanghai, and were lower in Qinghai, Hainan, InnerMongolia, Yunnan, and Guangxi. The proportion of EGC in-creased from 19.7% in 2014 to 20.9% in 2017. In terms oftreatment, the proportions of endoscopic treatment, laparoscop-ic surgery, and open surgery were 24.3%, 37.7%, and 38.0%.From 2014 to 2017, the proportions of endoscopic treatmentand laparoscopic surgery increased while the proportion ofopen surgery decreased. Among patients received surgery,5.9% of pT1 a patients and 19.6% of pT1 b patients were withlymph node metastasis. In conclusion, the proportion of EGCincreased slightly in China but was still lower than that of Ja-pan and South Korea. Minimally invasive treatment graduallybecome the main treatment method of EGC.

Immunotherapy-based combination strategies for treatment of gastrointestinal cancers: current status and future prospects / 医学前沿

Strategies in comprehensive therapy for gastrointestinal (GI) cancer have been optimized in the last decades to improve patients' outcomes. However, treatment options remain limited for late-stage or refractory diseases. The efficacy of immune checkpoint inhibitors (ICIs) for treatment of refractory GI cancer has been confirmed by randomized clinical trials. In 2017, pembrolizumab was approved by the US Food and Drug Administration as the first agent for treatment of metastatic solid tumors with mismatch repair deficiency, especially for colorectal cancer. Given the different mechanisms, oncologists have focused on determining whether ICIs-based combination strategies could achieve higher efficacy than conventional therapy alone in late-stage or even front-line treatment of GI cancer. This review discusses the current status of combining immune checkpoint inhibitors with molecular targeted therapy, chemotherapy, or radiotherapy in GI cancer in terms of mechanisms, safety, and efficacy to provide basis for future research.