Clinical characteristics of 272 437 patients with different histopathological subtypes of primary esophageal malignant tumors / 中华内科杂志

Objective:To characterize the histopathological subtypes and their clinicopathological parameters of gender and onset age by common, rare and sparse primary esophageal malignant tumors (PEMT).Methods:A total of 272 437 patients with PEMT were enrolled in this study, and all of the patients were received radical surgery. The clinicopathological information of the patients was obtained from the database established by the State Key Laboratory of Esophageal Cancer Prevention & Treatment from September 1973 to December 2020, which included the clinical treatment, pathological diagnosis and follow-up information of esophagus and gastric cardia cancers. All patients were diagnosed and classified by the criteria of esophageal tumor histopathological diagnosis and classification (2019) of the World Health Organization (WHO). The esophageal tumors, which were not included in the WHO classification, were analyzed separately according to the postoperative pathological diagnosis. The χ 2 test was performed by the SPSS 25.0 software on count data, and the test standard α=0.05. Results:A total of 32 histopathological types were identified in the enrolled PEMT patients, of which 10 subtypes were not included in the WHO classification. According to the frequency, PEMT were divided into common (esophageal squamous cell carcinoma, ESCC, accounting for 97.1%), rare (esophageal adenocarcinoma, EAC, accounting for 2.3%) and sparse (mainly esophageal small cell carcinoma, malignant melanoma, etc., accounting for 0.6%). All the common, rare, and sparse types occurred predominantly in male patients, and the gender difference of rare type was most significant (EAC, male∶ female, 2.67∶1), followed with common type (ESCC, male∶ female, 1.78∶1) and sparse type (male∶ female, 1.71∶1). The common type (ESCC) mainly occurred in the middle thoracic segment (65.2%), while the rare type (EAC) mainly occurred in the lower thoracic segment (56.8%). Among the sparse type, malignant melanoma and malignant fibrous histiocytoma were both predominantly located in the lower thoracic segment (51.7%, 66.7%), and the others were mainly in the middle thoracic segment.Conclusion:ESCC is the most common type among the 32 histopathological types of PEMT, followed by EAC as the rare type, and esophageal small cell carcinoma and malignant melanoma as the major sparse type, and all of which are mainly occur in male patients. The common type of ESCC mainly occur in the middle thoracic segment, while the rare type of EAC mainly in the lower thoracic segment. The mainly sparse type of malignant melanoma and malignant fibrous histiocytoma predominately occur in the lower thoracic segment, and the remaining sparse types mainly occur in the middle thoracic segment.

Investigation on iodine nutritional status and thyroid function of women in early pregnancy after the implementation of a new standard of iodized salt in Chengde / 公共卫生与预防医学

Objective To investigate the iodine nutritional status and thyroid function of women in early pregnancy after the implementation of a new standard of iodized salt in Chengde. Methods A total of 136 early pregnancy women who had lived in Chengde were randomly selected in this study from January 2018 to March 2020. A questionnaire survey was conducted. The iodized salt, urine and blood samples of the pregnant women were collected to analyze the salt iodine concentration, serum iodine, urinary iodine, serum thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4). Results In 2018 and 2019, the iodized salt coverage rates were 96.97% and 98.57%, the non-iodized salt rates were 3.03% and 1.43%, the iodized salt qualification rates were 95.45% and 97.14%, and the qualified iodized salt consumption rates were 93.94% and 92.86%, respectively. In addition, the median of iodized salt consumption was 22.20 mg/kg and 25.51 mg/kg, in 2018 and 2019, respectively. There was a statistically significant difference in the median urine iodine from 2018 to 2019 among women in early pregnancy (P0.05). Conclusion After the implementation of a new standard of iodized salt in Chengde, the iodine nutritional status of early pregnant women in 2019 was significantly improved, but there was still a small amount of insufficient iodine intake. The incidence of thyroid diseases in early pregnant women with abnormal iodine intake was higher than that in early pregnant women with appropriate iodine intake.

Effect of ionizing radiation on the occupational health of radiologists / 中国辐射卫生

Objective To analyze peripheral blood hemogram, lymphocyte micronucleus and chromosomal aberrations of radiologists, so as to provide basis for occupational protection and health monitoring of radiologists. Methods Lymphocyte micronucleus, chromosome and blood hemogram analysis were performed on 127 radiologists who received health examinations in 2015, 2017 and 2019, and they were assigned to the radiation group. In addition, 133 medical staff with no history of radiation exposure were selected as the control group. Results The micronucleus rate and chromosome aberration rate of the radiation group were higher than those of the control group, and the white blood cell and platelet counts were lower than those of the control group, both of which were statistically significant (P < 0.05). The total number of white blood cells in peripheral blood of 127 radiologists decreased gradually with the increase of exposure time to ionizing radiation, and the chromosome aberration rate increased gradually, all of which had statistical significance (P < 0.05). The rate of chromosomal aberration was higher in radiologists with damage work age of more than 20 years than in the low-work age group, and there was no statistical significance between different damage work age (P > 0.05). The chromosome aberration rate of nuclear medicine and interventional therapy was higher than that of other types, with statistical significance (P < 0.05). Conclusion Long-term exposure to low-dose ionizing radiation can reduce the total number of white blood cells and increase the chromosome aberration rate of radiologists. It is necessary to strengthen the protective measures for radiologists to reduce the degree of ionizing radiation damage, especially to strengthen the occupational protection for radiologists in nuclear medicine and interventional therapy.

The association between the whole blood riboflavin level and the occurrence, development and prognosis of esophageal squamous cell carcinoma / 中华预防医学杂志

Objective@#To investigate the association between the whole blood riboflavin level and the occurrence, development and prognosis of esophageal squamous cell carcinoma (ESCC) in China. @*Methods@#From March 2014 to September 2018, ESCC patients from three hospitals (the Affiliated Hospital of Medical College of Shantou University, Shantou Central Hospital in Southern Chaoshan area and First Affiliated Hospital of Zhengzhou University in Northern Taihang Mountain) were selected as a case group; non-esophageal patients who had a physical examination were selected as a control group. The case and control group were paired by age (±5 years) and a 1:1 ration. A total of 1 528 subjects were enrolled including 764 patients in the case group and 764 patients in the control group. About 3-5 ml venous blood samples were collected, and the erythrocyte glutathione reductase activity coefficient (GRAC) was measured to assess the whole blood riboflavin level. A multivariate conditional logistic regression model was used to analyze the association between the GRAC and the risk of ESCC. The association between the GRAC and the prognosis of ESCC was analyzed by using Cox proportional risk regression model based on 288 patients with complete survival data. They were divided into two groups, the high GRAC group (GRAC≥7.87) group and the low GRAC group (GRAC<7.87) according to the strongest correlation between the total survival time, survival outcome and GRAC (GRAC=7.87). @*Results@#Among the 1 528 patients, 958 patients were from Southern Chaoshan area, including 479 patients in the case group with an average age about (59.90±9.34) years and 479 patients in the control group with an average age about (59.55±8.77) years. Other 570 patients were from Northern Taihang Mountain area, including 285 patients in the case group with an average age (58.39±5.19) years and 285 patients in the control group with an average age about (58.74±4.57) years. The multivariate conditional logistic regression showed that the OR (95%CI) of the GRAC and the risk of ESCC was 1.009 (0.998-1.019). The Cox proportional hazard regression model analysis showed that the HR (95%CI) of the high GRAC group was 1.712 (1.034-2.824) compared with the low GRAC group in the 50-70 years group. @*Conclusion@#The whole blood riboflavin level might not be associated with the occurrence of ESCC. The high whole blood riboflavin level would be more beneficial to the prognosis of ESCC patients aged 50-70 years.

Expression of PD-L1 in breast cancer and its correlation with cellular immunity / 重庆医学

Objective To observe the expression of PD-L1 in breast cancer tissue and to investigate its correlation with cellu-lar immunity.Methods One hundred and fourteen paraffin-embedded specimens of breast cancer were collected from the Qian′an Municipal People′s Hospital.The expression of PD-L1 in breast tumor tissue was detected by immunohitochemical technique,then the relationship between PD-L1 expression and tumor clinicopathological characteristics was analyzed;the levels of peripheral blood CD3+,CD3+CD4+,CD3+CD8+,CD3-CD19+,CD3-CD16+CD56+cells and CD4+/CD8+in the patients with PD-L1 negative and PD-L1 positive of the two groups were detected by the flow cytometry.Results Among 114 cases of breast cancer specimen,35 ca-ses(30.7%)were PD-L1 expression positive with the expression rate of 30.7%.The PD-L1 expression was correlated with the tumor size,histological grade and Ki-67 high expression(P<0.05);the cellular immunity status in the patients with PD-L1 negative expression was better than that in the patients with PD-L1 positive expression(P<0.05).Conclusion The PD-L1 expression is closely correlated with the poorer clinicopathological characteristics of breast cancer,its mechanism may be correlated with the dis-ruption of cellular immunity in the patients with PD-L1 positive expression.

Comparative analysis on survival of the patients with esophageal squamous cell carci-noma from rural and urban regions / 中国肿瘤临床

Objective:To elucidate the factors influencing the differences in the survival rates of esophageal squamous cell carcinoma (ESCC) patients between the rural and urban regions in China. Methods:A total of 36,723 ESCC patients derived from the clinical data-bases containing 500,000 esophageal and gastric cardia carcinoma cases (1973-2015) of the Henan Key Laboratory for Esophageal Can-cer Research of the First Affiliated Hospital, Zhengzhou University, were analyzed. Of these patients, 33,625 were from the rural re-gions (91.6%), comprising 20,906 male patients with an average age of 58.98 ± 8.71 years and 12,719 females with an average age of 59.59 ± 8.53 years. The remaining 3,098 were from the urban regions and composed of 2,089 male patients with an average age of 60.84±9.10 years and 1,009 females with an average age of 62.46 ± 9.14 years. All the patients underwent radical esophagectomy, de-tailed histopathological diagnosis, and TNM staging. Chi square test, Kaplan-Meier, Log-rank, and Cox proportional hazards regression model were used to analyze the differences between ESCC patients from rural regions and those from urban regions and among the risk factors in prognosis. Results:Kaplan-Meier and Log-rank analysis results showed that the ESCC patients from the rural regions had significantly higher overall survival than the urban patients (χ2=12.971, P=0.000). Further analysis showed that rural patients≥50 years old and diagnosed with stage IIa and IIb (middle stage) ESCC had higher survival rates than urban patients in males and females (male:χ2=16.188, P0.05). The results of Cox proportional hazards regression model analysis showed that age, gender, and TNM stages were independent risk factors for rural and urban ESCC patients. When the rural and urban ESCC patients were both considered, the Cox proportional hazards regression model analysis results showed that male ESCC patients≥50 years old, urban residence, and TNM stages were independent risk factors. Conclusion:Rural ESCC patients have significantly high-er overall survival than urban patients. Male, age of≥50 years old, urban residence, and TNM stages were independent risk factors for ESCC patient survival.

Expression of tissue neuronal cell adhesion molecule 56, chromogranin A, and synapto-physin and its relationship with clinicopathological features and prognosis in 92 Chi-nese patients with primary esophageal small cell carcinoma / 中国肿瘤临床

Objective:To investigate the expression level of synaptophysin (Syn), tissue neuronal cell adhesion molecule 56 (CD56) and chromogranin A (CgA) in 92 primary esophageal small cell carcinoma (PESC) and to explore its repationship with clinicopathological features and clinical outcome. Methods:Immunohistochemical studies of CD56, CgA, and Syn were performed in 92 paraffin-embed-ded tissues with clinical-related information obtained from 500,000 esophageal and gastric cardia carcinoma databases established by Henan Key Laboratory for Esophageal Cancer Research of the First Affiliated Hospital of Zhengzhou University in Henan, China. Binary logistic regression was used to analyze the correlations of CgA, Syn, and CD56 expression with clinicopathological features. Kaplan-Mei-er survival analysis and Cox proportional hazards regression models were performed for univariate and multivariate survival analyses. Log-rank test was used to compare the difference in survival rates. Results:The CgA-positive expression rate in PESC at lower segment of esophagus (72.2%) was higher than those at the middle and lower segments (41.1%, 10.0%) (P=0.001). The expression level of CD56, CgA, and Syn was not correlated with gender (P=0.262, 0.998, 0.931), age (P=0.250, 0.998, 0.703), tumor invasion (P=0.253, 0.997, 0.061), and lymph node metastasis (P=0.767, 0.998, 0.613). Univariate analysis showed no survival influence in patients with and without lymph node metastasis (P=0.563). Multivariate survival analysis showed that patients with PESC mixed squamous cell car-cinoma (HR=2.58;95%Cl, 1.11-5.98) and higher CgA protein expression (HR=1.87;95%Cl, 1.02-3.43) exhibited a longer survival time than those with pure PESC and without CgA expression. Conclusion:Tissue CgA level was associated with tumor location in PESC. His-tological type and tissue CgA expression were independent important prognostic factors, and lymph node metastasis exerted no influ-ence on survival in PESC.

The clinical progress in the relationship of Golgi protein 73 and primary hepatic carcinoma / 中国医师进修杂志

Golgi protein 73(GP73) was closely correlated with primary hepatic carcinoma(PHC). GP73 had a higher sensitivity and specificity than alpha fetal protein(AFP), so GP73 had a great diagnostic value for early PHC. Although there were many related research reports in the domestic and foreign, their conclusions were inconsistent. This article reviewed these studies results.

Analysis of the levels of serum hepatitis B surface antigen in different clinical stages of hepatitis B ;virus infection / 中国医师进修杂志

Objective To explore the levels of serum hepatitis B surface antigen (HBsAg) in different clinical stages of hepatitis B virus(HBV) infection and their correlation with serum HBV DNA. Methods Five hundred and seventy-five patients with HBsAg-positive and without antiviral therapy were enrolled in this study. The patients were classified into six group:IT group (immune tolerant phase, 120 patients), EPH group (hepatitis B e antigen positive hepatitis, 110 patients), LR group (low replicative phase, 90 patients), ENH group (hepatitis B e antigen negative hepatitis, 110 patients), LC group (liver cirrhosis stage, 85 patients) and HCC group (hepatocellular carcinoma, 60 patients). Serum HBsAg and HBV DNA levels were quantified and analyzed through statistics. Results The levels of serum HBsAg in IT group, EPH group, LR group, ENH group, LC group and HCC group were (4.58 ± 0.40), (4.12 ± 0.50), (2.60 ± 0.68), (3.31 ± 0.27), (2.82 ± 0.57) and (3.03 ± 0.39) lg U/ml respectively, and there was significantly different among the different phase (P<0.01). The levels of serum HBsAg in IT group, EPH group, LR group, ENH group, LC group and HCC group had positive correlation with serum HBV DNA level, and the correlation coefficients were 0.627, 0.579, 0.134, 0.317, 0.159 and 0.224 respectively. Conclusions The levels of serum HBsAg is significantly different in the different clinical phase of HBV infection, and the tendency of the correlation between serum HBsAg and serum HBV DNA gradually weakens in general.

Analysis of the clinical characteristics and treatment of 494 cases of esophageal adeno-squamous carcinoma / 中国肿瘤临床

Objective:To investigate the clinicopathological characteristics, treatments, and survival of patients with esophageal adeno-squamous carcinoma (EASC). Methods:A total of 494 patients with EASC were selected from the clinical information databases of 500, 000 cases with esophageal and gastric cardiac carcinomas in the Henan Key Laboratory for Esophageal Cancer Research. Among the 494 EASC cases, 361 were males with an average age of 61.47 ± 8.32 years, and 133 were females with an average age of 65.56 ± 8.06 years. SPSS 21.0 software was applied to determine the statistical differences among the different groups. A life-table method was also used to calculate the five-year survival rate. A linear regression model was used to analyze the correlation of changes at different peri-ods. Results:The incidence of EASC in our database was 0.196%(494/251707). EASC occurred predominantly in male patients (male:female=2.71:1.00). The peak age was within 60-69 years in both males and females (39.6%vs. 40.6%). Notably, the incidence of male patients showed a downward trend (R2=0.063), whereas that of female patients showed an upward trend (R2=0.004). The prevalence of EASC was obviously higher in low-incidence areas for esophageal cancer than in high-incidence areas (53.1%vs. 46.9%, P<0.001). Ac-cording to the TNM staging criteria for esophageal cancer, phases II and III patients comprised the majority of cases, which accounted for 40.8%(173/424). The positive lymph node metastasis rate was 47.0%(206/438), and the number of positive lymph node metasta-ses ranged within 1-2 (48.5%, 100/206). In addition, preoperative biopsy was performed in 467 cases, and more than half of the pa-tients (53.96%, 252/467) were diagnosed before the operation. Surgical resection was the predominant treatment method for EASC (88.8%, 419/472). Only 1.9%patients (9/472) underwent radiotherapy and chemotherapy. The five-year survival rate of male patients who were neither smoking nor drinking of alcohol was higher than that of male smokers (26.5%vs. 12.1%). In patients with stagesⅠ,Ⅱ, andⅢ+Ⅳcarcinomas with surgery as lone treatment, the three-year survival rates were 64.7%, 50.9%, and 48.5%, respectively. Correspondingly, these rates were 51.7%, 47.8%, and 33.1%after adjuvant radiotherapy and chemotherapy. Conclusion:EASC is a rare type of esophageal malignant tumor. The preoperative biopsy pathological diagnosis has high misdiagnosis rate. Smoking and drinking of alcohol can influence the prognosis of patients. In EASC patients, lymph node metastasis easily occurs, and a simple surgery is bet-ter than other cancer treatments.

Molecular basis and precision medicine for interactions of genetic and environmental risk factors in esophageal cancer / 中国肿瘤临床

Esophageal cancer is a unique malignant disease in China. A fundamental difference exists between the Chinese population and the western population on esophageal cancer in terms of epidemiology, histogenesis, and carcinogenic risk factors. Therefore, ap-plying the western academic achievements to Chinese is difficult. Thus, Chinese scientists have the responsibility to conquer esopha-geal cancer in China. This article reviews the progress of esophageal cancer focused on the molecular mechanism for interactions of ge-netic and environmental risk factors and human esophageal multistage carcinogenesis.

Clinicopathological characterization of 1,058 cases with primary esophageal benign tu-mor in China / 中国肿瘤临床

Objective:To analyze the clinicopathological characterization of primary esophageal benign tumor (EBT). Methods:A total of 1,058 EBTs were enrolled from 500,000 cases in an esophageal and cardiac tumor biological sample and clinical information data-base of Henan Key Laboratory for Esophageal Cancer Research (1973-2015) in the First Affiliated Hospital of Zhengzhou University. SPSS 21.0 software was applied for data analysis. Results:In this database, 1,058 cases with primary EBTs among the 249,246 esopha-geal tumor patients with detailed clinical and pathological information were identified with an incidence of 0.42%(1,058/249,246). A total of 544 patients were male with an average age of 50±11 years old, whereas 514 patients were female, with an average age of 52± 11 years old. Among the 10 types of EBTs, leiomyoma was the most common type (84.50%, 894/1,058), followed by papilloma (6.90%, 73/1058). Adenoma (0.38%, 4/1,058) was the rarest type. Leiomyoma, gastrointestinal stromal tumor, and neurofibroma mainly oc-curred in male patients. By contrast, lipoma, granulosa cell tumor, schwannoma, and hemangioma mainly occurred in female patients.All five cases of hamartoma occurred only in female patients. Given the incidence of≥50%as the common standard, the common EBT in sequence in young male patients was leiomyoma and gastrointestinal stromal tumor, whereas that in young female patients was granulosa cell tumor and lipoma. The common EBT in sequence in older male patients was papilloma, gastrointestinal stromal tumor, and leiomyoma, whereas that in older female patients was schwannoma, papilloma, leiomyoma, gastrointestinal stromal tumor, and hamartoma. Additionally, lipoma, hemangioma, neurofibroma, and adenoma in male patients and neurofibroma in female patients oc-curred in older patients. The different ages of patients with EBTs (P=0.034) and leiomyoma (P=0.004) had a statistical significance. In these EBTs, leiomyoma, papilloma, gastrointestinal stromal tumor, and schwannoma mainly occurred in the middle esophagus, where-as lipoma mainly occurred in the lower esophagus. The major treatment for EBT in the present study was surgery (57.54%, 492/855), which was followed by endoscopic resection (38.01%, 325/855) and others (4.45%, 38/855). Conclusion:The incidence of EBT is low, with a couple of different histological types. Gender, age, and predilection sites are different depending on the histological types of EBTs. Surgery and endoscopic resection are the major treatment methods.

Analysis of the clinical and epidemiological changes, treatments, and prognoses of pri-mary esophageal small cell carcinoma / 中国肿瘤临床

Objective:To characterize the clinical and epidemiological changes, treatments, and prognoses of primary esophageal small cell carcinoma (PESC). Methods:A retrospective analysis was conducted using the clinical epidemiology data of 529 PESC patients se-lected from the clinical databases of 500,000 esophageal and gastric cardiac carcinomas of the Henan Key Laboratory for Esophageal Cancer Research (1992-2015). Among these patients, 241 cases were included in the survival analysis. The five-year survival rate was calculated using Kaplan-Meier analysis, and the differences in survival rates were compared using the Log-rank analysis model. Re-sults:All 529 PESC cases were analyzed, which accounted for 0.2%of esophageal cancers diagnosed in the same period. The incidence of PESC increased annually (R2=0.574). The survival rates for 1-, 2-, 3-, and 5-year of 241 PESC patients were 55%, 40%, 29%, and 9%, respectively, and the median survival time was 21.9 months. On the basis of the VALSG criteria of lung small cell carcinoma, a statisti-cal difference was observed in the overall survival rates for limited and extensive diseases (P=0.003), with the median survival time of 24.3 and 17.5 months, respectively. Furthermore, significant differences were observed on survival with various treatment modalities (P=0.004). The median survival time of PESC patients treated with combined surgery and radiochemotherapies (28.8 months) was lon-ger than those with either chemotherapy (17.8 months, P=0.015) or chemoradiotherapy (14.5 months, P=0.004). In limited disease pa-tients, the median survival time was longer in patients treated with surgery (27.7 months) than in those without surgery (16.2 months, P=0.007). Notably, the biopsy diagnosis before surgery for PESC was only 40.8%. Conclusion:PESC is a rare malignant carcinoma with increasing incidence. PESC presents poor prognosis, and the survival rate can be improved through combined therapies based on sur-gery. A high misdiagnosis rate for PESC is observed before surgery with biopsy.

Clinical characteristics and prognostic factors of primary duodenal carcinoma / 中华消化外科杂志

Objective To summarize the clinical characteristics and investigate the prognostic factors of primary duodenal carcinoma.Methods The clinical data of 122 patients with primary duodenal carcinoma who were admitted to the Shengjing Hospital Affiliated to China Medical University from November 2007 to May 2013 were retrospectively analyzed.All the patients received different operations according to the characteristics of tumors.Primary duodenal carcinomas of patients were confirmed by the postoperative pathological diagnosis.All the patients were followed up by outpatient examination, telephone interview and correspondence till November 30,2014.The treatment process, results of imaging examination and laboratory examination and postoperative survival were recorded.The clinical features, diagnostic criteria, therapeutic regimens and prognostic factors were analyzed.The survival rate and survival curve were analyzed and drawn by the Kaplan-Meier method.The univariate analysis was done using the Log-rank test, and multivariate analysis was done using the COX regression model.Results Among the 122 patients with primary duodenal carcinoma, jaundice as the first symptom was detected in 57 patients, abdominal pain and upper abdomen discomfort in 37 patients, gastrointestinal obstruction in 14 patients,anorexia and reduction of body weight in 4 patients, gastrointestinal hemorrhage in 3 patients, diarrhea in 3 patients, pyrexia in 3 patients and abdominal mass in 1 patient.The positive rates of CT examinations, endoscopic examinations, magnetic resonanced cholangio-pancreatography (MRCP), B-ultrasound examinations and upper gastrointestinal contrast examinations were 69.67％ (85/122), 85.56％ (77/90), 79.76％ (67/84), 12.73％ (7/55) and 75.00％ (36/48), respectively.Among the 122 patients, anemia was detected in 48 patients,positive fecal occult blood test in 94 patients, increasing level of CA19-9 in 71 patients, increasing level of CEA in 22 patients and increasing level of AFP in 9 patients.The tumors located at the descending part of duodenum,duodenal bulb and horizontal part of duodenum were detected in patients of 86.07％ (105/122), 7.37 ％ (9/122) and 6.56％ (8/122), respectively.The mean diameter of tumors was 2.3 cm (range, 1.0-15.0cm).All the 122 patients received operation.Pancreaticoduo-denectomy was performed in 100 patients, including combined with jejunostomy in 17 patients, pylorus-preserving pancreatoduodenectomy in 7 patients, segmental resection of duodenum and gastrojejunostomy in 5 patients, local resection of duodenal papilla in 6 patients and palliative gastrojejunostomy in 11 patients.Nineteen patients with complications were cured by symptomatic treatment.Of the 122 patients, adenocarcinoma, carcinoid tumor, lymphoma, small cell carcinoma, intraepithelial neoplasm combined with differentiated rhabdomyoma and with undifferentiated rhabdomyoma were detected in 116, 2, 1, 1,1 and 1 patients, respectively.The Ⅰ , Ⅱ , Ⅲ and Ⅳ stage of tumors were detected in 10, 4, 74 and 34 patients.There were 100 patients without lymph node metastasis, 13 patients with 0 ＜ metastatic lymph node ratio (MLR) ≤0.2, 4 patients with 0.2 ＜ MLR≤0.4 and 5 patients with MLR ＞ 0.4.One-hundred and twelve of 122 patients were followed up for 1-70 months with a median follow-up time of 20 months.The postoperative survival time, a median of survival time, postoperative 3-and 5-year survival rates were 1-70 months, 18 months, 36.6％ and 13.5％ , respectively.The results of univariate analysis showed that the lymph node metastasis, differentiated grade of tumor, MLR and with invasion of pancreas were risk factors affecting the prognosis of patients (x2 =8.465, 57.355, 16.232, 20.112, P ＜ 0.05).The multivariate analysis showed that the low-differentiation of tumor, invasion of pancreas, lymph node metastasis and MLR ＞ 0.4 were independent risk factors affecting the prognosis of patients (RR =3.330, 3.718, 2.623, 95％ confidence interval: 1.861-5.956, 1.292-10.696,1.624-4.236, P ＜ 0.05).Conclusions Most of the primary duodenal carcinomas are located at the descending part of duodenum without specific clinical symptoms in the early stage.The joint usage of assistant examinations can improve the diagnostic rate of primary duodenal carcinoma, and surgery is mainly therapeutic method.The low-differentiation of tumor, MLR ＞ 0.4 and invasion of pancreas are independent risk factors affecting the prognosis of patients.

The clinical efficacy of dural reconstruction plates for treatment of humeral intercandylar fracture / 中国医师进修杂志

Objective To investigate the of dural reconstruction plates for treatment of humeral intercandylar fracture.Methods The 52 cases with humeral intercandylar fracture were treated with dural reconstruction plates internal fixation.Watched the clinical efficacy Postoperative in outpatient,and guide early exercise of elbow.Result Using Elbow Scoring Standard System to assess:16 cases of C1,excellent and good in 14 cases,fair in 2 cases,and 87.5％ excellent and good results were obtained.Twenty-four cases of C2,excellent and good in 20 cases,fair in 4 cases,and 83.3％ excellent and good results were obtained.Twelve cases of C3,excellent and good in 6 cases,fair in 2 cases,and poor in 4 case,and 50.0％ excellent and good results were obtained.Fifty-two cases were followed up,excellent and good in 40 cases,fair in 8 cases,and poor in 4 case,and 76.9％ excellent and good results were obtained.Conclusion Dural reconstruction plates internal fixation was the relatively effective method for treatment of humural intercandylar fracture.

The relationship between C20orf54 gene rs3746804 position single nucleotide polymorphism and susceptibility to esophageal squamous cell carcinoma / 中华内科杂志

Objective To explore the association of C20orf54 gene rs3746804 position single nucleotide polymorphism and susceptibility to esophageal squamous cell carcinoma (ESCC).Methods Purification of genomic DNA from whole blood was used the Maxwell(R) 16 System.rs3746804 in C20ort54 was detected by direct sequencing in 434 ESCC patients from Changzhi (Shanxi province) and Linzhou (Henan province) and 554 healthy controls from Changzhi,Linzhou and including immigrators from Linzhou to Changzhi.Results For rs3746804,the genotypic frequencies of CT(37.5％ vs 51.0％,37.5％ vs 52.0％),CC (44.2％ vs 34.8％,44.2％ vs 33.0％) in Changzhi ESCC patients showed significant differences with healthy Changzhi controls and the healthy immigrator controls (all P ＜ 0.05),and the frequencies of TT(18.3％ vs 4.1％) and CC (44.2％ vs 54.6％) in Changzhi ESCC patients showed significant differences with Linzhou ESCC patients (all P ＜0.05).The genotypic frequencies of TT (4.1％ vs 15.0％),CT (41.2％ vs 52.0％) and CC(54.6％ vs 33.0％) showed significant differences between Linzhou ESCC patients and the healthy immigrator controls (all P ＜ 0.05),and the frequencies of TT (4.1％ vs 14.1％) and CC (54.6％ vs 34.8％) showed significant differences between Linzhou ESCC patients and Changzhi healthy controls (all P ＜ 0.01).Meanwhile,there were significant differences between ESCC patients (including Changzhi and Linzhou ESCC patients) and healthy controls (including the healthy Changzhi,Linzhou and immigrator controls) in genotypic frequencies of CT(39.2％ vs 48.7％) and CC (48.8％ vs 38.2％) (all P ＜ 0.01).CT and CT + TT genotype could decrease the risk of ESCC compared with the CC genotype (OR =0.630,95％ CI0.481-0.826 ; OR =0.654,95％ CI 0.507-0.844).Conclusion There is a closed relationship between SNP rs3746804 in C20orf54 and susceptibility to ESCC.

A comparison and significance of plasma riboflavin levels in patients with esophageal squamous cell carcinoma versus Linzhou healthy migrants in Changzhi of Shanxi / 中华内科杂志

ObjectiveTo study the relationship between plasma riboflavin levels and esophageal squamous cell carcinoma.Methods We detected and compared plasma concentrations of riboflavin in patients with esophageal squamous cell carcinoma (ESCC) and immigrants of Linzhou living in Changzhi.Plasma riboflavin levels were quantified in 445 ESCC patients,689 healthy control subjects and 347 immigrants of Linzhou living in Changzhi by using enzyme-linked immunosorbent assay.ResultsThe plasma riboflavin levels in patients with ESCC were significantly lower than those in the healthy controls and immigrants of Linzhou living in Changzhi [ (731.69 ± 330.67 ) μg/L vs ( 1090.43 ± 445.08 ) μg/L,(731.69 ± 330.67) μg/L vs ( 897.58 ± 177.78) μg/L,respectively,all P ＜ 0.05 ],and the plasma riboflavin levels of the healthy controls were higher than those in the immigrants of Linzhou living in Changzhi (P ＜ 0.05).ConclusionPatients with ESCC have decreased plasma riboflavin levels as compared with the healthy controls and immigrants of Linzhou living in Changzhi,there exists a lack of riboflavin in ESCC patients,but the specific mechanism needs further study.

Relationship between expression of DAS-1 protein in intestinal metaplasia and gastric cardia adenocarcinoma / 中华消化杂志

Objective To investigate the relationship between expression of DAS-1 in gastric cardia intestinal metaplasia(CIM)and gastric cardia adenocarcinoma (GCA). Methods The cancerous tissues and CIM tissues (2 cm apart from caneer) obtained from 65 patients with GCA were examined for the expression of DAS-1 protein using immunohistoehemistry. The CIM tissues (<2 cm below Z line) obtained from 15 outpatients and inflammatory mucosa from 25 outpatients were also examined for expression of DAS-1 protein. Results The type Ⅲ IM was accounted for 55.4% (36/65) in GCA patients, which was significantly higher than that in outpatients [13.3% (2/15), P<0.01]. The positive rate of DAS-1 expression in cancerous tissues [78.5 % (51/65)] was also significantly higher than that in CIM tissues [38.8 %(30/80), P<0.01]. The expression of DAS-1 protein in IM tissues was gradually increased from type Ⅰ (0%) to type Ⅲ (71.1%) with positive correlation (P<0.01). Conclusions The type Ⅲ IM with over-expression of DAS-1 is closely related to GCA, which might be one of important precancerous lesions for GCA.

Expression of Rb in precancerous lesions of esophagus and gastric cardia in same patients / 临床与实验病理学杂志

Purpose To characterize the alterations and significance of Rb in concurrent esophageal and gastric cardia precancerous lesions (dysplasia) from the same patients in Henan,a high-incidence area of esophageal carcinoma.Methods Rb protein expression was detected by the immunohistochemical staining (ABC method) in 30 patients with both esophageal and gastric cardia dysplasia in Henan area.Results Rb positive rates in esophageal epithelial dysplasia (EDYS) and gastric cardia dysplasia (GDYS) were 70% (21/30) and 80% (24/30), respectively, and the difference was not significant,(χ~2=0.800,P>0.05).However, there were 25 patients with Rb coincident changes in EDYS and GDYS from the same patient in 30 cases of esophageal and gastric cardia dysplasia (83%,25/30). The positive coincidence rate for Rb positive expression in EDYS and GDYS from the same patient accounted for 67% (20/30) and the negative coincidence rate was 17% (5/30) (Kappa=0.561,P<0.01).The significant relationship between Rb coincidence expression in EDYS and GDYS was found (P<0.01).Conclusions The high coincident alterations of Rb in EDYS and GDYS from the same patient indicate the possibility of similar molecular basis, which provides an important etiological clue for the similar geographic distribution and risk factors involved in esophageal squmaous cell carcinoma and gastric cardia adenocarcinoma.

The Inhibiting Effect of Photofrin-Diomed 630-PDT Photodynamic Therapy on Human Immortalization Eesophageal Epithelial Cell Line SHEE and Its Malignant Transformation Cell Line SHEEC / 中国医科大学学报

Objective To investigate the sensitivity of tumor cells to photodynamic therapy(PDT), and to select the optimal photo-dose and photo density for PDT to the cultured cells. Methods Cells of SHEE and SHEEC cell lines were divided into 21 groups randomly,after 24 h inoculation, the cells accreted on paries of culture capsule completely, we replaced M199 complete culture solution with 30 μg/rnl Photofrin-Ⅱ solution 100 μl and then replacd with M199 complete culture solution without Photofiin-Ⅱ after 150 min of incubation in Photofrin-Ⅱ. Within 15 min,we dealed the cells with PDT using Photofrin-Diomed 630 under three different power densities:25 raW/cm~2,50 mW/cm~2 and 100 mW/cm~2 for 10 s,20 9,30 s,50 s, 100 s, 150 s and 200 s respectively,and then continue for 24 h culture. We examined the inhibiting effect on cell line SHEE and SHEEC under PDT by the method of CCK-8. Results There was no significant difference in the inhibition ratio with same power density of PDT between cell line SHEE and SHEEC under the concentration of 30 μg/ml Photofrin-Ⅱ. However, the inhibition ratio increased with the raising of photo-dose of PDT,but there was a platform stage after the 2.5～30 J/cm~ 2 photo-dose. Conclu-sion The difference for photodynamic sensitivity between human immortalization esophageal epithelial cell line SHEE and the malignant transformation cell line SHEEC is not significant. The targeting of PDT to malignant tumor cell may not be involved in the photosensitivity for tumor cell.