Clinicopathology and prognosis of alpha fetoprotein-producing gastric carcinoma / 中华普通外科杂志

Objective:To analyze the clinicopathological features and prognostic factors of alpha‐fetoprotein‐producing gastric carcinoma (AFPGC).Methods:A retrospective analysis was made on 2 671 GC patients admitted from Jan 1998 to Dec 2018 , AFPGC patients and matching AFP negative GC cases were enrolled and their clinicopathological features and prognostic factors were analyzed. The survival curve was drawn by Kaplan-Meier method. Log-rank test was used to test the significance, Univariate analysis was performed by using COX proportional hazard model.Results:There were 98 AFPGC in this study accounting for 4.5% of all GC of the corresponding time period. The proportion of male to female was 2.16∶1, the average age was (65±12) years. The serum AFP levels significantly decreased after operation in most patients (median: 52 ng/ml vs. 5 ng/ml, Ｚ=-2.736, P=0.001). Serum AFP and CEA levels in patients with AFPGC before treatment were significantly higher than that in patients with AFP negative GC (both P<0.05) . Vascular invasion(62.71% vs. 40.68%) and liver metastasis (31.63% vs .6.12%) were more likely to occur in AFPGC groups (both P<0.05). However, there was no significant difference between the two groups in tumor size, location, differentiation and lymph node metastasis (all P>0.05). The prognosis of AFPGC was significant pooer than that in AFP negative GC ( P<0.05). Prognosis of AFPGC patients was significantly correlated with preoperative serum AFP level, TNM stage, lymph node metastasis, simultaneous liver metastasis and vascular invasion (all P<0.05) . COX multivariate survival analysis found that preoperative serum AFP level was independent risk factors of patients with AFPGC ( P<0.05). Conclusion:AFPGC is a special GC charactering poor prognosis .

Primary screening of children with vaccination contraindications and referral recommendations: suggestions for primary care of children in Shenzhen / 中华实用儿科临床杂志

Guideline or consensus for the vaccination of children with special conditions like immunocompromised children may be more suitable for pediatricians.However, the vaccination of children in China is mainly performed by general practitioners or child health care practitioners in community health service centers.They need to master the screening knowledge of contraindications and precautions for the vaccination of children, and make the decision to referral to specialists.Based on the technical guidelines for Immunization of National Health Commission of the People′s Republic of China, Best Practices Guidance of the Advisory Committee on Immunization Practices and contraindications and precautions proposed by the Immunization Action Coalition, 20 suggestions for primary screening of children with vaccination contraindications and referral recommendations for primary care providers were developed by experts from the Integration of Medicine and Prevention in Children of Health Commission of Shenzhen Municipality.

A study on the correlation between imagingtopographic anatomy and anastomotic leakage after anterior resection for rectal cancer / 中华普通外科杂志

Objective:To study the relation ship between the branch patterns of inferior mesenteric artery (IMA) and imaging pelvic measurement parameters for anastomotic leakage (AL) after anterior resection (AR) of rectal cancer.Methods:Five hundred thirty-four patient were enrolled from Jan 2008 to Dec 2018 at the General Surgery Department of Guizhou Provincial People's Hospital. The AL related imaging risk factors were analyzed by chi-square test or Fisher's exact test.Results:AL was found in 36 (6.7%) patients. AL related mortality rate was 11.1% (4/36) compared to 0.4% (2/498) in those without the complications of no AL cases ( P<0.001). Seven pelvic imaging measurement results were attained in 412 patients including anteroposterior diameter of the inlet of the pelvis, anteroposterior diameter of the outlet of the pelvis, upper edge of the symphysis pubis to the tip of the coccyx, sacrococcygeal distance angle from the lower edge of the pubis to the upper edge of the pubis to the sacral promontory, distance between the ischial spines and that of ischial tuberosity. Univariate analysis showed that there was no significant relationship between the above 7 pelvic measurement parameters and the occurrence of AL (all P>0.05). There was no significant relationship between branch patterns of IMA and AL after rectal cancer surgery ( P=0.712). Conclusion:AL as a severe postoperative complication in rectal cancer patients undergoing AR procedure were caused by multiple factors. Neither IMA branch patters nor pelvic imaging measurement seem to be related to the occurrence of AL after AR for rectal cancer.

Pathological staging criteria for carcinoma in the remnant stomach: an exploratory study / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the prognostic value of the tumor-ratio-metastasis (TRM) staging system for carcinoma in the remnant stomach(CRS).</p><p><b>METHODS</b>Clinicopathological data of 91 CRS patients who underwent surgery at Peking University People's Hospital between March 1992 and December 2017 were retrospectively analyzed. According to the ratio of metastatic lymph node to dissected lymph node, the R staging was obtained, and the pN staging was replaced by the R staging to create the TRM staging. To compare the predictive accuracy of TRM and tumor-node-metastasis (TNM, UICC version 7), the R staging and pN staging were included in the prognostic factor analysis model, and the survival curve, c-index, and 95% confidence interval (CI) of the TRM staging and TNM staging system were compared. A higher c-index value means higher prediction accuracy.</p><p><b>RESULTS</b>Of 91 CRS patients, 77 were male and 14 were female with the mean onset age of (65.2±10.4) years. The mean interval from the first operation to CRS onset was 156(6-600) months. The primary diseases of 49(53.8%) cases were benign and of 42(46.2%) cases were malignant. The median number of retrieved lymph node (RLN) was 8 (0-38), and 64 patients (70.3%) had an RLN ≤15. Lymph node metastasis occurred in 50 patients (54.9%). pN staging result was as follows: 41 cases in N0 stage, 14 in N1 stage, 19 in N2 stage, and 17 in N3 stage. R staging result was as follows: 41 cases in R0 stage, 4 in R1 stage, 19 in R2 stage, and 27 in R3 stage. TNM staging result was as follows: 13 cases in stage I(, 25 in stage II(, 10 in stage III(a, 23 in stage III(b, and 6 in stage III(c. TRM staging result was as follows: 13 cases in stage I(, 24 in stage II(, and 4 in stage III(a, 18 in stage III(b, and 18 in stage III(c. Univariate analysis showed that tumor diameter ≥7 cm (HR=2.696, 95%CI: 1.307-5.563, P=0.007), T3-4 stage (HR=4.350, 95%CI: 1.949-9.707, P=0.000), N2-3 stage (HR=1.883, 95%CI: 1.167-3.038, P=0.009), R2-3 stage (HR=1.642, 95%CI: 1.026-2.628, P=0.039), TNM III(-IIII( stage (HR=2.448, 95%CI:1.490-4.021, P=0.000), and TRM III(-IIII( stage (HR=2.504, 95%CI:1.515-4.137, P=0.000) were related to prognosis. Tumor diameter, pT staging, and pN staging were included in the Cox multivariate analysis, and the result showed that pT staging (HR=5.507, 95%CI:2.254-13.454, P=0.000) and pN staging (HR=1.698, 95%CI: 1.022-2.789, P=0.041) were independent risk factors for overall survival of CRS in this group. While R staging replaced pN staging and was included in the Cox multivariate analysis together with tumor diameter and pT staging, the result showed that R staging was not an independent risk factor for CRS in this group (HR=1.622, 95%CI: 0.866-2.329, P=0.164). Survival curve revealed pN and TNM staging systems provided better stratified curves according to each staging than R and TRM staging systems. The overall survival c-index of TNM and TRM staging systems was 0.813(95%CI: 0.732-0.826) and 0.809(95%CI: 0.741-0.847) respectively, and no significant difference in predictive accuracy was found (P=0.693). In 42 patients with primary malignance, the overall survival c-index of TNM and TRM staging systems was 0.774(95%CI: 0.589-0.901) and 0.761(95%CI: 0.596-0.912) respectively, and there was no significant difference in predictive accuracy as well (P=0.881).</p><p><b>CONCLUSION</b>TRM staging is not superior to TNM staging (7th UICC) in evaluating the resected samples of CRS.</p>

Meta-analysis of gastric stump cancer after gastrectomy for gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the clinicopathological features and prognosis of gastric stump cancer (GSC) following subtotal gastrectomy for gastric cancer, to compare the clinicopathologic differences between narrow GSC and generalized GSC, and to compare the prognosis between GSC and primary proximal gastric cancer (PPGC) after radical resection.</p><p><b>METHODS</b>Literatures of GSC-associated clinical study were searched by computer from the Cochrane Library, Medline, PubMed, CNKI, Wanfang and VIP databases, and the retrieval period was from the establishment of database to December 31, 2017.</p><p><b>INCLUSION CRITERIA</b>(1) GSC was defined as a carcinoma arising in the gastric remnant after radical gastrectomy for gastric cancer, and confirmed by the pathological or histological examination, the elapsed time from the initial operation was not considered in the definition. (2) Retrospective or prospective clinical cohort study. (3) Study included at least one of below items: gender, anastomotic type in gastric cancer surgery, the interval between the initial surgery and diagnosis of GSC, the location, treatment, pathological differentiation, pathologic stage, lymph node metastasis rate and prognosis of GSC. (4) When similar studies were reported by the same institution or author, either the better quality study or the newest publication was chosen.</p><p><b>EXCLUSION CRITERIA</b>(1) Abstracts, reviews, case reports, meeting record, editorials and repeated research. (2) Studies including patients with initial non-gastric cancer. In this study, gastric stump cancer(GSC) after gastric cancer was divided into two groups: the incidence without limit interval time (generalized GSC group) and above 10 years (narrow GSC group). Selective trials were Meta-analyzed by the Stata13.0 software and statistical analysis was performed using SPSS 21.0 software.</p><p><b>RESULTS</b>A total of 27 literatures were finally enrolled, which comprised 1463 GSC patients, including 1146 males and 317 females. The generalized group and narrow GSC group had 921 and 542 patients respectively. The generalized GSC group and the narrow GSC group did not significantly differ in terms of previous reconstruction mode, types of differentiation, pathologic T staging, postoperative pathology tumor-node-metastases staging, and distant metastasis rate (χ=2.341, 0.926, 0.350, 0.965, 2.311 respectively, all P>0.05). As compared to generalized GSC group, narrow GSC group had higher ratio of male patients (82.8% vs. 75.7%, χ=9.909, P=0.002), more lesions locating in anastomotic stoma (37.8% vs. 26.1%, χ=18.091, P=0.000), higher ratio of patients undergoing radical resection (84.2% vs. 70.3%, χ=11.738, P=0.001), higher positive rate of postoperative lymph node (45.8% vs. 34.5%, χ=6.319, P=0.012), and larger size of tumor [(5.9±2.2) cm vs. (4.5±1.9) cm, t=9.151, P=0.000]. The overall 5-year survival rate and postoperative pathology stage III(-IIII( survival ratio in narrow GSC group were higher compared to general GSC group (42.7% vs. 30.6% and 27.5% vs. 18.1%, respectively), which were significantly different (χ=10.938, P=0.000; χ=4.128, P=0.042), while the postoperative pathology stage I(-II( survival ratio was not significantly different between two groups (67.3% vs. 67.0% respectively, χ=0.015, P=0.92). There was no significant difference in the 5-year survival rate between GSC with radical resection and PPGC(RR=1.04, 95%CI:0.79-1.36, P=0.805) and the 5-year survival rate of same postoperative pathology stage was not significantly different between two groups (I(-II( stage: RR=1.08, 95%CI:0.93-1.26, P=0.328; III(-IIII( stage: RR=0.59, 95%CI:0.33-1.04, P=0.111).</p><p><b>CONCLUSIONS</b>There are some different clinicopathological features between the generalized and the narrow GSC after gastric cancer surgery. The prognosis of GSC after radical resection is similar to primary proximal gastric cancer.</p>

Progress and controversy on diagnosis and treatment of gastric stump cancer / 中华胃肠外科杂志

Gastric stump cancer (GSC) is a carcinoma arising from the remnant stomach following gastric surgery for benign or malignant disease, and is more common in men. The risk of morbidity has an obvious time dependence. GSC incidence is likely to rise with lengthening of the initial operation interval. The GSC time interval after malignant disease is significantly shorter than that of benign disease. GSC etiologies mainly include duodenogastric reflux and denervation of the gastric mucosa resulting in the change of the gastric environment after gastrectomy and the Helicobacter pylori infection. Due to atypical clinical symptoms, GSC is always identified at an advanced stage and the long-term survival rate is low. An optimal endoscopic surveillance system is essential to improve early detection rates. Treatments in GSC and primary gastric cancer are the same and include resection of the lesion and radical lymph node dissection. R0 resection is an important prognostic factor. Here we review previous reports with respect to epidemiological characteristics, etiology, clinical symptoms, treatment, and prognosis of GSC.

The relationship between plasma ghrelin levels and glucose and lipid metabolisms of child and adolescent obesity / 中国基层医药

Objective To explore the relationship between plasma ghrelin levels and glucose and lipid metabolisms of child and adolescent obesity.Methods 30 cases of obesity and 30 healthy normal weisht children and adolescents with same age and gender were selected.Plasma ghrelin level,serum insulin(INS),C-peptide(CPE),fasting blood glucose(FBG),total cholesterol(TC),triglyceride(TG),high-density lipoproteins(HDL),low-density lipoproteins(LDL)were measured.Results For the obesity group:Plasma ghrelin level significantly decreased [(15.49±1.98)vs(19.47 ±1.50)μg/L]compared with control(P＜0.05);BMI,waistline,FBG,INS were very significantly increased(28.19±3.83)vs(21.07±1.53)kg/m2;(88.60±6.13)vs(78.52 ±4.40)cm;(5.23±0.49)vs(4.59 ±0.63)mmol/L;(22.32 ±3.50)vs(16.98±2.50)μIU/ml,respectively compared with control(all P＜0.01);TC was significantly increased(5.87±0.88)vs(4.05±0.76)nmol/L compared with control(P＜0.05).For the plasma ghrelin level of obesity:The relationship between plasma ghrelin level and body weight,BMI,waistline,INS,TC was obviously negative(r=-0.385,-0.466,-0.336,-0.387,-0.373,respectively,all P＜0.01);The relationship between plasma ghrelin level and FBG was obviously negative(r=-0.324,P＜0.05);No relationship between plasma ghrelin level and age,body height,CPE,TG,HDLC,LDLC.Conclusion Plasma ghrelin level of children and adolescent obesity was obviously decreased,and was strongly related with disordem of glucose and lipid metabolisms.