The impact of microbial immune enteral nutrition on the patients with acute radiation enteritis in bowel function and immune status.

The aim of the study was to investigate the effect of microbial immune enteral nutrition by microecopharmaceutics and deep sea fish oil and glutamine and Peptisorb on the patients with acute radiation enteritis in bowel function and immune status. From June 2010 to January 2013, 46 acute radiation enteritis patients in Liaocheng People's Hospital were randomized into the microbial immune enteral nutrition group and the control group: 24 patients in treatment group and 22 patients in control group. The immune microbial nutrition was given to the study group, but not to the control group. The concentration of serum albumin and prealbumin and the number of CD3 (+) T cell, CD4 (+) T cell, CD8 (+) T cell, CD4 (+)/CD8 (+) and natural killer cell of the two groups were detected on the 1, 7 and 14 days after treatment. The arm muscle circumference and triceps skinfold thickness (TSF) were recorded, and the tolerance of the two groups for enteral nutrition and intestinal symptoms was collected and then comparing the two indicators and get results. The tolerance of microbial immune enteral nutrition group about abdominal pain, bloating and diarrhea was better than the control group (P values were 0.018, 0.04 and 0.008 after 7 days; P values were 0.018, 0.015 and 0.002 after 14 days); and the cellular immune parameters were better than the control group((△) P = 0.008,([Symbol: see text]) P = 0.039, (☆) P = 0.032); No difference was found in nutrition indicators. To the patients with acute radiation enteritis, microbial immune enteral nutrition could improve the patient's immune status, and the tolerance of enteral nutrition could be better for the bowel function and the patients' rehabilitation.

[Changing trends in the clinicopathological characteristics of patients with gastric carcinoma undergoing surgery between 1979 and 2008 in Liaocheng Shandong province].

OBJECTIVE: To evaluate the changing trends in clinicopathological characteristics of patients with gastric carcinoma undergoing surgery between 1979 and 2008. METHODS: Two thousand seven hundred and fifteen patients with gastric cancer who received operation in Liaocheng People's hospital between 1979 and 2008 were analyzed retrospectively, and were compared to 168 patients between 1974 and 1978. Categorical data were evaluated with Chi-squared or Fisher's exact test. Quantitative data were analyzed with nonparametric test. Time series analysis was used to evaluate the changing trend of data. RESULTS: The male to female ratio during 1979-2008 was 3.393, which was higher than that (1.897) during 1974-1978 (χ2=12.193, P<0.01). The median age (59 years) during 1979-2008 was higher than that (53.5 years) during 1974-1978 (z=-6.294 P<0.01). Comparing the tumor distribution of gastric cancer during 1979-2008 with that during 1974-1978, proportion of gastric cardia and fundus cancer was higher (45.7% vs. 13.0%, χ2=56.596, P<0.01), while the proportion of gastric antrum cancer was lower (44.9% vs. 73.2%, χ2=53.980, P<0.01). There was no significant difference in gastric body cancer (13.8% vs. 9.4%, χ2=2.026, P=0.155). Compared to 1994-1998, there were more poorly differentiated adenocarcinomas during 2004-2008 (62.1% vs. 51.7%, χ2=12.267, P<0.01), and there were less tubular adenocarcinomas during 2004-2008 (23.9% vs. 31.8%, χ2=8.78, P<0.01). Time series analysis showed the patient age during 1979 to 2008 increased (Root mean square error=1.275, R-square=0.702), gastric cardia and fundus cancer was increasing and antrum cancer was decreasing (Root mean square error=0.055, R-square=0.798). CONCLUSIONS: In the past 30 years from 1979 to 2008, the male to female ratio and the median age of surgical patients with gastric cancer increased with time. The gastric cardia and fundus cancer increased over time, however antrum cancer decreased with time. In the past 15 years from 1994 to 2008, the proportion of poorly differentiated adenocarcinoma increased, and that of tubular adenocarcinoma declined.

[Familiar gastric cancer: case report and systematic review of the Chinese literature].

OBJECTIVE: To investigate the clinicopathologic characteristics of familiar gastric cancer (FGC) in Chinese. METHODS: A family with FGC was screened. China National Knowledge Infrastructure was retrieved, and fifteen families with FGC were collected. Systematic literature review was carried out on these sixteen families. RESULTS: There were 63 cases of FGC in these 16 families, 38 males and 25 females, aged 54 (30 - 72). The mean age of the parental patients was 61, older than that of the filial patients (43 years, Z = 3.494, P < 0.01). There was a correlation between the ages of sibling patients (r(s) = 0.664, P < 0.01). Among the 44 cases with clearly described tumor location, the tumor was located in the gastric antrum in 21 patients (47.7%). Among the 8 families with complete records of tumor location, 4 families showed consistent tumor location. Accompanying other malignant tumors were seen in 7 families, 5 being tumors in the alimentary canal. CONCLUSION: The onset age of filial patients with FGC is younger than that of the parental patients in Chinese. The onset ages of the sibling cases are significantly correlated. In a specific family the tumor is nearly located at the same places. And most of tumors are located in gastric antrum.Most of the accompanying tumors are alimentary canal tumors.

[The value of metastatic lymph nodes ratio in predicting the prognosis of patients with T3 gastric carcinoma].

OBJECTIVE: To evaluate the value of the metastatic lymph node ratio (MLR) in predicting the postoperatively survival time of patients with T(3) gastric carcinoma. METHODS: Eighty-nine patients with T(3) gastric carcinoma who underwent curative gastrectomy were analyzed retrospectively. The correlations between MLR, positive nodes and the total lymph nodes (15 or more) in histologic examination were analyzed using Spearman's correlation analysis. The influence of MLR and positive nodes on survival time of patients was identified with univariate Kaplan-Meier survival analysis and multivariate Cox proportional hazard model analysis. The predicting accuracy of MLR to death of patients within 2 years postoperatively was determined by receiver working characteristic curve and was compared with that of positive nodes. RESULTS: (1) The MLR did not correlate with the total lymph nodes in histologic examination (Spearman's correlation coefficient was -0.0022, P > 0.05), whereas positive lymph nodes did (correlation coefficient was 0.2504, P < 0.05). (2) Kaplan-Meier survival analysis identified that the MLR influenced significantly the survival time postoperatively (Log-rank chi(2) = 35.7470, P < 0.01). Cox proportional hazard model showed the high MLR was an independent poor prognostic factor (chi(2) = 7.9708, P < 0.01). (3) There was not difference between the area under the receiver working curve of MLR and positive nodes to predict the death of patients within 2 years postoperatively (P > 0.05). CONCLUSION: The MLR in T(3) gastric carcinoma is not correlated with the number of total lymph nodes examined on the condition that 15 or more lymph nodes were assessed in pathology. The predicting accuracy of MLR to death of patients with T(3) gastric carcinoma within 2 years postoperatively is same as, but not better than that of positive nodes if the extent of lymphadenectomy is optimal.

[A prognostic scoring system for preoperative prediction of lymph node metastases in gastric cancers].

OBJECTIVE: To establish a preoperative scoring system to predict the lymph node metastases (N) in gastric cancers. METHODS: The clinicopathologic data of 291 cases with gastric cancer were analyzed retrospectively. The factors influencing significantly actual lymph node status (pN) were selected through the univariate and the multivariate analysis, and the score of each factor was identified. Scores predicting different N stages were identified using receiver operating characteristic curves. The N stages defined by the score system were compared with the actual pN status using kappa statistics and diagnostic test. RESULTS: Tumor size, depth of invasion and histopathological types were selected to establish the scoring system. According to this score system, scores 0-4 predict N0, scores 5-7 predict N1, scores 8-9 predict N2 and scores 10-13 predict N3. There was a good agreement between N stages predicted by the scoring system and the actual pN status (weighted kappa = 0.605, u = 14.548, P < 0.0001). The crude agreement, positive predictive value and negative predictive value of the scoring system were 82.8%, 65.6% and 88.5%, respectively. CONCLUSION: The scoring system can provide accurate and reliable information to predict the lymph node metastases of gastric cancers preoperatively. It is simple and practical to use in clinical work and can help surgeons to choose an optimal extent of lymph node dissection for gastric cancer.

[Distribution of sentinel lymph nodes in gastric cancer and factors correlated with its metastasis].

OBJECTIVE: To investigate the distribution of sentinel lymph nodes in gastric cancer, and evaluate clinicopathologic characteristics leading its metastasis. METHODS: The location of metastatic lymph nodes was analyzed retrospectively in 27 patients of gastric carcinoma with solitary lymph node metastases, and in 80 cases metastasis was limited to only 1 station in Japanese nodal classification. The clinicopathologic characteristics of the patients with solitary lymph node metastases and 111 cases without lymph node metastases were compared. RESULTS: Twenty-five in 27 cases with solitary lymph node metastases were limited in level I. Skip metastasis occurred in 2 cases. Sentinel lymph nodes of 16 cases in 21 patients with the tumors in the lower and middle third stomach were located in less curvature (No. 3) and in greater curvature (No. 4). Sentinel lymph nodes of 3 cases in 6 patients in the upper third stomach were located in right cardia (No. 1). Multivariate analysis showed that the frequency of sentinel lymph node metastasis of pT(3) lesion was significantly higher than that of pT(1) lesion with an odds ratio of 4.926 (P < 0.01). The frequency of sentinel lymph node metastasis in the tumor located in the upper third stomach was significantly higher than that in lower third stomach, with an odds ratio of 4.381 (P < 0.05). Early gastric cancer had lower risk for sentinel lymph node metastasis than that in Borrmann type I cancer, with an odds ratio of 0.082 (P < 0.05). CONCLUSIONS: Majority of sentinel lymph nodes are located in the regional perigastric lymph node groups close to the tumor. Skip metastasis is rare. Depth of invasion and location of tumor are correlated with sentinel lymph node metastasis. Sentinel lymph node assessment can instruct to determine extent of lymph node dissection for gastric cancer.

Safe major abdominal operations: hepatectomy, gastrectomy and pancreatoduodenectomy in elder patients.

AIM: To evaluate the impact of advanced age on outcome after hepatectomy, gastrectomy and pancreatoduodenectomy. METHODS: Two hundreds and eleven patients undergone hepatectomy, gastrectomy and pancreatoduodenectomy from January 1998 to September 2002 were analyzed retrospectively. Clinicopathologic features and operative outcome of 83 patients aged 65 years or more were compared with that in 128 younger patients aged less than 65 years. RESULTS: The nutritional state, such as pre-operation level of serum albumin and hemoglobin in the older patients was poorer than that in the younger patients. The older patients had higher comorbidities than the younger patients (48.2% vs 15.6%). No significant difference was observed in perioperative mortality, and complication rate between the older and younger patients (2.4% vs 1.6% and 22.9% vs 20.3%, respectively). Multivariate analysis demonstrated that pancreatoduodenectomy, hepatectomy with resection of more than 2 segments and comorbidities were independent predictors of postoperative complication, whereas age was not (P=0.3172). CONCLUSION: It is safe for patients aged 65 years or more to undergo hepatic, pancreatic and gastric resection if great care is taken during perioperative period.

[Clinical significance and correlation between elevated serum TR6 and lympho-metastasis in gastric cancer].

OBJECTIVE: To evaluate the value of serum TR(6) for the diagnosis and TNM classification in patients with gastric carcinoma. METHODS: Serum TR(6) levels were measured using ELISA method in 31 gastric cancer patients, 19 patients with nonmalignant conditions and 29 healthy individuals. TR(6) expression in tumor mass was studied with immunohistochemistry. TR(6) gene copy number in tumor tissues was evaluated by real time PCR. RESULTS: Ninety-seven point nine percent (47 of 48 cases) of healthy individuals and patients with nonmalignant conditions were serum TR(6)-negative. In contrast, 71% (22 of 31 cases) of gastric cancer patients were serum TR(6)-positive. Serum TR(6) positiveness was closely correlated with tumor differentiation status and TNM classification. TR(6) gene amplification did not occur in gastric carcinoma. CONCLUSIONS: Serum TR(6) levels were correlated significantly with TNM stage and histopathological type of tumor. This can help to determine the pre-operative TNM classification and to choose the optimal extent of lymph node dissection for gastric cancer.