Clinicopathological characteristics and longterm survival of patients with synchronous multiple primary gastrointestinal stromal tumors: A propensity score matching analysis.

BACKGROUND: Multiple gastrointestinal stromal tumors (MGISTs) are specific and rare. Little is known about the impact of MGISTs on the survival of patients with gastrointestinal stromal tumors (GIST). The diagnosis, treatment and follow-up strategies of MGISTs is not specifically described in guidelines. AIM: To compare the clinicopathological characteristics and prognosis of MGISTs and solitary GISTs (SGISTs). METHODS: Patients diagnosed with primary GISTs from March 2010 to January 2020 were included. Due to the inhomogeneous distribution of several baseline characteristics and uneven MGIST and SGIST group sizes, propensity score matching was performed according to comorbidities, body mass index, tumor location, mitotic index, sex, age and American Society of Anesthesiologists score. Differences in clinicopathological characteristics and prognosis between patients with MGISTs and patients with SGISTs were compared. RESULTS: Among the entire cohort of 983 patients, the incidence of MGISTs was 4.17%. Before matching, patients with MGISTs and those with SGISTs had disparities in body mass index, surgical approach, tumor size and mitotic index. After 1:4 ratio matching, the clinical baseline data were comparable. The 5-year progression-free survival rate was 52.17% in the MGIST group and 75.00% in the SGIST group (P = 0.031). On multivariate analysis, tumor location, tumor size, mitotic index, imatinib treatment and MGISTs (hazard ratio = 2.431, 95% confidence interval = 1.097-5.386, P = 0.029) were identified as independent prognostic factors of progression-free survival. However, overall survival was similar between the SGIST and MGIST groups. CONCLUSION: Patients with MGISTs had poorer progression-free survival than patients with SGISTs. Risk criteria and diagnostic and treatment strategies should be developed to achieve personalized precision therapy and maximize the survival benefit.

Bifidobacterium and Lactobacillus for preventing necrotizing enterocolitis in very-low-birth-weight preterm infants: a systematic review and meta-analysis.

BACKGROUND: The therapeutic effect of Bifidobacterium and Lactobacillus on necrotizing enterocolitis (NEC) in very-low-birth-weight preterm infants was controversial, and we aimed to explore the exact impact of the two probiotics. METHODS: The PubMed, EMBASE, Web of Science and Cochrane Library were systematically searched for studies published from January 1, 2010 to February 28, 2019. Results were combined with fixed-effect model or random-effect model with specific conditions. Sensitivity analysis was conducted by the trim-and-fill method, and the Begger's and Egger's test were used to measure publication bias. RESULTS: The meta-analysis included 16 original articles with 4632 very-low-birth-weight preterm infants. With respect to the intervention of Bifidobacterium, we estimated non-significant decrease in the morbidity of NEC with a risk ratio (RR) of 0.75 [95% confidence internal (CI) 0.56-1.01, P = 0.06]. Regarding the effect of Lactobacillus, there was no evidence of significant lower risk in the incidence of NEC (RR = 0.67, 95% CI 0.39-1.17, P = 0.16). The use of mixture of probiotics (Bifidobacterium and Lactobacillus) reduced the risk of NEC in the probiotics group (RR = 0.45, 95% CI 0.25-0.80, P = 0.007). CONCLUSION: The mixture of Bifidobacterium and Lactobacillus could prevent the morbidity of NEC in very-low-birth-weight preterm infants. But Bifidobacterium or Lactobacillus alone did not show this effect.

[Ecological vulnerability of coal mining area: a case study of Shengli Coalfield in Xilinguole of Inner Mongolia, China].

In this paper, an ecological vulnerability evaluation index system for the Shengli Coalfield in Xilinguole of Inner Mongolia was established, which included 16 factors in ecological sensitivity, natural and social pressure, and ecological recovery capacity, respectively. Based on the expert scoring method and analytic hierarchy process (AHP), an ecological vulnerability model was built for the calculation of the regional ecological vulnerability by means of RS and GIS spatial analysis. An analysis of the relationships between land use and ecological vulnerability was also made, and the results were tested by spatial auto-correlation analysis. Overall, the ecological vulnerability of the study area was at medium-high level. The exploitation of four opencast areas in the Coalfield caused a significant increase of ecological vulnerability. Moreover, due to the effects of mine drained water and human activities, the 300 -2000 m around the opencast areas was turning into higher ecologically fragile area. With further exploitation, the whole Coalfield was evolved into moderate and heavy ecological vulnerability area, and the coal resources mining was a key factor in this process. The cluster analysis showed that the spatial distribution of the ecological vulnerability in the study area had reasonable clustering characteristics. To decrease the population density, control the grazing capacity of grassland, and regulate the ratios of construction land and cultivated land could be the optimal ways for resolving the natural and social pressure, and to increase the investment and improve the vegetation recovery coefficient could be the fundamental measures for decreasing the ecological vulnerability of the study area.