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Background and Aim Accumulating evidence indicates a plausible association between inflammatory bowel diseases and the risk of adverse health outcomes. However, the conclusions are inconsistent. We aimed to perform an umbrella review of meta-analyses to appraise and grade the evidence of the association between inflammatory bowel diseases and the risk of adverse health outcomes. Methods Meta-analyses of observational studies that examined the associations between inflammatory bowel disease and the risk of adverse health outcomes in PubMed, EMBASE, and Web of Science were screened. Results This umbrella review identified 25 meta-analyses, which yielded 123 effect estimates for 60 unique putative health outcomes. Patients with inflammatory bowel diseases had a higher risk of adverse health outcomes, including multiple cancers, cardiovascular disease, adverse pregnancy outcomes, adverse oral outcomes, and other adverse events. Moreover, inflammatory bowel diseases caused greater harm to health based on the presented evidence. However, none of the evidence was classified as “high” quality, only 15% was classified as “moderate,” and 65% of outcomes were rated as “very low.” Conclusion Patients with inflammatory bowel diseases had a higher risk of adverse health outcomes and further studies should be conducted to draw firmer conclusions.

Background Current studies on the number of removed lymph nodes (LNs) and their prognostic value in small-bowel neuroendocrine tumors (SBNETs) are limited. This study aimed to clarify the prognostic value of removed LNs for SBNETs. Methods SBNET patients without distant metastasis from 2004 to 2017 in the SEER database were included. The optimal cutoff values of examined LNs (ELNs) and negative LNs (NLNs) were calculated by the X-tile software. Propensity score matching (PSM) was done to match patients 1:1 on clinicopathological characteristics between the two groups. The Kaplan-Meier method with log-rank test and multivariable Cox proportional-hazards regression model were used to evaluate the prognostic effect of removed LNs. Results The cutoff values of 14 for ELNs and 9 for NLNs could well distinguish patients with different prognoses. After 1:1 PSM, the differences in clinicopathological characteristics between the two groups were significantly reduced (all P > 0.05). Removal of more than one LN significantly improved the prognosis of the patients (P < 0.001). The number of lymphatic metastasis in the sufficiently radical resection group (SRR, 3.74 ± 3.278, ELN > 14 and NLN > 9) was significantly more than that in the insufficiently radical resection group (ISRR, 2.72 ± 3.19, ELN < 14 or NLN < 9). The 10-year overall survival (OS) of the SRR was significantly better than that of the ISRR (HR = 1.65, P = 0.001, 95% CI: 1.24–2.19). Conclusion Both ELNs and NLNs can well predict the OS of patients. Systematic removal of more than 14 LNs and more than 9 NLNs can increase the OS of SBNET patients.

The purpose of this meta-analysis was to assess the associations between inflammatory bowel disease (IBD) and risk of the gastric, small bowel and colorectal cancer. We searched the PubMed and Web of Science for observational studies published before June 2020, and the quality of each included study was evaluated according to the Newcastle–Ottawa–Scale. Twenty-six studies comprising 531 449 IBD patients and more than 65 million reference individuals were included. Although IBD was significantly associated with 67% increased risk of the total gastric, small bowel and colorectal cancer. After stratifying by cancer location, IBD mainly increased the risk of intestinal cancer instead of gastric cancer. Furthermore, Crohn’s disease (CD) significantly increased the risk of both small bowel cancer and colorectal cancer, while ulcerative colitis (UC) only increased the risk of colorectal cancer. In subgroup analysis, associations between IBD and risk of total gastric, small bowel and colorectal cancer were similar between male and female, except for that male IBD patients but not female had a significantly higher risk of small bowel cancer. Additionally, IBD patients in different geographical areas had different associations with risk of various gastrointestinal tract cancers. IBD is mainly associated with increased risk of cancers in the lower gastrointestinal tract, including small bowel cancer and colorectal cancer. Because studies about the association between IBD and risk of gastric cancer and the populations in Asia are limited, more observational studies are required in the future.

Observational studies have reported an association between metabolic syndrome (MetS) and colorectal cancer risk with inconsistent risk estimates. We conducted this meta-analysis to evaluate the risk of colorectal cancer in individuals with MetS. PubMed, Embase, and Web of Science were searched for related studies from database inception to 21 January 2021. Risk estimates for colorectal cancer were extracted from individual articles and pooled using a fixed-effect or random-effect model according to the heterogeneity. MetS was significantly associated with a higher risk of colorectal cancer in both sexes (relative risk [RR] 1.36, 95% confidence interval [CI] 1.26–1.47, P

Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) used for super obesity (SO) and super super obesity (SSO) remain controversial. The meta-analysis was to summarize the evidence. We searched in MEDLINE and PubMed for studies concerning RYGB and SG for SO or SSO and pooled complication, percentage excess weight loss (%EWL), and resolution of comorbidities. Twelve studies were identified. RYGB achieved higher %EWL at 12 months, but no significant difference at 24 months. Resolution of diabetes mellitus and dyslipidemia reached a statistical significance; however, there was no significant difference in hypertension. RYGB was superior in %EWL for SSO and SO at 12 months. However, regarding at 24 months, RYGB was equal to SG, which is from a meta-analysis and cannot be seen as a definitive conclusion.

Purpose: Preoperative platelet-to-monocyte ratio (PLR), albumin and hemoglobin are suggested prognostic indicators in various malignancies. However, the prognostic values of PLR, albumin and hemoglobin remain elusive. The objective of the present study was to evaluate the prognostic values of PLR, albumin and hemoglobin in stage I-III colon cancer. Patients and methods: A total of 312 patients with non-metastatic colon cancer undergoing curative resection were enrolled in this study. The prognostic values of PLR, albumin and hemoglobin were identified by receiver operating characteristics, and univariate and multivariate analyses. Results: Univariate analysis revealed that preoperative PLR, albumin and hemoglobin were significantly associated with overall survival (OS) and that preoperative PLR and albumin were significantly associated with progression-free survival (PFS). Multivariate analysis revealed that preoperative PLR was significantly associated with OS. Conclusion: Reduced preoperative PLR was significantly associated with better OS in patients with stage I-III colon cancer. Preoperative PLR was an independent prognostic indictor for OS in patients with colon cancer undergoing curative resection.

Background Bariatric surgery could increase the risk of cholelithiasis, although it is unclear whether the incidence rates of cholelithiasis are similar after different bariatric procedures. Objectives To compare the incidence rates of cholelithiasis after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) in people with obesity. Setting Meta-analysis of cohort studies. Methods We searched the PubMed and Web of Science databases for relevant studies before December 2020, and estimated the summary odds ratios (OR) and 95% confidence intervals (CI) using a random-effects model or fixed-effects model, according to the heterogeneity. Results In total, 8 cohort studies were included in this meta-analysis, and 94,855 and 106,844 participants received SG and RYGB, respectively. Compared with those receiving RYGB, the summary results showed that participants receiving SG had a 35% lower rate of cholelithiasis (OR, .65; 95% CI, .49–.86). Also, the participants receiving SG had a significantly lower incidence of cholecystectomy than those receiving RYGB (OR, .54; 95% CI, .30–.99). In a subgroup analysis, SG was associated with a significantly lower incidence of subsequent cholelithiasis than RYGB in both Western and non-Western countries. SG led to a significantly lower incidence of cholelithiasis than RYGB only when the follow-up was Conclusion Participants receiving SG had a significantly lower incidence of cholelithiasis than those receiving RYGB, particularly within the first 2 years after the bariatric surgery.

BACKGROUND The contemporary risk classification criteria of gastrointestinal stromal tumors (GISTs) may still have room to improve. The aim of our research was to analyze the impact factors for GIST patients' relapse-free survival (RFS). Furthermore, we explore whether gastrointestinal (1) bleeding will be a valuable indicator to predict GIST patients' prognosis. MATERIAL AND METHODS R0 resection GISTs patients were retrospectively enrolled during an 8-year period at West China Hospital of Sichuan University, and all patients' data were from the WCHSU-GIST database. Of a total of 333 GIST patients, 164 patients had GI bleeding. Univariate analysis and Cox regression analysis were used to calculate the survival and recurrence rates. RESULTS Compared with non-GI-bleeding patients, GI-bleeding patients had a shorter relapse-free survival (RFS, P=0.003), but among the different risk groups, GI bleeding only affected the RFS rate of the high-risk group. A Cox regression analysis illustrated that tumor site (P

The duration of adjuvant imatinib for high-risk patients with gastrointestinal stromal tumors (GISTs) is still controversial. Therefore, we retrospectively analyzed the data of high-risk patients with GISTs to investigate the appropriate duration. All 185 patients were divided into 4 groups: 3 years (Group D). The mean recurrence-free survival (RFS) in Groups A, B, and C were 44.3, 62.1, and 86.8 months, respectively (P P = 0.009). The 5-year RFS in Groups A, B, C, and D was 15%, 26%, 83%, and 100%, respectively (P P P P

We read with interest the study by Axelrad et al 1 which reported that Crohn’s disease (CD) and UC were associated with nearly ninefold and twofold increased risk of small bowel cancer (SBC), respectively. However, there were also two observational studies2 3 suggesting that UC was not associated with risk of SBC. Because epidemiological studies about IBD and risk of SBC were controversial, to better understand this issue, we conducted this meta-analysis. We searched the PubMed and Web of Science for relevant studies published before 1 June 2020. We included observational studies investigating the associations between IBD and risk of SBC (including adenocarcinoma, neuroendocrine tumour and sarcoma) and reporting the HR, OR or other measures of association. The pooled OR and 95% CIs were estimated with random-effect model when the significant …

We read with interest the study by Zhang et al 1 which investigated the associations between oral antibiotic use and risk of colorectal cancer (CRC). The study included 166 057 participants and found that antibiotic use was associated with an increased risk of colon cancer but a reduced risk of rectal cancer. We also noticed another study by Armstrong et al 2 reporting that patients prescribed antibiotics in up to 15 years preceding diagnosis were associated with a higher risk of CRC. However, the study by Armstrong et al did not analyse the risk of colon cancer and rectal cancer, respectively. Considering current studies about antibiotic use and risk of CRC were inconsistent, we conducted this meta-analysis. The PubMed and Web of Science were …

We read with interest the study by Cheung et al 1 reporting that long-term use of proton pump inhibitors (PPIs) was associated with an increased risk of gastric cancer (GC) in participants after Helicobacter pylori eradication. Considering PPIs were widely used for the treatment of acid-related disorders, and previous studies about PPIs use and risk of GC did not have a consistent result. To better understand this issue, we conducted this meta-analysis that investigated the associations between long-term PPIs use and risk of GC. We searched the PubMed, Embase and Web of Science for potential studies published before March 2018. …

Background The role of resistant starch (RS) in glucose, insulin, insulin resistance or sensitivity, and lipid parameters have been reported in several studies and remained controversial. A pooled analysis which assessed these parameters has not been performed. Thus, we conducted a meta-analysis to sum up existing evidence about the issue. Methods We searched in MEDLINE and PUBMED for studies that were published before November 2018. Meta-analysis of diabetics and nondiabetics trials were performed by use of a random-effects model. Results A total of 13 case–control studies that included 428 subjects with body mass index ≥25 were identified. RS supplementation reduced fasting insulin in overall and stratified (diabetics and nondiabetics trials) analysis (SMD = –0.72; 95% CI: –1.13 to –0.31; SMD = –1.26; 95% CI: –1.66 to –0.86 and SMD = –0.64; 95% CI: –1.10 to –0.18, respectively), and reduced fasting glucose in overall and stratified analysis for diabetic trials (SMD = –0.26; 95% CI: –0.5 to –0.02 and SMD = –0.28; 95% CI: –0.54 to –0.01, respectively). RS supplementation increased HOMA-S% (SMD = 1.19; 95% CI: 0.59–1.78) and reduced HOMA-B (SMD =–1.2; 95% CI: –1.64 to –0.77), LDL-c concentration (SMD =–0.35; 95% CI: –0.61 to −0.09), and HbA1c (SMD = –0.43; 95% CI: –0.74 to –0.13) in overall analysis. Conclusions This meta-analysis has provided evidence that RS supplementation can improve fasting glucose, fasting insulin, insulin resistance and sensitivity, especially for diabetic with overweight or obesity. However, owing to potential sophistication, individual difference and composition of intestinal microbiota, this result should be carefully taken into account.

Whether the dynamic change of neutrophil to lymphocyte ratio (delta-NLR) can predict the outcome in various malignancies remained controversial. The delta-NLR has not been evaluated in colon cancer. Thus, we conducted the study to evaluate the predictive value of the delta-NLR in patients with colon cancer who underwent curative resection. Three-hundred and fifty-four patients with stage I-III colon cancer were retrospectively analysed. Clinicopathological features, preoperative NLR and postoperative NLR were collected. Prognostic factors were evaluated by univariate and multivariate analysis. The one, three and five-year overall survival rate in the delta-NLR P = 0.002). Univariate and multivariate analysis showed that there was a strong relationship between delta-NLR and overall survival. In conclusion, the delta-NLR was an independent prognostic factor for overall survival in early stage colon cancer. Patients with increased delta-NLR had an favourable clinical outcome.

The tumor microenvironment plays a pivotal role in cancer progression. The purpose of the present study was designed to evaluate the predictive value of peripheral absolute monocyte count, tumor-associated macrophage, microvessel density, and to clarify the correlation between them in patients with colon cancer. A series of 216 patients with colon cancer were enrolled in this study. The peripheral absolute monocyte count was obtained from preoperative routine blood test. Tumor-associated macrophage and microvessel density were assessed on tissue microarray by immunohistochemistry. The one, three, five-year overall survival rate for the low absolute monocyte count group was 98.4%, 91.1%, 87.1%, respectively; and for the high absolute monocyte count group was 94.6%, 83.7%, 77.2%, respectively (P = .046). The one, three, five-year progression-free survival rate for the low absolute monocyte count group was 94.4%, 87.1%, 85.5%, respectively; and for the high absolute monocyte count group was 90.2%, 75.0%, 73.9%, respectively (P = .024). Univariate and multivariate analysis showed that there was a strong association between peripheral monocyte count and clinical outcome. The correlation between peripheral absolute monocyte count, tumor-associated macrophage, and microvessel density were not observed. The peripheral absolute monocyte count was an independent prognostic factor for overall survival and progression-free survival in colon cancer. The high absolute monocyte count was significantly associated with poor outcome.

We read with interest the study by Villumsen et al 1 which reported that patients with IBD had a 22% increased risk of Parkinson’s disease (PD) compared with non-IBD individuals. The study supported the theory that intestinal environment could influence the function of central nervous system which was also called the gut–brain axis. Recently, a meta-analysis by Zhu et al 2 suggested that the overall risk of PD in patients with IBD was significantly higher than controls (OR 1.41; 95% CI 1.19 to 1.66). However, only four studies were included in the meta-analysis. We also noticed a case–control study by Camacho-Soto et al 3 reporting that the risk of PD was inversely associated with IBD (OR 0.85; 95% CI 0.80 to 0.91), which was not …

The aim of this study was to investigate the role of the fast-track surgery (FTS) program in elderly patients (aged ≥75 years) who underwent open surgery for gastric cancer (GC) in China. A total of 256 patients with GC were randomly assigned to four groups, each of which consisted of 64 cases: the 45–74-year-old age group was subdivided into the FTS-1 group and the conventional care (CC)-1 group, and the 75–89-year-old age group was subdivided into the FTS-2 group and the CC-2 group. All patients underwent open gastrectomy by the same experienced surgical team. We compared the differences between the pairs of groups in different age ranges with respect to the postoperative recovery index, complications, and medical costs. Compared with the CC-1 group, the FTS-1 group exhibited earlier postoperative flatus, a shorter postoperative hospital stay, lower medical costs, and a decreased incidence of sore throat (P = 0.010, P = 0.000, P = 0.000, and P = 0.019, respectively). Compared with the CC-2 group, the FTS-2 group had more nausea and vomiting, stomach retention, and intestinal obstruction, as well as a higher readmission rate (P = 0.015, P = 0.011, P = 0.041, and P = 0.013, respectively). The application of FTS can significantly speed up postoperative rehabilitation, shorten the hospitalization time, and lower the medical costs for 45–74-year-old GC patients, but this procedure does not show the same benefits for elderly patients. These findings suggest that we should carefully consider whether the FTS program should be applied to elderly patients with GC.

Background and objectives: Diarrhea is a common complication of enteral nutrition (EN), which affects recovery and prolongs the length of hospital stay (LOHS). To investigate the effect of fiber and probiotics in reducing diarrhea associated with EN in postoperative patients with gastric cancer (GC), the authors designed this prospective randomized-controlled trial. Methods and study design: This study included 120 patients with GC, and the patients were classified into 3 groups via random picking of envelopes: fiber-free nutrition formula (FF group, n = 40), fiber-enriched nutrition formula (FE group, n = 40), and fiber- and probiotic-enriched nutrition formula (FEP group, n = 40). All patients were given EN formulas for 7 consecutive days after surgery. Results: The number of diarrhea cases was higher in the FF group than in the FE group (P = .007). The FEP group had a lower number of diarrhea cases compared with the FE group (P = .003). Patients in the FE group had a significantly shorter first flatus time than the FF group (P = .002). However, no significant difference was observed between the FE group and FEP group (P = .30). Intestinal disorders were similar between the FE group and FF group (P = .38). The FEP group had a lower number of intestinal disorder cases than the FF group (P = .03). LOHS in the FE and FEP groups was shorter than that in the FF group (P = .004; P

Summary Background and objective X-ray repair cross-complementing group 3 (XRCC3) is responsible for maintaining the integrity of the genome, playing a critical role in protecting it against mutations which lead to cancer. Polymorphisms at exons 7 of the XRCC3 gene may alter the XRCC3 repair efficiency. The aim of this study is to derive a precise estimation of the relationship between XRCC3 Thr241Met polymorphism and gastric cancer (GC) risk. Methods Two investigators independently searched the databases of Pubmed, EMBASE and China National Knowledge Infrastructure (CNKI) up to May 15, 2013. Odds ratio (OR) and 95% confidence intervals (CI) for XRCC3 Thr241Met polymorphism and GC were calculated in a fixed- or random- effects model depending on statistical heterogeneity. Results This meta-analysis included 9 case-control studies, which included 2209 cases and 3269 controls. Overall, the combined results based on all studies indicated that there was no association between XRCC3 Thr241Met polymorphism and GC susceptibility for all genetic models. When stratifying for race, we found the 241Met/Met genotype carriers might be at high risk of GC among Asians, but not among Caucasians. When stratifying by the location of gastric cancer, the combined results showed that Met/Met genotype carriers might have an increased risk of GC in non-cardiac gastric cancer, but not in cardiac cancer. Conclusion This meta-analysis confirmed that the XRCC3 Thr241Met gene polymorphism might be a risk factor for GC among Asians, and that differences in genotype distribution may be related to the location of gastric cancer. More well-designed studies based on larger population are needed to confirm our results.

The associations between E-cadherin ( CDH1 ) gene polymorphisms and gastric cancer (GC) susceptibility are still controversial. Given this uncertainty, we carried out a meta-analysis of published case–control studies to derive more precise estimations of these relationships. Relevant studies were identified from PubMed and EMBASE up to March 2011. Seventeen studies with 3511 GC cases and 4826 controls were selected. Crude odds ratios (OR) and 95% confidence intervals (CI) were used to investigate the strength of the associations. No associations between CDH1 (+54T>C, −160C>A, −347G>GA, −616G>C, −2076C>T and −3159T>C) gene polymorphisms and GC risk for all genetic models were found. As for CDH1 −160C>A polymorphism, subgroup analyses by country, gender, study design, smoking status, Helicobacter pylori infection, and the Lauren classification of GC did not change the results. When stratified by ethnicity, we found the A allele carriers had a significantly increased risk of GC among Caucasians (AA vs . CA + CC: OR = 1.50, 95% CI = 1.03–2.19, P = 0.03), but not among Asians (AA vs . CA + CC: OR = 0.87, 95% CI = 0.56–1.37, P = 0.56). No publication bias was found in the present study. This meta-analysis suggests that CDH1 −160C>A gene polymorphism may contribute to increased risk of GC among Caucasians.

The association between vascular endothelial growth factor (VEGF) gene polymorphisms and gastric cancer risk is still controversial and ambiguous. The objective of this study was to investigate the association between VEGF gene polymorphisms and gastric cancer risk in Chinese Han patients. We extracted the peripheral blood samples in 150 patients with gastric cancer and 150 controls. Polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) analysis was performed to detect three VEGF gene polymorphisms (−634 G/C, +936 C/T, and +1612 G/A) in these patients. Patients with gastric cancer had a significantly higher frequency of 1612 AA genotype (OR = 6.26, 95% CI = 1.80, 21.85; P = 0.004) than controls. Patients with cardia gastric cancer had a significantly lower frequency of AA (OR = 0.11, 95% CI = 0.01, 0.89; P = 0.04) than those with noncardia gastric cancer. Patients with Lauren's diffuse-type gastric cancer had a significantly higher frequency of AA (OR = 3.41, 95% CI = 1.22, 9.55; P = 0.02) than those with Lauren's intestinal-type gastric cancer. The −634 G/C and +936 C/T gene polymorphisms were not associated with a risk of GC and its progression. This study suggests that the VEGF +1612 G/A gene polymorphisms may be associated with gastric cancer in Chinese Han patients, and that difference in genotype distribution may be associated with the location and Lauren's classification of gastric cancer. Mol. Carcinog. © 2010 Wiley-Liss, Inc.

studies investigating the association between p53 codon 72 polymorphism and gastric cancer risk report conflicting results. Our recent meta-analysis suggests that the p53 codon 72 polymorphism may be associated with gastric cancer among Asians.the objective of this study was to investigate the association between p53 codon 72 polymorphism and gastric cancer risk in Chinese Han patients.we extracted the peripheral blood samples from 150 patients with gastric cancer and 150 control subjects. Polymerase chain reaction-restriction fragment length polymorphism analysis was performed to detect p53 codon 72 polymorphism in these patients.patients with gastric cancer had a significantly lower frequency of Arg/Arg (odds ratio [OR] = 0.48, 95% confidence interval [95% CI] = 0.28, 0.80; p = 0.005) than control subjects. Patients with cardia gastric cancer had a significantly higher frequency of Pro/Pro (OR = 2.26, 95% CI = 1.12, 4.55; p = 0.02) than those with noncardia gastric cancer. Patients with advanced gastric cancer had a significantly higher frequency of Arg/Arg (OR = 2.66, 95% CI = 1.06, 6.65; p = 0.03) than those with early gastric cancer. When stratified by the Lauren's classification, histological differentiation of gastric cancer, no statistically significant result was observed.this study suggests that the p53 codon 72 polymorphism may be associated with gastric cancer in Chinese Han patients, and that difference in genotype distribution may be associated with the location and stage of gastric cancer.

Studies investigating the association between interleukin-10 (IL-10) -1082 promoter polymorphism and gastric cancer risk report conflicting results. Our recent meta-analysis suggests that the IL-10 -1082 promoter polymorphism may be associated with gastric cancer among Asians. The objective of this study was to investigate the association between IL-10 -1082 promoter polymorphism and gastric cancer risk in Chinese Han patients. We extracted the peripheral blood samples in 150 patients with gastric cancer and 150 controls. PCR-RFLP analysis was performed to detect IL-10 -1082 promoter polymorphism in these patients. Patients with gastric cancer had a significantly lower frequency of AA (OR = 0.45, 95% CI = 0.27, 0.76; P = 0.003) than controls. Patients with cardia gastric cancer had a significantly higher frequency of GG (OR = 2.17, 95% CI = 1.08, 4.38; P = 0.03) than those with noncardia gastric cancer. Patients with advanced gastric cancer had a significantly higher frequency of AA (OR = 5.21, 95% CI = 1.71, 15.87; P = 0.004) than those with early gastric cancer. When stratified by the Lauren's classification, histological differentiation of gastric cancer, no statistically significant results were observed. This study suggests that the IL-10 -1082 promoter polymorphism may be associated with gastric cancer in Chinese Han patients, and that difference in genotype distribution may be associated with the location and stage of gastric cancer.

To evaluate the effectiveness of resecting liver metastases of gastrointestinal stromal tumors (GISTs), when performed in conjunction with imatinib treatment. Forty-one patients with pathologically diagnosed GIST and liver metastases were randomly assigned to an operation group (neoadjuvant therapy + resection + adjuvant therapy with imatinib) or a nonoperation group (imatinib alone). Patients were monitored for up to 36 months, and survival was analyzed. We monitored 39 patients throughout the 36-month follow-up period, recording 1- and 3-year survival rates of 100% and 89.5% in the operation group and 85% and 60% in the nonoperation group, respectively. There was a significant difference in overall survival between the operation and nonoperation groups (P = 0.03). Furthermore, resection improved the survival of patients who responded poorly to 6 months of preoperative imatinib treatment, compared with that of their counterparts in the nonoperation group (P = 0.04). These findings suggest that surgical intervention in combination with imatinib treatment is more effective than imatinib alone against GIST liver metastases, with minimal complications and side effects.

The association between vascular endothelial growth factor (VEGF) +936 C/T gene polymorphisms and gastric cancer risk is still controversial and ambiguous. The objective of our study was to investigate this association. The Medline and Embase databases were searched by two investigators. Crude odds ratios (OR) and 95% confidence intervals (CI) were used to test the association between VEGF +936 C/T polymorphisms and gastric cancer risk. Our meta-analysis comprised seven case-control studies, which included 1,893 gastric cancer cases and 2,245 controls. The combined results showed that there was no relationship between VEGF +936 C/T gene polymorphisms and gastric cancer risk (cc: OR 0.97, 95% CI 0.85, 1.11; CT: OR 1.01, 95% CI 0.88, 1.16; TT: OR 1.10, 95% CI 0.79, 1.55). Subgroup analysis by ethnicity and stage, location, and Lauren classification of gastric cancer did not change the results. This meta-analysis suggests that there is no association between VEGF +936 C/T polymorphisms and gastric cancer risk. Further studies should pay attention to other potentially functional SNPs.

Studies investigating the association between genetic polymorphism of glutathione S-transferase T1 (GSTT1) and gastric cancer risk have reported conflicting results. Therefore, we conducted this meta-analysis to provide more precise evidence.We searched the databases Medline, PubMed, Embase, and China National Knowledge Infrastructure up to July 30, 2009. Thirty-six studies with 4,357 gastric cancer cases and 9,796 controls were selected. Odds ratio (OR) and 95% confidence intervals (CI) were calculated based on fixed- and random-effects models.The combined results based on all studies showed there was a significant link between GSTT1 null genotype and gastric cancer risk (OR = 1.14, 95%CI = 1.01-1.28). In subgroup analysis stratified on the basis of ethnic group, we also observed positive association between GSTT1 polymorphism and gastric cancer risk among Caucasians (non-Europeans + non-Americans), but not among East Asians. When stratifying by control source, the overall ORs for population- and hospital-based studies were 1.09 (95%CI = 0.94-1.28) and 1.17 (95%CI = 1.03-1.34), respectively. Subjects with both GSTM1 and GSTT1 negative genotypes had increased gastric cancer risk compared with those who had nonnull genotypes of both GST genes. Subgroup analyses for Helicobacter pylori infection and smoking habit did not reveal any significant association between GSTT1 polymorphism and gastric cancer development.This meta-analysis suggests that GSTT1 gene polymorphism may be not associated with increased gastric cancer risk among Europeans, Americans, and East Asians. More large-scale studies based on the same racial group are needed.

Studies investigating the association between glutathione S-transferase P1 (GSTP1) codon 105 polymorphism and gastric cancer risk report conflicting results. The objective of this study was to quantitatively summarise the evidence for such a relationship. Two investigators independently searched the Medline and Embase databases. This meta-analysis included 10 case-control studies, which included 1161 gastric cancer cases and 2847 controls. The combined results based on all studies showed that there was no significant difference in genotype distribution [AA odds ratio (OR) = 1.14, 95% confidence interval (CI) = 0.91, 1.44; AG (OR=0.82, 95% CI = 0.66, 1.03); GG (OR = 1.11, 95% CI = 0.55, 2.24)] between gastric cancer and non-cancer patients. When stratifying for race, results were similar except that patients with gastric cancer had a significantly higher frequency of AA (OR = 1.53, 95% CI = 1.14, 2.06) and lower frequency of AG (OR = 0.70, 95% CI = 0.55, 0.89) than non-cancer patients among Caucasians. When stratifying by the location and Lauren’s classification of gastric cancer, we observed no statistically significant differences in genotype distribution. This meta-analysis suggests that the GSTP1 codon 105 polymorphism may be associated with gastric cancer among Caucasians.

Summary Background and objective The association between glutathione S-transferase T1 (GSTT1) gene polymorphisms and colorectal cancer (CRC) susceptibility is still controversial. In order to clarify the effect of GSTT1 genotype on the CRC risk, we carried out an updated meta-analysis of published case-control studies to provide more precise evidence. Methods Two investigators independently searched the databases of Pubmed, EMBASE and China National Knowledge Infrastructure (CNKI) up to October 15, 2012. Crude odds ratios (OR) and 95% confidence intervals (CI) were calculated to investigate the strength of the association in a fixed- or random-effects model depending on statistical heterogeneity. Results Forty-six case-control studies with 15,373 colorectal cancer cases and 21,238 controls were included. Overall, the pooled results indicated that GSTT1 null genotype was significantly associated with increased CRC risk (OR = 1.21, 95% CI = 1.10–1.33). When stratifying for ethnicity and control sources, we also observed positive association between GSTT1 null genotype and increased risk of CRC. When stratifying by the location, we found there was a statistically significant association in the rectal cancer (OR = 1.28, 95% CI = 1.01–1.64), but not in colon cancer (OR = 1.27, 95% CI = 0.94–1.73). Subgroup analyses for Dukes stage, histological differentiation of CRC and smoking habit did not reveal any significant differences in genotype distribution. In addition, we observed a strong correlation between increased CRC risk and the combined GSTM1 and GSTT1 null genotype. Conclusions This meta-analysis suggests that the GSTT1 null genotype may contribute to increased risk of colorectal cancer. More well-designed studies based on larger population are needed to confirm our results.

To estimate the efficacy of pro-/synbiotics treatment in patients undergoing colorectal resection, a meta-analysis of randomized controlled trials was conducted.An electronic search of PubMed, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Academic Search Premier, and China National Knowledge Infrastructure was performed, and RevMan 5.0 was used for statistical analysis.Six studies including 361 patients undergoing elective colorectal surgery were retrieved. The combined analysis revealed that perioperative pro-/synbiotics administration had a positive effect on the incidence of diarrhea (OR 0.29, 95% CI 0.14 to 0.62, P=0.001), the incidence of symptomatic intestinal obstructions (OR 0.39, 95% CI 0.19 to 0.78, P=0.008), the incidence of operative total infections (OR 0.39, 95% CI: 0.22 to 0.68, P=0.0010), and pneumonia infection (OR 0.32, 95% CI 0.11 to 0.93, P=0.04). The regimen increased the numbers of Lactobacillus (MD 2.66, 95% CI: 2.13 to 3.18; P0.00001), and decreased the counts of Enterobacteriaceae (MD -1.52, 95% CI: -1.93 to -1.11, P0.00001). No significant differences were found between the two groups in septic morbidity, incision infection, perineal infection, intraabdominal infection, anastomotic leak, the first defecation time, length of hospital stay, mesenteric lymph nodes for bacterial translocation. No mortality related to pro-/synbiotics treatment was revealed in all studies.Based on the meta-analysis, perioperatively use pro-/synbiotics as prophylaxis in patients undergoing colorectal resection improved clinical outcomes. The best preventive strategy (including species and the optimal dose) of pro-/synbiotics should be considered in future meta-analyses.

Summary Background and objective Imatinib is approved worldwide for use in gastrointestinal stromal tumours (GISTs). To evaluate the efficacy and safety of two dose of imatinib treatment for patients with GISTs, a meta-analysis was performed. Methods Electronic search of the PubMed and EMBASE, which have articles published between 1980 and February 2012, was conducted to select studies for this meta-analysis. Results Five articles with a total number 1861 of advanced GISTs patients were involved in this meta-analysis. There was a slight but significant 2-year PFS advantage with high-dose group (OR = 1.25, 95% CIs = 1.03–1.52, P = 0.03), but not in the 2-year OS (OR = 1.02, 95% CIs = 0.84–1.24, P = 0.87), CR (OR = 1.02, 95% CIs = 0.66–1.58, P = 0.93), and PR (OR = 1.13, 95% CIs = 0.94–1.36, P = 0.20). In safety, the high-dose group increased the incidence of above grade 3 toxicity (OR = 2.05, 95% CIs = 1.70–2.48, P Conclusions This analysis confirms a slight 2-year PFS advantage of high-dose imatinib, but imatinib dose escalation could not lead to any other major clinical benefits, and brought more toxic effects for patients.

Peutz–Jeghers syndrome is a rare autosomal dominantly inherited disease characterized by mucocutaneous pigmentations and gastrointestinal polyps. The polyps are located predominantly in the small intestine and usually cause intussusceptions. Adult intussusception caused by Peutz–Jeghers syndrome occurs very rarely. The purpose of this study was to analyze the clinical characteristics, preoperative diagnosis, and surgical management of Peutz–Jeghers syndrome associated with acute intussusception in adult patients. Consecutive patients with the postoperative diagnosis of acute intussusception caused by Peutz–Jeghers syndrome from 1995 to 2010 were reviewed retrospectively for this study. Data concerning clinical considerations, morphological examinations, and surgical procedure were analyzed. Different clinical manifestations were presented in patients with intussusception due to Peutz–Jeghers syndrome. Computed tomography associated or not with ultrasonography may be the most accurate examination for acute intussusceptions caused by Peutz–Jeghers syndrome. Surgical intervention is the first choice regimen in acute intussusceptions caused by Peutz–Jeghers syndrome. Prophylaxis and polypectomy of the entire small bowel is a worthy way in Peutz–Jeghers syndrome patients to reduce the frequency of laparotomies.

Background & Aims The chemopreventive effects of Allium vegetables (onions, garlic, shallots, leeks, chives, and so forth) have been studied extensively, although their effect on gastric cancer risk is controversial. We performed a meta-analysis of cohort and case-control studies to analyze this association. Methods We searched MEDLINE for studies of Allium vegetable consumption and gastric cancer that were published in any language, from January 1, 1966, to September 1, 2010. We analyzed 19 case-control and 2 cohort studies, of 543,220 subjects. We pooled the relative risks from individual studies using a random-effects model and performed dose-response, heterogeneity, and publication bias analyses. Results In a pooled analysis of all studies, consumption of large amounts of Allium vegetables (in a comparison of the highest and lowest consumption groups) reduced the risk for gastric cancer (odds ratio, 0.54; 95% confidence interval, 0.43–0.65). Specific analyses for onion, garlic, leek, Chinese chive, scallion, garlic stalk, and Welsh onion yielded similar results, except for onion leaf. The estimated summary odds ratio for an increment of 20 g/day of Allium vegetables consumed (approximately the average weight of 1 garlic bulb) was 0.91 (95% confidence interval, 0.88–0.94), based on case-control studies from the dose-response meta-analysis. Conclusions In a meta-analysis, consumption of high levels of Allium vegetables reduced the risk for gastric cancer risk. Because of potential confounding factors and exposure misclassification, further studies are required to establish this association.

AIM: To perform a meta-analysis to answer whether long-term recurrence rates after laparoscopic-assisted surgery are comparable to those reported after open surgery. METHODS: A comprehensive literature search of the MEDLINE database, EMBASE database, and the Cochrane Central Register of Controlled Trials for the years 1991-2010 was performed. Prospective randomized clinical trials (RCTs) were eligible if they included patients with colon cancer treated by laparoscopic surgery vs open surgery and followed for more than five years. RESULTS: Three studies involving 2147 patients reported long-term outcomes based on five-year data and were included in the analysis. The overall mortality was similar in the two groups (24.9%, 268/1075 in the laparoscopic group and 26.4%, 283/1072 in open group). No significant differences between laparoscopic and open surgery were found in overall mortality during the follow-up period of these studies [OR (fixed) 0.92, 95% confidence intervals (95% CI): 0.76-1.12, P = 0.41]. No significant difference in the development of overall recurrence was found in colon cancer patients, when comparing laparoscopic and open surgery [2147 pts, 19.3% vs 20.0%; OR (fixed) 0.96, 95% CI: 0.78-1.19, P = 0.71]. CONCLUSION: This meta-analysis suggests that laparoscopic surgery was as efficacious and safe as open surgery for colon cancer, based on the five-year data of these included RCTs.

The results of animal studies suggest there is a significant role for dietary fat in the development of colorectal cancer (CRC). However, inconsistent results have been reported by epidemiological studies. To evaluate the association between total dietary fat and risk of colorectal cancer development using a meta-analysis based on prospective cohort studies. Published literature was retrieved from Medline, Embase and CNKI (China Knowledge Resource Integrated Database) databases updated to 1st May, 2009. Overall, thirteen prospective cohort studies with 3,635 cases and 459,910 participants were included. The combined relative risk (RR) [95% confidence interval (95%CI)] for the risk of CRC was 0.99 (0.89,1.09) when the highest level of total dietary fat was versus (vs.) the lowest level. Stratified analyses according to gender, ethnicity, country and age showed that the highest level of total dietary fat did not increase the risk of CRC [RR (95%CI): 0.89 (0.77,1.03) for males; 1.09 (0.94,1.26) for females; 1.08 (0.94,1.25) for Caucasians; 0.90 (0.77,1.04) for Asians; 1.13 (0.94,1.36) for Americans; 0.92 (0.81,1.04) for individuals older than 40]. Besides those, the highest level of total fat diet also did not increase the risk of neither colon cancer [RR (95%CI): 0.96 (0.82,1.13)] nor rectal cancer [RR (95%CI):1.07 (0.63,1.82)]. Furthermore, neither animal fat nor plant fat were associated with the risk of CRC [RR (95%CI): 1.05 (0.91–1.22) for animal fat and 0.96 (0.82–1.11) for plant fat]. This meta-analysis suggests that dietary fat may not be associated with the increased risk of CRC. More well-designed studies with larger population performed among Asians are needed to further evaluate the associations. In addition, probable bias caused by measurement error should be noticed in this meta-analysis, and measurement error needs to be adjusted in the future studies.

AIM: To investigate the 152 cases of paragangliomas resected over the past 32 years in West China Hospital clinicopathologically. METHODS: All cases of paragangliomas diagnosed at the Department of Gastrointestinal Surgery and Department of Pathology, West China Hospital, China were reviewed. The pathological documents were supplied by the Department of Pathology, West China Hospital, and other necessary data were extracted from the hospital records. The statistical analyses were performed by survival analysis (Kaplan-Meier method), descriptive statistical analyses and χ2 analysis. RESULTS: The neuroendocrine marker vimentin was found to be selectively expressed in the benign tumors, and there were significant differences in the expression of those markers in both benign and malignant tumors. The survival analysis revealed that survival correlated significantly with the malignancy, metastasis and nodal status. CONCLUSION: Vimentin may be useful in the differential diagnosis between malignant and benign tumors. The difference in the expression of this marker in the tumors could be a clue to the future clinical diagnosis. The malignancy, metastasis and the nodal status may predict the prognosis of this disease.

The Glutathione S-transferases (GSTs) play multiple roles in the pathogenesis and treatment of cancer. Studies investigating the association between Glutathione S-transferase M1 (GSTM1) null genotype and gastric cancer risk report conflicting results. The purpose of this study was to quantitatively summarize the evidence for such a relationship.This meta-analysis included 35 studies, which included 4,505 gastric cancer cases and 9,062 controls. The combined results based on all studies showed that the GSTM1 null genotype was associated with an increased risk of gastric cancer (OR = 1.15, 95% confidence interval [CI] = 1.02, 1.29). When stratifying for race, results were similar among Asians (OR = 1.24, 95% CI = 1.07, 1.44) except Caucasians (OR = 1.04, 95% CI = 0.88, 1.24). When stratifying by the location, stage, Lauren's classification, histological differentiation, lymph node metastasis, smoking, and Helicobacter pylori infection of gastric cancer, we observed that patients with diffuse classification had a significantly higher frequency null genotype (OR = 4.80, 95% CI = 1.65,13.94) than those with intestinal classification among Caucasians.This meta-analysis suggests that the GSTM1 null genotype may be associated with gastric cancer among Asians.

Studies investigating the association between interleukin10 (IL10) -592 promoter polymorphism and gastric cancer risk report conflicting results. The objective of this study was to quantitatively summarize the evidence for such a relationship.Two investigators independently searched the MEDLINE and Embase databases. This meta-analysis included ten case-control studies, which included 1,715 gastric cancer cases and 2,783 controls.The combined results based on all studies showed that there was no significant difference in genotype distribution (AA odds ratio [OR] = 0.88, 95% confidence interval [CI] = 0.66, 1.18; AC OR = 1.09, 95% CI = 0.95, 1.24; CC OR = 1.03, 95% CI = 0.89, 1.18) between gastric cancer and noncancer patients. When stratifying for race, the results were similar, except that patients with gastric cancer had a significantly lower frequency of AA (OR = 0.67, 95% CI = 0.52, 0.87) and a higher frequency of AC (OR = 1.34, 95% CI = 1.07, 1.68) than noncancer patients among Asians. When stratifying by the location of gastric cancer, we found that patients with cardia gastric cancer had a significantly lower frequency of AA (OR = 0.41, 95% CI = 0.20, 0.84) than those with noncardia gastric cancer among Caucasians. When stratifying by Lauren's classification of gastric cancer, we found that patients with diffuse gastric cancer had a significantly higher frequency of AA (OR = 1.91, 95% CI = 1.07, 3.41) than those with intestinal gastric cancer among Caucasians.This meta-analysis suggests that the IL10 -592 promoter polymorphism may be associated with gastric cancer among Asians, and that differences in genotype distribution may be associated with the location and Lauren's classification of gastric cancer.

To investigate the incidence of incidental gastrointestinal stromal tumor (GIST) and its etiopathogenesis.From January 1, 2000 to December 31, 2007, 13804 cases of gastrointestinal epithelial malignant tumor (EMT) and 521 cases of pancreatic adenocarcinoma (PAC) were successfully treated with surgery at the Department of General Surgery and the Department of Thoracic Surgery, West China Hospital, Sichuan University, China. The clinical and pathologic data of 311 cases of primary GIST, including 257 cases with clinical GIST and 54 cases of incidental GIST were analyzed.Of the 311 patients, 54 had incidental GIST, accounting for 17.4%. Of these tumors, 27 were found in 1.13% patients with esophageal squamous cell carcinoma (ESCC), 22 in 0.53% patients with gastric adenocarcinoma (GAC), 2 in 0.38% patients with PAC, 2 in 0.03% patients with colorectal adenocarcinoma, and 1 in one patient with GAC accompanying ESCC, respectively. Patients with incidental GIST presented symptoms indistinguishable from those with EMT. All incidental GIST lesions were small in size, and the majority had a low mitotic activity while only 1.9% (5/257) of clinical GIST lesions had a high risk.Incidental GIST may occur synchronously with other tumors and has a high prevalence in males. Surgery is its best treatment modality.

The relationship between excess body weight and gastric cancer risk has not been well studied to date. We therefore carried out a systematic review and meta-analysis of published cohort studies to evaluate the association between excess body weight and gastric cancer risk. An electronic search of the MEDLINE, PubMed, EMBASE and Academic Search Premier (EBSCO) databases, which contain articles published from 1950 onwards, was conducted in order to select studies for this meta-analysis. Ten studies with a total number of 9492 gastric cancer cases and a studied population of 3,097,794 were identified. Overall, excess body weight [body mass index (BMI)25] was associated with an increased risk of gastric cancer [odds ratio (OR)=1.22; 95% confidence intervals (CIs)=1.06-1.41]. Specifically, a stratified analysis showed that excess body weight was associated with an increased risk of cardia gastric cancer [overweight and obese (BMI 25), OR=1.55, 95% CIs=1.31-1.84] and gastric cancer among non-Asians (overweight and obese, OR=1.24, 95% CIs=1.14-1.36); however, the stratified analysis also showed that there was no statistically significant link between excess body weight and gastric cancer in the following subgroups: males (overweight and obese, OR=1.22, 95% CIs=0.96-1.55), females (overweight and obese, OR=1.13, 95% CIs=0.65-1.94), non-cardia gastric cancer (overweight and obese, OR=1.18, 95% CIs=0.96-1.45) and Asians (overweight and obese, OR=1.17, 95% CIs=0.88-1.56). The combined results of this meta-analysis, however, do indicate that overweight and obesity are associated with an increased risk of gastric cancer. The strength of the association also increases with increasing BMI.

Studies investigating the association of polymorphisms in the 5′-untranslated regions (5′UTR) and 3′-untranslated regions (3′UTR) of thymidylate synthase with gastric cancer susceptibility and sensitivity to fluoropyrimidine-based chemotherapy report conflicting results. The objective of this study was to quantitatively summarize the evidence for such a relationship. This meta-analysis included ten studies, which included 1,730 gastric cancer cases and 1,843 controls. The combined results based on all studies showed that there was no significant difference in genotype distribution of 5′UTR or 3′UTR between gastric cancer and noncancer patients. When stratifying for race, we found that: (1) among Asians, patients with gastric cancer had significantly higher frequency of 2R/2R of 5′UTR than did noncancer patients, and (2) among Caucasians, patients with gastric cancer had significantly lower frequency of ins6/ins6 and higher frequency of ins6/del6 of 3′UTR than did noncancer patients. No significantly different response rate or survival of gastric cancer with fluoropyrimidine-based chemotherapy were observed with genotype distribution of 5′UTR or 3′UTR among Caucasians or Asians. This meta-analysis suggests that polymorphisms in the 5′UTR and 3′UTR of thymidylate synthase may be associated with gastric cancer susceptibility, but are not correlated with sensitivity of gastric cancer to fluoropyrimidine-based chemotherapy.

Studies investigating the association between interleukin-10 (IL-10) -1082 promoter polymorphism and gastric cancer risk report conflicting results. The objective of this study was to quantitatively summarise the evidence for such a relationship. Two investigators independently searched the Medline and Embase databases. This meta-analysis included 13 case-control studies, which included 2227 gastric cancer cases and 3538 controls. The combined results based on all studies showed that there was no significant difference in genotype distribution [AA odds ratio (OR) = 0.92, 95% confidence interval (CI) = 0.73, 1.14; AG (OR = 1.09, 95% CI = 0.87, 1.36); GG (OR = 1.03, 95% CI = 0.85, 1.25)] between gastric cancer and noncancer patients. When stratifying for race, results were similar except that patients with gastric cancer had a significantly lower frequency of AA (OR = 0.71, 95% CI = 0.52, 0.97) and higher frequency AG (OR = 1.53, 95% CI = 1.15, 2.03) than noncancer patients among Asians. When stratifying by the location of gastric cancer, we found that patients with cardia gastric cancer had a significantly lower frequency of AA (OR = 0.53, 95% CI = 0.34, 0.83) and higher frequency AG (OR = 1.50, 95% CI = 1.06, 2.11) than those with noncardia gastric cancer among Caucasians. When stratifying by the Lauren’s classification of gastric cancer, we observed no statistically significant differences in genotype distribution. This meta-analysis suggests that the IL-10 -1082 promoter polymorphism may be associated with gastric cancer among Asians, and that differences in genotype distribution may be associated with the location of gastric cancer.

AIM: To evaluate the efficacy of telomerase activity assay and peritoneal lavage cytology (PLC) examination in peritoneal lavage fluid for the prediction of peritoneal metastasis in gastric cancer patients, and to explore the relationship between telomerase activity and proliferating cell nuclear antigen expression. METHODS: Telomeric repeated amplification protocol (TRAP)-enzyme-linked immunosorbent assay (ELISA) was performed to measure the telomerase activity in 60 patients with gastric cancer and 50 with peptic ulcer. PLC analysis of the 60 patients with gastric cancer was used for comparison. The proliferating cell nuclear antigen (PCNA) in gastric carcinoma was immunohistochemically examined. RESULTS: The telomerase activity and PLC positive rate in peritoneal lavage fluid from patients with gastric cancer was 41.7% (25/60), and 25.0% (15/60), respectively. The positive rate of telomerase activity was significantly higher than that of PLC in the group of pT4 (15/16 vs 9/16, P < 0.05), P1-3 (13/13 vs 9/13, P < 0.05) and diffuse type (22/42 vs 13/42, P < 0.05). The patients with positive telomerase activity, peritoneal metastasis, and serosal invasion had significantly higher levels of average PCNA proliferation index (PI), (55.00 ± 6.59 vs 27.43 ± 7.72, 57.26 ± 10.18 vs 29.15 ± 8.31, and 49.82 ± 6.74 vs 24.65 ± 7.33, respectively, P < 0.05). CONCLUSION: The TRAP assay for telomerase activity is a useful adjunct for cytologic method in the diagnosis of peritoneal micrometastasis and well related to higher proliferating activity of gastric cancer. The results of this study also suggest a promising future therapeutic strategy for treating peritoneal dissemination based on telomerase inhibition.

Studies investigating the association between p53 codon 72 polymorphism and gastric cancer risk report conflicting results. The objective of this study was to quantitatively summarize the evidence for such a relationship. Two investigators independently searched the Medline and Embase databases. This meta-analysis included 12 case-control studies, which included 1,665 gastric cancer cases and 2,358 controls. The combined results based on all studies showed that there was no significant difference in genotype distribution [Arg/Arg odds ratio (OR) = 0.96, 95% confidence interval (CI) = 0.79, 1.16; Pro/Pro (OR = 1.21, 95% CI = 0.92, 1.58); Pro/Arg (OR = 0.95, 95% CI = 0.79, 1.14)] between gastric cancer and noncancer patients. When stratifying for race, results were similar except that patients with gastric cancer had a significantly lower frequency of Arg/Arg (OR = 0.84, 95% CI = 0.72, 0.99) than noncancer patients among Asians. Stratified the various studies by the location, stage, Lauren's classification, and histological differentiation of gastric cancer, we found that (i) patients with cardia gastric cancer had a significantly higher frequency of Pro/Pro (OR = 3.20, 95% CI = 1.46,7.01) than those with noncardia gastric cancer among Asians; (ii) patients with advanced (stage III/IV) gastric cancer had a significantly higher frequency of Arg/Arg (OR = 1.48, 95% CI = 1.01, 2.16) than those with early (stage I/II) gastric cancer among Asians; (iii) patients with poor differentiation had a significantly lower frequency of Pro/Pro (OR = 0.13, 95% CI = 0.03, 0.64) than those with well differentiation among Caucasians. This meta-analysis suggests that the p53 codon 72 polymorphism may be associated with gastric cancer among Asians, and that difference in genotype distribution may be associated with the location, stage, and histological differentiation of gastric cancer. © 2007 Wiley-Liss, Inc.

To investigate the effectiveness and safety of recombinant human growth hormone (rhGH) in postoperative patients.A total of 48 consecutive patients undergoing abdominal operations were randomized to receive either subcutaneous rhGH (0.15 IU/kg) or placebo (menstruum) injections daily for 7 d after surgery. The two groups had similar nutritional intake. Blood samples for serum fibronectin, albumin, prealbumin, transferrin and the total lymphocyte count, as well as glucose levels were collected to study the rhGH effect. Basal laboratory evaluation, and nutritional status were estimated on d 1 before as baseline and d 3 and 10 after operation using standard laboratory techniques. Nitrogen balance was measured from d 3 to 9 after operation.The cumulative nitrogen balance was significantly improved in rhGH group compared with the placebo group (11.37 +/- 16.82 vs -9.11 +/- 17.52, P = 0.0003). Serum fibronectin was also significantly higher in the rhGH group than in the placebo group (104.77 +/- 19.94 vs 93.03 +/- 16.03, P0.05), whereas changes in serum albumin, prealbumin, transferrin and total lymphocyte counts were not statistically significant. Mean blood glucose levels were significantly higher in the rhGH group from d 3 to 6 after operation.If blood glucose can be controlled, low-dose growth hormone together with hypocaloric nutrition is effective on improving positive nitrogen balance and protein conservation and safe is in postoperative patients.

AIM: To assess the effectiveness and safety of perioperative growth hormone (GH) in patients undergoing abdominal surgery. METHODS: We searched the following electronic databases: MEDLINE, EMBASE, the Cochrane Controlled Trials Register, Chinese Bio-medicine Database. The search was undertaken in February 2003. No language restrictions were applied. Randomized controlled trials (RCT) comparing GH with placebo in patients undergoing abdominal surgery were extracted and evaluated. Methodological quality was evaluated using the Jadad scale. RESULTS: Eighteen trials involving 646 patients were included. The combined results showed that GH had a positive effect on improving postoperative nitrogen balance (standardized mean difference [SMD] = 3.37, 95%CI [2.46, 4.27], P < 0.00001), and decreasing the length of hospital stay (weighted mean difference [WMD] = -2.07, 95%CI [-3.03, -1.11], P = 0.00002), and reducing the duration of postoperative fatigue syndrome (SMD = -1.83, 95%CI [-2.37, -1.30], P < 0.00001), but it could increase blood glucose levels (WMD = 0.91, 95%CI [0.56, 1.25], P < 0.00001). CONCLUSION: GH for patients undergoing abdominal surgery is effective and safe, if blood glucose can be controlled well. Further trials are required with a sufficient size to account for clinical heterogeneity and to measure other important outcomes such as infection, morbidity, mortality, fluid retention, immunomodulatory effects, and tumor recurrence.

AIM: To establish a successful model of heterotopic total small intestinal transplantation (SIT) in rats in order to reduce the complications and increase the survival rate. METHODS: A total of 196 Wistar rats underwent heterotopic SIT with microsurgical technique. Technical modifications included shortening fasting time and supplying energy before surgery, administering optimal volume of crystalloid fluid to the donor and recipient during surgical procedures, reducing mechanical and ischemic injuries to donor intestine, revascularizing small intestinal graft with a combination of conventional aorta to aorta anastomosis and a cuffed portal vein to left renal vein anastomosis which resulted in an acceptably short warm ischemic time, and also an adequate blood supply and drainage of the graft. RESULTS: The average time for the donor surgery was 86 min ± 20 min, the mean operative time for the recipient was 115 min ± 20 min and warm ischemia time was shortened to 40 min ± 5 min. There was a shorter revascularizing time of the graft, the abdominal aorta (AA) to AA anastomosis being 21 min ± 10 min, and the cuffed portal vein (PV) to the renal vein anastomosis being 5 min ± 5 min. The one-week survival rate of 98 rats with SIT was 88.78% (87/98), without thrombosis and stenosis of anastomosis. The longest survival time of recipient rats was more than 389 d after SIT, the rats were maintaining normal weight, with perfect intestinal function and intact intestinal histology. CONCLUSION: These modified techniques for SIT would remarkably reduce the complications and improve survival rate in rats, which provided a potentially more consistent and practical model for experimental and clinical studies.

To assess the clinical outcomes of pre-, pro- and synbiotics therapy in patients with acute pancreatitis.The databases including Medline, Embase, the Cochrane Library, Web of Science and Chinese Biomedicine Database were searched for all relevant randomized controlled trials that studied the effects of pre-, pro- or synbiotics in patients with acute pancreatitis. Main outcome measures were postoperative infections, pancreatic infections, multiple organ failure (MOF), systemic inflammatory response syndrome (SIRS), length of hospital stay, antibiotic therapy and mortality.Seven randomized studies with 559 acute pancreatic patients were included. Pre-, pro- or synbiotics treatment showed no influence on the incidence of postoperative infections [odds ratios (OR) 0.30, 95% confidence interval (CI): 0.09-1.02, P = 0.05], pancreatic infection (OR 0.50, 95% CI: 0.12-2.17, P = 0.36), MOF (OR 0.88, 95% CI: 0.35-2.21, P = 0.79) and SIRS (OR 0.78, 95% CI: 0.20-2.98, P = 0.71). There were also no significant differences in the length of antibiotic therapy (OR 0.75, 95% CI: 0.50 - 1.14, P = 0.18) and the mortality (OR 0.75, 95% CI: 0.25-2.24, P = 0.61). However, Pre-, pro- or synbiotics treatment was associated with a reduced length of hospital stay (OR -3.87, 95% CI: -6.20 to -1.54, P = 0.001). When stratifying for the severity of acute pancreatitis, the main results were similar.Pre-, pro- or synbiotics treatment shows no significant influence on patients with acute pancreatitis. There is a lack of evidence to support the use of probiotics/synbiotics in this area.

To investigate the effects of short-term application of low-dose growth hormone on trace element metabolism and blood glucose in surgical patients.A total of 48 consecutive patients undergoing abdominal operations were randomized to receive either subcutaneous rhGH (0.15 IU/kg) or placebo (menstruum) injections daily for 7 d after surgery. The two groups had similar nutrition intake. Blood, feces, urine and drain samples were collected to measure zincum, cuprum and ferrum as well as glucose levels. Accumulative intake, excretion and balance of zincum, cuprum and ferrum, apparent absorption (AA) and apparent utilization (AU) of zincum, cuprum and ferrum, blood glucose levels and adverse events were estimated.There were no differences in accumulative intake and drain excretion between the two groups. The feces excretion and accumulative excretion of cuprum were lower in the rhGH group (P0.05). The urinary excretion of zincum, cuprum and ferrum was all significantly decreased in the rhGH group (P0.05) and the accumulative balance of zincum, cuprum and ferrum was improved compared with the placebo group (P0.05). AA of cuprum in the rhGH group was almost twice as much as the placebo group (P0.05), and AU of zincum, cuprum and ferrum was all improved in the rhGH group (P0.05). The mean blood glucose level was significantly higher in the rhGH group than in the placebo group from d 3 to d 6 after operation (P0.05).Postoperative low-dose rhGH treatment improves the retention of zincum, cuprum and ferrum and decreases the excretion of zincum, cuprum and ferrum, improves the balance of zincum, cuprum and ferrum, and promotes the AA and AU of zincum, cuprum and ferrum. rhGH can be well tolerated without significant adverse effects and the blood glucose level can be well controlled.