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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.

BackgroundMatrix metalloproteinase 7 (MMP7), as the smallest member of the matrix metalloproteinase family, has been verified to be implicated in cancer progression, especially metastasis. However, its expression pattern and function in tongue cancer is not clear.MethodsThe expression of MMP7 in human tongue squamous cell carcinoma (TSCC) specimens compared with their respective paired nontumour tissues by real-time PCR and immunohistochemical staining. The effect of MMP7 on the proliferation, apoptosis, migration, invasion of tongue cancer cells was tested in appropriate ways after MMP7 siRNA knockdown or overexpression. The effect of MMP7 on lymph node metastasis in vivo was analyzed using a high-metastasis orthotopic nude mouse tongue transplanted tumour model.ResultsWe found markedly elevated expression of MMP7 in human TSCC specimens compared with their respective paired nontumour tissues, and this high expression was correlated with the patients’ lymph node metastasis. Furthermore, the results of molecular functional assays confirmed that MMP7 promotes cell proliferation, migration and invasion of TSCC cells. Knockdown of MMP7 inhibited lymph nodes metastasis in vivo.ConclusionsMMP7 plays an oncogenic role in carcinogenesis and metastasis of tongue cancer, and may serve as a potential therapeutic target for tongue cancer.

The development of novel approaches for the treatment of gastric cancer is of utmost importance. Taxifolin (Tax) has been reported to possess biological activities against a number of types of cancer. The objective of the present study was to examine the effects of Tax on gastric cancer and to explore its potential mechanisms of action. For this purpose, AGS and NCI-N87 cells, as well as BALB/c mice with gastric cancer cell-derived tumors were treated with Tax. Cell Counting Kit-8 and colony formation assays were performed to detect cell viability and proliferation, respectively. Wound-healing and Transwell assays were also conducted to determine the cell migratory and invasive abilities, respectively. Western blot analysis was performed to determine protein expression in vitro and in vivo. The results revealed that Tax significantly inhibited the viability, proliferation, migration and invasion of gastric cancer cells through the aryl hydrocarbon receptor (AhR)/cytochrome P450 1A1 (CYP1A1) signaling pathway. SB203580, an AhR agonist, partly abolished the inhibitory effects of Tax on gastric cancer cell viability, proliferation, migration and invasion. In addition, Tax also suppressed tumor growth in vivo. Collectively, the present study demonstrated that Tax significantly suppressed the tumor characteristics of gastric cancer. Tax may thus prove to be a potential therapeutic strategy for gastric cancer.

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

Background Proximal gastrectomy with double-tract reconstruction (DTR) has been used for upper third gastric cancer as a function-preserving procedure. However, the safety and feasibility of laparoscopic proximal gastrectomy (LPG) with DTR remain uncertain. This study compared open proximal gastrectomy (OPG) with DTR and LPG with DTR for proximal gastric cancer. Methods Sixty-four patients who had undergone OPG with DTR and forty-six patients who had undergone LPG with DTR were enrolled in this case–control study. The clinical characteristics, surgical outcomes and postoperative nutrition index were analysed retrospectively. Results The operation time was significantly longer in the LGP group than in the OPG group (258.3 min vs 205.8 min; p = 0.00). However, the time to first flatus and postoperative hospital stay were shorter in the LPG group [4.0 days vs 3.5 days (p = 0.00) and 10.6 days vs 9.2 days (p = 0.001), respectively]. No significant difference was found between the two groups in the number of retrieved lymph nodes, complications or reflux oesophagitis. The nutrition status was assessed using the haemoglobin, albumin, prealbumin and weight levels from pre-operation to six months after surgery. No significant difference was found between the groups. Conclusion LPG with DTR can be safely performed for proximal gastric cancer patients by experienced surgeons.

Background & aims: The strategy of increasing the postoperative enteral nutrition dose to the target goal has not yet been clarified. This study aimed to determine whether an immediate goal-dose enteral nutrition (IGEN) strategy is non-inferior to a gradual goal-dose enteral nutrition (GGEN) strategy in reducing infections in patients undergoing abdominal surgery involving the organs of the digestive system. Methods: This randomized controlled trial enrolled postoperative patients with nutritional risk screening 2002 scores ≥3 from 11 Chinese hospitals. Energy targets were calculated as 25 kcal/kg and 30 kcal/kg of ideal body weight for women and men, respectively. Patients were randomly assigned 1:1 to IGEN or GGEN group after enteral tolerance was confirmed (30% of the target on day 2). The IGEN group immediately started receiving 100% of the caloric requirements on day 3, while the GGEN group received 40% progressing to 80% of target on day 7. The primary endpoint was the infection rate until discharge, based on the intention-to-treat population. Results: A total of 411 patients were enrolled and randomized to the IGEN and GGEN groups, and five patients did not receive the allocated intervention. A total of 406 patients were included in the primary analysis, with 199 and 207 in the IGEN and GGEN groups, respectively. Infection was observed in 17/199 (8.5%) in the IGEN group and 19/207 (9.2%) in the GGEN group, respectively (difference, −0.6%; [95% confidence interval (CI), −6.2%–4.9%]; P = 0.009 for non-inferiority test). There were significantly more gastrointestinal intolerance events with IGEN than with GGEN (58/199 [29.1%] vs. 32/207 [15.5%], P < 0.001). All other secondary endpoints were non-significant. Conclusions: Among postoperative patients at nutritional risk, IGEN was non-inferior to GGEN in regards to infectious complications. IGEN was associated with more gastrointestinal intolerance events. It showed that IGEN cannot be considered to be clinically directive. ClinicalTrials.gov (#NCT03117348).

Objective: Lung cancer is often associated with hypercoagulability. Thromboelastography provides integrated information on clot formation in whole blood. This study explored the possible relationship between thromboelastography and lung cancer. Methods: Lung cancer was staged according to the Tumor, Node, and Metastasis (TNM) classification system. Thromboelastography parameters in different stages of disease were compared. The value of thromboelastography for stage prediction was determined by area under the receiver operating characteristic curve analysis. Results: A total of 182 patients diagnosed with lung cancer were included. Thromboelastography parameters, including kinetics time, α-angle, and maximum amplitude, differed significantly between patients with metastatic and limited lung cancers ( P < 0.05). Kinetics time was significantly reduced and maximum amplitude was significantly increased in patients with stage I and II compared with stage III and IV tumors ( P < 0.05). TNM stage was significantly negatively correlated with kinetics time ( r = −0.186), and significantly positively correlated with α-angle ( r = 0.151) and maximum amplitude ( r = 0.251) (both P < 0.05). The area under the curve for kinetics time in patients with stage I cancer was 0.637 ( P < 0.05) and that for α-angle in stage ≥ II was 0.623 ( P < 0.05). The areas under the curves for maximum amplitude in stage ≥ III and stage IV cancer were 0.650 and 0.605, respectively (both P < 0.05). Thromboelastography parameters were more closely associated with TNM stage in patients with lung adenocarcinoma than in the whole lung cancer population. Conclusion: This study identified the diagnostic value of thromboelastography parameters for determining tumor stage in patients with lung cancer. Thromboelastography can be used as an independent predictive parameter for lung cancer severity.

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

Gastrointestinal stromal tumor (GIST) is a common sarcoma of gastrointestinal tract (GIT) with high metastatic and recurrence rates, but the proteomic features are still less understood. Here we performed systematic quantitative proteome profiling of GIST from 13 patients classified into very low/low, intermediate and high risk subgroups. An extended cohort of GIST (n = 131) was used for immunohistochemical validation of proteins of interest. In total, 9177 proteins were quantified, covering 55.9% of the GIT transcriptome from The Human Protein Altas. Out of the 9177 quantified proteins, 4930 proteins were observed in all 13 cases with 517 upregulated and 187 downregulated proteins in tumorous tissues independent of risk stage. Pathway analysis showed that the downregulated proteins were mostly enriched in metabolic pathway, whereas the upregulated proteins mainly belonged to spliceosome pathway. In addition, 131 proteins showed differentially expressed patterns among GIST subgroups with statistical significance. The 13 GIST cases were classified into 3 subgroups perfectly based on the expression of these proteins. The intensive comparison of molecular phenotypes and possible functions of quantified oncoproteins, tumor suppressors, phosphatases and kinases between GIST subgroups was carried out. Immunohistochemical analysis of the phosphatase PTPN1 (n = 117) revealed that the GIST patients with high PTPN1 expression had low chances of developing metastasis. Collectively, this work provides valuable information for understanding the inherent biology and evolution of GIST.

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.

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

Scope To assess the existing evidence of associations between consumption of soy and isoflavone and multiple health outcomes. Methods and results This is an umbrella review of meta-analyses and systematic reviews of randomized trials and observational studies in humans. 114 Meta-analyses and systematic reviews are identified with 43 unique outcomes. Soy and isoflavone consumption seems more beneficial than harmful for a series of health outcomes. Beneficial associations are identified for cancers, cardiovascular disease, gynecological, metabolic, musculoskeletal, endocrine, neurological, and renal outcomes, particularly in perimenopausal women. Harmful association is only found for gastric cancer (RR: 1.17, 95% CI: 1.02-1.36) for high intake of miso soup (1-5 cups per day) in male. Conclusion Generally, soy and isoflavone consumption is more beneficial than harmful. The results herein support promoting soy intake as part of a healthy diet. Randomized controlled trials are necessary to confirm this finding.

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.

Background : Studies investigating the association between genetic polymorphism of glutathione S-transferase T1 (GSTT1) and risk of colorectal cancer have reported conflicting results. In order to clarify the effect of GSTT1 polymorphism on the risk of developing colorectal cancer, we carried out a meta-analysis using published data to obtain more precise estimates of risk. Methods : Electronic searches of PubMed and EMBASE were conducted to select studies for this meta-analysis. Papers were included if they were observational studies investigating the association between GSTT1 polymorphism and colorectal cancer risk. The principal outcome measure was the odds ratio (OR) with 95% confidence interval (CI) for the risk of colorectal cancer associated with GSTT1 null genotype. Results : We identified 30 eligible studies, which included 7635 cases and 12,911 controls. The combined results based on all studies showed that there was a statistically significant link between GSTT1 null genotype and colorectal cancer risk (OR=1.20, 95% CI=1.03–1.40). In the analysis of ethnic groups, we observed distinct differences associated with GSTT1 null genotype, the pooled odds ratios for the GSTT1 polymorphism were 1.32 in Caucasians (95% CI=1.09–1.58) and 1.03 in Asians (95% CI=0.81–1.32). As far as concerned the interaction between GSTT1 genotype and colorectal cancer risk in relation to smoking history, there was no increase in risk for smokers or nonsmokers with the GSTT1 null genotype (smokers: OR=1.13, 95% CI=0.80–1.60, nonsmokers: OR=0.99, 95% CI=0.71–1.38). When stratifying by the location of colorectal cancer, we found that there was a statistically significant link in rectal cancer (OR=1.50, 95% CI=1.09–2.07), but not in colon cancer (OR=1.33, 95% CI=0.94–1.88). No associations could be detected between null GSTT1 polymorphism and age, sex, tumor stage and differentiation. Conclusion : Our current study demonstrates that GSTT1 null genotype is associated with an increased risk of colorectal cancer, specifically, among Caucasians.

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.

Recent observations have suggested that overexpression of cyclooxygenase-2 (COX-2) promotes tumor lymphangiogenesis through an upregulation of vascular endothelial growth factor-C (VEGF-C) expression. It is unclear whether this mechanism also acts in gastric cancer. The aim of this study was to determine the relationship between COX-2 and VEGF-C expression in human gastric cancer, as well as to correlate with lymph node involvement, prognosis, and other clinicopathologic parameters.Sixty-eight primary gastric cancers were immunohistochemically examined for COX-2, VEGF-C, vascular endothelial growth factor receptor-3 (VEGFR-3, also known as Flt-4), and CD34 expressions. Assessment of Flt-4-positive vessel density (FVD) and microvessel density (MVD) was performed. Then we analyzed their relationships and correlations with clinicopathologic findings and patients' survival time.The positivity rate of COX-2 and VEGF-C in the primary tumor was 67.7 and 54.4 percent, respectively. A significant correlation was found between the expression of VEGF-C and COX-2, and both were also correlated to MVD, FVD, lymphatic invasion, and TNM stage (p0.05). COX-2 immunoreactivity was also associated with lymph node metastasis and serosa invasion. Increased MVD was significantly associated with lymph node metastasis and TNM stage. Both COX-2 and VEGF-C expression significantly correlated with poorer prognosis.Our data suggest that the expression of COX-2 correlates with VEGF-C expression and both of them correlate with the presence of lymphatic invasion and prognosis in gastric cancer. COX-2-mediated VEGF-C overexpression might promote lymphatic invasion via lymphangiogenesis pathway in patients with gastric cancer.

Background The infrainguinal plug technique for femoral hernia (FH) has gained popularity for its feasibility, simplicity, and encouraging rate of success, but materials and structures of traditional mesh plugs may cause postoperative discomfort, plug migration, and even recurrence. The new hernia repair device ULTRAPRO Plug (UPP) may avoid those problems. Materials and methods In 121 of patients, a total of 125 elective FH repairs with UPP were performed between March 2009 and March 2013. Demographics, surgical information, and outcome were assessed. Results Out of 121 patients, 105 were female. The mean age was 57.6 y. FHs occurred more often on the right (72) than the left (45), and in 4 patients the hernias were bilateral. Mean duration of a hernia surgery was 14.7 min, and 91% patients were discharged within 24 h. Mean time to complete return to daily activities was 7.4 d. No mortality or major complications occurred during the perioperative period. Median follow-up was 26 mo, and the total follow-up rate was 91%. No recurrence or chronic mesh infection was noted. Postoperative chronic pain in two patients, sensory loss in one patient, and foreign body sensation in three patients were found in the follow-up. Conclusions Repair of FHs with UPP through an infrainguinal approach is a simple and effective procedure without major postoperative events.

BackgroundMost resting energy expenditure (REE) predictive equations for adults were derived from research conducted in western populations; whether they can also be used in Chinese young people is still unclear. Therefore, we conducted this study to determine the best REE predictive equation in Chinese normal weight young adults.MethodsForty-three (21 male, 22 female) healthy college students between the age of 18 and 25 years were recruited. REE was measured by the indirect calorimetry (IC) method. Harris-Benedict, World Health Organization (WHO), Owen, Mifflin and Liu’s equations were used to predictREE (REEe). REEe that was within 10% of measured REE (REEm) was defined as accurate. Student’s ttest, Wilcoxon Signed Ranks Test, McNemar Test and the Bland-Altman method were used for data analysis.ResultsREEm was significantly lower (P P P ConclusionsLiu’s, Owen, and Mifflin equations are appropriate for the prediction of REE in young Chinese adults. However, the use of ideal body weight did not increase the accuracy of REEe.

The aim of this study was to compare resting energy expenditure (REE) obtained by indirect calorimetry (IC) and Harris-Benedict (H-B) equations, and to examine whether hypocaloric nutrition support could improve protein nutritional status in mechanically ventilated patients with chronic obstructive pulmonary disease (COPD). Thirtythree COPD patients (20 males, 13 females) were recruited and REE was measured by IC. Measured REE (REEm) was compared to predictive REE by H-B equations (REEH-B) and its corrected values. Correlation between REEm and APACHE II score was also analyzed. Patients were randomly divided into hypocaloric energy group (50%-90% of REEm, En-low) and general energy group (90%-130% of REEm, En-gen) for nutrition support. The differences of albumin, prealbumin, transferrin, hemoglobin, and lymphocyte count before and after 7 days nutrition support were observed. Results show that REEH-B and REEH-B×1.2 were significantly lower than REEm (p0.01). REEm positively correlated with APACHE II score (p0.05 or p0.01). After nutrition support, hemoglobin decreased significantly in En-gen group (p0.05); lymphocyte count in both groups, and transferrin and prealbumin in the En-low group increased significantly (p0.05 or p0.01). Our data suggest that 1) these patients' REE were increased; 2) since IC is the best method to determine REE, in the absence of IC, H-B equations (with standard body weight) can be used to calculate REE, but the value should be adjusted by correction coefficients derived from APACHE II; 3) low energy nutrition support during mechanical ventilation in COPD patients might have better effects on improving protein nutritional status than high energy support.

To investigate the optimal condition of bromodeoxyuridine (BrdU) labeling for bone marrow mesenchymal stem cells (BMSCs) in vitro and the feasibility of in vivo tracing of BrdU-labeling BMSCs.BMSCs were isolated from Wistar rats and were in vitro routinely cultured. The third passage BMSCs was used for identification of special surface antigens by immunohistochemical methods. The purified BMSCs were incubated with BrdU at different concentrations for different incubating time to investigate optimal BrdU concentration and incubating time for cell labeling. The cell labeling index of BrdU was calculated with immunohistochemical analysis. BMSCs labeled BrdU were injected into damaged gastric mucosa of rats by micro injector. The colonization of BMSCs labeled BrdU in gastric mucosa was viewed.After purification and proliferation, the primary cultured BMSCs were uniformly long spindle-shapped form and formed cell colony, which showed the characteristics of stem cell. Immunocytochemistry showed BMSCs were positive for CD44 and CD90, while negative for CD14, CD45. The labeling rate of BrdU increased with the labeling time lasting and reached its height at 48 h. After incubating 48 and 72 hours, the labeling rate of BrdU with a concentration of 10 micromol/L was higher than that of BrdU with a concentration of 5 micromol/L (P0.05) and similar with that of BrdU with a concentration of 15 micromol/L (P0.05). In addition, the BrdU labeling could be detected after five consecutive passages and the labeling time could keep 21 d. The pathological observation demonstrated that BrdU-labeled BMSCs could colonize the damaged gastric mucosa with normal morphologic characteristics during observation period.BrdU labeling might be a feasible method for dynamic observation of the migration, growth and differentiation of migrating BMSCs in colonizing sites.

To determine the level of TWIST expression and its clinical significance in gastric adenocarcinoma.Tumor specimens resected from 43 patients with gastric carcinoma were obtained, and 12 normal gastric tissues were used as normal control. The expression level of TWIST was detected by immunohistochemical staining. Furthermore, The distinctive expression of TWIST in MKN45 and MKN28 gastric cell lines was studied by western blot analyze, and the subcellular localization of TWIST in MKN45 cells was examined by the method of confocal microscopy.The positive expression rate of TWIST in gastric cancerous tissue was 58.14%, which was significantly higher than that in normal tissue (P0.01). The expression rate in the patients with metastasis was also significantly higher than that in those with locally advanced disease (P0.01). In MKN45 cells, TWIST was observed locating in cytoplasm and nucleus, predominately at perinuclear area in the cytoplasm. Western blot demonstrated an expected band in both cytoplasmic and nuclear extracts from MKN45 cells. In addition, MKN45, a cell line derived from undierentiated carcinomas cells, expressed high level of TWIST. While MKN28, a cell line derived from moderate dierentiated carcinomas, showed a lower expression of TWIST.Overexpression of TWIST may correlate to tumor invasion in the gastric adenocarcinoma.

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.

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.

To explore a suitable method for isolation, purification and multiplication of bone marrow mesenchymal stem cells (BMSCs).Density gradient centrifugation and adherence separation methods were applied for isolation of BMSCs from Wistar rats. The cells were cultured and proliferated in culture medium containing calf serum (CS), fetal bovine serum (FBS), free of serum or different volume fraction of FBS. The characteristic and the morphology of BMSCs were observed under inverted microscope every day. The growth curves were draw and the surface antigen of BMSCs were detected by immunocytochemistry technique. The microstructure was observed by transmission electron microscope (TEM).The pure primary cells can be procured by density gradient centrifugation. But the primary cells cultured by adherence separation methods demonstrated higher cytoactive, more rapid proliferation, earlier colony confluence and shorter time for passage than that cultured by density gradient centrifugation method. The cells by adherence separation methods were essentially purified at passage 4. Both CS and FBS can promote the growth and proliferation of BMSCs, but the colony forming efficacy of cells (46.50%) cultured in medium containing 0.12 volume fraction FBS was the highest. The cells surface markers CD44, CD90 were positive and CD14, CD45 were negative. BMSCs were observed by TEM and possessed the characteristic of stem cells. Conclusion BMSCs with high quality and activity can be obtained with adherence separation by suitable method and culture conditions. L-DMEM medium containing 0.12 volume fraction FBS showed more profitable for the growth and proliferation of BMSCs.

To compare the effects of enteral nutrition (EN) and parenteral nutrition (PN) on gut mucosal barrier function and intestinal epithelial tight junctions in rats after surgical stress.Fifty SD rats with surgical trauma were randomly divided into three groups: total parenteral nutrition (TPN) group and enteral nutrition (EN) group with isocaloric and isonitrogenous nutrition and placebo group. Nutrients were administered via the neck vein and needle jejunostomy for the TPN group. The homogenated tissues of liver, lung, and mesenteric lymph nodes were cultured to determine the bacterial translocations rates. The transmembrane binding proteins (occludin) were measured with immunohistochemistry. The ultrastructure and morphology of intestinal epithelial tight junctions were observed by electron microscope. The feces in cecum were cultured for anaerobic bacterial growth analyses.The EN group had more lactobacteria and bifydobacteria than the TPN group, but not statistical significant. The EN group had greater expression of occludin in the intestines than the TPN group. Furthermore, the intestinal epithelial tight junction and microvilli of the EN group were more intact compared with those of the TPN group. The bacterial translocations rates of liver, lung and mesenteric lymph nodes were significantly lower in the EN group than in the TPN group.Neither EN nor standard PN maintains intestinal membrane barriers. But EN increases the expression of transmember binding proteins, maintains the gut epithelial tight junction, improves intestinal mucosal barrier and reduces gut bacterial translocation.

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.

To investigate the effects of ecoimmunonutrition supplement on intestinal microecology, epithelial tight junctions, and barrier function in rats with surgical stress.Seventy SD rats after surgical trauma were randomly divided into four groups:(1) placebo group,(2)total parenteral nutrition(TPN) group,(3)enteral nutrition(EN) group and (4)ecoimmunonutrition (EEN)group respectively. Rats received isocaloric and isonitrogenous nutrition. Nutrients were administered via the neck vein and the needle jejunostomy for five days. The homogenated tissues of liver, lung, and mesenteric lymph nodes were cultured to determine the bacterial translocation rate. The transmembrane binding proteins(occludin) was measured by immunohistochemistry. The ultrastructure and morphology of intestinal epithelial tight junctions in the intestine were observed by electron microscope. The feces in cecum was cultured for anaerobic bacterial growth and analysed.The amounts of lactobacteria and bifidobacteria in EEN group were significantly higher than those in TPN group(P0.05). The expression levels of occludin in the intestine was significantly higher in EEN group than that in TPN and EN group. Furthermore, the intestinal epithelial tight junction and microvilli of EEN group were more intact compared with those of TPN group. The bacterial translocation rates of liver, lung and mesenteric lymph nodes were significantly lower in EEN and EN group than those in TPN group(P0.05).Application of ecoimmunonutrition can protect intestinal mucosal barrier in rats with operative stress, increase the expression of occludin, maintain the gut epithelial tight junction, and eliminate gut bacterial translocation.

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.

To evaluate the impact of recombinant human growth hormone (rhGH) combined with hypocaloric nutrition on nitrogen balance and blood glucose in patients after gastrointestinal operation.Forty-eight patients undergone abdominal operations were randomly divided into either subcutaneous rhGH (0.15 IU/kg) or placebo (menstruum) injection daily for 7 days postoperatively. These two groups had similar nutritional intakes. Body weight, blood cell count, liver and renal function, plasma albumin, prealbumin, transferrin and fibronectin were measured at day 1 before operation as baseline and day 3 and day 10 after operation by standard laboratory techniques. Nitrogen balance and blood glucose were measured from day 3 to day 9 after operation.At postoperative day 10, the cumulative nitrogen balance and the level of plasma fibronectin were significantly higher in rhGH group [13.21 g,(104.77+/-19.94) mg/L] than those in placebo group [-6.88 g, (93.03+/-16.03) mg/L] (P0.05). Furthermore, at day 4 and from day 6 to day 9 after operation, daily nitrogen balance was higher in rhGH group than that in control group (P0.05). Mean blood glucose level was significantly higher in rhGH group from day 3 to day 6 after operation [(7.68+/-2.15) vs (5.95+/-2.34) mmol/L, P0.05]. But hyperglycemia could be controlled well by insulin treatment.Growth hormone combined with hypocaloric nutrition is effective and safe in promoting positive nitrogen balance and protein synthesis in post-operative patients, which is also beneficial to the improvement of nutritional status and prognosis.

Primary clear cell adenocarcinoma of the colorectum is a rare neoplasm, which differs from ordinary carcinomas of the colorectum in morphological features, but shares some traits of clear cell carcinoma of other organs. The tumor is usually composed of polygonal or oval cells with abundant granular and clear cytoplasm. The nuclei are often in hyperchromatic shapes with vesicular nucleoli. We report the first case of clear cell adenocarcinoma of the colorectum in China and review the related published cases. The tumor was located in descending colon of a 37-year-old man, and was rich in glycogen but poor in mucin. By immunoperoxidase and histochemical staining, we clarified the clinicopathological characteristics, diagnosis and differential diagnoses, and pursued its potential pathogenesis. In our case, necrosis, high mitotic activity and lymph node metastasis may suggest a highly malignant tumor and an advanced pathological stage. Nevertheless, the patient has survived for one year with the help of operation and postoperative adjuvant chemotherapy. Regardless of the stage and differentiation, surgical therapy and proper adjuvant chemotherapy are effective means to treat the clear cell adenocarcinoma of the colorectum.

To investigate the effect of eco-nutrition on postoperative patients with colorectal diseases.32 patients undergoing the colorectal operation were randomized into the eco-nutrition enteral nutrition (EEN) group and the normal enteral nutrition (NEN) group. A series parameters, including gastrointestinal symptom, diarrhea and diarrhea score, intestinal flora ratio, inflammatory status markers, immune function markers et al. , were measured before and after the operation.(1) Compared with the NEN group, the EEN group had less days with getting flatulence and abdominal pain (P0. 05). At 6th day the EEN group had a less occurrence of flatulence and abdominal pain (P0. 05). 0 The EEN group had less occurrences of diarrhea at the 6th day (P0. 05). In the EEN group, the total occurrences and days of diarrhea were lower than those in the NEN group (P0. 05), and the mean diarrhea scores were also lower at 6th day (P0. 05). ( Intestinal flora ratios were higher in the EEN group at 6th day (P0. 05).The econutrition application to postoperative patients with colorectal diseases is beneficial in alleviating gastrointestinal symptom and diarrhea, and correcting intestine flora disturbance.

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.

To investigate relationship between the expression of hepatocyte growth factor(HGF) and lymphatic vessel formation in gastric cancer(GC), and to further clarify the possible ways of HGF promoting GC lymphangiogenesis and lymphatic metastasis.The expression of HGF, VEGF-C, c-Met and microlymphatic density(MLD) in tumor and non-tumor areas of 60 cases of GC and 20 cases of peptic ulcer (PU) were evaluated by immunohistochemistry. The relationships between MLD and clinicopathologic features of GC were analyzed.The proteins of HGF, VEGF-C, and c-Met were overexpressed in GC tissues, which were significantly higher than those in normal gastric and PU tissues (P0.001). The MLD of GC was also significant higher than those of normal gastric tissue and PU tissues (P0.05). C-Met was expressed on enlarge lymphatic vessels in GC and PU tissues. MLD was positively correlated with the expression of HGF in GC (P0.001).HGF as well as VEGF-C is a lymphangiogenic factor in GC. HGF can directly or indirectly stimulate lymphangiogenesis and contribute to lymphatic metastasis in GC.

To identify the expression of Cyclooxygenase-2 (Cox-2) in lung tissues and its potential role in pulmonary microcirculation disorder in rats with acute pancreatitis.The acute hemorrhagic and necrotic pancreatitis (AHNP) model was induced by the standard retrograde infusion of bilio-pancreatic duct with 4% sterile sodium taurocholate solution in Sprague-Dawley rats. The rats were randomly allocated into sham surgery group, AHNP group, and prophylactic celecoxib treated AHNP (C+ AHNP) group. The HE, phosphotungstic acid hematain (PTAH) and immunohistochemistrical (IHC) staining were employed to assess the dynamical alterations and interrelations of the histopathology, density of micro-thrombus and Cox-2 expression of lung tissue respectively over a time course of 3, 6, 12 and 24 hours.A significant and progressing increase in histopathologic scoring and Cox-2 expression in the lung tissues were found. There was a positive correlation between the Cox-2 expression and the histopathological scoring. A significant increase of pulmonary micro-thrombosis was detected at the early stage of the rat AHNP induced by sodium taurocholate, and the density of micro-thrombus was positively associated with the histopathological scoring. The prophylactic treatment with celecoxib, a highly selective inhibitor of Cox-2, attenuated the changes in histopathology, pulmonary micro-thrombosis and Cox-2 expression (P0.05). The down-regulated intensity of the Cox-2 expression by celecoxib was positively correlated with the improvement of the histopathology injury, but not with the change of the pulmonary micro-thrombosis.The pulmonary microcirculation dysfunction caused by micro-thrombosis is an early event or even an enabler of the development of APALI. The over-expression of Cox-2 may have promoted the procoagulant activity which plays a key role in the development of pulmonary thrombus.

This is a randomized controlled trial to evaluate the efficacy of recombinant human growth hormone (rhGH) in preventing the development or reducing the duration of postoperative fatigue syndrome (POFS).Informed consent was obtained from each prospective subject. A total of 48 consecutive patients undergoing the elective abdominal operations were randomly divided into the rhGH group and the placebo group. The rhGH group was given daily rhGH 0.15 U/kg from day 3 to day 9 after operation. The two groups had similar nutritional intakes. Plasma proteins, fatigue (Christensen score) and body weight were investigated before and after operations. Nitrogen balance was measured from day 3 to day 9 after operation.On postoperative day 10, the fatigue score in rhGH group was significantly lower than that in control group (P0.05); the level of fibronectin in rhGH group was significantly higher than that in control group (P0.05). Furthermore, a positive nitrogen balance was achieved and kept in the rhGH-treated group during the postoperative period from the third day onward, whereas it was not achieved in the control group till day 9 postoperatively. Cumulative nitrogen balance was significantly higher in rhGH group than in control group (P0.05). There was no significant difference between the two groups in weight loss after operation (P0.05).The application of low doses of recombinant human growth hormone can improve positive nitrogen balance and reduce the courses of POFS. The serum fibronectin level is proved to be a reliable biochemical indicator of POFS.

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.

To investigate the effects of epidermal growth factor(EGF) on mucosal structure after small bowel transplantation in rat.Total small bowel transplantation was performed in inbred Wistar(RT1k) rats heterotopically, either total parenteral nutrition(control group, n=10) or TPN supplemented with epidermal growth factor(EGF group, n=10) was given to the recipients from the second day to 10th day after operation. The changes of morphology, ultrastructure, mucosal protein and DNA contents were determined.The height of mucosal villus,the depth of crypt, the thickness of mucosa and the surface area of villus were (284.47+/-31.58)microm, (98.78+/-10.83 microm, (389.56+/-31.72)microm and (0.089+/-0.009 )mm(2) respectively in EGF group,and (176.45+/-14.62)microm, (74.45+/-8.34)microm, (259.38+/-24.65) microm, and (0.041+/-0.005)mm2 respectively in the control group. The morphological parameters were significantly higher in EGF group than those in the control group. Mucosal protein content was (84.65+/-8.32)mg/g wet wt in EGF group,significantly higher than (53.73+/- 11.45) mg/g wet wt in the control group(P=0.012). DNA content was also significantly higher in EGF group than that in the control group. [(0.86+/0.10)mg/g wet wt vs (0.51+/-0.06)mg/g wet wt, P=0.008]. Nearly normal ultrastructure of the graft enterocyte was maintained in EGF group, while atrophic microvilli and broken mitochondrial crista were observed in the control group.EGF can preserve the mucosal structure of the graft, maintain the integrity of the ultrastructure of graft enterocyte after small bowel transplantation in rat.

To evaluate the efficacy and safety of postoperative adjuvant chemotherapy with imatinib in gastrointestinal stromal tumor(GIST) patients who had high risk of recurrence.A prospective, open-label, multi-center trial conducted in sixteen teaching hospitals in China was carried out. The criteria of the enrolled patients included age more than 18 years old, CD117 positive GIST, tumor size more than 5 cm, pathological mitosis counts more than 5/50 HPF, and treatment beginning within 4 weeks after complete resection and with imatinib (400 mg, once a day) for at least 12 months. The 1, 3 year recurrence rates, disease free survival, overall survival rate and quality of life were evaluated.From Aug. 16th 2004 to Sep. 13th 2005, there were totally 74 patients screened and 57 patients (34 men, 23 women) enrolled in the imatinib treatment group. The primary tumors were located in the stomach in 50.9%, the small intestine in 38.6% and the colorectum in 10.5% of the cases. All the patients received radical resection. Until the cut-off date of interim analysis, there was no evidence of tumor relapse or metastasis in all patients and no death was reported either. Among the 57 enrolled patients with intention to treat(ITT), twelve patients finished the protocol (per protocol, PP). The disease free survival was (268.3 +/-120.2) d in ITT analysis, and (396.7+/-38.2) d in the PP analysis. The incidence of adverse effect was 44.4% . The score in quality of life showed no statistically significant difference between the baseline visit and the follow-up visits.Imatinib is a promising postoperative adjuvant chemotherapy in GISTs patients with high risk of recurrence, and the adverse effects are receivable.

This study assessed the safety and efficacy of structured triglyceride (ST) for parenteral nutrition. A meta-analysis of all the relevant randomized controlled trials (RCTs) was performed. Clinical trials were identified from the following electronic databases: MEDLINE, EMBASE, the Cochrane Controlled Trials Register, Chinese Bio-medicine Database. The search was undertaken in March 2005. Language was restricted to Chinese and English. Literature references were checked at the same time. Only RCTs were extracted and evaluated by two reviewers independently of each other. The statistical analysis was performed by RevMan4.2 software which was provided by the Cochrane Collaboration. A P value of0.05 was considered statistically significant. Ten RCTs involving 236 patients were included. Eight of them compared ST with the long-chain triglyceride (LCT), and the combined results showed that the ST had significant effect on resting energy expenditure (weighted mean difference [WMD] =1.54, 95%CI [ 1.26, 1.82], p0.00001), plasma glycerol (WMD = 0.14, 95%CI [0.06, 0.22], P= 0.0007), free fatty acids (WMD=0.24, 95%CI [0.10, 0.37], P=0.0006), and beta-hydroxybutyric acid (WMD=0.14, 95%CI [0.06, 0.22], P=0.0007), but no differences was found regarding nitrogen balance (standardized mean difference [SMD] = 0.64, 95%CI [-0.30, 1.59], P=0.18), respiratory quotient (WMD =-0.02, 95%CI [-0.04, 0.01], P= 0.18), and plasma triglycerides (WMD = -0.10, 95%CI [-0.30, 0.10], P=0.32). Only two RCTs compared ST with the physical mixture of medium- and long-chain triglyceride (MCT/LCT), data from trials were not combined due to clinical differences between trials, and conclusions can not be drew from the present data. ST appeared to be safe and well tolerated. Further trials are required, especially compared with the MCT/LCT, with sufficient size and rigorous design.

To search for the role of galectin-3 gene in gastric cancer with peritoneal metastasis.Using real-time quantitative RT-PCR for detecting the expression of galectin-3 mRNA in 35 matched samples, including primary cancer lesions, lymph node lesions, peritoneal metastasis and adjacent noncancerous mucosa. ANOVA and SNK-q test were used.The levels of mean expression of galectin-3 mRNA in gastric cancer (385.639 +/- 98. 534), in peritoneal metastasis (368.589 +/- 93.431) and in lymph node metastasis (375.920 +/- 94.346) were significantly higher than that in noncancerous mucosa (2.158 +/- 0.896); there were statistically significant differences respectively (P0.05). However, the levels of the expression in gastric cancer, in peritoneal metastasis and in lymph node metastasis were shown to be of no significant differences by multiple comparison, P0.05. The expression level in the group of gastric cancer was noted to have positive correlation with that in the group of peritoneal metastasis. These data indicated that the expression levels of galectin-3 in gastric cancer were well correlated to peritoneal metastasis.The overexpression of galectin-3 in gastric cancer is well correlated with peritoneal metastasis. Galectin-3 mRNA level may serve as a biological marker in the pre-operative judgment on whether the gastric cancer has had peritoneal metastasis or has just the potential of metastasis.

To detect the expression of IGFBP-2 mRNA in gastric cancer tissues and its roles in neoplasia and peritoneal metastasis of gastric cancer.The IGFBP-2 mRNA expression levels in the fresh tissues from normal mucosa, primary cancer and peritoneal metastasis of 35 patients with gastric cancer were determined by the quantitative real time RT-PCR method, and the samples were sliced up and stained with hematoxylin-eosin for pathologyical examination.The levels of IGFBP-2 mRNA expression in gastric primary cancer tissues were significantly higher than those in the tissues from normal mucosa and peritoneal metastasis (P0.05). Yet, IGFBP-2 mRNA expression levels showed no difference between the tissues of normal mucosa and peritoneal metastasis (P0.05).The expression of IGFBP-2 mRNA possibly plays an important role in proliferation, differentiation and peritoneal metastasis of gastric cancer, and it might be useful in a new method for clinical prognostication and treatment of gastric cancer peritoneal metastasis.

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 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.