Objective To investigate the regulations of lymphatic metastasis of rectal carcinoma which can provide help of clinical diagnosis and treatments.Methods A retrospective analysis was performed of 222 patients with rectal carcinoma who underwent surgical resection from November 2006 to January 2012.Summarize the relevance of each factor and lymph node metastasis by logistic regression analysis.Results (1) Gender and lymph node metastasis has no significant correlation (x2 =0.000,P ＞ 0.05).(2) Lymph node metastasis rate reduced with increasing age and the difference was statistically significant (x2 =5.001,P ＜ 0.05).(3) There is no significant difference between tumor location and lymph node metastasis rate (x2 =0.052,P ＞ 0.05),when the distance between anal rectal cancer and the anus was closer,the tendency of lymph node metastasis was higher,and there has the obvious correlation with lymph node metastasis rate of its size,2.5 to 5.5 cm group and more than 5.5 cm lymph node metastasis rate was significantly higher than less than 2.5 cm group with a significant difference (x2 =2.267,P ＜ 0.05).(4) Tumor invasion of the intestinal circumference was closely related with lymph node metastasis rate (x2 =2.323,P ＜0.01).(5) Lymph node metastasis rate was closely related to the depth of invasion,metastasis rate increased with the depth of invasion increasing(x2 =2.277,P ＜0.05).(6) Lymph node metastasis was significantly higher with the decrease of the degree of tumor differentiation (x2 =4.322,P ＜ 0.01).Logistic regression analysis showed that the degree of tumor differentiation,infiltration and invasion of intestinal circumference diameter lymph node metastasis influential,OR (95 ％ CI) was 5.562 (0.105-0.444),2.178 (0.144-0.971),1.563 (0.038-8.613) respectively (P ＜0.01).Conclusion The lymphatic metastasis of rectal carcinoma is related to age,tumor size,intestinal circumference invasion,depth of tumor invasion and the differentiating degree of the tumor,and the differentiating degree is the major factor.

Objective To evaluate whether the gastroesophageal reflux disease (GERD) questionnaire (GerdQ) symptom score could reflect the acid exposure indicated by 24-hour esophageal pH monitoring in patients with GERD, and to further validate the clinical application value of GerdQ.Methods From November 2008 to March 2010, 134 GERD patients from outpatient department with heartburn and acid reflux symptoms were enrolled.All the patients had undergone endoscopy examination, 24-hour esophageal pH monitoring and GerdQ scoring.According to 24-hour esophageal pH monitoring result, acid exposure group and none acid exposure group was divided by the percentage of time that pH was lower than 4 over 4.2% or DeMeester score over 14.72, the difference of GerdQ score was assessed.The receiver operating characteristic (ROC) curve of GerdQ score was drawn according to DeMeester score and the percentage of time that pH was lower than 4 as the gold standard.With SPSS 17.0 statistical software, the ratio was compared with the u test and Chi-square test, comparison between groups with t test.Results The BMI of acid exposure group was higher than that of none acid exposure group(t= 2.365, P= 0.019).The GerdQ score of acid exposure group (8.51± 2.34) was significantly higher than that of none acid exposure group (6.67 ± 2.79), the difference was statistically significant (t = 4.002, P = 0.000) .ROC curve was drawn according to DeMeester score over 14.72 as gold standard; the area under curve (AUC) was 0.70.When the critical value of GerdQ score was 7.5, Youden index was up to 0.3365, the sensitivity of diagnosis was 0.6909 and specificity was 0.6454.The percentage of time that PH was lower than 4 over 4.2% as the gold standard, the AUC of GerdQ score was 0.663.When the critical value of GerdQ score was 7.5, Youden index was up to 0.2790, the sensitivity of diagnosis was 0.6600 and specificity was 0.6190.Conclusions GerdQ score greater than 7.5 can better reflect acid exposure at the lower esophageal.There is stronger association between GerdQ score with the DeMeester acid exposure score over 14.72 than with the percentage of time that pH lower than 4 over 4.2% as the critical value for acid exposure.Obesity may aggravate the transient lower esophageal sphincter relaxation leading to occurrence of GERD symptoms.