Objective To evaluate the diagnosis and surgical management for pancreatic duct stones (PDS). Methods The clinical data of 19 PDS patients admitted to our hospital from Jan. 1985 to Sep. 2003 were analyzed retrospectively. Results Epigastric pain was the first symptom in all patients,and chronic pancreatitis was associated, pancreatic carcinoma coexisted in 6 cases. Fifteen cases were found to have PDS or pancreatic duct dilation by B-type ultrasonography. Twelve patients underwent pancreatolithotomy plus side to side Roux-en-Y pancreaticojejunostomy. Pancreatoduodenectomy was performed on four patients ,caudal pancreatectomy and pancreatolithotomy on three patients. Six pancreatic carcinoma patients died during follow-up of 9～26 months. Abdominal pain was relieved completely in 11 cases and partially in 1,stones and pain recurred in one patient. Conclusions B-type ultrasonography、CT and endoscopic retrograde cholangiopancreatography(ERCP) are most useful diagnostic methods;Surgical procedures should be selected according to the following factors: (1) location of the pancreatic duct stones. (2) stenosis of the main pancreatic duct.(3) pancreatic duct stones associated with or without pancreatic carcinoma.

Objective: To study the relationship between the number of circulating tumor cells (CTC) and the clinicopathological parameters of patients with gastric cancer, and its value in neoadjuvant chemotherapy for gastric cancer. Methods: The number of CTC in 83 patients with gastric cancer before the operation was detected by density gradient centrifugation combined with immunomagnetic negative enrichment and immunofluorescence in situ hybridization. The relationship between CTC number and the clinicopathological factors of patients with gastric cancer was analyzed by defining more than 3 CTCs in 5 mL peripheral blood as positive CTC. According to the random number table, 66 patients with advanced gastric cancer (24 cases in stage Ⅱ and 42 cases in stage III according the seventh edition of AJCC staging of cancer) were divided into neoadjuvant chemotherapy group and non-neoadjuvant chemotherapy group. The relationships of positive CTC, tumor pathological characteristic and neoadjuvant chemotherapy with the prognosis of gastric cancer patients were analyzed. Results: There was no statistical correlation of positive CTC in peripheral blood with gender, age, tumor location, carcinoembryonic antigen (CEA), cancer antigen 19-9 (CA19-9), Borrmann typing, early and progressive stage, degree of differentiation, size of gastric cancer, depth of invasion, lymph node metastasis, distant metastasis and TNM stage (all P > 0.05) in gastric cancer patients. Neoadjuvant chemotherapy, tumor differentiation and positive CTC were independent prognostic factors for the patients with gastric cancer. Neoadjuvant chemotherapy prolonged the postoperative overall survival (OS) of patients with CTC-positive gastric cancer (P < 0.05), but had no statistically significant effect on the postoperative OS of patients with CTC-negative gastric cancer (P > 0.05). Conclusion: CTC can appear in peripheral circulation blood of patients with early gastric cancer. The positive CTC is associated with poor prognosis of patients with gastric cancer. Neoadjuvant chemotherapy can prolong the OS of patients with CTC-positive gastric cancer, but has little value in the patients with CTC-negative advanced gastric cancer.

Lysine demethylase 6 (KDM6) is involved in the demethylation regulation of histone H3 as an important modification enzyme in epigenetic modification,and plays an important role in embryonic development,inflammation and disease development.Current researches indicate that KDM6 is involved in the occurrence and development of various tumors (pancreatic cancer,colon cancer,gastric cancer,breast cancer,bladder cancer,etc.),affects proliferation,metastasis,prognosis and chemotherapy resistance of tumors,and plays different roles due to different tumor backgrounds.

Objective To study the expression of hypoxia-inducible factors-1 α and pyruvate kinase type M2 in Hp infected gastric carcinoma and their clinical significances.Methods The expression levels of hypoxia-inducible factors-1α and pyruvate kinase type M2 in 85 cases of gastric carcinoma tissues were detected by using RT-PCR and immunohistochemical method.The Virulence level of CagA gene were detected in Hp infected gastric tissue.Results As the degree of tumor differentiation,invasion depth and clinical stage of tumor increased,the positive expression rate of HIF-1 α and PKM2 increased,and the expression level of the two was in positive correlation.The positive expression rate of HIF-1α (73％)was related to lymph node metastasis (x2 =4.204,P =0.041).The positive expression rate of PKM2 (85 ％)was related to tumor diameter.The positive expression rate of HIF-1α and PKM2 (75％ and 85％,respectively)significantly increased in Hp infected gastric carcinoma tissue (x2 =6.486,P =0.010;x2 =7.341,P =0.009,respectively) and related to CagA + type.Conclusion HIF-1α and PKM2 may be closely correlated to development and metastasis of gastric carcinoma with Hp infection.

OBJECTIVETo explore the effect of body mass index (BMI) on postoperative short-term prognosis and survival rate of gastric cancer patients.

METHODSClinical and follow-up date of 153 gastric cancer cases undergoing radical operation in our hospital from January to June 2010 were retrospectively analyzed. According to BMI, patients were divided into low group (BMI<18.5, 23 cases), normal group (18.5≤BMI<25.0, 95 cases) and high group (BMI≥25.0, 35 cases). Clinicopathological features and outcomes were compared the among three groups.

RESULTSAmong three groups, the differences in operation time, intraoperative blood loss, number of lymph node retrieved, postoperative hospital stay, lymph node metastasis rate, tumor staging and postoperative complication morbidity were not statistically significant (all P>0.05). Preoperative hemoglobin in the low group was significantly lower as compared to normal and high groups [(106.1±13.8) g/L vs. 113.5±5.2) g/L and (123.5±8.7) g/L, F=3.265, P=0.041], and so was the preoperative albumin [(38.7±2.5) g/L vs. (41.3±0.8) g/L and (43.5±1.4) g/L, F=8.516, P=0.000]. The ratio of gastric cardiac cancer in the low group was significantly lower as compared to the normal and high groups[34.8%(8/23) vs. 68.4%(65/95) and 62.9%(22/35), χ(2)=8.913, P=0.012]. Five-year survival rate of the low, normal and high groups were 43.5%, 50.5% and 65.7% respectively(P=0.189). Subgroup analysis showed that the 5-year survival rate of patients with gastric cardiac cancer in the low group was significantly lower as compared to those in the high group (25.0% vs. 84.6%, P=0.004).

CONCLUSIONSBMI dose not generally play a role in short-term outcomes and long-term survival of the gastric cancer patients. Nutritional improvement and body weight maintenance may be beneficial to low BMI patients, especially those with gastric cardiac cancer.

Blood Loss, Surgical ; Body Mass Index ; Gastrectomy ; Humans ; Length of Stay ; Lymph Nodes ; Lymphatic Metastasis ; Neoplasm Staging ; Operative Time ; Postoperative Complications ; Postoperative Period ; Retrospective Studies ; Stomach Neoplasms ; surgery ; Survival Rate ; Treatment Outcome

Thymidylate synthase (TS) is a key enzyme in DNA synthesis and is often used as a target for chemotherapy drugs. In a variety of tumors such as non-small cell lung cancer, colorectal cancer, breast cancer, etc, the expression of TS is closely related to the clinical prognosis and chemotherapy drug resistance of patients. Reducing the expression of TS in tumor tissues through various molecular mechanisms has become an important means to improve the efficacy of chemotherapy drugs and improve the clinical prognosis.

Objective:To investigate the relationship between KDM6A mutation or expression and clinicopathological characteristics of gastric cancer.Methods:Fifty-seven cases of gastric cancer tissues were analyzed by second-generation sequencing, and bioinformation database such as Cbioportal, Kaplan Meier-Plotter, and the Human Protein Atlas were used to analyze the relationship between KDM6A mutation and clinicopathological characteristics of gastric cancer.Results:Among 57 gastric cancer samples, 14 were KDM6A mutation, and the mutation proportion was 24.6%. Compared with the non-mutation group, the Borrmann classification, T stage, TNM stage and tumor diameter of KDM6A mutant group were significantly different (all P<0.05). The median survival time of the KDM6A mutant patients was 53.5 months, significantly shorter than 72.0 months of the KDM6A non-mutation patients ( P=0.007). The analysis result of Kaplan Meier-Plotter database showed that, among all of the 875 patients, 655 patients had low KDM6A expression and 220 patients had high expression. The median survival time of patients with low expression was 23.5 months, significantly shorter than 30.8 months of patients with high expression ( P=0.002). In male, gastric cancer patients with stage Ⅲ, intestinal type, diffuse type, simple surgical treatment and fluorouracil chemotherapy, the expression of KDM6A is related to the patient's overall survival time (all P<0.05). The analysis result of Cbioportal database showed that, among all of the 1 172 gastric cancer patients, 70 patients with KDM6A mutation, 1100 patients with non-mutation. The median overall survival time of mutant patients was 28.9 months, significantly shorter than 35.9 months of non-mutation patients ( P<0.001). The analysis result of Human Protein Atlas database showed that, among all of the 355 gastric cancer patients, 97 patients had high KDM6A expression and 258 patients had low KDM6A expression. The median survival time of patients with low expression was 13.7 months, significantly shorter than 19.8 months of patients with high expression ( P=0.022). Conclusions:The survival time of gastric cancer patients with KDM6A mutation or low expression is shorter. The mutation and expression of KDM6A are related to clinical pathological factors, which may become a potential target for the diagnosis and treatment of gastric cancer.

Objective:To investigate the relationship between KDM6A mutation or expression and clinicopathological characteristics of gastric cancer.Methods:Fifty-seven cases of gastric cancer tissues were analyzed by second-generation sequencing, and bioinformation database such as Cbioportal, Kaplan Meier-Plotter, and the Human Protein Atlas were used to analyze the relationship between KDM6A mutation and clinicopathological characteristics of gastric cancer.Results:Among 57 gastric cancer samples, 14 were KDM6A mutation, and the mutation proportion was 24.6%. Compared with the non-mutation group, the Borrmann classification, T stage, TNM stage and tumor diameter of KDM6A mutant group were significantly different (all P<0.05). The median survival time of the KDM6A mutant patients was 53.5 months, significantly shorter than 72.0 months of the KDM6A non-mutation patients ( P=0.007). The analysis result of Kaplan Meier-Plotter database showed that, among all of the 875 patients, 655 patients had low KDM6A expression and 220 patients had high expression. The median survival time of patients with low expression was 23.5 months, significantly shorter than 30.8 months of patients with high expression ( P=0.002). In male, gastric cancer patients with stage Ⅲ, intestinal type, diffuse type, simple surgical treatment and fluorouracil chemotherapy, the expression of KDM6A is related to the patient's overall survival time (all P<0.05). The analysis result of Cbioportal database showed that, among all of the 1 172 gastric cancer patients, 70 patients with KDM6A mutation, 1100 patients with non-mutation. The median overall survival time of mutant patients was 28.9 months, significantly shorter than 35.9 months of non-mutation patients ( P<0.001). The analysis result of Human Protein Atlas database showed that, among all of the 355 gastric cancer patients, 97 patients had high KDM6A expression and 258 patients had low KDM6A expression. The median survival time of patients with low expression was 13.7 months, significantly shorter than 19.8 months of patients with high expression ( P=0.022). Conclusions:The survival time of gastric cancer patients with KDM6A mutation or low expression is shorter. The mutation and expression of KDM6A are related to clinical pathological factors, which may become a potential target for the diagnosis and treatment of gastric cancer.