Objective:To investigate gut barrier dysfunction and bacterial translocation (BT) in patients who underwent digestive tract reconstruction and to study the relationship between BT and acute systemic inflammatory state (SIRS). Method： Sixty patients who underwent selective digestive tract reconstruction were observed. Blood were collected before surgery and 1, 3, 5 days after surgery to detect plasma diamine oxidase(DAO) and bacterial DNA. PCR analysis was performed with β-Galactosidase gene of Eschenchia coli and 16SrRNA gene as target gene. The SIRS of all the patients were observed for 10 days. Result：All the PCR results before operation were negative, while there was positive in 14 patients after digestive tract reconstruction. There were 23 patients with SIRS after surgery, and 12 patients PCR result were positive among 23 patients with SIRS. 85.7% of the patients(12/14) with positive PCR result had SIRS, while 23.9% patients (11/46) with negative PCR result had SIRS (P<0.01).The positive PCR rate in SIRS was 52.2% (12/23), which was remarkably higher than that without SIRS(5.4%, 2/37, P<0.01).The levels of plasma DAO in patients with positive PCR result was significantly higher than those of the patients with negative PCR result (P<0.01). The levels of plasma DAO in patients with SIRS was significantly higher than those of patients without SIRS (P<0.01). Conclusion:The gut barrier dysfunction was closely related to BT, and BT was closely related to postoperative SIRS. PCR analysis can be used in early diagnosis of BT, the positive PCR result might be a useful early warning sign of postoperative SIRS.

Objective: To investigate changes in species and amounts of intestinal flora after reconstruction of upper digestive tract, and the relationship with the infective complications.Methods: 52 patients with advanced malignancy being performed reconstruction of upper gastrointestinal tract was prospectively observed .The species of bacteria and counts of the colony forming units(CFU) were measured from juice taking from the upper jejunum through nasointestinal tube during operation, the second day and the fifth day after operation. Meanwhile, the plasma endotoxin concentration was determined with the modified chromogenic limulus assay.Results: There weren't significant changes of intestinal flora in species and amounts between groups (P＞0.05.) No any signs of bacterial translocation were seen. There was no significant difference for the level of plasma endotoxin between groups.Conclusion: There is no disorder of intestinal flora and bacterial translocation during the perioperative period after upper digestive tract reconstruction successfully.

Objective To explore the factors related to the tolerance to enteral nutrition (EN) in gastric carcinoma patients undergoing surgical treatment and the implementation strategy of EN.Methods Fifty-four patients with gastric carcinoma undergoing surgery from November 2011 to September 2012 in the Affiliated Hospital of Medical College of Qingdao University were enrolled.EN were applied with sequential and gradual strategies.The tolerance status to EN was recorded.Factors related to the patient tolerance to EN were analyzed using single-factor and multiple-factor Logistic regression analysis.The incidences of gastrointestinal symptoms during EN application were recorded.Results Among the 54 patients,49 (90.74％) patients could tolerate EN.Single-factor analysis and multiple-factor Logistic regression analysis both showed that tumor staging (single-factor analysis:x2 =7.287,P =0.007 ; multiple-factor analysis:t =2.559,P =0.014) and surgical approach (singlefactor analysis:x2 =7.825,P =0.005 ; multiple-factor analysis:t =2.254,P =0.043) were major factors affecting patient tolerance to EN.Among the patients tolerant to EN,abdominal distension (19/49,38.8％) was the major gastrointestinal symptom of EN.Conclusion The sequential and gradual EN application strategy is suitable for the patients with gastric cancinoma after surgery,and can be widely used in clinical practice.

Objective To explore 18F-FDG PET-CT in the detection of malignant tumors of the gastrointestinal tract.Methods 39 patients with gastrointestinal tumors who was diagnosed with operation,pathological examination,clinical and imaging follow-up undertake the whole-body 18F-FDG PET-CT.Results The sensitivity and specificity were both 100.0 ％ for primary malignant tumors.Gastric metastases sensitivity,specificity and accuracy were 80.0 ％ (4/5),90.9 ％ (10/11),87.5 ％ (14/16),and the colorectal metastases sensitivity,specificity,accuracy of diagnostic results were 88.9 ％ (8/9),92.9 ％ (13/14),91.3 ％ (21/23).The gastric cancer lymph node metastasis sensitivity,specificity and accuracy were 50.0 ％ (3/6),90.0 ％ (9/10),75.0 ％ (12/16),in the diagnosis of colorectal local lymph node metastasis the sensitivity,specificity and accuracy were 71.4 ％ (5/7),93.8 ％ (15/16),87.0 ％ (20/23).Conclusion The 18F-FDG PET-CT imaging for gastrointestinal malignant tumor diagnosis and residual lesions recurrence or lesions metastases of detection is of important value and better than traditional examination methods.

Objective To observe the changes of serum myostatin (MSTN) level in patients with gastric carcinoma-associated cachexia and to investigate the relationship between MSTN and tumor necrosis factor α (TNF-α) preliminarily.Methods Eighty patients with gastric cancer were divided into two groups based on their Patient-Generated Subjective Global Assessement (PG-SGA) scores:gastric carcinoma-associated cachexia group (GCC group,32 cases; PG-SGA stage C) and gastric carcinoma non-cachexia group (GCNC,48 cases; PG-SGA stage A + B).The serum MSTN and TNF-α levels were measured by enzyme linked immunosorbent assay,and relevant parameters including height,weight,albumin,hemoglobin,and C-reactive protein were also recorded before operation.Eighty healthy adults were chosen as the control group.Results The serum MSTN level in the GCC group [(1.36 ±0.50) μg/L] was significantly higher than that in the GCNC group [(0.91 ±0.49) μg/L; x2 =14.67,P =0.00],whereas the serum MSTN level in the GCNC group was significantly higher than that in the control group [(0.70 ± 0.37) μg/L; x2 =36.45,P =0.00].Serum MSTN level was not correlated with TNF-α in the GCC group (r=0.18,P=0.31),GCNC group (r=0.08,P=0.58),or control group (r=-0.16,P＝0.16).Conclusions Serum MSTN level is elevated in patients with gastric carcinoma-associated cachexia.However,it is not correlated with serum TNF-α.

Objective To review the experience on the surgical management for advanced gastric carcinoma with portal hypertension. Methods In this study, 14 advanced gastric carcinoma with portal hypertension patients were analyzed retrospectively, liver cirrhosis was found in 13 cases. In 10 esophageal variceal patients, 5 had upper gastrointestinal bleeding history. All of those cases were associated with different degree of hypersplenism. The tumours situated at the upper third of the stomach in 2 patients, middle and upper third in 2 and lower third in 10. Five patients underwent curative distal subtotal gastrectomy and splenectomy, 2 cases did radical distal subtotal gatrectomy and pericardial devascularizaion, 2 curative distal subtotal gastrectomy combined with splenic artery ligation,2 did total gastrectomy and pericardial devascularizaion,2 cases did radical proximal gastrectomy and pericardial devascularization and 1 patient did distal subtotal gastrectomy only. Results Three died from extensive wound bleeding, jejunal fistula and liver failure respectively. 3 patients were complicated by left subdiaphragmatic abscess, hepatic dysfunction and massive ascites individually. The morbidity and mortality rate were 42.86% and 21.43% respectively. Conclusion The surgical procedures for patients of advanced gastric carcinoma with portal hypertension caused a considerably high postoperative mortality and morbidity rate.