Objective To study the clinicopathologic characteristics and the prognostic factors of gastric stump cancer (GSC). Methods A total of forty-seven patients with GSC from Jan 2000 to Dec 2006 were enrolled in this study for retrospective analysis. Initial surgery was performed for gastric benign disease in 39 patients and for malignant disease in 8 patients, which were divided into 2 groups for analysis. The prognosis of all 47 patients were analyzed. Results The mean interval between previous gastrectomy and diagnosis of GSC was 24.4 years. Tumor developed mostly in the patients with Billroth- Ⅱ reconstruction, and male more than female. Tumor located at anastomotic site mostly, at stump stomach and cardia secondly. The mean interval for patients who had undergone their first gastrectomy for malignant disease was shorter than that with benign disease(P＜0.05). Histology, therapy and prognosis showed no significant differences between two groups (P＞0.05). Disease TNM stage and total radical gastrectomy were shown to be significant predictor for the outcome of patients with GSC (P ＜0.01). Conclusion Now the GSC patients with initial surgery performed for malignant disease are increased, which are no siginificant different to patients with benign disease. Early diagnosis and an aggressive surgical approach are crucial to achieve better outcomes for patients with GSC.

BACKGROUND: High molecular materials have been proved to enhance the mechanical properties of calcium phosphate bone cement, as well as attenuate the injectability of composite materials. It thereby influences the clinical application of composite materials.OBJECTIVE: To observe the compressive strength and injectability of silk fihroin compound calcium phosphate bone cement, to evaluate the effect of silk fibroin on calcium phosphate, and to investigate the feasibility of applying silk fibroin as an injectable hone substitute to repair hone defects.DESIGN, TIME AND SETTING: Controlled study was performed in the central laboratory of Analysis and Testing Center, Soochow University from September to December in 2007.MATERIALS: Calcium phosphate cement was purchased from Shanghai Rebone Biomaterials Co., Ltd; silk fibroin was offered by Institute of Material & Engineering, Soochow University.METHODS: Six groups were set with different mass fractions (0.5%, 1%, 1.5%, 2%, 2.5%, 3%) of silk fibroin, which were mixed with bone cement at a certain liquid/solid ratio of 0.4 mL/g to prepare the calcium phosphate composite. The calcium phosphate cement without silk fibroin was served as control group.MAIN OUTCOME MEASURES: The compressive strength and injectability were determined. The characteristic microstructure was observed using scanning electron microscope.RESULTS: The compressive strength increased firstly and then decreased with the addition of silk fibroin. The compressive strength of the experimental groups was remarkably higher than the control group when the silk fibroin content was 1%-2.5% (P<0.05). The injectability of the paste diminished with the addition of silk fibroin, which was statistically different when the silk fibroin content was 1.5%-3% (P<0.05). Scanning electron microscope result revealed that the silk fihroin penetrated throughout calcium phosphate crystals, which were tightly connected.CONCLUSION: Silk fibroin can improve the compressive strength of silk fibroin/calcium phosphate cement composites without significant influence of manipulation, and can widen the application field of calcium phosphate bone substitute.

Objective To investigate the change of 25-hydroxyl vitamin D level and its impact on glucose metabolism and bone mineral density in type 2 diabetic patients.MethodsTwo hundred and fifty-eight cases of type 2 diabetic patients in our hospital were collected.In accordance with 25 (OH) D =50 nmol/L for the critical values,they were grouped into vitamin D deficiency group ( n =192) and the relative lack of vitamin D group ( n =66).Dual-energy X-ray absorptiometry (DXA) measurement of the lumbar vertebrae L2 - L4 and femoral neck bone mineral density were undertaking.Taking the total value of the lumbar spine,femoral neck and total value as judgment indicators,homeostasis model assessment of insulin resistance (HOMA-IR),we collected and statistically analyzed glucose metabolism and bone metabolism indicators in patients with diabetes.Results Among 258 cases of type 2 diabetes,there were 57 cases of osteoporosis accounting for 22.1％.There was significant difference on the duration of diabetes [ (7.98 ± 1.09 ) years old vs (3.77 ± 1.21 ) years old,t =4.849,P ＜0.05],FINS [ (6.42 ± 1.30) mU/L vs (5.79 ± 1.08) mU/L,t =3.871,P ＜0.05] and HOMA-IR [ (2.35 ±0.54) vs ( 1.85 ±0.41 ),t =2.705,P ＜0.05],but no significant difference on the FPG and HbA1c ( P ＞ 0.05 ) between two groups.PTH [ ( 36.51 ± 7.59) ng/L vs ( 32.02 ± 6.89 ) ng/L,t =2.008,P ＜ 0.05 ],bone mineral density in the lumbar total value [ (0.87 ±0.14) g/cm2 vs (0.99 ±0.12) g/cm2,t =2.799,P ＜0.05 ],femoral neck Neck [ ( 0.70 ± 0.10 ) g/cm2 vs ( 0.79 ± 0.11 ) g/cm2,t =2.564,P ＜ 0.05 ] and Total [ (0.84 ± 0.14) g/cm2 vs (0.97 ± 0.15 ) g/cm2,t =3.340 P ＜ 0.05 ] were statistically different,but no significant difference on the rest of the indicators.Conclusion The prevalence of vitamin D deficiency was found in patients with diabetes.Vitamin D level could affect insulin resistance and glycemic control and bone mineral density level.Therefore,routine vitamin D testing to the diabetic patients and giving vitamin D replacement therapy to vitamin D deficiency patients in a timely manner were necessary.

Objective To evaluate the osteogenic characteristics of an injectable silk fibroin (SF) enhanced calcium phosphate cement (CPC) composite loaded with recombinant human bone morphogenetic protein-2 (rhBMP-2) on lumbar interbody fusion in sheep. Methods Twenty-four mature sheep were randomly divided into two groups. Each sheep underwent L1.2, L3.4 and L5.6 lumber interbody fusion, and the three disc spaces were randomly implanted with three of the following materials: SF/CPC, CPC/rhBMP-2, SF/CPC/rhBMP2 and autogenous iliac crest bone. One group was killed at 6 months and the other at 12 months. The fusion segments were observed and analyzed by manual palpation, CT scan, undestructive biomechanical testing, undecalcified histology, and histomorphology. Results The fusion rates of SF/CPC, CPC/rhBMP-2, SF/CPC/rhBMP-2 and autogenous bone assessed by manual palpation were 0, 33.33%, 55.56% and 77.78% respectively at 6 months. At 12 months, the fusion rates improved to 11.11%, 44.44%, 77.78% and 77.78%, respectively.The biomechanical results showed that fusion stiffness was significantly greater in autograft compared with SF/CPC/rhBMP-2, CPC/rhBMP-2, and SF/CPC in 4 degrees of freedom (flexion, extension, right bending, and left bending) at 6 months. The SF/CPC/rhBMP-2 composite showed similar stiffness as autograft, which was significantly greater than CPC/rhBMP-2 and SF/CPC at 12 nonths. Both CPC/rhBMP-2 and SF/CPC/rhBMP-2 showed significantly greater stiffness at 12 months compared with that of at 6 months. The results showed that bone volume was significantly greater in autograft compared with SF/CPC/rhBMP-2, CPC/rhBMP-2, and SF/CPC at 6 months. There was significant difference among ceramic residue among SF/CPC, CPC/rhBMP-2 and SF/CPC/rhBMP-2, with SF/CPC the greatest and SF/CPC/thBMP-2 the least. At 12 months, the bone volume of SF/CPC/rhBMP-2 composite was comparable with autograft, and greater than that of CPC/rhBMP-2 and SF/CPC. The bone volume of SF/CPC, CPC/rhBMP-2 and SF/CPC/rhBMP-2 was significantly greater at 12 months than that of at 6 months. The ceramic residue of SF/CPC, CPC/rhBMP-2 and SF/CPC/rhBMP-2 were significantly decreased. Conclusion The SF/CPC/rhBMP-2 composite had excellent osteoconduction and osteoinduction, and balanced degradation and osteogenesis, which may be a kind of ideal bone grafts in spinal fusion.

Objective To explore the effect of oridonin on the endoplasmic reticulum stress (ERS) in colonic epithelium of ulcerative colitis (UC) mice.Methods The UC mice model was established by sodium dextran sulfate (DSS),and the intervention group of oridonin and sulfasalazine was set up,the disease activity index (DAD was measured,the colonic tissue was evaluated by histopathologidscore (HPS),and RT-qPCR was used to detect the expression of inflammatory cytokines tumor factor-α (TNF-α),interleukin 6 (IL-6),cyclooxygenase 2 (COX-2),glucose-regulated protein 78 (GRP78),transcription factor EBP homologous protein (CHOP),activator transcription factor 6 (ATF6),protein kinase R like endoplasmic reticulum kinase (PERK) and inositol requiring enzyme 1α (IRE1α).Results The expression of TNF-α,IL-6,COX-2,GRP78,ATF6,CHOP,PERK and IRE1α mRNA in the colonic epithelium of the model group were all up-regulated obviously as compared with the healthy control group(P＜0.05,P＜0.01).When compared with the model group,DAI and HPS in oridonin-treated group were significantly decreased (P＜0.05,P＜0.01),which the curative effect was similar to that of the sulfasalazine group(P＞0.05,P＜0.01).The expression of TNF-α,IL-6,COX-2,GRP78,CHOP,ATF6 and PERK mRNA levels were significantly reduced in oridonin-treated group(P＜ 0.05,P＜0.01).Conclusion Oridonin can alleviate colonic inflammation induced by DSS and its mechanism may be related to ERS of colonic epithelial tissue.