1.The application of scissors knife in difficult endoscopic submucosal dissection
Geng CHEN ; Hong XU ; Tongyu TANG ; Ke TAO ; Yan XIA
Chinese Journal of Digestive Endoscopy 2013;30(11):631-633
Objective To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) with scissors knife in difficult cases.Methods A total of 36 sessions of ESD in 34 patients were performed from May 2010 to May 2012 with application of new scissors knife.The complications and followup outcomes were recorded.Results All lesions were removed successfully with an en bloc resection rate at 91.7%.Delayed bleeding occurred in 2 patients (5.6%),and both of them were cured sucessfully with endoscopy.No perforation happened and the average hospitalization time was 5 days.Follow-up endoscopy performed 6 or 12 months after ESD in 6 patients revealed no recurrence or residual lesions.Other patients are under follow-up now.Conclusion The scissors knife is easy to manipulate,which can ensure the safety and efficiency of ESD.
2.Long-term effect on radiofrequency heat-coagulation endometrial ablation in the treatment of anovulatory dysfunctional uterine bleeding
Geping YIN ; Juan LI ; Tongyu ZHU ; Ming CHEN ; Shujun YANG ; Xiaoli ZHAO
Chinese Journal of Obstetrics and Gynecology 2011;46(9):664-668
ObjectiveTo investigate long-term effect on radiofrequency heat-coagulation (RF)endometrial ablation in treatment of anovulatory dysfunctional uterine bleeding (DUB). MethodsFrom Jul.2001 to Nov. 2009, 1 196 patients with DUB who were failed by medical treatment( including 127 patients with dysmenorrheal) were enrolled into this study in Jinan Millitary General HospitaL Those patients were divided into two groups according to age:427 patients at age of or more than 45 years (average age 48 years) in Group A who were treated by RF procedure for amenorrhea;769 patients at age of less than 45 years old (average 37 years) in group B were treated by RF for controlling excessive menstrual bleeding. All the patients had the results of menstrual score (pictorial blood loss assessment chart, PBAC), hemoglobin (Hb) ,endometrial curettage pathology and hysteroscopy examination immediately after RF procedure; Some patients still had another endometrial curettage pathology and clinical results in 6 months after RF. The mean follow-up time was 72 months ( range:6 to 100 months). The evaluation criterion for RF treatment was to use optimal and significant effect measurements. For group A, the optimal treatment effect (cure) was defined as bleeding cessation and achieving amenorrhea that continued for more than 12 months after treatment. For group B, the optimal treatment effect (cure) was also defined as bleeding cessation and resuming normal menstruation which continued for more than 12 months after treatment. Significant treatment effect was defined as irregular, minor bleeding, but PBAC score less than 100 within 12 months. If patient symptoms and PBAC scores did not change compared with those before treatment, the treatment was defined as failure. For dysmenorrhea, the optimal treatment effect was disappearance for more than 12 months, the significant treatment effect was remission, and treatment failure was not changed from the pre-treatment baseline. The effective rate was the sum of that of the optimal and significant effect. One hundred and twentyfive patients with DUB treated by agents at the same time were chosen as control group. Results( 1 ) The recent and long-term effective rates for bleeding cessation by RF: the total recent effective rates within 1 months were 94. 82% ( 1134/1196), including 96. 5% (412/427) in group A and 93.9% (722/769) in group B. The total curative rates for dysmenorrheal were 82. 7% ( 105/127 ), including 86. 4% ( 38/44 ) in group A and 80. 7% ( 67/83 ) in group B. Pathology examination after hysteroscopy immediately after RF showed a completely and whole destroyed endometrium in group A, and a little rested endometrium in group B. The long-term effect rates for bleeding cessation by RF after 12, 24 and 36 months were 92. 55% (969/1047), 93.9% (866/922) and 93.7% (609/650), respectively. PBAC and Hb in group A and group B within 12, 24, 36 and more than 36 months were improved significantly ( P < 0. 05 ). (2) Complications : the major complication was irregular minor bleeding in 1 to 2 months after treatment, the rate was 8.03% (96/ 1196). The second one was menorrhea in 3 months after RF, the rate was 5. 18% (62/1 196 ). This condition was corrected by the second RF. No hysterectomy was performed on those patients. Conclusion RF is the safe, efficient and minimal invasive procedure in treatment for DUB. The mechanism of keeping longterm curative effect and preventing recurrence is due to endonetrium inactivation and fibrosis by thermocoagulation.
3.Correlation of Traditional Chinese Medical Syndrome Elements with Plasma Connective Tissue Growth Factor and Platelet-derived Growth Factor in Early Liver Cirrhosis Induced by Type B Hepatitis
Yao LIU ; Tongyu WU ; Dongliang LI ; Jianying SHEN ; Lingyuan ZHANG ; Shanshan DING ; Zhiping SHI ; Xiangjun CHEN
Journal of Guangzhou University of Traditional Chinese Medicine 2015;(1):4-9
Objective To explore the correlation of traditional Chinese medical syndrome elements with plasma connective tissue growth factor ( CTGF) and platelet-derived growth factor ( PDGF) in early liver cirrhosis induced by type B hepatitis. Methods The distribution of traditional Chinese medical syndrome elements in early liver cirrhosis induced by type B hepatitis was analyzed, plasma contents of CTGF and PDGF were detected by enzyme-linked immunosorbent assay ( ELISA) , and the correlation of syndrome elements with CTGF and PDGF was discriminated. Results ( 1) The distribution of traditional Chinese medical syndrome elements in early liver cirrhosis induced by type B hepatitis showed as follows: the syndrome elements involved the viscera of liver and spleen, and the pathogenesis was characterized as dampness, heat, qi stagnation, and yin deficiency. ( 2) CTGF was closely related with spleen, gallbladder and dampness, with OR value being 1.598, 1.567, 2.797, respectively. PDGF was closely related with heat, with OR value being 1.134. Conclusion Early liver cirrhosis induced by type B hepatitis mainly affects the viscera of liver and spleen, the pathogenesis is characterized by dampness, heat, qi stagnation, and yin deficiency. The patients with higher CTGF are apt to show the pathological changes of spleen, gallbladder, dampness, and have the syndrome el-ements of spleen, gallbladder, dampness. The patients with higher PDGF are apt to show the pathological changes of heat, and have the syndrome element of heat.
4.Meta analysis of solid pseudopapillary tumors of the pancreas
Yong YIN ; Zhaoli LI ; Qin WANG ; Rongchao WANG ; Zhong LI ; Qicheng LU ; Jun XU ; Changqing LU ; Tongyu CHEN
Chinese Journal of Pancreatology 2010;10(5):341-344
Objective To summarize the experience of diagnosis, treatment and prognosis of solid pseudopapillary tumors of the pancreas (SPT) in China. Methods The Chinese literature from January 1992 to April 2009 in Chinese Journal Full-text Database was systematically searched and a total of 439 cases of SPT from 42 reports were found. Clinical data of these cases were retrospectively analyzed. Results Among 439 was 28 years old (range 8 ~76 yrs). The clinical symptoms were recorded in 377 cases, including abdominal pain (35. 3%), mass (31. 3%), discomfort (7. 7%). 101 patients (26. 8%) were completely asymptomatic, and the lesions were detected during routine check-up. All of the patients underwent surgical resection. The preoperative misdiagnosis rate was 65.4% ( 161/246 ). The rate of curative resection was 97.3% (427/439). Mean diameter of the tumor was 7.8 cm ( range 1.5 ~ 25.0 cm). Among 394 patients with information on metastases or invasions, 80 patients(20.3% ) were positive. In all patients, 418(95.2% )were followed up and the mean follow-up period was 34 months ( range 1 month to 25 years ). During the follow-up period, 403 ( 96. 4% ) patients were alive with no evidence of recurrence or metastases, local recurrence developed in 4 patients, the liver metastases developed in 6 patients, 4 patients died from the disease. Conclusions SPT is a rare and potentially low-grade malignant tumor, and predominantly affect young women. The correct diagnosis depends on the histopathological examination. Radical surgical resection is the only effective treatment for SPT, which usually has an excellent prognosis.
5.Tacrolimus once daily (Advagraf) vs twice daily (Prograf) in De Novo renal transplantation: a multicentre, randomized, open label, parallel control phase Ⅲ study
Jianhua AO ; Weizhen WU ; Liming WANG ; Lixin YU ; Zhishui CHEN ; Ye TIAN ; Jianghua CHEN ; Yinfu ZHANG ; Longkai PENG ; Tongyu ZHU ; Lizhong CHEN
Chinese Journal of Organ Transplantation 2011;32(7):399-402
Objective To compare the efficacy and safety of twice-daily tacrolimus (Tacrolimus BID; Prograf) vs once-daily prolonged release tacrolimus (Tacrolimus QD; Advagraf), combined with steroids and mycophenolate mofetil in preventing acute rejection in De Novo renal transplantation patients. Methods 241 patients from 11 centers were randomized into two groups with 3 months observation period post-transplantation. Advagraf was administered as a single oral dose in the morning (initially 0. 1-0. 15 mg/kg every day) and Prograf was administered in two equal oral doses 12h apart (initially 0. 1-0. 15 mg/kg). Study visits were scheduled for days 1, 3, 7, 14, 28, 56, 84post-transplantion. The efficacy, safety, compliance and adverse effects were compared between two groups. Results Totally 223 patients completed the study. The two groups were comparable in age,gender and primary disease. There were 12 episodes of acute rejection in each group. There was no graft loss or patient death in both groups. The incidence of drug related adverse events was 32. 1 %and 33. 3% respectively in the control and experimental groups. Dosage was decreased in both groups and there was significant difference in each group. The trough level was similar at the initiate period.Twenty-eight days post-transplantation the trough level in the Advagraf group was lower than in the Prograf group. Conclusion Advagraf has the same efficacy, safety and drug related adverse effects as Prograf. It is practical and feasible for Advagraf substitute for Prograf in clinical practice.
6.Multicenter safety study on cetuximab combined with intensity modulated radiotherapy and concurrent chemotherapy of cisplatin in locoregionally advanced nasopharyngeal carcinoma
Chunyan CHEN ; Chong ZHAO ; Li GAO ; Jinyi LANG ; Jianji PAN ; Ghaosu HU ; Feng JIN ; Rensheng WANG ; Conghua XIE ; Tongyu LIN ; Taixiang LU
Chinese Journal of Radiation Oncology 2012;21(3):201-204
Objective To evaluate the safety of cetuximab combined with intensity-modulated radiotherapy (IMRT) plus concurrent cisplatin chemotherapy in locoregionally advanced nasopharyngeal carcinoma (NPC) in a Chinese multicenter clinical study.MethodsFrom July 2008 to April 2009,100Patients with primary stage Ⅲ- Ⅳb non-keratinizing NPC were enrolled.The planned dose of IMRT to gross tumor volume and positive cervical lymph nodes was 66.0-75.9 Gy and 60-70 Gy in 30-33 fractions.Cisplatin (80 mg/m2,q3 week (w)) and cetuximab (400 mg/m2 one w before radiation,and then 250mg/m2 per w) were given concurrently.The adverse events (AEs) were graded according to common terminology criteria for adverse events v3.0.ResultsThe compliance of the entire group of patient was satisfactory.Actual median dose to gross tumor volume was 69.96 Gy,and the median dose to positive cervical lymph nodes was 68 Gy.Median dose of cisplatin was 133 mg,median first-dose of cetuximab was 690 mg,and median weekly dose was 410 mg.AEs were well tolerated and manageable,mainly consisting of acneiform skin eruptions,dermatitis and mucositis.Grade 4 mucositis was observed in 2% of the patients and no other grade 4 AEs were observed.ConclusionsThe combined treatment modality of IMRT +concurrent chemotherapy + cetuximab in loco-regionally advanced NPC is well tolerated.
7.The role of ineffective esophageal motility in non-erosive reflux disease and its correlation with acid exposure
Xi ZHAO ; Yuting JIA ; Bang CHEN ; Tongyu TANG ; Hong XU ; Dan WANG
Chinese Journal of Digestion 2020;40(8):518-523
Objective:To investigate the role of ineffective esophageal motility (IEM) in the diagnosis of non-erosive reflux disease (NERD) and its relationship with acid exposure.Methods:From March 2013 to May 2019, in First Hospital Affiliated to Jilin University, patients who underwent gastroendoscopy exam, esophageal high-resolution manometry (HRM), 24-h pH monitoring and had gastroesophageal reflux symptoms, and without mucosal or structural abnormal changes under gastroendoscopy were retrospectively selected. Based on Rome Ⅳ criteria, the patients were reevaluated and the diagnostic types were NERD, reflux hypersensitivity (RH) and functional heartburn (FH). The changes of esophageal HRM metrics and acid reflux-related parameters of patients with IEM were analyzed and compared. Independent sample t-test, nonparametric test and chi-square test were used for statistical analysis. Results:The data of 228 patients were collected. Thirty-seven cases with esophageal gastric junction (EGJ) outflow obstruction and severe esophageal motility disorder (8 cases of achalasia, 9 cases of EGJ outflow obstruction, 4 cases of distal esophageal spasm, 14 cases of absent contractility and 2 cases of hypercontractile esophagus) and fifty-three cases with endoscopic reflux esophagitis under endoscopy (20 cases of Los Angeles grade A, 15 cases of grade B, 13 cases of grade C, and 5 cases of grade D) were excluded. In the end 138 patients were enrolled, including 60 males and 78 females, with a mean age of (50.1±14.1) years, including 36 cases of NERD, 44 cases of RH and 58 cases of FH. According to esophageal HRM Chicago classification standard, 138 patients with gastroesophageal reflux symptoms were divided into IEM group (46 cases, including 15 cases of NERD, 12 cases of RH, and 19 cases of FH) and normal manometry group (92 cases, including 21 cases of NERD, 32 cases of RH, and 39 cases of FH). There was no statistically significant difference in the proportion of patients diagnosed as NERD, RH and FH between the two groups ( P> 0.05). The length of lower esophageal sphincter (LES) (2.70 cm, 2.40 to 3.00 cm vs. 3.00 cm, 2.70 to 3.20 cm), the average value of LES resting breathing pressure (16.55 mmHg, 7.98 to 22.95 mmHg vs. 19.10 mmHg, 14.15 to 25.68 mmHg, 1 mmHg=0.133 kPa), the distal contractile integral (DCI)(417.90 mmHg·s·cm, 279.08 to 584.45 mmHg·s·cm vs. 1 429.40 mmHg·s·cm , 994.38 to 1 852.80 mmHg·s·cm) and EGJ contractile integral (37.86 mmHg·cm, 26.97 to 46.78 mmHg·cm vs. 45.19 mmHg·cm, 35.39 to 58.20 mmHg·cm) of IEM group were all lower than those of normal manometry group, ( Z=3.33, 2.09, 8.09, and 2.90, all P<0.05). There were no statistically significant differences in LES resting pressure at the end of the breath, 4 s-intergrated reloxation pressure, distal latency, upper esophageal sphincter (UES) resting pressure (UESP), UES residual pressure, UES baseline relaxation time, UES recovery time, EGJ type, acid reflux related parameters (total acid exposure time (AET), AET in upright position, AET in supine position, and Demeester score) between the two groups (all P>0.05). The 36 NERD patients were divided into IEM group (15 cases) and normal manometry group (21 cases). The distal contractile integral was lower in IEM group than that in normal manometry group (401.10 mmHg·s·cm, 276.60 to 555.60 mmHg·s·cm vs. 1 135.00 mmHg·s·cm, 903.20 to 1 537.65 mmHg·s·cm), the difference was statistically significant ( Z=3.93, P<0.01). There was no statistically significant difference in EGJ type, other HRM parameters or acid reflux-related parameters between IEM group and normal manometry group (all P>0.05). Conclusions:IEM is not related with the diagnosis of NERD. In patients with gastroscopy-negative gastroesophageal reflux symptoms or NERD with IEM, except for weakened peristaltic function, the EGJ morphological evaluation of the anti-reflux barrier function has nothing to do with IEM. In NERD patients, the relationship between IEM and acid exposure needs further study.
8.Clinical outcomes in renal allograft recipients switched to long-term immunosuppressive therapy with mycophenolate mofetil after renal transplantation
Lizhong CHEN ; Zhihong LIU ; Bingyi SHI ; Jianghua CHEN ; Jianyu LING ; Wei ZHANG ; Genfu ZHANG ; Jianhua AO ; Yiping LU ; Xiaodong ZHANG ; Yu FAN ; Ye TIAN ; Lulin MA ; Liming WANG ; Shunliang YANG ; Wujun XUE ; Changsheng MING ; Tongyu ZHU ; Da XU ; Xiangtie LI
Chinese Journal of Organ Transplantation 2012;(12):716-720
Objective To document the impact of conversion to mycophenolate mofetil (MMF)at different time points after transplantation on the renal function of renal function.Methods A longterm,multicenter,non-interventional and observational study was done.Two cohorts were included:One was Switch cohort (340 cases) including renal allograft recipients who switched to MMF at least 6 months after renal transplantation and followed up for 4 years after switch; The other was Stay cohort (123 cases),including renal allograft recipients who received MMF treatment after transplantation and followed up for 4 years after enrollment.Results GFR values of patients in Switch cohort was significantly increased after switch,and the change in GFR slope was 3.1 mL· min-1 · year-1 (P<0.01).GFR values of patients in Stay cohort kept steady before and after enrollment,and the change in GFR slope was 0.44 mL·min-1 ·year-1 (P>0.05).Statistically significant difference in the onset time of GFR decline (defined as 20% decline from the baseline) was observed among subgroups within Switch cohort (P<0.01),but there was no significant difference among subgroups within Stay cohort (P>0.05).Stay cohort was 12% higher than in Switch cohort every year.Conclusion Conversion to MMF >6 months or even many years after transplantation can obviously improve the renal function of recipients.The earlier conversion can benefit improvement of the renal function.
9.Human umbilical cord mesenchymal stem cell-derived extracellular vesicles enhance the regenerative capability of fibrotic liver
Yunguo LEI ; Jia YAO ; Jun ZHENG ; Tongyu LU ; Jiebin ZHANG ; Jiaqi XIAO ; Yasong LIU ; Haitian CHEN ; Xuegang ZHAO ; Xingye YANG
Organ Transplantation 2023;14(3):379-
Objective To investigate the role of human umbilical cord mesenchymal stem cell-derived extracellular vesicle (hUC-MSC-EV) in the regeneration of fibrotic liver. Methods C57BL/6 mice were randomly divided into the 70% normal liver resection group (Oil+PHx group), 70% liver fibrosis resection group (CCl4+PHx group) and 70% liver fibrosis resection+mesenchymal stem cell-derived extracellular vesicle (MSC-EV) treatment group (CCl4+PHx+MSC-EV group), with 8 mice in each group. LX-2 cell lines were assigned into the phosphate buffer solution (PBS) group, transforming growth factor (TGF)-β group and TGF-β+MSC-EV group. The serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) in mice after partial liver resection were detected in each group. The expression levels of liver fibrosis and proliferation-related parameters were analyzed in each group. The messenger RNA (mRNA) expression levels of epidermal growth factor (EGF), fibroblast growth factor (FGF), vascular endothelial growth factor (VEGF) and hepatocyte growth factor (HGF) in LX-2 cells were detected in each group, and their effects on HGF expression in mouse liver were observed. Results Compared with the Oil+PHx group, the serum levels of AST, ALT and LDH were up-regulated, and the degree of fibrosis was more severe, the positive area of Sirius red and α-smooth muscle actin (α-SMA) staining was larger, and the expression level of α-SMA protein was up-regulated in the CCl4+PHx group. Compared with the CCl4+PHx group, the serum levels of AST, ALT and LDH were decreased, the degree of fibrosis was slighter, the positive area of Sirius red and α-SMA staining was decreased, and the expression level of α-SMA protein was down-regulated in the CCl4+PHx+MSC-EV group, and the differences were statistically significant (all
10.An Integrated Nomogram Combining Clinical Factors andMicrotubule-Associated Protein 1 Light Chain 3B Expression to PredictPostoperative Prognosis in Patients with Intrahepatic Cholangiocarcinoma
Liang CHEN ; Hongyuan FU ; Tongyu LU ; Jianye CAI ; Wei LIU ; Jia YAO ; Jinliang LIANG ; Hui ZHAO ; Jiebin ZHANG ; Jun ZHENG ; Yingcai ZHANG ; Yang YANG
Cancer Research and Treatment 2020;52(2):469-480
Purpose:
Microtubule-associated protein 1 light chain 3B (LC3B) serves as a key component of autophagy,which is associated with the progression of carcinoma. Yet, it is still unclear whetherLC3B is also an independent risk factor for intrahepatic cholangiocarcinoma (ICC). We aimto explore the predictive value of LC3B on prognosis of ICC, and to establish a novel andavailable nomogram to predict relapse-free survival (RFS) and overall survival (OS) for thesepatients after curative-intent hepatectomy.
Materials and Methods:
From August 2004 to March 2017, 105 ICC patients were eligibly enrolled in the ThirdAffiliated Hospital of Sun Yat-sen University. Preoperative clinical information of enrolledpatients was collected. Expression LC3B in the ICC specimen was detected by immunohistochemistry.
Results:
The 5-year RFS and OS in this cohort were 15.7% and 29.6%, respectively. On multivariateCox regression analysis, independent risk factors for 5-year OS were cancer antigen 125,microvascular invasion, LC3B expression and lymph node metastasis. Except for the above4 factors, neutrophil/lymphocyte ratio and tumor differentiation were independent factorsfor 5-year RFS. The area under the curve of nomograms for OS and RFS were 0.820 and0.747, respectively.
Conclusion
The nomograms based on LC3B can be considered as effective models to predict postoperativesurvival for ICC patients.