Objective To explore the clinical features and treatment of upper gastrointestinal bleeding with rare etiologies.Methods A total of 45 cases with rare etiologies was selected from a group of 1200 patients with upper gastrointestinal bleeding admitted from January 2012 to December 2015.Results The incidence of gastric stromal tumor (24.4％) and Dieulafoy's lesion (20.0％) was the highest.Among rare etiologies of upper gastrointestinal bleeding were Mallory-Weiss syndrome (17.8％) and stomal ulcer and hemorrhage of efferent loops after subtotal gastrectomy (17.8％),as well as left-side portal hypertension (6.7％),liver cirrhosis complicated with variceal bleeding in the descending part of the duodenum (2.1％),esophageal hematoma (2.1％),esophageal mucosa avulsion (2.1％),P-J syndrome (2.1％),duodenal adenocarcinoma (2.1％),and cutaneous malignant melanoma with duodenal metastasis (2.1％).Conclusions Gastroscopy in early stages played a role in etiologies identification,while etiological treatments could substantially reduce recurrent bleeding rate,thus enhanced cure rate.Analysis on rare etiologies promoted the medical understanding,with clinical diagnosis and treatment improved.

Objective To explore the correlation between COX-2 and Ki-67 expression and microvessel density in primary gastric cancer tissue and clinicopathological parameters and to investigate their effect on postoperative gastric cancer recurrence. Methods Forty-eight postoperative recurrent gastric cancer patients were enrolled in this study, their clinicopathologic characters of primary tumors were analyzed retrospectively and compared with 48 cases without recurrence. Expression of COX-2 and Ki-67 and microvessel density ( MVD) in gastric cancer tissue were detected by immunohistochemical method. Risk factors correlated with tumor recurrence were studied by univariate and multivariate analysis. Results Expression of COX-2, Ki-67 label index (LI) and MVD were correlated with each other, and they were all correlated with depth of invasion and TNM stages in gastric cancer tissue. Patients with pelvic metastatic lymph node, cancer invasion to serosa, of Borrmann III or IV, high COX-2 and MVD expression are on high risk of recurrence (P

OBJECTIVETo study the regulation and effect of the expression of nm23-H1 gene in different processes of regional lymph node metastases of oral squamous cell carcinomas(OSCC).

METHODSBy immunohistochemical analysis in 200 paraffin-embedded tissues of OSCC and Western Blot in 9 fresh tissues of OSCC using a monoclonal antibody, the expression of nm23-H1/NDPK-A were detected in dividing groups accompanied with the clinical and pathological data of cervical lymph node metastases and modes of invasion.

RESULTSThe rates of negative expression of nm23-H1/NDPK-A had significant differences between metastatic cases(34/81) and non-metastatic cases(15/119). The nm23-H1/NDPK-A negative group showed higher frequency of lymph node metasteses (P < 0.01). In the different metastatic processes, There were significantly differential expressions of nm23-H1/NDPK-A among stage N0, N1 and N2(P < 0.01), distinct involved quantities of lymph nodes (P < 0.01), dissimilar metastatic involved levels(P < 0.05), definite modes of invasion(P < 0.01) and different cell differentiations(P < 0.01). There were much higher negative expressions in those cases of N1 stage(23/38), only one lymph node to be involved(23/39), metastasized to submandibular nodes or/and superior deep cervical nodes(17/28 and 12/29, respectively), IV c types of invasion(33/54) and poor differentiations(9/19).

CONCLUSIONThe results indicated that nm23-H1/NDPK-A played an more important role in switching the initial metastases formation than in influencing the later metastases spread because the negative expressions of nm23-H1/NDPK-A in solid tumors of OSCC would induce the formation of high metastatic cellular subpopulations. It was also confirmed that nm23-H1 gene might be a metastatic suppressor and may be useful in predicting the initial lymph node metastases in OSCC.

Carcinoma, Squamous Cell ; genetics ; pathology ; Gene Expression Regulation, Neoplastic ; Genes, Tumor Suppressor ; Humans ; Lymphatic Metastasis ; Mouth Neoplasms ; genetics ; pathology ; NM23 Nucleoside Diphosphate Kinases ; Nucleoside-Diphosphate Kinase ; Protein Biosynthesis ; Proteins ; genetics

OBJECTIVE To study the risk factors related to the infection in the patients with the breast implant and soft tissue expander postoperatively,such as the time of drainage and retro-irrigation.METHODS Thirty consecutive patients who underwent breast implants and soft tissue expander involving at least two sites and set negative pressure drainage tube were studied.For each patient with drainages at two sites,one was retro-irrigated during the early stage postoperatively,the other was not.The samples were from the skin out of the drainage tube,the drainage tube out of skin and the end of drainage after 2,4,6 and 8 days of the operation and at the time of removing the tube.Total samples were tested for bacteriology.RESULTS Samples were divided into two groups: common groups and retro-irrigated group with negative pressure drainage.A total of samples from each group for bacterial test were 170.The postive rate was 2.94% and 1.76%,respectively(P=0.474).The positive rate of bacterial test was closely related to the time at all 3 different sampling sites(P

ObjectiveTo explore risk factors of colorectal cancer with synchronous liver metastases and its prognosis. Methods From Aug 1994 to Feb 2004, 106 colorectal cancer patients with synchronous hepatic metastases were enrolled. Fifteen clinicopathological parameters were collected for mono-variable and multi-variable analysis. Treatment result was analyzed by Kaplan-Meier method and COX regression. Results Bowel obstruction, ascites, pelvic nodules, peritoneal invasion, serosal infiltration, organs involvement, tumor size, circumference of bowel invasion, depth of invasion were all individually relevant with synchronous hepatic metastasis. Logistic regression demonstrates depth of invasion, serosal infiltration, pelvic nodules and ascites were most important factors resulting in synchronous hepatic metastases. Radical resection(57 cases), palliative resection(39 cases) and laparotomy only(10 cases) resulted respectively in mean survival time and median survival time of 41.0 and 34.0 months,23.6 and 18.0 months,16.5 and 12.0 months,respectively (all P=0.0095).Surgery, location of tumor and pelvic nodules were independent prognostic factors. Conclusions Synchronous liver metastasis may present when primary tumor infiltrates serosa, or pelvic nodules and ascites are present. Radical excision significantly improves survival rate.

Background::Carotid intima-media thickness (IMT) and diameter, stiffness, and wave reflections, are independent and important clinical biomarkers and risk predictors for cardiovascular diseases. The purpose of the present study was to establish nationwide reference values of carotid properties for healthy Chinese adults and to explore potential clinical determinants.Methods::A total of 3053 healthy Han Chinese adults (1922 women) aged 18-79 years were enrolled at 28 collaborating tertiary centers throughout China between April 2021 and July 2022. The real-time tracking of common carotid artery walls was achieved by the radio frequency (RF) ultrasound system. The IMT, diameter, compliance coefficient, β stiffness, local pulse wave velocity (PWV), local systolic blood pressure, augmented pressure (AP), and augmentation index (AIx) were then automatically measured and reported. Data were stratified by age groups and sex. The relationships between age and carotid property parameters were analyzed by Jonckheere-Terpstra test and simple linear regressions. The major clinical determinants of carotid properties were identified by Pearson’s correlation, multiple linear regression, and analyses of covariance.Results::All the parameters of carotid properties demonstrated significantly age-related trajectories. Women showed thinner IMT, smaller carotid diameter, larger AP, and AIx than men. The β stiffness and PWV were significantly higher in men than women before forties, but the differences reversed after that. The increase rate of carotid IMT (5.5 μm/year in women and 5.8 μm/year in men) and diameter (0.03 mm/year in both men and women) were similar between men and women. For the stiffness and wave reflections, women showed significantly larger age-related variations than men as demonstrated by steeper regression slopes (all P for age by sex interaction <0.05). The blood pressures, body mass index (BMI), and triglyceride levels were identified as major clinical determinants of carotid properties with adjustment of age and sex. Conclusions::The age- and sex-specific reference values of carotid properties measured by RF ultrasound for healthy Chinese adults were established. The blood pressures, BMI, and triglyceride levels should be considered for clinical application of corresponding reference values.

ObjectiveTo explore and establish the liver injury risk prediction model of indirect toxicity of Chinese medicinals under the condition of compound formulas， and provide new ideas and methods for the study of evaluation of liver injury of Chinese medicinals based on indirect toxicity. MethodsTaking Buguzhi （Fructus Psoraleae） pre-parations as model drug， the combined Chinese medicinals with Buguzhi （Fructus Psoraleae） of high frequency are screened out， and their components and action targets were obtained through TCMSP， TCMIP and PharmMapper databases. The association strength value and risk value of Chinese medicinals that acted on the nuclear factor κB （NF-κB） pathway were analyzed. For those having greater values than the median association strength value and risk value were regarded as indirect Chinese medicinals of liver injury risk. In this way， a prediction model of liver injury risk of Chinese medicinals was constructed based on immune activation-related indirect liver injury process （taking NF-κB pathway as an example）. And verification of the prediction model was performed using Heshouwu （Radix Polygoni Multiflori） preparations. ResultsThe prediction model of liver injury risk based on important immunoactivated pathway （taking NF-κB pathway as an example） found that Yinyanghuo （Herba Epimedii） （association strength value = 0.18， risk value = 0.25） was a Chinese medicinal with potential risk of indirect liver injury within Buguzhi （Fructus Psoraleae） prepartions， which may increase the risk of liver injury by positively regulating Bruton's tyrosine kinase （Btk） and protein kinase C theta （PKCθ） on NF-κB pathway. Further verification of prediction model by Heshouwu （Radix Polygoni Multiflori） preparations showed that Buguzhi （Fructus Psoraleae） （association strength value = 0.25， risk value = 0.33） and Tusizi （Semen Cuscutae） （Semen Cuscutae， association strength value = 0.34， risk value = 0.33） may increase the liver injury risk of Heshouzu. ConclusionThe liver injury risk prediction model of indirect toxicity of Chinese medicinals has been constructed in this study， providing metho-dological reference for the identification of Chinese medicinals of indirect liver injury risk under the condition of compound formulas.