1.Mechanisms of dorsoventral axis formation and its clinical implications
Journal of Peking University(Health Sciences) 2012;44(5):673-677
Dorsal-ventral axis formation is one of the earliest and the most important steps of patterning formation during early embryogenesis.The molecular basis of dorsoventral axis formation reflects the fundamental issues of orchestrated cell proliferation and differentiation.Wildly speculated since the Renaissance,the effort of deciphering the mechanisms of dorsal-ventral axis formation has contributed significantly to our current understanding of disease pathogenesis.Here,we focused our discussion on the recent discovery of the convergence of dorsal and ventral signaling pathways during early embryogenesis and its implications in cancer biology and beyond.
2.Evaluation of the diagnostic kits for hepatitis E and establishment of a quantification method for de-tecting anti-HEY IgG
Cheng ZHOU ; Weijin HUANG ; Xin YAO ; Oiang YAN ; Jun ZHANG ; Fengcai ZHU ; Hemin LI ; Zhenglun LIANG
Chinese Journal of Microbiology and Immunology 2009;29(9):854-857
Objective To evaluate anti-HEV IgG and IgM diagnostic kits with sera from convalescent hepatitis E patients and to establish the quantification method of detecting anti-HEV lgG.Methods Detect 42 convalescent serum samples of over 6 months after onset of hepatitis E patients from Jiangsu province with anti-HEV IgM and IgG diagnostic kits. Select and mix the anti-HEV IgG positive sera which were confirmed by Western blot with ORF2 and ORF3 antigen. The mixed serum was calibrated with a WHO anti-HEV Ig standard. A series quantitative linear standard was made for quantitative detection of anti-HEV IgG in hepatitis E vaccine clinical trials phase Ⅲ. Results The positive rates of the anti-HEV IgG di-agnose kits of G, K, MP, Wantai were 71.4%, 78.6%, 92.9% and 100% respectively. The positive rates of G was lower than that of MP (χ~2 = 5.19, P<0.05) and obviously lower than Wantai (χ~2 = 11.76,P<0.01). The positive rates of K was also obviously lower than that of Wantai (χ~2 =7.96, P <0.01).The positive rates of the anti-HEV IgM diagnose kits of MP, G, X, Wantai, K were 21.4%, 7.1%,21.4%, 64.3%, 78.6% respectively. The positive rate of both K and Wantai were obviously higher than that of MP(χ~2 = 15.75 ,P<0.01 ; X2 = 27.43 ,P< 0.01). With the Western blot confirmation test, 30 and 18 sera were reactive to ORF2 and ORF3 antigen separately. The anti-HEV IgG concentration of HEV-D01 mixed by 13 samples was 57.94 U/ml by the calibration. Prepare seven 1.5-fold dilution series of quantita-tive linear standard for HEV vaccine clinical trials phase Ⅲ, concentration range from 0.077 to 0.877 U/ml. The quantitive values of high, medium and low concentrations quality control samples lay in the range of average ± 2s, and the CV of quantitative values were 16%, 16%, 12% respectively. Conclusion The quality of different anti-HEY IgM and IgG diagnose kits were different. This study had set up a set of anti-HEV IgG linear quantitative standard, which fit for detecting anti-HEV IgG antibodies quantitatively in HEVvaccine clinical trial phase Ⅲ.
3. Predictive factors for lymph node metastasis in patients with poorly differentiated early gastric cancer
Boran PANG ; Zhenglun ZHU ; Chen LI ; Wentao LIU ; Birendra KUMARSAH ; Min YAN ; Zhenggang ZHU
Chinese Journal of Gastrointestinal Surgery 2019;22(5):446-450
Objective:
This study aimed to identify clinicopathological factors predictive of lymph node metastasis in patients with the poorly differentiated early gastric cancer (EGC) to assess the feasibility of using endoscopic submucosal dissection (ESD).
Methods:
The records of patients with poorly differentiated early gastric cancer undergoing gastric radical resection between January 2012 and December 2016 were reviewed in Ruijin hospital. Those with distant metastasis, two or more malignant tumors, remnant gastric cancer, neo adjuvant therapy, previous history of gastric surgery or clear history of perigastric lymphadenectomy, and mixed tumors were excluded. Age, sex, presence of ulcerous lesion, tumor size, tumor location, depth of invasion, type of differentiation, lymphatic vessel invasion, vascular invasion, nerve invasion and HER2 expression were collected. Univariate and multivariate stepwise logistic regression analyses were used to identify the independent risk factors of perigastric lymph node metastasis.According to the Guidelines for the Treatment of Gastric Cancer (2018 edition) of the Chinese Society of Clinical Oncology (CSCO), the expanded indications of ESD for EGC are as follows: (1)no ulcerative lesions, the maximum diameter of lesions >2 cm of differentiated intramucosal cancer; (2)ulcerative lesions, the maximum diameter of lesions ≤3 cm of differentiated intramucosal cancer; (3)no ulcerative lesions, undifferentiated intramucosal carcinoma with diameter ≤2 cm. The relationship between clinicopathological factors and lymph node metastasis was analyzed.
Results:
A total of 517 patients, aged 21-83 (57.1±11.7), including 307 males and 210 females, were enrolled in the study. Among them, 114 (22.0%) patients had lymph node metastasis. Univariate analysis showed that ulcerative lesion (
4.Feasibility of delta-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy for gastric cancer.
Chao YAN ; Min YAN ; Zhenglun ZHU ; Wentao LIU ; Mingmin CHEN ; Ming XIANG ; Xuexin YAO ; Renda BI ; Zhenggang ZHU
Chinese Journal of Gastrointestinal Surgery 2014;17(5):438-443
OBJECTIVETo investigate the feasibility of delta-shaped (DS) gastroduodenostomy in totally laparoscopic distal gastrectomy (TLDG) for gastric cancer.
METHODSFrom July 2013 to November 2013, 22 gastric cancer patients underwent DS gastroduodenostomy using laparoscopic linear stapler. All the patients underwent TLDG with D2 lymphadenectomy. In addition, modified DS anastomosis (when closing the common entry hole, previous duodenal staple line was also removed) was used in selected patients. Clinical data of these 22 patients were retrospectively analyzed.
RESULTSAll the patients underwent TLDG with D2 lymphadenectomy and DS gastroduodenostomy. Among them, 12 patients underwent modified DS anastomosis. The total operative time was (194.6±38.4) min, and the DS anastomosis time was (19.1±14.1) min. The number of linear stapler cartridges used per patient was 5.8±0.8. The intraoperative blood loss was (49.5±24.0) ml. The number of lymph nodes harvested per patient was 32.8±12.4. All the patients achieved microscopic cancer-free resection margin. The time to the first postoperative flatus, first water intake, and semi-liquid diet was (2.9±0.7) d, (4.8±1.1) d, and (6.6±1.2) d, respectively. The duration of postoperative hospital stay was (10.1±2.3) d. The postoperative complication rate was 9.1% (2/22). No patients developed anastomosis-related complications including anastomotic leakage, stenosis, or bleeding.
CONCLUSIONSDelta-shaped gastroduodenostomy is simple, easy, safe, and feasible. It will be an ideal choice for reconstruction after totally laparoscopic distal gastrectomy, and has great value in clinical practice.
Adult ; Aged ; Duodenum ; surgery ; Female ; Follow-Up Studies ; Gastrectomy ; methods ; Gastroenterostomy ; methods ; Humans ; Laparoscopy ; Lymph Node Excision ; Male ; Middle Aged ; Retrospective Studies ; Stomach Neoplasms ; surgery ; Treatment Outcome
5.Analysis of clinicopathological features and risk factors for postoperative complications in the elderly gastric cancer patients.
Sheng LU ; Min YAN ; Chen LI ; Chao YAN ; Xuexin YAO ; Minming CHEN ; Runhua FENG ; Renda BI ; Wentao LIU ; Zhenglun ZHU ; Zhenggang ZHU
Chinese Journal of Gastrointestinal Surgery 2016;19(5):514-521
OBJECTIVETo investigate the clinicopathological features and postoperative short-term complications in the elderly gastric cancer patients.
METHODSClinical data of 270 elderly patients with gastric cancer who underwent gastrectomy in Department of Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine between July 2012 and June 2014 were analyzed retrospectively. Among 270 patients, 220 were 70 to 79 years old( old group) and 50 were ≥80 years old(oldest group). The clinicopathological features were compared between the two groups. Perioperative factors were analyzed to determine if they are associated with postoperative complications. Multivariate logistic regression model was performed.
RESULTSBefore operation, most elderly patients (n=161, 59.6%) had 2 or more than 2 comorbidities, including hypertension (n=154, 57.0%), anaemia (n=126, 46.7%), diabetes (n=53, 19.6%), arhythmia (n=52, 19.3%), cardiovascular disease(n=33, 12.2%), and chronic pulmonary disease(n=28, 10.4%). Elderly gastric cancers were more likely to locate at the lower third of the stomach (n=116, 43.0%). The pathological type was mainly the poorly differentiated carcinoma (n=152, 56.3%), and stage III was more common in TNM staging(n=138, 51.1%). As compared to the old group, the oldest group had more preoperative comorbid diseases(P=0.048), more previous surgery(P=0.029), more preoperative transfusion (P=0.019), more combined cholecystectomy (P=0.007) and feeding jejunostomy (P=0.037), but less tumor invasion of nerves(P=0.045). No significant differences in other clinicopathological parameters were found between the two groups (all P>0.05). A total of 121 (44.8%) patients presented postoperative complications, including severe complication in 30 cases(11.1%) and death in 4 cases(1.5%). Forty-seven patients(17.4%) presented operation-associated complications, including infection in 28 cases(10.4%) and leakage in 21 cases(7.8%). One hundred and seven(39.6%) patients presented non-operation-associated complications, including pneumonia in 48 cases(17.8%), hypertension in 23 cases(8.5%), and arhythmia in 17 cases(6.3%). Postoperative morbidities of Clavien-Dindo class II complication and non-operation-associated complication were higher in the oldest group compared with old group(P<0.05), while other postoperative complications were compared between the two groups, only urinary tract infection was significantly different(P<0.05). Univariate analysis showed that postoperative complications were significantly associated with age(χ(2)=7.308, P=0.007), number of comorbid diseases (χ(2)=10.872, P=0.001), cardiovascular disease (χ(2)=9.412, P=0.002), hypertension (χ(2)=4.934, P=0.026) and preoperative transfusion (χ(2)=3.911, P=0.048). Multivariate analysis showed that only the number of comorbid diseases was an independent risk factor for postoperative complications(OR=2.810, 95% CI: 1.710 to 4.616, P=0.000).
CONCLUSIONNon-operation-associated postoperative complications are more likely to occur in the elderly patients due to more comorbid diseases. Perioperative intensive care should be carried out for the elderly gastric cancer patients with comorbid diseases in order to improve surgical safety and efficacy.
Aged ; Aged, 80 and over ; China ; Comorbidity ; Gastrectomy ; adverse effects ; Humans ; Hypertension ; complications ; Logistic Models ; Multivariate Analysis ; Neoplasm Staging ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; complications ; surgery
6. Analysis and comparison of the clinical features and prognosis between extra - gastrointestinal stromal tumors and duodenal gastrointestinal stromal tumors
Hongpeng SHI ; Zhenqiang WANG ; Zhiyuan FAN ; Mingde ZANG ; Jiaomeng PAN ; Qingqiang DAI ; Yanan ZHENG ; Zhenglun ZHU ; BirendraKumar SAH ; Wentao LIU ; Zhongyin YANG ; Runhua FENG ; Xuexin YAO ; Mingmin CHEN ; Chao YAN ; Min YAN ; Zhenggang ZHU ; Chen LI
Chinese Journal of Gastrointestinal Surgery 2019;22(9):856-860
Objective:
To investigate the differences of clinicopathological features, diagnosis, treatment and prognosis between patients with extra-gastrointestinal stromal tumors (EGIST) and duodenal gastrointestinal stromal tumors (DGIST).
Methods:
A retrospective case - control study was performed. Case inclusion criteria: (1) tumor confirmed by histology and pathology; (2) primary tumor locating in the extra - gastrointestinal tract or duodenum; (3) without other synchronous tumors; (4) complete clinical and pathological data. Clinical data of 20 EGIST patients and 32 DGIST patients from March 2011 to September 2016 at Department of Gastrointestinal Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine were retrospectively collected and analyzed. The observational parameters included clinicopathological characteristics, treatment and prognosis conditions. Continuous data of abnormal distribution were expressed as median (range) and compared using the Mann-Whitney