Objective　To investigate the feasibility of hypocaloric nutrition support in elderly patients.Methods　Sixteen elderly patients ( ＞ 85 years) were treated with hypocaloric nutrition for 4 weeks. The calorie intake was 75-96 kJ·kg-1·d -1 , including 44％ -59％ of carbohydrates ( 137-207 g·d -1 ) , 26％ -42％ of lipids (40-67 g·d-1) , and 14％-16％ of proteins (0.7-0.9 g·kg-1·d-1). Nonprotein calorie-to-nitrogen ratio was 131∶1-150∶1. After 4 weeks of treatment, changes in blood routine test, biochemistry, and clotting function were compared with those before hypocaloric nutrition support. Results　After hypocaloric nutrition support, the plasma proteins, blood fats, and lymphocytes in these 16 elderly patients were well maintained, and no obvious adverse effect on clotting function or liver/kidney functions was observed. Conclusion　Hypocaloric nutrition support is safe and effective for elderly patients who are older than 85 years.

0 05). The results suggested that early diagnosis and treament were important factors to improve survival rate and prolong life expectancy for elderly patients with mutiple primary malignant tumors. Cardiac and cerebral vascular accidents, respiratary faliure, and gastrointestinal bleeding were common causes of death in elderly without eancer.

Objective To investigate the clinical value of serum CEA, CA19-9 and CA724 in patients with colonic carcinoma. Methods Serum levels of CEA, CA19-9 and CA724 were detected with ELISA in 89 patients suffering from colonic cancer. Results The positive rates of CEA, CA19-9 and CA724 in Dukes' stages C and D patients were remarkably higher than those in Dukes' stages A and B patients(64% vs 26%,46% vs 22%,26% vs 8% respectively, P

Objective To sum up the trend of changes in symptoms of prolonged symptomatic gastroesophageal reflux(GERD), and discuss the relationship between reflux symptoms and the medical treatment in the elderly patients with GERD. Methods 98 elderly GERD patients over 60 years old were followed up for 5 years through questionaires. The changes of reflux symptoms and effect of medication were analyzed. Results Reflux symptoms were improved in 71 subjects (72.4%), disappeared in 10, worsened in 9, and remained unchanged in 18. The symptom improvement rate of medication group was significantly higher than that of non-medication group(P0.05). In 62 subjects who modified their life styles and diet habits, 53 of them had their symptoms improved (85.5%), and 9 of them had their symptoms unchanged (14.5%). Among 98 patients who underwent endoscopic examination, 44 were found to have erosive esophagitis, and were diagnosed as reflux esophagitis(RE). Although the other 54 subjects complained of typical "heart burn" and regurgitation symptoms, no erosive esophagitis was found with endoscopy, and they were regarded designated as having non-erosive reflux disease(NERD). The symptom improvement rate of NERD group was significantly higher than that of RE group(P

2cm) and undifferentiated type were significantly related to lymph node metastasis in submucosal cancer. No lymph node metastasis was observed in 25 patients with submucosal invasion who showed none of the three risk factors, whereas 72.7% (8/11) of patients with all the three factors had lymph node metastasis. Conclusion The tumor size and lymphatic vessel involvement are related with lymph node metastasis in mucosal cancer. Poor differentiation, tumor size and lymphatic vessel involvement are related with lymph node metastasis in submucosal cancer.

Objective To analyze clinicopathological characteristics of recurrence after gastrectomy for early gastric cancer. Methods 308 patients were treated surgically for early gastric cancer from 1983 to 2005. 245 patients were followed up after gastric resection.Clinicopathologic factors were investigated by using univariate methods and multivariate analysis for the possible relationship to recurrence. Results 30 patients developed recurrent disease (median 28 months). The 1-year, 3-year, 5-year, 7-year, 10-year and 15-year recurrent rates were 5.49%, 8.44%, 11.27%, 14.83%, 16.39% and 37.79%, respectively. 13 patients with mucosal gastric cancer developed recurrent disease (median 24 months). The 1-year, 3-year, 5-year, 7-year, 10-year and 15-year recurrent rates were 4.23%, 6.68%, 7.75%, 9.34%, 9.34% and 28.24%, respectively. 17 patients with submucosal gastric cancer developed recurrent disease (median 31 months). The 1-year, 3-year, 5-year, 7-year, 10-year and 15-year recurrent rates were 7.39%, 11.14%, 16.54%, 24.49%, 29.69% and 64.85%, respectively. Cox multivariate analysis showed that submucosal invasion (P=0.044, OR=2.172) was a positive independent risk factor and paracarcinomatous mucosal medium-severe intestinal metaplasia (P=0.047, OR=0.460) was a negative independent risk factor for recurrence. 76.7% (23/30) patients with recurrence did not have indication of resection for a cure, and they did not undergo surgery again. 23.3% (7/30) patients with recurrence had indication for curative resection, and 4 of whom underwent curative resection, but 3 did not because of poor health. Pathological examination after surgery showed that in 3 patients there was early gastric cancer in the remnant stomach without lymph node metastasis, and in one patient there was advanced gastric cancer in remnant stomach with regional lymph node metastasis. The patient with advanced gastric cancer survived for 28 month without detectable tumor. Logistic regression analysis showed paracarcinomatous mucosal medium-severe intestinal metaplasia (P=0.016, OR=17.000) was a positive independent predictor for second radical surgery. The follow-up examinations including endoscopy were performed in 86.7% (26/30) of patients after operation at least every 1-2 years. Conclusion Early gastric cancer patients with submucosal invasion have a high risk of recurrence, and those with paracarcinomatous mucosal medium-severe intestinal metaplasia have a low risk of recurrence. The patients with paracarcinomatous mucosal medium-severe intestinal metaplasia and cancer recurrence are feasible for a curative resection. The follow-up examinations including endoscopy every 1 or 2 years contributed highly to finding an early recurrent cancer in the remnant stomach. But it is not so helpful to increase the possibility of a curative surgery in patients with recurrence and metastasis after gastrectomy.

Objective To analyze clinical characteristics of patients with gastrointestinal bleeding (GIB)and the death-related risk factors.Methods A retrospective analysis Was conducted in 414 patients hospitalized for GIB during a 16-year period of 1994 to 2009.Logistic regression analysis identified predictors of mortality.Results The mean age of the 414 patients is 83.5 years old,ranging from 65 to 96years old.The main causes of GIB were peptic ulcer(33.1%,137/414),gastroduodenal mucosal erosion (28.5%,118/414)and tumor(21.0%,87/414).The main symptom was melena(71.0%,294/414).Drugs that induced GIB were mainly non-steroidal anti-inflammatory drugs,including aspirin(11.1%,46/414),acetaminophen(8.9%,37/414)and indomethacin(1.9%,8/414).14%of patients(58/414) died of GIB in 30 days.The proportion of drug-induced GIB and gastroduodenal mucosal erosion caused GIB had increased significantly during the period of 2004 to 2009(P<0.05).Analysis of 30-day mortality risk showed advanced age,low diastolic blood pressure,high heart rate,low hemoglobin levels at presentation and hemorrhage volume in dead GIB elderly patients were significantly different compared with GIB elderly patients alive.Presence of severe comorbidity(heart failure and renal failure)and caused by cirrhosis and portal hypertension in GIB elderly patients were the only independent predictors of 30-day mortality (P<0.001).Conclusion Death of GIB patients occurred predominantly in elderly patients with severe comorbidities and systemic conditions at presentation.

Objective To investigate the related factors of recurrence of early gastric cancer (EGC) after endoscopic resection. Methods Clinicopathologic data of 169 patients with EGC who underwent endoscopic resection and periodically followed up by the Chinese PLA General hospital were analyzed retrospectively. Results During a follow-up of 13-57 months (median time 24. 5 months), 12patients had gastric cancer again and the recurrence rate was 7. 1% (12/169). The recurrence time varied from 3 to 36 (28 ± 23)months and the median time was 18 months. The recurrence rates of 0.5 year, 1st year, 2nd year and 3rd year were 1.18% (2/169), 3.55% (6/169), 9.91% (11/111) and 12.24%(12/98), respectively. Eleven patients had gastric cancer again within 2 years after resection.Undifferentiated histology (including poorly differentiated carcinoma and signet ring cell carcinoma),submucosal infiltration and lymphovascular invasion of the primary lesion of EGC were related to thepostsurgical recurrence ( all P ＜ 0. 05). Conclusion Most recurrence of EGC occurred within 2 years afterendoscopic resecton and is related with undifferentiated histology, submucosal infiltration andlymphovascular invasion. It is important for these patients to receive endoscopy follow up.

Objective To investigate the relationship of gastric pH value with intragastric bacterium and pulmonary infection in rats at different ages.Methods Thirty Wister rats were divided into three groups: young control group, senile group garaged with saline and young omeprazole group garaged with omeprazole (30mg/kg/d). The gastric pH value was measured after two weeks, and bacterial culture of gastric and lung tissues were done and the pathological sections of lung tissues were made.Results The gastric pH (2. 450±1. 344), number of intragastric bacterium (5. 579±4. 316) cfu/g and number of pulmonary bacterium (1. 617±3. 509) cfu/g in senile group had no differences compared with young control group [(2. 010±0. 507), (1. 505±3. 259)cfu/ g, (0. 475±1. 503)cfu/g, respectively, all P>0. 05]. The differences in gastric pH value, number of intragastric bacterium and number of pulmonary bacterium had statistical significances between young omeprazole group and young control group [(5. 560±1. 007)vs. (2. 010±0. 507), (9. 942±1. 663) cfu/g vs. (1. 505±3. 259)cfu/g, (6. 272±3. 830) cfu/g vs. (0. 475±1. 503)cfu/g, all P<0. 01]. The lung tissues were slightly infiltrated with lymphocytes both in young control group and senile group, and 30% of rats in young omeprazole group had pulmonary infection.Conclusions The number of intragastric bacterium and pulmonary bacterium is increased with the increasing of the gastric pH value, and the pulmonary infection becomes heavier in these rats. But the number of intragastric bacterium and pulmonary bacterium and the pulmonary inflammation have no changes with the increasing of age.

Objective To observe the changes of tissue structure of gastric mucosa with aging in rats. Methods Twelve healthy Wistar rats were divided into two groups: aged (12 months,n=6) and non-aged rats (3 months,n=6). The thickness of gastric gland and muscular layer of mucosa were observed under the light microscopy. Pepsin activity and the expression of proliferating cell nuclear antigen (PCNA) were detected by biochemical method and immunohistochemical method respectively. Results Intestinal metaplasia, dysplasia and adenoma were not found in gastric mucosa in two groups. In aged versus non-aged rat group, the thickness of gastric gland was decreased [(271.5±47.4) μm vs. (350.9±53.3) μm, t=2.731, P<0.05], while the thickness of muscular layer of mucosa was increased [(98.1±13.1) μm vs. (62.4±10.6)μm, t=5.174, P<0.01]. The content of pepsin in aged rats were lower than in non-aged rats[(3. 011±1. 222) U vs. (4.733±1.304) U, t= 2.361, P<0.05]. Immunohistochemistry results showed that the positive cells of PCNA were located in gastric stem cells in cervical part, and the thickness of the gastric stem cells was decreased in aged rats. Conclusions The incidences of gastric gland atrophy and muscular layer hypertrophy are increased, and the secretion of pepsinogen and the proliferation ability of gastric stem cells are decreased in aged rats.