Objective To evaluate hepatectomy for liver metastasis in patients of gastric carcinoma.Methods Clinical data of 32 gastric cancer cases undergoing hepatectomy for hepatic metastatic tumor were reviewed retrospectively from 2006 to 2012.16 cases underwent radical gastrectomy and synchronous hepatectomy for liver metastasis,the remaining 16 cases underwent radical resection of gastric cancer and liver resection heterochronously.The relationship between prognosis and clinicopathology was analyzed.Results The overall survival rates were 84％,50％ and 37％ in 1 year,3 years and 5 years.The median survival time was 32 months.Gastric cancer invasion depth,intravascular tumor thrombi,lymphatic metastasis and intraoperative blood transfusion was related to poor prognosis by single factor analysis,while gastric serosal invasion,tumor thrombus and liver metastasis tumor ＞ 5 cm related to poor prognosis by multiple factors analysis.Conclusions Gastric cancer patients with liver metastasis who underwent hepatic resection can achieve good prognosis if hepatic metastatic tumor ＜ 5cm or the primary gastric cancer does not invade the serosa and without tumor thrombus.

Between January 2011 and December 2011,86 patients undergoing operation for anorectal disease were randomized in a double-blind manner to receive a mixed injection of methylene blue,ropivacaine and sodium chloride (observation group,n =43) or traditional analgesic methods (control group,n =43).Patients in observation group had less visual analog scale (VAS) scores of pain at 6-48 h postoperation than control group (P ＜0.05).The scores had no significant difference at 72 h postoperation between two groups (P ＞ 0.05).The total postoperative complications (8,19％) and hospitalization duration [(5.3 ± 2.2) days] in observation group were significantly less than those [15,35 ％ and (6.4 ±1.7) days] in control group (P ＜ 0.05).A mixed injection of methylene blue and ropivacaine intraoperatively can relieve the postoperative pain of patients with anorectal disease and reduce the incidence of postoperative complications and the duration of hospitalization.

Objective To study the effects of postoperative immune-enhancing enteral nutrition (IEEN)on the liver function and postoperative infectious complications after hepatectomy in patients with hepatocellular carcinoma.Methods Between January 2010 and December 2011,96 patients undergoing hepatectomy for hepatocellular carcinoma were randomized in a double-blind manner to receive postoperative enteral nutrition with IEEN (IEEN group,n =48) or standard enteral nutrition (control group,n =48) for 5 days,respectively.Calorie and nitrogen of the same quantity were provided for both groups from the first day after surgery.The liver function tests and routine blood tests were performed.The postoperative hospital stay and postoperative infectious complications were also compared between these two groups.Results The serum albumin,prealbumin,alanine aminotransferase,and total bilirubin levels had no significant differences between the two groups (all P ＞ 0.05).On the 6th day after operation,the level of total lymphocyte count was significantly higher in the IEEN group than that in the control group [(2106 ± 1057) vs.(1648 ± 1079) / μL,P =0.038).The postoperative hospital stay was (10.3 ±5.6) days in the IEEN group and (13.4 ±6.7) days in the control group (P =0.016).Postoperative infectious complications were observed in 8 (16.7％) patients in the IEEN group and 17 (35.4％) patients in the control group (P =0.036).Conclusion Early postoperative IEEN can improve the clinical outcomes of liver cancer patients after hepatectomy.

Objective: To evaluate the incidence, clinical features, diagnosis and treatment of primary ex-tranodal non-Hodgkin' s lymphoma (PE-NHL). Methods: The data of 110 patients diagnosed as PE-NHL be-tween January 2001 and May 2008 were reviewed. Results: These PE-NHL patients counted 60.11% of the 183 malignant lymphoma patients at the same period. The primary sites affected were the gastrointestinal tract 21.82% (24/110), Waldeyer ring 10.91% (12/110), nasal cavity 9.10% (10/110), soft tissue 9.10% (10/110), mediastinum 7.27% (8/110) and other unusual sites 41.82% (46/110). Symptoms and signs of PE-NHL were not specific, and 77.27% of these cases had a swelling organ or lump of the primary organ affected. Ac-cording to the International Prognosis Index (IPI), the percentage of patients in low, intermediate, and high group was 41.11%, 44.44% and 14.44%, respectively. Immunophenotype was assayed in 93 cases. The per-centage of B-cell lymphoma was 69.90% while that of T-cell lymphoma was 30.10%. For those 95 cases treat-ed, the effective rate including complete remission (61.05%) and part remission (16.84%) was 77.89%, the median survival was 30 months, and the 5-year overall survival (OS) was 27%. While, for patients with prima-ry gastrointestinal non-Hodgkin' s lymphomas (PGIL), the complete remission rate, part remission rate and the effective rate was 65.21%, 17.39% and 82.80%, respectively. The median survival was 24 months, and the 5-year overall survival (OS) was 30%. Conclusion: PE-NHL is more common than nodal lymphoma. The symptoms and signs of PE-NHL of different sites are quite different. To improve the curative strategies of PE-NHL, it is important to make an allround understanding of PE-NHL and follow reasonable mode of diagno-sis and therapy.

Objective To deplore the immunoregulatory function changes of mesenchymal stem cells(MSCs)from multiple myeloma(MM)patients and its effects on the pathogenesis of myeloma bone disease.Methods MSCs from MM patients and normal controls were isolated and the immunophenotype was detected.Real-time PCR was performed to detect the expressions of TGF-β1,TGF-β2,TGF-β3,IL-6,IL3,TNF-α,FasL and RANKL of MSCs.Transwell coculture systems were performed between MSCs and T cells.Lymphocyte proliferative assay was employed to detect the effect of MSCs on T cell proliferation.The effect of MSCs on T cell cycle and T cell activation markers CD25 and CD69 expression were analyzed by flow cytometry.Cleaved caspase 3 protein by western blot and hoechst 33258 staining were employed to detect the apotosis of T cells.Influence of T cells on the osteogenesis potential of MSCs were detected by Von kossa stain,real-time PCR and Western blot.Results MSCs from both MM patients and normal controls possessed similar morphology and immunophenotypes.MM derived MSCs exhibited increased expressions of TGF-β1,IL-6,IL-3,TNF-α and RANKL and decreased expression of TGF-β2,TGF-β3 and FasL.The inhibitory effect of MM derived MSCs on T cell proliferative ability was attenuated compared to control MSCs.MSCs from normal controls silence more T cells in Go/G1 phase than those from MM patients.The daupening effect of MM derived MSCs on activation-induced T apoptosis seemed to be enhanced.Expression of T cell activation markers were significantly inhibited by MSCs from normal controls.Both T cells cocultured with MM deprived MSCs and T cells directly from MM patients inhibited osteogenesis potential of MSCs from normal controls.Conclusion MSCs from MM patients showed impaired immunoregulatory capability on T cells.The activated T cells,in turn,inhibited the osteogenesis potential of MSCs.This may participate in the pathogenesis of myeloma bone disease.

[Objective] To explore whether diabetes mellitus (DM) can influence the early bacterial translocation (BT) and progression of acute necrotizing pancreatitis (ANP) for guiding the early clinical treatment.[Methods] 35 Wistar male rats were randomly allocated to 4 groups,Group ANP associatcd with DM (DM+ANP,n =10):DM underwent induction of ANP;Group DM (n =10):DM underwent laparotomy with only manipulation of the pancreas and duodenum;Group ANP (n =10):non-DM underwent induction of ANP;Group sham operation (SO,n =5):non-DM underwent SO.After 12 h of the induction of ANP or laparotomy,the following parameters were analyzed:bacterial culture and identification of portal vein blood,mesenteric lymph nodes (MLNs),pancreas and liver,and calculate the total incidence of BT;serum amylase and endotoxin levels of portal vein blood;histological assessment of pancreas and ileum lesions.[Results] All animals except 3 in group DM+ANP (mortality rates:30％) and 1 in group ANP (mortality rates:10％) survived the experiment.The total incidence of BT was 23/28 (82.1％) in group DM+ANP whereas 16/36 (44.4％) in group ANP (P =0.002).Gram-positive bacteria were 17/23 (73.9％),3/16 (18.8％) in group DM+ANP and group ANP,respectively (P =0.001).Amylase activity (2302 ± 346) U/L in group ANP increased significantly (P =0.000) compared with other groups.However,group DM+ANP (501 ± 142) U/L decreased significantly (P =0.001) in comparison to group SO.Regarding to endotoxin concentrations and the severity of pancreas and ileum lesions,group DM + ANP increased significantly compared with group ANP,group DM and group SO (P ＜ 0.05).[Conclusion] Gram-positive bacteria translocates more frequently than Gram-negative bacteria in the early period of DM+ANP rats.DM aggravates the progression of ANP and increases early bacterial translocation,endotoxemia and severity of pancreas and ileum lesions.

Adult stem cells are drawing more and more attention due to the potential application in degenerative medicine without posing any moral problem. There is growing evidence showing that the human amnion contains various types of adult stem cell. Since amniotic tissue is readily available, it has the potential to be an important source of regenerative medicine material. In this study we tried to find multipotent adult stem cells in human amnion. We isolated stem cells from amniotic mesenchymal cells by limiting dilution assay. Similar to bone marrow derived mesenchymal stem cells, these cells displayed a fibroblast like appearance. They were positive for CD105, CD29, CD44, negative for haematopoietic (GlyA, CD31, CD34, CD45) and epithelial cell (pan-CK) markers. These stem cells had the potential to differentiate not only into osteogenic, adipogenic and endothelial lineages, but also hepatocyte-like cells and neural cells at the single-cell level depending on the culture conditions. They had the capacity for self-renewal and multilineage differentiation even after being expanded for more than 30 population doublings in vitro. So they may be an ideal stem cell source for inherited or degenerative diseases treatment.
Adult Stem Cells ; cytology ; Amnion ; cytology ; Cell Differentiation ; physiology ; Humans ; Mesenchymal Stromal Cells ; cytology ; Multipotent Stem Cells ; cytology

Objective:To explore the clinical characteristics and laboratory data of aggressive non-Hodgkin's lymphoma(NHL)compli-cated by autoimmune hemolytic anemia(AIHA).Methods:Data of six patients with aggressive NHL complicated by AIHA treated at the Second Affiliated Hospital of Suzhou University between September 2013 and July 2016 were reviewed retrospectively. The onset symptoms,disease progression,therapy,and prognostic factors were analyzed.Results:From September 2013 to July 2016,155 pa-tients with aggressive NHL were treated in our hospital.Six of them were complicated by AIHA(3.9%),with three males and three fe-males,aged from 62 to 74.The median age was 67 years.The first clinical symptoms included the following:five presented with lymph-adenectasis,three had fever,and one presented with multiple bone destruction and bone pain,all complicated by progressive hemo-globin decrease.Histological examination of the six patients revealed three cases with diffuse large B-cell lymphoma(DLBCL),including one case with positive Bcl-2,Bcl-6,and C-myc,and one case with positive CD5;one case was peripheral T-cell lymphoma-not other-wise specified(PTCL-NOS);and two cases with angioimmunoblastic T-cell lymphoma(AITCL).Epstein-Barr virus(EBV)-mRNA(EBER) was detected by chromogenic in situ hybridization(CISH).Up to 100%(5/5)cases were EBER-positive.Eastern Cooperative Oncology Group scores of the six patients were three to four.All six cases were in the Ann-Arbor stagesⅢ-Ⅳand International Prognostic Index score 4-5.All cases belonged to the high risk group.At the time when lymphoma was confirmed by pathology,the median level of he-moglobin was 56(34-79)g/L.The median ratio of reticulocytes was 6.7(0.2-21.0)%.The positive rate of Coombs test was 100%.All cas-es showed autoantibodies against C3(1:64-1:2 048).Four cases showed antoantibodies against G antigen(±~1:16).The plasma con-centration of EBV DNA of three patients was detected and all increased.Except that 1 case gave up treatment,five patients received the chemotherapy with CHOP or R-CHOP.Four patients received prednisone between chemotherapy intermittent period.Two cases showed sustained complete response(CR).The overall survival(OS)was 20 and 14 months.Another patient with DLBCL and one pa-tient with PTCL-NOS died from secondary severe pulmonary infection and heart failure during the myelosuppression.The OS times were 1.5 and 2 months,respectively.One patient with AITCL died in the disease progression after four cycles of chemotherapy.The OS was 4.5 months.Conclusion:Aggressive NHL complicated by AIHA is common in older patients with poor prognosis.The incidence rate of EBV infection was high,and hemolysis is rapid and serious.The patients'tolerance to chemotherapy was poor.Early diagnosis and effective chemotherapy may improve patients'prognosis.

Objective:To construct a predictive nomogram incorporating pretreatment CT-based radiomics for radiation pneumonitis (RP) in esophageal cancer (EC) patients treated with intensity-modulated radiotherapy (IMRT), and to evaluate the value of CT radiomics in predicting RP.Methods:Clinical data of 267 EC patients sequentially treated with IMRT in Quanzhou First Hospital affiliated to Fujian Medical University from January 2019 to December 2021 were prospectively analyzed. Among them, the first 206 patients were assigned into the training cohort and the last 61 patients were enrolled in the validation cohort. Radiomics features of bilateral lungs were extracted by radiotherapy CT simulation. Univariate analysis was performed to screen the potential predictive variables for symptomatic RP. Machine learning algorithms, such as least absolute shrinkage and selection operator (LASSO), extreme gradient boosting (XGboost), and support vector machine (SVM), were performed for radiomic features selection, respectively. The best classifier was chosen to construct a radiomic signature (RS). Clinical, radiomics and combined nomogram predictive model were developed, respectively. The predictive efficiency and clinical benefits of three models were compared by calculating the area under the receiver operating characteristic (ROC) curve (AUC), calibration curve and decision curve analysis (DCA), and then validated in the validation cohort. Multivariate logistic regression analysis was conducted. Different ROC curves were compared by Delong test.Results:Cardiovascular disease, minimum internal diameter of esophagus and adjuvant chemotherapy and RS were the independent related factors of RP. The AUC of clinical, radiomics and combined models were 0.772, 0.745, 0.842 in the training cohort, and 0.851, 0.811, 0.901 in the validation cohort, respectively. DCA showed that combined radiomic model yielded better clinical benefits compared with clinical model.Conclusion:Radiomics features from pretreatment CT have the potential of improving the efficiency of RP prediction models for EC patients treated with IMRT.

Objective:To evaluate the efficacy and safety profile of ixazomib/lenalidomide/dexamethasone (IRd) in Chinese patients with relapsed/refractory multiple myeloma (MM) .Methods:This study comprising 14 medical centers in China included patients with relapsed/refractory MM who received at least. Ixazomib at an initial oral dose of 4 mg was administered. Seven patients had dose adjustment to 3 mg at the time of first dose. The lenalidomide doses were adjusted according to creatinine clearance rate. The efficacy and safety were evaluated every cycle.Results:In the study cohort of 74 patients, the median age was 65 years and 11 (14.9% ) patients received over three lines of therapy. Overall response rate (ORR) was 54.1% (40/74) , and 7 (9.5% ) , 14 (18.9% ) , and 19 (25.7% ) patients achieved stringent complete response or complete response, very good partial response, and partial response, respectively. The median progression-free survival and overall survival were 9.9 and 20 months, respectively. The median time to response was 1 month. The efficacy and survival outcome were similar to those reported in the Tourmaline-MM1 China Continuous Study. The ORR of patients refractory to bortezomib, lenalidomide, and bortezomib plus lenalidomide were 52.0% (13/25) , 57.1% (4/7) , and 33.3% (6/18) , respectively. The rate of grade 3-4 adverse events was 36.5% (27/74) . Common hematological toxicities were anemia, thrombocytopenia, lymphopenia, and neutropenia. Common non-hematological toxicities were fatigue, gastrointestinal symptoms, and infections. Two cases of grade 3 peripheral neuropathy were reported. The patients eligible for the Tourmaline-MM1 China Continuous Study had a higher ORR than the ineligible patients [77.8% (14/18) vs 46.4% (26/56) , P=0.020]. There was no difference in the rate of grade 3-4 adverse events [33.3% (6/18) vs 37.5% (21/56) , P=0.749]. Conclusion:The IRd regimen had good efficacy and acceptable toxicity in Chinese patients with relapsed/refractory MM.