The definition of esophagogastric junction (EGJ) adenocarcinoma and progress in multidisciplinary treatment for the tumor were revised in this review. Siewert classification is especially useful for the surgical approach of EGJ adenocarcinoma. Siewert I should be treated as esophageal cancer, and Ivor-Lewis esophagogastrectomy (right thoracotomy and laparotomy) is recommended as an extended two-field lymphadenectomy. For Siewert II or III tumors, left thoracophreno-laparotomy is preferred, especially in case of positive thoracic lymph nodes or positive resection margin. If there is any contraindication against thoracotomy, or a high operating risk, a transhiatal esophagectomy with lower mediastinal lymphadenectomy is an alternative. Preoperative chemoradiotherapy or perioperative chemotherapy improves overall survival and the rate of complete resection for patients with large tumor or lymph node metastasis. Neoadjuvant chemoradiotherapy is associated with high but acceptable postoperative complications. Adjuvant chemoradiotherapy remains a rational standard therapy for curatively resected EGJ cancer with T3 or greater lesion or positive nodes.
Adenocarcinoma ; surgery ; therapy ; Combined Modality Therapy ; Esophageal Neoplasms ; surgery ; therapy ; Esophagogastric Junction ; Humans ; Stomach Neoplasms ; surgery ; therapy

Objective To analyze the surgical operation and prognosis of gastric stump carcinoma in elderly patients. Methods The clinical data of 25 cases of elderly gastric stump carcinoma in our department from 1993 to 2003 were analyzed retrospectively. Results In this group of cases, TNM stages Ⅰ, Ⅱ, Ⅲ and Ⅳ was 3, 5, 8 and 7 cases, respectively. Among them, radical resection was performed in 12 cases(48.0%), palliative operation in 9 cases(36.0%), exploratory laparotomy in 2 cases, and 2 cases lost the chance of resection due to extensive tumor dissemination. Nutritional jejunostomy was performed in all the cases received resection operation. 1, 3 and 5 years survival rates in the patients who underwent radical dissection were 81.2%, 41.5% and 28.6%, respectively. Conclusion Endoscopy examination plus gastric mucosa biopsy were major means for diagnosis of gastric stump carcinoma in elderly patients. Perioperative managements should be emphasized. Radical resection was a reasonable therapeutic procedure of elderly gastric stump cancer, and was also an important factor affecting prognosis.

Objective To investigate the causes of hernia recurrence after tension free inguinal hernioplasty and its prevention and treatment Methods The clinical data of 10 hernia recurrence cases were retrospectively analyzed Results There were 6 recurrent cases after mesh plug tension free hernioplasty and 4 cases after Lichtenstein repair The causes of recurrence included too small for size of the mesh, mesh was coiled and migrated, too large holes of mesh left for spermatic cord, mesh plugs not properly fixed, internal rings too large miss matching the mesh plug, two mesh plugs not mounted together, etc Conclusion The main causes of recurrent hernia after tension free inguinal hernioplasty were related with failure in applying correct operative techniques, the recurrence needs open mesh repair, especially mesh plug tension free hernioplasty

Objective To compare the contents in polysaccharide of aloe in gel of aloe with preparation in different processing methods on fresh aloe of outer cuticle and investigate their stability. It could provide technology of preparation of polysaccharide of aloe.Methods The aloe gel had been prepared through the fresh juicing method, and alcohol sinking was applied to abstract polysaccharides of aloe in proportion of sixty, seventy, eighty and ninety percent. The colorimetric method of anthracenone - thick sulfuric acid had been taken to determine contents of polysaccharide in different proportions by alcohol sinking. The contents of polysaccharide were compared among different processing methods in fresh aloe of outer cuticle, and then the stability on condition of different temperatures, pH and the reagent of reductant-oxidant with polysaccharides of aloe were investigated. Results The content abstracted from polysaccharide of aloe was the higher when the proportion was eighty percent and its character of powder was better. And content abstracted from polysaccharide of aloe with the outer cuticle was higher than that out of the outer cuticle. The powders from the polysaccharide of aloe with the outer cuticle were gray-green, gray-brown or gray-white. The powders from polysaccharide of aloe without the outer cuticle were partial-white, more well-distributed and delicate. The stability in polysaccharide of aloe was better with the condition of low temperature, reducing agent and the solution with pH from five to seven, while the stability was lower when in high temperature, oxidizing agent and the solution with strong acid and strong alkali. Conclusions The proportion of eighty percent with alcohol sinking, decorticating the outer cuticle of fresh aloe has the higher content and the better character in the polysaccharide of aloe.

Objective To explore the role of microRNA (miR)-22 and miR-1825 in the diagnosis and differential diagnosis of juvenile systemic lupus erythematous (JSLE).Methods The cases of JSLE hospitalized in Capital Institute of Pediatrics Teaching Hospital Affiliated to Peking University from June 2013 to May 2014 were selected as study group.The cases with systemic juvenile idiopathic arthritis (sJIA),nephrotic syndrome (NS),Kawasaki disease (KD),Henoch-Schonlein purpura(HSP) were selected as patients control group.The healthy children were selected as healthy control group.The expression levels of miR-22 and miR-1825 in the plasma of JSLE,sJIA,NS,KD,HSP and healthy children were detected by using real-time PCR respectively.Receiver operating characteristic curve (ROC) analysis was performed to evaluate the value of miR-22 and miR-1825 miRNA as a biomarker with the sensitivity and specificity.Three data bases,included Targetscan,PicTar and miRanda,were applied to predict the target gene.The target gene was analyzed by adopting Gene Ontology (GO) in terms of molecular function,biological process and cellular component,and by adopting Kyoto Encyclopedia of Genes and Genomes (KEGG) in terms of pathway.Results Compared with healthy children,the amount of miR-22 and miR-1825 in JSLE patients were lower,and there were significant differences(t =-3.076,-9.054,P ＜0.01,0.000 1).The levels of the miR-22 and miR-1825 miRNAs in controls of sJIA,NS,KD,HSP were significantly higher than those of JSLE (t =-4.410,-4.477,-4.494,-2.971,all P ＜ 0.000 1;t =-9.043,-6.045,-10.416,-8.712,all P ＜ 0.000 1),but there was no difference compared with healthy children(all P ＞ 0.05).The area under ROC curve(AUC) of miR-22 between JSLE and healthy children was 0.777.The AUC of miR-1825 between JSLE and healthy children was 1.000.The AUCs between JSLE and controls of sJIA,NS,KD,HSP of miR-22 were 0.731-1.000.The AUCs between JSLE and controls of sJIA,NS,KD,HSP of miR-1825 were 0.939-1.000.There was positive relation between the amount of miR-22 and complement C3 in plasma(r =0.493,P =0.027).Conclusions The amount of miR-22 and miR-1825 in the plasma of JSLE embrace the potential of distinguishing JSLE from healthy children,sJIA,NS,KD,HSP.MiR-22 has the ability to predict the activity of JSLE.

Objective To develop experimental animal model of the brain stem myoclonus,which more closely replicate clinic features of mechanism, behavior, neuroelectrophysiology and pharmacodynamics.Methods L-5-HTP (the precursor of L-5-HT)was microinjected into the dorsal pons of young guinea pig to induce myoclonus (electromyogram burst of myoclonus≤400 ms by synchronous recording).Some animals were pretreated with anticonvulsant VPA,CZP or CBZ at effective dose 50 (EC_(50)).Myoclonus was induced when the drug level was within their effective anticonvulsion concentration.The neuroelectrophysiological characteristics of myoclonus including latency,time of reaching its peak,duration of seizure peak,the maximum seizure frequency and total duration were detected.EMG and ictal electroencephalogram(EEG)were recorded synchronously.The origin of myoclonus and its correlation with epileptic discharges were further confirmed by jerk-locked back averaging(JLA).Results (1)L-5-HTP induced pure myoclonus from the dorsal pons of guinea pig permanently(8/every site,the rate of producing myoclonus is 100%).(2)The myoclonus presented bilaterally or as general myoclonus,which was sensitive to tactile and sound sensation.(3)The EMG duration of the myoclonus wag longer((208.75 ± 81.42)ms),and ictal EEG showed scattered and irregular spikes and sharp waves without time-locked correlation with EMG activities.(4)The synchronous ictal EEG of the myoclonus showed spike and sharp waves,but there was no time-locked EEG activity in JLA.(5)In the animals treated with anticonvulsant at EC_(50) concentrations:VPA and CZP decreased the maximum seizure frequency(there are 28.13±3.79 per minutes in VPA group and 37.17±4.67 perminutes in CZP group)and shortened the duration of peak time ((55.00±14.14)minutes in VPA group and(50.00±11.73)minutes in CZP group respectively)and total time(VPA group was(124.17±40.04)minutes and CZP group was(156.88±30.71)minutes)of myoclonus(F value were between 23.41 and 35.44,P＜0.01 or P＜0.05).CBZ increased duration of peak time((98.75±13.86)minutes)and total time((257.50±14.79)minutes)of myoclonus(P＜0.05 and 0.01).Conclusions The new model generates pure myoclonus originating from brain stem and also has a shorter duration of muscle construction(≤400 ms)and more sensitivity to tactile and sound sensation.Therefore,the model presents characteristics closer to the brain stem myoclonus in the clinic phenotype in respect of seizure behavior,pharmacodynamics and neuroelectrophysiology.

Objective To study the inhibitory effects of dendritic cells modified by sCD41)gene on T lymphocytes phenotypes and cytokines production and the mechanism of inducing donor-specific immune tolerance in vitro.Methods T lymphocytes prepared with Nylon Fiber Column from Balb/c mice(as reaction cells)and DCs of different groups(as stimulation cells)were subjected to primary mixed lymphocyte culture(MLC).After incubation for 7 days,the responsiveness of the cells was de- tected by MTS method at the indicated time points,and supernatants were assayed for IFN-?,IL-2, IL-4,IL-10 by ELISA kits.On the day 5,the cultured cells were assessed for the expression of CD4, CDS,CD25 and CD69 by using flow cytometry(FCM).After secondary MLC for 5 days,the same indexes were assayed hy using the same methods.Results Dendritic cells modified by sCD40 could in- duce the hyporesponsiveness to alloantigen in primary and secondary MLC.In primary MLC,the ex- pression of CD4~+ and CD8~+ T cells and CD4~+ CD25~+,CD8~+ CD25~+,CD4~+ CD69~+,CD8~+ CD69~+ T cells in IX;modified by sCD40 group were less than those in control group(P

Objective To observe the influence of epalrestat combined with insulin therapy on islet beta cell function in newly diagnosed type 2 diabetic patients.Methods 45 newly diagnosed type 2 diabetic patients were randomly treated with 4 times of subcutaneous insulin therapy(RI group) or epalrestat plus 4 times of subcutaneous insulin therapy(RI + EP group).Patients were followed up for 3 months.The fasting blood-glucose (FPG),the 2 hour postprandial blood glucose (2 h PG),fasting insulin (FINS),the 2 hour postprandial blood insulin (2 h INS),glycated hemoglobin (HbA1 C),superoxide dismutase (SOD),malondialdehyde (MDA),insulin resistance index (HOMA-IR) and insulin release index(HOMA-β) were observed at 3th month after the initiation of therapy.Results Follow-up evaluation of 22 cases in RI group,23 cases in group RI + EP were completed 3 months of treatment.After treatment,FPG,2 h PG,HbA1 C,MDA and HOMA-IR in the two groups were decreased than those before treatment,the serum FINS,2 h INS,SOD and HOMA-β were higher than those before treatment,the differences were statistically significant (all P ＜0.05).After treatment,FINS,2 h INS,SOD and HOMA-β of RI + EP group were higher than those in RI group,MDA was lower than that of RI group,the differences were statistically significant (t =3.228,2.536,3.021,2.343,2.122,all P ＜ 0.05).FPG,2 h PG,HbA1 C,HOMA-IR between the two groups had no significant differences (all P ＞ 0.05).Linear regression analysis showed that HOMA-β was positively correlated with SOD level (r =0.888,r2 =0.783,all P ＜ 0.01).Conclusion The results suggest that epalrestat combined with insulin therapy can inhibit oxidative stress,and improve islet beta cell function in newly diagnosed type 2 diabetic patients,and its clinical effect is better than monotherapy with insulin.

Objective To determine the efficacy of hysteroscopy and laparoscopy in differential diagnosis of pregnancy-related diseases,including gestational trophoblastic neoplasia(GTN),incomplete abortion and ectopic pregnancy.Methods Twenty-seven patients with a suspected diagnosis of GTN were transferred to Peking Union Medical College Hospital from September 2003 to March 2006,and underwent hysteroscopy and laparoseopy.Clinical data of patients were reviewed retrospectively.Most patients had abnormal vaginal bleeding and persistently elevated plasma beta human chorionic gonadotropin(?-hCG) level for a median(53?37)days(range,15-125 days)after evacuation.Ultrasound revealed a lesion with affluent blood flow in intrauterine,unilateral horn of uterus,or myometrium.No positive findings were revealed by computerized tomography or X-ray of the chest in all patients.Eleven patients underwent evacuation under hysteroscope,10 patients were diagnosed and treated by laparoscopy,and 6 by hysteruscopy and laparoseopy.Results Choriocarcinoma was diagnosed in 4 patients,who achieved complete remission by chemotherapy later.The diagnosis of GTN was ruled out in the other 23 patients, including cornual pregnancy in 12,pregnancy in rudimentary horn in 1,and incomplete abortion in 10,who were cured by hysteroscopic and laparoscopic surgery and postoperative adjuvant single dose methotrexate.Conclusions The major causes of pregnancy-related abnormal bleeding include incomplete abortion,eetopic pregnancy,and GTN.Hysteroscopy and laparoseopy are effective alternative of diagnosis for differentiation of GTN from non-GTN and can also offer therapeutic treatment.