Objective To analyze the clinical characteristics and treatment methods of recurrence hand,foot and mouth disease (HFMD).Methods The clinical data of 436 HFMD patients were retrospectively analyzed.The characteristics of clinical manifestations,laboratory tests were analyzed.Results There were a total of 211 patients,accounting for 48.4％,the recurrence age was 2 to 5 years old.All relapsed patients rash appeared in the hand,foot and mouth or buttocks,there were 104 cases of rash appeared in elbow and knee,9 cases appeared in the torso.The recurrence patients proned to occur respiratory system,digestive system,cardiovascular system and nervous system complications.Respiratory complications were the most common,accounting for about 76.4％,followed by the digestive system,accounting for 18.5％.The distribution of relapse in children with time to recurrence and recurrence in-terval analysis found mainly in April to June,a total of 251 patients,the total relapse proportion was 57.6％ ;time in-terval was more common between 3 months to 12 months,a total of 326 cases of recurrence,accounting for 74.8％.Conclusion Clinical manifestations are not typical in recurrence HFMD patients,most are ordinary,less critically illpatients,it is easy to merge the respiratory system,digestive system complications.Early detection and diagnosis is the key to the treatment.

Objective To investigate the relationship between the expression of Fascin and breast cancer prognosis. Methods Paraffin sections of breast cancer from 110 patients were investigated by immunohostochemistry with monoclonal anti-fascin antibody. Data of the Fascin expression and clinicopathological variables were analyzed for disease-free survival(DFS)and overall survival(OS)by Kaplan-miere and cox model. Results The expression of Fascin was significantly associated with ER negative,PR negative and lymph node metastasis,but not with age,HER2 status and tumor size. The patients with positive expression of Fascin had shorter disease free survival time than those without Fascin expression. Conclusion High expression of Fascin is associated with poor prognosis in breast cancer. Fascin is an independent prognostic indicator of disease-free survival time.

The factors influencing the long-term survival of patients with proximal gastric cancer (PGC) after curative resection were investigated. Data from 171 patients who underwent curative resection for PGC were retrospectively analyzed. The patients were grouped according to the clinicopathological factors and operative procedures. The tumor depth (T stage) and lymph node metastasis (pN stage) were graded according to the fifth edition of TNM Staging System published by UICC in 1997. The metastatic lymph node ratio (MLR) was divided into four levels: 0%, <10%, 10%-30% and >30%. The data of survival rate were analyzed by Kaplan-Meier method (log-rank test) and Cox regression model. The 5-year overall survival rate of 171 patients was 37.32%. The univariate analysis demonstrated that the survival time of the postoperative patients with PGC was related to tumor size (chi (2)=4.57, P=0.0325), gross type (chi (2)=21.38, P<0.001), T stage (chi (2)=27.91, P<0.001), pN stage (chi (2)=44.72, P<0.001), MLR (chi (2)=61.12, P<0.001), TNM stage (chi (2)=44.91, P<0.001), and range of gastrectomy (chi (2)=4.36, P=0.0368). Multivariate analysis showed that MLR (chi (2)=10.972, P=0.001), pN stage (chi (2)=6.640, P=0.010), TNM stage (chi (2)=7.081, P=0.007), T stage (chi (2)=7.687, P=0.006) and gross type (chi (2)=6.252, P=0.012) were the independent prognostic factors. In addition, the prognosis of patients who underwent total gastrectomy (TG) was superior to that of patients who underwent proximal gastrectomy (PG) for the cases of tumor >/=5 cm (chi (2)=6.31, P=0.0120), Borrmann III/IV (chi (2)=7.96, P=0.0050), T4 (chi (2)=4.57, P=0.0325), pN2 (chi (2)=5.52, P=0.0188), MLR 10%-30% (chi (2)=4.46, P=0.0347), MLR >30% (chi (2)=13.34, P=0.0003), TNM III (chi (2)=14.05, P=0.0002) or TNM IV stage (chi (2)=4.37, P=0.0366); and combining splenectomy was beneficial to the cases of T3 (chi (2)=5.68, P=0.0171) or MLR >30% (chi (2)=6.11, P=0.0134). It was concluded that MLR, pN stage, TNM stage, T stage, and gross type had advantages in providing a precise prognostic evaluation for patients undergoing curative resection for PGC, in which MLR was the most valuable index. TG and combining splenectomy were useful to improve the prognosis to patients with PGC of TNM III/IV stage, serosa invasion, or extensive regional lymph node metastasis.

OBJECTIVETo investigate the prognostic factors of patients with lymph node-negative metastasis gastric cancer (pN0).

METHODSClinicopathological data of patients with pN0 gastric cancer who underwent radical operation at the Department of Surgical Oncology, The First Hospital of China Medical University from May 1980 to August 2012 were collected and analyzed retrospectively.

INCLUSION CRITERIA(1) Patients were diagnosed as gastric adenocarcinoma; (2) Postoperative pathology confirmed T1a to 4bN0M0 gastric cancer; (3) Total number of harvested lymph node was more than 15. The patients, who died within 1 month after the operation, died of other diseases, had remnant gastric cancer, or had incomplete follow-up data, were excluded. Univariate analysis was used to analyze the clinical factors that may influence the prognosis of patients with stage pN0 gastric cancer, then, those significant variables were entered into the Cox's proportional hazards regression model for multivariate analysis to obtain the independent prognostic factors for patients with pN0 gastric cancer finally. Furthermore, the prognosis of patients with pN0 advanced gastric cancer (invasive depth ≥ T2) were analyzed using the same method.

RESULTSA total of 610 patients with pN0 gastric cancer were enrolled in the study, including 441 males and 169 females with age ranging from 19 to 83 (mean 56.4±11.0) years, D1 lymph node dissection in 45 cases, D2 lymph node dissection in 543 cases, D3 lymph node dissection in 22 cases, and 384 cases of advanced gastric cancer. The overall followed-up was 1 to 372 (median 32) months. Ninety cases (14.8%) were dead during the follow-up. The median survival was 277.7(95%CI: 257.6 to 297.8) months, and the 1-, 3-, 5-year survival rates were 96.5%, 87%, 83.2%. Univariate analysis showed that tumor diameter, depth of invasion, gross type, lymph node dissection and lymph vessel cancer embolus were related to the prognosis (all P<0.05). The 5-year survival rate of patients with tumor diameter >4 cm was significantly lower than those with tumor diameter ≤4 cm (75.6% vs. 87.8%, P=0.000). The 5-year survival rates of T1a, T1b, T2, T3 and T4 were 98.4%, 92.8%, 84.2%, 61.0% and 31.4% respectively, and the difference was statistically significant (P=0.000). In gross type, 5-year survival rate of early gastric cancer was 96.0%, and of Borrmann I( to IIII( type gastric cancer was 100%, 83.4%, 73.7% and 68.9% respectively, whose difference was statistically significant(P=0.000). The 5-year survival rates in patients undergoing lymph node dissection D1, D2 and D3 were 100%, 83.3% and 58.7%, and the difference was significant (P=0.005). The 5-year survival rate of patients with positive lymphatic cancer embolus was lower than those with negative ones (69.4% vs. 86.9%, P=0.000). Multivariate analysis showed that the gross type [Borrmann II(/early gastric cancer: HR(95% CI)=15.129(3.284 to 69.699), Borrmann III(/early gastric cancer: HR(95% CI)=14.613 (3.292 to 64.875), Borrmann IIII(/early gastric cancer: HR (95% CI)=15.430 (2.778 to 85.718),Borrmann IIIII(/early gastric cancer: HR(95%CI)=12.604 (1.055 to 150.642), P=0.025] and the positive lymphatic cancer embolus [HR(95% CI)=3.241 (2.056 to 5.108), P=0.000] were the independent prognostic factors of patients with pN0 gastric cancer. For pN0 patients with advanced gastric cancer, multivariate analysis showed that the depth of invasion [stage T3/stage T2: HR(95%CI)=1.520 (0.888 to 2.601), stage T4/stage T2: HR(95%CI)=2.235(1.227 to 4.070); P=0.031] and the positive lymphatic cancer embolus [HR(95%CI)=3.065 (1.930 to 4.868); P=0.000] were the independent risk factors influencing the prognosis.

CONCLUSIONSPositive lymphatic cancer embolus and worse gross pattern indicate poorer prognosis of patients with pN0 gastric cancer, which may be used as effective markers in evaluating the prognosis. As for pN0 advanced gastric cancer, invasion depth and positive lymphatic cancer embolus can play a more important role in the prediction.

Adenocarcinoma ; classification ; diagnosis ; mortality ; Adult ; Aged ; Aged, 80 and over ; China ; Female ; Humans ; Lymph Node Excision ; statistics & numerical data ; Lymph Nodes ; pathology ; surgery ; Lymphatic Metastasis ; physiopathology ; Lymphatic Vessels ; pathology ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Invasiveness ; pathology ; physiopathology ; Neoplasm Staging ; statistics & numerical data ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; classification ; diagnosis ; mortality ; Survival Rate

The factors influencing the long-term survival of patients with proximal gastric cancer(PGC)after curative resection were investigated.Data from 171 patients who underwent curative resection for PGC were retrospectively analyzed.The patients were grouped according to the clinicopathological factors and operative procedures.The tumor depth(T stage)and lymph node metastasis(pN stage)were graded according to the fifth edition of TNM Staging System published by UICC in1997.The metastatic lymph node ratio(MLR)was divided into four levels: 0%,<10%,10%-30%and >30%.The data of survival rate were analyzed by Kaplan-Meier method(log-rank test)and Cox regression model.The 5-year overall survival rate of 171 patients was 37.32%.The univariate analysis demonstrated that the survival time of the postoperative patients with PGC was related to tumor size(;(2=4.57,P=-0.0325),gross type(χ2=21.38,P<0.001),T stage(χ2=27.91,P<0.001),pN stage(χ2=44.72,P<0.001),MLR(χ2=61.12,P<0.001),TNM stage(χ2=44.91,P<0.001),and range of gastrectomy (χ2=4.36,P=0.0368).Multivariate analysis showed that MLR(χ2=10.972,P=0.001),pN stage(χ2=6.640,P=0.010),TNM stage(χ2=7.081,P=0.007),T stage(χ2=7.687,P=0.006)and gross type(χ2=6.252,P=0.012)were the independent prognostic factors.In addition,the prognosis of patients who underwent total gastrectomy(TG)was superior to that of patients who underwent proximal gastrectomy(PG)for the cases of tumor ≥5 cm(χ2=6.31,P=0.0120),Borrmann Ⅲ/Ⅳ(χ2=7.96,P=0.0050),T4(χ2=4.57,P=0.0325),pN2(χ2=5.52,P=0.0188),MLR 10%-30%(χ2=4.46,P=0.0347),MLR >30%(χ2=13.34,P=0.0003),TNM Ⅲ(χ2=14.05,P=0.0002)or TNM Ⅳ stage(χ2=4.37,P=0.0366);and combining splenectomy was beneficial to the cases of T3(χ2=5.68,P=0.0171)or MLR >30%(χ2=6.11,P=0.0134).It was concluded that MLR,pN stage,TNM stage,T stage,and gross type had advantages in providing a precise prognostic evaluation for patients undergoing curative resection for PGC,in which MLR was the most valuable index.TG and combining splenectomy were useful to improve the prognosis to patients with PGC of TNM Ⅲ/Ⅳ stage,serosa invasion,or extensive regional lymph node metastasis.

OBJECTIVETo elucidate the current diagnosis and treatment status of gastric cancer in the Chinese population based on three high volume databases.

METHODSClinical and pathological data of patients who underwent gastric cancer resection with complete follow-up information between January 2000 and December 2012 from Sun Yat-sen University Cancer Center, The First Affiliated Hospital of China Medical University and Tianjin Medical University Cancer Hospital were retrospectively analyzed. The overall survival rate was calculated by Kaplan-Meier method. The prognostic risk factors were analyzed by using Cox proportional hazards model.

RESULTSA total of 8 338 cases were enrolled into the study, including 2 977 cases (35.7%) from Sun Yat-sen University Cancer Center, 3 043 cases (36.5%) from The First Affiliated Hospital of China Medical University and 2 318 cases (27.8%) from Tianjin Medical University Cancer Hospital. There were 5 852 male cases and 2 486 female cases with a ratio of 2.4 to 1.0. The age of patients was from 15 to 89 years old (median 59 years old). The ratio of early gastric cancer (T1NanyM0) was 11.5% (956/8 338). There were 2 226 gastric cancer cases (26.7%) originating from the fundus and cardiac region, 1 637 cases (19.6%) from the body, 3739 (44.9%) cases from the antrum, and 736 cases (8.8%) from the whole stomach. The median maximal tumor diameter was (4.5 ± 2.8) cm. Based on the Lauren classification, 3 448 cases (41.4%) were intestinal type and 4 890 cases (58.6%) diffuse type. A total of 1 975 cases (23.7%) and 6 363 cases (76.3%) underwent complete and subtotal gastrectomy respectively. The majority of patients (7 707 cases, 92.4%) underwent radical gastric resection, while 631 cases (7.6%) palliative resection. According to AJCC/UICC seventh edition of gastric cancer TNM staging system, 802 patients (9.6%) were stage I(A, 735 patients (8.8%) stage I(B, 695 patients (8.3%) stage II(A, 1 507 patients (18.1%) stage II(B, 1 247 patients (15.0%) stage III(A, 1 342 patients (16.1%) stage III(B, 1 583 patients (19.0%) stage III (C and 427 patients (5.1%) stage IIII(. The average number of retrieved lymph node was 21.0 ± 13.1, in which 5 761 patients (69.1%) had more than 15 retrieved lymph nodes. The overall 1-, 3-, 5- and 10-year survival rates were 83.0%, 56.8%, 49.1% and 43.0% respectively. For patients receiving radical resection, the 1-, 3-, 5- and 10-year survival rates were 84.9%, 59.5%, 51.7% and 45.3% respectively. The overall 5-year survival rates for different stages were as follows: stage I(A 93.8%, stage I(B 80.8%, stage II(A 70.8%, stage II(B 59.6%, stage III(A 44.4%, stage III(B 32.9%, stage III(C 18.9% and stage IIII( 10.2%. Cox regression model showed that age, tumor site, tumor size, Lauren type, T staging, N staging, M staging and number of retrieved lymph nodes were independent factors affecting the prognosis of gastric cancer patients (P=0.000).

CONCLUSIONRetrospective study on these domestic three high volume databases demonstrates the clinical and pathological characteristics of gastric cancer based on Chinese population, which is expected to stand as a ground of basic data for future clinical research.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; China ; Databases, Factual ; Female ; Gastrectomy ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; diagnosis ; surgery ; Survival Rate ; Young Adult