Objective To investigate the expression of stromal cell-derived factor-1(SDF-1)and its clinical significance in blood plasma of patients with breast tumor.Methods The level of SDF-1 protein was examined by enzyme linked immunosorbent assay(ELISA)in blood plasma of 26 patients with breast benign tumor and 52 patients with breast cancer.Results The SDF-1 protein in blood plasma was detected in both breast benign tumor patients and breast cancer ones.The level of SDF-1 protein in patients with breast cancer was higher than that in ones with breast benign tumor,and there was a statistical difference between them(P=0.000).In patients with breast cancer,the level of SDF-1 protein in axillary lymph node(ALN)metastasis positive patients was significantly higher than that in ALN metastasis negative ones(P=0.036).Conclusion The level of SDF-1 protein in blood plasma may be a specific tumor marker.Its level is correlated with lymph node involvement in breast cancer.

AIM: To investigate the effect of single immunoglobin IL-1 receptor related protein (SIGIRR) on damage of alveolar epithelial cells in acute lung injury induced by lipopolysaccharide. METHODS: The acute alveolar epithelial cell injury model was constructed by stimulation of A549 cells with LPS. In order to over-express SIGIRR, the A549 cells were transferred with eukaryotic expression vector containing full length SIGIRR cDNA. The transcriptional activity of NF-κB was measured by dual-luciferase reporter assay system. The concentrations of IL-1β, TNF- α and IL-6 were detected by ELISA. The levels of these inflammatory factors between the transfected cells and untransfected cells were compared. RESULTS: The over-expression of SIGIRR inhibited the transcriptional activity of NF-κB. The increases in IL-1β, TNF-α and IL-6 concentrations in alveolar epithelial cells induced by LPS were observed. CONCLUSION: SIGIRR in alveolar epithelial cells inhibits TLR4 signals triggered by LPS and attenuates the inflammatory reactions in alveolar epithelial cells, which plays a protective role against the acute damage of the alveolar epithelial cells.

We report the management and maternal and neonatal outcomes of four cases of delayed interval delivery after cervical cerclage in twin pregnancies, who hospitalized in Shanghai First Maternity and Infant Hospital from year 2017 to 2018. Four patients with dichorionic diamniotic twin pregnancies all presented with gradually weakened uterine contractions after spontaneous vaginal delivery of twin 1. After informed consent, the patients received cervical cerclage at 2 to 3 days after delivery when the maternal and fetal conditions were stable, to delay delivery of twin 2. The gestational weeks at delivery of twin 1 were 25 +4, 23 +1, 27 +1, and 23 weeks, which were noted for 30 +1, 32 +6, 31 +4, and 24 weeks for twin 2, respectively. Delayed delivery intervals were 32, 69, 31 and 7 d. Three of the four twin 2 survived, with Apgar score ≥ 8 at 1 minute and birth weight of 1 390, 2 290 and 1 620 g. During a 2-year follow-up, no developmental abnormalities were observed in the children, and no serious maternal complications were found, including severe infection, bleeding or cervical laceration.

Objective To evaluate laparoscopic radical resection of metachronous colorectal carcinoma.Methods A total of 13 patients with metachronous colorectal carcinoma undergoing laparoscopic resection in Department of Gastrointestinal Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2013 to December 2015 were analyzed retrospectively.Results The mean time of surgery was (156 ± 9) min.Tumors were located in the right hemicolon in 3 cases,in the transverse colon in one,in the left hemicolon in 2,in the sigmoid colon in four and in the rectum in 4.The mean blood loss was (66 ± 21) ml.There was no conversion to open surgery.Two patients were done with protective ileostomy.Postoperative gastrointestinal function recovery time was (2.5 ± 0.7) days.One postoperative intra-abdominal bleeding was successfully controlled laparoscopically.Posteperative length of hospital stay was (26.2 ± 2.9) days.The median follow-up was 12 months (5-30 months) with no cancer recurrence.Conclusions Laparoscopic radical resection of metachronous colorectal carcinoma has good curative effect,and high success rate in spite of previous history of laparotomy.

Objective To investigate the changes of the N-acetylaspartate(NAA) concentrations in different brain regions and executive function skills in alcohol dependence,and to study the relationship between NAA levels and cognitive functions in subjects.Methods 49 male,non-smoking,alcohol-dependent patients and 45 healthy control subjects were measured with Proton 1H Magnetic resonance spectroscopy (MRS) and Wisconsin Card Sorting Test (WCST).Results Alcoholics had lower NAA/Cr ratios in prefrontal grey matter(GM) (1.59± 0.13) and white matter(WM) (1.58±0.12) regions and performed poorly on executive function tests compared to controls (P＜0.001).NAA/Cr in left prefrontal regions positively correlated with certain parameters of EF testing (number of correct responses 30.37± 3.73,perseverative errors 11.49± 3.39,random errors 6.18± 2.64,categories completed 2.08± 1.59)in alcoholic group (P＜0.01).NAA/Cr in prefrontal WM regions correlated with certain parameters of EF testing in alcoholic group (number of correct responses r=0.379,categories completed r=0.433,P＜ 0.05).Conclusion Long-term,chronic alcoholism will damage neuronal viability and cognitive functions,which suggests that NAA concentrations can reflect the extent of damage of cognitive functions with decreased levels reflecting neuronal loss.

Anastomotic leakage is one of the common complications after rectal cancer surgery. Advances in the field of rectal surgery, such as introduction of total mesorectal excision, double-stapling reconstruction techniques, and minimally invasive surgery have improved oncologic outcomes and resulted in more favorable functional results, with a greater proportion of patients undergoing sphincter-preserving surgeries. Despite technical improvements, the incidence of anastomotic leakage has not decreased significantly. The incidence of anastomotic leakage is related to many factors, including patient-related factors, such as male sex, obesity, low score of nutrition risk screening, and Ⅲ-Ⅴ grade of ASA grading; disease-related factors, such as lower tumor location, tumor diameter > 3 cm, preoperative chemoradiotherapy and comorbidity; surgery-related factors, such as open or laparoscopic surgery, blood supply of anastomosis, tension of anastomosis, preventive stoma, duration of surgery, intraoperative blood loss, intraoperative events, and contamination, as well as selection and use of anastomotic device. Fully understanding the risk factors of anastomotic leakage are very important for reducing the occurrence of anastomotic leakage. For patients with risk factors, appropriate preventive measures should be implemented timely to reduce the risk of anastomotic leakage.

Objective To evaluate the safety,effectivity and feasibility of Video-assisted thoracoscopic surgery(VATS) for the treatment of bronchiectasis.Methods The data of patients with bronchiectasis treated by surgery from January 2010 to September 2016 in Tangdu hospital,the Forth Military Medical University,were reviewed and analyzed retrospectively.Results There were 343 cases enrolled in this study,which were divided into Thoracotomy group(230 cases) and VATS group(113 cases,17 of them were converted into open surgery).There were 125 males and 105 females in Thoracotomy group,with the average age of(46.1 ± 14.4) years,and 45 males and 68 females in VATS group with the average age of(45.8 ± 13.4) years.Four patients died during the perioperative period and all of them were from Thoracotomy group.Compared with the Thoractomy group,the blood loss [(292.1 ± 301.7) ml vs(475.7 ± 525.4) ml,P =0.001],length of hospitalization [(6.4 ± 2.4) dvs.(9.1 ±6.6)d,P＜0.001],drainage time[(6.4 ±2.4)d vs.(9.1 ±6.6)d,P ＜0.001] were significantly lower in VATS group,but no difference in operation time.The cost in VATS group was higher [(4.5 ± 1.3) ten-thousand yuan vs (3.9 ± 1.8) ten-thousand yuan,P =0.001].For patients without comorbidities,the incidence of postoperative complications was lower in VATS group compared with that in Thoractomy group (P =0.003).There was no significant difference between two groups for patients with comorbidities (P =0.274),but there was a trend of declining in VATS group.Conclusion VATS is safe,effective and feasible to treat bronchiectasis,and should be a priority.

Elderly patients with colorectal cancer have different clincopathological characteristics from younger patients. Colorectal cancers tend to localize in the proximal colon, from cecum to the splenic flexure in the elderly patients. Changes in the stools, rectal bleeding or black stool, abdominal pain, fatigue, weight loss and anemia are the common symptoms. Analysis showed that age is one of independent risk factors for lower completion rates of colonoscopy. Therefore, the choice of diagnosis methods in elderly patients should be careful. Achieving a clear diagnosis and avoiding complications should be considered at the same time. Most colorectal cancers in elderly are highly and moderately differentiated adenocarcinomas and locally advanced, and have less lymphatic and blood metastasis. The proportion of poorly differentiated adenocarcinoma increases with the increase of age, which should be concerned. Multiple colorectal cancers and colorectal cancer with extra-colorectal malignancy are not rare in the elderly patients. The common extra-colorectal tumors consist of gastric cancer, lung cancer, biliary carcinoma, pancreas cancer and malignancy from blood system. Molecular events, such as mutations of KARS, BRAF, TP53 and deficiency of DNA mismatch repair, are more frequent in elderly colorectal cancer patients. Many factors have impact on treatment decision in elderly patients with colorectal cancer, including age, comorbidities, physiological functions of organs and willingness of patients and their relatives. Although surgery is still the main treatment, the proportion of radical surgery is lower and emergency surgery is higher as compared to younger patients. With the development of minimally invasive surgical techniques and advances in anesthesia and perioperative management, laparoscopic surgery has become widespread in elderly patients with colorectal cancer. In addition, more attention should be paid to adjuvant therapy. Comprehensive individualized treatment plan should be taken to improve outcomes.
Adenocarcinoma ; pathology ; Aged ; Colonoscopy ; Colorectal Neoplasms ; diagnosis ; genetics ; pathology ; surgery ; Humans ; Laparoscopy ; Mutation ; Risk Factors

Objective: To analyze the consistency of gastroscopic biopsy in the diagnosis of high grade intraepithelial neoplasia(HGIN) and postoperative pathological diagnosis, and explore the risk factors associated with missed diagnosis of HGIN. Methods: From January 2012 to December 2018, the clinical data of 63 patients who were diagnosed with HGIN by gastroscopic biopsy prior to operation and underwent complete resection in the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology were retrospectively analyzed. There were 55 males and 8 females, with a median age of 60 (35 to 76) years old. The gender, age, endoscopic lesion shape, longest diameter, CT image and inflammatory markers were analyzed, to investigate the correlation between them and pathological upgrading after operation. Receiver operating characteristic (ROC) curve was drawn to analyze the cut off value of measurement data, and the comparison of count data was performed by chi-square test or Fisher exact probability method. Univariate analysis was used to screen potential risk factors, and multivariate logistic regression analysis was futher utilized to analyze the independent risk factors of postoperative pathological upgrading. Results: A total of 63 patients were enrolled, including 47 cases underwent surgical resection and 16 cases underwent endoscopic submucosal dissection(ESD). Among them, 19 patients(30.2%) were pathologically diagnosed with HGIN, while 44 patients(69.8%) were pathologically diagnosed with invasive cancer after resection. Preoperative contrast-enhanced CT showed that 11 patients(17.5%) with perigastric fat spiculation around the lesion, all of which were confirmed as invasive carcinoma after operation. Univariate analysis showed that the longest diameter of the lesion ≥2 cm (P=0.002), ulcer lesions under gastroscopy (P=0.013), platelet to lymphocyte ratio (PLR) ≥103 (P=0.030), lymph node enlargement (P=0.046) and spiculation of the perigastric fat (P=0.025) were significant differences between the groups. Logistic regression analysis showed that the longest diameter of the lesion ≥2 cm (P=0.033) and ulcer lesions under gastroscopy (P=0.007) were independent risk factors for predicting postoperative pathological upgrading. Conclusions Gastroscopy biopsy in the diagnosis of high-grade intraepithelial neoplasia of the stomach has poor consistency with pathological diagnosis after operation. Clinicians should take active surgical intervention, especially for cases with the longest diameter of the lesions ≥2 cm, ulcer or perigastric fat spiculation on CT.

OBJECTIVETo investigate the clinical characteristics, diagnosis and treatment as well as prognostic factors of the giant gastrointestinal stromal tumor (GIST).

METHODSClinical data of 235 patients with high risk GIST treated in the Union Hospital, Tongi Medical College, Huazhong University of Science and Technology between January 2005 and July 2015 were retrospectively analyzed. Patients were divided into giant GIST group (diameter equal to or larger than 10 cm, 119 cases) and high risk group (diameter less than 10 cm, 116 cases) according to tumor size. Clinical characteristics and prognosis of two groups were compared and the clinical features of giant GIST were summarized. Multivariate analysis was performed to evaluate the prognostic factors of giant GIST with Cox regression model.

RESULTSOf the 119 patients with giant GIST, which accounted for 50.6%(119/235) of all the high risk patients, there were 63 male and 56 female patients with a median age of 53(20-82) years. Primary giant GIST of 43(36.1%) located in the stomach, of 39(32.8%) in the small intestine, 5(4.2%) in the colon and rectum, and of 32 (26.9%) outside the gastrointestinal tract (mesentery, retroperitoneum, abdominal cavity, etc) and pelvic. Compared to high risk group, age of onset was younger [ratio of ≤50 years, 44.5%(53/119) vs. 31.9%(37/116), P = 0.046] and incidence of outside the gastrointestinal tract was significantly higher [26.9%(32/119) vs. 9.5%(11/116), P=0.000] in giant GIST group. All the giant GIST patients underwent surgical resection, including 115 cases(96.6%) of R0 resection, 3 cases(2.5%) of R1 resection and 1 case(0.9%) of R2 resection, besides, 32 cases(26.9%) underwent expanded resection (namely, underwent lymphadenectomy or combined organ resection simultaneously). Thirty-nine giant GIST cases(32.8%)accepted imatinib 400 mg/d for targeted therapy after operations, which was not significantly different with high risk group (46 cases, 39.6%, P=0.232). Relapse and metastasis occurred in 8 cases in giant GIST group. The 1-, 3-, 5-year overall survival rates of giant GIST group were 94.5%, 89.3%, 79.4% respectively and of high risk group were 99.1%, 92.9%, 85.1% respectively, and no significant difference was found (P=0.788). The 1-, 3-, 5-year recurrence-free survival rates of giant GIST group were 93.6%, 85.1%, 72.8% respectively and of high risk group were 99.1%, 91.7%, 84.2% respectively, and no significant difference was found as well (P=0.932). Multivariate analysis revealed that gender (P=0.047, RR=0.383, 95%CI:0.149-0.987), mitotic count (P=0.001, RR=0.216, 95%CI:0.087-0.538) and targeted therapy(P=0.019, RR=5.719, 95%CI:1.324-24.695) were prognostic risk factors of overall survival (OS), moreover, tumor size (P=0.024, RR=0.368, 95%CI:0.155-0.875) and mitotic count(P=0.007, RR=0.357, 95%CI:0.169-0.755) were prognostic risk factors of RFS.

CONCLUSIONSGiant GIST is not unusual in GIST and more likely occurs outside gastrointestinal tract. Complete surgical excision combined with targeted therapy can improve the prognosis significantly. The prognosis of giant GIST and common high risk GIST is similar. Mitotic count is the most important prognostic factor.

Abdominal Cavity ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents ; therapeutic use ; Female ; Follow-Up Studies ; Gastrointestinal Stromal Tumors ; drug therapy ; pathology ; Humans ; Imatinib Mesylate ; therapeutic use ; Intestine, Small ; Lymph Node Excision ; Male ; Middle Aged ; Multivariate Analysis ; Prognosis ; Retrospective Studies ; Risk Factors ; Survival Rate ; Young Adult