Objective:To investigate the clinicopathological features of gastric adenocarcinoma of fundic gland type (GA-FG).Methods:A total of 12 patients, including 7 cases treated with endoscopic submucosal dissection (ESD), were diagnosed as having GA-FG in Nanjing Drum Tower Hospital from January 2018 to August 2019. Morphological changes were analyzed by reviewing endoscopic and pathological results. Patients were followed up after definitive diagnosis.Results:The clinical symptoms of patients with GA-FG were nonspecific. No Helicobacter pylori infection was identified. The lesions were found in the non-atrophic gastric mucosa of the upper 1/3 portion in 10 cases and middle 1/3 portion in 2 cases. Endoscopically, the most common features were whitish color (9 cases), and all lesions diameter≤1 cm. Their macroscopic types were classified as 0-Ⅰ (2 cases), 0-Ⅱa (9 cases) and 0-Ⅱc (1 case) respectively. All lesions had sharp boundary, with branching dilated blood vessels on the surface. Five in 7 cases who were treated with ESD showed submucosal invasion. Immunohistochemically, 9 cases were classified as the chief cell type , 3 as the mixed type, 11 MUC6 positive, 4 MUC5AC positive, 2 MUC2 positive, and 3 CD10 positive. P53 was detected in all 12 cases, and 9 cases had low Ki-67 staining index (<10%). The mean time of follow-up was 11 months, and 11 patients survived. Conclusion:GA-FG should be taken into consideration when the polyps are found in the upper part of the stomach, with whitish color, and branch dilated blood vessels on the surface. Excellent clinical outcomes can be achieved for GA-FG patients with ESD.

Objective:To observe the inhibiting effects of manual acupuncture(MA)on bladder cell apoptosis in rats with diabetic neurogenic bladder(DNB)based on the protein and mRNA expression of B-cell lymphoma-leukemia(Bcl)-2,Bcl-2-associated X(Bax)protein,caspase-3,and the protein expression of α-smooth muscle actin(α-SMA),transforming growth factor(TGF)-β in the bladder tissue. Methods:A DNB rat model was established via intraperitoneal injection of streptozotocin(STZ).The rats were randomly divided into a control group,a model group,and an MA group,with 10 rats in each group.For the MA group,MA was applied after modeling.The body mass,fasting blood glucose(FBG),bladder wet weight,and bladder histomorphology were observed.Protein and mRNA expression levels of Bcl-2,Bax,and caspase-3 and the protein expression of α-SMA and TGF-β in the bladder tissue were determined.The apoptotic index of bladder cells was also evaluated. Results:After STZ injection,compared with the control group,the model group and the MA group both showed higher FBG from week 3 and lower body mass from week 9(P<0.05),and had a larger bladder wet weight(P<0.05).Compared with the model group,the MA group showed a smaller bladder wet weight(P<0.05).The histopathological evaluation indicated that MA improved muscle fiber alignment and detrusor cell compensatory hypertrophy in the bladder tissue.In addition,compared with the control group,the apoptotic index increased significantly in the model group and the MA group(P<0.05);the protein and mRNA expression levels of Bax and caspase-3 and the protein expression level of TGF-β in the bladder tissue in the model group and the MA group increased significantly(P<0.05),while the protein and mRNA expression levels of Bcl-2 and the protein expression level of α-SMA in the bladder tissue decreased significantly(P<0.05).Compared with the model group,the apoptotic index of the MA group decreased significantly(P<0.05);the protein and mRNA expression levels of Bax and caspase-3 and the protein expression level of TGF-β in the bladder tissue decreased significantly(P<0.05),while the protein and mRNA expression levels of Bcl-2 and the protein expression level of α-SMA in the bladder tissue increased significantly(P<0.05). Conclusion:MA can protect the bladder by inhibiting the excessive apoptosis of bladder cells,which may be related to the down-regulation of Bax and caspase-3 proteins and mRNAs and TGF-β protein expression,and the up-regulation of Bcl-2 protein and mRNA and α-SMA protein expression.

Objective To investigate the relationship between aberrant expression of interleukin 6 (IL-6) and gene methylation in patients with ulcerative colitis (UC),and to clarify the mechanism of epigenetics in UC.Methods From March 2017 to March 2018,a total of 59 UC patients admitted to the Department of Gastroenterology,General Hospital Affiliated to Tianjin Medical University were enrolled,and at the same time 58 normal individuals who received health checkups were selected as healthy controls.Blood samples and colonic mucosa specimens of UC group and healthy control group were collected.DNA methyltransferase (DNMT) activity,methylation level of CpG locus in IL-6 promoter region and expression level of IL-6 were detected.Chi-square test and student's t test were performed for statistical analysis.Results The methylation level and IL-6 expression level examination were completed in 24 and 30 cases of UC group,respectively;which were detected in 21 and 20 cases of healthy control group,respectively.The activity of DNMT of UC group was significantly lower than that of healthy control group ((16.48 ± 6.17) OD · h-1 · mg-1 vs.(62.48 ± 33.88) OD · h-1 ·mg-1),and the difference was statistically significant (t =3.707,P ＜ 0.05).The ratios of methylation,partial methylation and non-methylation of UC group were 31.2％ (15/48),50.0％ (24/48) and 18.8％ (9/48),respectively,and those of healthy control group were 58.3％ (35/60),21.7％ (13/60) and 20.0％ (12/60),and the difference between the two groups was statistically significant (x2 =10.495,P ＜ 0.05).The positive expression rate of IL-6 in intestinal mucosa of UC group was higher than that of healthy control group (100.0％,21/21 vs.25.0％,5/20),and the difference was statistically significant (x2 =24.837,P ＜0.05).The serum IL-6 level of UC group was higher than that of healthy control group ((1 075.02 ±661.95) ng/L vs.(583.43 ± 425.10) ng/L),and the difference was statistically significant (t =3.245,P ＜ 0.05).Conclusion The decrease of DNMT activity in the intestinal mucosa of UC patients may reduce the methylation level of IL-6 gene promoter region,which is correlated with the increased level of IL-6 expression in the intestinal mucosa and serum,and involve in the inflammatory process of UC.

Objective:To investigate the effect of laparoscopic radical resection of colon cancer on the shedding of cancer cells in the abdominal cavity and intestinal cavity and peritoneal fibrinolysis in patients with locally advanced colon cancer, to provide a reference for treatment.Methods:From March 2018 to May 2020, 76 patients with locally advanced colon cancer in Wanbei Coal and Electricity Group General Hospital were selected and divided into group A (33 patients) and group B (43 patients) according to different treatment procedures. Group A underwent laparoscopic radical resection of colon cancer, group B underwent open radical resection of colon cancer. The related indexes, complications, and serum immune function indexes (CD 4+, CD 8+, CD 4+/CD 8+) before operation and 1 d and 3 d after operation, peritoneal fibrinolytic function indexes of the peritoneal tissue: peritoneal tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), the positive rate of peritoneal cancer cell shedding at the beginning of the operation and immediately after the operation, the positive rates of intestinal cancer cell shedding before and immediately after surgery were compared between the two groups. Results:Although the operation time of group A was longer than that of group B: (186.21 ± 24.07) min vs. (149.49 ± 17.82) min, the postoperative anal exhaust time and hospital stay were shorter than those of group B: (3.32 ± 0.75) d vs. (3.84 ± 1.02) d, (10.62 ± 1.74) d vs. (12.85 ± 2.26) d, and the amount of intraoperative blood loss was less than that of group B: (102.08 ± 16.39) ml vs. (159.50 ± 23.14) ml, the differences were statistically significant ( P<0.05). The complication rate of group A was lower than that of group B: 9.09% (3/33) vs. 27.91%(12/43)( P<0.05). Serum CD 4+, CD 8+, CD 4+/CD 8+ levels in the two groups at 1 and 3 days after operation were lower than those before the operation, but those in group A were higher than those in group B ( P<0.05). The t-PA level of the peritoneal tissue immediately after the operation in the two groups was lower than that at the beginning of the operation, but that in group A was higher than that in group B. The level of PAI-1 was higher than that at the beginning of the operation, but the level of PAI-1 in group A was lower than group B ( P<0.05). There was no significant difference in the positive rate of cancer cells in the abdominal cavity and intestinal cavity at each time point in the two groups ( P>0.05). Conclusions:Application of laparoscopic radical resection of colon cancer for locally advanced colon cancer can reduce surgical trauma, promote postoperative recovery, reduce complications, reduce the impact on the body′s immune function and peritoneal fibrinolytic function, and does not increase the risk of shedding cancer cells in the abdominal cavity and intestinal cavity after surgery.

Objective:To construct a case management index for acute myocardial infarction based on multidisciplinary collaboration, and to provide guidance for the case management of patients with acute myocardial infarction.Methods:From October 2021 to April 2022, a research group with clinical experience was established to initially formulate an index system for acute myocardial infarction case management based on multidisciplinary collaboration after a literature review. After 2 rounds of Delphi expert correspondence, the items of the case management index system were revised according to the opinions of the expert correspondence.Results:Twenty-two experts were interviewed in the first round, and the effective recovery rate of the questionnaire was 95.45%(21/22); in the second round, 21 experts were interviewed, the effective recovery rate of the questionnaire was 100.00%(21/21). The first and the second round of the expert authority coefficient was 0.896 and 0.912, respectively, the coefficient of variation of each item was 0-0.17, Kendall′s coefficient of concordance was 0.20 ( P<0.01), the average importance value of indexes were 4.43-5.00, and the rate of full marks was 38.1%-100.0%. Finally, an acute myocardial infarction case management index system based on multidisciplinary collaboration was established, including 3 primary indexes and 51 secondary indexes. Conclusions:The case management index constructed in this study is scientific and reliable, closely integrated with clinical practice, and has strong clinical practical value.

Objective:To investigate the clinical effect of endoscopic injection of norepinephrine on cerebral infarction complicated by stress-induced gastrointestinal bleeding.Methods:A total of 150 patients with cerebral infarction complicated by stress-induced gastrointestinal bleeding who were admitted to the Intensive Care Unit of Lishui City People's Hospital from October 2020 to October 2021 were included in this study. These patients were randomly divided into a control group and an observation group using the random number table method, with 75 patients in each group. Patients in the control group received routine clinical treatment, while those in the observation group received endoscopic injection of norepinephrine in addition to routine clinical treatment. The hemostatic time, blood transfusion volume, and length of hospital stay were compared between the two groups. The stress index and inflammatory index were compared between the two groups before and after treatment. The hemostatic effect and adverse reactions were evaluated in each group.Results:The hemostatic time, blood transfusion volume, and length of hospital stay in the observation group were (16.16 ± 4.36) hours, (385.35 ± 41.28) mL, and (5.35 ± 1.28) days, respectively, which were significantly shorter or less than (27.27 ± 6.34) hours, (447.07 ± 32.07) mL, and (7.07 ± 2.07) days in the control group ( t = 12.50, 10.22, 6.12, all P < 0.001). After treatment, the levels of cortisol, norepinephrine, antidiuretic hormone, high-sensitivity C-reactive protein, interleukin-6, and tumor necrosis factor-α in the observation group were (288.33 ± 19.53) mmol/L, (29.17 ± 4.26) μg/L, (4.08 ± 1.08) mU/L, (38.27 ± 8.72) ng/L, (6.69 ± 1.35) μg/L, and (6.37 ± 1.51) mg/L, respectively, which were significantly lower than (327.22 ± 22.01) mmol/L, (39.32 ± 5.54) μg/L, (5.36 ± 1.22) mU/L, (51.24 ± 13.23) ng/L, (8.67 ± 2.29) μg/L, and (11.44 ± 3.13) mg/L in the control group ( t = 11.44, 12.57, 6.80, 7.08, 6.45, 12.63, all P < 0.001). The overall response rate of hemostasis in the observation group was 94.67% (71/75), which was significantly higher than 82.67% (62/75) in the control group ( χ2 = 5.37, P < 0.05). The incidence of adverse reactions in the observation group was 8.00% (6/75), which was slightly, but not significantly, lower than 14.67% (11/75) in the control group ( χ2 = 1.66, P > 0.05). Conclusion:Endoscopic injection of norepinephrine for the treatment of cerebral infarction complicated by stress-induced gastrointestinal bleeding can rapidly stop bleeding, effectively reduce inflammation,improve stress index, and be highly safe.

Objective:To observe the effects of Zhulian stimulant type Ⅰ acupuncture on the expression of brain-derived neurotrophic factor (BDNF) and its receptor TrkB and tissue homogenate cyclic adenosine phosphate (cAMP) in rats with diabetic bladder (DCP); To explore the mechanism of Zhulian stimulant type Ⅰacupuncture on DCP.Methods:Totally 50 SD rats were divided into control group, model group, Western medicine group, ordinary acupuncture group, Zhulian stimulant type Ⅰ acupuncture treatment group (acupuncture treatment group) according to random number table method, with 10 rats in each group. DCP rat model was prepared by intraperitoneal injection of streptozotocin (STZ), except for the control group. The Western medicine group was given mecobalamine for gavage; acupoints of "Zhongji", "Sanyinjiao", "Liechou" and "Taichong" were selected. The ordinary acupuncture group was treated with ordinary acupuncture technique, and the acupuncture treatment group was treated with Zhulian stimulant type Ⅰ acupuncture, 1 time/d, 30 minutes/time. Samples were taken after 4 weeks of treatment. The maximum bladder volume, residual urine volume and wet weight of the bladder were detected. The morphology of rat bladder was observed by HE staining. The expression level of BDNF was detected by immunohistochemistry. The expression of cAMP was detected by Western blot. The level of TrkB was determined by ELISA. Real-time fluorescence quantitative PCR (RT-PCR) was used to detect the mRNA expressions of BDNF and cAMP.Results:Compared with model group, maximum bladder volume, residual urine volume and wet weight of bladder in Western medicine group, ordinary acupuncture group and acupuncture treatment group decreased ( P<0.01), and those in Western medicine group and acupuncture treatment group were lower than those in ordinary acupuncture group ( P<0.01). The expressions of BDNF mRNA and protein, cAMP mRNA and protein in Western medicine group, ordinary acupuncture group and acupuncture treatment group increased ( P<0.05), and the level of TrkB increased, and the Western medicine group and acupuncture treatment group were higher than that in ordinary acupuncture group ( P<0.05). Conclusions:Zhuliping stimulant type Ⅰ acupuncture has a protective effect on the bladder function of diabetic rats. The mechanism may be related to the up-regulation of BDNF and mRNA, TrkB, cAMP and mRNA expressions.

Objective:To investigate the clinical, endoscopic and pathologic characteristics of gastric hyperplastic polyps coexisting with gastric cancers.Methods:A retrospective study was performed involving 18 patients who were pathologically confirmed with gastric hyperplastic polyps coexisting with gastric cancers. The clinical features, endoscopic findings, pathological characteristics and treatment strategy were analyzed.Results:The age of 18 patients was 67. 2±7. 8 years (ranged 45-79), including 6 males and 12 females. The symptoms included abdominal pain, distention, and some patients were asymptomatic. Multiple polyps (13/18) were common. Single lesions were often located in the gastric corpus (7/18). Endoscopy showed various morphological changes. Pedunculated polyp was the most common type (15/18). All polyps were larger than 10 mm in diameter, and the polyps in 9 patients were larger than 20 mm. Fourteen patients had atrophic gastritis in the background mucosa, and 4 patients had Helicobacter pylori ( HP) infection. Conclusion:Gastric hyperplastic polyps coexisting with gastric cancers shows no specific symptoms. For HP (-) atrophic gastritis patients accompanied with multiple gastric polyps, malignant transformation of those larger and pedunculated polyps is of possibility.

Objective:To study the different clinical features of early gastric cardia carcinoma (EGCC) patients with synchronous tumor, and identify the risk factors and prognosis of the occurence of synchronous tumor after endoscopic resection.Methods:A retrospective study was made on the data of 499 patients (512 lesions) who underwent cardiac endoscopic submucosal dissection (ESD) and were pathologically confirmed as EGCC in Nanjing Drum Tower Hospital from January 2011 to June 2018. The patients were divided into synchronous tumor group (47 patients with 50 lesions) and non-synchronous tumor group (452 patients with 462 lesions). Univariate and multivariate logistic regression analysis were performed to identify independent risk factors for the occurrence of synchronous tumor. Kaplan-Meier method was conducted to prognosis. Differences between the two groups were analyzed for significance by the log-rank test.Results:Among the 499 patients, the incidence of synchronous tumor was 9.4% (47/499). Logistic regression analysis showed that the lesion size ( P=0.046, OR=0.807, 95% CI: 0.653-0.996), atrophic gastritis and intestinal metaplasia ( P=0.017, OR=3.207, 95% CI: 1.229-8.371), Helicobacter pylori infection ( P=0.046, OR=1.952, 95% CI: 1.013-3.761) were independent risk factors for the occurrence of synchronous tumor after endoscopic resection. A total of 453 (90.8%)patients were successfully followed up. Kaplan-Meier curve showed that the overall survival rate of the synchronous tumor group and the non-synchronous tumor group were 95.2% and 97.6%, respectively ( P=0.72). Conclusion:The incidence of EGCC accompanied with synchronous tumor is not high, but it should not be neglected. For patients with small lesions, it is necessary to consider the possibility of main cancer in other parts. For patients with Helicobacter pylori infection or severe mucosal atrophy and intestinal metaplasia, more attention should be paid to the mucosa around the lesion during endoscopic examination and strict endoscopic follow-up should be carried out.

Objective:To compare the efficacy and safety of endoscopic submucosal excavation (ESE) and endoscopic full-thickness resection (EFR) for intraluminal gastric stromal tumors.Methods:Data of 441 patients diagnosed as having gastric stromal tumors in Nanjing Drum Tower Hospital from June 2009 to June 2020 were retrospectively analyzed. A total of 241 patients underwent ESE (ESE group) and 200 EFR (EFR group). Epidemiological data (gender, age and body mass index), tumor size, procedure related parameters, complications, hospital stay, cost and follow-up were compared between the two groups.Results:There were no significant differences between the two groups in gender, age, body mass index, tumor size, National Institutes of Health risk grade, complete resection rate, or block resection rate ( P>0.05). Compared with the EFR group, the ESE group required less titanium clips to close defects in the stomach wall [6.0 (4.0, 6.0) VS 6.0 (5.0, 8.0), U=18 424.0. P<0.001], shorter time of first postoperative fluid intake [2.0 (1.0, 2.0) days VS 2.0 (2.0, 3.0) days, U=17 420.0, P<0.001] and hospital stay [6.0 (5.0, 8.0) days VS 7.0 (6.0, 9.0) days, U=18 906.0, P<0.001], and lower total cost [18.9 (16.4, 21.4) thousand yuan VS 20.9 (18.1, 23.8) thousand yuan, U=17 956.0, P<0.001]. Moreover, the total incidence of complications of the ESE group was lower than that of the EFR group [5.8% (14/241) VS 11.5% (23/200), χ2=4.605, P=0.032]. Patients were followed up with the median period of 45.0 months. The disease recurrence rate was 0.45% (2/441), and there were no disease-related deaths. Conclusion:The efficacy is comparable between ESE and EFR for treating intraluminal gastric stromal tumors, but ESE shows a lower incidence of complications, and requires a shorter hospital stay and lower cost.