Objective To explore diagnosis and treatment of traumatic chylothorax. Methods We summarized 16 cases with traumatic chylothorax from 1385 patients who suffered from thoracic trauma from Dec.1980 to Dec.2001. Among them, 4 cases had left chylothorax, 11 cases had right chylothorax,and 1 case had bilateral chylothorax. 11 cases were treated with conservative therapy and 5 cases were treated by ligation of thoracic duct. Results 2 patients died,and the others were cured. Conclusion Diagnosed early and treated suitably, traumatic chylothorax can readily be cured, otherwise it would be delayed.

Objective To assess the value of ultrasonic probe (USP) in the diagnosis of Submucous eminence of colorectume.Methods Sixty-eight patients with colorectal submucous eminence in 70 areas received USP under colonoscope.The accuracy of diagnosis was evaluated.Results Twenty carcinoid tumor were detected which manifested submucous hypoechoic ; Lipoma 12,located in right half colon which manifested submucous layer,clear boundaries hyperechoic; Cyst 12 manifested single or multi lattices no-echo on submucous which have integrated involucrum.Mesenchymoma or myoma levicellulare 12,most of them located inthe rectum manifested uniform or no-uniform hypoechoic on the muscularis mucosa or below and were difficult to discriminate.Malignant lymphoma,3 manifested muscularis mucosa and submucosa thickening,muscularis propria were seldom affected.Vascular diseases (hemangioma,varicosity) 3,manifested no-echoic on mucosa or submucosa,some medium,high echoic,circular or irregular,and also endometriosis 2,pigment deposition 1,appendix abscess 1,extramural compression 2,ultrasonic test is marched with clinic diagnosis.Accuracy rate is 100％.Conclusion USP can diagnose colorectal submucous eminence with high accuracy,and even provide information about the size,layer of origin,border of the colorectal submucous eminence and can distinguish benign or malignant tumor according to ultrasonic check,at the same time provide differentiation with extramural compressive lesions.

ObjectiveTo investigate the colonoscopic manifestations, the prevalence and natural history of vascular malformation (VM) in elderly patients .MethodsTotally 2917 elderly patients were examined by colonoscopy and the colonoscopic apperances and prevalence were studied. A 3 years follow-up for VM patients was carried to assess bleeding risk. ResultsPrevalence in elderly group was 2.4%, while 0.8% for the non-elderly(P

Objective To report on the clinical presentations of patients with colonic angiodysplasia and the results of electrocoagulation under the guide of colonoscopy. Methods Study on the clinical and endoscopic manifestation of patient with colonic angiodysplasia and follow-up study for the risk of bleeding in asymptomatic AD and in those after electrocoagulation. Results Totally 10 200 cases were involved in colonoscopy, among them 126(1. 24%) cases of CAD were found. Prevalence rate in asymptomatic group was 0. 89%, in bleeding group 2. 62%, and in nonbleeding group 0. 82%. In 9 asymptomatic AD cases no bleeding occurred in a period of 3-year follow-up. However, most of the bleeding AD patients have bleeding relapsed within 3 years. The curative effect of electrocoagulation during 1 year is significant the relapse rate of bleeding, 18% as compared to 54% in patients with bleeding without electrocoagilation P

Background:Multidrug resistance of tumor cells is one of the important factors that cause failure of chemotherapy in advanced gastric cancer. Tumor necrosis factor-related apoptosis-inducing ligand(TRAIL)may enhance the killing effect of chemotherapeutics on tumor cells,and reverse drug-resistant cell lines to sensitive cell lines,but its mechanism is not yet clear. Aims:To study the effect of TRAIL on expression of multidrug resistance gene glutathione S-transferase-π(GST-π)in drug-resistant human gastric cancer cell line SGC-7901 / VCR and the potential mechanism of TRAIL in reversing multidrug resistance of gastric cancer cells. Methods:SGC-7901 / VCR cells were treated with TRAIL in different doses (50,100,200 and 400 μg/ L)for 48 hours. After treatment,expression of GST-π mRNA in SGC-7901 / VCR cells and concentration of GST-π in culture supernatant were detected by RT-PCR and ELISA,respectively. Results:TRAIL could inhibit mRNA expression and protein secretion of GST-π in SGC-7901 / VCR cells in a dose-dependent manner within a certain range(≤200 μg/ L). The relative expression levels of GST-π mRNA in 50,100,200 and 400 μg/ L TRAIL groups were 0. 89 ± 0. 04,0. 77 ± 0. 08,0. 65 ± 0. 06 and 0. 61 ± 0. 03,respectively,and the concentrations of GST-π in culture supernatant in these groups were(57. 56 ± 1. 19)ng/ mL,(56. 30 ± 0. 80)ng/ mL,(31. 41 ± 1. 65)ng/ mL and (30. 80 ± 1. 34)ng/ mL,respectively,all were significantly lower than those in control group[1. 01 ± 0. 13 and(58. 62 ± 1. 38)ng/ mL,P all < 0. 05]. Conclusions:TRAIL may play a potential role in reversing multidrug resistance of gastric cancer cells through down-regulating GST-π expression.

Objective To evaluate surgical approach,safety and efficacy of endoscopic submucosal excavation (ESE) for the treatment of gastric submucosal tumors originated from the muscularis propria layer.Methods Fifty-three patients with submucosal tumors of the stomach diagnosed by gastroscope,were examined using endoscopic ultrasonography (EUS) from February 2012 to April 2013.The patients were completed ESE at general anesthesia.Results The diameter of the tumor was from 5 to 35 mm (median 13.2 mm).The tumors of 48 patients were complete resection,the complete resection rate was 90.6％(48/53).The operation time was from 30 to 150 min (median 45 min).Three patients (5.7％,3/53) had impulsivity hemorrhage during ESE,no patients had unmanageable hemorrhea under the gastroscope.Perforation occurred in 6 patients during ESE,perforation rate was 11.3％ (6/53),the perforation was closed by endoclip in 5 patients.Five patients with inability resection and 1 patient with perforation inability closed were treated with surgical operation.None was developed perforation postoperative and hemorrhea.Conclusion ESE is a safety and efficacy method for treating gastric submucosal tumors originating from the muscularis propria layer.

Purpose: Globally, there is a high incidence of gastric cancer (GC). Leucine zipper-EF-hand containing transmembrane protein 1 (LETM1) is reported to play a vital role in several human malignancies. However, there is limited understanding of the role of LETM1 in GC. This study aims to investigate the effects of LETM1 on proliferation, migration, and invasion of GC cells. Materials and Methods: The expression levels of LETM1 in the normal gastric mucosal epithelial cells (GES-1) and GC cells were analyzed by quantitative real-time polymerase chain reaction and western blotting. CCK-8, wound healing, and Transwell invasion assays were performed to evaluate the effect of LETM1 knockdown or overexpression on the proliferation, migration, and invasion of the GC cells, respectively. Additionally, the effect of LETM1 knockdown or overexpression on GC cell apoptosis was determined by flow cytometry. Furthermore, the effect of LETM1 knockdown or overexpression on the expression levels of PI3K/Akt signaling pathway-related proteins was evaluated by western blotting. Results: The GC cells exhibited markedly higher mRNA and protein expression levels of LETM1 than the GES-1 cells. Additionally, the knockdown of LETM1 remarkably suppressed the GC cell proliferation, migration, and invasion, and promoted the apoptosis of GC cells, which were reversed upon LETM1 overexpression. Furthermore, the western blotting analysis indicated that LETM1 facilitates GC progression via the PI3K/Akt signaling pathway. Conclusions LETM1 acts as an oncogenic gene to promote GC cell proliferation, migration, and invasion via the PI3K/Akt signaling pathway. Therefore, LETM1 may be a potential target for GC diagnosis and treatment.

Objective To study the molecular mechanism of cisplatin to enhance the ability of tumor necrosis factor?related apoptosis?inducing ligand ( TRAIL ) in reversing multidrug resistance in vincristine?resistant human gastric cancer SGC7901/VCR cells. Methods MTT assay was used to measure the 50% inhibiting concentration( IC50 ) and cell survival in SGC7901 and SGC7901/VCR cells after different treatments.SGC7901/VCR cells were treated with different concentrations of DDP, different concentrations of TRAIL alone or in combination, and then the mRNA and protein levels of several genes were determined by RT?PCR, RT?qPCR and Western?blot analysis. After targeted silencing with specific siRNA and transfection of recombinant plasmid c?myc into the SGC7901/VCR cells, the mRNA and protein levels of DR4, DR5 and c?myc were determined by RT?PCR and Western?blot analysis. Results After combined treatment with TRAIL and DDP of the SGC7901/VCR cells, the IC50 of VCR, DDP, ADM, and 5?Fu treatment was significantly decreased compared with the control group or TRAIL?treated group (P<0.05). After treatment with 0, 10, 50 ng/ml TRAIL in combination with 0. 4 μg/ml DDP, the SGC7901/VCR cells showed significantly higher activation of caspase 3, down?regulation of DNA?PKcs/Akt/GSK?3β signaling pathway, and higher inhibition of MDR1(P?gp) and MRP1 than those treated with TRAIL alone (P<0.01 for all). The mRNA and protein levels of DR4, DR5, c?myc were significantly decreased after silencing c?myc with specific siRNA in the SGC7901/VCR cells ( P<0. 01 for all ) , and were significantly increased after transfection of recombinant plasmid c?myc into the SGC7901/VCR cells (P<0.01 foe all). After the treatment with 10 ng/ml TRAIL, 0. 25 μg/ml DDP+10 ng/ml TRAIL and 0. 5 μg/ml DDP+10 ng/ml TRAIL, the relative expression level of c?myc protein in the SGC7901/VCR cells was 0.314±0.012, 0.735±0.026, and 0.876±0.028, respectively, and the relative expression of cytochrome C was 0.339±0.036, 0.593±0.020 and 0.735±0.031, respectively, and the relative expression levels of DR4, DR5, active?caspase 3 and active?caspase 9 in the SGC7901/VCR cells were also increased along with increasing DDP concentrations. Conclusions The activation of DNA?PKcs/Akt/GSK?3β signaling pathway and high expression of MDR1 and MRP1 play an important role in the multi?drug resistance properties of SGC7901/VCR cells. After combining with TRAIL, DDP can enhance the expression of DR4 and DR5 through up?regulating c?myc and enhancing the activation of caspase 3 and caspase 9 by facilitating mitochondrial release of cytochrome C. It may be an important molecular mechanism of DDP?induced sensitization of TRAIL to reverse the multidrug resistancein SGC7901/VCR cells.

Objective: To investigate clinicopathological features, risk of lymph node metastasis, and indications of endoscopic submu-cosal dissection (ESD) in young patients with intramucosal early gastric cancer (EGC). Methods: In total, 325 EGC patients who under-went radical gastrectomy and had complete clinicopathological data in Anhui Provincial Hospital from March 2009 to December 2016 were retrospectively evaluated. All patients were confirmed to have intramucosal cancer based on their postoperative pathology re-sults. The patients were assigned into two groups according to their age: young group (≤40 years) and old group (>40 years). The clini-copathological features and safety of ESD in the youth group were analyzed. Results: Among all patients with intramucosal EGC, 30 (9.2%) were in the youth group. Intramucosal cancer in the youth group occurred predominantly in women, and the pathological types were mainly undifferentiated and mixed, which were more likely to metastasize to the lymph nodes. In the youth group, EGC patients with intramucosal differentiated type, who had ESD indications, had no risk of lymph node metastasis. However, the rate of lymph node metastasis was up to 25% in intramucosal undifferentiated-type EGC patients who had expanded ESD indications. Conclusions:Young patients with intramucosal EGC have poor pathological differentiation and strong invasiveness, and ESD may be considered for the treatment of differentiated intramucosal cancer.

Background: The OLGIM (operative link on gastric intestinal metaplasia assessment) staging system is important for the prediction of gastric cancer risk in patients with chronic gastritis. However, there are few studies focusing on the correlations of OLGIM stage with gastric mucosal serology and Helicobacter pylori ( Hp) infection. Aims: To investigate the correlations between OLGIM stage and serum pepsinogens (PGs) , gastrin-17 (G-17) , and Hp infection in patients with chronic gastritis. Methods: Individuals undergoing health examination and upper GI endoscopy in the Affiliated Provincial Hospital of Anhui Medical University from May 2015 to December 2017 were enrolled consecutively in this retrospective study. Information on demography, gastric mucosal serology, endoscopy, biopsy pathology and Hp infection was collected. The severity, topography and extension of intestinal metaplasia were assessed by OLGIM staging system. The clinical features of chronic gastritis patients with different OLGIM stages were compared; the risk factors for OLGIM stage HI-IV and the predictive performance of PG I to PG II ratio (PGR) for OLGIM stage HI -TV were analyzed. Results: A total of 1 112 health examination subjects were included in this study. The Hp infection rate was 49. 1%. The serum levels of PG I , PGII , and G-17 were higher, whereas the PGR was lower in Hp-positive subjects than those in Hp-negative ones (all P <0. 05). With the increasing of OLGIM stage, the serum levels of PG II and G-17 were increased, and the PGR was decreased ( all P < 0. 05 ). Meanwhile, the Hp infection rate and the proportion of family history of GI tumors were increased in patients with higher OLGIM stages (all P < 0. 05). In multivariate Logistic regression analysis, age was identified as the independent risk factor for OLGIM stage IH -IV ( OR = 1. 032 , 95% CI: 1. 002-1. 063 , P = 0. 035 ) , while higher PGR was a protective factor ( OR = 0. 837, 95% CI: 0. 754-0. 928 , P = 0. 001) . The optimal cut-off value of PGR for predicting OLGIM stage HI -IV was 8. 065 , with the sensitivity and specificity of 73. 8% and 69. 4% , respectively. Conclusions: Older age and lower PGR are independent risk factors for OLGIM stage HI-IV- PGR can be used as an indicator for screening OLGIM stage HI -IV individuals.