Background and purpose:Over-expression of Hypoxia-inducible factor-1? in tumors was known to be associated with resistance to radiation,chemotherapy and with the more malignant tumor phenotypes relative to increased invasiveness,metastatic potential.Furthermore,research has shown that HIF-1? over-expression is associated with aberrant P53 accumulation in human tumors.So we investigated the significance of HIF-1? expression and the relationships among expression of HIF-1?,P53 and P-gp in gastric carcinoma.Methods:The expressions of HIF-1?,P53 and P-gp were investigated by immunohistochemistry in 74 specimens of gastric carcinoma.Results:The positive percentage of P53 protein was higher in the group with HIF-1? positive than the one with HIF-1? negative(70.45% vs 30.0%).The positive rate of P-gp protein was also higher in HIF-1? positive group than in HIF-1? negative group(61.36% vs 36.67%),The positive expression of HIF-1? was significantly related to expression of P-53 and P-gp(r_(s)=0.372,0.256).The positive rate of P-gp protein was higher in P53 positive group than in P53 negative group.Spearman rank correlation test showed a positive correlation between P53 expression and P-gp(r_(s)=0.0283,P

Objective To observe the curative effect of imatinib mesylate combined with myeloablative allogeneic hematopoietic stem cell transplantation for treatment of chronic myeloid leukemia advanced phase. Methods To retrospectively analyze clinical effect of 6 patients with chronic myeloid leukemia advanced phase were treated with imatinib mesylate combined with myeloablative allogeneic hematopoietic stem cell transplantation from July 2005 to April 2009, and literature review. Results The disease-free survival and the survival rate of 4 patients were 66.67 %. 2 patients died (one case die for Chemotherapy pretreatment in the third transplantation after two years, the other case die for Chemotherapy pretreatment in the second transplantation after six months ). Conclusion The clinical cure rate of chronic myeloid leukemia advanced phase may be improved with the treatment of imatinib mesylate combined with myeloablative allogeneic hematopoietic stem cell transplantation.

Objective To compare the clinical effect, hematopoietic reconstitution, and adverse effects of compatriots HLA in the same period with haploidentical allogeneic hematopoietic stem cell transplantation among relatives for treatment of haematological malignancies. Methods 9 patients of compatriots HLA and 9 patients of haptoidentical allogeneic were recruited. The clinical effect, hematopoietic reconstitution, and transplant-related adverse effects of the observation groups were retrospectively analyzed. Results There was no statistical difference between the clinical effect in two groups, hematopoietic reconstitution, pretreatment-related toxicity and acute and chronic GVHD. The infusion volume of blood products, CMV infection and fungal infection in haploidentical transplant group was higher than that in compatriots HLA group. Conclusion HLA haploidentical family donor transplantation is a good way to increase the source of donor for the treatment of haematological malignancies.

Common iliac artery ureteral fistula is a rare but potentially life-threatening disease which is difficult to diagnose clinically. This paper reports a case of common iliac artery ureteral fistula. The patient was admitted to our hospital due to ureterostomy bleeding for one day. He underwent radical cystectomy and bilateral ureterostomy for bladder cancer 4 years ago, and also underwent radiotherapy and bilateral ureteral stents indwelling after the operation. Angiography revealed a left common iliac artery pseudoaneurysm, and a left common iliac artery ureteral fistula was considered. The left common iliac artery stent-graft was implanted. The patient recovered well after the operation, and there was no obvious hematuria during follow-up period of 6 months.

Objective:To compare the clinical efficacy between reservation and sacrifice of remnants in the footprint area in arthroscopic repair of rotator cuff tear.Methods:A retrospective study was conducted to analyze the clinical data of 32 patients with rotator cuff tear plus remnants in the footprint area (2 cm < tear size <5 cm) who had been admitted to Department of Sports Medicine, The People's Hospital of Northern Jiangsu from May 2020 to July 2021. The patients were divided into 2 groups according to reservation or sacrifice of remnants in the footprint area in arthroscopic repair of rotator cuff tear. In the remnant-reservation group (16 cases): 5 males and 11 females with an age of (61.8±9.9) years, 9 left and 7 right shoulders affected, and (3.7±1.1) cm in size of rotator cuff tear; in the remnant-sacrifice group (16 cases): 4 males and 12 females with an age of (61.3±8.8) years, 8 left and 8 right shoulders affected, and (3.9±0.9) cm in size of rotator cuff tear. The 2 groups were compared in terms of visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley shoulder function score (Constant score), and range of motion of the affected shoulder before surgery, 3 months after surgery and at the last follow-up. The ratio of bilateral abductor muscle strengths (affected side/healthy side) was analyzed and compared between the 2 groups, and the healing of the rotator cuff was evaluated by MRI at the last follow-up.Results:The 2 groups were comparable because there were no significant differences in all their preoperative demographic data ( P>0.05). The 32 patients were followed up for (14.3±3.5) months after surgery. At 3 months after surgery, the VAS score in the remnant-reservation group [1.0 (0.0,1.0) point] was significantly lower than that in the remnant-sacrifice group [1.0 (1.0,1.0) point] ( P<0.05), but there was no significant difference between the 2 groups in ASES score, Constant score or range of motion of the affected shoulder ( P>0.05). At the last follow-up, the ASES score, forward flexion, abduction and ratio of bilateral abductor muscle strengths (affected side/healthy side) in the remnant-reservation group [(96.1±4.8) points, 170.0 (170.0,170.0)°, 160.0 (160.0,170.0)°, and 85.5%±13.8%]were significantly better than those in the remnant-sacrifice group [(91.4±5.9) points, 160.0 (160.0,170.0)°, 150.0 (140.0,155.0)°, and 72.6%±16.9%] ( P < 0.05), but there were no statistically significant differences between the 2 groups in VAS score, Constant score, neutral external rotation angle, or body-side internal rotation ( P>0.05). The Sugaya grading for MRI rotator cuff healing was significantly different between the 2 groups at the last follow-up ( P<0.05). Conclusion:In arthroscopic repair of rotator cuff tear, reservation of remnants in the footprint area can significantly relieve postoperative shoulder pain, and has obvious advantages in restoration of shoulder forward flexion, abduction and abductor muscle strength, leading to better healing of the rotator cuff and the large nodule than the remnant-sacrifice technique.

Objective To retrospectively compared the hospitalization days and hospitalization costs of patients with thyroid tumor and breast cancer between patients who accepted selective hospitalization management and patients who accepted routine hospital management, and analyze the effect of selective hospitalization management to shorten the average hospitalization days.Methods A total of 419 patients with thyroid tumor and 318 patients with breast cancer who were treated in Fujian Provincial Hospital from March 2013 to February 2016 were chosen as the study object, and they were divided into the control group and the study group according to whether accepting the selective hospitalization management. Evaluating indicators included the total hospitalization days, preoperative hospitalization days, postoperative hospitalization days and hospitalization costs.Results Compared with the control group, the average total hospitalization days [(6.56±2.94)d vs (8.09± 3.71)d,(12.44±3.91)d vs (14.73±6.66)d)] and preoperative hospitalization days[(2.42±1.94)d vs (4.17± 2.68)d,(2.98±1.70) vs (5.29±4.00)d] in the study group were all reduced (P<0.05). There was no significant difference in the postoperative hospitalization days and the average hospitalization costs between two groups ( P > 0. 05 ) . Conclusions Selective hospitalization management could effectively shorten the hospitalization days of patients undergoing selective operation, and increase beds turnover rate. So the new management method would produce good social and economic benefits for the hospital.

Objective:To analyse the factors associated with the selection of breast- conserving surgery in early female patients with breast cancer.Methods:The targeted patients were females diagnosed with early-stage breast cancer and received surgical treatment at Fujian Provincial Hospital from January 1, 2015, to December 31, 2019. The targeted patients' clinical, demographic, and social-economic characteristics were extracted from the hospital health information system. Relevant information of their attending surgeons was collected through a smart-phone based self-respond online survey. We performed multivariate logistic regression to explore the associated factors with breast-conserving surgery (BCS) decision-making.Results:The age of the patient and attending surgeon and the economic development level of the patient's residence area were the associated factors with BCS decision-making of female early-stage breast cancer. By controlling the other factors unchanged, patients from middle-income areas were more likely to accept BCS ( OR=1.91, 95% CI: 1.01-3.62, P=0.05) than those from low-income areas. When the attending surgeon was at the average age of 45 years old, increasing of 1 year age of patient led to 4% decrease of the probability of BCS (95% CI: -0.07 - -0.01, P=0.01). When the patient was at the average age of 52 years old, increasing of 1 year age of the attending surgeon reduced 10% of the probability of BCS (95% CI: -0.19 - -0.01, P=0.03). The interaction effects related to the age of attending surgeon and patient for some observations to choose BCS were statistically significant, and the average interaction effect was 0.06% ( Z=2.11, s x =0.000 3, P<0.05). Conclusion:To promote breast-conserving surgery in the indicated early female patients with breast cancer, it is necessary to consider factors from both the surgeons and the patients.

Objective To evaluate the short-term clinical effect of arthroscopic repair of rotator cuff injury with all-suture anchor using a prospective and single-cohort clinical trial.Methods Twenty-five patients with rotator cuff injuries(1.5 cm0.05).Conclusion Arthroscopic rotator cuff repair with all-suture anchor is feasible and safe,and has good short-term clinical effect.

OBJECTIVE: To explore the safety, feasibility and short-term efficacy of intracavitary uncut Roux-en-Y (URY) anastomosis in digestive tract reconstruction following laparoscopic total gastrectomy (LTG). METHODS: From November 2015 to January 2018, 67 gastric cancer patients underwent intracavitary URY following LTG to reconstruct the digestive tract at Oncological Surgery Department of Fujian Provincial Hospital. There were 41 males and 26 females with age of 50 to 81 (61.9±7.4) years and body mass index (BMI) of (23.4±3.2) kg/m². Among 67 patients, 19 were gastric cardia carcinomas, 33 were gastric body carcinomas, and 15 were gastric fundus carcinomas; tumor size was (3.4±2.3) cm; 22 were Borrmann type I, 15 were type II, 21 were type III, and 19 were type IV; 29 were highly or moderately differentiated adenocarcinoma, 23 were lowly differentiated adenocarcinoma, and 15 were signet-ring cell carcinoma. After conventional laparoscopic D2 radical gastrectomy, the duodenum was closed and dissociated at 2 cm below the pyloric ring using the Echelon-flex endoscopic articulated linear Endo-GIA stapler, and the esophagus was dissociated above the esophagogastric junction (EGJ).URY and digestive tract reconstruction were performed under the direct vision of laparoscope: (1) Side-to-side esophagojejunostomy: An incision of 0.5 cm was made in the left lower edge of the esophageal closed end; jejunum about 25 cm distal away from the Treitz ligament was elevated to the lower end of esophagus; another incision of 0.5 cm was made in the contralateral of mesenteric side; both arms of the linear Endo-GIA stapler were inserted into the windows opened through esophagus and jejunum respectively to complete side-to-side anastomosis. The common opening of esophagus and jejunum was closed to complete esophagojejunostomy, forming the chyme outflow tract. (2) Side-to-side Braun jejunojejunostomy: Incisions of 0.5 cm were made in the proximal jejunum about 10 cm away from the esophagojejunal anastomosis and 35-40 cm away from the contralateral of mesenteric side of distal jejunum respectively for proximal-distal side-to-side jejunojejunostomy. The common opening was closed to form the biliopancreatic duodenal juice outflow tract. (3) Closure of the input loop jejunum in the esophagojejunal anastomosis: The input loop jejunum 2-3 cm away from the esophagojejunal anastomosis was closed using the non-blade linear stapler (ATS45NK), and the biliopancreatic duodenal juice reflux was blocked. Clinical data of these patients were collected for retrospective case series study. Surgical and digestive tract functional recovery, perioperative complications, as well as postoperative nutritional status were observed. Moreover, related indexes, such as anastomosis function and tumor recurrence were evaluated through endoscopic and imaging examinations during postoperative follows-up. RESULTS: All the 67 patients completed the surgery successfully. The mean operative time was (259.4±38.5) minutes, digestive tract reconstruction time was (38.2±13.2) minutes, intraoperative blood loss was (73.4±38.4) ml, and number of harvested lymph node was 36.2±14.2. The mean distance from upper resection margin to upper tumor edge was (3.3±1.2) cm, distance from upper resection margin to dentate line was (1.2±0.7) cm, and 1 case had positive upper incisal margin, which became negative after the second resection. Moreover, the average length of the auxiliary incision was (3.2±0.4) cm. The mean postoperative intestinal exhaust time was (52.8±26.4) hours, time to liquid diet was (64.8±28.8) hours, and postoperative hospital stay was (8.4±2.5) days. The morbidity of postoperative complication was 10.4%(7/67). Among these 7 cases, 4 cases were grade IIIa of Clavien-Dindo classification, including 2 with esophagojejunal anastomosis leakage, 1 with duodenal stump leakage, and 1 with abdominal infection, and all these patients were recovered after conservative treatment. All the 67 patients were followed up. The mean nutrition index 12 months after surgery was 53.4±4.2, diameter of esophagojejunal anastomosis was (3.9±0.6) cm, the incidence of Roux-en-Y stasis syndrome was 3.0% (2/67), and the incidence of reflux esophagitis was 4.5% (3/67). No patient had recanalization of the closed input loop of esophagojejunal anastomosis, anastomotic stenosis, obstruction, or tumor recurrence at anastomosis. CONCLUSION Intracavitary URY anastomosis following LTG for digestive tract reconstruction is safe and feasible, leading to fast postoperative recovery of digestive tract function and favorable short-term efficacy.
Anastomosis, Roux-en-Y ; methods ; Anastomosis, Surgical ; Female ; Gastrectomy ; methods ; Humans ; Jejunum ; Laparoscopy ; Male ; Retrospective Studies ; Stomach Neoplasms ; surgery

Objective:To explore the incidence and mortality of digestive system cancers, and the trend of the disease burden attributed to different risk factors in population in China.Methods:Data were obtained from the GLOBOCAN 2020 and the Global Burden of Disease Study in 2019 databases and only the data from the Chinese population were included. Using Excel 2019 and R 4.2.1 software, indicators including age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), age-standardized disability-adjusted life year (DALY) rate and its rate of change were used to illustrate the disease burden of digestive system cancers attributed to different factors and their trends.Results:In 2020, the ASIR of digestive system cancers in China was 83.00/100 000, and the ASMR was 63.80/100 000. The numbers of digestive system cancer cases and deaths increased with age, and more cases and deaths occurred in men than in women in all age groups. The age-standardized DALY rate of esophageal cancer, gastric cancer and liver cancers showed decreasing trends in China from 1990 to 2019 (rate of change: -45.26%, -46.87%, and -65.63%, respectively), whereas the age-standardized DALY rate of pancreatic cancer, colorectal cancer and gallbladder and biliary tract cancer showed increasing trends (rate of change: 67.61%, 30.52%, and 7.21%, respectively). The trend of the mortality rate was consistent with the DALY rate. Compared with the age-standardized DALY rate attributed to behavioral factors, the annual proportion of the age-standardized DALY rate attributed to metabolic factors to the total age-standardized DALY rate of esophageal cancer, liver cancer, pancreatic cancer, and colorectal cancer increased from 1990 to 2019. There was no significant change in the rank of age-standardized DALY rate of gastric cancer, liver cancer, pancreatic cancer, and gallbladder and biliary tract cancer attributed to different risk factors in China from 1990 to 2019, but the rank of certain attributed risk factors for the age-standardized DALY rate of esophageal cancer and colorectal cancer moved ahead (esophageal cancer: high BMI; colorectal cancer: low milk intake, and low whole-grain intake).Conclusions:The incidence and mortality of digestive system cancers was serious in China in 2020, and the annual proportion of the disease burden of digestive system cancers attributed to metabolic factors increased from 1990 to 2019. The rank of attributed risk factors for several digestive system cancers changed significantly.