The total effective rate for clinical symptomstreated with oral decoction with Weiweikang(benefit-ting atrophic stomach)granules and Huoli(vitality)Bolus guided by the principle of invigorating Qi,warming the interior,activating circulation and elimi-nating blood stasis,was 91.8%,while that for thechronic atrophic gastritis with metaplasia and atypicalhyperplasia of intestinal epithelium was 87.5% and74.4% respectively.After treatment,the volume ofblood flowing was markedly increased(P

Adult ; Aged ; Carcinoid Tumor ; diagnosis ; surgery ; Endosonography ; methods ; Female ; Humans ; Male ; Middle Aged ; Rectal Neoplasms ; diagnosis ; surgery ; Treatment Outcome

Objective To obtain the elasticity value of solid breast lesions with supersonic shear wave elastrography (SWE) and apply the binary Logistic regression in order to evaluate the value of SWE in differential diagnosis of benign and malignant breast lesions. Methods SWE quantitative elastography was preformed in 91 breast lesions of 91 patients in Zhenghai Longsai Hospital to obtain the maximum and mean elasticity value (Emax, Emean). And receiver operating characteristic (ROC) curves were used to assess the diagnostic performance. A Logistic regression for the gray scale ultrasound and the elastic modulus was conducted with multiple variables including Emax, Emean, border, echo, form, calcification. Results Pathological examination showed 73 benign lesions and 18 malignant lesions. Emax and Emean of malignant lesions were obviously higher than those of benign lesions [(99.73±41.15) kPa vs (38.59±14.28) kPa, (61.45±24.88) kPa vs (23.46±11.44) kPa, t=-15.05,-14.12, both P=0.000]. The area under the ROC curve of Emax and Emean were 0.932 and 0.915. Taking 63.70 kPa as the threshold of Emax, the sensitivity was 77.8%and the speciifcity was 97.3%. Then taking 44.22 kPa as the threshold of Emean, the sensitivity was 83.3%and the speciifcity was 94.5%. The results of Logistic regression analysis showed:the 3 most effective variables were Emax, border of the lesions and Emean. Conclusions The multivariate analysis model of binary Logistic regression can select the valuable indexes of differential diagnosis of benign and malignant breast lesions. SWE plays an important role in differentiating benign and malignant lesions and it is valuable in clinical practice.

OBJECTIVETo evaluate the clinical value of submucosal tunneling endoscopic resection(STER) for gastric submucosal tumor(SMT) originating from the muscularis propria (MP) layer.

METHODSClinicopathological data of 23 cases with gastric SMT originating from the MP layer treated with STER from September 2010 to December 2011 were analyzed retrospectively.

RESULTSThere were 13 males and 10 females. The age ranged from 28 to 73(mean, 52.4) years old. Of the 23 SMTs, 11 were located in the cardia adjacent to the gastric body, 4 in the cardia adjacent to the fundus, 5 in the lesser curvature of gastric body and 3 in the gastric antrum of greater curvature. All the SMTs originating from the MP layer, 14 were located in the superficial MP layer and 9 in the deep MP layer(including 5 gastric SMTs close to serosa). En bloc STER was performed successfully in all the patients. The mean lesion size was 2.1 cm(range 1.5-3.2 cm). The mean procedure time was 54.8 min(range 30-125 min). Pathological examination showed that the lesions were leiomyomas(n=10), stromal tumors(n=8), glomus tumor(n=2), Schwannoma(n=2), and calcifying fibrous tumor(n=1). Both lateral and vertical margins were negative in all the cases. Three patients developed pneumothorax and subcutaneous emphysema and 5 pneumoperitoneum. One patient developed effusion under the left half of the diaphragm and secondary infection. All of them recovered uneventfully after conservative treatments. No delayed bleeding or GI tract leakage was noticed. None of the 23 cases encountered submucosal hematoma or infection. No tumor residual or recurrence was found during the follow up(range, 3-18 months).

CONCLUSIONSSTER is a safe, effective for appropriate lesions in the MP layer of the stomach. En bloc resection and accurate histopathological evaluations can be achieved.

Adult ; Aged ; Female ; Follow-Up Studies ; Gastric Mucosa ; surgery ; Gastroscopy ; methods ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stomach Neoplasms ; surgery ; Treatment Outcome

OBJECTIVETo investigate the effects of peroral endoscopic myotomy(POEM) on esophageal dynamics in patients with esophageal achalasia.

METHODSFrom September 2011 to November 2011, 20 cases with esophageal achalasia received POEM at the Endoscopic Center in the Zhongshan Hospital of Fudan University. Pre-operation esophageal dynamics of all the patients were evaluated by high resolution manometry(HRM) system and 3 days after operation the test was repeated. Lower esophagus sphincter resting pressure(LESP), 4-second integrated relaxation pressure(4sIRP), lower esophagus sphincter relax rate(LESRR), lower esophagus sphincter length(LESL), and esophageal manometry were analyzed.

RESULTSAfter POEM, LESP decreased from(29.1±17.0) mm Hg to(14.6±4.9) mm Hg, and decrease rate was 49.8%(P<0.01). However, the decreases in LESRR and LESL were not statistically significant(P>0.05). Esophageal peristaltic contraction was absent in all the 20 patients preoperatively. After POEM, changes in the esophageal contraction were seen in 7 patients, and peristalsis was noticed but was below normal level. There were no significant changes in peristalsis in the remaining 13 patients.

CONCLUSIONPOEM can significantly reduce LESP and 4sIRP in patients with achalasia, but can not affect the contraction of the esophagus.

Adolescent ; Adult ; Aged ; Esophageal Achalasia ; physiopathology ; surgery ; Esophagoscopy ; methods ; Esophagus ; physiopathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Young Adult

Objective: To investigate the relationship between P27，P53 and PCNA expression in human gastric carcinoma tissues and clinicopathological parameters. Methods: The expression of P27，P53 and PCNA in 62 human gastric carcinoma tissues was examined with immunohistochemistry SP method. Results: Positive rates of P27，P53 and PCNA expression were 37.1％, 40.4%，83.9％. P27 expression was related with Bormann type, infiltrative depth, lymph node and distant metastasis and clinical stage. P53 expression was related with sex of patients, distant metastasis and clinical stage. PCNA expression was related with age of patients and infiltrative depth of tumor. P27 positive expression group was higher than negative group as to 5-year survival. P27 expression was in reverse relation with PCNA expression. Conclusion: The expression of P27, P53 and PCNA may be regarded as an important marker in judging malignant degree of gastric carcinoma,distant metastasis and prognosis.

Differential proteomics analysis of Sika deer antlers at rapid growth stage (60 d) and ossification stage ( 90 d) was performed by isobaric tags for relative and absolute quantitation ( iTRAQ ) , ultra high performance liquid chromatography and mass spectrometry technologies. A total of 127 differential proteins were identified. Compared with the ossification stage, 80 differential proteins were significantly up-regulated and 47 differential proteins were significantly down-regulated at the rapid growth stage. These differential proteins were mainly distributed in the regions of extracellular matrix, nucleosome, haptoglobin-hemoglobin complex, actin filament, endoplasmic reticulum-Golgi intermediate compartment, endoplasmic reticulum lumen, and endometrium, etc. The up-regulated differential proteins were mainly involved in the regulations of oxygen transport in the blood, nerve growth and regeneration, cartilage and bone development and ATP synthesis compared with ossification stage, and the down-regulated differential proteins were mainly involved in the endochondral ossification process. The changes of protein expression at different growth stages were closely related to antler rapid growth and ossification. Therefore, the results of this study provided a basic data for discovering the molecular mechanisms of antler rapid growth and ossification, and it was of great significance for further study of the pharmacological basis and clinical application of antlers.

OBJECTIVETo evaluate the long-term efficacy of endoscopic excision for rectal carcinoids.

METHODSClinical data of 91 patients with rectal carcinoids treated by endoscopic excision from 2000 to 2007 were analyzed retrospectively.

RESULTSThe average size of the primary tumor was 0.8 cm(range 0.3 to 2.3 cm). All the tumors were localized within the submucosal layer showing typical histology without lymphatic or vessel infiltration. Follow-up was available for 80 patients with mean 32.5 months (range 6 to 96 months). There was no recurrence in 65 patients with tumor size < 1.0 cm. Recurrence occurred in 3 cases among 25 patients with tumor size from 1.0 to 2.0 cm, and 1 died of hepatic metastasis. The 1-, 3-, and 5-year survival rates of the patients were 100%, 98.0%, and 91.4% respectively.

CONCLUSIONSTumor size and depth of invasion are two important prognostic factors of rectal carcinoids. Endoscopic excision is useful for rectal carcinoid patients with tumor size < 1.0 cm and located within the submucosal layer.

Adult ; Aged ; Carcinoid Tumor ; pathology ; surgery ; Endoscopy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Rectal Neoplasms ; pathology ; surgery ; Retrospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVETo evaluate the safety and efficacy of endoscopic submucosal dissection (ESD) for gastrointestinal stromal tumor(GIST) in the esophagogastric junction(EGJ).

METHODSTwenty patients with pathologically confirmed GIST in the EGJ were screened from all the patients undergoing ESD between November 2007 and June 2011. The clinicopathological and postoperative follow up data were analyzed.

RESULTSThere were 11 males and 9 females with the age ranging from 29 to 67 years(mean, 54.1 years). The maximum diameter of the lesions ranged from 8 to 20 mm(mean,14.8 mm). Fifteen patients underwent endoscopic submucosal excavation, 4 patients underwent endoscopic full-thickness resection, and 1 patient underwent submucosal tunneling endoscopic resection. The operative time ranged from 15 to 90 min(mean, 47.8 minutes). The estimated blood loss was 5 to 200 ml. The en bloc resection rate was 100%. Perforations occurred in 4 patients, pneumoperitoneum in 3 patients, cardia mucosal tear in 1 patient. All the complications were successfully managed with endoscopic intervention and conservative therapy. The post-operative follow up ranged from 3 to 36 months(mean, 13.2 months). No local recurrence or distant metastasis occurred.

CONCLUSIONESD is a safe and effective procedure for GIST in the EGJ.

Adult ; Aged ; Endoscopy ; Esophagogastric Junction ; Female ; Follow-Up Studies ; Gastrointestinal Stromal Tumors ; surgery ; Humans ; Male ; Middle Aged

OBJECTIVETo evaluate the feasibility, efficacy, and safety of metallic clips for closure of full-thickness defects in the stomach wall.

METHODSForty-eight rabbits were randomly divided into 4 groups with 12 in each group using random digits table. A 2 cm×2 cm full-thickness defect was created in the gastric body. No closure was performed in the first group; in the second group, mucosa closure with metallic clips; the third group, closure of full-thickness gastric tissue with metallic clip; the fourth group closure with 3-0 silk suture. After operation the animals were sacrificed at the third day and the seventh day. Wound healing was evaluated. Bursting pressure was recorded. HE and Masson staining was performed to inspect wound inflammation and tissue fibrosis situation.

RESULTSAfter operation all the animals in the first group died within 34 hours, while those in other groups survived. No intraperitoneal bleeding or infection were seen in the survived animals. General observation showed that the metallic closure group caused less intraperitoneal adhesions. Operative time was shorter in the second and third group compared to the fourth group [(45.8 ± 1.6) min and (42.5 ± 1.5) min vs. (48.0 ± 1.4) min, P<0.05]. The bursting pressure on the third day was lower [(36.9 ± 4.6) mm Hg and (39.8 ± 4.1) mm Hg vs. (50.5 ± 4.2) mm Hg, P<0.05]. There was no significant difference in bursting pressure on the 7th day among the three groups [(95.0 ± 7.9) mm Hg and (97.8 ± 6.8) mm Hg vs. (98.5 ± 7.0) mm Hg, P>0.05]. HE staining revealed that metal closure had a better healing and Masson staining reflected no significant difference in healing at the same time point.

CONCLUSIONSMetal clips closure full-thickness defects in the stomach, regardless in full thickness or mucosa closure, is as safe and effective as suture closure.

Animals ; Pilot Projects ; Rabbits ; Stomach ; surgery ; Surgical Instruments ; Suture Techniques ; Sutures ; Wound Healing