Objective To analyze and explore the clinical features,pathological characters,treatment and prognosis of rectum carcinoid.Methods From January 1997 to January 2010,69 pathologically diagnosed rectum carcinoid cases were collected from Union Hospital of Tongji Medical College,Huazhong University of Science and Technology and other 7 hospitals.The clinical features,pathological characters,treatment and prognosis were analyzed. Results Of 69 rectum carconid cases,there were 36 males and 33 females.The average age was (49.3±12.9) years.The common symptom were hemotochezia,abdominal pain,constipation,diarrhoea and abdominal distension.There were 55 cases with lesions from the anus less than 8 cm and in other patients,lesions from the anus were all more than 8 cm.66 cases were typical carcinoid,3 cases were atypical carcinoid.40 cases underwent the immunohistochemical staining.The common markers for immunohistochemical staining were Syn,CgA and NSE,the positive percentage were 90％ (36/40),75％ (30/40) and 82.5％(33/40) respectively.A total of 24 patients received endoscopic therapy,44 patients had surgery,1 patient who refused surgery received only life support and symptomatic treatment.Conclusion No specific clinical symptoms of rectum carcinoid,and most were typical carcinoid.Lesions confined to mucosa and submucosa could be considered the endoscopic therapy.

Background:Gastrointestinal carcinoids are prone to be neglected in clinical practice because of the poor specific symptoms in early stage. Aims:To analyze the clinicopathological characteristics,treatment modalities and prognosis of a series of cases of gastrointestinal carcinoids for strengthening the understanding of the disease. Methods:A total of 116 patients diagnosed as gastrointestinal carcinoids by pathology from Jan. 1997 to Jan. 2010 in 8 hospitals at Wuhan were enrolled in this retrospective study. Data on sex,age,major symptoms,diagnostic approaches,treatment modalities, pathological features and prognosis, etc. were collected and analyzed. Results:The most common sites of the gastrointestinal carcinoids were rectum(59. 5%)and stomach(19. 8%);the most common symptoms were abdominal pain,abdominal distention and hematochezia. The positivity rates of immunohistochemical marker NSE,Syn and CgA were 92. 7%,87. 5% and 62. 5%,respectively. The proportion of stomach carcinoids with diameter larger than 2 cm was 73. 9%, and that of rectal carcinoids was only 13. 0%(P <0. 001). Most of the gastric carcinoids(81. 8%)infiltrated into or breakthrough the serosa;the rate of lymph node involvement in gastric carcinoids was significantly higher than that in rectal carcinoids(72. 7% vs. 17. 1%,P<0. 001),while typical carcinoids were less common in stomach than in rectum(60. 9%vs. 95. 7%,P<0. 001). Only one(4. 3%)gastric carcinoid patient underwent endoscopic therapy,while that for rectal carcinoids was 24 cases(34. 8%,P=0. 003). Surgical operation was the main therapeutic method for both gastric and rectal carcinoids. The 3-and 5-year survival rates for rectal carcinoids were 92. 8% and 62. 3%,respectively,and those for gastric carcinoids were 62. 6% and 49. 2%,respectively;there were no significant differences between the two groups(P>0. 05). Conclusions:Gastrointestinal carcinoids enrolled in this study distributed mainly in rectum and stomach. As compared with rectal carcinoids,gastric carcinoids were more advanced in disease stage with poorer prognosis. Regular health checks, strengthening the understanding of the disease,and grasping the specificities of carcinoids distributed at different sites might be helpful for the early diagnosis and treatment of gastrointestinal carcinoids,thus improving the survival rate.

Objective To provide the evidences for the management strategies of ventilator-associated pneumonia (VAP) in neonates,we systematically reviewed all related studies and analyzed the high-risk primary disease and medical factors of VAP in neonates.Methods We retrieved all related studies in CNKI,Wanfang,VIP,CBM,Pubmed and Embase and evaluated their quality by Newcastle-Ottawa Scale and analyzed all data by qualitative and Meta-analysis.Results There were 12 case-control studies with higher methodological quality and involving 1 994 neonates and with 708 VAP patients.Six studies involving 872 neonates were included,the odds ratio of respiratory distress syndrome(OR=2.81) and malnutrition(OR=5.18) had significant differences between VAP and non-VAP group.Seven studies involving 1 110 neonates were included and the odds ratio of patients with corticosteroids (OR=3.12),central inhibitors (OR=2.31),antacids (OR=4.35) and Gamma globulin with large doses (OR=2.35) had significant differences between VAP group and non VAP.Four studies involving 554 neonates were included and the odds ratio of patients with closed chest drainage (OR=1.81)and umbilical vein catheterization (OR=9.19) had significant differences between VAP group and non VAP.Six studies involving 1 139 neonates were included and the odds ratio of patients with parenteral nutrition (OR=1.82)and blood transfusions (OR=2.49) had significant differences between VAP group and non VAP.Conclusions Our study confirms that the respiratory distress syndrome and malnutrition corticosteroids,central inhibitors,antacids,Gamma globulin with large doses,closed chest drainage,umbilical vein catheterization,parenteral nutrition and blood transfusions are important risk and early-warning factors.

Objective To analyze risk factors and complication characteristics of healthcare-associated infection (HAI)in patients with lung cancer,and provide evidence for the formulation of HAI management strategy. Methods HAI-related articles were retrieved from China Biology Medicine (CBM),China National Knowledge Infrastructure (CNKI),Wanfang database,Vip database,PubMed,and Embase,all data were conducted Meta-analysis.Results A total of 19 articles involving 8 069 hospitalized patients with lung cancer (1 280 had HAI)were included.Meta-analysis on combined values of medical factors for HAI were as follows:OR(95%CI )of anti-tumor therapy(radiotherapy and chemotherapy),number of chemotherapy (≥ 2 times ),antimicrobial prophylaxis, immunosuppressant therapy,and invasive operation were 3.13 (1 .82,5.39),9.20 (3.04,27.87),3.23 (1 .77, 5.91),2.00(1 .56,2.57),and 2.28(1 .81 ,2.88),respectively;Meta-analysis on combined values of complication factors for HAI were as follows:OR (95% CI )of pulmonary diseases,chronic obstructive pulmonary disease (COPD),diabetes,renal dysfunction,malnutrition,hypoalbuminemia,neutropenia,and leukopenia were 2.65 (1 .74,4.02),2.40 (1 .76,3.27),2.25 (1 .85,2.73 ),2.56 (1 .18,5.52),5.51 (1 .70,17.89),2.05 (1 .56, 2.70),3.38(1 .40,8.18),and 2.10 (1 .22,3.62),respectively.Conclusion HAI-related factors of medical treat-ment and complications in patients with lung cancer are diversity,risk factors for HAI in patients with lung cancer are anti-tumor therapy,immunosuppressant therapy,antimicrobial prophylaxis,invasive operation,pulmonary dis-eases,COPD,diabetes,renal dysfunction,malnutrition,hypoalbuminemia,neutropenia,and leucopenia.

Endoscopic ultrasonography (EUS)is routinely performed before endoscopic submucosal dissection (ESD)for treatment of upper gastrointestinal stromal tumors.However,when a miniprobe sonography (12,15 and 20 MHz)was used,the size of tumor revealed by EUS was often inconsistent with what it actually was,which might increase the difficulty of ESD and the risk of perforation and massive bleeding.Aims:To investigate the value of standard probe (5 and 7.5 MHz)EUS in detecting the size of upper gastrointestinal stromal tumors before ESD.Methods:Clinical data of patients who were suspicious of esophageal and gastric stromal tumors by gastroscopy and EUS from Jan.2012 to Oct.2014 at the Renmin Hospital of Wuhan University were collected.Of them,195 cases treated by ESD were retrospectively analyzed.Results:Of 195 cases treated by ESD,37 cases diagnosed by standard probe EUS and 108 cases diagnosed by miniprobe EUS were confirmed as stromal tumors by pathology.Fourteen cases were failure for ESD and then transferred to surgical treatment,one was due to misjudgement of the origin of tumor by standard probe EUS and 9 were due to misjudgement of the size of tumor by miniprobe EUS.The misjudgement rate of standard probe EUS was lower than that of miniprobe EUS with an insignificant difference (2.7%vs.8.3%,P>0.05).In 9 cases misjudged by miniprobe EUS, the size of tumor presented by miniprobe EUS was significantly smaller than its real size [(1.22 ±0.51)cm vs.(3.97 ±1.06)cm,P<0.01].ESD was avoided or terminated in 3 cases because of the accurate estimation of tumor origin, structure and blood flow by standard probe EUS.Conclusions:For patients who are going to receive ESD for suspected upper gastrointestinal stromal tumors,it would be best to select standard probe EUS to detect the size,origin and blood flow of the tumor before ESD.It will decrease the risk and improve the success rate of ESD.

Objective To evaluate Zeus robot-assisted laparoscopic cholecystectomy. Methods Forty patients were divided into two groups receiving respectively Zeus robot-assisted laparoscopic cholecystectomy (group A, 20 cases), and laparoscopic cholecystectomy (group B, 20 cases). A variety of clinical parameters were evaluated. Compared between these two groups. Results Camera clearing (1.1?1.0) times and time used for operation field adjustment in group A (2.2?0.7) min were significantly less than those in group B (4.5?1.5,7.5?1.2) min. Dissection actions(337?86)times and operative errors(10%) in group A were less than those in group B(389?94) times,25%. The operation time(104.9?20.5) min and setup time (29.5?9.8) min in group A were longer than those in group B (78.6?17.1) min,(12.6?2.5) min. The blood loss,and postoperative hospital stay were similar. There were no postoperative complications in either groups, and conversion to open surgery was done in one each patients. Conclusions Compared with laparoscopic technique, Zeus robotic surgical system offers greater ability of controlling operation field, precise and stable operative manipulations though it requires longer operation time.

Objective To investigate a detective methods of choledocholithiasis.Methods Using retrospective study methods, a logistic regression descriminant analysis of 16 factors related to choledocholithiasis was made and a relative discriminant model was constructed.Results Logistic regression analyses that had sex, history of jaundice or jaundice, the widest inner diameter of choledochus, AST,ALT and the history of cholecystectomy, cholecystolithiasis and pancreatitis included into discriminant model, gave the best predictive result. A test sample showed the discriminant model had a sensitivity of 89.4%, and a specificity of 80.0%.Conclusions Discriminant analysis of logistic regression with clinical data is helpful for diagnosis and treatment of choledocholithiasis.It can also increase the accuracy of the predicion of cholecystolithiasis and serve as a clinical guide.

Objective To investigate the clinical characteristics of primary gastrointestinal lymphoma (PGIL) on different origin site in order to improve its diagnosis.Methods The clinical data from 202 patients with PGIL diagnosed by histology from January 1999 to June 2007 were identified from the clinical databases of 8 hospitals in Wuhan area and retrospectively analyzed.The patients were divided into gastric,small intestinal and large intestinal lymphoma groups according to the site of origin and there clinical characteristics were compared.Results The PGIL localization was gastric in 113 (56.0%) cases, small intestine in 37(18.3%) cases and large intestine in 52 (25.7%) cases.One hundred and thirty (64.4%) were males and 72 (35.6%) were females.The male patients were predominant.The median duration of symptoms in gastric lymphoma group was longer than small intestinal lymphoma group (3.0 months vs.1.0 month,P=0.013).The most common symptoms were abdominal pain and anemia. The clinical stage was Ⅰ E and Ⅱ E in 71.3% of cases.The large intestinal lymphoma group presented more advanced-stage disease compared with gastric lymphoma group (P = 0.014).The frequent histological type was mucosa-associated lymphoid tissue lymphoma (MALT),diffuse large B-cell lymphoma and T-cell lymphoma.Gastric,small intestinal and large intestinal lymphomas presented more frequently as low-grade MALT lymphoma (56.9%),T-cell lymphoma (34.4%) and high-grade B-cell lymphoma (51.1%),respectively (all P value ＜0.05).The common macroscopic type of PGIL were nodular protruding and ulcerative type.Compared with gastric lymphoma,nodular protruding type was more common and ulcerative type was less common in large intestinal lymphoma (P = 0.000).The diagnosis confirmed by endoscopic biopsy were 58.7% (61/104),25.0% (4/16),48.2% (13/27) in gastric,small intestinal and large intestinal lymphoma groups,respectively.Conclusions The clinical characteristics are different in patients with different localization of PGIL including patient characters, initial symptoms,histological classification,clinical stage,macroscopic feature,endoscopic findings. Analysis of these clinical characteristics is helpful to improve its diagnosis.

Objective To observe the clinical efficacy of shugan yishen recipe in the treatment of postmenopausal estrogen receptor-positive breast cancer patients during endocrine therapy.Methods A total of 110 postmenopausal breast cancer patients undergoing aro-matase inhibitor endocrine therapy at Shanghai Municipal Hospital of Traditional Chinese Medicine from July 2021 to September 2023 were divided into observation group and control group by random number table method,with 55 patients in each group..Both groups received standard treatment;the observation group also took shugan yishen recipe,while the control group also took shugan yishen recipe placebo,treatment for 12 weeks.The clinical efficacy,traditional Chinese medicine syndrome scores,bone metabolism,tumor markers,T-cell subsets(CD4+,CD8+,CD4+/CD8+)of the two groups were observed,and the safety was evaluated.Results A total of 106 patients completed the experiment,with 53 patients in each group.After treatment,the total clinical effective rate was 75.5％in the observation group,and 58.5％in the control group,the clinical effect of the observation group was better than that of the control group(P＜0.01).Compared with before treatment,TCM syndrome scores in both groups were decreased(P＜0.01).After treatment,β-c-terminal te-lopeptide of type-Ⅰ collagen(β-CTX),carbohydrate antigen 125(CA125),carbohydrate antigen 153(CA153)and CD8+were all decreased compared with those before treatment(P＜0.05);N-mid osteocalcin(N-MID),CD4+,CD4+/CD8+were higher than those before treatment(P＜0.01).After treatment,β-CTX,N-MID,CA153,CD8+and CD4+/CD8+in the observation group were significantly better than those in the control group(P＜0.01).Conclusion Shugan yishen recipe can improve bone metabolism abnor-malities caused by endocrine treatment in postmenopausal patients with estrogen receptor-positive breast cancer,reduce serum tumor marker levels,enhance immune function of patients,and is safe and effective.

Objective To evaluate the efficacy of one stage laparoscopic choledocholithotomy and cholecystectomy vs.ERCP cholecystolithiasis and cholecystectomy (staged) for cholecystolithiasis complicated with choledocholithiasis.Methods From Jan 2015 to Jun 2017,100 consecutive patients underwent randomized one-stage (TCLCBDE + LC) or two-stage (ERCP + subsequent LC) treatment for common bile duct (CBD) stones.Data evaluated were hospital costs,success rate of one-stage versus two-stage management,postoperative morbidity and GIQLI.Results 47 patients underwent ERCP plus LC two-stage treatment while 46 patients underwent one-stage treatment.Overall success rate of primary intervention for CBD stone clearance was 95.7％ and 97.8％ (P =1.0).Postoperative morbidity was 10.6％ vs.6.5％ (P =0.735),and postoperative hospital stay was (16 ± 5) days vs.(11.9 ± 2.9) days (P ＜ 0.01).One-stage laparoscopic transcystic management was the least costly option compared to two-stage management (19 415 ±2 167)yuan vs.(26 767 ±4 387)yuan (P ＜0.01).GIQLI improved faster in one-stage management group.Conclusion Transcystic one-stage management for gall stones with choledocholithiasis results in shorter hospital stay,lower costs and faster recovery than the two-stage management.