Objective:To evaluate the new scoring system for gastric cancer screening and risk assessment of gastric precancerous lesions.Methods:A total of 442 patients who underwent endoscopy due to stomach discomfort at the First Hospital of Jiaxing from March 2018 to September 2019 were enrolled. The patients were divided into three groups based on the new scoring system for gastric cancer screening before endoscopy: low-risk group (0-11 points), median-risk group (12-16 points) and high-risk group (17-23 points). The detection rates of gastric cancer and atrophic gastritis in three groups were analyzed. According to the range or degree of atrophy or intestinal metaplasia, patients were divided into five groups of stage 0 to Ⅳ based on the operative link for gastritis assessment (OLGA) or operative link for gastritis intestinal metaplasia (OLGIM). The correlation between the new gastric cancer screening scoring system and OLGA or OLGIM staging system were evaluated.Results:Among 442 patients, 211 were assigned to low-risk group, 207 median-risk group and 24 high-risk group according to the new scoring system. For OLGA staging system, there were 241 cases of stage-0, 105 of stage-Ⅰ, 58 stage-Ⅱ, 27 stage-Ⅲ and 11 stage-Ⅳ. For OLGIM staging system, there were 224 cases of stage-0, 113 stage-Ⅰ, 61 stage-Ⅱ, 31 stage-Ⅲ and 13 stage-Ⅳ. The pepsinogen (PG) Ⅰ and pepsinogen ratio (PGR) levels had differences among different OLGA stages ( F=2.844, P=0.027; F=5.435, P=0.001), and these two variables at Stage-Ⅲ and Ⅳ were significantly lower than three other OLGA stages (all P<0.001). The PGR level had differences among different OLGIM stages ( F=3.887, P=0.008), which was significantly lower at Stage-Ⅳ than at other OLGIM stages (all P<0.001). Gamma coefficient analysis and Kendall′s tau-b analysis showed significant correlations between OLGA/OLGIM staging system and new gastric cancer screening scoring system ( P<0.001). Conclusion:The new scoring system is reliable for gastric cancer screening, and is closely linked with OLGA/OLGIM staging system in the risk assessment of gastric precancerous lesions.

Objective:To compare the value of new gastric cancer screening scoring system and serum pepsinogen (PG) combined with gastrin-17 (G-17) (new ABC method) in screening gastric cancer and precancerous lesions.Methods:A total of 576 patients were enrolled after the examination of endoscopy at Endoscopy Center,Department of Gastroenterology,from December 2017 to December 2019. There were 275 males and 301 females with an age of 40-72 (52±10) years. According to the new ABC method and the new gastric cancer screening scoring system, the population was divided into three groups according to age,gender,serum helicobacter pylori antibody test, PG Ⅰ/PG Ⅱ(PGR) and G-17 before endoscopy. The detection rates of gastric cancer and atrophic gastritis by two different methods were analyzed and the value in screening gastric cancer and precancerous lesions were evaluated. Statistical analysis was accomplished by Chi-square test and Gamma coefficient analysis. Results:A total of 576 patients were enrolled. According to the new ABC method, 382 patients were classified into low-risk group, 170 patients into middle-risk group and 24 patients into high-risk group, respectively. In the new ABC method, 1 case of gastric cancer (0.3%) was detected in low-risk group, 8 cases (4.7%) in middle-risk group and 3 cases (12.5%) in high-risk group. As for atrophic gastritis, 89 cases (23.3%) was detected in low-risk group, 94 cases (55.3%) in middle-risk group and 18 cases (75.0%) in high-risk group. According to the new gastric cancer screening scoring system, 336 patients were classified into low-risk group, 205 patients into middle-risk group and 35 patients into high-risk group, respectively. One case of gastric cancer (0.3%) was detected in low-risk group, 6 cases (2.9%) in middle-risk group and 5 cases (14.3%) in high-risk group. As for atrophic gastritis, 41 cases (12.2%) were detected in low-risk group, 134 cases (65.4%) in middle-risk group and 26 cases (74.3%) in high-risk group. In this two methods, the prevalence of gastric cancer increased according to the disease stage ( χ2 =22.509, P<0.01; χ2=24.156, P<0.01); in terms of atrophic gastritis, the detection rate of the new screening scoring system in the low-risk group was significantly lower than that in the new ABC method ( χ2=14.844, P<0.01), but higher in the middle-risk group ( χ2=3.955, P=0.047). Gamma coefficient test showed that there were strong correlations between gastroscopy pathology and classification grade of both methods ( P<0.01). Conclusions:Both methods are suitable for screening gastric cancer and precancerous lesions, and the new scoring system may be more valuable in screening gastric cancer and precancerous lesions.

Objective To evaluate different operative modalities for sphincter-preserving procedures in patients of lower rectal cancer. Methods A total of 137 patients with lower rectal cancer underwent sphincter-perserving surgery between January 2003 and January 2008. In the operation, the proximal colon with satisfactory blood supply was pulled down to reestablish intestinal continuity without any tension. Results Among the 137 patients, 102 patients underwent low anterior resection by double stapling technique, 16 patients were dealed with the Parks operation, 19 patients were dealed with the modified Bacon operation. In the double-stapling technique group, the distance between the anal verge and inferior margin of the tumor was 6-8 cm in 91 patients and 5-6 cm in 11 patients whose tumors were located at posterior rectal wall. In the other two groups, the distance between the anal verge and inferior margin of the tumor was 5-6 cm. In the Parks operation, the sigmoid colon was anastomosed with the anus in all of 19 patients. In the modified Bacon operation group, the descending colon was pulled through anus in all of 16 patients. Conclusions The low anterior resection with double stapling technique can be applied to a patient if the distance from the inferior margin of the tumor to the anal verge is 6 cm to 8 cm. The Parks operation or the modified Bacon operation can be applied to a patient if the the distance from the inferior margin of the tumor to the anal verge is 5 to 6 cm, The Parks operation can be performed with the sigmoid colon being anastomosed with the anus if the length of the sigmoid colon is long enough to reach the anus, the modified Bacon operation can be performed with the descending colon being pulled through the anus by mobilization of splenic flexure or left colon if the length of the sigmoid is not long enough to reach the anus.

BACKGROUND:The expression efficiency of recombinant adeno-associated virus serotype 9(rAAV9)carrying the macrophage-specific promoter synthetic promoter 146-C1(SP146-C1)and the exogenous gene vascular endothelial growth factor C(VEGFC)in atherosclerosis is uncertain. OBJECTIVE:To investigate the expression efficiency of rAAV9-SP146-C1-VEGFC in atherosclerotic mice and its effect on lymphangiogenesis. METHODS:Thirty ApoE-/-mice were fed high-fat diet for 12 weeks to establish atherosclerosis models and were randomly divided into six groups,five in each group:7-,14-,21-,28-,and 35-day transfection groups and control group.The mice in the transfection groups were transfected with 5.0×1011 vg rAAV9-SP146-C1-VEGFC by caudal vein injection.In the control group,the mice were injected with the same amount of control virus rAAV9-SP146-C1-Scramble.Animals in the first five groups were killed under anesthesia at 7,14,21,28 and 35 days after transfection,respectively,and those in the control group were killed under anesthesia at 7 days.Serum,femur,tibia,heart and aorta tissue samples were collected and retained in each group.The femur and tibia of mice in each group were used to extract bone marrow-derived macrophages.The gene expression of vascular endothelial growth factor C(VEGFC),vascular endothelial growth factor receptor 3(VEGFR3),Podoplanin and lymphatic vessel endothelial hyaluronan receptor-1(LYVE-1)in bone marrow-derived macrophages and the aorta were detected by RT-qPCR.VEGFC protein expression levels in bone marrow-derived macrophages and the aorta were detected by western blot,serum level of VEGFC was detected by ELISA,and VEGFC expression in the aortic sinus and LYVE-1 expression around the aorta and in the myocardium was detected by immunofluorescence. RESULTS AND CONCLUSION:The serum level of VEGFC,the mRNA expression of VEGFC,VEGFR3,Podoplanin,and LYVE-1 in bone marrow-derived macrophages and the aorta,the protein expression of VEGFC in bone marrow-derived macrophages,and the fluorescence intensity of VEGFC in aortic sinus plaques were significantly increased in the 7-day transfection group compared with the control group(P＜0.05,P＜0.01).Serum VEGFC level of mice transfected with rAAV9-SP146-C1-VEGFC gradually increased with time and began to decrease at 28 days.mRNA levels of VEGFC,VEGFR3,Podoplanin and LYVE-1 in mouse aorta and bone marrow-derived macrophages,VEGFC protein level in bone marrow-derived macrophages,VEGFC fluorescence intensity in aortic sinus plaques,LYVE-1 fluorescence intensity around the aortic sinus and in the myocardium gradually increased with time(P＜0.05).In addition,the mRNA level of LYVE-1 in the aorta and the fluorescence intensity of LYVE-1 around the aortic sinus and in the myocardium were the highest at 28 days(P＜0.05),and gradually decreased(P＜0.05).The expression of the other indicators reached the peak at 21 days.To conclude,rAAV9-SP146-C1-VEGFC could effectively transfect bone marrow-derived macrophages and promote lymphatic hyperplasia in atherosclerotic mice.

ObjectiveTo explore the clinical effect of Tiaoxin formula in the treatment of patients with coronary heart disease and anxiety/depression and its impact on serum levels of 5-hydroxytryptamine （5-HT）， β- thromboglobulin （β-TG） and myeloperoxidase （MPO）. MethodA total of 66 patients with coronary heart disease and anxiety/depression were randomly divided into the Tiaoxin formula group and Deanxit group， 33 cases in each group. Both groups were given fundamental western treatment for coronary heart disease. Additionally， the Deanxit group was treated with flupentixol and melitracen tablets and the Tiaoxin formula group was treated with Tiaoxin Formula. The treatment lasted 8 weeks. Before and after treatment， the changes of clinical efficacy， Patient Health Questionnaire （PHQ-9）， Generalized Anxiety Disorder （GAD-7） scale， Seattle Angina Questionnaire （SAQ）， heart rate variability， and serum 5-HT， β-TG and MPO levels， and incidence of adverse reactions in the two groups were observed. ResultThere was no significant difference in the baseline indexes of patients in the two groups， and thus the two groups were comparable. After treatment for 8 weeks， the total effective rate for traditional Chinese medicine （TCM） syndromes in the Tiaoxin Formula group was 87.88% （29/33） higher than 63.64% （21/33） in the Deanxit group （Z=-2.653， P<0.05）. Compared with those before treatment， the PHQ-9 and GAD-7 scores of the two groups were decreased at week 4 and 8 of treatment （P<0.05）， and there was no statistical difference between two groups. And the SAQ dimension scores of the two groups were increased at week 4 and 8 of treatment （P<0.05）. Compared with the Deanxit group， the Tiaoxin Formula group had elevation in two dimension scores： Physical limitation and angina stability （P<0.05）. Compared with the conditions before treatment， the serum 5-HT level in the two groups were increased， while the β-TG and MPO levels were lowered （P<0.05）， and there was no distinct difference between two groups. In addition， the standard deviation of normal-to-normal intervals （SDNN） and standard deviation of average normal-to-normal intervals （SDANN） of the heart rate variability in the Tiaoxin formula group were elevated after treatment （P<0.05）， which were more significant than those of the Deanxit group （P<0.05）. During the treatment period， the incidence of adverse drug reactions in the Tiaoxin formula group was lower than that in the Deanxit group （P<0.05）， and no adverse events were observed in the two groups. ConclusionTiaoxin formula was effective for the treatment of patients with coronary heart disease accompanied by anxiety and depression， which improved the clinical symptoms， increased serum 5-HT levels， and decreased serum β-TG and MPO levels， and had few adverse reactions and high safety for patients， showing a high clinical value.