Objective To investigate the expression of Epstein-Barr virus(EBV)-latent membrane protein 1 (LMP1) in chronic atrophic gastritis (CAG) with intestinal metaplasia and discuss its effect on gastric cancer.Methods Immunohistochemistry was used to examine the expression of EBV-LMP1 in 45 cases of chronic superficial gastritis(CSG),63 cases of CAG with intestinal metaplasia and 36 cases of gastric cancer.Results There was no expression of EBV-LMP1 in CSG and gastric cancer,while the positive rate of EBV-LMP1 in CAG with intestinal metaplasia was 36.5％ (23/63) and EBV-LMP1 was mainly stained in the cell nucleus.The expression of EBV-LMP1 in CAG with intestinal metaplasia was significantly higher than that in CSG and gastric cancer,and there was significant difference (P =0.000).Conclusions EBV-LMP1 is expressed in CAG with intestinal metaplasia.The expression of EBV-LMP1 is significantly higher than that in CSG and gastric cancer indicating that EBV infection in gastric carcinogenesis may play an important role in the early stages.

Objective To investigate the methods of repair the lateral skin and soft tissue defect of the middle and rear foot with the plantar medial flap transferred before the achilles tendon.Methods Fifteen cases with the lateral skin and soft tissue defect of the middle and rear foot were repaired with the plantar medial flap pedicled with posterior tibia artery transferred before the achilles tendon from January,2012 to October,2015.All the 15 patients were followed up in the way by telephone or back to hospital postoperatively 3 months to 3 years,including 6 cases by telephone follow-up and 9 cases of back-to-hospital follow-up,to observe the appearance,functions of the skin flap and whether the skin flap survived well.Results The flaps of 15 cases survived well.Postoperative followup of 3 months to 3 years,the sensation of the flap was good,without any ulcer or necrosis.The patients walked well and were satisfied with the flap.Conclusion To repair the lateral skin and soft tissue defect with the plantar medial flap transferred before the achilles tendon as a new method is feasible with the good ability of faster sensory recovery,the good appearance and function.

Objective To detecte the expression of COX-2,VEGF-C and lymphatic vessel density (LVD)in pancreatic cancerous and paracancerous tissues,and investigate their correlation.Methods The expression of COX-2.VEGF-C and LVD in 40 cases of pancreatic cancer tissues and paracancerous tissues and 12 cases of normal pancreas was detected by tissue chip and immunohistochemical assays,and the relationship between them and the cljnicopathological parameters was analyzed. Results The expression of COX-2,VEGF-C in pancreatic cancer tissues were 70.0%(28/40)and 67.5%(27/40),respectively,which were significantly higher than that in paracancerous tissues(42.5%,17/40)and(35.0%,14/40),and that in normal pancreas(8.3%,1/12)and(25.0%,3/12).The LVD in pancreatic cancerous,paracancerous and normal pancreatic tissues were 4.75±2.77,15.2 ±4.70 and 1.67±1.15,respectively.The expression of COX-2 in cancerous tissues and LVD in paracancerous tissues was correlated with tumor differentiation and lymph metastasis;the expression of VEGF-C Was correlated with lymph metastasis.LVD in paracancerous tissues was correlated with the expression of COX-2 and VEGF-C.Conclusions Pancreatic cancer lymphangiogenesis mainly existed in paracancerous tissues,COX-2 and VEGF-C may play an important role in the lymphangiogenesis.

Objective To investigate the methods and results of hand reconstruction by transplanting the fostered residual finger and the second toe,which share the same blood supply system.Methods From January,2014 to January,2016,3 cases with destructive hand injuries in our hospital;and debridement was performed in one session during the early stage of trauma,with skin grafting to cover the wrist stump and foster the residual finger to a branch of the dorsalis pedis artery.The first dorsal metatarsal artery around the toe web was identified and then gradually isolated proximally with dissection of the branches of the dorsalis pedis artery supplying the fostered finger until the convergence of the two blood vessels.Then,reconstructed hand by residual finger and combined second toe transplantation.Results After a follow-up period of 3 months to 2 years,the reconstructed hand had a good appearance and was able to complete basic mundane actions.The function of the limb was restored to a large extent andthe patient was satisfied with the reconstructed hand.Conclusion Transfer of a fostered residual finger and combined second toe which have the same blood supply system for hand reconstruction as a new method need to anastomose only one set of arteries,and it is feasible with the good appearance and function of the reconstructed hand.

Objective To explore the clinical effect of transurethral resection combined with intravesical mitomycin perfusionon in the treatment of cyslitis glandular (CG).Methods A total of 70 patients with CG in our hospital were randomly divided into control group (n =35)and obser-vation group (n =35).After transurethral resection,the control group was given pirarubicin hy-drochloride by perfusion of bladder,while the observation given pirarubicin hydrochloride combined with mitomycin by perfusion of bladder.The quality of life was evaluated by Quality of Life Scale in both groups,and clinical effects were compared.Results The difference was not significant though the overall response rate in observation group was slightly higher than that in the control group;The score of different items of quality of life in the obeservation group was evidently higher,but the inci-dence of adverse reactions was markedly lower in the observation group than that in the control group,and the differences was statistical significant.Conclusion Transurethral resection combined with intravesical mitomycin perfusion is effective in treating CG with low incidence of adverse reac-tions and high quality of life for patients,so it is worthy of being widely promoted in clinic.

Objective To explore the clinical effect of transurethral resection combined with intravesical mitomycin perfusionon in the treatment of cyslitis glandular (CG).Methods A total of 70 patients with CG in our hospital were randomly divided into control group (n =35)and obser-vation group (n =35).After transurethral resection,the control group was given pirarubicin hy-drochloride by perfusion of bladder,while the observation given pirarubicin hydrochloride combined with mitomycin by perfusion of bladder.The quality of life was evaluated by Quality of Life Scale in both groups,and clinical effects were compared.Results The difference was not significant though the overall response rate in observation group was slightly higher than that in the control group;The score of different items of quality of life in the obeservation group was evidently higher,but the inci-dence of adverse reactions was markedly lower in the observation group than that in the control group,and the differences was statistical significant.Conclusion Transurethral resection combined with intravesical mitomycin perfusion is effective in treating CG with low incidence of adverse reac-tions and high quality of life for patients,so it is worthy of being widely promoted in clinic.

Objective To explore the relationship between polyp features at first-time colonoscopy and the recurrence, and to analyze the risk factors of recurrence at different time points of follow-up. Methods The data of 614 patients undergoing colorectal polypectomy between May 2008 and May 2016 were retrospectively analyzed. Patients were classified into 3 groups according to the characteristics and polyp features at first-time colonoscopy. The risk factors influencing polyp recurrence at different time points during follow up were analyzed. Results Univariate analysis showed that age ≥70 years, polyp′s diameter ≥0.5 cm,the number of polyps >2 and distribution throughout colon were risk factors for recurrence. In multivariate models,the number of polyps at baseline was the only significant predictor for recurrence(OR=2.36,95%CI:1.06-5.25). All of 614 patients underwent 6-87 months surveillance colonoscopy. The total recurrence rate was 58.6%(360/614). During four different surveillance intervals including 6-24 months,>24-36 months, >36-48 months, and >48-87 months,the cumulative recurrence rate of high-risk group was 60.1%,65.7%,80.7%,and 83.8%,respectively,whereas,that of low-risk group was 22.7%,40.0%, 53.8%,and 65.4%, respectively. There was a significant difference between the two groups(P=0.00). Conclusion The number of initial colorectal polyps is useful for predicting the risk of polyp recurrence,and the rate of polyp recurrence during surveillance increases with the passage of time. The cumulative recurrence rate of high-risk group after polypectomy is significantly higher than that of low-risk group.

This study examined the value of volume rendering (VR) interpretation in assessing the growth of pulmonary nodular ground-glass opacity (nGGO).A total of 47 nGGOs (average size,9.5mm; range,5.7-20.6 mm) were observed by CT scanning at different time under identical parameter settings.The growth of nGGO was analyzed by three radiologists by comparing the thin slice (TS) CT images of initial and repeat scans with side-by-side cine mode.One week later synchronized VR images of the two scans were compared by side-by-side cine mode to evaluate the nGGO growth.The nodule growth was rated on a 5-degree scale:notable growth,slight growth,dubious growth,stagnant growth,shrinkage.Growth standard was defined as:Density increase ≥ 30 HU and (or) diameter increase (by 20％ in nodules ≥10 mm,30％ in nodules of 5-9 mm).Receiver operating characteristic (ROC) was performed.The results showed that 32 nGGOs met the growth criteria (29 nGGOs showed an increase in density; 1 nGGO showed an increase in diameter; 2 nGGOs showed an increase in both diameter and density).Area under ROC curve revealed that the performance with VR interpretation was better than that with TS interpretation (P＜0.01,P＜0.05 and P＜0.05 for observers A,B and C respectively).Consistency between different observers was excellent with both VR interpretation (κ=0.89 for observers A&C,A&B,B&C) and TS interpretation (κ=0.71 for A&B,κ=0.68 for A&C,κ=0.74 for B&C),but time spending was less with VR interpretation than with TS interpretation (P＜0.0001,P＜0.0001 and P＜0.05for observers A,B and C,respectively).It was concluded that VR is a useful technique for evaluating the growth of nGGO.

Objective:To investigate the prognostic value of the combined preoperative albumin-globulin score (AGS) and skeletal muscle index (SMI), referred to as the CAS classification, in predicting postoperative outcomes in patients with pancreatic cancer.Methods:The clinical data from 265 patients who underwent surgical treatment and were pathologically confirmed to have pancreatic cancer at the Affiliated Hospital of Qingdao University between January 2012 and December 2022 were retrospectively analyzed. Patients were randomly divided into a training group ( n=184) and a validation group ( n=81) in a 7∶3 ratio. Patients' age, gender, body mass index (BMI), smoking history, alcohol consumption history, previous history of metabolic diseases, AGS, SMI, and CAS classifications within 7 days before surgery, preoperative upper abdominal CT imaging features, presence of vascular and neural invasion, and lymph node metastasis were recorded. Patients with AGS grade 0 were classified into the low AGS group ( n=48), while those with AGS grades 1 and 2 were classified into the high AGS group ( n=136). The optimal cutoff value for SMI was determined using X-tile software: male patients with SMI>42.6 cm 2/m 2 or female patients with SMI>37.8 cm 2/m 2 were categorized into the high SMI group ( n=125), while those below these thresholds were categorized into the low SMI group ( n=59). Patients with AGS grade 0 and SMI>42.6 cm 2/m 2 for males or >37.8 cm 2/m 2 for females were classified into the CAS grade 1 group (n=32). Patients with AGS grades 1 or 2 and SMI ≤42.6 cm 2/m 2 for males or ≤37.8 cm 2/m 2 for females were classified into the CAS grade 3 group ( n=43). The remaining patients were classified into the CAS grade 2 group ( n=109). Clinical characteristics were compared across these groups. Cumulative survival rates were estimated using the Kaplan-Meier method, and survival curves were plotted to analyze the relationship between AGS, SMI, and CAS classifications and overall survival after pancreatic cancer surgery. Differences among groups were assessed using the Log-Rank test. Receiver operating characteristic curves (ROC) were plotted, and the area under the curve (AUC) was calculated to evaluate the predictive efficacy of AGS, SMI, and CAS on postoperative survival. Results:Compared to the high AGS group, the low AGS group exhibited higher SMI values [(46.17±9.63) cm 2/m 2vs (44.11±7.43) cm 2/m 2], and a lower incidence of lymph node metastasis (16 vs 66, 33.3% vs 48.5%). The mortality rate in the low AGS group was 50.0%(24/48), significantly lower than the 70.6% (96/136) observed in the high AGS group, with a median overall survival of 22.08 months (95% CI 16.87-29.62) longer than 13.1 months (95% CI 8.84-18.82) in high AGS group. Compared to the low SMI group, the high SMI group had a lower prevalence of metabolic diseases (26.4% vs 44.1%). The mortality rate in the low SMI group was 78.0% (46/59), higher than the 58.4% (73/125) in the high SMI group, with a median overall survival of 12.97 months (95% CI 9.37-18.20) obviously shorter than 16.20 months (95% CI 10.7-24.12) in high SMI group. Lymph node metastasis rate for CAS grade 1, 2, and 3 was 34.4% ( n=11), 44.0% ( n=48), and 62.8% ( n=27), respectively, with corresponding mortality rate of 34.3% (11/32), 67.9% (74/109), and 79.1% (34/43), and median overall survival time of 25.55 months (95% CI 19.49-30.07), 14.10 months (95% CI 10.22-19.14), and 12.5 months (95% CI 8.53-18.00), respectively. All the differences were statistically significant (all P value <0.05). Kaplan-Meier survival analyses demonstrated that patients in the low AGS group had significantly longer overall survival than those in the high AGS group in both the training and validation cohorts. Similarly, patients in the high SMI group had longer overall survival compared to those in the low SMI group. Notably, patients in CAS grade 1 exhibited the longest overall survival, whereas those in CAS grade 3 had the shortest. ROC curve analysis revealed that the AUC for CAS classification was superior in the training cohort (0.649) compared to AGS (0.588) and SMI (0.593), and in the validation cohort (0.644) compared to AGS (0.587) and SMI (0.577). Conclusions:CAS classification could effectively predict postoperative prognosis in pancreatic cancer patients, with higher CAS grades correlating with poorer outcomes.

Objective:To investigate the clinical characteristics of de novo malignancies (DNMs) after liver transplantation (LT) and to study the clinical management strategies.Methods:Adult LT recipients who were regularly followed-up in the Organ Transplantation Center, the Affiliated Hospital of Qingdao University from January 2005 to April 2021 were enrolled in this study. The clinical characteristics of DNMs were retrospectively analyzed. Of 601 LT recipients, there were 105 females and 496 males, aged (51.4±9.6) years old. They were divided into the DNMs group ( n=26) and the non-DNMs group ( n=575) according to whether there were DNMs on followed-up. Clinical data including age, sex, basic diseases before LT and operation time were collected. These patients were follow-up in outpatient clinics. Results:Twenty-six patients were diagnosed to develop DNMs after LT, but there were 28 DNMs (of which 2 patients were diagnosed to have DNMs twice). The incidence of DNMs after LT was 4.3% (26/601), the median time from LT to DNMs was 42 (20, 70) months, and the cumulative incidence rates of DNMs were 0.5%, 2.0%, 6.3%, 21.0% and 34.5% at 1, 3, 5, 10 and 15 years after LT, respectively. Among the 28 DNMs, digestive system tumors were most common, with 17 lesions (60.7%), followed by 3 lesions (11.1%) of lung cancer, 2 lesions (7.4%) of lymphoproliferative diseases, and 1 lesion (3.7%) of cervical cancer, thyroid cancer, soft palate cancer, eyelid cancer, laryngeal cancer, and prostate cancer. The follow-up time of 55.9 (36.6, 102.5) months in the DNMs group after LT was longer than the 33.4 (18.5, 58.9) months in the non-DNMs group ( P<0.001). The 1, 5, and 10 year survival rates of patients with DNMs after LT were 96.3%, 83.5%, and 49.8%, respectively. The 1, 5, and 10 year survival rates of patients with non-DNMs after LT were 94.5%, 77.7%, and 75.4%, respectively. There was no significant difference in the cumulative survival rates between the two groups (log rank=0.402, P=0.526). Conclusion:The incidence of DNMs in LT recipients was 4.3%. The majority of them were digestive system tumors. Early diagnosis and treatment of DNMs significantly improved the prognosis and quality of life of these patients.