Proton pump inhibitors as a kind of acid drug are widely used in clinical.However,it is overused all over the world although generally safe and effective.Studies have shown the uncertainty of potential long-term adverse effects,especially the contact with the mechanism of gastric cancer.Clinicians should pay more attention to the potential carcinogenic risk of long-term proton pump inhibitors in treatment.The mechanism of pathophysiology and the clinical researches of proton pump inhibitor-induced gastric neuroendocrine tumors,gastric carcinoma,and gastric cardia cancers are summarized as follows.

Objective To study the safety and efficacy of laparoscopic splenectomy and portoazygous devascularization for portal hyperteation.Methods The data of 58 patients who underwent laparoscopic splenectomy and portoazygous devascularization were retrospectively collected and analyzed.Results The operative time for laparoscopic splenectomy and portoazygous devascularization was (2.6 ±0.6) hours.The intraoperative bleeding was (149.5 ± 32.7) ml.The time taken for the bowel to return function was 3.5 ±1.3 days.The hospitalization time was (5.1 ± 1.2) days.When the splenic volume was greater than or equal to 1.5 liters, the conversion to open surgery rate significantly increased [36.0％ (5/14);P ＜ 0.05].The 1, 2, 3, and 4 years cumulative recurrent gastrointestinal bleeding rates were 0, 5.2％, 10.0％, and 15.8％, respectively.Conclusions Laparoscopic splenectomy and pericardial devascularization was safe, efficacious and feasible.When the splenic volume was greater than 1.5 L, whether laparoscopic surgery should be attempted requires further research.

Objective To investigate the expression of heparanase and vascular endothelial growth factor-C (VEGF-C) protein in human gastric carcinoma, and to evaluate its clinical implications during the progress of gastric carcinoma. Methods The expression of heparanase and VEGF-C protein in 97 cases of gastric cancer, adjacent tissues and normal tissues in 20 subjects was determined by immuno- histochemistry. Results The positive rate of heparanase and VEGF-C protein in tumor tissues (61.9% and 66.0%) were significantly higher than those in adjacent tissues of cancer (7.2% and 5.0%) and normal tissues (8.3% and 5.0%, P 0.05) . The positive expression of VEGF-C protein in the tumor tissues was significantly related with serosal infiltration, lymphatic invasion, lymph node metastasis and TNM stage Ⅲ-Ⅳ (P0.05). The 1, 3 and 5-year survival rates of patients with expression of heparanase or VEGF-C protein were significantly less than that of patients without expression of heparanase or VEGF-C (P

Objective To investigate the prognostic significance of proteolysis-inducing factor (PIF) in gastric cancer patients.Methods Biopsies of the rectus abdominis muscle were obtained intra operatively from 53 gastric cancer patients and 53 subjects undergoing surgery for benign abdominal diseases,muscle and serum PIF,ubiquitin expression,and proteasome proteolytic activities were assessed through reverse-transcription polymerase chain reaction (RT-PCR),Western blot,and enzyme-linked immunosorbent assay (ELISA).Results PIF was significantly upregulated in muscle of gastric cancer compared to control muscles.PIF was upregulated in 60％ (32/53) muscle of gastric cancer.Over expression of PIF in muscles of gastric cancer were associated with level of serum albumin,tumor node metastasis (TNM) stage,and percent of weight loss.The survival rate of patients with a high expression of PIF was significantly lower than those in patients with low expression (P ＜ 0.05).Conclusions PIF was significantly upregulated in muscle of gastric cancer,over expression of PIF in muscles of gastric cancer was associated with level of serum albumin,TNM stage,percent of weight loss,and prognosis.PIF might play an important role in progression and prognosis of gastric cancer.

Objective To investigate the impact of enteral nutrition (EN) through jejunal feeding tube on the nutritional status and immunologic function of patients during chemotherapy after total gastrectomy.Methods Totally 86 patients with gastric cancer who had undergone total gastrectomy with radical resection and jejunostomy received adjuvant venous chemotherapy in our department from January 2009 to June 2010.They were divided into EN group ( n =43 ) and control group ( n =43 ) according to the hospitalization number.The EN group maintained the jejunostomy tube until the end of 6 courses of chemotherapy,and was given EN support for 7 days through jejunal tube during each course of chemotherapy; the control group removed the tube before chemotherapy without further dietary restriction or nutrition support.The nutritional and immunologic indicators on the 1 st day before chemotherapy and the 1st day after 6 chemotherapy courses were measured.ResultsThree patients in the EN group withdrew from the study because of catheter blockage or catheter loss and 2 patients in the control group failed to complete the trial because of chemotherapy side effects or economic reasons; 81 patients entered the final analysis.After 6 courses of chemotherapy,both groups experienced body weight loss,but the percentage is significantly lower in EN group than in control group (6.9％ ± 0.95％ vs.11.2％ ± 1.32％,P =0.0000).Compared with the nutritional status before the first chemotherapy,the prognosis nutritional index (PNI) in both groups declined after the 6th chemotherapy.Such decline was not statistically significant in EN group ( P =0.1534) but was significant in control group (P =0.0000).The PNI in EN group after chemotherapy was significantly higher than that in control group (P =0.0040).The levels of IgG,NK,CD4 +,and CD4 +/CD8 + were significantly higher in EN group than in control group ( P =0.0083,0.0143,0.0000,and 0.0000,respectively) after chemotherapy.ConclusionEN during postoperative chemotherapy may improve the nutritional status and immunologic function in gastric cancer patients after total gastrectomy.

Objective To improve the quality of life in gastric cancer patients after total gastrectomy by exogenous trypsin supplement.Method In this study 106 patients were divided into two groups,with 53 patients in each group,oral pancreatic enzyme capsule was given in comparison without in control group.Patients were asked to fill in EORTC QLQ-C30 questionnaire and Korenaga questionnaire at half a year postoperation,stool sample was collected at the same time for fecal fat assay.Results A total of 86 patients completed this test at postoperation half a year.With a comprehensive assessment of quality of life in patients by the scoring system of EORTC QLQ-C30 and Korenaga and the fecal fat contents measurement.Exogenous trypsin plays a positive role in preventing weight loss,improving emotional function,alleviating loss of appetite,insomnia,fatigue,postprandial fullness,nausea,vomiting and diarrhea,and improving intestinal tolerance to fat and the overall health status of patients.Conclusions Total gastrectomy causes exocrine pancreatic dysfunction,exogenous supplement of the enzyme improves postoperative quality of life in these patients.

Objective To evaluate the advantage of transabdominal modified Sugiura procedure Methods We retrospectively analyzed 45 cases undergoing transabdominal modified Sugiura procedure from May 1997 to May 2003 The procedure included devascularization of near half gastric and inferior part of esophagus after splenotomy The left and right vagus nerves, the anterior and posterior Latarjet nerves and paraesophageal collateral veins were left intact The gastric submucous vasculature was sutured on the plane 3～5 cm distal to cardia (suture group); or the esophagus 3 cm above cardia was cut and reanastomosed with pipe anastomat Results There was no inhospital mortality Free portal veinous pressure and portal vein flow speed did not change significantly The flow volume of portal vein decreased ( P

Objective To investigate the expressions of myostatin (MSTN) in the gastric cancer patients' rectus abdominis and serum,and to discuss its relation with the nutritional status and outcome of the gastric cancer patients.Methods We recruited 102 patients with gastric cancer and another 53 patients with benign abdominal disease who were admitted to Zhejiang Province People's Hospital and Tongde Hospital of Zhejiang Province from February 2008 to February 2011.We tested MSTN expression in the malignant patients' rectus abdominis and serum using reverse transcription polymerase chain reaction,Western blot,and enzymelinked immunosorbent assay.Relationship between MSTN expression and nutrition status of gastric cancer patients was explored.Results The relative expression of MSTN mRNA of rectus abdominis muscle in gastric cancer group and control group was 3.43 ± 1.11 and 1.07 ± 0.31 (t =19.406,P ＜ 0.01),the relative expression level of MSTN protein in gastric cancer group and control group was 0.115±0.696 and 0.085±0.499 (t=2.856,P＜0.05) and its serum expression 8.79±4.32 and 1.21±0.55 in these two group (t =16.701,P＜0.05),showing significant difference.The high (defined as higher than median) expression of MSTN in rectus abdominis muscle of gastric cancer patients was significantly correlated with age (x2 =22.039,P =0.000),percentage of more than 10％ decline in body weight in half a year (x2 =14.365,P=0.000),body mass index (BMI) ＜22 kg/m2 (x2 =6.800,P=0.009),serum albumin (x2 =31.018,P=0.000),hemoglobin (x2=10.079,P =0.001),prognostic nutritional index (x2 =10.074,P =0.002),higher Nutritional Risk Screening 2002 Score (Z=2.628,P=-0.009),tumor stage of TNM (Z=2.550,P=0.011).The expression of the rectus abdominis muscle in patients with gastric cancer was significantly correlated with the survival rate of the patients (x2 =12.200,P＜0.01).Conclusions The expression of MSTN increases in the rectus abdominis and serum of gastric cancer patients with cachexia.The increased MSTN expression is closely related with malnutrition and TNM stage in these patients,suggesting MSTN may also play an important role in the muscle consumption of the gastric cancer patients.

Objective To evaluate effects of alimentary reconstruction procedures (integral continual jejunal interposition, Billroth Ⅱ and isolated jejunal interposition) after subtotal gastrectomy on postoperative plasma gastrin, motilin and cholecystokinin. Methods Twenty-four dogs were divided into 3 groups undergoing distal subtotal gastrectomy and three different digestive tract reconstruction (integral continual jejunal interposition, Billroth Ⅱ and isolated jejunal interposition). The concentration of plasma gastrin, motilin and cholecystokinin were detected by enzyme-linked immunosorbent assay before and after operation. Results Two months after operation, plasma gastrin level of the integral continual jejunal interposition group (2. 2 ±0. 7 ) ng/L, ( 3.9 ± 0. 8 ) ng/L was significantly lower than that of preoperative both in fasting and postprandial state (3.8 ± 1.0) ng/L, (5.3 ± 1.6) ng/L, all P ＜0.05, but was significantly higher than other two groups in postprandial state (2. 7 ± 1.0) ng/L, (3.6 ±0. 6) ng/L, P ＜0. 05. Two months after operation, plasma motilin concentration of integral continual jejunal interposition group (577 ±204) ng/L, (1003 ± 209) ng/L were significantly higher than that of preoperative both in fasting and postprandial (429 ± 128) ng/L, (854 ± 218 ) ng/L, P ＜ 0. 05. The postoperative plasma motilin of integral continual jejunal interposition group ( 1003 ± 209 ) ng/L was significantly higher than other two groups in postprandial state (840 ±205) ng/L, (986 ± 189) ng/L, P ＜0. 05. Two months after operation,plasma cholecystokinin concentration of integral continual jejunal interposition group ( 19.6 ± 2.0 ) ng/Lwere significantly higher than that of preoperative both in postprandial ( 19.0 ± 2. 0) ng/L, P ＜ 0. 05. The postoperative plasma cholecystokinin of integral continual jejunal interposition group ( 19. 6 ± 2. 0) ng/L was significantly lower than other two groups (22.2 ± 2. 1 ) ng/L, (20. 1 ± 2. 5 ) ng/L, P ＜ 0. 05. Conclusion Integral continual jejunal interposition after distal gastrectomy maintains the postoperative plasma motilin and gastrin in a relatively higher level and decreases the concentration of plasma cholecystokinin.

Objective To compare the quality of life,nutritional status and immune function of gastric cancer patients with digestive tract reconstruction using Roux-en-Y anastomosis and uncut Roux-en-Y anastomosis after radical gastrectomy.Methods 86 patients with gastric cancer were selected from May 2015 to June 2017 with radical total gastrectomy.According to the different ways of the reconstruction of the digestive tract,the patients were divided into URY group (non-severed group,41 patients) and RY group (traditional group,45 patients).The quality of life of the two groups was compared at 1 month,3 months and 6 months after operation.The nutritional status of albumin,prealbumin,transferrin,hemoglobin,retinol binding protein and weight,as well as CD4+ lymphocyte,CD8+ lymphocyte,CD4+/CD8+ ratio,IgG,IgM,IgA and other immune related indexes were observed at pre-operation and 1 month,3 months and 6 months after operation.Results As for quality of life,the score of diet limitation in group URY was significantly lower than that in group RY at 1 month after operation (P＜0.05),and no significant difference at 3 months and 6 months after operation (P＞0.05);As for anxiety,the score of group URY was higher than that in group RY (P＜ 0.05) at 1 month after operation (P＜0.05),and was lower than that in group RY at 3 months and 6 months after operation (P＜0.05).As for dry mouth,group URY was higher than that in group RY (P＜0.05) at 3 months and 6 months after operation (P＜0.05),and the other indexes were not statistically significant (P＞ 0.05).As for the nutritional indexes,prealbumin in the URY group was higher than that in the RY group at 6 months after operation (P＜0.05),and the rest were not statistically significant (P＞0.05).There was no statistical significance in immune indexes between the two groups (P ＞ 0.05).The postoperative hospitalization time of URY group was less than that of RY group (P＜0.05),and the incidence of mild reflux symptoms was lower than that of RY group (P＜0.05).There was no significant difference in the incidence of other complications between the two groups (P＞0.05).Conclusion Except for the length of hospitalization and postoperative complications in which uncut Roux-en-Y anastomosis was superior to Roux-en-Y anastomosis,there is no significant difference in quality of life and nutritional and immune indicators between the two alimentary tract reconstruction methods.