Objectives To investigate the etiological factors of gastric eosinophilic granuloma(GEG).Methods Clinical manifestations,histopathological features, diagnosis and treatment were analysed retrospectively.Reformed Giemsa staining was employed to detect the helicobacter pylori in 23 patients.Results There was a significant sex difference in patients with GEG. And the misdiagnosis was quite high before resection. Lymphoid follicles were found in 68 8% of the lesion tissues and helicobacter infection was detected in 69 6% of the patients. Increased eosinophils in peripheral blood was observed in 11 patients.Conclusions Helicobacter infection, estrogen and allergic reaction may be related to the development of GEG.

Objective To investigate the effect of pancreatic stellate cells on invasion and metastasis of human pancreatic cancer cell AsPC-1,and to determine the role of SDF-1 in this process.Methods PSCs were routinely isolated and cultured,and PSCs conditioned media(PSC-CM) was collected and concentrated.Different concentrations of PSC-CM,anti SDF-1 and their combination were used to treat AsPC-1 cells,and MTT assay was applied to detect the proliferation of pancreatic cancer cells.Transwell chamber migration assay was employed to detect the migration of AsPC-1 cells.In vitro invasion assay was used to determine the invasion of AsPC-1 cells.Results A490 values of AsPC-1 cell in control group and 0.25,0.5,1 μg/lμl PSCCM group were 0.437 ±0.041,0.472 ±0.048,0.553 ±0.057,0.690 ±0.051,and PSC-CM promoted cell proliferation in a dose dependant manner.The difference between 0.5,1 μg/μl PSC-CM group and control group,and between 1 μg/l and 0.5 μg/μl PSC-CM group was statistically significant (P＜0.05).A490 values of control group,anti SDF-1 group,PSC-CM group and PSC-CM ± anti SDF-1 group were 0.407 ±0.028,0.416 ±0.030,0.629 ±0.048,0.481 ±0.049.The numbers of penetrating cells were 35.3 ±7.1,34.8±5.6,140.9 ± 12.7,56.5±5.9,and the numbers of invasive cells were 27.1 ±2.9,29.1 ±4.2,81.5 ±8.2,46.4 ± 4.4.The difference between anti SDF-1 group and control group was not statistically significant.The proliferation,migration and invasion of pancreatic cancer cells in PSC-CM group was significantly higher than those of control group (P ＜0.05 or P ＜0.01).The proliferation,migration and invasion of pancreatic cancer cells in PSC-CM ± anti SDF-1 group was significantly lower than those of PSC-CM group,but they were significantly higher than those of control group (P ＜ 0.01).Conclusions PSCs can promote proliferation,migration and invasion of pancreatic cancer cells AsPC-1,and the mechanism may be partly due to SDF-1/CXCR4 receptor ligand axis.

Objective To investigate the effects of blockade on non-peptide specific SDF-1/CXCR4 receptor ligand system with AMD3100 on the proliferation and angiogenesis of human pancreatic cancer cells AsPC-1. Methods AsPC-1 was divided into control group, SDF-1α group, group, SDF-1α + AMD3100 group. MTT test was performed to determine the proliferative level of AsPC-1 cells. Vascular endothelial growth factor (VEGF) was detected with Western blotting assay. Immunohistochemistry was used to detect the microvessel density (MVD) in subcutaneous xenografts of AsPC 1 of nude mice model, which was intratumorally and peritumorally injected with AMD3100. Results SDF-1α could induce the proliferation of AsPC-1(1.430 ±0. 122 vs 1. 002 ± 0. 001, P <0. 05). While the proliferative effect induced by SDF-1α could be inhibited by AMD3100 (0.983 ±0. 068vs 1.430 ± 0. 122, P <0.05). SDF-1α could induce the expression of VEGF (0. 565 ± 0. 047 vs 0. 439 ± 0.034, P < 0.05). While the protein expression of VEGF induced by SDF-1α on AsPC-1 cells was inhibited by AMD3100 (0. 450 ± 0. 071 vs 0. 565 ± 0. 04, P <0. 05). The growth and angiogenesis of subcutaneous xenografts of nude mice model were inhibited by AMD3100; the tumor inhibitory rate was 59. 5% at 24th day. The MVD of xenografts was significantly decreased (28.56 ± 6.94 vs 98.75 ± 20. 60, P < 0. 01 ). Conclusions AMD3100 could inhibit the proliferation and angiogenesis of AsPC-1 cells both in vitro and in vivo.

Objective To investigate the expressions of stromal cell-derived factor1 (SDF-1) and its receptor CXCR4 in human pancreatic carcinoma tissues, cell lines and pancreatic stellate cells (PSCs). Methods SDF-1 /CXCR4 and α-SMA protein expression levels and SDF-1 and CXCR4 protein in AsPC-1 and PSCs were detected by immunohistochemical staining in 10 cases of peri-eareinoma tissues and 37 cases of pancreatic carcinoma tissues. The expression of SDF-1 and CXCR4 mRNA in pancreatic cell lines and PSCs were detected by RT-PCR. Results CXCR4 were positively expressed in all pancreatic carcinoma tissues [(+) 8 cases, (+ +) 20 cases, (+ + +) 9 cases]; and there were no CXCR4 expression in 2 cases of pori-careinoma tissues and CXCR4 were positively expressed in 8 cases [(+) 7 cases, (+ +) 1 cases]; with significant difference (P <0.01). And the expression of SDF-1 protein in carcinomatous stromal tissues was much higher than that in the stromal tissues of peri-carcinoma (P < 0.01), and it corresponded to the increase of α-SMA expression. The CXCR4 protein expression was found in AsPC-1, while SDF-1 protein expression was found in PSC. The CXCR4 mRNA expression was found in AsPC-1, BxPC3, SW1990, while there were no SDF-1 mRNA expression in the above mentioned cell lines. SDF-1 mRNA was expressed in PSC and CXCR4 mRNA was weakly expressed in PSC. Conclusions The expression of CXCR4 mRNA and protein were found in pancreatic carcinoma specimens and cell lines. PSCs expressed SDF-1 mRNA and protein. PSCs may promote the invasion and metastasis through SDF-1/CXCR4 axis.

Objective To investigate the expression of chemokine receptor (CXCR)4 in human pancreatic cancer cell lines,and its association with proliferation,adhesion and invasion of pancreatic cancer cells.Methods The CXCR4 mRNA and protein in three pancreatic cancer cell lines were detected by RT-PCR and Western blotting,respectively.Confocal microscopy was used to detect the fluorescence intensity induced by SDF-lα in AsPC-1 cells.MTT test was performed to study the proliferation of pancreatic cancer cells.The invasive ability of pancreatic cell lines was determined by transwell invasion assay kit and the adhesive ability was detected by cell adhesive test in vitro.Results There were expressions of CXCR4 mRNA and protein in different extent in three pancreatic cancer cell lines.The strong expression was seen in AsPC-1 cell line,but weak expression in SW1990 cell line.The CXCR4 was functional expressed on AsPC-1 ceils.SDF-1α improved the proliferation,adhesion and invasion of three pancreatic cancer cell lines,especially in AsPC-1 cell line,while the proliferation in SW1990 cell line was weak.But all above effects of the SDF-1α could be inhibited by AMD3100.Conclasions CXCR4 mRNA and protein were expressed in pancreatic cancer cell lines.The efficacy that SDF-1 can increase the invasive ability of pancreatic cancer ceils through SDF-1/CXCR4 axis is closely related to the expression of CXCR4.

Objective To report the preliminary result of cylindrical abdominoperineal resection (cylindrical APR) and pelvic reconstruction with human acellular dermal matrix (HADM). Methods Cylindrical APR was performed in 13 consecutive patients with advanced very low rectal cancer between January 2008 and April 2009. The mesorectum was not dissected off the levator muscles at abdominal part of the operation, the perineal part of the operation was done in the prone position. The levator muscles were exposed circumferentiaUy. The coccyx and part of the 5th sacrum were dissected and Waldeyer" s fascia divided. The levator muscles were divided laterally on both sides from posterior to anterior. The remaining pelvic floor muscle fibers were divided just posterior to the transverse perineal muscles and the levator muscles were resected en bloc with the anus and lower rectum. The specimen was cylindrical. The pelvic defects were reconstructed with HADM. Results There was no bowel perforation, and all specimens were proved CMR negative by pathology. Perineal wounds were healed uneventfully. After 8 months" follow-up, no patient developed perineal wound breakdown, bulge or hernia. There was 1 patient developed perineal wound infection; one patient developed seroma and three with perineal pain. Five patients with short-term urinary retention recovered within 10 days. Conclusion Clinical APR and HADM pelvic reconstruction can reduce circumferential margin positive and rectum perforation rate, and made the procedure easier and safer without increasing complications.

Objective To evaluated intra-articular injection of TNF-α inhibitors into the sacroiliac joint as an effective and viable alternative. Methods Sixteen patients with documented ankylosing spondylitis (AS), without steroids or disease modifying anti-rheumatic drugs (DMARDs) were performed CT-guided intra-articular injections of etanercept (TNF-α antagonist) at week 0, 4 and 8 (25 mg per dose). Similarly, 20 patients with AS in the control group received systemic etanercept therapy at a dose of 50 mg per week for 8 weeks. All patients were followed up clinically and evaluated periodically. Pathological features of sacroiliitis were observed with light microscopy and immunohistochemistry. Expression of cytokines in joint biopsy samples was estimated by RT-PCR. Image changes of sacroiliitis were observed by SPECT/CT and MRI. Ttest, t'tesr and χ2 Fisher's test were selected. Results All the 16 patients who received intra-articular etanercept, the mean value of radiological nuclide decrease of the SIJ ROI (region of interest) in the SPECT improved significantly after 8 weeks treatment [(1.38±0.16 vs 1.45±0.14) P<0.05] . Bone marrow edema and fat deposition in MRI were relieved significantly after 8 weeks (P<0.05). In 8 patients the expression of TNF-α and TGF-β mRNA in joint tissue decreased significantly after 8 weeks [(0.89±0.06, 0.84±0.05) vs (l.08± 0.19, 1.13±0.33) (P<0.05)]. The occurrence of gynonitis, enthesitis, chondritis, subehondral bony plate destruction, bone marrow inflammation and inflammatory cell index also decreased significantly (P<0.05). Participants given intra-articular injection showed significant clinical improvement after 8 weeks and 12 weeks treatment(P<0.01 ) in BASDAI score [(32±13) mm]. Conclusion This study has shown that intra-articular injection of etanercept in SIJ can improve joint function and quality of life. It has a satisfactory safety profile and is cost effective. This mode of treatment is most beneficial in local arthropathy of recent onset and in those patients who do not tolerate systemic etanercept therapy.

Objective: To explore the effectiveness of KeyPort access in transanal endoscopic mircrosurgery (TEM). Methods: A descriptive case series study was performed. Clinicopathological data of 20 patients undergoing KeyPort access TEM in Beijing Chaoyang Hospital of Capital Medical University from December 2016 to April 2018 were collected and analyzed retrospectively. Procedure of KeyPort access TEM: general anesthesia or combined spinal epidural anesthesia (CSEA); lithotomy or prone jack-knife position; anal dilation; placement of the KeyPortaccess; connection of TEM pneumoperitoneum device, light source and imaging equipment; placement of 5 mm dedicated endoscope; insufflation of CO2 with pressure of 1.6-2.0 kPa (12-15 mmHg); after rinsing the intestinal lumen, circular resection marginlabeled by the needle-shaped electrocautery;electric coagulation or ultrasonic knife used to perform a full-thickness resection with a 0.5 cm-1 cm margin along the marking line. Indications of KeyPort access TEM: (1) benign large sessile polyps which were difficult to resect under colonoscopy; (2) submucosal lesions with diameter <2 cm; (3) Tis and T1 stage rectal carcinoma without lymph node metastasis; (4) palliative resection of T2 stage rectal carcinoma without lymph node metastasis. Contraindications: (1) accompanying serious diseases without the tolerance of anesthesia and operation; (2) distance from lesion to anal verge >20 cm. Results: There were 10 males and 10 females with age of (63±15) years old and BMI of (24.5±3.3) kg/m². The diameter of the lesions was (2.0±1.3) cm, and the distance from lesion to anal verge was (6.2±2.2) cm. One patient had 3 lesions at different positions in rectum with diameters of 0.5 cm, 0.5 cm, and 1 cm, respectively. All operations were accomplished through the KeyPort access TEM and no case was transferred to other methods. The duration of surgery was 75 (30-220) minutes; intraoperative blood loss was 10 (0-30) ml. Two patients with rectal anterior wall lesions underwent full-thickness resection of the intestine wall reaching the peritoneal reflex with penetration into the peritonealcavity, and received suture closure immediately. For the patient with 3 rectal lesions, the 1.0 cm lesion received a full-thickness resection and the other 2 lesions received submucosal resection. No postoperative complication occurred. Postoperative pathology showed that there were 1 case of chronic inflammatory lesion, 4 cases of benign tumor, 3 cases of carcinoma in situ, 4 cases of neuroendocrine tumor, 6 cases of pT1 rectal cancer, 2 cases of pT2 rectal cancer (both invading the superficial muscle layer). The median hospital stay was 6 (3-7) days. The postoperative follow-up was (7.2±3.8) months. No postoperative complication or recurrence was observed. Conclusion TEM with KeyPort access is safe, rapid and effective in the treatment of rectal tumors.

Objective:To investigate the efficacy of clinical pathway teaching method in standardized training of general practitioners in gastroenterology.Methods:From 2018 to 2019, 40 residents who participated in the standardized training of general practitioners in the Department of Gastroenterology, Zhongshan Hospital Qingpu Branch, Fudan University Medical College were randomized into the experimental group and the control group. The residents of the experimental group were trained by clinical pathway teaching method, while the control group were trained by traditional methods. After 6 weeks' teaching, theoretical examination, operation skills and case analysis test were assessed and satisfaction surveys were conducted.Results:The operation skills and case analysis scores of the experimental group were significantly better than those of the control group [operation test (91.50±2.77) vs. (89.80±3.74), P<0.01; case analysis (92.10±1.98) vs. (86.40±2.87), P<0.01]. The teaching satisfaction of the experimental group was significantly higher than that of the control group, and the difference was statistically significant ( P<0.01). Conclusion:The teaching model of clinical pathway can improve the teaching quality of the residents in the department of gastroenterology, improve the satisfaction of the doctors in the training, and broaden clinical thinking, which is worthy of promotion in clinical teaching.

OBJECTIVETo evaluate the laparoscopy combined with transperineal extralevator abdominoperineal excision (TP-ELAPE) for locally advanced low rectal caner.

METHODSClinical data of 12 patients with locally advanced low rectal cancer undergoing laparoscopy combined with TP-ELAPE in our department from May 2013 to March 2015 were retrospectively analyzed. There were 8 male and 4 female patients with median aged of 63 (46 to 72) years. The median distance from tumor lower margin to anal verge was 3.5(2.0 to 4.0) cm. A self-made transanal suit for minimally invasive operation was used to make a sealed lacuna outside the sphincter, thus laparoscope can be applied to perform transperineal operation.

RESULTSAll the patients underwent operations successfully without conversion to open abdominal operation. The median operating time was 206 (180 to 280) minutes with perineal operating time 95(80 to 120) minutes. The median intraoperative blood loss was 120(50 to 200) ml. The median postoperative hospital stay was 12(9 to 18 ) days. Postoperative pathology revealed that all circumferential margins (CRM) were negative. The area of sample horizontal section was (2 824±463) mm(2), and of outer muscularis propria was(2 190±476) mm(2). Postoperative complications included chronic sacrococcygeal region pain in 2 cases, urinary retention in 3 cases, perineal wound infection in 1 case. No perineal seroma, perineal hernia, wound dehiscence and sinus tract formation were observed. Among 8 patients with preoperative normal sexual function, sexual dysfunction occurred in 2 patients. There was no local recurrence and metastasis during a median follow-up of 21(12 to 34) months.

CONCLUSIONLaparoscopy combined with TP-ELAPE has the potential to simplify the operation procedure for low rectal cancer, can ensure the radical treatment and safety of operation, and may be carried out in experienced centers.

Abdomen ; Aged ; Anal Canal ; Blood Loss, Surgical ; Digestive System Surgical Procedures ; methods ; Female ; Humans ; Laparoscopy ; Length of Stay ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Operative Time ; Perineum ; Postoperative Complications ; Postoperative Period ; Rectal Neoplasms ; surgery ; Rectum ; Retrospective Studies