Background: Chronic atrophic gastritis (CAG) is a precancerous lesion of gastric cancer.The diagnostic value of serum gastrin-17 (G-17) level for CAG differs substantioulsy, and Helicobacter pylori (Hp) infection may play an important role.Aims: To explore the effect of Hp infection on serum G-17 level, and the diagnostic value of serum G-17 level for CAG under different Hp infection status.Methods: A total of 204 patients with chronic non-atrophic gastritis and 81 patients with CAG from May 2014 to May 2015 at the three different hospitals were enrolled.Gastroscopy was performed, fasting serum G-17 level, postprandial serum G-17 level and Hp-IgG antibody were determined by ELISA.Results: Fasting serum G-17 level was significantly increased in Hp positive group than in Hp negative group (P=0.001), and postprandial serum G-17 level was significantly decreased in CAG group than in non-atrophy group (P=0.002).AUC of fasting serum G-17 level for diagnosing Hp positive and negative CAG were 0.634 (95% CI: 0.537-0.732) and 0.576 (95% CI: 0.478-0.675), respectively, the accuracy were 62.6% and 54.9%, respectively.AUC of postprandial serum G-17 level for diagnosing Hp positive and negative CAG were 0.675 (95% CI: 0.581-0.769) and 0.595 (95% CI: 0.495-0.694), respectively, the accuracy were 61.8% and 53.1%, respectively.Conclusions: Hp infection has impact on serum G-17 level, as a result, the diagnostic value of G-17 level for CAG is different for patients with and without Hp infection.Diagnostic values of fast and postprandial serum G-17 for Hp positive CAG are higher than Hp negative CAG.

Objective To explore the etiology,clinical manifestations,diagnoses,treatments and prognoses of spontaneous spinal epidural and subdural hematomas.Methods Medical records of 10 patients with spontaneous spinal epidural hemorrhage and 4 patients with subdural hemorrhage,collected in our hospital from September 2013 to January 2016,were analyzed retrospectively.Evacuation of the hematoma was carried out in 12 patients and the other two patients were treated conservatively.The functions of spinal cords were assessed by American Spinal Injury Association impairment scale (ASIA) before and after the treatment.Results Spontaneous spinal epidural and subdural hematomas appeared mostly in young patients with sudden onset.Spinal epidural hematomas were much more common than subdural ones.The pathological examination showed that one suffered from arteriovenous malformation,one suffered from perimedually artriovenous fistula,and 12 had intracranial hematomas which were resulted from undefined causes.The ASIA before the operation was as follows:5 were in grade A,2 in grade B,4 in grade C and 3 in grade D.The ASIA after the operation was as follows:4 were in grade A,one in grade C,3 in grade D and 4 in grade E.The two patients received conservative treatments achieved total recovery of the neurological functions (grade E).Conclusions It should be stressed that early diagnosis and prompt surgical intervention are of great importance for prompt of spontaneous spinal epidural.The better the preoperative neurological status,the better the neurological outcome after the surgical operation.

Objective To evaluate the adenoma detection rate( ADR)of fecal occult blood test (FOBT)-positive population in colorectal cancer screening programme and to analyse potential influence of“resection and discard”strategy on ADR. Methods Data of patients who paticipated in the Shanghai color-ectal cancer screening programme with FOBT-positive and received colonoscopy in the Digestive Endoscopic Center of Changhai Hospital from July 2013 to July 2014 were retrospectively analysed. ADR was calculated and compared by different genders. Multivariate logistic regression model was used to analyse the risk factors of polyp resection without retrieval. Results A total of 222 FOBT-positive patients were involved with 36. 5% male proportion. The total ADR was 19. 8%,higher in male(28. 4%)than in female(14. 9%)(P=0. 015). The independent risk factors of polyp resection without retrieval were diminutive polyp( OR =15. 256,95% CI:4. 159-55. 957),located in rectum( OR = 3. 663,95% CI:1. 427-9. 398) and polyp number >2(OR= 3. 988,95%CI:1. 562-10. 187).Conclusion ADR of FOBT-positive population is approx-imately 20%in our center. Low male proportion and“resection and discard”strategy may lead to lower ADR. ADR should be calculated by different genders and advanced endoscopic technology should be employed rou-tinely to predict the pathological diagonosis of the lesions.

Objective To develop a scoring system to determine peptic ulcer risks and to evaluate its screening efficiency.Methods A total of 862 people who underwent gastroscopy for the first time ranging from 18 to 45 years old were enrolled in this study.They were divided into two cohorts with the method of simple random sampling,514 in the original cohort and 348 in the validation cohort.Information such as demographic characteristics,dietary intake,lifestyle,symptoms relating to peptic ulcer was obtained.A multivariable logistic regression method was used to determine independent predictors of peptic ulcer.Based on the logistic regression model,a scoring system was developed with a regression coefficient-based scoring method.Then the scoring system was internally and externally validated.Each value of calibration,discrimination and accuracy were computed and then compared with those of original cohort to assess its screening efficiency.Results Three variables (gender,smoking and melena) composed the scoring system with scores ranging from 0 to 4 points.It had good calibration (P =0.956) and discrimination (area under the ROC =0.70,95％CI:0.65-0.76).With 2.5 points as the screening cutoff value,the sensitivity,specificity,accuracy rate,positive predictive value,negative predictive value,positive likelihood ratio and negative likelihood ratio were 49.5％,82.2％,75.5％,41.6％,86.4％,2.78 and 0.61,respectively.In the validation cohort,the sensitivity,specificity,accuracy rate,positive predictive value,negative predictive value,positive likelihood ratio and negative likelihood ratio were 27.2％,92.7％,71.3％,64.6％,72.3％,3.89 and 0.79.The results above indicated that the screening efficiency of the scoring system in the original cohort was similar to that in the validation cohort.Conclusion The scoring system to determine peptic ulcer risks,containing gender,smoking and melena,has good screening efficiency and can be applied to predict the risks of peptic ulcer.

BACKGROUND:Deep vein thrombosis is a common postoperative complication after spinal surgery in clinical department of neurosurgery anddepartment of orthopedics. Deep vein thrombosis is mostly related to vein intima injury, stasis and activation of blood coagulation factor. Early effective prediction can effectively avoid the adverse effects on the prognosis of patients with deep vein thrombosis. D-dimer used in the prediction of deep venous thrombosis has high sensitivity and specificity, andcan be used as a sensitive predictor for deep vein thrombosis. OBJECTIVE:To explore the relationship between plasma D-dimer mass concentration and deep vein thrombosis after spinal surgery. METHODS:A total of 83 patients treated with spinal surgery colected fromDepartment of Neurosurgery, First Affiliated Hospital of Xinjiang Medical University from April 2014 to August 2015 were retrospectively analyzed. They were divided into two groups according to postoperative plasma D-dimer mass concentration:D-dimer positive group (n=48) and D-dimer negative group (n=35). We monitored D-dimer mass concentration in both groups preoperatively and postoperatively 1, 3, 5, 9 and 14 days, and analyzed the relationship between D-dimer mass concentration and deep vein thrombosis. RESULTS AND CONCLUSION:(1) No significant difference in D-dimer mass concentration was determined between the two groups (P> 0.05). D-dimer mass concentration was significantly higher in the D-dimer positive group than in the D-dimer negative group 1, 3, 5, 9, and 14 days postoperatively (P<0.05). (2) After operation, plasma D-dimer of 28 cases was positive, with persistent increasing. Double lower limb deep vein color Doppler ultrasound demonstrated that seven patients experienced deep vein thrombosis and four patients suffered from pulmonary embolism in D-dimer positive group. There was no deep vein thrombosis and pulmonary embolism in the D-dimer negative group. (3) These results indicate that positive D-dimer concentration of patientsafter spinal surgery suggests the possibility of deep vein thrombosis. If the concentration of D-dimer is persistently high, we should highly alert to the occurrence of deep vein thrombosis.

Objective To discuss the efficacy and safety of endoscopic endonasal transsphenoidal surgery for sympatomatic Rathke' s cleft cysts.Methods The clinical manifestations, imaging features, surgical methods, pathology features, postoperative complications, postoperative recurrence and outcomes of 24 patients with Rathke's cleft cysts, admitted to our hospital from January 2007 to December 2014, were reviewed retrospectively.Results Total resection was achieved in 0 patient and subtotal resection was achieved in 24 patients.In the 16 patients with headache, 4 got relief and 12 achieved cure.In the 9 patients with hypopsia, 3 recovered to normal, 5 got improvement and one enjoyed no obvious changes.In the 21 patients with endocrine function disorder, 2 recovered to normal, 2 got improvement and one had transient diabetes insipidus.One patient appeared transient diabetes insipidus.Nine patients had transient decreased thyroid hormones, and those patients with progesterone, follicle stimulating hormone, luteinizing hormone, growth hormone and prolactin disorders recovered to normal;one patient got postoperative recurrence and accepted surgery for the second time.Conclusion Endoscopic endonasal transsphenoidal surgery is a rational choice for sympatomatic Rathke' s cleft cysts, which can effectively perform the cyst drainage and resection of the capsule wall, enjoying small trauma, safety and low postoperative recurrence rate.

Objective To report outcomes of patients with PSA ≥ 30 μg/L with initial negative transperineal template-guided saturation biopsy (TTSB). Methods From 2003 to 2010,a total of 1824 patients underwent transperineal saturation biopsies with the prostate template at the Peking Union Medical College Hospital.44 of them had initial negative biopsy with PSA ≥ 30 μg/L were reviewed in this study.The mean age was 68 years old (range,51 to 80).The mean biopsy cores were 28.7 (range,11 to 44).The median PSA level was 40 μg/L (range,30 to 128),and the median prostate volume was 73 ml (range,30 to 190).They were divided into four groups:TURP group,chronic prostatitis group,repeat biopsy group and miscellaneous group. Results Patients were followed up for a mean of 49 months (range,12 to 91).All patients of TURP group (15 cases) were identified as prostatic hyperplasia by postoperative pathology.2 of them had a second TTSB for PSA ＞ 10 μg/L after TURP,which were negative.5 patients of chronic prostatitis group had a declining PSA level after antibiotic therapy for 3 to 4 weeks.One patient took a second biopsy,which was identified as prostatitis.All patients of repeat biopsy group (18 cases) showed no significant decrease in PSA level during follow-up and undertook biopsies 2 to 4 times,6 of which were proved to be prostate cancer.All patients of the miscellaneous group (6 cases) had a declining PSA and didn't take a second biopsy. Conclusions Close follow-up and regular PSA testing for patients who had a high PSA level with initial negative biopsy would be help to avoid both false negative of prostate cancer and unnecessary biopsy.

The resistance of anti-VEGF therapy which casually occurs during the course of tumor therapy by using anti-VEGF drugs may be associated with alternative angiogenesis signaling activation, bone marrowderived stem cells recruitment, pericyte coverage, perivascular invasion and so on. Thus, to investigate the mechanisms of drug resistance will guide us to understand deeply the relationship among normal tissues, tumors and drugs and to find out new therapeutic targets for anti-tumor therapy.

Objective To investigate the related factors of percutaneous balloon compression (PBC) for the treatment of trigeminal neuralgia complicating cerebrovascular disease in order to reduce the incidence of surgical complications. Methods The clinical data in patients with trigeminal neuralgia complicating cerebrovascular disease treated with PBC in the People's Hospital of Liaoning Province from December 2000 to December 2010 were analyzed retrospectively. The reasons for its occurrence were investigated. Results Of the 6 759 patients with trigeminal neuralgia who received PBC treatment, 10 (0. 15％ ) developed cerebrovascular disease,and 2 of them had arteriovenous fistula; 5 patients developed intracranial hemorrhage: 2 acute subdural hemorrhage, 2 intraventricular hemorrhage with subarachnoid hemorrhage, and 1 small amount of bleeding in brain stem; 1 patient developed internal carotid hemorrhage during the intraoperative puncture and the operation was stopped temporarily, and he was reoperated successfully after 2 weeks; 2 patients had cerebral infarction, they were all in the risk population of cerebrovascular disease, and 3 weeks after treatment, their disease conditions were improved. One of them left severe paralysis of limbs at discharge. Condusions The treatment of trigeminal neuralgia with PBC is safe and the incidence of cerebrovascular complications is lower. The surgical operations and blood pressure changes are the important causes of cerebrovascular complications.

Objective To investigate the predictive factors for malignancy and invasive carcinoma of IPMN, and the survival rates of different pathological type of IPMN were compared. Methods Seventy-eight patients with IPMN admitted to Changhai Hospital from January 1993 to September 2009, who underwent surgery with histological evidence were retrospectively analyzed. The univariate and multivariate analysis of potential predictive factors, including medical history, clinical presentations, liver function, CEA, CA19-9,and imaging findings was conducted to identify the predictive factors for malignancy and invasive carcinoma of IPMN. Results Univariate analysis identified jaundice, acute pancreatitis history, CA19-9 Level > 37U/ml,AKP, unclear border of tumour as independent predictive factors for malignancy and invesiveness, main pancreatic duct dilation, branch pancreatic duct diameter > 30 mm, presence of mural modules were identified as malignancy predictor. CEA > 6 ng/ml was identified as invasive carcinoma predictor. Multivariate analysis identified one independent predictive factor for malignancy or invasive carcinoma: unclear border of tumour.Another factor of invasive IPMN was acute pancreatitis. The 5 year survival rate for benign 1PMN was 100%,while 2 year survival rate for malignant IPMN was 78.9%, 5 year survival rate was 68.5%. The 2 year survival rate for invasive IPMN was 64.6%, 5 year survival rate was 43.1%. Conclusions Unclear border of tumour was predictive factors for malignancy; acute pancreatitis and unclear border of tumour were predictive factors for invasive carcinoma.