Background: s/Aims: Non-invasive models stratifying clinically significant portal hypertension (CSPH) are limited. Herein, we developed a new non-invasive model for predicting CSPH in patients with compensated cirrhosis and investigated whether carvedilol can prevent hepatic decompensation in patients with high-risk CSPH stratified using the new model. Methods: Non-invasive risk factors of CSPH were identified via systematic review and meta-analysis of studies involving patients with hepatic venous pressure gradient (HVPG). A new non-invasive model was validated for various performance aspects in three cohorts, i.e., a multicenter HVPG cohort, a follow-up cohort, and a carvediloltreating cohort. Results: In the meta-analysis with six studies (n=819), liver stiffness measurement and platelet count were identified as independent risk factors for CSPH and were used to develop the new “CSPH risk” model. In the HVPG cohort (n=151), the new model accurately predicted CSPH with cutoff values of 0 and –0.68 for ruling in and out CSPH, respectively. In the follow-up cohort (n=1,102), the cumulative incidences of decompensation events significantly differed using the cutoff values of <–0.68 (low-risk), –0.68 to 0 (medium-risk), and >0 (high-risk). In the carvediloltreated cohort, patients with high-risk CSPH treated with carvedilol (n=81) had lower rates of decompensation events than non-selective beta-blockers untreated patients with high-risk CSPH (n=613 before propensity score matching [PSM], n=162 after PSM). Conclusions Treatment with carvedilol significantly reduces the risk of hepatic decompensation in patients with high-risk CSPH stratified by the new model.

Background: s/Aims: Non-invasive models stratifying clinically significant portal hypertension (CSPH) are limited. Herein, we developed a new non-invasive model for predicting CSPH in patients with compensated cirrhosis and investigated whether carvedilol can prevent hepatic decompensation in patients with high-risk CSPH stratified using the new model. Methods: Non-invasive risk factors of CSPH were identified via systematic review and meta-analysis of studies involving patients with hepatic venous pressure gradient (HVPG). A new non-invasive model was validated for various performance aspects in three cohorts, i.e., a multicenter HVPG cohort, a follow-up cohort, and a carvediloltreating cohort. Results: In the meta-analysis with six studies (n=819), liver stiffness measurement and platelet count were identified as independent risk factors for CSPH and were used to develop the new “CSPH risk” model. In the HVPG cohort (n=151), the new model accurately predicted CSPH with cutoff values of 0 and –0.68 for ruling in and out CSPH, respectively. In the follow-up cohort (n=1,102), the cumulative incidences of decompensation events significantly differed using the cutoff values of <–0.68 (low-risk), –0.68 to 0 (medium-risk), and >0 (high-risk). In the carvediloltreated cohort, patients with high-risk CSPH treated with carvedilol (n=81) had lower rates of decompensation events than non-selective beta-blockers untreated patients with high-risk CSPH (n=613 before propensity score matching [PSM], n=162 after PSM). Conclusions Treatment with carvedilol significantly reduces the risk of hepatic decompensation in patients with high-risk CSPH stratified by the new model.

Background: s/Aims: Non-invasive models stratifying clinically significant portal hypertension (CSPH) are limited. Herein, we developed a new non-invasive model for predicting CSPH in patients with compensated cirrhosis and investigated whether carvedilol can prevent hepatic decompensation in patients with high-risk CSPH stratified using the new model. Methods: Non-invasive risk factors of CSPH were identified via systematic review and meta-analysis of studies involving patients with hepatic venous pressure gradient (HVPG). A new non-invasive model was validated for various performance aspects in three cohorts, i.e., a multicenter HVPG cohort, a follow-up cohort, and a carvediloltreating cohort. Results: In the meta-analysis with six studies (n=819), liver stiffness measurement and platelet count were identified as independent risk factors for CSPH and were used to develop the new “CSPH risk” model. In the HVPG cohort (n=151), the new model accurately predicted CSPH with cutoff values of 0 and –0.68 for ruling in and out CSPH, respectively. In the follow-up cohort (n=1,102), the cumulative incidences of decompensation events significantly differed using the cutoff values of <–0.68 (low-risk), –0.68 to 0 (medium-risk), and >0 (high-risk). In the carvediloltreated cohort, patients with high-risk CSPH treated with carvedilol (n=81) had lower rates of decompensation events than non-selective beta-blockers untreated patients with high-risk CSPH (n=613 before propensity score matching [PSM], n=162 after PSM). Conclusions Treatment with carvedilol significantly reduces the risk of hepatic decompensation in patients with high-risk CSPH stratified by the new model.

Objective:To investigate the safety and prognostic value of neoadjuvant chemotherapy and surgery for advanced gastric cancer patients with para-aortic lymph node metastasis.Methods:Clinicopathological data of 25 patients admitted to the Department of Gastrointestinal Surgery, Fujian Cancer Hospital from Jan 2015 to Jun 2017 were retrospectively analyzed. All patients were treated with SOX chemotherapy for 3 cycles. D 2 + paraaortic lymphadenectomy was performed in patients with stable disease (SD) . After operation, SOX regimen was used for 5 cycles of chemotherapy. Results:After 3 cycles of neoadjuvant chemotherapy, there were 2 cases with progressive disease, 6 cases of SD and 17 cases of partial remission. There was no treatment-related death. Twenty-three patients underwent surgery, including 19(76%) patients of R 0 resection. Tirty-four out of 128 para aortic lymph nodes were metastatic. Postoperative complications occurred in 5(22%) patients, with no mortality . The median progression free survival time and median overall survival time were 20 and 29 months respectively. The 1, 3-year overall survival rates were 80% and 48%, and the 1-year and 3-year progression free survival rates were 72% and 38%, respectively. For those with para-aortic lymph node metastasis the 1-year and 3-year OS rate were 70% and 17%, respectively. Multivariate analysis showed that the efficacy of neoadjuvant chemotherapy was an independent prognostic factor. Conclusion:Neoadjuvant chemotherapy is among others an independent prognostic factor affecting the post-op survival of advanced gastric carcinoma with para-aortic lymph node metastasis.

Objective:To analyze the long-term efficacy and safety of thalidomide on refractory Crohn′s disease (CD).Methods:A total of 79 patients with refractory CD in the First Affiliated Hospital of Sun Yat-sen University treated with thalidomide were enrolled in this retrospective study from September 2005 to July 2018. Clinical effects and adverse drug reactions were recorded and assessed.Results:In this cohort,69 patients were treated with thalidomide for ≥6 months. Sixty-eight patients among the 69 patients achieved complete clinical remission and were followed up for a median 33.5 months (range, 7-110 months). Seventeen cases relapsed during follow-up. The cumulative probabilities of remaining in remission at 12, 24, 60 months were 88.6% (95% CI 80.6%-96.6%), 80.7% (95% CI 70.3%-91.1%), 53.7% (95% CI 32.1%-75.3%) respectively. Disease activity was the only variable associated with relapse risk, with a hazard ratio ( HR) of 3.559 for Crohn′s disease activity index (CDAI) ≥220(95% CI 1.213-10.449, P<0.05). Adverse reactions were recorded in 42 (53.2%) patients including12 (15.2%) leading to discontinuation of thalidomide. No serious side effects were observed in all subjects. Conclusions:This study suggests a long-term benefit of maintenance treatment with thalidomide in refractory CD.Moderate to severe patients have an increased risk of relapse. The high incidence of drug adverse reactions may restrain the clinical application of thalidomide.

Objective To analyze the risk factor of delayed gastric emptying (DGE) and the impact of DGE on prognosis after radical gastrectomy of distal gastric carcinoma.Methods The clinical and pathological data of 1 447 distal gastric cancer patients undergoing gastrectomy from Jul 2007 to Jan 2018 at Fujian Tumour Hospital was analyzed retrospectively.Result DGE was found in 101 patients (7.0％),occurring at a median of (6.0 ± 2.1) d after surgery.It was significantly correlated with age,diabetes,hypoproteinemia,preoperative pyloric obstruction,operation time,surgical mode,anastomotic procedure,postoperative analgesia(all P ＜ 0.05).Multivariate analysis showed that hypoproteinemia,diabetes,pyloric obstruction in preoperative period,surgical mode,postoperative analgesia,anastomotic procedure were independently associated with DGE.The average hospitalization time for DGE was significantly higher than patients with non DGE(16.3 ± 4.2) d vs.(8.1 ± 2.1) d,P ＜ 0.05.The five-year survival of patients with DGE and non DGE were 54.9％ and 54.2％ respectively(P ＞0.05) Conclusion DGE prolonged hospital stay,but did not influence patients' prognosis.

Background/Aims: Crohn’s disease (CD) primarily affects young female adults of reproductive age. Few studies have been conducted on this population’s ovarian reserve status. The aim of study was to investigate potential risk factors associated with low ovarian reserve, as reflected by serum anti-Müllerian hormone (AMH) in women of reproductive age with CD. Methods: This was a case-control study. Cases included 87 patients with established CD, and healthy controls were matched by age, height and weight in a 1:1 ratio. Serum AMH levels were measured by enzyme-linked immunosorbent assay. Results: The average serum AMH level was significantly lower in CD patients than in control group (2.47±2.08 ng/mL vs. 3.87±1.96 ng/mL, respectively, P<0.001). Serum AMH levels were comparable between CD patients and control group under 25 years of age (4.41±1.52 ng/mL vs. 3.49±2.10 ng/mL, P=0.06), however, serum AMH levels were significantly lower in CD patients over 25 years of age compared to control group (P<0.05). Multivariable analysis showed that an age greater than 25 (odds ratio [OR], 10.03; 95% confidence interval [CI], 1.90–52.93, P=0.007), active disease state (OR, 27.99; 95% CI, 6.13–127.95, P<0.001) and thalidomide use (OR, 15.66; 95% CI, 2.22–110.65, P=0.006) were independent risk factors associated with low ovarian reserve (serum AMH levels <2 ng/mL) in CD patients. Conclusions Ovarian reserve is impaired in young women of reproductive age with CD. Age over 25 and an active disease state were both independently associated with low ovarian reserve. Thalidomide use could result in impaired ovarian reserve.

OBJECTIVETo evaluate the safty and feasibility of the D2 radical resection of omental bursa and No.12p and No.8p for gastric carcinoma (GC).

METHODSClinical data of 1801 GC patients undergoing D2 radical resection of omental bursa and No.12p and No.8p at Fujian Medical University Cancer Hospital from January 2000 to January 2010 were analyzed retrospectively. Inclusion case criteria: (1)age of 18 to 90 years;(2)pathologically diagnosed as GC and receiving D2 radical resection of omental bursa and No.12p and No.8p;(3)complete clinical, pathological and follow-up data; (4)operation performed by same leading surgeon;(5)exclusion of other gastric malignancies, postoperative relapse of GC, and other simultaneous or heterochronous primary malignancies. Surgical procedure points: (1)The outer part of the peritoneum of duodenum descending was cut; the serosa was migrated to the anterior leaf of the gastrointestinal ligament. (2)The posterior lobe of the gastrocolic ligament and the transverse mesocolon were separated bluntly from left side to reach the omentum attaching to the colon portion; incision was made at the edge of the omentum attaching to the transverse colon behind the gastrocolic ligament; the leaves were turned to the anterior mesenteric anterior leaflets, and the entire anterior leaflet of the transverse mesentery was free.(3)The pancreas was separated, and resection of the posterior wall of the omentum sac continued up so that the entire retinal capsule was free; along the edge of the liver the attachment of the omentum was cut to reach the front of esophagus, and transverse incision was made in abdominal peritoneal layer of the esophagus, and then turned to the spleen on the pole; from the obturator to the esophagus incision was performed behind the peritoneum for the net; the uppermost edge of the resection of the capsule was performed as the posterior peritoneal incision to the right edge of the esophagus and was connected with the posterior parietal lobe of the previous resection; the posterior peritoneum was attached along the right edge of the esophagus and descended to the celiac artery; the posterior wall of the omental sac was removed. In the meantime, the liver duodenum ligament was cut, and the portal vein, hepatic artery trilocular was formed. Then the ligament lymph nodes were cleared.(4)The lymph nodes of celiac artery and its major branches were cleared; the envelope in front of pancreas and the part of the pancreas in posterior abdomen were resected; spleen and part of the pancreas tail were free.

RESULTSA total of 1801 cases were enrolled, including 1292 males and 509 females with a ratio of 2.54 with a mean age of(58.9±11.5)(18 to 89) years. The proportion of cases with T1a, T1b, T2, T3, T4a and T4b was 4.8% (87 cases), 6.6% (118 cases), 10.7% (193 cases), 17.5% (315 cases), 55.7% (1003 cases) and 4.7%(85 cases) respectively. All the patients completed operations successfully. The mean number of harvested lymph node was 28.5±13.7(10 to 85). Lymph node metastasis was found in 1439 cases (79.9%), including 180 cases (10.0%) in No.12p and 232 cases(12.9%) in No.8p respectively. Subgroup analysis showed that in T1a, T1b, T2, T3, T4a and T4b stage, the proportion of No.12p was 0, 1.7% (2/118), 5.2%(10/193), 10.5% (33/315), 12.4% (124/1003) and 12.9%(11/85) respectively, and the proportion of No.8p was 0, 0.8%(1/118), 2.1%(4/193), 4.8%(15/315), 18.9%(190/1003), and 25.9%(22/85) respectively. Postoperative complications were found in 195 patients (10.8%), including 63 cases(3.5%) of peritoneal infection, 52 cases (2.9%) of pulmonary infection, 33 cases(1.8%) of pancreatic leakage, 37 cases (2.1%) of anastomotic fistula, 45 cases (2.5%) of intestinal obstruction and 13 cases(0.7%) of gastroplesia. The 5-year overall survival rate was 53.6%.

CONCLUSIOND2 radical resection of omental bursa and No.12p and No.8p is safe and feasible in the treatment of gastric cancer.

Objective To evaluate the clinicopathologic characteristics and prognosis of gastric stump cancer in relation to serum albumin level.Methods The clinical data of 149 gastric stump cancer patients treated from Jan 1999 to Jun 2015 were analyzed.Patients were divided into normal serum albumin group (＞ 35 g/L,n =81) and group of hypoalbuminemia (≤ 35 g/L,n =68).Results Clinicopathologic characteristics,tumor size,depth of invasion,lymph node status and TNM stage were significantly different between the two groups (P ＜ 0.05).Univariate analysis showed that factors that influence prognosis were serum albumin level,tumor size,serosal invasion,tumor location and tumor curative resection rate (all P ＜ 0.05).Cox's proportional hazard regression model showed that serum albumin level and tumor curative resection rate were independent prognostic factors for survival,lymph node matastasis(2.2 ±4.3) vs.(4.1 ±4.4)were significantly different between the two groups (P ＜0.05).The overall 5-year survival rate was 44.1％.The 5-year survival rate were 54.0％ for normal albumin group and 32.2％ for hypoalbuminemic group,P =0.011.Conclusion Lower preoperative serum albumin level is associated with poorer prognosis in gastric stump cancer patients.

OBJECTIVETo analyze the feasibility of No.8p lymphadenectomy for the patients with advanced gastric cancer and to preliminaryly explore its value in improving prognosis.

METHODSClinical data of 1158 patients with advanced gastric cancer undergoing radical gastrectomy plus D2 or above D2 lymphadenectomy (No.8 lymphadenectomy) from July 2003 to July 2013 at Department of Gastrointestinal Surgery, Fujian Cancer Hospital were collected. A retrospective cohort study was carried out. Among 1158 patients, 343 patients from July 2003 to June 2008 only received No.8a lymph node dissection (No.8a group), and 815 patients from July 2008 to July 2013 received No.8a+No.8p lymph node dissection (No.8a+No.8p group). Patients in No.8a group received the dissection of the lymph nodes in the upper margin of the pancreas and the front of total hepatic artery, and those in No.8a+No.8p group, on the basis of No.8a group, received the dissection of lymph nodes in the common hepatic artery and the left lymph nodes behind the hepatic artery and the portal vein. The metastasis degree and metastasis rate of lymph node(No.8a and No.8p), as well as intraoperative and postoperative presentations in both groups were investigated. The prognosis of two groups were analyzed with Kaplan-Meier method and Log-rank test.

RESULTSAmong 1158 patients with advanced gastric cancer, 849 were males and 309 were females with aged 17 to 83(58.5 ±11.7) years. Radical distal gastrectomy was performed in 325 cases (28.1%) and radical total gastrectomy in 833 cases(71.9%). All the patients completed operations successfully. A total of 2587 No.8a lymph nodes were removed, and the lymph node metastasis rate and metastasis degree of No.8a were 20.6% (239/1158) and 13.0%(336/2587), respectively. A total of 2170 No.8p lymph nodes were removed, and the lymph node metastasis rate and metastasis degree of No.8p were 10.9%(89/815) and 7.2%(156/2170), respectively. The operation time of the No.8a+No.8p group was longer than that of No.8a group [(180.2±40.3) minutes vs. (168.4±41.8) minutes], and the difference was statistically significant (t=-4.627, P=0.000). However, intraoperative blood loss [(222.8±92.8) ml vs. (215.6±91.1) ml], postoperative 1-day peritoneal drainage volume [(257.7±120.0) ml vs. (270.3±121.0) ml], time to withdraw of gastric tube [(2.1±0.9) days vs. (2.2±0.8) days], time to withdraw of peritoneal tube [(6.8±1.1) days vs. (6.9±1.1) days], time to withdraw of nasal feeding tube[(6.5±1.2) days vs. (6.4±1.1) days], the morbidity of complications [19.8%(68/343) vs. 16.0%(130/815)] and postoperative hospital stay [(8.1±3.0) days vs.(8.3±3.1) days] in No.8a group and No.8a+No.8p group were not significantly different(all P>0.05). The average follow-up period was 41(2 to 144) months. The median postoperative survival was 83.0 months, and the 1-, 2-, and 5-year survival rates were 90.9%, 78.8% and 56.9% in No.8a group respectively. The median survival was 94.8 months, 1-, 2-, and 5-survival rates were 94.9%, 82.3% and 63.0% in No.8a+No.8p group respectively. The survival rate of No.8a+No.8p group was significantly higher than that of No.8a group (P=0.016). The stratified analysis showed that in stage II patients, the survival rate of No.8a+No.8p lymph node dissection was significantly higher than that of only No.8a lymph node dissection(P=0.021), but difference of survival between two groups was not significantly different in stage I patients(P=0.469) and stage III patients (P=0.820).

CONCLUSIONFor the patients with advanced gastric cancer, the dissection of No.8a+No.8p is safe and feasible, and may improve the prognosis, especially for those with stage II, suggesting that No.8a+No.8p lymphadenectomy should be performed for selected patients with advanced gastric cancer.