Objective To analyze the correlation between the pulmonary immune prognostic index(LIPI)and the prognosis of patients with advanced non-small cell lung cancer(NSCLC)treated with sintilimab.Methods A total of 145 patients with advanced NSCLC were selected as study subjects.All patients received treatment with sintilimab,and their clinical baseline data were recorded.Accord-ing to the LIPI score,patients were divided into low-risk,intermediate-risk,and high-risk groups.The correlation between LIPI and the prognosis of advanced NSCLC patients was analyzed.Factors in-fluencing progression-free survival(PFS)and overall survival(OS)were identified.Results Univa-riate analysis showed that patient age,smoking status,pathological type,clinical stage and LIPI were factors affecting PFS(P＜0.05);age,pathological type,clinical stage and LIPI were factors affecting OS(P＜0.05).Multivariate Logistic regression analysis revealed that age of 60 to 70 years,age＞70 years,adenocarcinoma,stage Ⅳ and high-risk LIPI were independent prognostic factors of PFS(P＜0.05);age＞70 years,poor stage Ⅳ,adenocarcinoma and high-risk LIPI were independent prognos-tic factors of OS(P＜0.05).LIPI influenced patient's prognosis,with low-risk patients showing better outcomes and longer median PFS and OS.Conclusion LIPI is correlated with the prognosis of advanced NSCLC patients treated with sintilimab.Patients with a low-risk LIPI assessment benefit more from sintilimab treatment.

Objective To explore the clinical value of endoscopic intervention in preventing rebleeding of Forrest Ⅱb grade ulcers.Method A retrospective analysis was conducted on the clinical data of 114 patients from January 2015 to April 2023 due to gastrointestinal bleeding,who were confirmed by gastroscopy as Forrest Ⅱb grade ulcers.86 (75.4％,86/114) patients received endoscopic treatment as endoscopic treatment group,while 28 patients only received medication treatment as medication treatment group.Compare the effectiveness of endoscopic treatment and different endoscopic hemostatic methods for preventing rebleeding.Results There were no statistically significant differences in age,gender,clinical symptom,systolic pressure,hemoglobin concentration,and ulcer site between endoscopic and medication treatment patients (P>0.05).In terms of ulcer size,the length of ulcer in the endoscopic treatment group was smaller than that in the medication treatment group[(9.5±5.3) mm vs (12.8±7.7) mm],the difference was statistically significant (P=0.013).The rebleeding rate of medication treatment group was 21.4％ (6/28);Among the endoscopic treatment group,85 patients (98.8％,85/86) successfully underwent endoscopic treatment,with a rebleeding rate of 11.8％ (10/85),which was lower than that of medication treatment group,but the difference was not statistically significant (P=0.337).Among the patients who successfully underwent endoscopic treatment,62 cases were treated with injection of diluted adrenaline alone,6 cases with titanium clips,and 17 cases were treated with electrocoagulation or electrocoagulation combined with other hemostatic methods.The rebleeding rate were 12.9％ (8/62),16.7％ (1/6),and 5.9％ (1/17),respectively,which were lower than that of medication treatment patients,but the difference was not statistically significant (P=0.474).Due to the need for endoscopic treatment,15 patients were treated with a snare or thermal hemostatic forceps to remove the surface blood clot of the ulcer.Among them,3 cases had jet bleeding at the base (2 cases were successfully stopped by electrocoagulation;1 case had a large amount of bleeding,but endoscopic hemostasis failed,and intervention embolization successfully stopped the bleeding).Among of 16 patients with rebleeding,3 patients were treated with conservative management,and all of them were successfully stopped bleeding;6 cases underwent endoscopic treatment again,of which 4 cases were successfully hemostasis by endoscopy,and 2 cases were successfully hemostasis by surgery after endoscopic hemostasis failure;interventional embolization in 1 case,and successfully hemostasis;6 patients underwent direct surgical procedures,all of which successfully stopped bleeding,but one patient developed multiple organ failure during hospitalization and died without bleeding.Conclusion Endoscopic intervention can to some extent reduce the incidence of rebleeding in Forrest Ⅱb grade ulcers.The effect of electrocoagulation hemostasis on preventing rebleeding is better than that of injection dilution adrenaline method.However,there is a risk of iatrogenic rebleeding when removing blood clots on the surface of ulcers,and careful selection should be made when conditions permit.

Objective To explore the clinical value of endoscopic intervention in preventing rebleeding of Forrest Ⅱb grade ulcers.Method A retrospective analysis was conducted on the clinical data of 114 patients from January 2015 to April 2023 due to gastrointestinal bleeding,who were confirmed by gastroscopy as Forrest Ⅱb grade ulcers.86 (75.4％,86/114) patients received endoscopic treatment as endoscopic treatment group,while 28 patients only received medication treatment as medication treatment group.Compare the effectiveness of endoscopic treatment and different endoscopic hemostatic methods for preventing rebleeding.Results There were no statistically significant differences in age,gender,clinical symptom,systolic pressure,hemoglobin concentration,and ulcer site between endoscopic and medication treatment patients (P>0.05).In terms of ulcer size,the length of ulcer in the endoscopic treatment group was smaller than that in the medication treatment group[(9.5±5.3) mm vs (12.8±7.7) mm],the difference was statistically significant (P=0.013).The rebleeding rate of medication treatment group was 21.4％ (6/28);Among the endoscopic treatment group,85 patients (98.8％,85/86) successfully underwent endoscopic treatment,with a rebleeding rate of 11.8％ (10/85),which was lower than that of medication treatment group,but the difference was not statistically significant (P=0.337).Among the patients who successfully underwent endoscopic treatment,62 cases were treated with injection of diluted adrenaline alone,6 cases with titanium clips,and 17 cases were treated with electrocoagulation or electrocoagulation combined with other hemostatic methods.The rebleeding rate were 12.9％ (8/62),16.7％ (1/6),and 5.9％ (1/17),respectively,which were lower than that of medication treatment patients,but the difference was not statistically significant (P=0.474).Due to the need for endoscopic treatment,15 patients were treated with a snare or thermal hemostatic forceps to remove the surface blood clot of the ulcer.Among them,3 cases had jet bleeding at the base (2 cases were successfully stopped by electrocoagulation;1 case had a large amount of bleeding,but endoscopic hemostasis failed,and intervention embolization successfully stopped the bleeding).Among of 16 patients with rebleeding,3 patients were treated with conservative management,and all of them were successfully stopped bleeding;6 cases underwent endoscopic treatment again,of which 4 cases were successfully hemostasis by endoscopy,and 2 cases were successfully hemostasis by surgery after endoscopic hemostasis failure;interventional embolization in 1 case,and successfully hemostasis;6 patients underwent direct surgical procedures,all of which successfully stopped bleeding,but one patient developed multiple organ failure during hospitalization and died without bleeding.Conclusion Endoscopic intervention can to some extent reduce the incidence of rebleeding in Forrest Ⅱb grade ulcers.The effect of electrocoagulation hemostasis on preventing rebleeding is better than that of injection dilution adrenaline method.However,there is a risk of iatrogenic rebleeding when removing blood clots on the surface of ulcers,and careful selection should be made when conditions permit.

Preeclampsia (PE) is a principal cause of maternal and newborn mortality that poses financial and physical burdens to tens of thousands of families each year. Unfortunately, there is no effective management to arrest the progression of this disease unless delivery. Therefore, standardized management or preventive treatments are needed urgently. PE is closely associated with placental hypoxia, which increases the secretion of soluble fms-like tyrosine kinase 1 (sFlt-1) as well as soluble endoglin (sEng) into the maternal circulation. Metformin has been found to inhibit those anti-angiogenic factors so it might be a candidate to prevent or treat PE. Women who are diagnosed with gestational diabetes mellitus (GDM) are more likely to have complications of hypertension or PE, so this review aims to demonstrate that the application of metformin in GDM might prevent the onset or progression of PE complicated with GDM.

Preeclampsia (PE) is a principal cause of maternal and newborn mortality that poses financial and physical burdens to tens of thousands of families each year. Unfortunately, there is no effective management to arrest the progression of this disease unless delivery. Therefore, standardized management or preventive treatments are needed urgently. PE is closely associated with placental hypoxia, which increases the secretion of soluble fms-like tyrosine kinase 1 (sFlt-1) as well as soluble endoglin (sEng) into the maternal circulation. Metformin has been found to inhibit those anti-angiogenic factors so it might be a candidate to prevent or treat PE. Women who are diagnosed with gestational diabetes mellitus (GDM) are more likely to have complications of hypertension or PE, so this review aims to demonstrate that the application of metformin in GDM might prevent the onset or progression of PE complicated with GDM.

Objective:To investigate the availability, prices and affordability of essential medicines in pediatric population across China, in the hope of improving rational use of medicines.Methods:A multicenter cross-sectional survey of medicine prices, availability and affordability was conducted in 17 provinces, municipalities and autonomous region across east, south-central part, west and north of China. Data on 42 medicines used in pediatric population, both original and generic, were collected in 55 public hospitals from May 26 to June 2, 2017. Availability was expressed as the percentage of hospitals with stock of the target medicine on the day of data collection,and median price ratio (MPR) was the ratio of price upon investigation to international reference. Based on national minimum daily wage, affordability represents the number of working days needed to earn the expense which covers a standard course using the target medicine. Statistical software SPSS 13.0 was applied for descriptive analysis of availability, MPR and affordability.Results:Mean Availability of original and generic medicine was 33% and 32%, with median MPR being 5.43 and 1.55. Among the 19 medicines with price information for both original and generic product, the median MPR was 7.73 and 2.04 respectively. Regarding the five medicines used to treat four common pediatric diseases (pneumonia,peptic ulcer, congenital hypothyroidism, refractory nephrotic syndrome), the affordability was 0.63 (0.16-6.17) d for generic medicine, and 1.03 (0.16-11.53) d for its original counterpart.Conclusions:The availability to both original and generic products of the 42 medicines used in pediatric population was low in China. The prices of generic medicines seem to be lower and affordability higher than those of original medicines. There is an urgent need to improve the availability and affordability of pediatric medicines.

Objective:To explore the diagnostic value of laparoscopy in the postoperative recurrence of peritoneal metastasis in gastric cancer, and to investigate the efficacy of bidirectional intraperitoneal and systemic (BIPS) chemotherapy for the recurrence.Methods:The descriptive case series study was conducted. Case inclusion criteria: (1) gastric cancer patients without synchronous distant metastasis received D2 radical gastrectomy; (2) postoperative adjuvant chemotherapy was administered; (3) no other distant metastasis except recurrence of peritoneal metastasis; (4) age of 18-75 years; (5) Eastern Cooperative Oncology Group (ECOG) performance-status score≤2; (6) pretreatment evaluation suggested that surgery and chemotherapy could be tolerated. Eight consecutive gastric cancer patients with postoperative recurrence of peritoneal metastasis who met the above criteria at Department of Gastrointestinal Surgery of Ruijin Hospital from September 2015 to September 2016 were enrolled into the study. There were 6 males and 2 females with the median age of 52 (38-68) years. They received laparoscopy or laparotomy first, and then were evaluated with reference to the Sugarbaker peritoneal cancer index (PCI) and the peritoneal metastasis classification of gastric cancer developed by the Japanese Gastric Cancer Research Association. A peritoneal access port was implanted in the subcutaneous space of the lower abdomen and the patients received chemotherapy for 21 days as a course of treatment. All the patients received intraperitoneal 20 mg/m 2 of paclitaxel (PTX) via implanted subcutaneous peritoneal access ports and intravenous 50 mg/m 2 of PTX at day 1 and day 8, meanwhile 80 mg/m 2 of Tigio was orally administered per day for 14 consecutive days, followed by 7 days of interval. Follow-up ended on December 15, 2019. Results:Of these 8 patients with recurrence of peritoneal metastasis after gastric cancer surgery, 1 case underwent laparotomy and loop stoma of terminal ileum because of complete colonic obstruction, and the remaining 7 cases underwent laparoscopy successfully and the recurrence of peritoneal metastasis was clearly diagnosed. Two patients with ovarian metastasis underwent laparoscopic bilateral adnexectomy. The median follow-up time was 17.5 (1.5 to 39.0) months, the median number of BIPS chemotherapy course was 11 (1 to 30), and the median survival time (MST) after BIPS chemotherapy was 17.0 months. The major adverse reaction in BIPS treatment was mainly myelosuppression, of which grade 3/4 leukopenia and neutropenia developed in 1 and 2 cases respectively. No BIPS-related death occurred. The MST of gastric cancer after radical gastrectomy was 40.0 months.Conclusions:Laparoscopy is a safe and feasible method for diagnosing the recurrence of peritoneal metastasis of gastric cancer. BIPS chemotherapy is effective and safe for its treatment and deserves further study.

Objective:To explore the diagnostic value of laparoscopy in the postoperative recurrence of peritoneal metastasis in gastric cancer, and to investigate the efficacy of bidirectional intraperitoneal and systemic (BIPS) chemotherapy for the recurrence.Methods:The descriptive case series study was conducted. Case inclusion criteria: (1) gastric cancer patients without synchronous distant metastasis received D2 radical gastrectomy; (2) postoperative adjuvant chemotherapy was administered; (3) no other distant metastasis except recurrence of peritoneal metastasis; (4) age of 18-75 years; (5) Eastern Cooperative Oncology Group (ECOG) performance-status score≤2; (6) pretreatment evaluation suggested that surgery and chemotherapy could be tolerated. Eight consecutive gastric cancer patients with postoperative recurrence of peritoneal metastasis who met the above criteria at Department of Gastrointestinal Surgery of Ruijin Hospital from September 2015 to September 2016 were enrolled into the study. There were 6 males and 2 females with the median age of 52 (38-68) years. They received laparoscopy or laparotomy first, and then were evaluated with reference to the Sugarbaker peritoneal cancer index (PCI) and the peritoneal metastasis classification of gastric cancer developed by the Japanese Gastric Cancer Research Association. A peritoneal access port was implanted in the subcutaneous space of the lower abdomen and the patients received chemotherapy for 21 days as a course of treatment. All the patients received intraperitoneal 20 mg/m 2 of paclitaxel (PTX) via implanted subcutaneous peritoneal access ports and intravenous 50 mg/m 2 of PTX at day 1 and day 8, meanwhile 80 mg/m 2 of Tigio was orally administered per day for 14 consecutive days, followed by 7 days of interval. Follow-up ended on December 15, 2019. Results:Of these 8 patients with recurrence of peritoneal metastasis after gastric cancer surgery, 1 case underwent laparotomy and loop stoma of terminal ileum because of complete colonic obstruction, and the remaining 7 cases underwent laparoscopy successfully and the recurrence of peritoneal metastasis was clearly diagnosed. Two patients with ovarian metastasis underwent laparoscopic bilateral adnexectomy. The median follow-up time was 17.5 (1.5 to 39.0) months, the median number of BIPS chemotherapy course was 11 (1 to 30), and the median survival time (MST) after BIPS chemotherapy was 17.0 months. The major adverse reaction in BIPS treatment was mainly myelosuppression, of which grade 3/4 leukopenia and neutropenia developed in 1 and 2 cases respectively. No BIPS-related death occurred. The MST of gastric cancer after radical gastrectomy was 40.0 months.Conclusions:Laparoscopy is a safe and feasible method for diagnosing the recurrence of peritoneal metastasis of gastric cancer. BIPS chemotherapy is effective and safe for its treatment and deserves further study.

OBJECTIVE: To investigate the clinical characteristics and prognostic factors of reoperation patients with postoperative recurrence or metastasis of gastrointestinal stromal tumor (GIST). METHODS: A retrospective case-control study was performed on the clinical data of 31 patients with GIST who had recurrence or metastasis after the first surgery and underwent one or more operations again from February 2003 to January 2016 at Ruijin Hospital, Shanghai Jiaotong University School of Medicine. The clinical characteristics of these patients were analyzed. Kaplan-Meier survival curve was used to calculate the survival rate, Cox univariate and multivariate regression model was applied to prognosis analysis. RESULTS: Age of these 31 patients at the first operation was 35-78 (median 49) years, including 17 males (54.8%) and 14 females (45.2%). The tumors of 21 cases located in small intestines (67.7%), 2 cases in stomach (6.5%), 4 cases (12.9%) in colorectum and of 4 cases (12.9%) in other sites. According to NIH criteria, risk assessment indicated 26 cases were(83.8%) with high risk, 3 cases (9.7%) with moderate risk, and 2 cases (6.5%) with low risk. After the first operation, 15 cases received the IM (imatinib) therapy regularly based on NCCN guideline,10 cases received the therapy irregularly, and the other 6 cases did not receive the therapy. R0 resection was performed in 29 cases (93.5%) and R1/R2 resection was performed in 2 cases (6.5%). The median interval between the first operation to the recurrence was 32.3 (5.2-117.6) months and the median age of recurrence was 56 years old. Refer to the recurrent location, 28 cases (90.3%) were found in the same location or liver, 1 case in greater omentum, and 2 cases in pelvic cavity. The median diameter of the tumor in reoperation was 6.5 cm. Twenty-three cases(74.2%) received R0 excision and the other 8 cases(25.8%) received R1/R2 excision. At diagnosis of tumor recurrence, 20 cases (64.5%) received the second surgery immediately and the other 11 cases received surgery after imatinib or sunitinib treatment. Twenty-nine (93.5%) patients were followed up for 7.3 to 160.3 (median 49.5) months. After the second surgery, the relapse-free survival (RFS) of the whole group was 3.2 to 148.6(median: 29.7) months. Till the end of follow-up, 9 cases died of recurrence. Among 20 alive cases, 8 cases were living with the tumor, 1 case received the third surgery. The median overall survival (OS) time was 38.4(6.2-160.3) months. The 5-year RFS and the 5-year OS of 15 cases who received regular targeted therapy after the first operation were 73.4% and 81.7% respectively, significantly higher than those of the other 16 cases who received irregular or no targeted therapy(37.6%, P=0.015 and 38.9%,P=0.023,respectively). The 5-year RFS rate and the 5-year OS rate of the 11 patients who were diagnosed or complicated with liver metastasis were 29.8% and 32.2% respectively, which were significantly lower than those of the 20 patients without liver metastasis (79.1% and 88.1% respectively, both P<0.001). Cox model for OS, the results showed that regular targeted therapy after first surgery(HR=0.362, 95%CI:0.210-1.074, P=0.089) and the liver metastasis (HR=5.342, 95%CI: 0.902-12.580, P=0.057) were not the independent risk factors. CONCLUSIONS Regular targeted therapy according to the guideline after the first operation for GIST patients with recurrence or metastasis may improve the prognosis. Prognosis of GIST patients with postoperative liver metastasis is poor.
Case-Control Studies ; China ; Female ; Gastrointestinal Stromal Tumors ; diagnosis ; surgery ; Humans ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Prognosis ; Reoperation ; Retrospective Studies

We constructed prokaryotic recombinant expression vector of P61 gene from Nocardia brasiliensis,expressing P61 protein with biological activity in E.coli,and lay a foundation for further studies related to P61.P61 gene was synthesized and cloned into an expression vector pET-30a(+).The recombinant vector was transformed into Escherichia coli BL21 and induced with IPTG.The production was analyzed with Western blot and the catalase activity of P61 was tested with Catalase Assay Kit.The protein of P61was successfully expressed in E.coli with solubility and high catalase activity,and could be identified by anti-N.brasiliensis sera from mice.The prokaryotic expression plasmid of protein P61 was constructed successfully and can be expressed efficiently in E.coli BL21 cells with higher catalase.