Objective To explore the incidence rate and independent risk factors of synchronous multiple early gastric cancer (SMEGC) in patients with early gastric cancer, and to provide evidence for early screening and intervention of high-risk population. Methods A retrospective analysis was performed on 308 patients with early gastric cancer who received treatment in the hospital from March 2019 to March 2024. The incidence rate of SMEGC was counted, and the risk factors were analyzed by univariate and multivariate Logistic regression analyses. Results Among the 308 patients with early gastric cancer in this study, 23 cases were SMEGC and 285 were single early gastric cancer, which were included in the SMEGC group and the single group respectively. The incidence rate of SMEGC was 7.47% (23/308). Compared with the single group, the proportions of male, smoking history, tumor diameter≤2 mm, chronic atrophic gastritis and intestinal metaplasia degree were higher in the SMEGC group (2=4.331、8.608、4.618、6.490、4.897，P=0.037、0.003、0.032、0.001、0.027). Logistic regression analysis suggested that chronic atrophic gastritis (OR=3.133, 95%CI: 1.240-7.918) and moderate-to-severe intestinal metaplasia (OR=3.171, 95%CI: 1.252-8.029) were independent risk factors for SMEGC (P<0.05). Conclusion Some patients with early gastric cancer are SMEGC. Chronic atrophic gastritis and moderate-to-severe intestinal metaplasia are independent risk factors affecting the occurrence of SMEGC. It is recommended to regularly screen high-risk patients and optimize management strategies to reduce the risk of SMEGC.

Myocardial dysfunction is the most serious complication of sepsis. Sepsis-induced myocardial dysfunction (SMD) is often associated with gastrointestinal dysfunction, but its pathophysiological significance remains unclear. The present study found that patients with SMD had higher plasma gastrin concentrations than those without SMD. In mice, knockdown of the gastrin receptor, cholecystokinin B receptor (Cckbr), aggravated lipopolysaccharide (LPS)-induced cardiac dysfunction and increased inflammation in the heart, whereas the intravenous administration of gastrin ameliorated SMD and cardiac injury. Macrophage infiltration plays a significant role in SMD because depletion of macrophages by the intravenous injection of clodronate liposomes, 48 h prior to LPS administration, alleviated LPS-induced cardiac injury in Cckbr-deficient mice. The intravenous injection of bone marrow macrophages (BMMs) overexpressing Cckbr reduced LPS-induced myocardial dysfunction. Furthermore, gastrin treatment inhibited toll-like receptor 4 (TLR4) expression through the peroxisome proliferator-activated receptor α (PPAR-α) signaling pathway in BMMs. Thus, our findings provide insights into the mechanism of the protective role of gastrin/CCKBR in SMD, which could be used to develop new treatment modalities for SMD.

Objective:To investigate the risk factors and prognoses of cerebral venous sinus thrombosis (CVST) caused by pegasparaginase (PEG-Asp).Methods:A total of 252 children with acute lymphoblastic leukemia (ALL) were treated with PEG-Asp chemotherapy in our hospital from December 2016 to July 2021, including 8 children with CVST. The clinical manifestations, laboratory and imaging features, treatments and prognoses of these children with CVST caused by PEG-Asp were analyzed retrospectively.Results:(1) CVST occurred during induction chemotherapy in 4 children, during re-induction chemotherapy in 3 children, and during consolidation stage in one child. CVST occurred in two children who received PEG-ASP chemotherapy once, in one child who received PEG-Asp chemotherapy twice, and 5 children who received PEG-Asp chemotherapy more than twice. The median time between CVST occurrence and last treatment of PEG-Asp was 20.5 d. (2) The clinical manifestations included paroxysmal headache ( n=4), nausea or vomiting ( n=3), convulsions ( n=2) and persistent blurred vision ( n=1). (3) CVST appeared at the sigmoid sinus ( n=6), transverse sinus ( n=4) and superior sagittal sinus ( n=4), of which one child was complicated with hemorrhage in left frontal parietal and right parietal cortex, and one with reversible posterior encephalopathy syndrome; 8 children were not complicated with thrombus in other parts. (4) Some of the children were complicated with abnormal blood coagulation. When CVST occurred, fibrinogen level decreased in 3 children, anti-thrombin III level decreased in 2 children, and D-dimer level increased in 3 children. (5) Six children were treated with low molecular weight heparin (LMWH), of which, 4 were treated with rivasaban and one with warfarin sequentially. The total course of anticoagulation was 56 d. (6) The symptoms of 6 children disappeared after anticoagulation; Magnetic resonance venography (MRV) showed disappeared thrombus in 4 children and reduced thrombus range in 2 children. One child with intracranial hemorrhage did not use PEG-Asp anymore; 7 accepted PEG-Asp further during follow-up chemotherapy, of which one had CVST recurrence and the range of thrombus was reduced after anticoagulant therapy. Conclusions:When children with ALL develop unexplained neurological symptoms during PEG-Asp chemotherapy, CVST should be highly vigilant. Enhanced MRI and MRV should be performed for early diagnosis. Some children are complicated with abnormal blood coagulation, and LMWH, warfarin and rivasaban are effective. The prognosis is good and there are no sequelae. Most children accepted PEG-Asp again will not have CVST again.

Objective To observe in vitro the effect of mechanical stress at different intensities on the pro-liferation, apoptosis and extracellular matrix of degenerative human nucleus pulposus cells. Methods The cells were isolated and cultured in vitro, and divided into a control group, a low-intensity group, a medium-intensity group and a high-intensity group. The low-, medium- and high-intensity groups were stretched mechanically by 1000 μ, 2000μor 4000μrespectively for 6 hours using a four-point bending system, while the control group was not stressed. Flow cytometry was used to explore any changes in the cell cycle and the proliferation index ( PI) . The expression of proliferating cell nuclear antigen ( PCNA) , B-cell lymphoma-2 ( BCL-2)/Bax, collagen II and aggrecan were meas-ured using real-time quantitative polymerase chain reactions. Results The mechanical stretching significantly influ-enced proliferation, apoptosis and the extracellular matrices compared with the control group. The PI and PCNA ex-pression increased at first and then decreased gradually with the exercise intensity. Compared with the control group, the mRNA expression level of Bcl-2/Bax increased significantly to 1.53 times that of the control group after 1000 μstretching, but to only 0.71 times that of the control group at 2000μand 0.43 times at 4000μ. The gene expression of collagen II increased significantly by 1. 1 times and that of aggrecan by 1. 3 times after 1000 μ stress stimulation compared with the control group ( P≤0.05) . However, the expression of collagen II and aggrecan was inhibited sig-nificantly at 2000 and 4000 μ , with the lowest levels at 4000 μ (P≤0.05). Conclusion Stretching at different intensities has different effects on the proliferation, apoptosis and extracellular matrix of human pulposus cells with degenerate nuclei.

Objective: To observe therapeutic effects of ticagrelor combined tirofiban on patients with ST elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) and their short-term prognosis.Methods: A total of 280 STEMI patients undergoing emergency PCI were selected.According to random number table, patients were randomly divided into clopidogrel group (received clopidogrel combined tirofiban therapy) and ticagrelor group (received ticagrelor combined tirofiban therapy).TIMI blood flow grade of infarct related arteries, platelet aggregation rate and P2Y12 reaction unit (PRU) before and after PCI, and incidence of major adverse cardiovascular events (MACE) within 30d follow-up, hemorrhage event and cardiac function were measured and compared between two groups.Results: Compared with clopidogrel group after PCI, there was significant rise in percentage of TIMI blood flow grade 3 (81.4% vs.91.4%), and significant reductions in platelet aggregation rate [(55.2±4.1)% vs.(50.8±4.4)%] and PRU [(196.2±15.1)U vs.(180.8±12.0)U] in ticagrelor group, P<0.05 all.Compared with clopidogrel group after 30d follow-up, there were significant reductions in incidence rates of re-myocardial infarction (5.0% vs.2.9%) and cardiogenic death (2.9% vs.0.7%), left ventricular end-diastolic dimension [(53.1±2.8)mm vs.(49.0±2.0)mm] and left ventricular end-systolic dimension [(40.2±2.1)mm vs.(37.4±1.8)mm], and significant rise in left ventricular ejection fraction [(51.8±2.7)% vs.(55.4±2.5)%] in ticagrelor group, P<0.05 all.There were no severe hemorrhage events in both groups, and no significant difference in incidence rate of mild hemorrhage (5.0% vs.6.4%) between clopidogrel group and ticagrelor group, P=0.591.Conclusion: For STEMI patients undergoing emergency PCI, ticagrelor combined tirofiban can effectively reduce platelet aggregation rate, improve TIMI blood flow of infarct related arteries, therapeutic effects and their short-term prognosis without increasing hemorrhage risk, which is worth extending.

With the global development of medical information standard, construction work of traditional Chinese medicine (TCM) information standard system has been promoted rapidly. The framework of ancient Chinese medical literature clinical terminology classification standardization is one of the foundations of TCM language system. Its research will further promote and perfect TCM information standard system. We have adhered to the connection among ancient TCM classification framework, modern TCM and western medicine classification framework. Exploration on framework construction of ancient Chinese medical literature clinical terminology classification standardization was based on previous work of Chinese medicine clinical terminology classification and code standard, reference frame structure of SNOMED CT, research findings of classification standard framework of Chinese medicine clinical terms, andQian Jin Fang.

Objective To explore whether fluid-attenuated inversion recovery can be used to estimate the onset time of acute ischemic stroke (ALS) based on the analysis of signal strength through the fluid-attenuated inversion-recov?ery (FLAIR)and volume of interest (ROI) in ALS patients with known time of onset. Method Forty-seven AIS patients who met the inclusion criteria were recruited from Baotou Central Hospital, Department of Neurology from January 2011 to December 2012. The patients had stroke onset within 12 hours and completed MRI scan including diffusion-weighted imaging DWI, apparent diffusion and coefficient ADC FLAIR. Based on MRI findings, patients were divided into, three groups:0~180 min, 180~360 min and 360~720 min groups. Signal strength values of the DWI、FLAIR and ADC in ipsi?lateral and contralateral sides were measured. Result There was a significant difference in the FLAIR signal strength among these three groups.The FLAIR signal strength was significantly lower in 0~180 min and 180~360 min groups than in 360-720 min. FLAIR positive rate was 16.7%, 62.5%, and 70.6% in 0~180 min, 180~360 min and 360~729 min groups, respectively. Conclusion FLAIR positive rate gradually increases as the onset prolongs. Thus, lower FLAIR posi?tive rate indicates shorter onset time of AIS, which can be used to assist acute intravenous thrombolytic therapy.

Objective To summarize the clinical efficacy of interventional treatment for lower extremity arteriosclerosis obliterans and its complications.Methods We analyzed sixty-nine patients with lower extremities arteriosclerosis obliterans undergoing interventional treatment from October 2011 to January 2013.During the same period,three patients were referred to us who suffered from the complications of interventional treatment.In these patients,eight were TASC ⅡA type,twenty-one were TASC Ⅱ B,twenty TASC Ⅱ C,and twenty-two TASC Ⅱ D lesions.All patients received CTA or DSA.Seventy patients were treated by interventional treatment,and two who had fractured stent underwent external iliacsuperficial femoral artery bypass grafting using artificial grafts.Results The technique success rate was 100％.The symptoms disappeared after surgery.During interventional treatment,one iliac artery ruptured,one patient suffered from arterial perforation and three patients suffered from distal embolization.Sixty-eight patients were followed-up for 9 ± 4 months.Conclusions Endovascular treatment has good early clinical efficacy.In order to reduce the incidence of complications,indication of interventional treatment should be controlled strictly and manipulation should be careful.

The cell-free plasma DNA (cfpDNA) has been suggested as a useful tumor marker for its quantitative and qualitative tumor-specific alterations that reflect the biological characteristics and the progression and outcomes of tumors.Therefore,it has been used as liquid biopsy to detect cfpDNA in peripheral blood for the diagnosis,monitoring of clinical effects,and prognosis of malignancies

PURPOSE: Our study aimed to evaluate the feasibility of adjuvant cyclophosphamide/vinorelbine/5-fluorourail (CVF) chemotherapy as an alternative to cyclophosphamide/methotrexate/5-fluorouracil (CMF) chemotherapy for treating early breast cancer. METHODS: One hundred and forty-nine patients were randomly assigned to CMF or CVF adjuvant chemotherapy for treating their early stage breast cancer between September 2000 and December 2007. The disease-free survival (DFS), the overall survival (OS), and the toxicity profiles of both groups were compared. RESULTS: Sixty-seven patients underwent CMF chemotherapy whereas 82 patients underwent CVF chemotherapy. The DFS and OS were 88 months (95% confidence interval [CI], 76-101 months) and 94 months (95% CI, 83-104 months), respectively for the CMF group, and 97 months (95% CI, 93-101 months), and 101 months (95% CI, 98-104 months), respectively for the CVF group. However, those survival gains of the CVF group were not statistically significant (p-value=0.069 for the DFS and 0.99 for the OS). The CVF group showed a favorable toxicity profile in terms of the grade 3/4 hematologic toxicities as compared to that of the CMF group. CONCLUSION: Clinical outcome of CVF chemotherapy was comparable to CMF with a favorable toxicity profiles. However, it is difficult to conclude the feasibility of CVF regimen because of small number of studied patients.
Breast ; Breast Neoplasms ; Chemotherapy, Adjuvant ; Cyclophosphamide ; Disease-Free Survival ; Fluorouracil ; Humans ; Methotrexate ; Vinblastine