Background/Aims: To determine the value of salivary pepsin in discriminating sub-types of gastroesophageal reflux disease (GERD) and GERD-related disorders. Methods: Overall, 322 patients with different sub-types of GERD and 45 healthy controls (HC) were studied. All patients took Gastroesophageal Reflux Disease Questionnaire (GerdQ) and underwent endoscopy and 24-hour esophageal pH monitoring and manometry. Salivary pepsin concentration (SPC) was detected by using colloidal gold double-antibody immunological sandwich assay. Oral esomeprazole treatment was administrated in the patients with non-erosive reflux disease (NERD) and extra-esophageal symptoms (EES). Results: Compared to HC, patients with erosive esophagitis, NERD, EES, EES plus typical GERD symptoms, or Barrett’s esophagus had a higher prevalence of saliva and SPC (all P < 0.001). There was no significant difference in the positive rate for pepsin in patients with functional heartburn or GERD with anxiety and depression, compared to HC. After esomeprazole treatment, the positive rate and SPC were significantly reduced in NERD (both P < 0.001) and in EES (P = 0.001 and P = 0.002, respectively). Of the 64 NERD patients, 71.9% (n = 46) were positive for salivary pepsin, which was significantly higher than the rate (43.8%, n = 28) of pathological acid reflux as detected by 24-hour esophageal pH monitoring (P = 0.002). Conclusions Salivary pepsin has an important significance for the diagnosis of GERD and GERD-related disorders. Salivary pepsin and 24-hour esophageal pH monitoring may complement with each other to improve the diagnostic efficiency.

Objective: To study the efficacy, safety and long-term outcomes of integrated strategy of bortezomib-based induction regimens followed by autologous hematopoietic stem cell (ASCT) and maintenance therapy in Chinese multiple myeloma (MM) patients. Methods: 200 MM patients receiving integrated strategy of bortezomib--based induction regimens followed by ASCT and maintenance therapy were retrospectively and prospectively analyzed from December 1. 2006 to April 30. 2018. Results: The complete remission rates (CR) and better than very good partial remission rates (VGPR) after induction therapy, transplantation and maintenance therapy were respectively 31% and 75.5%, 51.8% and 87.7%,73.6% and 93.4%. There was no difference between 4 cycles and more than 5 cycles induction chemotherapy. The negative rate of MRD detection by flow cytometry was 17.6% and 38.2% respectively after induction and 3 months after transplantation. The negative rate of MRD gradually increased during the maintenance therapy. The success rate of high dose CTX combined with G-CSF mobilization was 95.5% and transplantation related mortality (TRM) was zero. The median time to progress (TTP) was 75.3 months and the median overall survival (OS) was 99.5 months. TTP of patients obtaining CR and negative MRD after induction were longer that those of no CR and positive MRD. TTP and OS of patients receiving triple-drug induction and ASCT in early stage were longer than those of double-drug induction and ASCT in late stage. LDH≥240 U/L, high risk cytogenetics, ISS II+III stage and HBsAg positive were prognostic factors at diagnosis. However, only MRD and high risk cytogenetics were independent prognostic factors after transplantation and maintenance therapy. The clinical characteristics of patients of TTP ≥6 years were listed below: light-chain type M protein, ISS I stage, normal level of hemoglobin and platelet, normal LDH, HBsAg negative, chromosome 17p-negative, good response and sustained good response. Conclusions: Integrated strategy of bortezomib-based induction regimens followed by ASCT and maintenance therapy can significantly improve the short-term and long-term efficacy. The prognostic factors of TTP in different disease stages were different. Response to treatment, especially MRD, played a more important role in prognostic factors.
Antineoplastic Combined Chemotherapy Protocols ; Bortezomib/therapeutic use* ; Follow-Up Studies ; Hematopoietic Stem Cell Transplantation ; Humans ; Induction Chemotherapy ; Multiple Myeloma/therapy* ; Retrospective Studies ; Stem Cell Transplantation ; Transplantation, Autologous ; Treatment Outcome

OBJECTIVETo investigate the influence of thymidylate synthase (TS) gene polymorphisms on high-dose methotrexate (HD-MTX)-related toxicities in childhood acute lymphoblastic leukemia (ALL).

METHODSA total of 73 children who were diagnosed with ALL between March 2011 and March 2013 were included into this study. Genomic DNAs were extracted from their peripheral blood. And then the genotypes of TS 5'-UTR were determined by direct DNA sequencing after PCR. The toxicity response of 73 patients receiving HD-MTX chemotherapy were observed and recorded, and plasma MTX concentrations at 42-48 hours after chemotherapy were measured.

RESULTSThe main HD-MTX-related toxicities of 73 patients receiving HD-MTX chemotherapy were neutropenia, decreased hemoglobin level, thrombocytopenia, liver toxicity, mucosal damage, and gastrointestinal reactions. There were no significant differences in the incidence rate of HD-MTX-related toxicities between children with different TS 5'-UTR genotypes after chemotherapy (P>0.05). TS 5'-UTR genotype was not significantly correlated with plasma MTX concentrations at 42-48 hours after chemotherapy (P>0.05).

CONCLUSIONSTS gene polymorphisms have no influence on the incidence of HD-MTX-related toxicities in childhood ALL.

Antimetabolites, Antineoplastic ; adverse effects ; Child ; Child, Preschool ; Female ; Genotype ; Humans ; Infant ; Male ; Methotrexate ; adverse effects ; Polymorphism, Genetic ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; drug therapy ; genetics ; Thymidylate Synthase ; genetics

OBJECTIVETo discuss the pattern of central lymph node metastasis of cN0 single thyroid papillary carcinoma and provide clinical evidence-supported proof for central lymph node dissection.

METHODSThe performed thyroidectomy and bilateral central lymph node dissection for 150 patients with cN0 single papillary thyroid carcinoma. The bilateral central lymph nodes were divided into 4 parts: the cornu inferius cartilaginis thyroideae region of ipsilateral central area, the lower part of ipsilateral central area, the cornu inferius cartilaginis thyroideae region of contralateral central area, the lower part of contralateral central area on the baseline of 1 cm below the cornu inferius cartilaginis thyroideae. We analyzed the differences and influencing factors of lymph node metastasis in these 4 parts.

RESULTSThe lymph node metastasis rate in lower part of ipsilateral central area was the highest (56.7%), followed by the lower part of contralateral central area (28.0%), the cornu inferius cartilaginis thyroideae region of ipsilateral central area (17.3%), and the cornu inferius cartilaginis thyroideae region of contralateral central area (0). In the logistic analysis of multiple factors, invaded thyroid capsule was an independent factor for lymph node metastasis in both the cornu inferius cartilaginis thyroideae region of ipsilateral central area (β = 0.1835, χ(2) = 0.3102, P < 0.05) and lower part of contralateral area (β = 0.3166, χ(2) = 1.4640, P < 0.05). The patients' age ≥ 45 years (β = 0.5737, χ(2) = 6.5923) and invaded thyroid capsule (β = 0.4258, χ(2) = 3.4735) were independent factors for lower part of ipsilateral central area (both P < 0.05).

CONCLUSIONThe cornu inferius cartilaginis thyroideae region of contralateral central area of cN0 single PTC patients could not be cleared routinely.

Adult ; Carcinoma ; surgery ; Carcinoma, Papillary ; surgery ; Female ; Humans ; Lymph Node Excision ; methods ; Lymphatic Metastasis ; Male ; Middle Aged ; Thyroid Neoplasms ; surgery ; Thyroidectomy

Objective To study the pattern of lymph node spread in papillary thyroid carcinoma (PTC) with clinically negative node(cN0).Methods A total of 106 patients with cN0 PTC who underwent total or subtoyal thyroidectomy plus unilateral or bilateral lateral neck dissection ( LND,level Ⅱ - Ⅴ or level Ⅰ - Ⅴ ) at West China Hospital of Sichuan University between April 2004 and August 2010 were analyzed retrospectively.Results The lateral neck lymph node metastasis in cN0 PTC was significantly associated with sex ( male,P =0.007 ),tumor stage ( T3/T4,P =0.006 ),tumor size ( ＞ 1 cm,P =0.014) and the number of positive central lymph nodes( ≥2,P ＜0.001 ),but not with age and multifocal tumor.Level Ⅲ (47/116,40.5％ ) was the most prevalent metastatic site,followed by level Ⅳ (41/116,35.3％),level Ⅱ (18/116,15.5％) and level Ⅴ (2/29,6.9％).Of the cases with lymph node metastases in level Ⅲ and Ⅳ,89.8％ ( 79/88 ) of primary thyroid tumors existed in the lower and middle sites of the thyroid lobes,while in the cases with lymph node metastases in level Ⅱ,77.8％ (14/18) of primary thyroid tumors in the upper sites of the thyroid lobes,and 83.3％ of cases with level Ⅱ metastases were accompanied with level Ⅲ metastases.Two cases with level Ⅴ metastases were accompanied with metastases in levels Ⅱ,Ⅲ and Ⅳ.Conclusions LND should be considered for cNO PTC in male,with T3/T4 lesions and positive central lymph nodes≥2,and the range of dissection should include level Ⅲ and Ⅳ.Dissection of level Ⅱ should be considered in cNO PTC with primary tumor localized in the upper site of the thyroid lobe or with level Ⅲ metastasis.Dissection of level Ⅴ should be considered at present of metastases in level Ⅱ,Ⅲ,and Ⅳ.For cN0 PTC with tumor size ＜ 1 cm,confined to the thyroid and without lymph node metastasis in the central compartment,LND is not recommended.

Objective To analyse the correlation between the virus isolation and the specimen collection of the H5N1 human hish pathogenic avain influenza cases in Mainland China.Methods The specimens were collected in Mainland China from 2005.10 to 2009.3 and the H5N1 viruses were isolated by passage in embryonated chicken eggs.Results Most specimens were obtained within 14 days after disease onset.For the specimens collected within 7 days,the isolation rate was relatively high and the difference of the positive rate between different years was lower than those specimens collected after 7 days.Most of the samples in our study were collected from the upper or lower respiratory tract with few from blood,feces,et al.The isolation rate of lower respiratory specimens was higher and the difference of the positive rate between different years was relatively lower than those from upper respiratory specimens.Conclusion We suggest that the samples should be collected from lower respiratory tract during the acute phase to get the higher isolation rate.

OBJECTIVETo study the characteristics of infrasound and its effects on the workers at power plants.

METHODSThe audible noise and infrasound in three thermoelectricity plants were measured and by using Symptom Checklist 90 (SCL-90), the subjective sensation, and the physiological indices were compared between exposed workers and controls.

RESULTSThe infrasound levels were different at different measure sites of the three thermoelectricity works ranging from 40 to 98 dB. There was still 40 approximately 80 dB infrasound even when the soot blower stopped running. Different apparatus produced different infrasound levels with the highest ranging from 62 to 115 dB. A single frequency (16 Hz) infrasound was produced in certain department during working hour with sound pressure levels of 110 to 120 dB, but the audible noise sound pressure level was less than 70 dB. There was no significant difference in the indices representing vision fatigue and neurobehaviour function between exposed workers and controls. Workers at certain department experienced evident subjective sensation of neurobehavioral dysfunction, and the scores of somatization, depression, hostility, phobic anxiety, and psychotism in the SCL-90 were significantly higher in the exposed group than in the control and the norm in China (P < 0.05).

CONCLUSIONInfrasound is ubiquitous in the working environment, but usually, the noise levels are less than 120 dB. In some special production department, there is persistent infrasound above 110 to 120 dB. No obvious health effects are found among those who are exposed to infrasound below 100 dB. However, the workers who are chronically exposed to infrasound above 110 to 120 dB present notable subjective sensation of autonomic neurobehavioral dysfunction, and their psychological health status is not as good as those in the control and those in the domestic normal pattern.

Adult ; China ; Humans ; Occupational Exposure ; adverse effects ; Power Plants ; Sound ; adverse effects ; Workplace

OBJECTIVETo evaluate the prognostic significance of micropapillary pattern (MPP) in adenocarcinoma of lung.

METHODSNinety-one consecutively excised cases of pulmonary adenocarcinoma, including follow-up data, were retrospectively studied. These tumors were divided into 2 major groups: those with MPP and those without MPP. The former was further subdivided according to extent of the micropapillary component, as follows: MPP + (constituting 1% to 10% of the tumor), MPP ++ (constituting 11% to 30% of the tumor) and MPP +++ (constituting more than 30% of the tumor).

RESULTSThe overall 5-year survival rate was 64.8%. The 5-year survival rates were 88.9% for stage I tumors, 46.2% for stage II tumors, and 23.8% for stage III tumor respectively (P = 0.000). The extent of micropapillary component showed no correlation with tumor stage, size and 5-year survival rate (P = 0.065, 0.358 and 0.206, respectively). On the other hand, the 5-year survival rate was 41.5% for patients in the MPP-positive group (number = 41) and 84.0% for patients in the MPP-negative group (number = 50). The percentage of nodal metastasis in MPP-positive group was also higher than that in MPP-negative group (P = 0.000). In pulmonary adenocarcinoma, this characteristic histology correlated with tumor stage and size, but not with patient's gender and smoking history. Within the same stage, the 5-year survival rates of MPP-positive and MPP-negative groups were as follows: for stage I, 78.6% versus 92.6% (P = 0.1548), for stage II, 30.0% versus 100% (P = 0.0598), and for stage III, 17.7% versus 28.6% (P = 0.4045).

CONCLUSIONSMPP in primary pulmonary adenocarcinoma, even when only constituting a minor component, predicts an aggressive clinical behavior and is associated with poor prognosis. Although it may not be an independent prognostic factor, presence of this histologic pattern should alert clinicians for more active treatment and closer follow up.

Adenocarcinoma ; pathology ; surgery ; Adenocarcinoma, Bronchiolo-Alveolar ; pathology ; surgery ; Adenocarcinoma, Papillary ; pathology ; surgery ; Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Lung ; pathology ; surgery ; Lung Neoplasms ; pathology ; surgery ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Survival Analysis

OBJECTIVETo discuss the clinicopathological features and prognostic factors of gastric lymphoma.

METHODS83 gastric lymphoma cases were analyzed retrospectively in accordance to the criteria of the new World Health Organization classification for neoplastic diseases of the hematopoietic and lymphoid tissues. The correlations between clinicopathological features, therapeutic measures and survival were discussed.

RESULTSThe age of patients ranged from 25 to 77, with a median of 52. The number of males were similar to that of females. There were no specific symptoms. The most common symptoms were stomach ache (60 cases, 72%) or discomfort. The duration of symptoms was often long and with a history of chronic gastric diseases (21 cases, 25%). 13 cases had multiple lesions in the gastrointestinal mucosa. 51 cases (61%) were accompanied by lymph node involvement. According to the new World Health Organization classification for neoplastic diseases of the hematopoietic and lymphoid tissues, 57 cases were extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT)-type (MALT lymphoma), 23 were diffuse large B cell lymphoma accompanying MALT lymphoma, 2 were diffuse large B cell lymphoma and 1 was follicular lymphoma. Of all the cases, 31 were stage I E, 38 stage II E, 8 stage III E and 6 stage IV by the Ann Arbor staging system (1972). The total 5-year and 10-year survival rates were 77.8% and 70.1% respectively, with the mean survival time of 146 months. The 5-year and 10-year survival rates of MALT lymphoma were 77.4% and 72.3%, the 5-year and 10-year survival rates of diffuse large B cell lymphoma accompanying MALT lymphoma were 81.8% and 68.2%, the 5-year survival rate of diffuse large B cell lymphoma was 50.0%.

CONCLUSIONSThere are no specific symptoms in gastric lymphoma patients. Extranodal marginal zone lymphoma of MALT-type is the main histopathological type of gastric lymphoma, often accompanied by multiple mucosa involvement and also often accompanied by a history of chronic gastric disease. The lesion is usually localized for a long time, with a very good prognosis. Survival rate has a significant correlation with lymph node involvement and clinical stage. No correlations were found between the survival rates with age, gender, B symptoms, invasive depth of the wall of stomach, the size and range of the tumors or different therapeutic measures.

Adult ; Aged ; Chemotherapy, Adjuvant ; Female ; Follow-Up Studies ; Gastrectomy ; methods ; Humans ; Lymphatic Metastasis ; Lymphoma ; pathology ; surgery ; therapy ; Lymphoma, B-Cell ; pathology ; surgery ; therapy ; Lymphoma, B-Cell, Marginal Zone ; pathology ; surgery ; therapy ; Lymphoma, Large B-Cell, Diffuse ; pathology ; surgery ; therapy ; Male ; Middle Aged ; Neoplasm Staging ; Radiotherapy, Adjuvant ; Retrospective Studies ; Stomach Neoplasms ; pathology ; surgery ; therapy ; Survival Rate

OBJECTIVE: To investigate the effects of ulinastatin (UTI) on cerebral inflammatory response during cardiopulmonary bypass (CPB). METHODS: Twenty-four NYHA II-III patients (13 males and 11 females) aged 23-45 years, undergoing elective cardiac valve replacement under hypothermic CPB were randomly divided into 2 groups: ulinastatin group (Group U, n=12) and control group (Group C, n=12). In group U, UTI (1.2 x 10(4) U/kg) was given intravenously after the induction of anesthesia, 0.6 x 10(4) U/kg UTI was added to the priming solution, and 0.6 x 10(4) U/kg UTI was given about 5 min before the aortic decamping. In Group C, normal saline was given instead of UTI. Internal jugular vein was cannulated and the catheter was advanced retrogradely till jugular bulb. Blood samples were taken simultaneously from artery and jugular bulb after induction of anesthesia (T1), 60 min (T2) and 6 h (T3) after discontinuation of CPB for determination of TNFalpha, IL-6, IL-8 and IL-10. The juguloarterial gradients of these cytokines (deltaTNFalpha, deltaIL-6, deltaIL-8, and deltaIL-10) were calculated. RESULTS: In Group C, arterial levels of TNFalpha, IL-6, IL-8, IL-10 at T2 and T3, deltaTNFalpha, deltaIL-8 and deltaIL-10 at T2, deltaTNFalpha, deltaIL-6 and deltaIL-10 at T3 significantly increased (P < 0.01). deltaIL-8 increased at T3 (P < 0.05). In Group U, arterial levels of IL-6, IL-8, IL-10 at T2, arterial levels of IL-6, IL-8,IL-L-10 and deltaTNFalpha, deltaIL-8 at T3 significantly increased (P < 0.01). Arterial levels of TNFalpha at T2 and T3, deltaTNFalpha, deltaIL-10 at T2, deltaIL-6 at T3 increased (P < 0.05). Arterial levels of TNFalpha, IL-6 and deltaTNFalpha, deltaIL-8 at T2, arterial levels of TNFalpha and deltaIL-6 at T3 in Group U were lower than those in Group C (P < 0.05). Arterial levels of IL-6 at T3, IL-8 at T2 and T3 in Group U were significantly lower than those in Group C (P < 0.01). Arterial levels of IL-10 and deltaIL-10 at T3 in Group U were higher than those in Group C (P < 0.05). CONCLUSION Systemic and cerebral activation of inflammatory response during CPB can be alleviated by ulinastatin.
Adult ; Cardiopulmonary Bypass ; adverse effects ; Encephalitis ; etiology ; metabolism ; prevention & control ; Female ; Glycoproteins ; therapeutic use ; Heart Valve Prosthesis Implantation ; Humans ; Interleukin-10 ; blood ; Interleukin-6 ; blood ; Interleukin-8 ; blood ; Male ; Middle Aged ; Trypsin Inhibitors ; therapeutic use ; Tumor Necrosis Factor-alpha ; metabolism