Objective To investigate the importance of echoendoscope in identifying common bile duct lesions associated with portal hypertension in liver cirrhosis.Methods From November 2022 to January 2023,a group of 37 individuals suffering from liver cirrhosis,portal hypertension,esophageal,and gastric varices underwent echoendoscope analysis to assess the common bile duct wall's thickness,its width,and to examine its cavity's dimensions.Result The common bile duct's wall exhibited roughness with 97.3%(36/37),with an average thickness of 0.19 cm,a width of 0.47 cm,and flocculent deposits constituting 73.0%(27/37).The typical bile duct exhibited curvature in 13.5%(5/37).None of the patients experienced bleeding either during or following the echoendoscope examination.Conclusion The use of echoendoscope distinctly reveals cirrhosis-induced common bile duct and portal hypertension;a majority of cirrhosis and portal hypertension sufferers exhibit inflammation in the common bile duct;this technique is deemed safe for assessing esophageal and gastric varices in cirrhosis patients.

Objective:To investigate the effect of the distance of the circumferential resection margin (CRM) on postoperative recurrence after laparoscopic radical resection of colon cancer.Methods:The clinical data of 83 patients who underwent laparoscopic radical resection of colon cancer in Yiwu Central Hospital from January 2020 to January 2022 were retrospectively included. They were divided into recurrent group (16 cases) and non-recurrent group (67 cases) according to the recurrence within 1 year after operation. The clinical data, postoperative CRM distance and laboratory indicators of the two groups were collected to analyze the influence of CRM distance on postoperative recurrence after laparoscopic radical resection of colon cancer.Results:The proportion of patients treated with postoperative chemotherapy, and postoperative CRM distance in the recurrent group were lower than those in the non-recurrent group: 9/16 vs. 83.58 % (56/67), (0.85 ± 0.23) mm vs. (1.64 ± 0.76) mm. The levels of CEA and CA19-9 at admission were higher than those in the non-recurrent group: (156.74 ± 11.58) μg/L vs. (149.96 ± 10.26) μg/L, (15.63 ± 2.77) kU/L vs. (14.04 ± 2.35) kU/L, and the differences were statistically significant ( P<0.05). Point binary correlation analysis showed that there was a negative correlation between CRM distance and postoperative recurrence after laparoscopic radical resection of colon cancer ( r = - 0.412, P<0.01). Multivariate Logistic regression analysis showed that the long distance of CRM was the protective factor of recurrence after laparoscopic radical resection of colon cancer ( OR<1, P<0.05). The results of the receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) of the CRM distance to predict the recurrence after laparoscopic radical resection of colon cancer was 0.833>0.7, and the predictive value was good. When the optimal threshold was 1.080 mm, the ideal sensitivity and specificity could be obtained 87.50% and 81.00%. Conclusions:The shorter the CRM distance after laparoscopic radical resection of colon cancer, the higher the risk of recurrence. The CRM distance can be used as a predictor of recurrence after laparoscopic radical resection of colon cancer.

Objective:To investigate the efficacy of endoscopic retrograde cholangiopancreatography in the treatment of Child-Pugh C cirrhosis complicated by obstructive jaundice and its effects on liver function and infection indexes.Methods:The clinical data of 86 patients with Child-Pugh C cirrhosis complicated by obstructive jaundice who received treatment in the Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, from June 2017 to June 2022 were retrospectively analyzed. These patients were divided into an observation group ( n = 56) and a control group ( n = 30) according to different treatment methods. Patients in the observation group underwent endoscopic retrograde cholangiopancreatography and those in the control group received conservative drug treatment. After 14 days of treatment, clinical efficacy was compared between the two groups. The changes in liver function [alanine aminotransferase (ALT), aspartate aminotransferase (AST), glutamyl transpeptide (GGT)] and infection indicators [white blood cell count (WBC), procalcitonin (PCT), and C-reactive protein (CRP)] were compared between the two groups before and after treatment. The incidence of postoperative complications was compared between the two groups. At 6 months after treatment, the prognosis was compared between the two groups. Results:The total response rate in the observation group was 98.21% (55/56), which was significantly higher than 60.00% (18/30) in the control group ( Z = 23.43, P < 0.001). Before treatment, serum ALT, AST, GGT levels in the control group were (294.53 ± 45.19) U/L, (286.62 ± 17.15) U/L, and (304.53 ± 12.34) U/L, respectively, and they were (96.25 ± 16.7) U/L, (113.25 ± 8.56) U/L, (122.25 ± 9.24) U/L after 14 days of treatment. Before treatment, serum ALT, AST, and GGT levels in the observation group were (352.36 ± 70.23) U/L, (303.31 ± 12.12) U/L, and (368.36 ± 10.23) U/L, respectively, and they were (108.65 ± 12.38) U/L, (95.65 ± 6.54) U/L, and (85.66 ± 7.28) U/L, respectively, after 14 days of treatment. After treatment, serum ALT, AST, and GGT levels in each group were significantly decreased compared with those before treatment (observation group t = 22.54, 49.54, 64.76; control group t = 25.57, 112.83, 168.48, all P < 0.05). After treatment, the amplitude of decrease in serum ALT, AST, and GGT levels in the observation group were significantly greater than those in the control group ( t = 2.27, 3.18, 4.61, all P < 0.05). After treatment, PCT, CRP, and WBC in each group were significantly decreased compared with those before treatment (observation group: t = 11.68, 11.46, 5.42, control group: t = 20.39, 18.69, 19.02, all P < 0.05). After treatment, the amplitude of decrease in serum PCT, CRP, and WBC in the observation group were significantly greater than those in the control group ( t = 5.14, 1.67, and 2.11, all P < 0.05). Within 14 days after treatment, there were two cases of acute pancreatitis, one case of hyperamylasemia, and one case of transient biliary bleeding in the observation group. There was one case of acute pancreatitis in the control group. The incidence of complications in the observation group was slightly, but not significantly, higher than that in the control group ( P > 0.05). After treatment, 12 patients (40.00%) in the control group experienced worsening jaundice, and additional endoscopic retrograde cholangiopancreatography salvage treatment was given. After treatment, total bilirubin level decreased by > 50%, reaching the standard of significant efficacy. At 6 months after treatment, stent obstruction occurred in two patients, which was effectively treated by replacement. There were no deaths in each group during the follow-up period. Conclusion:Implantation of a nasobiliary duct or a biliary duct stent during endoscopic retrograde cholangiopancreatography is more effective at treating yelloxemia in patients with Child-Pugh C cirrhosis complicated by obstructive jaundice than medication. The former method can effectively relieve obstructive jaundice, smooth drainage, improve liver function, reduce infection, and be relatively safe.

Photothermal therapy has been intensively investigated for treating cancer in recent years. However, the long-term therapeutic outcome remains unsatisfying due to the frequently occurred metastasis and recurrence. To address this challenge, immunotherapy has been combined with photothermal therapy to activate anti-tumor immunity and relieve the immunosuppressive microenvironment within tumor sites. Here, we engineered silica-based core‒shell nanoparticles (JQ-1@PSNs-R), in which silica cores were coated with the photothermal agent polydopamine, and a bromodomain-containing protein 4 (BRD4) inhibitor JQ-1 was loaded in the polydopamine layer to combine photothermal and immune therapy for tumor elimination. Importantly, to improve the therapeutic effect, we increased the surface roughness of the nanoparticles by hydrofluoric acid (HF) etching during the fabrication process, and found that the internalization of JQ-1@PSNs-R was significantly improved, leading to a strengthened photothermal killing effect as well as the increased intracellular delivery of JQ-1. In the animal studies, the multifunctional nanoparticles with rough surfaces effectively eradicated melanoma via photothermal therapy, successfully activated tumor-specific immune responses against residual tumor cells, and further prevented tumor metastasis and recurrence. Our results indicated that JQ-1@PSNs-R could serve as an innovative and effective strategy for combined cancer therapy.

Objective:To analyze the prognosis of patients with positive resection margin after radical prostatectomy, as well as the prostate-specific antigen (PSA)level and risk factors for PSA progression.Methods:A retrospective analysis was performed on the data of 141 patients with pathologically diagnosed prostate cancer who underwent RP from May 2012 to August 2020 in Beijing Hospital. The mean age was (67.4±6.7)years, the preoperative median PSA was 9.6 (1.4-152.8) ng/ ml and the median follow-up time was 56 months. Postoperative pathology was T 2 stage 74 (52.5%), T 3 stage 63 (44.7%), T 4 stage 4 (2.8%). Biochemical recurrence after radical resection was defined as PSA rose to more than 0.2 ng/ml and showed an upward trend after two consecutive follow-ups. In this study, serum PSA ≥ 0.1 ng/ml without biochemical recurrence after radical operation was defined as PSA progression. The PSA level, risk factors of PSA progression and prognosis of patients with positive resection margin were analyzed. Univariate and multivariate Cox regression analysis was used to analyze the correlation between age, preoperative PSA level, pathological stage (pT), ISUP classification, surgical approach, lymph node dissection, single/multiple positive margins and PSA progression. Results:The median follow-up of 141 patients was 52 months(1-104 months). There were 69 (48.9%) patients in the PSA progression group and 72 (51.1%) patients in the non PSA progression group. In the PSA progression group, 13 (18.8%) patients did not receive treatment and 8 (61.5%) patients had biochemical recurrence. 4 (5.8%) patients received radiotherapy alone, and 2 (50.0%) patients had biochemical recurrence. 52 (75.4%) patients received endocrine therapy or endocrine therapy combined with radiotherapy, and 5 (9.6%) patients developed castration resistance. Multivariate Cox regression analysis showed preoperative PSA ( HR=1.015, 95% CI 1.005-1.025, P =0.004), ISUP grade and group ( HR=1.351, 95% CI 1.091-1.673, P =0.006), surgical method ( HR=2.233, 95% CI 1.141-4.370, P =0.019) was correlated with PSA progression. Conclusions:The incidence of surgical positive margin is high after RP. Nearly half of the patients with surgical positive margin developed a PSA progression status. Preoperative PSA, ISUP grade group, and the surgical approach are risk factors for PSA progression in patients with positive surgical margins. Patients with these risk factors should be monitored more closely and treated more aggressively.

Objective: To evaluate the clinical observation of rectal prolapse by partial perineal rectal sigmoidectomy. Methods: Sixty patients with rectal prolapse who met the diagnostic criteria of rectal prolapse in Yiwu Central Hospital from April 2013 to June 2015 were selected as the research subjects.They were divided into two groups according to random number table, with 30 cases in each group.The observation group used Altemeier, and the control group underwent triple surgery (rectal mucosal ligation, periorbital injection, and anal ring retraction). The total effective rate after surgery was compared and analyzed. Results: The operation of the two groups was successfully completed.The total effective rate of the observation group was 96.67%, which was significantly higher than 80.00% of the control group, the difference was statistically significant(χ²=5.856, P=0.048). The Wexner constipation score of the observation group was (1.4±1.6)points, which was significantly lower than that of the control group[(3.2±2.0)points, t=3.849, P<0.05]. The Wexner anal incontinence score of the observation group after 24 months was (2.9±1.8)points, which was significantly lower than that of the control group [(4.4±2.7)points, t=2.532, P<0.05]. The proportions of anastomotic bleeding, pelvic swelling and perianal eczema in the observation group were 0.00%, 0.00% and 3.33%, respectively, which were significantly lower than those in the control group(20.00%, 23.33% and 30.00%, χ²=4.630, 5.822, 7.680, all P<0.05). Conclusion Altemeier can significantly improve the quality of life of patients, with a high cure rate and good clinical results.

Objective To study the expression and clinical significance of ARHGAP4 in colorectal cancer Method Real?time PCR,Western blot and immunocytochemistry were used to detect the expression of ARHGAP4 in colorectal cancer tissues and cell lines ,and the correlation between its expression and clinical features of patients was analyzed Results ARHGAP4 is overexpressed in colorectal cancer tissues and cell lines and its overexpression is correlated with T stage, N stage, clinical stage, and metastasis. Conclusion ARHGAP4 may promote the progression of colorectal cancer ,and have the potential to be a novel prognosis marker.

Objective To evaluate the clinical effect and efficacy of endoscopy treatment for isolated gastric varices 1 with tissue glue and metal clips. Metheds The clinical date of 21 patients who treated tissue glue and metal clips were retrospectively analyzed from Jan 2015 to Dec 2016. Results The treatments were completed successfully and reviewed by endoscopy after 1 week, 1 month, 3 months, 6 months. The gastric varices were reduced, and the serious complications of bleeding, embolism were little. Conclusion The endoscopy treatment for isolated gastric varices 1 with tissue glue and metal clips is contributed to clinical effect, and the treatment provides a reference for clinical treatment.

OBJECTIVETo investigate clinicopathologic features of succinate dehydrogenase-deficient gastrointestinal stromal tumors (SDH-deficient GIST).

METHODSImmunohistochemical EnVision technique was used to assess the expression of succinate dehydrogenase subunit B (SDHB) in 192 cases of GIST. Cases of SDH-deficient GIST were further evaluated for the presence of CKIT exons 9, 11, 13 and 17 mutations and PDGFRA exons 12 and 18 mutations with clinical followed-up data.

RESULTSSeven of the 192 cases showed SDHB-deficiency (3.6%, 7/192). The patients ranged in age from 35 to 84 years (median=56 years; mean=60 years). Four were male and three were female. Six tumors involved stomach and one involved mesentery. Histopathologic features of SDHB-deficient GIST included four cases of mixed-cell type and three of epithelioid cell type. The tumors commonly involved muscularis propria of the stomach as multiple nodules, creating a plexiform pattern. The tumors had high cellularity with cytoplasmic vacuolization. Five cases developed lymph node metastases including one also metastasizing to liver and pancreas. Two cases showed no evidence of metastasis. None of the 7 cases of the SDHB-deficient GIST had CKIT exons 9, 11, 13 and 17 mutations and PDGFRA exons 12 and 18 mutations. Three of the seven SDHB-deficient GIST cases had followed-up data: two did not recur and one died after 24 months of surgery of unknown cause.

CONCLUSIONSDHB-deficient GIST has characteristic clinicopathologic features with wide-type CKIT gene and a favorable prognosis.

Adult ; Aged ; Aged, 80 and over ; Exons ; Female ; Gastrointestinal Stromal Tumors ; diagnosis ; genetics ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Mutation ; Prognosis ; Succinate Dehydrogenase ; genetics

Humans ; Kidney Transplantation ; Multiple Myeloma