胃癌证型与肿瘤增殖的关系

目的:探索胃癌中医证型与肿瘤增殖的关系方法:胃癌患者91例,术前按中医辨证分型标准归类成6型,术后标本用免疫组化Envision法检测胃癌组织Ki67与Cyclin E的蛋白表达,观察不同证型肿瘤增殖差异．结果:Ki67,Cyclin E阳性表达率分别为 98．90％(90／91),72．53％(66／91)．Cyclin E的表达与胃癌病理分型(P=0．0394)及远处转移(P =0．0096)存在相关性,女性患者有无远处转移与Cyclin E表达有统计学意义(P=0．0193),有远处转移的患者表达较高．Ki67与预后相关因素未见相关性．Ki67的表达与证型存在相关性 (P=0．0377),肝胃不和型与痰湿凝结型、气血双亏型Ki67表达存在差异,肝胃不和型高于痰湿凝结型(P<0．01)、气血双亏型(P<0．05), 胃热伤阴型与痰湿凝结型Ki67存在差异,胃热伤阴型高于痰湿凝结型(P<0．05);Cyclin E的表达各证型未见统计学差异(P<=0．1254)．结论:Cyclin E可作为判断胃癌预后的重要指标．胃癌不同证型存在部分增殖差异,Ki67与胃癌证型相关,Cyclin E与证型无关．     

原发性高血压患者的个性特征与中医辨证分型

目的:探讨原发性高血压患者的个性特征与中医辨证分型的关系。方法:采用艾森克个性问卷(EPQ)对197例原发性高血压患者进行心理学检测,分析患者的个性特征,并结合中医学的个性理论和中医对原发性高血压的辩证分型,对高血压患者进行个性特征与中医辨证分型的对照研究。结果:原发性高血压患者以外向情绪不稳定型多见(38.58%),情绪不稳定的患者共有147例,占74.62%。中医辨证分型多为肝火亢盛型多(48.7%)。结论:原发性高血压的发病与个性特征有明显的关系,且中医辨证分型多为肝火亢盛型。     

The relationship of traditional Chinese medicine and Helicobacter pyloriinfection, expression of oncogene and tumor suppresser genes in patientswith gastric cancer and precancerous lessions

AIM To study the relationship among typing of Traditional Chinese Medicine (TCM) and Helicobacterpylori infection, expression of oncogene and tumor suppresser genes in gastric cancer and precancerouslessions.METHODS According to TCM typing, 120 patients with chronic superficial gastritis, intestinal metaplasia,atypical hyperplasia and gastric cancer were divided into 4 groups: 21 patients with coexistence of cold andheat syndrome (group R), 22 patients with in coordination between the liver and the spleen (group U), 29patients with deficiency of the spleen-yin (group I) and 48 patients with insufficiency of the spleen-yang(group H). Protein expression of c-myc, p21 and p53 were detected immunohistochemically, and Hp wereconfirmed by modified Giemsa method.RESULTS The Hp infection of the group H was significantly higher (72.9%) than that of group R(38.1%, P<0.01) and group U (40.9%, P<0.01). Expression of c-myc, p21 and p53 were significantlyrelated to Hp infection and severity of gastric mucosa lesions (group H>group I>group U>group R).CONCLUSION Hp infection, expression of oncogene and tumor suppresser genes were related to TCMtyping. These parameters were helpful in identification of symptoms and signs and TCM differentiationdiagnosis.     

Pathohistological classification systems in gastric cancer:Diagnostic relevance and prognostic value

Several pathohistological classification systems exist for the diagnosis of gastric cancer.Many studies have investigated the correlation between the pathohistological characteristics in gastric cancer and patient characteristics,disease specific criteria and overall outcome.It is still controversial as to which classification system imparts the most reliable information,and therefore,the choice of system may vary in clinical routine.In addition to the most common classification systems,such as the Laurén and the World Health Organization(WHO)classifications,other authors have tried to characterize and classify gastric cancer based on the microscopic morphology and in reference to the clinical outcome of the patients.In more than 50 years of systematic classification of the pathohistological characteristics of gastric cancer,there is no sole classification system that is consistently used worldwide in diagnostics and research.However,several national guidelines for the treatment of gastric cancer refer to the Laurén or the WHO classifications regarding therapeutic decision-making,which underlines the importance of a reliable classification system for gastric cancer.The latest results from gastric cancer studies indicate that it might be useful to integrate DNA-and RNA-based features of gastric cancer into the classification systems to establish prognostic relevance.This article reviews the diagnostic relevance and the prognostic value of different pathohistological classification systems in gastric cancer.     

Characterization of Bouveret's syndrome: a comprehensive review of 128 cases

AIM: The aim of the study was to characterize the clinical presentation, evaluation, and therapy of Bouveret's syndrome, by comprehensively reviewing all the identified previously reported cases, to facilitate early diagnosis and thereby to improve the prognosis. METHODS: Relevant articles were identified by MEDLINE computerized searches, by consultation with all available reference books, and by review of the first author's teaching files. A new case in which the diagnosis of Bouveret's syndrome was missed at esophagogastroduodenoscopy (EGD)--despite endoscopic findings of gastric outlet obstruction caused by a hard, nonfleshy, and convex pyloric mass--prompted this review. RESULTS: Review of 128 reported cases identified syndromic characteristics. Patients on average were 74.1 +/- 11.1 (SD) yr old. The female-to-male sex ratio was 1.86. Prominent symptoms were nausea and vomiting in 87%, abdominal pain in 71%, hematemesis in 15%, recent weight loss in 14%, and anorexia in 13% of patients. Prominent signs were abdominal tenderness in 44%, signs of dehydration in 31%, and abdominal distention in 26% of patients. Endoscopy revealed gastroduodenal obstruction in nearly all cases, but identified the obstructing stone in only 69%. Abdominal ultrasound or computerized tomography was diagnostic in about 60% of cases. CONCLUSIONS: The following endoscopic findings are suggestive of Bouveret's syndrome: a dilated stomach containing old digested food from gastrointestinal obstruction together with a hard and nonfleshy mass at the obstruction. These endoscopic findings, in the setting of the currently reported characteristic epidemiologic and clinical findings, should strongly suggest this syndrome. Abdominal ultrasound or computerized tomography is recommended to confirm and extend the endoscopic diagnosis.     

Significance of Survivin and PTEN expression in full lymph node-examined gastric cancer

AIM:To study the relationship between Survivin andPTEN expression and lymph node metastasis,depth ofinvasion and prognosis of gastric cancer patients in Chi-na.METHODS:Specimens of gastric cancer tissue were col-lected from the Affiliated Hospital of Jianghan University.All the 140 patients had complete examination data.Alllymph nodes were found by the fat-clearing method.Theinterrupted serial 4-micron sections,routine hematoxylinand eosin staining and immunohistochemical methodswere used to detect the lymph node metastases.Gastriccancer tissue microarray was performed to test the ex-pression of Survivin and PTEN(17A)in gastric cancer byimmunohistochemical method.All data were processedusing x~2 test,Fisher's exact test,Kaplan-Meyer Log-rankmethod and Cox multivariate analysis(SPSS 12.0 soft-ware).RESULTS:One hundred and eighteen specimenswere used in our tissue microarray(utilization rate was82.4%).A total of 7580 lymph nodes were found.Metas-tases were found in 90 specimens and 1618 lymph nodeswere detected.The positive rate of Survivin and PTENexpression was 52.5%(62/118)and 76.2%(90/118),respectively.A highly positive correlation was found be-tween Survivin and PTEN expression(x~2=4.17,P=0.04).Survivin expression was positively correlated with UICCN stage(x~2=8.69,P=0.03)and histological classifica- tion(x~2=4.41,P=0.04)by x~2 tests.PTEN expression waspositively correlated with depth of invasion(P=0.02)andhistological classification(x~2=5.47,P=0.02).But Survivinand PTEN expressions were not related with prognosis ofgastric cancer patients.A significant correlation betweenlymph node metastasis and prognosis was demonstratedby Cox multivariate analysis(x~2=4.85,P=0.028).CONCLUSION:Survivin is positively correlated withPTEN expression in gastric cancer and is a molecularmarker of lymph node metastasis while PTEN expressionis a molecular marker of advanced gastric cancer.UICCN stage is the most important prognostic factor of gastriccancer in China.     

胃黏膜低级别上皮内瘤变中胃癌检漏的研究

目的探讨胃黏膜低级别上皮内瘤变(low grade intraepithelial neoplasia,LGIEN)中胃癌漏诊的情况。方法胃镜活检病理诊断为LGIEN的190例患者总结内镜下病灶部位和形态分类,并行内镜复查了解胃癌漏诊情况。结果 190例LGIEN患者病灶主要位于胃窦的137例(72.1%)。镜下病灶形态多样,其中糜烂及溃疡98例(51.6%)。190例患者平均随访时间11.7个月,经内镜病理或手术病理证实胃癌14例,HGIEN患者3例,较前加重者占8.95%;其中符合漏诊患者13例(76.5%),符合可能漏诊患者3例(17.6%)。结论胃镜活检病理检查为LGIEN的患者中部分同时存有癌灶,内镜短期、重复检查可减少胃癌漏诊率。     

Detection and prognosis of recurrent gastric cancer--is routine follow-up after gastrectomy worthwhile?

BACKGROUND/AIMS: Although routine follow-up after surgery for gastric cancer is recommended its value after gastrectomy has not been evaluated. METHODOLOGY: All patients who underwent gastrectomy for gastric cancer entering the routine follow-up program between January 1987 and August 1996 were identified. The patients studied were those with either histologically proven recurrence or those in whom recurrence was highly probable from clinical course. Two groups were compared. The first group comprised the patients whose recurrence was detected by routine follow-up prior to the development of clinical signs (asymptomatic group). The second group consisted of the patients who developed clinical symptoms due to a recurrence that was detected subsequently (symptomatic group). The main parameters were the time until recurrence occurred, the pattern of recurrence, treatment and survival. RESULTS: Out of 184 patients entering the routine follow-up 135 patients had undergone potentially curative gastrectomy. Sixty-seven patients (49.6%) had recurrences. Only 15 (22.3%) belonged to the asymptomatic group and 52 (77.7%) to the symptomatic one. The time until recurrence occurred was not different between the 2 groups (17.1 vs. 18.0 months). Chemotherapy was performed more frequently in the asymptomatic group and survival was longer (8.4 vs. 5.9 months). This difference was due to the time the patients remained asymptomatic (average 43 months). No effect of either early detection or chemotherapy was seen. In the asymptomatic group distant recurrence was common while recurrence in the symptomatic group was more often local but this difference did not reach statistic significance. CONCLUSIONS: Routine follow-up after gastrectomy for gastric cancer does not contribute to early detection of gastric cancer recurrence. It has no benefit with respect to treatment and survival of patients with recurrent disease and should therefore be reduced to symptomatic and psychological aftercare.     

共聚焦激光显微内镜对胃癌病理分型的诊断价值

目的建立共聚焦激光显微内镜（CLE）对胃癌病理分型的诊断标准,评价CLE对胃癌病理分型的诊断价值。方法分析行CLE检查且经组织病理证实为胃癌的36例患者的共聚焦图像,建立CLE对胃癌病理分型的诊断标准。根据共聚焦图像上腺体结构的有无和微血管形态的改变,CLE可将胃癌分为分化型和未分化型两种病理类型。以组织病理结果作为金标准,回顾性研究CLE对不同胃癌病理分型诊断的敏感性、特异性和准确性。结果CLE对分化型胃癌的诊断敏感性、特异性和准确性为81．8％、93．5％和88．7％,对未分化型胃癌的诊断敏感性、特异性和准确性为85．7％、92．3％和90．5％。结论共聚焦激光显微内镜对分化型和未分化型胃癌的诊断与组织病理学诊断有良好的一致性,提供了一种于内镜检查同时在体诊断胃癌病理分型的新工具。     

Comparison of endoscopic gastritis based on Kyoto classification between diffuse and intestinal gastric cancer

BACKGROUND Gastric cancers can be categorized into diffuse-and intestinal-type cancers based on the Lauren histopathological classification. These two subtypes show distinct differences in metastasis frequency, treatment application, and prognosis. Therefore, accurately assessing the Lauren classification before treatment is crucial. However, studies on the gastritis endoscopy-based Kyoto classification have recently shown that endoscopic diagnosis has improved.AIM To investigate patient characteristics including endoscopic gastritis associated with diffuse-and intestinal-type gastric cancers in Helicobacter pylori(H. pylori)-infected patients.METHODS Patients who underwent esophagogastroduodenoscopy at the Toyoshima Endoscopy Clinic were enrolled. The Kyoto classification included atrophy, intestinal metaplasia, enlarged folds, nodularity, and diffuse redness. The effects of age, sex, and Kyoto classification score on gastric cancer according to the Lauren classification were analyzed. We developed the Lauren predictive background score based on the coefficients of a logistic regression model using variables independently associated with the Lauren classification. Area under the receiver operative characteristic curve and diagnostic accuracy of this score were examined.RESULTS A total of 499 H. pylori-infected patients(49.6% males; average age: 54.9 years) were enrolled; 132 patients with gastric cancer(39 diffuse-and 93 intestinal-type cancers) and 367 cancer-free controls were eligible. Gastric cancer was independently associated with age ≥ 65 years, high atrophy score, high intestinal metaplasia score, and low nodularity score when compared to the control. Factors independently associated with intestinal-type cancer were age ≥ 65 years(coefficient: 1.98), male sex(coefficient: 1.02), high intestinal metaplasia score(coefficient: 0.68), and low enlarged folds score(coefficient:-1.31) when compared to diffuse-type cancer. The Lauren predictive background score was defined as the sum of +2(age ≥ 65 years), +1(male sex), +1(endoscopic intestinal metaplasia), and-1(endoscopic enlarged folds) points. Area under the receiver operative characteristic curve of the Lauren predictive background score was 0.828 for predicting intestinal-type cancer. With a cut-off value of +2, the sensitivity, specificity, and accuracy of the Lauren predictive background score were 81.7%, 71.8%, and 78.8%, respectively.CONCLUSION Patient backgrounds, such as age, sex, endoscopic intestinal metaplasia, and endoscopic enlarged folds are useful for predicting the Lauren type of gastric cancer.