Role of sex hormones in gastrointestinal motility in pregnant and non-pregnant rats

AIM: To correlate gastric contractility, gastrointestinal transit, and hormone levels in non-pregnant(estrous cycle) and pregnant rats using noninvasive techniques. METHODS: Female rats(n = 23) were randomly divided into(1) non-pregnant,(contractility, n =6; transit, n = 6); and(2) pregnant(contractility, n = 5; transit, n = 6). In each estrous cycle phase or at 0, 7, 14, and 20 d after the confirmation of pregnancy, gastrointestinal transit was recorded by AC biosusceptometry(ACB), and gastric contractility was recorded by ACB and electromyography. After each recording, blood samples were obtained for progesterone and estradiol determination. RESULTS: In the estrous cycle, despite fluctuations of sex hormone levels, no significant changes in gastrointestinal motility were observed. Days 7 and 14 of pregnancy were characterized by significant changes in the frequency of contractions(3.90 ± 0.42 cpm and 3.60 ± 0.36 cpm vs 4.33 ± 0.25 cpm) and gastric emptying(168 ± 17 min and 165 ± 15 min vs 113 ± 15 min) compared with day 0. On these same days, progesterone levels significantly increased compared with control(54.23 ± 15.14 ng/m L and 129.96 ± 30.52 ng/mL vs 13.25 ± 6.31 ng/mL). On day 14, we observed the highest level of progesterone and the lowest level of estradiol compared with day 0(44.3 ± 15.18 pg/mL vs 24.96 ± 5.96 pg/mL). CONCLUSION: Gastrointestinal motility was unaffected by the estrous cycle. In our data, high progesterone and low estradiol levels can be associated with decreased contraction frequency and slow gastric emptying.     

Significance of serum leptin and adiponectin levels in Egyptian patients with chronic hepatitis C virus associated hepatic steatosis and fibrosis

AIM: To study serum levels of leptin and adiponectin in patients with chronic hepatitis C virus infection genotype-4 (HCV-4) related steatosis and fibrosis. METHODS: We prospectively studied 45 untreated men with chronic HCV-4, with proven steatosis (group I, 30 patients), and fibrosis (group II, 15 patients), on liver biopsy. In addition, 15 healthy men (group III), matched for age, and body mass index were included. However, we excluded another five patients with steatohepatitis, and six patients with cirrhosis. We measured total serum leptin and adiponectin levels, as potential predictors for liver steatosis and fibrosis. Also, a correlation between these adipokines and various clinical and laboratory data were evaluated. All subjects were selected from Tropical and Internal medicine departments, Menoufiya University Hospital, Menoufiya, Egypt, during the period from February 2010 to August 2011. RESULTS: In group I, severity of hepatic steatosis was mild, moderate, and severe, in 19 patients (63.5%), 8 patients (26.5%), and 3 patients (10%), respectively. In contrast, in group II, hepatic fibrosis was found to be in stage 1, 2, and 3, in 6 patients (40%), in 6 patients (40%), and in 3 patients (20%), respectively. On comparing group I with group II, there was a significant decrease in serum adiponectin levels (131.4 ± 7.91 pg/mL vs 436 ± 9.75 pg/mL, P < 0.001), while there was no significant difference between both groups regarding serum leptin levels (34.69 ± 7.69 ng/mL vs 35.17 ± 1.06 ng/mL, P > 0.05). However, in the same group, when compared with group III, there was a significant increase in serum leptin levels (34.69 ± 7.69 ng/mL vs 10.69 ± 0.84 ng/mL, P < 0.001), while there was a significant decrease in serum adiponectin levels (131.4 ± 7.91 pg/mL vs 342.4 ± 44.48 pg/mL, P < 0.001). In contrast, in group II, when compared with group III, there was a significant increase in serum leptin and adiponectin levels (35.17 ± 1.06 ng/mL vs 10.69 ± 0.84 ng/mL, P < 0.001, and 436 ± 9.75 pg /mL vs 342.4 ± 44.48 pg/mL, P < 0.05, respectively), while there was no significant difference between both groups regarding serum creatinine (0.83 ± 0.34 vs 0.89 ± 0.24, P > 0.05). On the other hand, serum leptin was not correlated with serum adiponectin in group I and in group II (r = 0.09, P > 0.05, and r = -0.1, P > 0.05, respectively). However, serum adiponectin was significantly negatively correlated with serum aspartate transaminase in group I, but no correlation detected in group II (r =-0.39, P > 0.05, and r = -0.03, P > 0.05). CONCLUSION: In male patients with chronic HCV-4, serum adiponectin levels are elevated in hepatic fibrosis, but decreased in steatosis. Therefore, in contrast to leptin, adiponectin may be used as a non-invasive marker.     

Prognostic role of neutrophil-lymphocyte ratio in operable esophageal squamous cell carcinoma

AIM: To determine the prognostic significance of preoperative serum neutrophil-lymphocyte ratio(NLR) in esophageal squamous cell carcinoma(ESCC).METHODS: Data from 371 eligible patients with ESCC who had undergone surgery with curative intent at our institution between October 2000 and May 2007 were retrospectively recruited for analysis. The cutoff value of NLR was 3.0 as determined by the receiver operating characteristic curve, which discriminated between survival and death; the area under the curve was 0.709, and the sensitivity and specificity were 66.1% and 69.1%, respectively, at the cutoff point. The correlation between the NLR and clinicopathological characteristics was analyzed using a χ2 test. The prognostic influence of the NLR and other clinicopathological factors on cancer-specific survival(CSS) and recurrence-free survival(RFS) was studied using the Kaplan-Meier method. To evaluate the independent prognostic value of NLR, multivariate Cox regression models were applied.RESULTS:The median age of the patients was 57.0years,and 276/371(74.4%)patients were male.The NLR was≤3.0 in 80.1%(297/371)of the patients,and the remaining 19.9%(74/371)had an NLR3.0.Median postoperative follow-up was 66.0 mo[interquartile range(IQR):49.0-76.0 mo],with a follow-up rate of 94%.Follow-up was not significantly different between patients with an NLR≤and3.0(63.13±1.64 vs 61.52±3.66,P=0.711).However,higher preoperative serum NLR was associated with significantly increased risks of higher pathological tumor status(P=0.007).A significant,independent association between high preoperative serum NLR and poor clinical outcome was identified in a multivariate analysis for CSS(HR=1.591;P=0.007)and RFS(HR=1.525;P=0.013).Moreover,when patients were stratified by pathological tumor-node-metastasis(TNM)staging,the adverse effects of preoperative serum NLR on CSS(HR=2.294;P=0.008)and RFS(HR=2.273;P=0.008)were greatest in those patients with stageⅢA disease.CONCLUSION:Preoperative serum NLR is a useful prognostic marker to complement TNM staging for operable ESCC patients,particularly in patients with stageⅢA disease.     

Prognostic value of silver-stained nucleolar organizer regions in colorectal carcinoma

AIM: Recently, silver-stained nucleolar organizing regions (AgNOR) analysis has been used as a criterion for tumor diagnosis and research. The purpose of this study was to investigate the prognostic value of AgNOR analysis in colorectal carcinomas. METHODS: The silver staining technique was applied to paraffin embedded tumor tissue sections from 114 patients with colorectal carcinoma. The number, morphology, size, and distribution of AgNOR were counted and analyzed. RESULTS: (1) The number of AgNOR in patients who died within 5 year of carcinoma diagnosis (x^-± s: 8.8 ± 2.3 per nucleus, n = 27) was significantly higher than that in those who survived beyond 5 year (6.3 ± 1.8, n = 30, p < 0.001). The number of large sized (> 2 μm) and small sized (< 1 μm) AgNOR was significantly higher in patients who died (x^-± s: 85.9 ± 20.7, 661.7 ± 250.5 in 100 nuclei) than in those who survived (71.7 ± 27.0, 398.3 ± 225.4, p = 0.04, 0.00 respectively). The concentrated type of distribution was significantly fewer in those who died (10.2%) than those who survived (31.4%, p = 0.00), whereas the mixed type of distribution was significantly greater in those who died (25.7%) than in those who survived (7.1%, p = 0.00). And (2) The number of AgNOR was also related to other factors that affected prognosis of colorectal carcinoma, such as age, histological type, depth of invasions, and metastasis to lymph nodes. CONCLUSION: The AgNOR analysis is a novel and useful parameter for assessing the prognosis of colorectal carcinoma.     

Circulating insulin-like growth factor-binding protein 3 as prognostic biomarker in liver cirrhosis

AIM: To investigate the prognostic significance of insulin-like growth factor-binding protein 3(IGFBP-3) in patients with cirrhosis.METHODS: Prospective study that included two cohorts: outpatients with stable cirrhosis(n = 138) and patients hospitalized for acute decompensation(n = 189). Development of complications, mortality or liver transplantation was assessed by periodical phone calls and during outpatient visits. The cohort of stable cirrhosis also underwent clinical and laboratory evaluation yearly(2013 and 2014) in predefined study visits. In patients with stable cirrhosis, IGFBP-3 levels were measured at baseline(2012) and at second re-evaluation(2014). In hospitalized subjects, IGFBP-3 levels were measured in serum samples collected in the first and in the third day after admission and stored at-80 ℃. IGFBP-3 levels were measured by immunochemiluminescence.RESULTS: IGFBP-3 levels were lower in hospitalized patients as compared to outpatients(0.94 mcg/mL vs 1.69 mcg/m L, P 0.001) and increased after liver transplantation(3.81 mcg/m L vs 1.33 mcg/mL, P = 0.008). During the follow-up of the stable cohort, 17 patients died and 11 received liver transplantation. Bivariate analysis showed that death or transplant was associated with lower IGFBP-3 levels(1.44 mcg/mL vs 1.74 mcg/m L, P = 0.027). The Kaplan-Meier transplant-free survival probability was 88.6% in patients with IGFBP-3 ≥ 1.67 mcg/mL and 72.1% for those with IGFBP3 1.67 mcg/mL(P = 0.015). In the hospitalized cohort, 30-d mortality was 24.3% and was independently associated with creatinine, INR, SpO_2/FiO_2 ratio and IGFBP-3 levels in the logistic regression. The 90-d transplant-free survival probability was 80.4% in patients with IGFBP-3 ≥ 0.86 mcg/mL and 56.1% for those with IGFBP3 0.86 mcg/mL(P 0.001). CONCLUSION: Lower IGFBP-3 levels were associated with worse outcomes in patients with cirrhosis, and might represent a promising prognostic tool that can be incorporated in clinical practice.     

胃癌患者血清肿瘤标志CA50和CEA的意义

目的比较胃恶性和良性病变血清人类结肠癌抗原 CA50和 CEA 的变化。方法用放射免疫法测定33例健康对照和86例胃部疾病(胃癌34例,胃溃疡27例和慢性萎缩性胃炎25例)患者血清 CA50和 CEA 含量,胃癌包括窦部27例,体部3例和底部9例,组织学类型包括腺癌21例,上皮癌4例和未分类9例;胃溃疡包括窦部18例,体部3例和底部9例;萎缩性胃炎均伴有肠上皮化生。结果与正常人比较,胃癌血清 CA50(112.67±38.36 kU/L vs 16.26±6.14 kU/L,P<0.01)和 CEA(10.28±3.76μg/L vs 3.12±1.03 μg/L,P<0.01)明显升高;CA50(>22 kU/L)阳性率在胃癌是53.0%(18/34),CEA(>5 μg/L)阳性率是55.8%(19/34);CA50和 CEA 升高呈正相关(r=0.648,P<0.01)。胃癌手术后(n=21),血清 CA50(46.4±25.9 kU/L,P<0.01)和 CEA(6.85±2.43μg/L,P<0.01)有明显下降。胃溃疡和萎缩性胃炎血清 CAS0(P<0.05)轻度升高,而 CEA 无明显变化(P>0.05)。结论血清 CAS0和 CEA 升高可作为诊断晚期胃癌的指标,胃癌手术后血清 CA50和 CEA 明显降低,提示联合测定血清CA50和 CEA 对晚期胃癌的诊治有一定临床意义。     

Effect of Helicobacter pylori eradication on serum ghrelin and obestatin levels

AIM: To investigate changes in serum ghrelin and obestatin levels before and after Helicobacter pylori (H. pylori ) eradication. METHODS: A total of 92 patients presenting with symptoms of dyspepsia were enrolled in the study. Upper endoscopy was performed on all patients and used to diagnose H. pylori infection according to the presence of characteristic histopathological findings; seventy patients were diagnosed with H. pylori infection and the remaining 22 non-infected patients were classified as healthy controls. H. pylori eradication was accomplished by administering the classical triple therapy drug regimen, consisting of lansoprazole 30 mg bid , amoxicillin 1 g bid , and clarithromycin 500 mg tid for 14 d. The eradication of H. pylori was assessed with C14-urea breath test, which was performed at eight weeks after treatment. Levels of serum active ghrelin and obestatin were assessed at beginning of the study (prior to treatment) and after eight weeks. The levels were comparatively analyzed between the H. pylori negative control group, the H. pylori eradicated group, and the H. pylori non-eradicated group. RESULTS: A total of 92 patients, 50 females and 42 males with a mean age of 38.2 ± 11.9 years (range: 19-64), were analyzed. H. pylori eradication success was achieved in 74.3% (52/70) of H. pylori positive patients. The initial levels of ghrelin in the H. pylori positive and control cases were 63.6 ± 19.8 pg/mL and 65.1 ± 19.2 pg/mL (P=0.78), respectively, and initial obestatin levels were 771±427 pg/mL and 830 ± 296 pg/mL (P=0.19), respectively. The difference between the initial levels and the week 8 levels of ghrelin and obestatin in the control group was insignificant [4.5% (P=0.30) and -0.9% (P=0.65), respectively]. The difference between the initial and week 8 levels of ghrelin and obestatin in the H. pylori non-eradicated group were also insignificant [0.9% (P=0.64) and 5.3% (P=0.32), respectively]. The H. pylori eradicated group had a greater change in obestatin levels when compared to the     

肝细胞癌患者血清HSP90α和PIVKA-Ⅱ水平变化及其临床意义探讨*

目的 探讨热休克蛋白90α(HSP90α)和维生素K拮抗剂诱导蛋白-Ⅱ(PIVKA-Ⅱ)在肝细胞癌(HCC)患者血清变化及在预后评估中的价值。方法 2014年1月～2016年6月我院诊治的HCC患者112例、乙型肝炎肝硬化患者96例、慢性乙型肝炎患者82例和健康体检者84例,所有肝癌患者接受经肝动脉化疗栓塞术,采用ELISA法检测血清HSP90α和PIVKA-Ⅱ水平,采用多元Logistic回归分析影响3 a生存的因素,应用ROC曲线评估血清HSP90α和PIVKA-Ⅱ单独或联合预测HCC患者3 a生存率的价值。结果 HCC组血清HSP90α和PIVKA-Ⅱ水平分别为(61.6±5.0)ng/mL和(832.6±66.7)mAU/mL,显著高于乙型肝炎肝硬化组[分别为(13.2±1.6)ng/mL和(29.4±2.9)mAU/mL,P<0.05]、慢性乙型肝炎组[分别为(4.3±0.4)ng/mL和(29.1±3.0)mAU/mL,P<0.05]或健康人组[分别为(3.2±0.4)ng/mL和(26.7±3.2)mAU/mL,P<0.05];入组时55例生存组血清HSP90α和PIVKA-Ⅱ水平分别为(44.4±4.4)ng/mL和(701.3±62.3)mAU/mL,显著低于57例死亡组[分别为(78.3±5.2)ng/mL和(959.2±92.2)mAU/mL,P<0.05];单因素分析表明肝外转移、肿瘤分化程度、Child-Pugh分级、TNM分期、血清HSP90α和PIVKA-Ⅱ水平影响HCC患者生存,而多因素Logistic回归分析发现,肝外转移、肿瘤分化程度低、Child-Pugh C级、TNM Ⅲ~Ⅳ期、血清HSP90α和PIVKA-Ⅱ水平高为影响HCC患者3 a生存率的独立危险因素(P<0.05);ROC曲线分析结果显示血清HSP90α和PIVKA-Ⅱ单独预测HCC患者3 a生存率的AUC分别为0.814和0.836,显著低于两者联合预测的0.929(P<0.05)。结论 血清HSP90α和PIVKA-Ⅱ水平影响肝细胞癌患者生存,对于高水平者,应密切观察其病情变化,并及时给予适当的干预。     

Duodenal epithelial transport in functional dyspepsia: Role of serotonin

AIM: To investigate functional duodenal abnormalities in functional dyspepsia (FD) and the role of serotonin (5-hydroxytryptamine, 5-HT) in mucosal ion transport and signalling. METHODS: Duodenal mucosal biopsies were obtained from 15 patients with FD and 18 healthy controls. Immunohistochemistry was used to study the number of 5-HT-containing cells and real-time polymerase chain reaction for expression of 5-HT receptors 1A, 1B, 2A, 2B, 3A, 3B, 3C, 3D, 3E, 4 and 7, as well as expression of the serotonin re-uptake transporter (SERT) gene SLC6A4 and tryptophan hydroxylase 1 (TPH1). Biopsies were mounted in Ussing chambers for evaluation of basal and 5-HT-stimulated short-circuit current (SCC). RESULTS: Conductance was lower in FD [42.4 ± 4.7 mS/cm² (n = 15) vs 62.5 ± 4.5 mS/cm² (n = 18), P = 0.005]. 5-HT induced a dose dependent rise in SCC in both FD (n = 8) and controls (n = 9), the rise was lower in FD (P < 0.001). Mean number of 5-HT stained cells per high power field was the same [34.4 ± 8.4 in FD (n = 15) and 30.4 ± 3.7 in controls (n = 18), P = 0.647]. The following genes were highly expressed: 5-HT receptor HTR3E, HTR4, HTR7, SERT gene (SLC6A4) and TPH1. Differences in expression levels were observed for HTR3E (higher expression in FD, P = 0.008), HTR7 (lower expression in FD, P = 0.027), SLC6A4 (higher expression in FD, P = 0.033) and TPH1 (lower expression in FD, P = 0.031). CONCLUSION: Duodenal ion transport in response to exogenous 5-HT is abnormal in FD patients and associated with high expression of the HTR3E receptor and the serotonin transporter.     

Prognostic value of preoperative mean corpuscular volume in esophageal squamous cell carcinoma

AIM: To evaluate whether preoperative mean corpuscular volume (MCV) is a prognostic indicator in patients with resectable esophageal squamous cell carcinoma (ESCC). METHODS: A total of 298 consecutive, prospectively enrolled patients with histologically diagnosed ESCC who underwent surgery with curative intent from 2001 to 2011 were retrospectively evaluated. Patients were excluded if they had previous malignant disease, distant metastasis at the time of primary treatment, a history of neoadjuvant treatment, had undergone nonradical resection, or had died of a non-tumor-associated cause. Survival status was verified in September 2011. Pathological staging was performed based on the 2010 American Joint Committee on Cancer criteria. Preoperative MCV was obtained from blood counts performed routinely within 7 d prior to surgery. Receiver operating characteristic (ROC) curve analysis was used to determine a cutoff for preoperative MCV. RESULTS: The 298 patients consisted of 230 males and 68 females, with a median follow-up of 30.1 mo. ROC analysis showed an optimal cutoff for preoperative MCV of 95.6 fl. Fifty-nine patients (19.8%) had high (> 95.6 fl) and 239 (80.2%) had low (≤ 95.6 fl) preoperative MCV. Preoperative MCV was significantly associated with gender (P=0.003), body mass index (P=0.017), and preoperative red blood cell count (P<0.001). The predicted 1-, 3and 5-year overall survival (OS) rates were 72%, 60% and 52%, respectively. Median OS was significantly longer in patients with low than with high preoperative MCV (27.5 mo vs 19.4 mo, P<0.001). Multivariate analysis showed that advanced pT (P=0.018) and pN (P<0.001) stages, upper thoracic location (P=0.010), lower preoperative albumin concentration (P=0.002), and high preoperative MCV (P=0.001) were negative prognostic factors in patients with ESCC. Preoperative MCV also stratified OS in patients with T3, N1-N3, G2-G3 and stage Ⅲ tumors. CONCLUSION: Preoperative MCV is a prognostic factor in patients with ESCC.     

2型糖尿病合并非酒精性脂肪性肝病患者血清网膜素、视黄醇结合蛋白4和Ⅰ型原胶原氨基端前肽水平及意义分析*

目的 探讨2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)患者血清网膜素、视黄醇结合蛋白-4(RBP4)和Ⅰ型原胶原氨基端前肽(PINP)水平变化及其临床意义。方法 2019年6月～2021年12月我院诊治的T2DM合并NAFLD患者102例(轻度39例,中度34例,重度29例)和T2DM患者98例,使用超声检查行脂肪肝分度,采用ELISA法检测血清网膜素、RBP4和PINP水平,应用受试者工作特征曲线(ROC)评估各指标诊断NAFLD严重程度的效能。结果 T2DM合并NAFLD患者血清网膜素和PINP水平分别为(45.4±12.4)ng/mL和(29.6±6.2)ng/mL,显著低于T2DM患者【分别为(68.3±15.6)ng/mL和(35.8±7.3)ng/mL,P＜0.05】,而血清RBP4水平为(26.6±5.1)mg/L,显著高于T2DM患者【(20.1±4.6)mg/L,P＜0.05】;重度NAFLD患者血清网膜素和PINP水平分别为(40.7±4.9)ng/mL和(25.8±3.7)ng/mL,显著低于中度患者【分别为(45.2±5.6)ng/mL和(29.9±4.0)ng/mL,P＜0.05】或轻度患者【分别为(49.1±6.2)ng/mL和(32.2±3.3)ng/mL,P＜0.05】,而血清RBP4水平为(30.3±3.0)mg/L,显著高于中度患者【(26.5±2.8)mg/L,P＜0.05】或轻度患者【(23.9±3.1)mg/L,P＜0.05】;联合血清网膜素、RBP4和PINP诊断T2DM合并重度NAFLD的曲线下面积(AUC)为0.856,其灵敏度、特异度和准确度分别为86.2%、79.5%和81.4%,显著高于三项指标单独评估(其AUC分别为0.744、0.752和0.704,P＜0.05)。结论 T2DM合并NAFLD患者血清网膜素和PINP水平显著降低,而RBP4水平显著升高,利用这些指标的变化规律可能能帮助临床判断合并脂肪肝的程度,值得进一步研究。     

Age-dependent slowing of enteric axonal transport in insulin-resistant mice

AIM:To investigate retrograde tracer transport by gastric enteric neurons in insulin resistant mice with low or high glycosylated hemoglobin(Hb).METHODS:Under anesthesia,the retrograde tracer fluorogold was superficially injected into the fundus or antrum using a microsyringe in KK Cg-Ay/J mice prior to onset of type 2 diabetes mellitus(T2DM;4 wk of age),at onset of T2DM(8 wk of age),and after 8,16,or 24 wk of untreated T2DM and in age-matched KK/HIJ mice.Six days later,mice were sacrificed by CO 2 narcosis followed by pneumothorax.Stomachs were removed and fixed.Sections from fundus,corpus and antrum were excised and mounted on a glass slide.Tracer-labeled neurons were viewed using a microscope and manually counted.Data were expressed as the number of neurons in short and long descending and ascending pathways and in local fundus and antrum pathways,and the number of neurons in all regions labeled after injection of tracer into either the fundus or the antrum.RESULTS:By 8 wk of age,body weights of KKAy mice(n=12,34±1 g) were heavier than KK mice(n=17,29±1 g;F(4,120)=4.414,P=0.002] and glycosylated Hb was higher [KK:(n=7),4.97%±0.04%;KKAy:(n=6),6.57%±0.47%;F(1,26)=24.748,P<0.001].The number of tracer labeled enteric neurons was similar in KK and KKAy mice of all ages in the short descending pathway [F(1,57)=2.374,P=0.129],long descending pathway [F(1,57)=0.922,P=0.341],local fundus pathway [F(1,53)=2.464,P=0.122],local antrum pathway [F(1,57)=0.728,P=0.397],and short ascending pathway [F(1,53)=2.940,P=0.092].In the long ascending pathway,fewer tracer-labeled neurons were present in KKAy as compared to KK mice [KK:(n=34),302±17;KKAy:(n=29),230±15;F(1,53)=8.136,P=0.006].The number of tracer-labeled neurons was decreased in all mice by 16 wk as compared to 8 wk of age in the short descending pathway [8 wk:(n=15),305±26;16 wk:(n=13),210±30;F(4,57)=9.336,P<0.001],local antrum pathway [8 wk:(n=15),349±20;16 wk:(n=13),220±33;F(4,57)=8.920,P<0.001],short ascending pathway [8 wk:(n=14),392±15;16 wk:(n     

Clinical scenarios for the use of S100&beta; as a marker of hepatic encephalopathy

AIM: To evaluate the association between serum concentrations of S100β in patients with cirrhosis and the presence of low grade hepatic encephalopathy (HE). METHODS: This was a cross-sectional study. The population was categorized into four groups healthy subjects, cirrhosis without HE, cirrhosis with covert hepatic encephalopathy (CHE) and cirrhosis with overt HE. Kruskal-Wallis, Mann Whitney’s U with Bonferroni adjustment Spearman correlations and area under the ROC were used as appropriate. RESULTS: A total of 61 subjects were included, 46 cirrhotic patients and 15 healthy volunteers. S100β values were different among all groups, and differences remained significant between groups 1 and 2 (P < 0.001), and also between groups 2 and 3 (P = 0.016), but not between groups 3 and 4. In cirrhotic patients with HE S100β was higher than in patients without HE [0.18 (0.14-0.28) ng/mL vs 0.11 (0.06-0.14) ng/mL, P < 0.001]. There was a close correlation between serum concentrations of S100β and psychometric hepatic encephalopathy score in patients with cirrhosis without HE compared to the patients with cirrhosis with CHE (r = -0.413, P = 0.019). ROC curve analysis yielded > 0.13 ng/mL as the best cutoff value of S100β for the diagnosis of HE (sensitivity 83.3%, specificity 63.6%). CONCLUSION: Serum concentrations of S100β are higher in patients with cirrhosis than in healthy volunteers, and are further increased in the presence of hepatic encephalopathy. The results suggest that serum biomarkers such as S100β could help in the correct characterization of incipient stages of HE.     

Prognostic and survival analysis of 837 Chinese colorectal cancer patients

AIM:To develop a prognostic model to predict survival of patients with colorectal cancer (CRC). METHODS:Survival data of 837 CRC patients undergoing surgery between 1996 and 2006 were collected and analyzed by univariate analysis and Cox proportional hazard regression model to reveal the prognostic factors for CRC. All data were recorded using a standard data form and analyzed using SPSS version 18.0 (SPSS, Chicago, IL, United States). Survival curves were calculated by the Kaplan-Meier method. The log rank test was used to assess differences in survival. Univariate hazard ratios and significant and independent predictors of disease-specific survival and were identified by Cox proportional hazard analysis. The stepwise procedure was set to a threshold of 0.05. Statistical significance was defined asP < 0.05. RESULTS:The survival rate was 74% at 3 years and 68% at 5 years. The results of univariate analysis suggested age, preoperative obstruction, serum carcinoembryonic antigen level at diagnosis, status of resection, tumor size, histological grade, pathological type, lymphovascular invasion, invasion of adjacent organs, and tumor node metastasis (TNM) staging were positive prognostic factors (P < 0.05). Lymph node ratio (LNR) was also a strong prognostic factor in stage Ⅲ CRC (P < 0.0001). We divided 341 stage Ⅲ patients into three groups according to LNR values (LNR1, LNR ≤ 0.33, n = 211; LNR2, LNR 0.34-0.66, n = 76; and LNR3, LNR ≥ 0.67, n = 54). Univariate analysis showed a significant statistical difference in 3-year survival among these groups:LNR1, 73%; LNR2, 55%; and LNR3, 42% (P < 0.0001). The multivariate analysis results showed that histological grade, depth of bowel wall invasion, and number of metastatic lymph nodes were the most important prognostic factors for CRC if we did not consider the interaction of the TNM staging system (P < 0.05). When the TNM staging was taken into account, histological grade lost its statistical significance, while the specific TNM staging system s     

Anti-CD163-dexamethasone conjugate inhibits the acute phase response to lipopolysaccharide in rats

AIM: To study the effect of a new anti-CD163-dexamethasone conjugate targeting activated macrophages on the hepatic acute phase response in rats. METHODS: Wistar rats were injected intravenous with either the CD163 targeted dexamethasone-conjugate(0.02 mg/kg) or free dexamethasone(0.02 or 1 mg/kg) 24 h prior to lipopolysaccharide(LPS)(2.5 mg/kg intraperitoneal). We measured plasma concentrations of tumour necrosis factor-a(TNF-a) and interleukin 6(IL-6) 2 h post-LPS and liver m RNAs and serum concentrations of the rat acute phase protein a-2-macroglobulin(a-2-M) 24 h after LPS. Also, plasma concentrations of alanine aminotransferase and bilirubin were measured at termination of the study. Spleen weight served as an indicator of systemic steroid effects.RESULTS: The conjugate halved the a-2-M liver m RNA(3.3 ± 0.6 vs 6.8 ± 1.1, P 0.01) and serum protein(201 ± 48 μg/mL vs 389 ± 67 μg/mL, P = 0.04) after LPS compared to low dose dexamethasone treated animals, while none of the free dexamethasone doses had an effect on liver m RNA or serum levels of a-2-M. Also, the conjugate reduced TNF-a(7208 ± 1977 pg/mL vs 21583 ± 7117 pg/mL, P = 0.03) and IL-6(15685 ± 3779 pg/mL vs 25715 ± 4036 pg/mL, P = 0.03) compared to the low dose dexamethasone. The high dose dexamethasone dose decreased the spleen weight(421 ± 11 mg vs 465 ± 12 mg, P 0.05) compared to controls, an effect not seen in any other group.CONCLUSION: Low-dose anti-CD163-dexamethasone conjugate effectively decreased the hepatic acute phase response to LPS. This indicates an anti-inflammatory potential of the conjugate in vivo.     

Low-dose amitriptyline combined with proton pump inhibitor for functional chest pain

AIM:To investigate the efficacy of amitriptyline with proton pump inhibitor(PPI)for the treatment of functional chest pain(FCP).METHODS:This was a randomized,open-label trial investigating the addition of low dose amitriptyline(10 mg at bedtime)to a conventional dose of rabeprazole(20 mg/d)(group A,n = 20)vs a double-dose of rabeprazole(20 mg twice daily)(group B,n = 20)for patients with FCP whose symptoms were refractory to PPI.The primary efficacy endpoints were assessed by global symptom score assessment and the total number of individuals with > 50% improvement in their symptom score.RESULTS:The between-group difference in global symptom scores was statistically significant during the last week of treatment(overall mean difference;3.75 ± 0.31 vs 4.35 ± 0.29,the between-group difference;P < 0.001).Furthermore,70.6% of patients in group A had their symptoms improve by > 50%,whereas only 26.3% of patients in group B had a similar treatment response(70.6% vs 26.3%,P = 0.008).Specifically,patients in group A had a significantly greater improvement in the domains of body pain and general health perception than did patients in group B(52.37 ± 17.00 vs 41.32 ± 12.34,P = 0.031 and 47.95 ± 18.58 vs 31.84 ± 16.84,P = 0.01,respectively).CONCLUSION:Adding amitriptyline to a PPI was more effective than a double-dose of PPI in patients with FCP refractory to a conventional dose of PPI.     

Studies on surgical operations and prognosis of extrahepatic bile duct cancer

AIM: To perform a clinical evaluation of the surgical procedures of extrahepatic bile duct cancer and their influence on prognosis. METHODS: A total of 55 patients with pathologically and clinically verified extrahepatic bile duct cancer treated in our department between January 1984 and December 1993 were analyzed retrospectively. Clinical courses, with respect to the surgical procedures, investigated by follow-up and the survival period was assessed. RESULTS: Among the 55 patients, 24 received surgery that involved the upper third of extrahepatic biliary tract, 12 involving the middle third, and 19 involving the lower third. The diagnosis of bile duct cancer was confirmed histopathologically in 42 of the patients, with a clear predominance of adenocarcinoma (97.6%). Eleven (26.2%) of the patients received curative resection, 30 received palliative procedures (i.e. biliary-enteric bypass (n = 14) and external drainage (n = 16)), 6 received permanent percutaneous transhepatic cholangio-drainage (PTCD) alone, and 8 received exploratory laparotomy only or conservative treatment. Forty-eight patients (87.3%) were followed-up. The overall mean survival period was 10.8 ± 9.7 mo (¯x ± s); patients with curative resection had the longest survival period (21.4 ± 16.7 mo, P < 0.01) and highest survival rate (P < 0.05). A significant survival difference was observed for patients with biliary-enteric anastomosis as compared with those who had external drainage, etc. (P < 0.05), but there was no significant difference in survival period between patients who had preoperative PTCD (n = 23) and those who did not (n = 26) (P < 0.05). CONCLUSION: Curative resection is the treatment of choice for suitable patients with extrahepatic bile duct cancer; biliary-enteric anastomosis is preferable for those with unresectable tumor in order to improve prognosis and quality of life.     

个性化疼痛护理在缓解妇科腹腔镜术后非切口性疼痛中的疗效观察

[目的]探讨个性化疼痛护理对妇科腹腔镜术(LS)后非切口性疼痛中的缓解作用。[方法]选择我院接受妇科LS术的病人96例,随机分成观察组和对照组各48例,观察组病人在手术期间给予个性化的疼痛护理,对照组仅给予常规护理。护理前后利用数字评分法(VAS)疼痛评分对两组病人的疼痛情况进行评价,并进行护理满意度调查。[结果]观察组病人非切口性疼痛发生率、重度疼痛率和疼痛持续时间分别为41.7%、4.2%和4.4h±3.9h,对照组分别为72.9%、25.0%和16.2h±5.8h,两组比较差异有统计学意义(P<0.05);两组病人术前VAS评分相比,差异无统计学意义(P>0.05),观察组术后12h和术后24hVAS评分明显低于对照组,差异有统计学意义(P<0.05);观察组护理满意度为91.7%,对照组护理满意度为68.8%,两组差异均有统计学意义(P<0.05)。[结论]个性化疼痛护理对妇科LS术后非切口性疼痛具有显著的缓解作用,可提高病人对护理服务的满意度。     

肝内胆管癌患者血清CXCL9和IFN-γ水平变化及其临床意义探讨

目的 探讨肝内胆管癌(ICC)患者血清C-X-C趋化因子配体9(CXCL9)和干扰素-γ(IFN-γ)水平变化及其临床意义。方法 2012年1月～2017年1月我院诊治的63例ICC患者和同期63例健康体检者,所有患者接受根治性肿瘤切除术,随访36个月。采用ELISA法检测血清CXCL9和IFN-γ水平,用Kaplan-Meier生存曲线分析不同血清CXCL9和IFN-γ水平的ICC患者预后的差异。结果 ICC患者血清CXCL9水平为(820.7±185.6)pg/mL,显著高于健康人【(275.1±51.3)pg/mL,P<0.05】,血清IFN-γ水平为(18.7±7.2)ng/L,显著低于健康人【(59.3±18.3)ng/L,P<0.05】;不同TNM分期(Ⅰ/Ⅱ期对Ⅲ/Ⅳ期)、有无淋巴结转移和低分化与中/高分化的ICC患者血清CXCL9和IFN-γ水平差异显著(P<0.05);对63例ICC患者随访36个月,结果死亡42例(66.7%),生存21例(33.3%);以ICC患者血清CXCL9水平为820.7 pg/mL为截断点,低水平者30例,高水平者33例,经Kaplan-Meier生存分析显示,血清CXCL9低水平的ICC患者术后36个月生存率为53.3%,显著高于CXCL9高水平组的15.2%(x²=12.448,P<0.001);以ICC患者血清IFN-γ水平为18.7 ng/L为截断点,低水平者34例,高水平者29例,IFN-γ低水平组术后36个月生存率为14.7%,显著低于高水平组的55.2%(x²=10.554,P=0.001)。结论 ICC患者血清CXCL9水平升高,而血清IFN-γ水平降低。它们均与ICC患者根治性手术后的预后相关,检测血清CXCL9和IFN-γ水平有助于评估ICC患者的预后,值得进一步研究。