Metastatic lymph nodes and prognosis assessed by the number of retrieved lymph nodes in gastric cancer.

BACKGROUND: The prognostic value of quantitative assessments of the number of retrieved lymph nodes (RLNs) in gastric cancer (GC) patients needs further study. AIM: To discuss how to obtain a more accurate count of metastatic lymph nodes (MLNs) based on RLNs in different pT stages and then to evaluate patient prognosis. METHODS: This study retrospectively analyzed patients who underwent GC radical surgery and D2/D2+ LN dissection at the Cancer Hospital of Harbin Medical University from January 2011 to May 2017. Locally weighted smoothing was used to analyze the relationship between RLNs and the number of MLNs. Restricted cubic splines were used to analyze the relationship between RLNs and hazard ratios (HRs), and X-tile was used to determine the optimal cutoff value for RLNs. Patient survival was analyzed with the Kaplan-Meier method and log-rank test. Finally, HRs and 95% confidence intervals were calculated using Cox proportional hazards models to analyze independent risk factors associated with patient outcomes. RESULTS: A total of 4968 patients were included in the training cohort, and 11154 patients were included in the validation cohort. The smooth curve showed that the number of MLNs increased with an increasing number of RLNs, and a nonlinear relationship between RLNs and HRs was observed. X-tile analysis showed that the optimal number of RLNs for pT1-pT4 stage GC patients was 26, 31, 39, and 45, respectively. A greater number of RLNs can reduce the risk of death in patients with pT1, pT2, and pT4 stage cancers but may not reduce the risk of death in patients with pT3 stage cancer. Multivariate analysis showed that RLNs were an independent risk factor associated with the prognosis of patients with pT1-pT4 stage cancer (P = 0.044, P = 0.037, P = 0.003, P < 0.001). CONCLUSION: A greater number of RLNs may not benefit the survival of patients with pT3 stage disease but can benefit the survival of patients with pT1, pT2, and pT4 stage disease. For the pT1, pT2, and pT4 stages, it is recommended to retrieve 26, 31 and 45 LNs, respectively.

Changing trends of clinicopathologic features and survival duration after surgery for gastric cancer in Northeast China.

BACKGROUND: Through analyzing the data from a single institution in Northeast China, this study revealed the possible clinicopathologic characteristics that influence the prognosis of patients with gastric cancer (GC). AIM: To evaluate the changing trends of clinicopathologic features and survival duration after surgery in patients with GC in Northeast China, which is a high-prevalence area of GC. METHODS: The study analyzed the difference in clinicopathologic features and survival duration after surgery of 5887 patients who were histologically diagnosed with GC at the Harbin Medical University Cancer Hospital. The study mainly analyzed the data in three periods, 2000 to 2004 (Phase 1), 2005 to 2009 (Phase 2), and 2010 to 2014 (Phase 3). RESULTS: Over time, the postoperative survival rate significantly increased from 2000 to 2014. In the past 15 years, compared with Phases 1 and 2, the tumor size was smaller in Phase 3 (P < 0.001), but the proportion of high-medium differentiated tumors increased (P < 0.001). The proportion of early GC gradually increased from 3.9% to 14.4% (P < 0.001). A surprising improvement was observed in the mean number of retrieved lymph nodes, ranging from 11.4 to 27.5 (P < 0.001). The overall 5-year survival rate increased from 24% in Phase 1 to 43.8% in Phase 3. Through multivariate analysis, it was found that age, tumor size, histologic type, tumor-node-metastasis stage, depth of invasion, lymph node metastasis, surgical approach, local infiltration, radical extent, number of retrieved lymph nodes, and age group were independent risk factors that influenced the prognosis of patients with GC. CONCLUSION: The clinical features of GC in Northeast China changed during the observation period. The increasing detection of early GC and more standardized surgical treatment effectively prolonged lifetimes.

Prognostic significance of Borrmann type combined with vessel invasion status in advanced gastric cancer.

BACKGROUND: Borrmann classification (types I-IV) for the detection of advanced gastric cancer has been accepted worldwide, and lymphatic and/or blood vessel invasion (LBVI) status is related to the poor prognosis after gastric cancer. AIM: To evaluate the significance of Borrmann type combined with LBVI status in predicting the prognosis of advanced gastric cancer. METHODS: We retrospectively studied the clinicopathological characteristics and long-term survival data of 2604 patients who were diagnosed with advanced gastric adenocarcinoma at Harbin Medical University Cancer Hospital from January 2009 to December 2013. Categorical variables were evaluated by the Pearson's χ 2 test, the Kaplan-Meier method was used to identify differences in cumulative survival rates, and the Cox proportional hazards model was used for multivariate prognostic analysis. RESULTS: A total of 2604 patients were included in this study. The presence of LVBI [LBVI (+)] and Borrmann type (P = 0.001), tumor location (P < 0.001), tumor size (P < 0.001), histological type (P < 0.001), tumor invasion depth (P < 0.001), number of metastatic lymph nodes (P < 0.001), and surgical method (P < 0.001) were significantly correlated with survival. When analyzing the combination of the Borrmann classification and LBVI status, we found that patients with Borrmann type III disease and LBVI (+) had a similar 5-year survival rate to those with Borrmann IV + LBVI (-) (16.4% vs 13.1%, P = 0.065) and those with Borrmann IV + LBVI (+) (16.4% vs 11.2%, P = 0.112). Subgroup analysis showed that the above results were true for any pT stage and any tumor location. Multivariate Cox regression analysis showed that Borrmann classification (P = 0.023), vascular infiltration (P < 0.001), tumor size (P = 0.012), pT stage (P < 0.001), pN stage (P < 0.001), and extent of radical surgery (P < 0.001) were independent prognostic factors for survival. CONCLUSION: Since patients with Borrmann III disease and LBVI (+) have the same poor prognosis as those with Borrmann IV disease, more attention should be paid to patients with Borrmann III disease and LBVI (+) during diagnosis and treatment, regardless of the pT stage and tumor location, to obtain better survival results.

[CircRNA as a new field in human disease research].

For the characteristics of high stability， high conservation between species， and tissue specificity， circular RNA(circRNA) has been expected to become a new molecular biomarker for the clinical diagnosis， treatment and prognosis， and the potential target for targeted therapy. Study on the traditional Chinese medicine(TCM) syndrome includes not only the macro indexes collected by using four traditional methods of diagnosis， but also contains some micro information that can not be achieved by using the four traditional diagnosis methods. The questions such as how to deal with the relationship between the holistic concept of TCM and micro research， and how to solve the contradiction between the fuzziness of syndrome description and the accuracy of microscopic research， need to be considered before the micro research in TCM syndrome. circRNA as a new field of understanding human disease， may provide some ideas for the TCM syndrome research due to its characteristics. Overall， it is necessary to pay attention to explore the molecular level with same syndrome in different diseases and reveal the connotation and essence of syndromes by understanding of circRNA.

[Analysis of Chinese patent medicine prescriptions for Qi stagnation and blood stasis syndrome].

To analyze the medication characteristics and compatibility rules in treatment of Qi stagnation and blood stasis syndrome. Chinese patent medicine prescriptions for Qi stagnation and blood stasis were collected from the 2015 edition of Pharmacopoeia of the people's Republic of China(herein after referred to as Chinese Pharmacopoeia) and Drug Standards of the People's Republic of China Ministry of Public Health-Chinese Patent Drug(herein after referred to as Chinese Patent Drug). Traditional Chinese medicine inheritance support system(TCMISS V2.5) was used to analyze the rules of prescription composition. Seventy-nine prescriptions included 105 symptoms, and dysmenorrhea, palpitations, chest tightness, stomach pain were common symptoms of Qi stagnation and blood stasis syndrome. Among 221 herbs, Chuanxiong Rhizoma, Salviae Miltiorrhizae Radix et Rhizoma and Angelicae Sinenses Radix ranked top 3 in usage frequency for the treatment of Qi stagnation and blood stasis. The herbal combinations included Angelicae Sinenses Radix-Chuanxiong Rhizoma, Salviae Miltiorrhizae Radix et Rhizoma-Carthami Flos, Chuanxiong Rhizoma-Carthami Flos, and Carthami Flos-Chuanxiong Rhizoma-Paeoniae Radix Rubra-Salviae Miltiorrhizae Radix et Rhizoma-Angelicae Sinenses Radix-Cyperi Rhizoma-Corydalis Rhizoma was the core herbal combination. In addition, a new prescription(Foenoculi Fructus-Alpiniae Officinarum Rhizoma-Caryophylli Flos-Angelicae Sinenses Radix-Chuanxiong Rhizoma-Leonuri Herba) for Qi stagnation and blood stasis syndrome was formed. Overall, the main symptom for the Qi stagnation and blood stasis syndrome could be pain, but because of different pathogenic factors, it could be reflected by different symptoms. Accordingly, invigorating the circulation of Qi and blood is the basic treatment for the Qi stagnation and blood stasis. Meanwhile, the treatment based on differentiation of symptoms and signs for different reasons should be considered. The prescriptions mainly included the herbs that could invigorate the circulation of Qi and blood, and were accompanied by the herbs that could warm spleen and stomach for dispelling cold.

[Application of ″Fu Yang and activating blood circulation″ in treatment of unstable angina pectoris patients].

Coronary heart disease(CHD) has become a major public health problem in the world, while the unstable angina (UA) is one of an important type. Hypofunction of yang qi in chest and cardiac blood stasis has been considered as the basic pathogenesis of UA.According to the deficiency of yang and blood stasis run through the process of CHD, fu yang and activating blood circulation could be main treatment. Wenxin decoction which has the function of fu yang and activating blood circulation, not only can effectively improve the symptoms of angina pectoris, the ischemic ECG, but also can significantly improve blood rheology, blood lipids and so on. So deepening the theory of ″fu yang and activating blood circulation″ and the application of ″Wenxin decoction″ in the treatment of UA would have an important clinical value for improving the therapeutic efficacy of CHD.

[Effect of dihydroartemisinin on the expression of BCR/ABL fusion gene in leukemia K562 cells].

OBJECTIVE: To investigate the effect of dihydroartemisinin (DHA) on the BCR/ABL fusion gene in leukemia K562 cell. METHODS: K562 cells were cultured in vitro. The rate of proliferation inhibition of cells treated with various concentrations of DHA were determined by using [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] (MTT) method. Expression of BCR/ABL fusion gene was analyzed by reverse transcription(RT-PCR) before and after DHA treatment. Apoptosis of K562 cells was detected by flow cytometry. RESULTS: The growth of K562 cells was inhibited when the concentrations of DHA were 10-160 umol/L. With the added dose of DHA, the growth inhibition was remarkable, with the rate of inhibition risen from 52.76% to 94.65%. The expression of BCR/ABL fusion gene, as detected by RT-PCR after incubating the K562 cells with 20 umol/L DHA, measured as ΔCt = 4.45 ± 0.25 after 12 h and ΔCt = 5.23 ± 0.21 after 24 h, which was significantly lower compared with that of the control ( ΔCt = 4.23 ± 0.21, P < 0.05). CONCLUSION: DHA can inhibit the proliferation of leukemia K562 cells and facilitate the induction of apoptosis by downregulating the expression of BCR/ABL fusion gene.

[Application of microcolumn gel immunoassay in screening the platelet antibody].

The purpose of this study was to explore the clinical value of the platelet antibody screening and typing in platelets transfusion by using microcolumn gel immunoassay (MGIA). The platelets antigen-antibody reactions including the antibody screen and blood crossmatch were detected by MGIA. The results indicated that the detection of platelet antibody showed positive in 30 cases of aplastic anemia (AA), 11 cases of myelodysplastic syndrome (MDS), 24 out of 25 cases of leukemia and 1 out of cases of other diseases, while detection of platelet antibody showed negative in 20 normal volunteer donors. The number of platelet antibody crossmatch coincidence in 112 specimens of AA, 42 specimens of MDS and 95 specimens of leukemia were 45, 20 and 40, the coincidence rates were 40.18%, 47.62% and 42.11%. The mean corrected count increment (CCI) in 20 patients received platelet transfusion many times was 18.2 after crossmatch and 4.7 before crossmatch. It is concluded that the positive rate of platelet antibody screening is very high in patients with hematologic malignancies, the coincidence rate of platelet antibody crossmatch in 249 blood samples is between 40% and 48%, and the efficiency of using crossmatched platelets in clinic is enhanced significantly.