[Adherence to adjuvant with therapy imatinib in patients with gastrointestinal stromal tumor: a national multi-center cross-sectional study].

Objective: To analyze the current adherence to imatinib in patients with gastrointestinal stromal tumors (GIST) in China and its influencing factors. Methods: A cross-sectional survey was conducted. Study period: from October 1, 2020 to November 31, 2020. Study subjects: GIST patients taking imatinib who were diagnosed and treated in public tertiary level A general hospitals or oncology hospitals; those who had not been pathologically diagnosed, those who never received imatinib, or those who had taken imatinib in the past but stopped afterwards were excluded. The Questionnaire Star online surgery platform was used to design a questionnaire about the adherence to adjuvant imatinib therapy of Chinese GIST patients. The link of questionnaire was sent through WeChat. The questionnaire contained basic information of patients, medication status and Morisky Medication Adherence Scale. Results: A total of 2162 questionnaires from 31 provinces, autonomous regions, and municipalities were collected, of which 2005 were valid questionnaires, with an effective rate of 92.7%. The survey subjects included 1104 males and 901 females, with a median age of 56 (22-91) years old. Working status: 609 cases (30.4%) in the work unit, 729 cases (36.4%) of retirement, 667 cases of flexible employment or unemployment (33.3%). Education level: 477 cases (23.8%) with bachelor degree or above, 658 cases (32.8%) of high school, 782 cases (39.0%) of elementary or junior high school, 88 cases (4.4%) without education. Marital status: 1789 cases (89.2%) were married, 179 cases (8.9%) divorced or widowed, 37 cases (1.8%) unmarried. Two hundred and ninety-four patients (14.7%) had metastasis when they were first diagnosed, including 203 liver metastases, 52 peritoneal metastases, and 39 other metastases. One thousand eight hundred and sixty-nine patients underwent surgical treatment, of whom 1642 (81.9%) achieved complete resection. The median time of taking imatinib was 25 (1-200) months. Common adverse reactions of imatinib included 1701 cases (84.8%) of periorbital edema, 1031 cases (51.4%) of leukopenia, 948 cases (47.3%) of fatigue, 781 cases (39.0%) of nausea and vomiting, 709 cases (35.4%) of rash, and 670 cases (33.4%) of lower extremity edema. The score of the Morisky Medication Adherence Scale showed that 392 cases (19.6%) had poor adherence, 1023 cases (51.0%) had moderate adherence, and 590 cases (29.4%) had good adherence. Univariate analysis showed that gender, age, work status, economic income, residence, education level, marriage, the duration of taking medication and adverse reactions were associated with adherence to adjuvant imatinib therapy (all P<0.05). Multivariate analysis showed that female (OR=1.264, P=0.009), non-retirement (OR=1.454, P=0.001), monthly income ≤4000 yuan (OR=1.280, P=0.036), township residents (OR=1.332, P=0.005), unmarried or divorced or widowed (OR=1.362, P=0.026), the duration of imatinib medication >36 months (OR=1.478, P<0.001) and adverse reactions (OR=1.719, P=0.048) were independent risk factors for poor adherence to adjuvant imatinib. Among patients undergoing complete resection, 324 (19.7%) had poor adherence, 836 (50.9%) had moderate adherence, and 482 (29.4%) had good adherence. Meanwhile, 55 patients with good adherence (11.4%) developed recurrence after surgery, 121 patients with moderate adherence (14.5%) developed recurrence, 61 patients with poor adherence (18.8%) developed recurrence, and the difference was statistically significant (P=0.017). Conclusions: The adherence to adjuvant therapy with imatinib in Chinese GIST patients is relatively poor. Females, non-retirement, monthly income ≤4000 yuan, township residents, unmarried or divorced or widowed, the duration of imatinib medication >36 months, and adverse reactions are independently associated with poor adherence of GIST patients. Those with poor adherence have a higher risk of recurrence after surgery. Positive interventions based on the above risk factors are advocated to improve the prognosis of patients with GIST.

Perioperative nursing intervention on patients undergoing laparoscopic gastric stromal tumor resection.

This study aimed to investigate the effectiveness of perioperative nursing intervention on patients undergoing laparoscopic gastric stromal tumor resection. Sixty patients with gastric stromal tumor were selected from our hospital and evenly divided into group A and group B. Patients in both groups underwent laparoscopic resection. Patients in group A were given conventional nursing intervention before and after surgery, while those in group B were given comprehensive nursing intervention. Various indicators were compared between the two groups. The amount of bleeding of group B was less than that of group A, and the first anal exsufflation of group B was also earlier than that of group A; the differences had statistical significance (p less than 0.05). Patients in group B felt less pain than patients in group A; except for 72 h after surgery, difference of pain degree between group A and B had statistical significance in other periods (p less than 0.05); the number of cases with complications and categories of complications of group B were less than those of group A, and the difference had statistical significance (p less than 0.05). The efficacy satisfaction of group B was also higher than that of group A, and the difference was statistically significant (p less than 0.05). Perioperative nursing intervention is beneficial and positive and has bright development prospects.

Role of hydroxyethyl starch in ischemia-reperfusion injury in rat intestinal transplantation.

OBJECTIVE: This study was designed to evaluate the role of 0%, 3%, 6% hydroxyethyl starch (HES) and University of Wisconsin (UW) perfusion and preservation solutions on ischemia-reperfusion injury (IRI) of rat intestinal transplantations, solutions, respectively. MATERIALS AND METHODS: Rats underwent orthotopic intestinal transplantation (Lewis to Lewis) after using perfusion and preservation saline (group l), 3% HES (group 2), 6% HES (group 3), or UW (group 4) solutions. The change in weight was recorded from preoperative to postoperative day (POD) 30. At 30 minutes after reperfusion, we harvested intestinal juice preoperatively as well as at 30 minutes after reperfusion and on POD 1 and 3 when recipients underwent open surgery for maltose absorption tests and sampling. The Park' scores of IRI were evaluated by light microscopy after hematoxylin and eosin (H&E) staining. RESULTS: An increased weight was more evident in group 2 than the other groups, particularly the on POD 1 and POD 3 (P < .05). It was significantly greater than groups 1 and 3 on POD 7 (P < .05). Compared with the other groups, the 30-minute post-reperfusion. Park score and intestinal juice content in group 2 was decreased significantly (P < .01), while in group 3 the Park score was increased, and the maltose absorption level decreased significantly (P < .05). CONCLUSION: Three percent HES solution attenuated IRI in rat intestinal transplantation. High-concentration HES solutions were unfit for intestinal preservation. Thus the adverse effects of UW solution may be attribute at least in part to its high HES, concentration.

Roles of neuronal nitric oxide synthase and inducible nitric oxide synthase in intestinal transplantation of rats.

OBJECTIVE: The study was designed to evaluate the role of neuronal nitric oxide synthase (nNOS) and inducible nitric oxide synthase (iNOS) in ischemia-reperfusion injury (IRI) and acute rejection (AR) in rat intestinal transplantation, by administration of nitric oxide inhibitor N(G)-nitro-L-arginine methyl ester (LNAME). MATERIALS AND METHODS: Rats that underwent orthotopic intestinal transplantation were assigned to 2 sets of groups: (1) iso-geneic group (Lewis-Lewis), L-NAME 0 mg/kg/d group (1-1), 4 mg/kg/d (group 1-2), or 8 mg/kg/d (group 1-3) injected intraperitoneally or (2) allogeneic group (Dark Agouti-Lewis), L-NAME 0 mg/kg/d (group 2-1) or 8 mg/kg/d (group 2-2) injected intraperitoneally. We examined survival times, light microscopy as well as maltose absorption tests. The nNOS and iNOS activities were measured by immunohistochemical methods. RESULTS: Histologic examination showed inhibited iNOS activity compared with group l-l, and Park scores decreased significantly in group 1-2 at 30 minutes after reperfusion (1.42 ± 0.38 vs 2.58 ± 0.49, P < .01). Both iNOS and nNOS activities were inhibited and Park scores increased significantly in group 1-3 from 30 minutes to day 3 after reperfusion (P < .0l). nNOS activity decreased and iNOS activity increased among group 2-1 during AR. Compared with group 2-1, iNOS activity was inhibited, progression of AR delayed, and survival significantly prolonged in group 2-2 (10.17 ± 0.98 vs 6.83 ± 0.75, P < .01). CONCLUSION: This study suggested that decreased nNOS and increased iNOS activity both contributed to IRI and AR. More importantly, nNOS more importantly than iNOS activity was closely related to graft structure and function.

Dexmedetomidine versus midazolam for conscious sedation in postoperative patients undergoing flexible bronchoscopy: a randomized study.

OBJECTIVE: This prospective randomized study evaluated the efficacy and patient tolerance of dexmedetomidine compared with midazolam for sedation in postoperative patients undergoing flexible bronchoscopy. METHODS: A total of 198 postoperative patients were randomized to receive dexmedetomidine (n=99) or midazolam (n=99) to produce conscious sedation for bronchoscopy. Peripheral oxygen saturation, heart rate and systolic and diastolic arterial pressures were recorded before, during and after the procedure. Patient tolerance was recorded using various visual analogue scales. RESULTS: The mean lowest peripheral oxygen saturation was significantly lower in the midazolam group than in the dexmedetomidine group. Heart rate and systolic arterial pressure were both significantly higher during bronchoscopy in the midazolam group than in the dexmedetomidine group. Bronchoscopy was well tolerated in both groups; there was no between-group difference in patient discomfort scores or in the percentage of patients who would accept repeat bronchoscopy. CONCLUSIONS: Compared with midazolam, dexmedetomidine provided better oxygen saturation and was equally well tolerated for conscious sedation in postoperative patients undergoing bronchoscopy.

Role of nitric oxide in ischemia-reperfusion injury and acute rejection in rat intestinal transplantation.

OBJECTIVE: This study was designed to evaluate the role of nitric oxide (NO) in ischemia-reperfusion injury (IRI) and acute rejection (AR) in rat intestinal transplantation, using administration of the NO inhibitor N(G)-nitro-L-arginine methyl ester (L-NAME). MATERIALS AND METHODS: Rats that underwent orthotopic allogeneic intestinal transplantation were assigned to 2 groups. In the normal allograft group (Wistar to Sprague-Dawley rats), L-NAME 0 mg/kg/d (group 1-1), 4 mg/kg/d (group 1-2), 8 mg/kg/d (group 1-3), or 12 mg/kg/d (group 1-4) was injected intraperitoneally. In the high responder allograft group (Dark Agouti to Lewis rats), L-NAME 0 mg/kg/d (group 2-1) or 8 mg/kg/d (group 2-2) was injected intraperitoneally. Survival times were observed and maltose absorption tests performed as well as light microscopic examination of the grafts. RESULTS: The mean survival time of group 1-3 was significantly prolonged compared with group 1-1 (P < .01). In group 2, the survival time of group 2-2 was significantly prolonged compared with group 2-1 (P < .01). Histological changes showed IRI was attenuated in group 1-2 compared with group 1-1, whereas it was aggravated in groups 1-3 and 1-4. Treatment with L-NAME (8 mg/kg/d) attenuated the graft damage of AR in groups 1 and 2. Maltose absorption tests showed that inhibition of NO impaired maltose absorption. CONCLUSION: This study suggested that NO plays a dual role as both a cytotoxic and a cytoprotective factor in IRI, and may serve as a kind of cytotoxic medium in AR in rat intestinal allotransplantation.

[Molecular phylogeny of canidae using mitochondrial cytochrome b DNA sequences].

372 bp mitochondrial cytochrome b DNA of blue fox, red fox, raccoon dog, and wolf were sequenced. Combined with the DNA fragments of dog, simien fox, and African wild dog, sequences were aligned and analyzed. There are 113 nucleotide sites substituted (30%). Molecular phylogenetic tree constructed by NJ method suggests that African wild dog is the earliest divergent. Wolf, dog, and simien fox which belong to genus Canis are combined into one branch which diverged earlier than raccoon dog, red fox and blue fox. Red fox is more related to blue fox than the other animals. The above result is in consistent with that of morphology.

Downregulation of cytokine-induced neutrophil chemoattractant and prolongation of rat liver allograft survival by interleukin-10.

We investigated whether the administration of recombinant human interleukin-10 (rhIL-10) regulates the production of cytokine-induced neutrophil chemoattractant (CINC) and improves graft survival in rat orthotopic liver transplantation (OLTx). Allograft recipients received injections of rhIL-10 at doses of 2, 10, 20, or 50 micrograms/kg/day. The allograft recipients that received rhIL-10 at 10 or 20 micrograms/kg/day showed a slight but significant prolongation of graft survival to 13.0 +/- 0.4 and 13.8 +/- 0.3 days, respectively, compared with 9.6 +/- 0.2 days in untreated allografts. Conversely, the administration of high-dose rhIL-10 shortened the allograft survival. In the rhIL-10 treatment groups, the mean serum and tissue levels of CINC at every time point after OLTx were reduced significantly compared with those in the no-treatment group. The mean peak neutrophil counts in the peripheral circulation (PC) of the groups given rhIL-10 at 10, 20, or 50 micrograms/kg/day from the samples obtained 12h after reperfusion were decreased significantly compared with the no-treatment group. Furthermore, the mean peak neutrophil counts in the PC of the groups given rhIL-10 at 10 or 20 micrograms/kg/day from the samples obtained between postoperative days (PODs) 7 and 10 were decreased significantly compared with the no-treatment group. The magnitude of liver damage and leukocyte infiltration in the rhIL-10-treated allografts on PODs 1 and 7 was reduced compared with that of untreated allografts. Our data indicate that the administration of rhIL-10 downregulates CINC production during the period of reperfusion injury and acute cellular rejection after OLTx, and prolongs liver allograft survival, suggesting that IL-10 therapy is potentially beneficial in OLTx.