Association between serum uric acid and cardiovascular fitness among US adults: A cross-sectional study.

Background: While serum uric acid (SUA) is known as a cardiovascular disease risk factor and is associated with increased cardiovascular mortality, the relationship between SUA and cardiovascular adaptability under exercise stress remains unclear. Aims: This study aims to elucidate the relationship between SUA levels and cardiovascular fitness, particularly as manifested during cardiopulmonary exercise testing. Methods: Utilizing data from the National Health and Nutrition Examination Survey (NHANES) 1999-2004, this study included 5765 participants aged 12-49 years. Heart rate recovery (HRR) during cardiopulmonary exercise testing was measured as an indicator of cardiovascular fitness. Multivariate linear regression analysis was used to explore the association between SUA levels and heart rate recovery at 1 min (HRR1) and 2 min (HRR2) post-exercise. Results: After adjusting for potential confounders, an inverse relationship was found between SUA levels and both HRR1 and HRR2. Multivariate adjusted smoothing spline plots demonstrated a decrease in HRR1 and HRR2 with increasing SUA levels. This negative correlation was observed across nearly all subgroups. Conclusions: Elevated SUA levels are indicative of poorer cardiovascular adaptability in the adult US population.

Prognostic Value of PtfV1 in Long-Term Outcomes of Patients with Unstable Angina.

Background: P-wave terminal force in lead V1 (PtfV1) irregularity has been associated with various cardiovascular conditions, including atrial fibrillation, left ventricular diastolic dysfunction, valvular heart disease, congestive heart failure, stroke, and mortality. However, its prognostic value for unstable angina (UA) has not been extensively studied. To address this knowledge gap, this study aimed to evaluate the long-term predictive significance of PtfV1 at discharge for UA patients. Methods: A total of 707 patients with newly diagnosed UA were included in this study. PtfV1 measurements were recorded at admission and discharge. PtfV1(+) was defined as an absolute value above 0.04mm·s, while PtfV1(-) was defined as an absolute value below 0.04mm·s. Based on their PtfV1 values at discharge, patients were categorized into two groups: PtfV1(-) and PtfV1(+). Univariate and multivariate regression analyses were conducted to identify variables that could potentially contribute to the risk of UA. Results: Univariate analysis revealed a higher incidence of total adverse outcomes and major adverse cardiovascular events (MACE) in the PtfV1(+) group compared to the PtfV1(-) group, with a risk ratio (RR) of 2.006 [95% confidence interval (95% CI): 1.389-2.896] for total outcomes and an RR of 2.759 (95% CI: 1.870-4.070) for MACE. After adjusting for confounding factors through multivariate analysis, participants with PtfV1(+) had a 46% increased risk [adjusted hazard ratio (HR): 1.458; 95% CI: 1.010-2.104]for total adverse outcomes and an 86% increased risk (adjusted HR: 1.863; 95% CI: 1.246-2.786) for MACE compared to those with PtfV1(-). Conclusion: The presence of PtfV1(+) at discharge is an independent predictor of poor outcomes and provides extended prognostic information for UA patients.

Coronary heart disease prediction method fusing domain-adaptive transfer learning with graph convolutional networks (GCN).

Graph convolutional networks (GCNs) have achieved impressive results in many medical scenarios involving graph node classification tasks. However, there are difficulties in transfer learning for graph representation learning and graph network models. Most GNNs work only in a single domain and cannot transfer the learned knowledge to other domains. Coronary Heart Disease (CHD) is a high-mortality disease, and there are non-public and significant differences in CHD datasets for current research, which makes it difficult to perform unified transfer learning. Therefore, in this paper, we propose a novel adversarial domain-adaptive multichannel graph convolutional network (DAMGCN) that can perform graph transfer learning on cross-domain tasks to achieve cross-domain medical knowledge transfer on different CHD datasets. First, we use a two-channel GCN model for feature aggregation using local consistency and global consistency. Then, a uniform node representation is generated for different graphs using an attention mechanism. Finally, we provide a domain adversarial module to decrease the discrepancies between the source and target domain classifiers and optimize the three loss functions in order to accomplish source and target domain knowledge transfer. The experimental findings demonstrate that our model performs best on three CHD datasets, and its performance is greatly enhanced by graph transfer learning.

Long-term prognostic value of Murray law-based quantitative flow ratio in jailed left circumflex coronary artery after left main crossover stenting.

We aimed to evaluate the impact of new Murray law-based QFR of jailed left circumflex coronary artery (LCx) on long-term clinical outcomes after left main coronary artery (LM) simple crossover stenting. 164 patients who underwent LM-to-left anterior descending coronary artery simple crossover stenting and had appropriate angiographic view of LCx for QFR computation were enrolled. The primary clinical outcome was the 5-year target lesion failure (TLF), defined as a composite of cardiac death, a target vessel myocardial infarction or target lesion repeat revascularization. The mean QFR of the LCx after LM stent implantation was 0.88 ± 0.09, and 29 patients (17.7%) had a low QFR (< 0.80), which was significantly associated with a higher 5-year rate of TLF when compared with the high QFR group (27.6% vs. 6.7%; HR: 4.235; 95% CI 1.21-14.95; p = 0.0015). The 5-year LCx ostium-related TLR rate in the low QFR group was also higher (17.2% vs. 3.0% in the high QFR group; HR: 6.07, 95% CI 1.63-22.59, p = 0.002). In a multivariate Cox regression analysis, a low QFR in the LCx after LM stenting was an independent predictor of the 5-year TLF rate (HR: 3.21, 95% CI 1.21-8.53; p = 0.019). ROC analysis showed that QFR a negative predictive value (NPV) of 89.6% ([AUC] 0.73, 95% CI 0.58-0.88, p < 0.05), the cutoff point is 0.85. The patients with a low QFR (< 0.80) in jailed LCX after LM simple crossover stenting had worse 5-year outcomes than those with a high QFR. Conversely, a QFR ≥ 0.85 of jailed LCx could serve as a good predictor of low risk of adverse outcome in LCx ostium. The QFR computation of the jailed LCx may be helpful to determine whether an additional procedure is required for the jailed side branch.

Explore the effects of forest travel activities on university students' stress affection.

This study aims to explore the effects of forest travel activities on university students' stress affection. Forty volunteer university students participated in this study. All participants were asked to complete physiological (Heart Rate Variability) and psychological (Brief Profile of Mood State and State-Trait Anxiety Inventory) tests before and after the travel activities. The results reported that students' heart rates were significantly lower after the forest travel activities than before. All domains of negative mood and anxiety decreased from the pre-test to the post-test. This study found that university students could feel less stressed if they went on forest travel activities.

Analysis of Prevention and Treatment of Anastomotic Leakage after Sphincter-Preserving Surgery for Middle- and Low-Grade Rectal Cancer under Laparoscopy.

Background: Anastomotic leakage is one of the most serious complications that can occur after laparoscopic-assistedsphincter-preserving surgery for middle- and low-grade rectal cancer. Objectives: To explore the cause, prevention, and treatment of anastomotic leakage after sphincter-preserving surgery for middle- and low-grade rectal cancer under laparoscopy. Methods: The clinical data from patients with mid- and low-grade rectal cancer who underwent laparoscopic-assistedanus-preserving surgery in the anorectal surgery department of our hospital have been analyzed. Patients with a definite diagnosis, indications for laparoscopic surgery, and sphincter-preserving surgery were included in the analysis, and patients with a protective loop ileostomy and laparotomy were excluded. Results: Among the 126 patients with middle- and low-grade rectal cancer undergoing sphincter-preserving surgery under laparoscopy. There were 75 male patients and 51 female patients, ranging in age from 37 to 89 years old, with an average age of 60.2 ± 6.7. The distance from the lower edge of the rectal tumor to the anal edge was ≤10 cm. 6 developed anastomotic leakage after the operation (leakage rate of 4.7%). Moreover, turbid purulent fluid was drained from the abdominal drainage tube in three patients on the third and fourth days after the operation, and the abdominal drainage tube drained serous drainage in three more patients on the fifth and sixth days, with signs of peritonitis appearing locally. All patients received continuous flushing and negative pressure drainage with a self-made double cannula and symptomatic treatment, and all were cured and discharged. Conclusion: Many factors can cause anastomotic leakage after this operation, and adequate perioperative preparation, meticulous operation during surgery, and careful postoperative management are key factors in preventing it.

How users make judgements about the quality of online health information: a cross-sectional survey study.

BACKGROUND: People increasingly use the Internet to seek health information. However, the overall quality of online health information remains low. This situation is exacerbated by the unprecedented "infodemic", which has had negative consequences for patients. Therefore, it is important to understand how users make judgements about health information by applying different judgement criteria. OBJECTIVE: The objective of this study is to determine how patients apply different criteria in their judgement of the quality of online health information during the pandemic. In particular, we investigate whether there is consistency between the likelihood of using a particular judgement criterion and its perceived importance among different groups of users. METHODS: A cross-sectional survey was conducted in one of the leading hospitals in a coastal province of China with a population of forty million. Combined-strategy sampling was used to balance the randomness and the practicality of the recruiting process. A total of 1063 patients were recruited for this study. Chi-square and Kruskal-Wallis analyses were used to analyse the survey data. RESULTS: In general, patients make quality judgement of health information more frequently based on whether it is familiar, aesthetic, and with expertise. In comparison, they put more weights on whether health information is secure, trustworthy, and with expertise when determining its quality. Criteria that were considered more important were not always those with a higher likelihood of being used. Patients may not use particular criteria, such as familiarity, identification, and readability, more frequently than others even if they consider them to be more important than other do and vice versa. Surprisingly, patients with a primary school degree put more weight on whether health information is comprehensive than those with higher degrees do in determining its quality. However, they are less likely to use this guideline in practice. CONCLUSIONS: To the best of our knowledge, this is the first study to investigate the consistency between the likelihood of using certain quality judgement criteria and their perceived importance among patients grouped by different demographic variables and eHealth literacy levels. The findings highlight how to improve online health information services and provide fine-grained customization of information for users.

Acute coronary syndrome risk prediction based on gradient boosted tree feature selection and recursive feature elimination: A dataset-specific modeling study.

Acute coronary syndrome (ACS) is a serious cardiovascular disease that can lead to cardiac arrest if not diagnosed promptly. However, in the actual diagnosis and treatment of ACS, there will be a large number of redundant related features that interfere with the judgment of professionals. Further, existing methods have difficulty identifying high-quality ACS features from these data, and the interpretability work is insufficient. In response to this problem, this paper uses a hybrid feature selection method based on gradient boosting trees and recursive feature elimination with cross-validation (RFECV) to reduce ACS feature redundancy and uses interpretable feature learning for feature selection to retain the most discriminative features. While reducing the feature set search space, this method can balance model simplicity and learning performance to select the best feature subset. We leverage the interpretability of gradient boosting trees to aid in understanding key features of ACS, linking the eigenvalue meaning of instances to model risk predictions to provide interpretability for the classifier. The data set used in this paper is patient records after percutaneous coronary intervention (PCI) in a tertiary hospital in Fujian Province, China from 2016 to 2021. In this paper, we experimentally explored the impact of our method on ACS risk prediction. We extracted 25 key variables from 430 complex ACS medical features, with a feature reduction rate of 94.19%, and identified 5 key ACS factors. Compared with different baseline methods (Logistic Regression, Random Forest, Gradient Boosting, Extreme Gradient Boosting, Multilayer Perceptron, and 1D Convolutional Networks), the results show that our method achieves the highest Accuracy of 98.8%.

All-Cause Death Prediction Method for CHD Based on Graph Convolutional Networks.

Coronary heart disease (CHD) has become one of the most serious public health issues due to its high morbidity and mortality rates. Most of the existing coronary heart disease risk prediction models manually extract features based on shallow machine learning methods. It only focuses on the differences between local patient features and ignores the interaction modeling between global patients. Its accuracy is still insufficient for individualized patient management strategies. In this paper, we propose CHD prediction as a graph node classification task for the first time, where nodes can represent individuals in potentially diseased populations and graphs intuitively represent associations between populations. We used an adaptive multi-channel graph convolutional neural network (AM-GCN) model to extract graph embeddings from topology, node features, and their combinations through graph convolution. Then, the adaptive importance weights of the extracted embeddings are learned by using an attention mechanism. For different situations, we model the relationship of the CHD population with the population graph and the K-nearest neighbor graph method. Our experimental evaluation explored the impact of the independent components of the model on the CHD disease prediction performance and compared it to different baselines. The experimental results show that our new model exhibits the best experimental results on the CHD dataset, with a 1.3% improvement in accuracy, a 5.1% improvement in AUC, and a 4.6% improvement in F1-score compared to the nongraph model.

Short-term clinical and oncological outcomes after single-incision plus one-port laparoscopic surgery for rectosigmoid cancer: a retrospective clinical analysis of 30 cases.

OBJECTIVE: To evaluate the safety and feasibility of single-incision laparoscopic surgery+1 (SILS+1) radical resection of sigmoid and upper rectal cancer. METHODS: The clinical data of 30 consecutive patients with sigmoid and upper rectal cancer who underwent SILS+1 radical resection between October 2018 and January 2020 in our hospital were retrospectively analyzed. An initial 5-cm periumbilical transverse incision was made. Then, a multiport device was placed in the umbilical incision. Two 10-mm ports were used for laparoscope insertion, and the other two ports were used for laparoscope device insertion. A 12-mm trocar was placed in the right lower abdominal quadrant under laparoscopic view and served as the surgeon's dominant operating channel. RESULTS: All operations were performed successfully without conversion to conventional laparoscopic surgery or open operation. Three patients developed postoperative complications: one patient developed ileus, one developed postoperative bleeding, and one developed wound infection. There were no perioperative deaths. CONCLUSIONS: The safety and feasibility of SILS+1 radical resection of sigmoid and upper rectal cancer was established by experienced surgeons in our study. However, further studies are needed to demonstrate the advantages of this procedure compared with the benefits of conventional laparoscopic surgery.

Clinical study of use of large C suture in procedure for prolapse and hemorrhoids for treatment of mixed hemorrhoids.

OBJECTIVE: To investigate the clinical use of a large C suture in the procedure for prolapse and hemorrhoids (PPH) for treatment of mixed hemorrhoids. METHODS: Patients with mixed hemorrhoids (grade III or IV) who underwent treatment with a large C suture during PPH in the Affiliated Hospital (Group) of Putian University from 1 April 2018 to 31 March 2019 were enrolled in this retrospective study. The incidences of anastomotic stenosis and anastomotic hemorrhage after the operation were observed. RESULTS: The study population comprised 126 patients (46 men and 80 women) ranging in age from 30 to 78 years (mean, 46.1 ± 2.5 years). Of these patients, 60 had circular mixed hemorrhoids, 36 had grade III circular internal hemorrhoids, and 30 had grade IV circular internal hemorrhoids. The onset time among all patients ranged from 0.5 to 25 years. All patients underwent 6 months of postoperative follow-up. None of the patients with mixed hemorrhoids developed anastomotic stenosis, although two patients developed secondary anastomotic bleeding. CONCLUSION: Placement of a large C suture during PPH is a reliable technique for treatment of mixed hemorrhoids. It is simple, effective, and applicable and can be helpful for a large number of patients in primary hospitals.

Roles of Morris Index on Poor Outcomes in Patients with Non-ST Segment Elevation Acute Coronary Syndrome.

BACKGROUND This study aimed to assess the roles of the Morris index in predicting poor outcomes in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS). MATERIAL AND METHODS This study included 905 patients with newly diagnosed NSTE-ACS. The Morris index, also known as P wave terminal force in lead V1 (PTFV1), was recorded at admission and discharge. PTVF1 (+) was defined as an absolute value >0.04 mm·s, while PTFV1 (-) was defined as an absolute value <0.04 mm·s. Based on their PTFV1 values at admission/discharge, patients were divided into 4 groups: PTFV1 (-)/(-), PTFV1 (+)/(-), PTFV1 (-)/(+), and PTFV1 (+)/(+). Univariate and multivariate regression analyses were utilized to identify the variables that could contribute to NSTE-ACS risk. RESULTS Compared with the PTFV1 (-)/(-) group, the incidence of poor outcomes was significantly higher in the PTFV1 (-)/(+) (hazard ratio [HR], 3.548; 95% confidence interval [95% CI], 2.024-6.219) and PTFV1 (+)/(+) (HR, 2.133; 95% CI, 1.141-3.986) groups, but not statistically different in the PTFV1 (+)/(-) group (risk ratio, 0.983; 95% CI, 0.424-2.277). CONCLUSIONS Primary PTFV1 (+) at discharge and PTFV1 (+) during hospitalization were independent risk factors for poor outcomes, which may provide useful prognostic information for patients with NSTE-ACS.

A predictive value of the dynamic changes of the P-wave terminal force in lead V1 in the long-term prognosis of patients with non-ST-segment elevation acute coronary syndrome.

BACKGROUND: The purpose of this study was to investigate the prognostic value of dynamic changes of P-wave terminal force in lead V1 (PtfV1 ) at electrocardiogram (ECG) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) during the long-term major adverse cardiovascular events (MACEs) of patients. METHODS: According to the PtfV1 value, the patients were divided into four groups: PtfV1 (-)/PtfV1 (-), PtfV1 (-)/PtfV1 (+), PtfV1 (+)/PtfV1 (-), and PtfV1 (+)/PtfV1 (+). RESULTS: The highest incidence of MACEs was the PtfV1 (-)/(+) group with 24 patients (24.7%). The lowest incidence was the PtfV1 (-)/(-) group with 28 patients (4.9%). Compared with the PtfV1 (-)/(-) group, the risk for the occurrence of MACEs in the PtfV1 (-)/(+)group was significantly increased (24.7% vs 4.9%, P = .000). Similarly, the risk in the PtfV1 (+)/(+) group was also increased (10.1% vs 4.9%, P = .000). CONCLUSION: The persistence of PtfV1 (+) and conversion of PtfV1 /(-) to PtfV1 /(+) at discharge significantly increased the incidence of MACEs.

Prognostic Factors for Primary Localized Gastrointestinal Stromal Tumors After Radical Resection: Shandong Gastrointestinal Surgery Study Group, Study 1201.

BACKGROUND: Most previous risk-prediction models for gastrointestinal stromal tumors (GISTs) were based on Western populations. In the current study, we collected data from 23 hospitals in Shandong Province, China, and used the data to examine prognostic factors in Chinese patients and establish a new recurrence-free survival (RFS) prediction model. METHODS: Records were analyzed for 5285 GIST patients. Independent prognostic factors were identified using Cox models. Receiver operating characteristic curve analysis was used to compare a novel RFS prediction model with current risk-prediction models. RESULTS: Overall, 4216 patients met the inclusion criteria and 3363 completed follow-up. One-, 3-, and 5-year RFS was 94.6% (95% confidence interval [CI] 93.8-95.4), 85.9% (95% CI 84.7-87.1), and 78.8% (95% CI 77.0-80.6), respectively. Sex, tumor location, size, mitotic count, and rupture were independent prognostic factors. A new prognostic index (PI) was developed: PI = 0.000 (if female) + 0.270 (if male) + 0.000 (if gastric GIST) + 0.350 (if non-gastric GIST) + 0.000 (if no tumor rupture) + 1.259 (if tumor rupture) + 0.000 (tumor mitotic count < 6 per 50 high-power fields [HPFs]) + 1.442 (tumor mitotic count between 6 and 10 per 50 HPFs) + 2.026 (tumor mitotic count > 10 per 50 HPFs) + 0.096 × tumor size (cm). Model-predicted 1-, 3-, and 5-year RFS was S(12, X) = 0.9926exp(PI), S(36, X) = 0.9739exp(PI) and S(60, X) = 0.9471exp(PI), respectively. CONCLUSIONS: Sex, tumor location, size, mitotic count, and rupture were independently prognostic for GIST recurrence. Our RFS prediction model is effective for Chinese GIST patients.

Punicalagin protects H9c2 cardiomyocytes from doxorubicin-induced toxicity through activation of Nrf2/HO-1 signaling.

Doxorubicin (DOX) is a wide-spectrum antitumor agent, but its clinical application is largely limited by its cardiotoxicity. Therefore, identification of effective agents against DOX-induced cardiotoxicity is of critical importance. The present study aimed to determine the beneficial role of punicalagin (PUN), a polyphenol isolated from pomegranate, in DOX-induced cardiotoxicity in vitro and explored the underlying mechanisms. H9c2 cardiomyocytes were pretreated with different concentrations (50, 100 and 200 µM) of PUN prior to DOX exposure. The results showed that PUN pretreatment significantly increased cell viability, inhibited lactate dehydrogenase (LDH) release and suppressed cell apoptosis induced by DOX. Additionally, PUN pretreatment attenuated the loss of mitochondrial membrane potential and cytochrome c release. Besides, PUN further enhanced the expression of nuclear Nrf2 and HO-1 in DOX-treated H9c2 cells, and the aforementioned beneficial effects of PUN were partially abolished by small interfering RNA (siRNA)-mediated Nrf2 knockdown. Hence, our findings clearly revealed that PUN might be a promising agent for alleviating the cardiotoxicity of DOX, and Nrf2/HO-1 signaling might serve a critical role during this process.

[Analysis of gastric gastrointestinal stromal tumors in Shandong Province: a midterm report of multicenter GISSG1201 study].

OBJECTIVE: To summarize the treatment status of gastric gastrointestinal stromal tumor (GIST) in Shandong province,by analyzing the clinicopathological features and prognostic factors. METHODS: Clinicopathological and follow-up data of 1 165 patients with gastric GIST between January 2000 and December 2013 from 23 tertiary referral hospitals in Shandong Province were collected to establish a database. The risk stratification of all cases was performed according to the National Institutes of Health(NIH) criteria proposed in 2008. Kaplan-Meier method was used to calculate the survival rate. Log-rank test and Cox regression model were used for univariate and multivariate prognostic analyses. RESULTS: Among 1 165 cases of gastric GIST, 557 were male and 608 were female. The median age of onset was 60 (range 15-89) years. Primary tumors were located in the gastric fundus and cardia in 623 cases(53.5%), gastric body in 346 cases(29.7%), gastric antrum in 196 cases(16.8%). All the cases underwent resection of tumors, including endoscopic resection (n=106), local resection (n=589), subtotal gastrectomy(n=399), and total gastrectomy(n=72). Based on the NIH risk stratification, there were 256 cases (22.0%) at very low risk, 435 (37.3%) at low risk, 251 cases (21.5%) at intermediate risk, and 223 cases (19.1%) at high risk. A total of 1 116 cases(95.8%) were followed up and the median follow-up period was 40 (range, 1-60) months. During the period, 337 patients relapsed and the median time to recurrence was 34 (range 1-60) months. The 1-, 3-, and 5-year survival rates were 98.6%, 86.1% and 73.4%, respectively. The 5-year survival rates of patients at very low, low, intermediate, and high risk were 93.1%, 85.8%, 63.0% and 42.3% respectively, with a statistically significant difference (P=0.000). Multivariate analysis showed that primary tumor site (RR=0.580, 95%CI:0.402-0.835), tumor size (RR=0.450, 95%CI:0.266-0.760), intraoperative tumor rupture(RR=0.557, 95%CI:0.336-0.924), risk classification (RR=0.309, 95%CI:0.164-0.580) and the use of imatinib after surgery (RR=1.993, 95%CI:1.350-2.922) were independent prognostic factors. CONCLUSIONS: The choice of surgical procedure for gastric GIST patients should be based on tumor size. All the routine procedures including endoscopic resection, local excision, subtotal gastrectomy and total gastrectomy can obtain satisfactory curative outcomes. NIH classification has a high value for the prediction of prognosis. Primary tumor site, tumor size, intraoperative tumor rupture, risk stratification and postoperative use of imatinib are independent prognostic factors in gastric GIST patients.

Cyclin-dependent kinase 5 decreases in gastric cancer and its nuclear accumulation suppresses gastric tumorigenesis.

PURPOSE: As a cyclin-independent atypical CDK, the role of CDK5 in regulating cell proliferation in gastric cancer remains unknown. EXPERIMENTAL DESIGN: Expression of CDK5 in gastric tumor and paired adjacent noncancerous tissues from 437 patients was measured by Western blotting, immunohistochemistry, and real-time PCR. The subcellular translocation of CDK5 was monitored during gastric cancer cell proliferation. The role of nuclear CDK5 in gastric cancer tumorigenic proliferation and ex vivo xenografts was explored. Furthermore, by screening for compounds in the PubChem database that disrupt CDK5 association with its nuclear export facilitator, we identified a small molecular (NS-0011) that inhibits gastric cancer cell growth. RESULTS: CDK5 level was significantly decreased in the majority of gastric tumor tissues, and the reduction of CDK5 correlated with the severity of gastric cancer based on tumor and lymph node metastasis and patient 5-year fatality rate. Nuclear localization of CDK5 was found to be significantly decreased in tumor tissues and gastric cancer cell lines, whereas exogenously expression of nucleus-targeted CDK5 inhibited the proliferation and xenograft implantation of gastric cancer cells. Treatment with the small molecule NS-0011, which increases CDK5 accumulation in the nucleus, suppressed both cancer cell proliferation and xenograft tumorigenesis. CONCLUSIONS: Our results suggest that low CDK5 expression is associated with poor overall survival in patients with gastric cancer, and nuclear accumulation of CDK5 inhibits the proliferation and tumorigenicity of human gastric cancer cells.

[A multicentre retrospective cohort study of patients with gastrointestinal stromal tumors in Shandong Province].

OBJECTIVE: To investigate the clinicopathological features and prognosis of patients with gastrointestinal stromal tumor(GIST) after surgery in Shandong Province. METHODS: Clinicopathological data of GIST patients undergoing surgery from January 2001 to June 2013 in four university teaching hospitals in Shandong Province were reviewed. Pathology results were rechecked. Patients were followed up. The prognostic factors were evaluated by univariate and multivariate analyses with Log-rank test and Cox proportional hazard model. RESULTS: A total of 1039 GIST cases were enrolled, including 509 males and 530 females, with age from 18 to 87 years(median, 58). Ninety-three patients died of GIST during follow-up. The 1-, 3-, 5-year survival rates were 94.6%, 91.7% and 87.8%, respectively. Patients undergoing R0 resection had a higher 5-year overall survival rate than those undergoing R1 resection(88.8% vs 69.0%, P<0.05). For patients with intermediate risk of recurrence after surgery, the 5-year overall survival rate was 94.4% and 89.2% respectively in imatinib and non-imatinib intervention groups(P>0.05). For patients with high risk of recurrence after surgery, the 5-year overall survival rate was 76.8% and 67.7% respectively(P<0.05). Multivariate analysis revealed that tumor size(P<0.01, RR=1.988, 95%CI:1.497-2.641), mitotic count(P<0.01, RR=2.326, 95%CI:1.686-3.208) and tumor rupture(P<0.01, RR=3.032, 95%CI:1.732-5.308) were independent prognostic factors. CONCLUSIONS: Tumor size, mitotic count and tumor rupture affect the prognosis of patients after resection of primary GIST independently. The standard treatment of localized GIST is R0 resection. Adjuvant imatinib therapy can improve overall survival of patients with high risk of recurrence after surgery. The efficacy of imatinib for patients with intermediate risk of recurrence remains to be verified.

Chemotherapy and resection for gastric cancer with synchronous liver metastases.

AIM: To investigate the effect of surgery and chemotherapy for gastric cancer with multiple synchronous liver metastases (GCLM). METHODS: A total of 114 patients were entered in this study, and 20 patients with multiple synchronous liver metastases were eligible. After screening with preoperative chemotherapy, 20 patients underwent curative gastrectomy and hepatectomy for GCLM; 14 underwent major hepatectomy, and the remaining six underwent minor hepatectomy. There were 94 patients without aggressive treatment, and they were in the non-operative group. Two regimens of perioperative chemotherapy were used: S-1 and cisplatin (SP) in 12 patients, and docetaxel, cisplatin and 5-fluorouracil (DCF) in eight patients. These GCLM patients were given preoperative chemotherapy consisting of two courses chemotherapy of SP or DCF regimens. After chemotherapy, gastrectomy and hepatectomy were preformed. Evaluation of patient survival was by follow-up contact using telephone and outpatient records. All patients were assessed every 3 mo during the first year and every 6 mo thereafter. RESULTS: Twenty patients underwent gastrectomy and hepatectomy and completed their perioperative chemotherapy and hepatic arterial infusion before and after surgery. Ninety-four patients had no aggressive treatment of liver metastases because of technical difficulties with resection and severe cardiopulmonary dysfunction. In the surgery group, there was no toxicity greater than grade 3 during the course of chemotherapy. The response rate was 100% according to the response evaluation criteria in solid tumors criteria. For all 114 patients, the overall survival rate was 8.0%, 4.0%, 4.0% and 4.0% at 1, 2, 3 and 4 years, respectively, with a median survival time (MST) of 8.5 mo (range: 0.5-48 mo). For the 20 patients in the surgery group, MST was 22.3 mo (range: 4-48 mo). In the 94 patients without aggressive treatment, MST was 5.5 mo (range: 0.5-21 mo). There was a significant difference between the surgery and unresectable patients (P = 0.000). Three patients in surgery group were still alive at the end of the cut-off date. CONCLUSION: Perioperative weekly DCF and SP achieved a good response, and combined with surgery, they could improve prognosis of GCLM.