[Learning curve of uniportal video-assisted thoracoscopic surgery lobectomy for the treatment of resectable lung cancer].

Objective: To analyze the learning curve of uniportal video-assisted thoracoscopic surgery (VATS) lobectomy for the treatment of resectable lung cancer. Methods: The clinical data of 160 patients with resectable lung cancer who underwent uniportal VATS lobectomy by a single surgical team between May 2016 and April 2017 at Department of Thoracic Surgery, the First Affiliated Hospital of the University of Science and Technology of China were analyzed retrospectively. The study group consisted of 90 male and 70 female patients with age of 28 to 84 years (median: 62 years). The patients were divided into four groups from group A to D according to chronological order. The operation time, incision length, intraoperative blood loss, number of dissected lymph nodes and nodal stations, the proportion of changes in operation mode, postoperative complications, chest drainage duration and hospitalization time were individually compared among the four groups by variance analysis and χ(2) test. Results: The 4 groups were similar in terms of incision length, chest drainage duration, number of dissected lymph nodes and nodal stations and postoperative hospitalization time (P>0.05). The difference of the operation time ((185.9±17.9) minutes vs. (139.9±10.7) minutes vs.(128.7±7.8) minutes vs.(124.0±9.3) minutes, F=219.605, P=0.000), intraoperative blood loss ((233.9±135.8) ml vs. (126.8±18.1) ml vs. (116.4±22.6) ml vs.(112.8±25.3) ml, F=26.942, P=0.000), the proportion of changes in operation mode (17.5% vs.7.5% vs. 5.0% vs. 5.0%, χ(2)=8.300, P=0.040), and the incidence of postoperative complications (27.5% vs. 10.0% vs. 10.0% vs. 7.5%, χ(2)=8.643, P=0.034) among the 4 groups was statistically significant. Conclusions: Uniportal VATS lobectomy can be safely and feasibly performed for resectable lung cancer, learning curve for uniportal VATS lobectomy is approximately 40 cases. Operation time, intraoperative blood loss, postoperative complications and the proportion of changes in operation mode can be used as the main measures during surgery.

[A prospective comparative study examing the impact of uniportal and three portal video-assisted thoracic surgery on short-term quality of life in lung cancer].

Objective: To evaluate the effect of the postoperative short-term quality of life between uniportal and three portal video-assisted thoracic surgery for radical lung cancer resection. Methods: The perioperative data and short-term quality of life of 120 patients received uniportal and three portal video-assisted thoracic surgery for radical lung cancer resection were analyzed from September to November 2017 at Department of Thoracic Surgery, the First Affiliated Hospital of University of Science and Technology of China. There were 64 male and 56 female patients aging of (62±10) years (ranging from 28 to 82 years). There were 60 cases received uniportal (uniportal group) and 60 cases received three portal video-assisted thoracic surgery (three-portal group). Quality of life by measurement of functional and symptom scales was assessed before surgery at baseline, and 1, 2, 4, and 8 weeks after the operation. The t test, χ(2) test, Fisher exact test and Wilcoxon rank-sum test were used to compare the date between the 2 groups. Repeated measurement variance was used for comparison of the quality of life at different time points. Results: There were no statistically significant differences in the clinicopathological features of the two groups (P>0.05). Intraoperative bleeding volume ((92±85) ml vs. (131±91) ml, t=2.387, P=0.019), postoperative catheter time ((4.4±3.1) days vs. (6.0±3.9) days, t=2.401, P=0.018), and postoperative hospitalization time ((6.2±4.0) days vs. (8.3±4.6) days, t=2.626, P=0.010) in the patients with uniportal group were less than that in three-portal group. Preoperative functional areas, symptom areas and overall health scores were similar in the two group. The functional areas such as physical function, role function, emotional function and social function and overall health status of uniportal group were significantly higher than those of three-portal group in postoperative time, while the fatigue and pain of uniportal group were significantly lower than that of three-portal group. Conclusions: Uniportal video-assisted thoracic surgery can achieve the same safety and radical of three-portal video-assisted thoracic surgery. It has advantages in intraoperative bleeding volume, postoperative time after operation, hospitalization time and postoperative life quality.

[A serum lipidomic study of patients with non-alcoholic fatty liver disease].

Objective: To investigate the serum lipidomic profile in patients with nonalcoholic fatty liver disease (NAFLD), and to analyze the lipid metabolism characteristics of NAFLD. Methods: The subjects were divided into control group (23 patients) and pathologically confirmed NAFLD group (42 patients), and ultra-high-performance liquid chromatography-tandem mass spectrometry was used to measure serum lipidomic metabolites. The partial least squares-discriminant analysis (PLS-DA) model was established to analyze the differences in lipid metabolism with reference to the univariate analysis. The t-test and Mann-Whitney U test were used for data analysis. Results: A total of 239 lipids were identified and qualitative and quantitative analyses were performed. The PLS-DA model (R2 = 0.753, Q2 = 0.456) and the univariate analysis showed that 77 lipids were metabolized differentially between the NAFLD group and the control group (VIP > 1, P < 0.05), including free fatty acid, phosphatidylcholine, phosphatidylethanolamine, phosphatidylinositol, lysophosphatidylcholine, lysophosphatidylinositol (LPI), choline plasmalogen (PlsCho), ethanolamine plasmalogen (PlsEtn), ceramide (Cer), sphingomyelin, and triglyceride (TG). Compared with the control group, the NAFLD group had significant increases in monounsaturated fatty acids (increased by 39%, t = -3.954, P < 0.05) and TGs (increased by 36%, Z = -2.662, P < 0.05), mainly TGs with low numbers of carbon atoms and unsaturated bonds, while there were reductions in TGs with high numbers of carbon atoms and unsaturated bonds. In addition, compared with the control group, the NAFLD group had significant increases in the levels of LPI (increased by 223%, t = -3.858, P < 0.05) and Cer (increased by 21%, t = -2.481, P < 0.05) and significant reductions in PlsCho (reduced by 18%, t = 3.184, P < 0.05) and PlsEtn (reduced by 20%, t = 2.363, P < 0.05). Conclusion: There is a significant difference in lipid metabolism profile between NAFLD patients and healthy people, and a serum lipidomic analysis of NAFLD helps to further clarify the characteristics of lipid metabolism in patients with NAFLD.

Intravenous fentanyl is exhaled and the concentration fluctuates with time.

Previous studies have reported that fentanyl is eliminated predominantly by hepatic biotransformation, and that some is eliminated unchanged in urine and stools. No reports have described the elimination of fentanyl via the lungs. In this study, exhaled gas samples from eight anaesthetized patients undergoing cardiac surgery were analysed using solid-phase microextraction (SPME) coupled with gas chromatography-mass spectrometry (GC-MS). Results confirmed that fentanyl was exhaled by patients after intravenous administration, that the concentration of exhaled fentanyl fluctuated with time and peak concentrations were reached approximately 15 - 20 min after intravenous fentanyl administration. Thus, in addition to hepatic biotrans formation and elimination via urine and faeces, fentanyl is also eliminated unchanged by the lungs. The potential risk to operating theatre personnel from long-term exposure to low levels of exhaled anaesthetic agents following intravenous administration to patients during surgery warrants further research.

Neoadjuvant chemotherapy versus none for resectable gastric cancer.

BACKGROUND: Gastric cancer is a major cause of cancer death, and many patients are only diagnosed when the cancer has reached an advanced stage. Neoadjuvant chemotherapy (NAC), that is, chemotherapy administered shortly before surgical treatment, could provide a method of increasing the possibility of complete resection and survival. OBJECTIVES: To evaluate the effect of neoadjuvant chemotherapy versus none for patients with resectable gastric cancer in terms of efficacy and toxicity. SEARCH STRATEGY: Electronic databases including Cochrane Library, MEDLINE, EMBASE, CancerLit, Chinese Biomedical Literature Database (CBMDISC) and ongoing clinical trials as well as handsearching of conference proceedings, were searched to retrieve relevant data. SELECTION CRITERIA: Randomized controlled clinical trials of neoadjuvant chemotherapy on resectable gastric cancer. DATA COLLECTION AND ANALYSIS: We identified a total of 36 published citations or meeting abstracts. Thirty-two items were excluded. Of the four remaining studies, three stated random allocation but the method of randomization was unclear. Two of these employed allocation concealment by sealed envelope which was controlled by an independent party. None of the trials was double blind. All trials presented a detailed description of the number of withdrawals, dropouts and losses to follow-up. MAIN RESULTS: Of the four clinical trials enrolled, there were 250 and 332 cases in total, with 106 and 126 deaths at the end of follow-up in the NAC and control group, respectively. The OR (odds ratio) was 1.05 (95%CI: 0.73-1.50), which was not statistically significant. Of the evaluable 129 patients receiving NAC, 28.7% demonstrated either a complete or a partial response. Two studies of NAC in resectable gastric cancer had resection rate data available for analysis The R0 resection rate in the NAC group was comparable to that in the control (OR: 0.96 (95%CI: 0.51-1.83)). The morbidity and mortality of NAC varied with the regimens used preoperatively. Of the 129 patients included in the analyzed studies, some acceptable toxicity was observed. AUTHORS' CONCLUSIONS: There is no definite evidence of the effectiveness of NAC in resectable gastric cancer, in terms of improvements in patient survival, in the trials we reviewed. Neoadjuvant chemotherapy should not be used routinely in clinical setting until further results from randomized clinical are available. Neoadjuvant chemotherapy of gastric cancer should be applied under the framework of clinical trials.

WITHDRAWN: Neoadjuvant chemotherapy versus none for resectable gastric cancer.

BACKGROUND: Gastric cancer is a major cause of cancer death, and many patients are only diagnosed when the cancer has reached an advanced stage. Neoadjuvant chemotherapy (NAC), that is, chemotherapy administered shortly before surgical treatment, could provide a method of increasing the possibility of complete resection and survival. OBJECTIVES: To evaluate the effect of neoadjuvant chemotherapy versus none for patients with resectable gastric cancer in terms of efficacy and toxicity. SEARCH STRATEGY: Electronic databases including Cochrane Library, MEDLINE, EMBASE, CancerLit, Chinese Biomedical Literature Database (CBMDISC) and ongoing clinical trials as well as handsearching of conference proceedings, were searched to retrieve relevant data. SELECTION CRITERIA: Randomized controlled clinical trials of neoadjuvant chemotherapy on resectable gastric cancer. DATA COLLECTION AND ANALYSIS: We identified a total of 36 published citations or meeting abstracts. Thirty-two items were excluded. Of the four remaining studies, three stated random allocation but the method of randomization was unclear. Two of these employed allocation concealment by sealed envelope which was controlled by an independent party. None of the trials was double blind. All trials presented a detailed description of the number of withdrawals, dropouts and losses to follow-up. MAIN RESULTS: Of the four clinical trials enrolled, there were 250 and 332 cases in total, with 106 and 126 deaths at the end of follow-up in the NAC and control group, respectively. The OR (odds ratio) was 1.05 (95%CI: 0.73-1.50), which was not statistically significant. Of the evaluable 129 patients receiving NAC, 28.7% demonstrated either a complete or a partial response. Two studies of NAC in resectable gastric cancer had resection rate data available for analysis The R0 resection rate in the NAC group was comparable to that in the control (OR: 0.96 (95%CI: 0.51-1.83)). The morbidity and mortality of NAC varied with the regimens used preoperatively. Of the 129 patients included in the analyzed studies, some acceptable toxicity was observed. AUTHORS' CONCLUSIONS: There is no definite evidence of the effectiveness of NAC in resectable gastric cancer, in terms of improvements in patient survival, in the trials we reviewed. Neoadjuvant chemotherapy should not be used routinely in clinical setting until further results from randomized clinical are available. Neoadjuvant chemotherapy of gastric cancer should be applied under the framework of clinical trials.

Screening and analysis of bioactive compounds in traditional Chinese medicines using cell extract and gas chromatography-mass spectrometry.

As the cost of drug development is always many times more than that of drug discovery, predictive methods aiding in the screening of bioavailable drug candidates are of profound significance. In this paper, a novel method for screening bioactive compounds from traditional Chinese medicines (TCMs) was developed by using living cell extract and gas chromatography (GC)-mass spectrometer (MS). The method was validated by using elemene emulsion injection (EEI), a typical TCM with known active compound, to interact with murine ascites hepatocarcinoma cell strain with high metastatic potential (HCa-F). Finally, the method was applied to screen the bioactive compounds from multi-component zedoary turmeric oil and glucose injection (ZTOGI). After HCa-F cells was incubated in ZTOGI, ethyl acetate (EtOAc) was used to extract the compounds in the cells for GC-MS analysis. Fourteen compounds were detected in the desorption eluate of HCa-F cell extract of ZTOGI, and further identified by MS. Curzerene and beta-elemene were found to be two major bioactive compounds in ZTOGI. These results show that the method developed may be applied to quickly screen the potential bioactive components in TCMs interacting with the target cells.

Cigarette smoking and other risk factors for progression of precancerous stomach lesions.

BACKGROUND: Stomach cancer is generally thought to evolve through a series of gastric mucosal changes, but the determinants of the precancerous lesions are not well understood. PURPOSE: Our purpose was to assess risk factors for intestinal metaplasia and gastric dysplasia arising from chronic atrophic gastritis in a general population at high risk for stomach cancer. METHODS: A population-based gastroscopic screening of more than 3000 residents was conducted in a county in China with one of the world's highest rates of stomach cancer. Information on the lifestyle and other characteristics of the participants was obtained by interview, and responses were compared between those in whom the most advanced gastric lesion was dysplasia or intestinal metaplasia versus those with chronic atrophic gastritis. RESULTS: Cigarette smoking was found to nearly double the risk of transition to dysplasia and to be a mild risk factor for intestinal metaplasia. Smoking accounted almost entirely for the 55% higher prevalence of dysplasia among men than among women. Risk of transition to dysplasia had a weak association with several dietary factors and was increased among those participants with a family history of stomach cancer and with blood type A. CONCLUSIONS: The findings provide strong evidence for a role of tobacco consumption and offer clues to other environmental and genetic factors involved in the process of gastric carcinogenesis.

Gastric dysplasia and gastric cancer: Helicobacter pylori, serum vitamin C, and other risk factors.

BACKGROUND: Gastric cancer is generally thought to arise through a series of gastric mucosal changes, but the determinants of the precancerous lesions are not well understood. To identify such determinants, we launched a follow-up study in 1989-1990 among 3433 adults in Linqu County, China, a region with very high rates of gastric cancer. METHODS: Data on cigarette smoking, alcohol consumption, and other characteristics of the participants were obtained by interview in 1989-1990, when an initial endoscopy was taken. At study entry, antibodies to Helicobacter pylori were assayed in 2646 adults (77% of people screened), and levels of serum micronutrients were measured in approximately 450 adults. Follow-up endoscopic and histopathologic examinations were conducted in 1994. Antibodies to H. pylori, levels of serum micronutrients, and other baseline characteristics were compared between subjects whose condition showed progression to dysplasia or gastric cancer from study entry to 1994 and subjects with no change or with regression of their lesions over the same time frame. All P: values are two-sided. RESULTS: The presence of H. pylori at baseline was associated with an increased risk of progression to dysplasia or gastric cancer (odds ratio [OR] = 1.8; 95% confidence interval [CI] = 1.2-2.6). The risk of progression to dysplasia or gastric cancer also was moderately increased with the number of years of cigarette smoking. In contrast, the risk of progression was decreased by 80% (OR = 0.2; 95% CI = 0.1-0.7) among subjects with baseline ascorbic acid levels in the highest tertile compared with those in the lowest tertile, and there was a slightly elevated risk in those individuals with higher levels of alpha-tocopherol. CONCLUSIONS: H. pylori infection, cigarette smoking, and low levels of dietary vitamin C may contribute to the progression of precancerous lesions to gastric cancer in this high-risk population.

Inactivation of p53 sensitizes U87MG glioma cells to 1,3-bis(2-chloroethyl)-1-nitrosourea.

We examined the effect of p53 inactivation on the response of U87MG glioma cells to 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU). These studies were motivated by three observations: (a) some human astrocytomas are sensitive to BCNU and some are resistant; (b) chemosensitive astrocytomas are more likely to be found in young adults whose tumors are more likely to harbor a p53 mutation; and (c) mouse astrocytes lacking the p53 gene are more sensitive to BCNU than wild-type cells. Here, we observed that p53 inactivation by transfection with pCMV-E6 sensitized U87MG cells to BCNU. Compared with control U87MG-neo cells with intact p53 function, the clonogenic survival of U87MG-E6 cells exposed to BCNU was reduced significantly. In U87MG-E6 cells, sensitization to BCNU was associated with failure of p21(WAF1) induction, transient cell cycle arrest in S phase, accumulation of polyploid cells, and significant cell death. In contrast, resistance to BCNU in U87MG-neo cells was associated with up-regulation of p53, prolonged induction of p21(WAF1), sustained cell cycle arrest in S phase, and enhancement of DNA repair. U87MG cells with disrupted p53 function were less able to repair BCNU-induced DNA damage and survive this chemotherapeutic insult. The question arises of whether p53 dysfunction might be a chemosensitizing genetic alteration in human astrocytic gliomas.

Diet and high risk of stomach cancer in Shandong, China.

A case-control investigation involving interviews with 564 stomach cancer patients and 1131 population-based controls was conducted to evaluate reasons for the exceptionally high rates of stomach cancer in Linqu, a rural county in Shandong Province in northeast China. Daily consumption of sour pancakes, a fermented indigenous staple, was associated with a 30% increase in risk. Risks of stomach cancer were also increased by 2- to 3-fold among persons with prior chronic gastritis or gastric ulcer, by 80% among those with stomach cancer in a family member, by 50% among men who smoked one or more packs of cigarettes/day, by 40% among those who preferred salty foods, and by 50% among families with moldy grain supplies. In contrast, risks tended to decrease in proportion to increasing consumption of fresh vegetables and fruits. This protective effect was more pronounced for vegetables, with those in the highest quartile of intake at less than one-half the risk of those in the lowest. Stomach cancer risks also declined with increasing dietary intake of carotene, vitamin C, and calcium, but not retinol. These findings provide leads to dietary factors that contribute to the high rates in Linqu, where stomach cancer is the leading cause of cancer and has not yet begun to decline as in other parts of the world.

Magnetic mediation effect of a C impurity in a Mn-doped Zn12O12 nanocluster: a case of multiple exchange interactions.

The stability and exchange interaction mechanism of a doped Zn12O12 cluster with Mn and C atoms were investigated by first-principles calculations. For the Mn-doped Zn12O12 cluster, it is identified that a superexchange interaction deriving the hybridization between the Mn 3d(2/x)-2/y and O 2p(xy) orbitals dominates the Mn(↑)-Mn(↓) antiferromagnetic coupling, although a direct exchange interaction deriving the Mn-Mn bonding is also found. In order to turn the Mn spin state in the Mn-doped Zn12O12 cluster, C doping is undertaken to change the magnetic interactions of these impurities. It is proved that the C incorporation into the Mn-doped Zn12O12 cluster destroys the short-ranged antiferromagnetic coupling, where multiple exchange interactions take over, including the direct exchange interaction and the kinetic p-d exchange interaction partially due to the geometric distortion and surface effect with dangling bonds (sp(2)-like hybrids). It is concluded that the kinetic p-d exchange interaction plays a dominant role in Mn/C-doped Zn12O12 clusters.

Familial predisposition to precancerous gastric lesions in a high-risk area of China.

Aggregation of intestinal metaplasia and dysplasia was investigated among families participating in a population-based gastroscopic screening survey in an area of China with one of the world's highest rates of stomach cancer. The prevalence of gastric dysplasia was significantly increased among those with dysplasia among siblings or spouses, but not parents. The odds of dysplasia were nearly doubled if an eldest brother or a spouse was affected. Sibling and spousal associations for intestinal metaplasia were much less pronounced and not statistically significant. The specificity of the findings suggests that familial risk of advanced precancerous lesions (dysplasia) is influenced not only by genetic factors, but also by environmental factors operating in childhood and early adult life.

Helicobacter pylori antibodies in relation to precancerous gastric lesions in a high-risk Chinese population.

Helicobacter pylori infection is a major cause of gastritis and may be a key risk factor for stomach cancer, but its role in the process of gastric carcinogenesis is not well understood. Herein, we examine H. pylori prevalence in relation to demographic and lifestyle factors and to severity of precancerous lesions in an area of China with one of the highest rates of stomach cancer in the world. H. pylori serum IgG antibody positivity was assayed among 2646 adults, ages 35-64, participating in a population-based gastroscopic screening survey in the high-risk area. The prevalence of positivity was evaluated according to gastric histology, environmental and lifestyle variables determined by interviews during the screening, and level of serum pepsinogens. The odds of advanced precancerous lesions (intestinal metaplasia and dysplasia) of the stomach among those with antibody positivity were estimated by logistic regression. Seventy-two % of the population was H. pylori antibody-positive, with nonsignificant variation by sex, age, income, education, family size, and cigarette smoking habits. H. pylori positivity was higher among those who ate sour pancakes, a fermented indigenous staple that is a risk factor for gastric dysplasia and stomach cancer in this population. The prevalence of H. pylori varied most notably, however, with gastric pathology. The percent of H. pylori positivity increased from 55 to 60 to 87% among those with superficial (nonatrophic) gastritis, mild chronic atrophic gastritis, and severe chronic atrophic gastritis, respectively, before falling to 78% among those with intestinal metaplasia or dysplasia. H. pylori antibody positivity also was strongly correlated with serum pepsinogen concentrations, particularly pepsinogen II, but knowledge of H. pylori status did not markedly improve serological identification of advanced precancerous lesions above that provided by pepsinogen ratios alone. The findings suggest that H. pylori infection contributes to the process of gastric carcinogenesis, particularly during the early stages, in this high-risk area.

Nitrite, N-nitroso compounds, and other analytes in physiological fluids in relation to precancerous gastric lesions.

Levels of gastric juice nitrite, several urinary N-nitroso compounds, and other analytes were examined among nearly 600 residents in an area of Shandong, China, where precancerous gastric lesions are common and rates of stomach cancer are among the world's highest. Gastric juice nitrite levels were considerably higher among those with gastric juice pH values above 2.4 versus below 2.4. Nitrite was detected more often and at higher levels among persons with later stage gastric lesions, especially when gastric pH was high. Of those with intestinal metaplasia, 17.5% had detectable levels of gastric nitrite, while this analyte was detected in only 7.2% of those with less advanced lesions. Relative to those with undetectable nitrite, the odds of intestinal metaplasia increased from 1.5 (95% confidence interval = 0.6-4.1) to 4.1 (95% confidence interval = 1.8-9.3) among those with low and high nitrite concentrations, respectively. Urinary acetaldehyde and formaldehyde levels also tended to be higher among those with more advanced pathology, particularly dysplasia. However, urinary excretion levels of total N-nitroso compounds and several nitrosamino acids differed little among those with chronic atrophic gastritis and intestinal metaplasia and dysplasia, consistent with findings from recent studies in the United Kingdom, France, and Colombia. The data from this high-risk population suggest that elevated levels of gastric nitrite, especially in a high pH environment, are associated with advanced precancerous gastric lesions, although specific N-nitroso compounds were not implicated.

Human chromosome pellicle antibody recognizing centromere protein-C (CENP-C), the main component of the kinetochore.

Recently the antichromosome antisera from several scleroderma patients have been found to recognize the pellicle of metaphase and anaphase chromosomes. In order to identify the pellicle components, we used these antichromosome antisera to screen a human embryonic cDNA library. The sequences of the positive clones are identical to the cDNA gene sequence of CENP-C (centromere protein C), a human centromere autoantigen. This result suggests that CENP-C is a component of the pellicle of human metaphase and anaphase chromosomes.

Helicobacter pylori prevalence and CagA status among children in two counties of China with high and low risks of gastric cancer.

BACKGROUND: Studies in adult populations in selected countries with widely varying rates of gastric cancer have shown a weak correlation between gastric cancer mortality rates and the prevalence of CagA+ strains of H. pylori. However, only limited data are available in ethnically homogenous populations with varying rates in the same region. METHODS; We compared the prevalence of H. pylori in general and of CagA+ strains in particular among children in Shandong Province, China in areas at high (Linqu County) and low risk (Cangshan County) of gastric cancer. H. pylori status among children aged 3 to 12 years was determined by 13C-UBT, and CagA status was determined by enzyme-linked immunosorbent assay (ELISA). Because of the difficulty in obtaining blood from young children aged 3 to 4 years and from some children aged 5 years, CagA status was determined among part of children 5 years old and children 6 to 12 years old. RESULTS; Among 98 children aged 3 to 12 years in Linqu, 68 (69.4%) was H. pylori-positive, as compared with 29 (28.7%) among 101 children in Cangshan. Among children positive for 13C-UBT, the proportion of the CagA+ strains were identified was 46 (88.5%) of 52 in Linqu and 13 (81.3%) of 16 in Cangshan, respectively. CONCLUSIONS: The prevalence of H. pylori was nearly three times higher among children in Linqu than in Cangshan, which may contribute to the large differential in gastric cancer rates for two neighboring populations in Shandong Province.

Blood type and family cancer history in relation to precancerous gastric lesions.

BACKGROUND: The increased odds of stomach cancer among subjects with blood type A have been reported in epidemiological studies. AIM: To study the relation of family history of gastric cancer and ABO blood type with precancerous gastric lesions in a high-risk area for stomach cancer. Subjects and setting We examined 3400 adults aged 35-64 in a population-based gastric endoscopic screening in a county in China with one of the highest rates of stomach cancer in the world. METHODS: In this cross-sectional study, data on family cancer history, ABO blood type and other characteristics of the participants were obtained by interview and blood test. Responses were compared between those with the most advanced gastric lesions, dysplasia (DYS) or intestinal metaplasia (IM), versus those with chronic atrophic gastritis (CAG) or superficial gastritis (SG). RESULTS: The prevalence odds ratio (OR) for blood type A relative to other types was 1.39 (95% CI : 1.12-1.73) for DYS and 1.28 (95% CI : 1.06-1.53) for IM. The OR associated with parental history of stomach cancer was 1.88 (95% CI : 1.20-2.95) for DYS, but the numbers were too small to evaluate aggregation among siblings. The combined OR associated with blood type A and a parental of history of gastric cancer was 2.61 (95% CI : 1.59-4.30) for DYS and 1.46 (95% CI : 0.93-2.31) for IM. CONCLUSIONS: The findings suggest that genetic factors play a role in developing precancerous gastric lesions.

Helicobacter pylori infection and mode of transmission in a population at high risk of stomach cancer.

BACKGROUND: Helicobacter pylori (H. pylori) is a recognized cause of chronic gastritis and peptic ulcer disease, and is strongly suspected to play a role in the aetiology of stomach cancer but little is known about the mode of transmission. AIM: To determine the prevalence of H. pylori infection in children and investigate potential modes of transmission in rural China. SUBJECTS AND SETTING: We examined 98 children aged 3-12 years and 289 adults aged 35-64 years in a village in Linqu County, China, which has one of the highest rates of stomach cancer in the world. METHOD: H. pylori infection was determined by 13C-urea breath test in children and by an enzyme-linked immunosorbent assay in adults. RESULTS: Among 98 tested children, 68 (69%) were H. pylori positive, but the prevalence rates varied as a function of age, rising from about 50% at ages 3-4 to 85% at ages 9-10 before falling to 67% at ages 11-12. Boys had a higher infection rate than girls (77.8% versus 59.1%, P < 0.05). Among 289 adults, 195 (68%) were H. pylori positive, with a somewhat higher rate of positivity in younger compared to older age groups. The prevalence of H. pylori infection clustered within families. In families with at least one infected parent, 85% of children were H. pylori positive, while in families with both parents uninfected, only 22% of children were H. pylori positive (odds ratio [OR] = 30.4, 95% CI : 4.0-232). CONCLUSIONS: These findings demonstrate the acquisition of H. pylori infection during early childhood in a population at high risk of stomach cancer, in a manner consistent with a person-to-person mode of transmission between parents and children.

Helicobacter pylori infection, garlic intake and precancerous lesions in a Chinese population at low risk of gastric cancer.

BACKGROUND: Cangshan County of Shandong Province has one of the lowest rates of gastric cancer (GC) in China. While intestinal metaplasia (IM) and dysplasia (DYS) are less common in Cangshan than in areas of Shandong at high risk of GC, these precursor lesions nevertheless affect about 20% of adults age > or = 55. SUBJECTS AND SETTING: In order to evaluate determinants of IM and DYS in Cangshan County, a low risk area of GC a survey was conducted among 214 adults who participated in a gastroscopic screening survey in Cangshan County in 1994. METHOD: A dietary interview and measurement of serum Helicobacter pylori antibodies were performed. RESULTS: The prevalence of H. pylori was lowest (19%) among those with normal gastric mucosa, rising steadily to 35% for superficial gastritis (SG), 56% for chronic atrophic gastritis (CAG), 80% for IM, and 100% for DYS. The prevalence odds of precancerous lesions were compared with the odds of normal histology or SG. The odds ratio (OR) or CAG associated with H. pylori positivity was 4.2 (95% confidence interval [CI] : 1.7-10.0), while the OR of IM/DYS associated with H. pylori positivity was 31.5 (95% CI: 5.2-187). After adjusting for H. pylori infection, drinking alcohol was a risk factor for CAG (OR = 3.2, 95% CI: 1.1-9.2) and IM/DYS (OR = 7.8, 95% CI: 1.3-47.7). On the other hand, consumption of garlic showed non-significant protective effects and an inverse association with H. pylori infection. CONCLUSIONS: The findings of this study suggest that infection with H. pylori is a risk factor and garlic may be protective, in the development and progression of advanced precancerous gastric lesions in an area of China at relatively low risk of GC.