[A retrospective comparative study of continuous pumping for home enteral nutrition after esophagectomy].

Objective: To discuss the effect and safety of continuous pumping for home enteral nutrition after esophagectomy. Methods: The current study retrospectively analyzed the esophageal cancer patients who underwent transthoracic esophagectomy between January 2017 and November 2017 at First Department of Thoracic Surgery, Peking University Cancer Hospital and Institute. There were totally 108 cases, including 88 males and 20 females, with an average age of 62 years. The patients were divided into pump feeding group (n=56) and traditional tube feeding group (n=52). The postoperative short-term safety, weight maintenance, enteral nutrition tolerance and nutritional support complete rate of the 2 groups were compared by χ(2) test, Fisher exact test and t test, respectively. Results: Compared with traditional tube feeding group, the patient safety in pumping feeding group was significantly better, with complications within 2 months after discharge were 11/52 and 4/56 respectively (χ(2)=2.393, P=0.035); the weight maintenance was significantly better, the weight loss within 4 weeks after discharge were 3.90 kg and 0.13 kg, respectively (t=7.720, P=0.000); the general enteral complications were significantly lower (26/52 vs. 5/56, χ(2)=22.225, P=0.000), the nutritional support complete rate was significantly higher (23/52 vs. 55/56, χ(2)=39.167, P=0.000). Conclusions: Continuous pump feeding enteral nutrition support after discharge postoperatively could help improve patient safety after discharge, which is better for weight maintenance of the patients. Pump feeding could also enhance tolerability of tube feeding and ensure the effective accomplishment of nutritional support.

[Clinical analysis of 138 multiple primary cancers diagnosed of digestive system malignant tumor initially].

Objective: To study the clinical characteristics, strategy of treatment and prognosis of multiple primary cancers(MPC) diagnosed of digestive system malignant tumor firstly. Methods: From January, 2000 to December, 2015, the clinical, follow-up and prognostic data of 138 MPC patients diagnosed of digestive system malignant tumor firstly were retrospectively analyzed. Results: 138 cases were found in 10 580 cases with malignant tumors, and the incidence was 1.30%. There were 129 cases of duplex primary cancers, 8 cases of triple primary cancers and 1 case of quintuple primary cancers. The repetitive primary cancer was occurred in digestive system (61cases, 44.2%) most frequently, with the next in respiratory system (46 cases, 33.3%). 52.2% (72 cases) suffered second primary cancer in 2 years after first primary cancer diagnosed, and 75.4% (104 cases) in 5 years. The median overall survival in patients with all cancer lesions radically treated was 168 months, better than any other treatment (68 months, P<0.05). Conclusions: The second primary cancers of MPC cases initially diagnosed of digestive system malignant tumor most frequently occurred in the digestive system and respiratory system. More concern should be attracted in follow-up, especially in the first 5 years. The key to improve patient' prognosis was radical treatment to every primary cancer.

[Relationship between HBcAg in the liver and mechanisms of chronic type B hepatitis HBVM in serum].

We detected the presence and distribution of HBcAg in the liver by immunohistochemistry (ABC method) and the presence of HBV-DNA in serum (spot hybridization) and anti-HBe in serum (ELISA) from 59 cases of hepatitis B hospitalized in our hospital, including 47 cases of CAH, 5 cases of CPH, and 7 cases of subacute fulminant hepatitis. 1. HBcAg in the liver was detected in 25 out of 47 cases (53%) of CAH, in 2 out of 5 cases of CPH and in 4 out of 7 cases of subacute fulminant hepatitis. The total percentage was 53% (31/59). 2. There was no positive correlation between HBV replication activity and liver disease activity (P greater than 0.05). Our results did not support the hypothesis that suggests a direct cytopathic effect of HBV. Oppositely, the fact was that the presence, the amount and the patterns of HBcAg in the liver, and the presence of HBV-DNA in serum were predominant in mild CAH compared with those in severe CAH, predominant in CAH without cirrhosis compared with those in CAH with cirrhosis. There was a tendency of inverse correlation between HBV replication activity and liver disease activity. The results above were in line with the concept that HBcAg expressed on the surface of infected hepatocytes may be relevant target for T lymphocyte cytotoxicity. The results have suggested that an immune response to HBV is present, leading to the destruction of most infected cells. 3. There was a positive correlation between HBV-DNA in serum and HBcAg in the liver (P less than 0.005), indicating that HBV-DNA in serum can represent HBV replication.(ABSTRACT TRUNCATED AT 250 WORDS)

[Correlation between hepatic microcirculation ultrastructural changes and hepatic dysfunction in chronic hepatitis B].

The author observed the ultrastructural changes of hepatic microcirculation and the function of the liver in 41 cases with chronic hepatitis B confirmed histologically. The main ultrastructural changes found in patients were swelling of the endothelium of hepatic sinusoids, hyperplasia of Kupffer cells and decrease of fenestrae in the endothelium. Proliferation of monocytes and fat-storing cells was also found in the lumina of hepatic sinusoids and space of hepatocytes and perisinusoid. The basement membrane in hepatic sinusoids and the base of hepatocytes were formed in the patients with marked pathologic changes of the liver, especially in CAH with cirrhosis. The observations also showed that whatever extent of hepatic microcirculation changes, all of them had more or less elevation of SGPT and ZnT or TT. As soon as hepatic function was impaired slightly, there occurred hepatic dysmicrocirculation. But in the cases of severe ultrastructural hepatic dysmicrocirculation serum gamma globulin elevation values and A/G ratio exchanges were much higher than those in the cases of slight changes. There was some significance on the judgment of sick condition, slight or severe. Values of the elevation of serum gamma globulin and A/G ratio exchanges were much more obvious than SGPT, ZnT and TT changes. These findings suggest that the extents of pathological changes and dysfunction of the liver in chronic viral hepatitis B are correlated to the extent of hepatic microcirculation impairment. So in the treatment of chronic hepatitis early administration of medicine to improve the liver microcirculation should be considered.