Morphometric features of gastric mucosa in atrophic gastritis: A different pattern between corpus and antrum.

Atrophic gastritis can cause mucosa thinning, while detailed metrological evidence is lacking. We aimed to compare the morphological features of full-thickness gastric mucosa in antrum and corpus and evaluate the diagnostic performance for atrophy. Gastric cancer patients were prospectively enrolled (N = 401). Full-thickness gastric mucosa was obtained. Foveolar length, glandular length and musculus mucosae thickness were measured. Pathological assessment was conducted using the visual analogue scale of the updated Sydney system. Areas under the receiver operating characteristic curves (AUCs) were calculated for different atrophy degrees. In corpus mucosa, foveolar length and musculus mucosae thickness were positively correlated with the atrophy degree (spearman's correlation coefficient [rs] = 0.231 and 0.224, respectively, P < .05); glandular length and total mucosal thickness were negatively correlated (rs = -0.399 and -0.114, respectively, P < .05). Total mucosal thickness did not correlate with antral atrophy degree (P = .107). The AUCs of total mucosal thickness for corpus and antral atrophy were 0.570 (P < .05) and 0.592 (P < .05), respectively. The AUCs for corpus atrophy, moderate and severe, and severe atrophy were 0.570 (P < .05), 0.571 (P = .003), and 0.584 (P = .006), respectively. The corresponding AUCs for antral atrophy were 0.592 (P = .010), 0.548 (P = .140), and 0.521 (P = .533), respectively. The tendency for mucosal thickness to thin with atrophy occurred in the corpus rather than in the antrum. The diagnostic performance of corpus and antral mucosal thickness was limited for atrophy.

Aggressive angiomyxoma of pelvis: A case report and literature review.

RATIONALE: Aggressive angiomyxoma (AAM) is a rare mesenchymal tumor primarily involving the lower genital tract of reproductive females. It often shares pathologic morphology with other mesenchymal lesions, which result in diagnostic difficulties for pathologists. PATIENT CONCERNS AND DIAGNOSES: We described the case of a 32-year-old female presenting with a pelvic mass. Imaging examination showed a "swirling sign" within the mass. The mass was 10.2 × 10 × 7.7 cm, located in the right front of the uterus, with unclear demarcation from the surrounding organs and tissues. The gross appearance was grayish brown with a solid section and a myxedematous cut surface. Microscopically, it was a mesenchymal tumor with a presence of perivascular smooth muscle fibers radiating from the blood vessel and an infiltrative growth pattern. The pelvic AAM was diagnosed based on clinicopathologic and imaging features. INTERVENTIONS AND OUTCOMES: A surgery with local excision of the mass was performed. The patient experienced 1 relapse during 2-year follow-up and underwent the radiation therapy. LESSONS: When the pathological morphology of AAM overlaps with other mesenchymal lesions, the comprehensive understanding of tumor clinicopathological characteristics combined with imaging features is important for the accurate diagnosis of AAM.

Small bowel perforation caused by thermal injury during colonic polypectomy: A case report and literature review.

RATIONALE: Iatrogenic gastrointestinal perforation is a known uncommon complication of colonoscopy. The perforation usually occurs in the colon itself. Rarely, colonoscopic procedures can also cause the perforations of the small intestine. PATIENT CONCERNS AND DIAGNOSES: We describe the case of a 70-year-old man who experienced abdominal pain several hours after electrical polypectomy in the transverse colon. Urgent abdominal computed tomography scans showed a few bubbles on the frontal surface around the liver and a little extraluminal free air in the upper abdomen. Urgent exploratory laparotomy revealed a round perforation with a diameter of approximately 5 mm in the ileum 80 cm proximal to the ileocecal valve, accompanied by the outflow of intestinal contents. A small bowel perforation by thermal injury was diagnosed during colonic polypectomy. INTERVENTIONS AND OUTCOMES: The ileal perforation was repaired primarily after debridement of the perforation site and abdominal cavity. The patient recovered well after surgery. Histopathological examination of the perforation site demonstrated inflammatory necrosis and infiltration of inflammatory cells. LESSONS: Small bowel perforation should be considered after colonoscopic procedures although the incidence is exceedingly rare. Urgent exploratory laparotomy is warranted when a visceral perforation is identified after colonoscopy.

Association between regular arrangement of collecting venules and Helicobacter pylori status in routine endoscopy.

BACKGROUND: The sensitivity of regular arrangement of collecting venules (RAC)-positive pattern for predicting Helicobacter pylori (H. pylori)-negative status greatly altered from 93.8 to 48.0% in recent two decades of various studies, while the reason behind it remained obscure. The aim of this study was to investigate the value of RAC as an endoscopic feature for judging H. pylori status in routine endoscopy and reviewed the underlying mechanism. METHODS: A prospective study with high-definition non-magnifying endoscopy was performed. RAC-positive and RAC-negative patients were classified according to the collecting venules morphology of the lesser curvature in gastric corpus. Gastric biopsy specimens were obtained from the lesser and greater curvature of corpus with normal RAC-positive or abnormal RAC-negative mucosal patterns. Helicobacter pylori status was established by hematoxylin and eosin staining and immunohistochemistry. RESULTS: 41 RAC-positive and 124 RAC-negative patients were enrolled from June 2020 to September 2020. The prevalence of H. pylori infection in patients with RAC-positive pattern and RAC-negative pattern was 7.3% (3/41) and 71.0% (88/124), respectively. Among all 124 RAC-negative patients, 36 (29.0%) patients were H. pylori-negative status. Ten patients (32.3%) demonstrated RAC-positive pattern in 31 H. pylori-eradicated cases. The sensitivity, specificity, positive predictive value, and negative predictive value of RAC-positive pattern for predicting H. pylori-negative status were 51.4% (95% CI, 0.395-0.630), 96.7% (95% CI, 0.900-0.991), 92.7% (95% CI, 0.790-0.981), and 71.0% (95% CI, 0.620-0.786), respectively. CONCLUSIONS: RAC presence can accurately rule out H. pylori infection of gastric corpus, and H. pylori-positive status cannot be predicted only by RAC absence in routine endoscopy. Trial registration The present study is a non-interventional trial.

Gastric foveolar elongation causes invisibility of regular arrangement of collecting venules in chronic active and inactive gastritis.

OBJECTIVES: Helicobacter pylori (H pylori) infection is the most common cause of gastritis. The disappearance of regular arrangement of collecting venules (RAC) is well known as one of the main manifestations of H pylori-affected gastritis while the reason behind it remains obscure. The aim of this study was to investigate the relationship between invisibility of RAC and the length of gastric foveolae. METHODS: 43 RAC-positive and 118 RAC-negative patients were enrolled. Gastric biopsy specimens were obtained from lesser and greater curvature of the corpus with RAC-positive or RAC-negative pattern. Histopathological evaluation was performed based on the updated Sydney System, and foveolar length was derived by a morphometric technique. RESULTS: The median gastric foveolar length in RAC-positive group (median [IQR], 138.54 µm [120.50, 159.09]) was significantly shorter than that in the RAC-negative group (median [IQR], 260.96 µm [217.40, 315.23], P < .05). The length of gastric foveolae in chronic active gastritis (RAC-negative, activity grades 1, 2, and 3) and inactive gastritis (RAC-negative, activity grade 0) was longer than that in normal group (RAC-positive, activity grade 0) (P < .05). The optimal cutoff value for gastric foveolae length of the corpus mucosa showing RAC-negative pattern was more than 181.53 µm. The sensitivity and specificity of more than cutoff value for predicting the invisibility of RAC were 93.03% and 91.78%, respectively. CONCLUSIONS: The elongation of gastric foveolae caused the invisibility of RAC in gastric corpus mucosa in chronic active and inactive gastritis on gastroendoscopy.

Volatile anesthetics versus total intravenous anesthesia in patients undergoing coronary artery bypass grafting: An updated meta-analysis and trial sequential analysis of randomized controlled trials.

BACKGROUND: The benefits of volatile anesthetics in coronary artery bypass grafting (CABG) patients remain controversial. We aimed to conduct an updated meta-analysis to assess whether the use of volatile anesthetics during CABG could reduce mortality and other outcomes. METHODS: We searched eight databases from inception to June 2019 and included randomized controlled trials (RCTs) comparing the effects of volatile anesthetics versus total intravenous anesthesia (TIVA) in CABG patients. The primary outcomes were operative mortality and one-year mortality. The secondary outcomes included the length of stay in the intensive care unit (ICU) and hospital and postoperative safety outcomes (myocardial infarction, heart failure, arrhythmia, stroke, delirium, postoperative cognitive impairment, acute kidney injury, and the use of intra-aortic balloon pump (IABP) or other mechanical circulatory support). Trial sequential analysis (TSA) was performed to control for random errors. RESULTS: A total of 89 RCTs comprising 14,387 patients were included. There were no significant differences between the volatile anesthetics and TIVA groups in operative mortality (relative risk (RR) = 0.92, 95% confidence interval (CI): 0.68-1.24, p = 0.59, I2 = 0%), one-year mortality (RR = 0.64, 95% CI: 0.32-1.26, p = 0.19, I2 = 51%), or any of the postoperative safety outcomes. The lengths of stay in the ICU and hospital were shorter in the volatile anesthetics group than in the TIVA group. TSA revealed that the results for operative mortality, one-year mortality, length of stay in the ICU, heart failure, stroke, and the use of IABP were inconclusive. CONCLUSIONS: Conventional meta-analysis suggests that the use of volatile anesthetics during CABG is not associated with reduced risk of mortality or other postoperative safety outcomes when compared with TIVA. TSA shows that the current evidence is insufficient and inconclusive. Thus, future large RCTs are required to clarify this issue.

Empirical antifungal treatment for diagnosed and undiagnosed invasive fungal disease in patients with hematologic malignancies.

BACKGROUND: Empirical antifungal therapy is effective in some patients with risk factors for invasive fungal disease (IFD) who do not qualify for the EORTC/MSG criteria for IFD, but who fail to respond to anti-bacterial and anti-viral therapy. OBJECTIVE: This retrospective single-center study investigated the epidemiology of IFD and empirical antifungal therapy in patients with hematological malignancies. METHODS: This study recruited 893 patients with hematologic malignancies who had failed to respond to anti-bacterial and anti-viral treatment and received antifungal therapy, but not for antifungal prophylaxis. Antifungal therapy regimens included amphotericin B, voriconazole, itraconazole and caspofungin. A total of 689 patients were diagnosed with proven, probable, or possible IFD, while 159 patients did not meet the EORTC/MSG criteria for IFD diagnosis but recovered with antifungal treatment, and 45 were excluded from having IFD. Effective treatment was defined as the disappearance or resolution of clinical symptoms of IFD. RESULTS: Patients diagnosed with IFD underwent chemotherapy at a higher proportion, and had significantly higher neutrophil counts compared to those who did not qualify for the EORTC/MSG criteria for IFD but responded to antifungals. The mortality due to all causes within 3 months was significantly higher for patients diagnosed with proven IFD, compared with those who did not qualify for the EORTC/MSG criteria for IFD. There was no discontinuation reported due to adverse events of caspofungin. CONCLUSION: Empirical antifungal treatment could help save the lives of some patients with severe infections who are strongly suspected of having IFD.

Ginsenoside-Rd Promotes Neurite Outgrowth of PC12 Cells through MAPK/ERK- and PI3K/AKT-Dependent Pathways.

Panax ginseng is a famous herbal medicine widely used in Asia. Ginsenosides have been identified as the principle active ingredients for Panax ginseng's biological activity, among which ginsenoside Rd (Rd) attracts extensive attention for its obvious neuroprotective activities. Here we investigated the effect of Rd on neurite outgrowth, a crucial process associated with neuronal repair. PC12 cells, which respond to nerve growth factor (NGF) and serve as a model for neuronal cells, were treated with different concentrations of Rd, and then their neurite outgrowth was evaluated. Our results showed that 10 µM Rd significantly increased the percentages of long neurite- and branching neurite-bearing cells, compared with respective controls. The length of the longest neurites and the total length of neurites in Rd-treated PC12 cells were much longer than that of respective controls. We also showed that Rd activated ERK1/2 and AKT but not PKC signalings, and inhibition of ERK1/2 by PD98059 or/and AKT by LY294002 effectively attenuated Rd-induced neurite outgrowth. Moreover, Rd upregulated the expression of GAP-43, a neuron-specific protein involved in neurite outgrowth, while PD98059 or/and LY294002 decreased Rd-induced increased GAP-43 expression. Taken together, our results provided the first evidence that Rd may promote the neurite outgrowth of PC12 cells by upregulating GAP-43 expression via ERK- and ARK-dependent signaling pathways.

Clinical study of hepatectomy combined with Jianpi Huayu Therapy for hepatocellular carcinoma.

BACKGROUND: Traditional Chinese Medicine (TCM) possesses several advantages for treating patients with hepatocellular carcinoma (HCC). The theory of 'Jianpi Huayu Therapy' rooted from 'Jin Kui Yao Lue' is one of the most important therapies in this respect. This study was conducted to investigate the clinical effect and safety of hepatectomy combining with 'Jianpi Huayu Therapy' in the treatment of HCC. MATERIALS AND METHODS: One hundred and twenty patients with HCC were randomized allocated into hepatectomy combined with 'Jianpi Huayu Therapy' group (treatment group, n=60) and hepatectomy alone group (control group, n=60). Disease-free survival (DFS) and overall survival (OS) were the primary end-points. Liver function at the end of one week after surgery, complications, average days of hospitalization as well as performance status (PS) at the end of one month post operation were also compared. RESULTS: No significant differences existed between two groups on baseline analysis (p>0.05). No treatment related mortality occurred in either group. Post-operative complications were detected among 14 patients (23.3%) in the treatment group, and 12 (20.0%) in the control group (p=0.658). Alanine aminotransferase (ALT) at the end of one week after operation was lower in the treatment than control groups (p=0.042). No significant differences in other indexes of liver function were discovered between two groups. Average days of hospitalization reduced by 0.9 day in treatment group than in control (p=0.034). During follow-up, 104 patients (86.6%) developed recurrence. The rates of 1-, 3-, and 5-year DFS and median DFS for all patients were 77.4%, 26.3%, 9.0% and 25.6 months (range, 6.0~68.0), respectively (78.2%, 29.2%, 14.3% and 28.7 months for the 48 patients in the treatment group and 75.0%, 23.3%, 6.4%, and 22.6 months for the 56 patients in the control group (p=0.045)). 101 patients had died at the time of censor, with 1-, 3-, and 5-year overall survival rates and median survival for all patients of 97.5%, 76.4%, 40.5% and 51.2 months (range, 10.0~72.0), respectively (98.3%, 78.0%, 43.6% and 52.6 months, for treatment and 96.7%, 74.7%, 37.4%, and 49.8 months, for controls, respectively (p=0.048)). CONCLUSIONS: Hepatectomy combined with 'Jianpi Huayu therapy' was effective in the treatment of HCC, and reduced post-operative recurrence and metastasis and improved DFS and OS of HCC patients.

[Role of connective tissue growth factor (CTGF) in proliferation and migration of pancreatic cancer cells].

OBJECTIVE: To explore the expression of connective tissue growth factor (CTGF) in pancreatic cancer and its influence on the proliferation and migration of cancer cells. METHODS: The expression of CTGF in pancreatic cell line PANC-1 cells was analyzed by real-time PCR and in pancreatic carcinoma (50 cases) tissues by immunohistochemistry. The ability of proliferation and migration in vitro of PANC-1 cells was tested by MTT assay, scratch test and Boyden chamber test after the CTGF gene was overexpressed by Ad5-CTGF or silenced with Ad5-siCTGF transfection. RESULTS: CTGF was overexpressed in both pancreatic cancer cells and tissues. Overxpression of CTGF leads to increased proliferation and migration of PANC-1 cells. The CTGF-transfected PANC-1 cells showed apparent stronger proliferation ability and scratch-repair ability than that of empty vector controls. The results of Boyden chamber test showed that there were 34 cells/field (200× magnificantion) of the CTGF-transfected overexpressing cells, much more than the 11 cells/field of the empty vector control cells; and 6 cells/microscopic field of the Ad5-siCTGF-transfected silenced cells, much less than the 15 cells/field of the control cells. CONCLUSIONS: CTGF is overexpressed in both pancreatic cancer cells in vitro and in vivo, indicating that it may play an important role in the cell proliferation and migration in pancreatic cancer.

Addition of low-dose ketamine to propofol-fentanyl sedation for gynecologic diagnostic laparoscopy: randomized controlled trial.

STUDY OBJECTIVE: To assess the feasibility of propofol-fentanyl sedation protocol with ketamine for gynecologic diagnostic laparoscopy. DESIGN: Prospective, double-blind, randomized study (Canadian Task Force classification I). SETTING: Outpatient operating unit in a university hospital specializing in obstetrics and gynecology. PATIENTS: Eighty women who underwent outpatient gynecologic diagnostic laparoscopy. INTERVENTIONS: Patients were randomly assigned to receive fentanyl, 1 microg/kg, and normal saline solution (group F, n = 40), or fentanyl, 1 microg/kg, and ketamine, 0.5 mg/kg (group FK, n =40), followed by propofol, 2.0 mg/kg, for sedation induction. During surgery, propofol was supplemented to achieve a target Ramsey score of 6, and cardiopulmonary support was required to maintain stable vital signs. MEASUREMENTS AND MAIN RESULTS: Five of 40 patients (12.5%) in group FK reported pain associated with propofol injection compared with 33 of 40 patients (82.5%) in group F. During surgery, 7 patients (17.5%) in group FK required rescue propofol compared with 32 patients (80.0%) in group F (p <.001). The mean (SD) rescue dose of propofol was 0.4 (0.5) mg/kg in group FK compared with 1.6 (0.6) mg/kg in group F (p <.001). In group F, 17 patients (42.5%) required assisted mask ventilation because of respiratory depression, and in 21 patients (52.5%), atropine therapy was necessary to treat bradycardia, compared with 6 patients (15.0%) and 11 patients (27.5%), respectively, in group FK (p <.05). The mean arterial blood pressure at the end of induction, pneumoperitoneum inflation, and trocar insertion was significantly decreased in group F compared with group FK (p <.05). No differences were observed between the 2 groups insofar as operation duration, recovery time, discharge time, intraoperative awareness, incidence of postoperative nausea and vomiting, and postoperative pain. Although patient satisfaction scores were comparable, a higher degree of gynecologist satisfaction was observed in group FK compared with group F (p <.001). CONCLUSION: Addition of low-dose ketamine to propofol-fentanyl sedation can provide more stable and satisfactory operation conditions in gynecologic diagnostic laparoscopy.

[Effects of granisetron/lidocaine combination on propofol injection-induced pain: a double-blind randomized clinical trial].

OBJECTIVE: To investigate the alleviation effect of vein pretreatment and granisetron/lidocaine combination on propofol injection-induced pain. METHODS: Two hundreds patients scheduled for gynaecological laparoscopic operations were randomly divided into four groups: control group (group I), lidocaine group (group II), granisetron group (group III) and granisetron/lidocaine combination group (group IV), with 50 patients in each group. The patients in the above four groups received placebo (saline), lidocaine 20 mg, granisetron 2 mg and granisetron 2 mg plus lidocaine intravenously respectively. The patients were injected with one-forth of scheduled propofol via a dorsal hand vein after one minute of venous occlusion. The pain during the injection of propofol was evaluated. RESULTS: Pain occurred in 84% of patients in the control group, 46% in the lidocaine group, 52% in the granisetron group and 24% in the granisetron/lidocaine combination group. There was a significant reduction in pain incidence in the three experimental groups compared with the control group (P<0.05). The incidence of pain, nausea, vomiting and shivering was less in the granisetron/lidocaine combination group than in the control group (P<0.05). CONCLUSION: Pretreatment with granisetron/lidocaine may be effective not only in attenuating pains during i.v. injection of propofol, but also in preventing postoperative nausea, vomiting and shivering.

[Effects of interleukin 21 on anti-leukemia activity of cytotoxic T lymphocytes induced by dendritic cells].

This study was aimed to explore the effects of interleukin 21 (IL-21) on the anti-leukemia activity of cytotoxic T lymphocytes (CTL) induced by dendritic cells (DCs) in vitro. The peripheral mononuclear cells from leukemia patients in complete remission were cultured with the specific cytokines to induce the production of DCs. The DCs loaded with RNA from autologous leukemic cells as antigen, and co-cultured with autologous T lymphocytes to get leukemia specific CTL. The cytotoxic activity of CTL against autologous leukemic cells was measured by LDH release method. The concentration of IFN-gamma and TNF-alpha in the culture supernatant was measured by enzyme immunoassay. The effects of IL-21 on the mature DCs were also studied by the measurement of the phenotype of DC and the allogenic mixed lymphocytic reactions induced by DCs. Experiments were divided into 2 groups: test group in which IL-21 (200 ng/ml) was added in coculture of DC/CTL and control group in which no IL-21 (200 ng/ml) was added. The results showed that when cultured with IL-21, the quantity of CTL increased from (56.73 +/- 10.21)% (control group) to (73.43 +/- 18.01)% (p < 0.01); The concentration of IFN-gamma and TNF-alpha in the culture supernatant increased from (154.91 +/- 67.20) ng/L (control group) to (310.62 +/- 141.15) ng/L (p < 0.01) and from (8.77 +/- 5.09) microg/L (control group) to (15.25 +/- 6.56) microg/L (p < 0.01) respectively. At the effector: target ratio of 20:1, the cytotoxic activity against autologous leukemic cells by CTL increased from (50.22 +/- 5.07)% (control group) to (75.38 +/- 9.47)% (p < 0.01). IL-21 had neither effect on the phenotype (CD1a, CD83, CD86, CD80 and HLA-DR) of mature DCs nor the allogeneic mixed lymphocytic reactions induced by DCs. It is concluded that IL-21 can strengthen the proliferation of CTL, and improve the production of IFN-gamma and TNF-alpha, thus enhance the anti-leukemia activity of CTL. Nevertheless, there is no effect of IL-21 on the function of mature DCs. These data indicate that IL-21 has a potential clinical value in the enhancement of anti-leukemia immunotherapy.

[Verapamil effect and influence on postoperative epidural analgesia and cell factors TNFalpha, IL-6 and IL-2].

OBJECTIVE: To evaluate the nonopioid analgesic drug effect and influence on serum cytokine and postoperative epidural analgesia. METHODS: With informed consent, fifty patients underwent the hysterectomy with double catheter epidural anesthesia and were assigned to intramuscular injection analgesia group (group V) and epidural analgesia group which was randomized into four groups: Bupivacaine group (group I), Bupivacaine + Fentanil group (group II), Bupivacaine + Verapamil group (group III) and Bupivacaine + Fentanil + Verapamil (group IV). At the same time, the levels of serum TNFalpha, IL-6 and IL-2 were detected, and the pain assessment was made (visual analogue scale, VAS). RESULTS: The effectiveness of epidural analgesia was better than that of intramuscular injection. Epidural verapamil reduced the analgesic cost. The postoperative levels of TNFalpha and IL-2 were higher than preanesthesia ones of them (P < 0.05). The postoperative levels of TNFalpha and IL-2 in epidural group were lower than those in intramuscular injection analgesia group at 6 hours after operation (P < 0.05). CONCLUSION: Epidural verapamil analgesia can reduce analgesic cost, and the effective epidural analgesia can reduce the postoperative distress.

[Wilms' tumor-1 gene expression in myelodysplastic syndrome and its changes in the process of myelodysplastic syndrome transforming into acute leukemia].

OBJECTIVE: To observe expression of Wilms' tumor-1 (WT1) gene in the different subtypes of myelodysplastic syndrome (MDS), and to explore the regularity of expression of WT1 gene in the process of MDS transforming into acute leukemia (AL). METHODS: The method of reverse transcriptase-polymerase chain reaction (RT-PCR) was used, the levels of WT1 gene's presentation in different types of montagers of MDS were analyzed, and the relationship between the level and the clinical characteristic was analyzed. At the same time, the expression of WT1 gene in AL patients, post-MDS-AL patients and normal controls were examined. RESULTS: The positive rate of WT1 gene expression in 49 patients with MDS was 22.4 percent (11/49), refractory anemia (RA) was 0(0/13), RA with excess of blast (RAEB) was 25.0 percent (6/24); RAEB in transformation (RAEB-t) was 41.7 percent (5/12). The positive rates of WT1 expression were gradually increased in three types of MDS (P<0.05 and P<0.01). The positive rates of WT1 expression were higher in AL and post-MDS-AL patients (48.5 percent, 32/66 and 50.0 percent, 4/8) than that in MDS patients (P<0.01). There was no expression of WT1 gene in normal control. CONCLUSION: There is a relatively high expression rate of WT1 gene in RAEB, RAEB-t of MDS, but relatively low expression rate in RA. The method of RT-PCR, is high sensitiveness and specificity, can trustful be used in the progression of monitoring MDS' progression and its transformation into AL.