Bilateral fourth branchial fissure: a case report and literature review / 口腔疾病防治

Objective@#To explore the diagnosis and treatment of fourth branchial cleft deformity.@*Methods@#The clinical data of a patient with bilateral fourth branchial cleft deformity in the neck were summarized, and the literature was reviewed@*Results@#The patient was a 17-year-old male who had a painless lump in his neck for 10 years. During specialized examination, a lump approximately 4.0 cm × 3.0 cm in size could be palpated subcutaneously on the right side of the neck, with clear boundaries, a regular shape, a soft texture, and a wave-like sensation without obvious tenderness. A fistula with a size of approximately 0.5 cm × 0.5 cm could be observed on the left side of the neck, and yellow clear liquid could be seen flowing out of the fistula. The surrounding skin was locally red and swollen, and the surface temperature of the skin was elevated. Computed tomography examination demonstrated a circular cystic low-density shadow approximately 4.4 cm × 3.4 cm in size in the right supraclavicular and anterior cervical regions. A flocculent isodense image could be observed in the middle; moreover, nodular calcification could be observed at the edge, and the surrounding fat spaces were blurred. The enhanced scan showed mild enhancement of the cyst wall but no obvious enhancement of the contents. On the left side, a circular nodular shadow with a diameter of approximately 1.4 cm could be seen, with enhanced scanning and circular enhancement. The surrounding skin was thickened, and the subcutaneous fat gap was blurred. Multiple small lymph nodes could be observed on both sides of the neck, with the larger nodes having a short diameter of approximately 0.8 cm. The size and morphology of the thyroid gland were not significantly abnormal, and there was no obvious abnormal density shadow inside of the gland. Upon admission, the diagnosis was a fourth gill fissure cyst in the right neck and a fourth gill fissure fistula in the left neck. Under general anesthesia and intravenous anesthesia, right branchial cleft cyst resection and left branchial cleft fistula resection were performed. Postoperative pathological examination demonstrated a left branchial cleft fistula and a right branchial cleft cyst. The wound healed by first intention, and there was no recurrence after 6 months of follow-up. According to the literature, fourth branchial cleft deformity is a congenital developmental abnormality of the branchial apparatus, the incidence of which accounts for only 1% of all branchial cleft deformities; moreover, it often occurs on the left side. The anatomical position is often located in the cervical root and supraclavicular region, thus demonstrating cysts or sinuses adjacent to the thyroid gland. The diagnosis should be confirmed by anatomical location, imaging examination or laryngoscopy combined with postoperative pathological results and should be differentiated from cervical masses such as thyroglossal duct cysts and lymph node metastasis. The main treatment methods include surgical procedures and endoscopic cauterization of the internal fistula. The prognosis is generally good, and there is a risk of recurrence; however, cancer rarely occurs@*Conclusion@#Deformity of the fourth branchial fissure is very rare; thus, it should be identified early to avoid excessive and ineffective surgical drainage, reduce potential complications during resection and completely remove the lesion to prevent recurrence.

Clinical characteristics of familial adenomatous polyposis / 中国现代医生

Objective To investigate the clinical manifestations of familial adenomatous polyposis(FAP).Methods The clinical data of 100 patients with FAP diagnosed in the First Affiliated Hospital of Zhengzhou University from 2011 to 2021 were analyzed retrospectively.Results The main clinical manifestations were bloody stool(44.0%),abdominal pain(40.0%),changes of stool characteristics(25.0%),abdominal distension(18.0%)and diarrhea(17.0%);The most common types of adenomas were villous tubular adenoma(44.9%)and tubular adenoma(32.1%);Extraintestinal manifestations:3 cases of desmoid fibroma,2 cases of osteoma and 1 case of lipoma.47 cases of gastric polyps and the mostly pathological type was fundic gland polyp(34.0%).18 cases of duodenal polyps including 6 cases of adenomatous polyps and most were located at descending duodenum(61.1%).Adenoma canceration occurred in 21 patients.The average age was 38.7 and the canceration mainly occurs in the rectum.The gender,family history,age of onset,number of adenomas,diameter and pathological type of adenomas were statistically compared between patients with and without canceration.It was found that there were significant differences in gender,average age of onset,number of adenoma polyps,diameter of adenoma and pathological type between the two groups(P<0.05).Conclusions FAP is mainly characterized by bloody stool and abdominal pain,with high canceration rate.The risk factors include the age of onset,the number and size of adenomas and the pathological type.The main pathological types are villous tubular adenoma and tubular adenoma.At present,preventive colorectal resection is still the most effective way to treat FAP.No matter what type of methods patients choose,they should be followed up strictly under endoscopy in order to find the lesions in time and treat if necessary.

Clinical features, diagnosis, and treatment of Peutz-Jeghers syndrome: Experience with 566 Chinese cases.

BACKGROUND: Peutz-Jeghers syndrome (PJS) is a clinically rare disease with pigmented spots on the lips and mucous membranes and extremities, scattered gastrointestinal polyps, and susceptibility to tumors as clinical manifestations. Effective preventive and curative methods are still lacking. Here we summarize our experience with 566 Chinese patients with PJS from a Chinese medical center with regard to the clinical features, diagnosis, and treatment. AIM: To explore the clinical features, diagnosis, and treatment of PJS in a Chinese medical center. METHODS: The diagnosis and treatment information of 566 cases of PJS admitted to the Air Force Medical Center from January 1994 to October 2022 was summarized. A clinical database was established covering age, gender, ethnicity, family history, age at first treatment, time and sequence of appearance of mucocutaneous pigmentation, polyp distribution, quantity, and diameter, frequency of hospitalization, frequency of surgical operations, etc. The clinical data was retrospectively analyzed using SPSS 26.0 software, with P < 0.05 considered statistically significant. RESULTS: Of all the patients included, 55.3% were male and 44.7% were female. Median time to the appearance of mucocutaneous pigmentation was 2 years, and median time from the appearance of mucocutaneous pigmentation to the occurrence of abdominal symptoms was 10 years. The vast majority (92.2%) of patients underwent small bowel endoscopy and treatment, with 2.3% having serious complications. There was a statistically significant difference in the number of enteroscopies between patients with and without canceration (P = 0.004, Z = -2.882); 71.2% of patients underwent surgical operation, 75.6% of patients underwent surgical operation before the age of 35 years, and there was a statistically significant difference in the frequency of surgical operations between patients with and without cancer (P = 0.000, Z = -5.127). At 40 years of age, the cumulative risk of intussusception in PJS was approximately 72.0%, and at 50 years, the cumulative risk of intussusception in PJS was approximately 89.6%. At 50 years of age, the cumulative risk of cancer in PJS was approximately 49.3%, and at 60 years of age, the cumulative risk of cancer in PJS was approximately 71.7%. CONCLUSION: The risk of intussusception and cancer of PJS polyps increases with age. PJS patients ≥ 10 years old should undergo annual enteroscopy. Endoscopic treatment has a good safety profile and can reduce the occurrence of polyps intussusception and cancer. Surgery should be conducted to protect the gastrointestinal system by removing polyps.

A Short-Term Efficacy of Anlotinib in the Treatment of Refractory Nasopharyngeal Inverted Papilloma: A Case Report.

To our knowledge, no studies have reported the use of anlotinib in the treatment of locally cancerous nasopharyngeal inverted papillomas that cannot be operated on or treated with radiotherapy. Here, we report a case of a 53-year-old woman diagnosed with recurrent local canceration of nasopharynx papilloma. Magnetic resonance imaging (MRI) showed that the right parapharyngeal space, nasopharynx, and ethmoid sinus were changed, and recurrence was considered. There was no indication for surgery or radiotherapy. Imaging showed that the tumor had obvious enhancement and abundant blood vessels. Immunohistochemistry showed that vascular endothelial growth factor receptor (VEGFR) 2 expression was positive in papilloma tissue and in local canceration tissue of the papilloma. After the patient's consent was obtained, anlotinib treatment was started in May and ended in November 2019. Then, the patient was treated with intensity-modulated radiotherapy (IMRT) with planning gross tumor volume (PGTV) 66 Gy, planning clinical tumor volume 1 (PCTV1) 60 Gy, and planning clinical tumor volume 2 (PCTV2) 54 Gy in 33 fractions. No disease recurrence was reported at 4 months after radiotherapy.

Multiparametric MRI-based machine learning models for preoperatively predicting rectal adenoma with canceration.

OBJECTIVES: To propose multiparametric MRI-based machine learning models and assess their ability to preoperatively predict rectal adenoma with canceration. MATERIALS AND METHODS: A total of 53 patients with postoperative pathology confirming rectal adenoma (n = 29) and adenoma with canceration (n = 24) were enrolled in this retrospective study. All patients were divided into a training cohort (n = 42) and a test cohort (n = 11). All patients underwent preoperative pelvic MR examination, including high-resolution T2-weighted imaging (HR-T2WI) and diffusion-weighted imaging (DWI). A total of 1396 radiomics features were extracted from the HR-T2WI and DWI sequences, respectively. The least absolute shrinkage and selection operator (LASSO) was utilized for feature selection from the radiomics feature sets from the HR-T2WI and DWI sequences and from the combined feature set with 2792 radiomics features incorporating two sequences. Five-fold cross-validation and two machine learning algorithms (logistic regression, LR; support vector machine, SVM) were utilized for model construction in the training cohort. The diagnostic performance of the models was evaluated by sensitivity, specificity and area under the curve (AUC) and compared with the Delong's test. RESULTS: Ten, 8, and 25 optimal features were selected from 1396 HR-T2WI, 1396 DWI and 2792 combined features, respectively. Three group models were constructed using the selected features from HR-T2WI (ModelT2), DWI (ModelDWI) and the two sequences combined (Modelcombined). Modelcombined showed better prediction performance than ModelT2 and ModelDWI. In Modelcombined, there was no significant difference between the LR and SVM algorithms (p = 0.4795), with AUCs in the test cohort of 0.867 and 0.900, respectively. CONCLUSIONS: Multiparametric MRI-based machine learning models have the potential to predict rectal adenoma with canceration. Compared with ModelT2 and ModelDWI, Modelcombined showed the best performance. Moreover, both LR and SVM have equal excellent performance for model construction.

Research progress on microRNAs connected with oral lichen planus / 口腔疾病防治

@#Oral lichen planus (OLP) is a common chronic inflammatory disease with unclear etiology, in which disorder of the cell-mediated local immune response plays an important role. MicroRNAs (miRNAs) have been found to play an important role in the occurrence and development of inflammatory responses and autoimmune diseases. In recent years, many studies have reported that miRNAs may be related to OLP. According to a literature review, high expression of miRNA-19a and low expression of miRNA-122, miRNA-199, miRNA-138, miRNA-635 and miRNA-578 may be related to the occurrence of OLP by regulating cytokines such as interleukin, interferon and tumor necrosis factor. The low expression of miRNA-125a and the high expression of miRNA-132, miRNA-146a and miRNA-155 may be related to the severity of OLP by influencing the differentiation of CD4+ T cells in the Th1/Th2 subgroup. High expression of miRNA-26a, miRNA-29a and miRNA-31 and low expression of miRNA-27b, miRNA-200a and miRNA-137 may be associated with malignant risk of OLP through functionally related genomes, transcription factors and miRNA coregulatory networks. Some deficiencies remain in current studies. For example, many studies using microarrays to screen differentially expressed miRNAs have not been further grouped according to the type of OLP or cancer risk.

Phenotypic Characteristics and Differentially Expressed Genes Enrichment Pathway of Inflammatory Cells in Gastritis With Cancerous Potential / 胃肠病学

Background: Gastric cancer, especially intestinal-type gastric cancer, is considered as the result of the process of non-atrophic gastritis-atrophic gastritis-dysplasia-carcinogenesis. Aims: To explore the phenotypic characteristics and differentially expressed genes (DEGs) enrichment pathway of inflammatory cells between gastritis that prone to canceration (atrophic gastritis) and gastritis that not prone to canceration (non-atrophic gastritis). Methods: The datasets of GSE2669, GSE83389, GSE106656 and GSE27411 were downloaded from GEO database. DEGs were screened by R language and verified by GSE116312 dataset. DEGs screened from 3 datasets of 'non-atrophic gastritis-atrophic gastritis' were overlapped with inflammatory cell phenotypic characteristic genes. REACTOME and KEGG analyses of DEGs were performed. Results: A variety of DEGs in the 'normal gastric mucosa-non-atrophic gastritis-atrophic gastritis' dynamic process were screened, and 5 common genes were verified by GSE116312 dataset. A total of 85 inflammatory cell phenotypic characteristic genes were screened from 3 datasets. The percentage of neutrophil was high during 'normal gastric mucosa-non-atrophic gastritis' process while the percentages of fibroblast and macrophage were high during 'non-atrophic gastritis-atrophic gastritis' process. REACTOME and KEGG analyses showed that DEGs of inflammatory cell phenotype during 'non-atrophic gastritis-atrophic gastritis' process were mainly enriched in IL-10, IL-4 and IL-13 signaling pathways and antigen presentation pathway. Conclusions: Macrophage, neutrophil and fibroblast are the inflammatory cell phenotypic characteristics of gastritis with cancerous potential, which enriched in IL and antigen presentation pathways.

Elevated peripheral inflammatory markers are related with the recurrence and canceration of vocal fold leukoplakia.

OBJECTIVE: To evaluate the predictive value of preoperative peripheral inflammatory markers in patients with vocal fold leukoplakia. METHODS: A retrospective study was performed of the patients diagnosed with vocal fold leukoplakia and who accepted carbon dioxide (CO2) laser resection in our center in the last 10 years. We calculated the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and monocyte-to-lymphocyte ratio (MLR) after collecting and analyzing the clinical, histopathological and laboratory data. The potential relation between blood indexes and clinical events as recurrence or canceration was evaluated. RESULTS: A total of 589 patients were involved, including 300 cases without recurrence (group A), 198 with recurrence but not canceration (group B) and 91 transformed into squamous cancer (group C). Baseline analysis of NLR, PLR, and MLR showed no difference among the three groups before the first surgery. But all the indexes significantly elevated in groups B (P < 0.001, < 0.001, 0.023, respectively) and C (P = 0.009, 0.004, 0.007, respectively) in the last operation. The receiver-operating curve (ROC) analysis showed NLR as a potential marker of canceration of leukoplakia (AUC = 0.837) and the cutoff value was 2.505. When regrouping with pathological outcomes, severe dysplasia and squamous cell carcinoma (SCC) groups both revealed a higher level of NLR, PLR, and MLR comparing to the no dysplasia, mild dysplasia, and moderate dysplasia groups. NLR, PLR, and MLR in high-risk group (moderate, severe dysplasia and carcinoma) also elevated comparing to low-risk group (no dysplasia, mild dysplasia) (P = 0.039, 0.011, 0.007, respectively). CONCLUSIONS: The peripheral inflammatory markers NLR, PLR, and MLR are closely connected with the development of vocal fold leukoplakia. NLR may be a potential marker to predict the poor outcomes (recurrence or canceration) of patients in first surgery.

Risk factors analysis of ulcerative colitis-associated colorectal cancer / 中华消化外科杂志

Objective To explore the risk factors of ulcerative colitis-associated colorectal cancer (UC-CRC).Methods The retrospective case-control study was conducted.The clinicopathological data of 536 patients with ulcerative colitis (UC) who were admitted to the Henan Tumor Hospital from March 2004 to June 2015 were collected.Observation indicators:(1) follow-up results:cases with follow-up,follow-up time,cases of UC-CRC,age of onset,pathological type of UC-CRC;(2) risk factors analysis affecting occurrence of UC-CRC:gender,age of onset,course of disease,severity of disease,disease classification,extent of lesion,smoking history,family history of colorectal cancer,anemia,hypoproteinemia,body weight loss,extraintestinal manifestations,colonic polyps,backwash ileitis,atypical hyperplasia,anxiety or depression,treatment method and regular endoscopy reexamination.Follow-up using outpatient examination and telephone interview was performed to detect prognosis of patients up to April 2017.Patients underwent colonoscopy once every 6 months within 3 years after diagnosis and once every 1 year after 3 years.Measurement data with skewed distribution were described as M (range).The univariate analysis was done using the chi-square test and Fisher exact probability.The multivariate analysis was done using the Logistic regression model.Results (1) Follow-up results:of 536 patients,450 were followed up for 26.0-120.0 months,with a median time of 76.4 months.During the follow-up,16 patients were complicated with UC-CRC,including 9 males and 7 females.Age of onset of colorectal cancer was 14-78 years,with an average age of onset of 44 years.Pathological type:high-differentiated right colon adenocarcinoma was detected in 5 patients,high-and moderate-differentiated left colon adenocarcinoma in 3 patients,left colon signetring cell carcinoma in 2 patients,moderate-differentiated rectal tubular adenocarcinoma in 3 patients,highdifferentiated rectal papillary adenocarcinoma in 2 patients and malignant lymphoma in 1 patient.(2) Risk factors analysis affecting occurrence of UC-CRC:the results of univariate analysis showed that course of disease,extent of lesion,colonic polyps and atypical hyperplasia were risk factors affecting occurrence of UC-CRC (x2 =14.848,18.885,10.554,P＜0.05).The results of multivariate analysis showed that course of disease ＞ 10 years,lesion involving the whole colon,colonic polyps and atypical hyperplasia were independent risk factors affecting occurrence of UC-CRC (OR=12.893,17.847,7.326,19.742,95％ confidence interval:1.726-74.337,1.445-89.793,1.263-43.128,3.625-96.524,P＜0.05).Conclusion The course of disease ＞ 10 years,lesion involving the whole colon,atypical hyperplasia and colonic polyps are independent risk factors affecting occurrence of UC-CRC.

Association of the recurrence and canceration rate of vocal leukoplakia with interleukin-10 promoter variants over a 2-year period.

Conclusion This study indicates that IL-10 promoter polymorphism variants, smoking, and alcohol consumption increase the risk of recurrence and canceration in vocal leukoplakia. Objective This prospective, clinical trial was performed to evaluate the association of interleukin (IL)-10 promoter polymorphism variants and canceration and recurrence rates in vocal leukoplakia (a pre-cancerous laryngeal carcinoma lesion) over a 2-year period. Participants and method Sixty-one post-operative patients with vocal leukoplakia were enrolled in this prospective, observational study and genotyped for the IL-10 promoter gene (IL-10-1082 A/G, -819 T/C and -592 A/C) using pyrosequencing, and responded to a 2-year follow-up survey. Recurrence and canceration rates were used to evaluate the association between the genotype variants and the clinical outcome. Results There was an increased canceration rate in the variant genotype group compared to that in the normal genotype group in the 2-year follow-up period (18.4% vs 0%, p-value = 0.038). Compared with the non-smoker group, the smoker group had a higher recurrence rate of vocal leukoplakia (29.3% vs 5%, p-value =0.044). Likewise, the recurrence rate in the alcohol consumption group was also higher (30.6% vs 8%, p-value =0.034). The percentage of cancerization in the alcohol consumption group was significantly higher than that in the non-alcohol consumption group (19.4% vs 0%, p-value =0.035).

Effect of PLCε gene silencing on inhibiting the cancerous transformation of ulcerative colitis.

The aim of the present study was to investigate the effect of phosphoinositide-specific phospholipase Cε (PLCε) gene silencing on the inhibition of cancer development in ulcerative colitis (UC) and to explore the pathogenesis and carcinogenic mechanism of UC, in order to facilitate the establishment of novel strategies for the treatment of UC, prevent the cancerous transformation of UC and discern the association between inflammation and cancer. A pGenesil-PLCε RNA interference vector was constructed and transfected into HEK293 cells (pGenesil-PLCε group). HEK293 cells transfected with pGenesil empty plasmid were set as the negative control (pGenesil-NC group). The expression of PLCε was observed, and molecules associated with the PLC signaling pathway were detected using a reverse transcription-quantitative polymerase chain reaction and western blotting. ELISA was used to determine the expression of serum interleukin-1 (IL-1) and tumor necrosis factor-α (TNF-α) of mice in which the PLCε gene had been silenced. Compared with the pGenesil-NC group, the mRNA and protein levels of PLCε were significantly decreased in the pGenesil-PLCε group. In addition, the mRNA levels of K-ras, NF-κB, Fas and Bcl-2 were markedly reduced, while P53 mRNA level was notably enhanced, in the pGenesil-PLCε group, and these changes were accompanied by similar changes in the corresponding protein levels. The serum IL-1 and TNF-α expression in the PLCε gene-silenced mice was significantly reduced compared with that in the control mice. In conclusion, PLCε RNA silencing can effectively inhibit the cancerous transformation of UC by regulating the colorectal cancer-related cell proliferation and cell cycle in vivo. In addition, PLCε RNA silencing can suppress the expression of inflammatory factors in vitro.

Value of contrast-enhanced ultrasound in the differential diagnosis between gallbladder adenoma and gallbladder adenoma canceration.

OBJECTIVES: To investigate the value of contrast-enhanced ultrasound (CEUS) in the differential diagnosis between gallbladder adenomas and gallbladder adenomas canceration. METHODS: CEUS data from 34 patients (25 patients with gallbladder adenomas and 9 patients with gallbladder adenomas canceration) were retrospectively analyzed, including the characteristics of contrast arrival time, time to peak enhancement, enhancement extend, enhancement morphology and the intactness of gallbladder wall below the lesions. RESULTS: On CEIS, the contrast arrival time and the time to peak enhancement were significantly shorter in patients with gallbladder adenomas than in patients with gallbladder adenomas canceration (12.63 ± 3.37 s vs. 18.11 ± 3.26 s, P < 0.001; 17.42 ± 3.69 s vs. 24.56 ± 4.36 s, P < 0.001). The time to iso-enhancement showed no significant difference between the two groups; while the time to hypo-enhancement was significantly shorter in patients with gallbladder adenomas canceration than in patients with gallbladder adenomas (55.56 ± 15.48 s vs. 84.71 ± 36.07 s, P = 0.027), and the enhancement time of the liver was significantly slower in patients with gallbladder adenomas canceration than in patients with gallbladder adenomas (22.78 ± 5.28 s vs. 16.63 ± 4.66 s, P = 0.004). Using receiver operating characteristic (ROC) analysis, the time to peak enhancement greater than 20 s had 89% sensitivity and 84% specificity for detecting patients with gallbladder adenomas canceration. The enhancement level showed no difference between the two groups. Inhomogeneous enhancement was found in 33% (3/9) gallbladder adenoma canceration and none (0/25) of gallbladder adenoma (P < 0.01). Destruction of gallbladder wall intactness was found in 66.7% (6/9) gallbladder adenoma canceration and none (0/25) of gallbladder adenoma (P < 0.01). CONCLUSION: CEUS is useful in differentiation between gallbladder adenoma and gallbladder adenoma canceration. The time to peak enhancement, the enhancement morphology and the intactness of gallbladder wall below the lesions are the diagnostic clues in differentiating diagnosis between gallbladder adenoma and gallbladder adenoma canceration.

Expression of Skp2 and P21 in the Process of Breast Hyperplasia Cancerating and its Significance / 医学研究杂志

Objective To investigate the expression and role of Skp2 and P21 in the process of breast hyperplasia cancerizing.Methods The expression of Skp2 and P21 protein in normal breast tissue,adenosis of breast,breast atypical hyperplasia,breast hyperplasia cancerization,and breast cancer were detected by immunohistochemical staining SP method.Results(1) The expression of Skp2 and P21 in normal breast tissue and adenosis of breast was negative,the positive staining rate of Skp2 and P21 in breast atypical hyperplasia was 25.71% and 37.14%,in breast hyperplasia cancerization 63.16% and 73.68%,breast cancer,75% and 100% respectively.The contradistinction between breast atypical hyperplasia and breast hyperplasia cancerization was of significant statistically.But there was no statistical significance between breast hyperplasia cancerization and breast cancer.(2) The expression of P21 could lead to accelerated expression of Skp2.(?2= 10.024,P=0.002).There was a significant positive correlation between Skp2 and P21(r=0.563,P=0.000).Conclusion Skp2 and P21 are involed in the early stage of breast cancer and contribute to the maligant phenotype without affecting infiltration.Both of them are danger factors for breast hyperplasia cancerizing and contribute to malignant process from normal breast tissue and atypical hyperplasia to breast cancer.They are effective indicators for prognosis of breast hyperplasia.

Determination and Significance of Telomerase Activation in Different Parts of Colorectal Canceration Adenoma / 医学研究杂志

Objective To explore relationship between telomerase and canceration of colorectal adenoma.Methods Telomerase activity was measured by hybridization-in-situ in 30 colorectal adenoma,30 normal colorectal mucosa ,30 colorectal adenoma canceration tissues and normal close adenoma.Results The expression of telomerase in colorectal adenoma canceration was 86.6%(strong positive 73.3%, weak positive 13.3%);60% in close adenoma tissues(strong positive 6.7%, weak positive 53.3%),10% in normal colorectal adenoma(strong positive 3.3%, weak positive6.7%),0% in normal colorectal mucosa.Conclusions Telomerase plays a critical role in colorectal adenoma canceration and is a internal factor.It is a sign of canceration tendency(not malignant transformation) in canceration.

Clinical analysis of 4 453 nodular goiter cases / 中国普通外科杂志

ObjectiveTo investigate the clinical characteristics of nodular goiter in Changchun area. Methods An retrospective analysis was made on 4 453 cases of nodular goiter proved by pathology in a period of 39 years. Results Surgery performed for nodular goiter accounted for 44.48% of all thyroid operations, with a rate of male to female of 1∶4.95. The male patients were significantly older than female. The correct diagnosis rate of nodular goiter was 71.95%, thyroid adenoma and thyroid cyst were common misdiagnosis. The right lobe was more subject to thyroid goiter than the left one, and canceration developed in 3.66% of all nodular goiter. Conclusions Changchun is an area of iodine deficiency. There are close relations between pregnancy, lactation, menses and the development of nodular goiter. Nodular thyroid goiter is subject to canceration.goit

Analysis of gastroscopic examination and follow－ up about 500 cases of precancerous diseases of stomach / 中华消化内镜杂志

Objectives To study the changes of precancerous lesions of stomach and their relationship with gastric cancer. Methods To collect and analyse the relevant data of 500 patients with precancerous which were diagnosed by gastroendoscopy and a follow－ up gastroscopic study was done for 5 to 10 years between 1988 and 1997. Results 1.Of the 156 cases of gastric ulcer, the efficacy of treatment was 84.6％ ; there were 4 cases of canceration, with a detecting rate of 2.6％ . 2.Of the 300 cases of chronic atrophic gastritis,98 (32.6％ )patients improved after treatment, 132(43.7％ ) patients showed no improvement, and 71(23.7％ ) patients deteriorated, among them there were 6(2％ ) cases of canceration, 3.Among the 44 cases of gastric polyps,2(4.5％ ) cases of multiple polyps were detected and canceration appared in both cases. Conclusion The result suggested that patients diagnosed pathologically of precancerous changes should be rendered with active clinical treatment, and there would be higher rate of being cured. But for various reasons, some patients might deteriorate and few might develop cancer. Therefore, long－ term gastroscopy follow－ up is inevitable.

Reoperation of congenital choledochal cyst: experience in 53 cases / 中国普通外科杂志

ObjectiveTo analyze the causes of and principles for reoperation of congenital choledochal cyst (CCC).MethodsDuring the period of 1986 to 2000, 120 cases of CCC were admitted to our unit,53 of them underwent reoperation. There were 33/14/2/4 cases respectively in Todani Type of Ⅰ/Ⅳa/Ⅳb and Ⅴ. First operation included simple external drainage in 17 cases, choledochoduodenostomy in 8 cases, and choledochojejunostomy with Roux en Y loop in 22 cases etc.ResultsPostoperative complications after external or internal drainage were cholangitis and hepatolithiasis, and high incidence of biliary carcinoma 19% (10/53). The mode of reoperation was mainly cyst excision with Roux Y hepaticojejunostomy (46/53).Conclusions Inappropriate surgical management of CCC incurred much complications that necessitated a reoperation. Cyst excision with reconstruction of the biliary tree by a Roux Y anastomosis is recommended as the therapy of choice for reoperation for patient with CCC.