Enhancing the Efficiency of a Radiation Oncology Department Using Electronic Medical Records: Protocol for Preparing Radiotherapy

BACKGROUND

Electronic medical records (EMRs) streamline medical processes, improve quality control, and facilitate data sharing among hospital departments. They also reduce maintenance costs and storage space needed for paper records, while saving time and providing structured data for future research.

OBJECTIVE

This study aimed to investigate whether the integration of the radiation oncology information system and the hospital information system enhances the efficiency of the department of radiation oncology.

METHODS

We held multidisciplinary discussions among physicians, physicists, medical radiation technologists, nurses, and engineers. We integrated paper records from the radiation oncology department into the existing hospital information system within the hospital. A new electronic interface was designed. A comparison was made between the time taken to retrieve information from either the paper records or the EMRs for radiation preparation. A total of 30 cases were randomly allocated in both the old paper-based system and the new EMR system. The time spent was calculated manually at every step during the process, and we performed an independent 1-tailed t test to evaluate the difference between the 2 systems.

RESULTS

Since the system was launched in August 2020, more than 1000 medical records have been entered into the system, and this figure continues to increase. The total time needed for the radiation preparation process was reduced from 286.8 minutes to 154.3 minutes (P<.001)-a reduction of 46.2%. There was no longer any need to arrange for a nurse to organize the radiotherapy paper records, saving a workload of 16 hours per month.

CONCLUSIONS

The implementation of the integrated EMR system has resulted in a significant reduction in the number of steps involved in radiotherapy preparation, as well as a decrease in the amount of time required for the process. The new EMR system has provided numerous benefits for the department, including a decrease in workload, a simplified workflow, and conserving more patient data within a confined space.

CircPTK2 inhibits the tumorigenesis and metastasis of gastric cancer by sponging miR-134-5p and activating CELF2/PTEN signaling

BACKGROUND

CircRNAs are a new subset of noncoding RNAs formed by covalent closed loops and play crucial roles in the regulation of cancer gene expression. However, the roles and underlying mechanisms of circRNAs in gastric cancer (GC) remain indistinct. This study aimed to explore the role and mechanism of hsa_circ_0006421 (circPTK2) in GC.

METHODS

The differential expression of circRNAs between GC tissues and adjacent normal tissues were identified by a circRNA expression profiling. Associations of circPTK2 or miR-134-5p expression with clinicopathological characteristics and prognosis of GC patients were analyzed by chi-square of Fisher's exact tests and Kaplan-Meier analysis. CCK8, colony formation, EdU assays and animal models were performed to assess the effects of circPTK2 on proliferation and invasion of GC cells. CircPTK2-specific probes were used to purify the RNA pulled down from the circPTK2, and enrichment of circPTK2 and miR-134-5p was detected by qRT-PCR. The effects of circPTK2 on miR-134-5p expression and CELF2/PTEN signaling were examined by qRT-PCR and Western blotting analysis.

RESULTS

Low expression of circPTK2 and high expression of miR-134-5p were related to the poor survival, and high expression of miR-134-5p was related to the tumor recurrence in GC patients. Overexpressing circPTK2 suppressed the proliferation, colony formation, DNA synthesis and cell invasion as well as xenograft tumor growth and lung metastasis in vitro and in vivo, whereas silencing circPTK2 had the opposite effects. Moreover, circPTK2 was negatively correlated and co-localized with miR-134-5p in the cytoplasm of GC tissue cells. circPTK2 bound to and sponged miR-134-5p in GC cells, and miR-134-5p facilitated cell growth and invasion but attenuated circPTK2 induced tumor suppressive effects and CELF2/PTEN signaling activation in GC cells.

CONCLUSIONS

circPTK2 functions as a tumor suppressor in GC by sponging miR-134-5p and activating the CELF2/PTEN axis.

CCR7 regulates ANO6 to promote migration of pancreatic ductal adenocarcinoma cells via the ERK signaling pathway

The increase in migratory ability of pancreatic ductal adenocarcinoma cells is a key event in the development of metastasis to the lymph nodes and distant organs. Although the C-C motif chemokine receptor 7 (CCR7) and its ligand, C-C motif chemokine ligand 21 (CCL21), have been revealed to serve an important role in tumor migration, their precise roles and potential underlying mechanisms remain largely unknown. The present study revealed that overexpression of CCR7 significantly promoted BxPC-3 cell migration, accompanied by the induction of anoctamin 6 (ANO6) expression, indicating that ANO6 is a downstream target of CCR7 signaling. Furthermore, the level of phosphorylated extracellular signal-regulated kinase (ERK) was significantly increased in CCR7-overexpressing BxPC-3 cells, indicating that ERK may be a potential mediator of CCR7-regulated ANO6 expression in BxPC-3 cells. To characterize the receptor-mediated pathway, a specific ERK inhibitor, U0126, was used, which reduced BxPC-3 cell migration and the expression of ANO6. In summary, the results of the present study demonstrate that CCR7 promoted BxPC-3 cell migration by regulating ANO6 expression perhaps via activation of the ERK signaling pathway.

Eriocalyxin B blocks human SW1116 colon cancer cell proliferation, migration, invasion, cell cycle progression and angiogenesis via the JAK2/STAT3 signaling pathway

Eriocalyxin B, a natural ent-kaurene diterpene compound, has been shown to prevent carcinogenesis and tumor development. However, little is known regarding the mechanism underlying the antitumor activity of Eriocalyxin B in human colon cancer. The aim of the present study was to examine the role of Eriocalyxin B in SW1116 cells, and to verify the hypothesis that the Janus kinase 2 (JAK2)/signal transducer and activator of transcription 3 (STAT3) signaling pathway may serve as a therapeutic target in human colon cancer treatment. Cell proliferation was measured with a Cell Counting kit‑8 assay, and the cell cycle was assessed by flow cytometry. Cell migration and invasion were measured by Transwell analysis. In addition, western blot analysis was performed to detect the protein expression levels in SW1116 cells treated with various concentrations of Eriocalyxin B. The results demonstrated that 1 µmol/l Eriocalyxin B was effective at inhibiting JAK2 and STAT3 phosphorylation, followed by the downregulation of JAK2 and STAT3 downstream target expression, which resulted in the inhibition of cell proliferation, migration, invasion and angiogenesis. Eriocalyxin B also suppressed the expression of proliferation‑associated protein (proliferating cell nuclear antigen) and angiogenesis‑associated proteins (vascular endothelial growth factor and vascular endothelial growth factor receptor 2), as well as that of migration- and invasion‑associated proteins (matrix metalloproteinase 2 and 9). These results suggested that Eriocalyxin B may suppress JAK2/STAT3 signaling, and thus act as a therapeutic or preventive agent in the treatment of human colon cancer.

Endogenous hydrogen sulfide is associated with angiotensin II type 1 receptor in a rat model of carbon tetrachloride-induced hepatic fibrosis

The present study aimed to investigate the effects of endogenous hydrogen sulfide (H₂S) on the expression levels of angiotensin II type 1 receptor (AGTR1) in a rat model of carbon tetrachloride (CCl₄)-induced hepatic fibrosis. A total of 56 Wistar rats were randomly divided into four groups: Normal control group, model group, sodium hydrosulfide (NaHS) group, and DL-propargylglycine (PAG) group. Hepatic fibrosis was induced by CCl₄. The rats in the PAG group were intraperitoneally injected with PAG, an inhibitor of cystathionine-γ-lyase (CSE). The rats in the NaHS group were intraperitoneally injected with NaHS. An equal volume of saline solution was intraperitoneally injected into both the control and model groups. All rats were sacrificed at week three or four following treatment. The serum levels of hyaluronidase (HA), laminin protein (LN), procollagen III (PcIII), and collagen IV (cIV) were detected using ELISA. The serum levels of alanine transaminase (ALT), aspartate transaminase (AST), and albumin (ALB) were detected using an automatic biochemical analyzer. The liver mRNA expression levels of CSE were detected by reverse transcription-quantitative polymerase chain reaction. The liver expression levels of AGTR1 and the plasma expression levels of H₂S were detected using western blot analyses. The results indicated that the severity of hepatic fibrosis, the serum expression levels of HA, LN, PcIII, cIV, ALT, and AST, the liver expression levels of CSE and AGTR1, and the plasma expression levels of H₂S were significantly higher in the PAG group, as compared with the model group (P<0.05). Conversely, the expression levels of ALB were significantly lower in the PAG group, as compared with the model group. In addition, the severity of hepatic fibrosis, the serum expression levels of HA, LN, PcIII, cIV, ALT, and AST, the liver expression levels of CSE and AGTR1, and the plasma expression levels of H₂S were significantly lower in the NaHS group, as compared with the model group (P<0.05). These results suggest that endogenous H₂S is associated with CCl₄-induced hepatic fibrosis in rats, and may exhibit anti-fibrotic effects. Furthermore, H₂S reduced the liver expression levels of AGTR1, which may be associated with the delayed progression of hepatic fibrosis.

Temporary placement of a paclitaxel or rapamycin-eluting stent is effective to reduce stenting induced inflammatory reaction and scaring in benign cardia stricture models

BACKGROUND/AIMS

To investigate whether temporary placement of a paclitaxel or rapamycin eluting stent is more effective to reduce stenting induced inflammatory reaction and scaring than a bared stent in benign cardia stricture models.

MATERIALS AND METHODS

Eighty dog models of stricture were randomly divided into a control group (CG, n=20, no stent insertion), a bare stent group (BSG, n=20), a paclitaxel eluting (Pacl-ESG, n=20) and a rapamycin eluting stent group (Rapa-ESG, n=20), with one-week stent retention. Lower-oesophageal-sphincter pressure (LOSP), 5-minute barium height (5-mBH) and cardia diameter were assessed before, immediately after the procedure, and regularly for 6 months. Five dogs in each group were euthanized for histological examination at each follow-up assessment.

RESULTS

Stent insertion was well tolerated, with similar migration rates in three groups. At 6 months, LOSP and 5-mBH improved in Pacl-ESG and Rapa-ESG compared to BSG (p<0.05), with no difference between Pacl-ESG and Rapa-ESG (p>0.05). Cardia kept more patency in the Pacl-ESG and Rapa-ESG than in BSG (p<0.05). Reduced peak inflammatory reactions and scarring occurred in the Pacl-ESG and Rapa-ESG compared to BSG (p<0.05), with a similar outcome in the Pacl-ESG and Rapa-ESG (p>0.05).

CONCLUSION

Paclitaxel or rapamycin-eluting stents insertion led to better outcomes than bare stents in benign cardia stricture models.

Clinical significance of hmgb1 expression in human gastric cancer

High mobility group box 1 (HMGB1) has been proved to be implicated in a variety of cell physiological and pathological behaviors including immune response, inflammation and cancer. Accumulating evidence suggests that HMGB1 plays a critical role in the development and progression of multiple malignancies. However, the clinical significance and prognosis of HMGB1 expression in some cancers remain controversial. The present study aimed to investigate whether overexpression of HMGB1 is an independent prognostic factor in patients with gastric cancer. The correlation of HMGB1 expression with clinicopathologic characteristics and prognosis was assessed by immunohistochemical assay through tissue microarray procedure in 50 primary gastric cancer cases. Our results indicated that the positive expression of HMGB1 was significantly increased in the nucleus of gastric cancer tissues compared with the adjacent non-cancerous tissues (ANCT) (64.0&#x0025; vs 44.0&#x0025;, P=0.025), but was not linked to the clinicopathologic features, including the TNM stage (P=0.533) and metastatic lymph node (P=0.771), in patients with gastric cancer. Kapalan-Meier and log-rank analysis demonstrated that overexpression of HMGB1 did not exert significant impact on the overall survival of patients with gastric cancer (P=0.805). Furthermore, Cox regression analysis showed that high HMGB1 protein expression did not represent an independent risk factor for patients with gastric cancer (P=0.677). Taken together, our findings suggest that high expression of HMGB1 is not correlated with the clinicopathologic characteristics of gastric cancer, and cannot serve as an independent prognostic biomarker for patients with gastric cancer.

Prediction of synchronous colorectal cancers by computed tomography in subjects receiving an incomplete colonoscopy: A single-center study

AIM: To assess the value of computed tomography (CT) for diagnosis of synchronous colorectal cancers (SCRCs) involving incomplete colonoscopy.

METHODS: A total of 2123 cases of colorectal cancer (CRC) were reviewed and divided into two groups according to whether a complete or incomplete colonoscopy was performed. CT results and final histological findings were compared to calculate the sensitivity and specificity associated with CT for detection of SCRCs following complete vs incomplete colonoscopy. Factors affecting the CT detection were also analyzed.

RESULTS: Three hundred and seventy-four CRC patients underwent incomplete colonoscopy and 1749 received complete colonoscopy. Fifty-six cases of SCRCs were identified by CT, and 36 were missed. In the incomplete colonoscopy group, the sensitivity and specificity of CT were 44.8% and 93.6%, respectively. The positive and negative predictive values were 23.6% and 95.0%, respectively. In contrast, the sensitivity and specificity of CT for the complete colonoscopy group were 68.3% and 97.0%, while the positive and negative predictive values were 22.2% and 98.7%, respectively. In both groups, the mean maximum dimension of the concurrent cancers identified in the CT-negative cases was shorter than in the CT-positive cases (incomplete group: P = 0.02; complete group: P < 0.01) Topographical proximity to synchronous cancers was identified as a risk factor for missed diagnosis (P = 0.03).

CONCLUSION: CT has limited sensitivity in detecting SCRCs in patients receiving incomplete colonoscopy. Patients with risk factors and negative CT results should be closely examined and monitored.

Inhibition of phosphoinositide 3-kinase/Akt pathway decreases hypoxia inducible factor-1α expression and increases therapeutic efficacy of paclitaxel in human hypoxic gastric cancer cells

The phosphatidylinositol-3-kinase (PI3K)/Akt signaling pathway plays an important role in cell proliferation, transformation, apoptosis, tumor growth and angiogenesis. Paclitaxel is commonly used to treat multiple human malignancies; however, the underlying mechanisms of paclitaxel in gastric cancer (GC) have not been fully investigated. In the present study, specimens from 45 GC and 36 chronic gastritis patients were collected, and the correlations of PI3K, phosphorylated-Akt (p-Akt) and hypoxia-inducible factor-1α (HIF-1α) expression with the clinicopathological characteristics of GC were analyzed by immunohistochemistry. The human SGC-7901 GC cells under hypoxic conditions were pretreated with the PI3K inhibitor, LY294002 (40 μM), and paclitaxel (0.1 μM). The expression levels of PI3K, p-Akt and HIF-1α were detected by quantitative polymerase chain reaction and western blotting. Cell proliferative activity and apoptosis were evaluated by the Cell Counting Kit-8 assay and flow cytometry. As a result, the rates of positive expression of PI3K, p-Akt and HIF-1α were significantly higher in GC compared with chronic gastritis patients (each P<0.01), and were positively associated with the tumor-node-metastasis (TNM) staging, lymph node metastases, lymphatic infiltration and vascular infiltration (each P<0.01), but inversely correlated with tumor differentiation (P<0.01) in patients with GC. Under hypoxic conditions, the combined inhibition of the PI3K/Akt pathway with paclitaxel markedly reduced the proliferative activity and induced cell apoptosis in GC cells compared with the single treatment of PI3K inhibitor or paclitaxel (each P<0.01), and was accompanied by a decreased expression of HIF-1α. Overall, our findings indicate that the increased expression of the PI3K/Akt/HIF-1α pathway was closely correlated with tumor differentiation, TNM staging, lymph node metastases and lymphatic and vascular infiltration. The inhibition of the PI3K/Akt pathway enhanced the therapeutic efficacy of paclitaxel in GC cells under hypoxic conditions, suggesting that the PI3K/Akt/HIF-1α pathway may act as an important therapeutic target for paclitaxel treatment of GC.

Biodegradable rapamycin-eluting nano-fiber membrane-covered metal stent placement to reduce fibroblast proliferation in experimental stricture in a canine model

BACKGROUND AND STUDY AIMS

The aim of the current study was to assess whether placement of the biodegradable rapamycin-eluting nano-fiber membrane-covered metal stent is followed by less fibroblast proliferation and tissue hyperplasia compared with bare stents in experimental stricture in a dog model.

METHODS

A total of 80 dog models of stricture were randomly divided into a control group (n = 20, no stent insertion), a bare stent group (BSG, n = 20, 1-week retention), and two drug-eluting stent sub-groups (DESG-1w, n = 20, 1-week retention; DESG-4w, n = 20, 4-week retention). Lower esophageal sphincter (LES) pressure, 5-minute barium height (5-mBH), and cardia diameter were assessed before, immediately after the procedure, and regularly thereafter for 6 months. Five dogs in each group were euthanized for histological examination at each follow-up assessment.

RESULTS

Stent insertion was well tolerated, with similar migration rates (0 % in BSG vs. 7.5 % in DESGs; P = 0.5441). At 6 months, LES pressure and 5-mBH improved in DESG-1w (26.70 ± 5.02 mmHg and 6.50 ± 2.98 cm) and DESG-4w (20.16 ± 5.50 mmHg and 1.54 ± 0.98 cm) compared with BSG (39.94 ± 5.22 mmHg and 11.1 ± 5.46 cm) (P < 0.05), with DESG-4w being more stable than DESG-1w (P < 0.05). The cardia maintained greater patency in the DESGs (7.10 ± 3.09 mm in DESG-1w; 9.16 ± 3.77 mm in DESG-4w) than in the BSG (1.86 ± 2.45 mm; P < 0.05). Reduced peak inflammatory reactions and scarring occurred in DESGs compared with the BSG (P < 0.05), with a better outcome in DESG-4w than in DESG-1w (P < 0.05).

CONCLUSIONS

In this experimental stricture model, rapamycin-eluting stents were more effective than bare stents for the reduction of fibroblast proliferation and tissue hyperplasia after stent placement. Furthermore, 4-week retention of the drug-eluting stent led to a better outcome than 1-week retention.

Application of the newly developed stents in the treatment of benign cardia stricture: an experimental comparative study

BACKGROUND

Retrievable temporary stent placement has recently been suggested as a potential treatment for benign esophageal stricture.

OBJECTIVE

To assess the efficacy of a newly designed cardia stent for the treatment of benign cardia stricture in a canine model compared with groups that received pneumatic dilation or standard esophageal stent insertion.

DESIGN

Basic experimental study.

SETTING

GI interventional center.

PATIENTS

Forty-eight dog models were randomly divided into a control group (no stent insertion) (n=12), a pneumatic dilation group (PDG) (n=12), a standard esophageal stent group (SESG) (n=12), and a novel cardia stent group (NCSG) (n=12).

INTERVENTIONS

Pneumatic dilation, standard esophagus stent, cardia stent.

MAIN OUTCOME MEASUREMENTS

Lower esophageal sphincter pressures and the 5-minute barium height were assessed before and immediately after the procedure, after 1 week, and at 1-, 3-, and 6-month follow-up. Three dogs in each group were killed for histological examination.

RESULTS

Stent insertion was tolerated by all dogs, with a lower migration rate in the NCSG (0% vs 41.7% in the SESG; P=.0373). At the 6-month follow-up, the lower esophageal sphincter pressure and 5-minute barium height values in the NCSG were still stable compared with those in the PDG and SESG (P<.05). Immunohistochemistry for mouse anti-proliferating cell nuclear antigen and α-smooth muscle actin revealed a stronger inflammatory reaction peak in the PDG than in the SESG and NCSG (P<.05). Collagen proliferation was most severe after 6 months in the PDG (P<.05).

LIMITATIONS

Longer follow-up studies are required to assess whether the recurrence rate is lower because of less inflammation and scarring.

CONCLUSIONS

The novel cardia stent was more effective than pneumatic dilation or a standard stent in this canine model.

Temporary self-expanding metallic stents for achalasia: A prospective study with a long-term follow-up

AIM: To compare the efficacy of self-expanding metallic stents (SEMSs) for the long-term clinical treatment of achalasia.

METHODS: Ninety achalasic patients were treated with a temporary SEMS with a diameter of 20 mm (n = 30, group A), 25 mm (n = 30, group B) or 30 mm (n = 30, group C). Data on clinical symptoms, complications and treatment outcomes were collected, and follow-up was made at 6 mo and at 1, 3-5, 5-8, 8-10 and > 10 years, postoperatively.

RESULTS: Stent placement was successful in all patients. Although chest pain occurrence was high, stent migration was less in group C than in groups A and B. The clinical remission rate at 5-8, 8-10 and > 10 years in group C was higher than that in the other two groups. The treatment failure rate was lower in group C (13%) than in groups A (53%) and B (27%). SEMSs in group C resulted in reduced dysphagia scores and lowered esophageal sphincter pressures, as well as normal levels of barium height and width during all the follow-up time periods. Conversely, these parameters increased over time in groups A and B. The primary patency in group C was longer than in groups A and B.

CONCLUSION: A temporary SEMS with a diameter of 30 mm is associated with a superior long-term clinical efficacy in the treatment of achalasia compared with a SEMS with a diameter of 20 mm or 25 mm.

Long-term safety and outcome of a temporary self-expanding metallic stent for achalasia: a prospective study with a 13-year single-center experience

To prospectively evaluate the long-term clinical safety and efficacy of a newly designed self-expanding metallic stent (SEMS) in the treatment of patients with achalasia. Seventy-five patients with achalasia were treated with a temporary SEMS with a 30-mm diameter. The SEMSs were placed under fluoroscopic guidance and removed by gastroscopy 4–5 days after stent placement. Follow-up data focused on dysphagia score, technique and clinical success, clinical remissions and failures, and complications and was performed at 6 months, 1 year, and within 3 to 5 years, 5 to 8 years, 8 to 10 years, and >10 years postoperatively. Stent placement was technically successful in all patients. Complications included stent migration (n = 4, 5.33%), chest pain (n = 28, 38.7%), reflux (n = 15, 20%), and bleeding (n = 9, 12%). No perforation or 30-day mortality occurred. Clinical success was achieved in all patients 1 month after stent removal. The overall remission rates at 6 months, 1, 1–3, 3–5, 5–8, 8–10, and >10 year follow-up periods were 100%, 96%, 93.9%, 90.9%, 100%, 100%, and 83.3%, respectively. Stent treatment failed in six patients, and the overall remission rate in our series was 92%. The median and mean primary patencies were 2.8 ± 0.28 years (95% CI: 2.25–3.35) and 4.28 ± 0.40 years (95% CI: 3.51–5.05), respectively. The use of temporary SEMSs with 30-mm diameter proved to be a safe and effective approach for managing achalasia with a long-term satisfactory clinical remission rate.

Management of acute malignant colorectal obstruction with a novel self-expanding metallic stent as a bridge to surgery

PURPOSE

To prospectively evaluate the safety and clinical efficacy of a newly designed self-expandable metallic stent (SEMS) in the treatment of patients with acute malignant colorectal obstruction.

METHODS

Between April 2001 and October 2007, 52 patients with acute malignant colorectal obstruction were treated with a new designed SEMS as an investigational bridge to surgery. Patients were prospectively followed and relevant data collection was collected, including details regarding technique, clinical symptoms, complications, need for elective surgery, and overall survival.

RESULTS

Stent placement was technically successful in all but two patients (due to complete obstruction) with no procedure-related complications. Complications included stent migration (n=4), anal pain (n=2) and stool impaction (n=1). Clinical success was achieved in 49 (98%) of 50 patients with resolution of bowel obstruction within 2 days of stent placement. In one patient with stool impaction 2 days after stent placement, endoscopic disimpaction was successfully performed. An elective one-stage surgical procedure was performed in all 50 patients who successfully received a SEMS as a bridge to surgery within a mean of 8+/-2 days (range: 4-11 days) after stent placement. Mean follow-up time was 36+/-12 months (range 3-70 months), and all patients remained alive at the time of this report.

CONCLUSION

The newly designed SEMS placement as a bridge to surgery was a safe and effective intervention for colonic decompression in patients with acute malignant colorectal obstruction and allowed a high proportion of patients to be successfully proceeded to elective surgery.

Treatment of peritoneal chemotherapy in combination with tocetaxel and cisplatin for advanced gastric cancer: an analysis of 45 cases

AIM: To investigate the therapeutic efficacy of peritoneal chemotherapy in combination with tocetaxel and cisplatin for advanced gastric cancer.

METHODS: Forty-five cases of advanced gastric cancer were treated with tocetaxel in combination with cisplatin by peritoneal chemotherapy. The tumor size, blood routine examination, hepatic and renal function were compared before and after peritoneal chemotherapy. The side effects were observed. All patients were followed-up and their survival time was recorded.

RESULTS: The tumor sizes of gastric cancer were decreased dramatically (72.4 ± 22.4 cm³vs 7.23 ± 2.4 cm³, t = 2.946, P < 0.01). The average survival time was 14.0 ± 1.4 months, and the short-term therapeutic efficacy was 59%. The peritoneal chemotherapy affected some indexes in blood routine examination, hepatic and renal function. The main side effects included hair loss, stomatitis, constipation and blood urine.

CONCLUSION: Peritoneal chemotherapy in combination with tocetaxel and cisplatin reduces the tumor size effectively, prolongs the survival period, and alleviates the tumor ascites in patients with advanced gastric cancer. It's convenient and safe for advanced gastric cancer treatment.

Alteration of T helper cells in rats with non-alcoholic fatty liver disease

AIM: To detect tumor necrosis factor-alpha (TNF-α), interferon-gamma (IFN-γ), interleukin-4 (IL-4) and forkhead/winged helix transcription factor p3 (Foxp3) gene expression of fatty liver rats under high fat diet and to explore the role of Th1/Th2 balance and Treg in non-alcoholic fatty liver disease (NAFLD).

METHODS: Sprague-Dawley rats, after one-week normal diet, were randomly divided into two groups: the normal group (treated with normal diet, n = 20) and the high fat diet group (treated with high fat diet, n = 20). The rats were all killed at the eighth and sixteenth week, respectively. TNF-a, IFN-γ, IL-4 and Foxp3 gene expression were detected using real time PCR and pathological changes in liver tissues were recorded.

RESULTS: After high fat diet for 8 weeks, liver became remarkably steatotic, but without significant inflammatory changes. IFN-γ mRNA and IL-4 mRNA had no significant change compared with the normal group, and TNF-α mRNA increased slightly but without statistical significance. The ct value of Foxp3 mRNA was significantly higher than normal (26.12 ± 0.69 vs 24.22 ± 0.62, P < 0.05). After high fat diet for 16 weeks, severe fatty liver, inflammatory cell infiltration and hepatocyte necrosis were observed in high fat diet rats. Both of IFN-γ mRNA and TNF-α mRNA were increased significantly (ct value: 24.52 ± 0.87 vs 29.94 ± 1.44, 24.31 ± 1.13 vs 28.88 ± 1.95, both P < 0.05). IL-4 mRNA was not significantly different from the normal group. Foxp3 mRNA was decreased significantly compared with both normal group and high fat diet group at wk 8 (ct value: 32.57 ± 1.54 vs 24.29 ± 1.08, 26.12 ± 0.69, both P < 0.05).

CONCLUSION: Decreased expression of Foxp3 mRNA and Treg in rat livers may play a key role in development of NAFLD. The combined effect of IFN-γ and TNF-α aggravates liver inflammatory injury.

In vitro effect of N-desulfated heparin on the expression of basic fibroblast growth factor in gastric carcinoma cell line SGC-7901

AIM: To investigate the effect of N-desulfated heparin on the expression of basic fibroblast growth factor (bFGF) in human gastric carcinoma SGC-7901 cells in vitro.

METHODS: Human gastric carcinoma cell line SGC-7901 was cultured in vitro, and then treated with N-desulfated heparin at different concentrations (0.1, 1.0 g/L). Meanwhile, SGC-7901 cells cultured in single RPMI 1640 medium were used as controls. Each group contained 3 paralleled samples. Enzyme-linked immunosorbent assay (ELISA) and real time polymerase chain reaction (PCR) were used to detect the expression of bFGF in SGC-7901 cells at 12 h and 24 h, respectively.

RESULTS: After treatment with 0.1 or 1.0 g/L N-desulfated heparin for 12 or 24 h, bFGF protein expression was decreased significantly (t = 7.502, P = 0.002; t = 55.416, P = 0.000; t = 52.221, P = 0.000; t = 48.080, P = 0.000). The expression of bFGF (CT value) in each N-desulfated heparin group was higher than that in the control group at the same time. The inhibition of N-desulfated heparin on bFGF protein and mRNA expression in SGC-7901 cells was dose- and time-dependent.

CONCLUSION: N-desulfated heparin can inhibit the expression of bFGF in gastric cancer cell line SGC-7901 in a dose- and time-dependent manner in vitro.

Fatty acids metabolic profile in high fat diet-induced non-alcoholic fatty liver disease in rats

AIM: To analyze fatty acid metabolic profile changes of fatty livers induced by a high fat diet and to determine it's role in non-alcoholic steatohepatitis (NASH).

METHODS: Sprague-Dawley rats were randomly divided into two groups: the control group (treated with normal diet, n = 7) and the model group (treated with high fat diet, n = 7). The rats were all killed at wk 16 to detect pathological changes in liver tissues. The metabolic profile changes of fatty acid in NASH and normal liver tissue samples were detected by ECF derivatization for GC/MS technology. Data were analyzed using SPSS 11.0 software package.

RESULTS: After a high fat diet for 16 wk, severe fatty livers (+++) were present in the high fat diet group with remarkable inflammation. A significant morphological difference was detected between the two groups. Total ion current (TIC) and principal component analysis (PCA) indicated that there were significantly different metabolic patterns in liver tissues between the two groups. Compared with the control group, all fatty acids were raised significantly except a 56% decrease in dodecanoic acid (P < 0.05). Octadecanoic acid, tetradecanoic acid, hexadecanoic acid, eicosanoic acid, 9-octadecenoic acid, 9, 12, 15-octadecatrienoic acid, 5, 8, 11, 14-eicosatetraenoic acid and 9, 12-octadecadienoic acid were raised 5.42, 4.10, 11.56, 5.86, 1.82 and 8.00, 2.44-folds, respectively. Moreover, ω-6/ω-3 polyunsaturated fatty acids (PUFAs) ratio was raised.

CONCLUSION: Our results suggest that there are significant fatty acids metabolic profile changes in NASH. Excessive fatty acids accumulation in hepatic cells, ω-6/ω-3 ratio imbalance and dudecanoic acid decrease may pay a crucial role in steatohepatitis and hepatic injury.

Long-term effects of achalasia on esophageal motility following temporary internal metal stent dilation

AIM: To explore the long term effects of achalasia on esophageal motility following temporary internal metal stent dilation.

METHODS: Nineteen patients with achalasia had temporary internal metal stents (20-25 mm diameter) placed under X-ray guidance. After stent dilation over 3-7 d, the stents were removed by endoscopy. We measured lower esophageal sphincter (LES) pressure, LES relaxation rate, and 24-hours pH in the 19 patients and 12 healthy control subjects (HS).

RESULTS: LES residual pressure before stent dilation was markedly higher than at 2 wk and 2 years after stent dilation (47.43 ± 9.84 mmHg vs 12.32 ± 5.87 mmHg, and 14.21 ± 7.34 mmHg; P < 0.05). LES relaxation rate was significantly different before stent dilation that at 2 wk and 2 years after (13.33% vs 76.66%, and 73.46%, P < 0.05). The frequency of gastroesophageal reflux (GER) at 2 years after stent dilation was markedly higher than before and two wk and before stent dilation (66.12% vs 27.72%, 2.95%, P < 0.01); residual pressure and relax rate showed no significant difference between HS and after stent dilation of 2 wk and 2 years.

CONCLUSION: Temporary internal metal stent dilation results in lower LES pressure and a higher rate of GER for patients with achalasia in the long term.

Effects of Helicobacter pylori infection and its eradication on IL-18 level in chronic erosive gastritis patients

AIM: To explore the effects of Helicobacter pylori infection and its eradication on Interleukin-18 (IL-18) level in patients with chronic erosive gastritis, and to detect levels of H. pylori IgG antibody before and after eradication.

METHODS: Sixty patients with chronic gastritis were randomly divided into two groups: chronic erosive gastritis (40 cases, group A) and chronic superficial gastritis (20 cases, group B). Group A patients who were H. pylori-positive received triple therapy [20 mg omeprazole (Losec) plus 500 mg clarithromycin and 1000 mg amoxicilin, twice daily) for 1 week; while those positive for H. pylori in group B were treated orally with only 20 mg omeprazole once daily until the end of week 4. Gastric endoscopy and 13C breath testing were performed 1 mo after anti-H. pylori therapy. CagA-IgG, VacA-IgG, Uresses-IgG and H. pylori IgG antibody, IL-18 were detected by Western blotting and ELISA, respectively.

RESULTS: The levels of IL-18 were significantly different between groups A and B (267.18 ± 148.23 ng/L, and 119.31 ± 45.34 ng/L, P < 0.05) in H. pylori-positive patients. H. pylori IgG level was not related to the presence of erosion; with no significant difference between H. pylori negative patients in groups A and group B. The levels of IL-18 and IgG antibody decreased after anti-H. pylori therapy compared with those before therapy (267.18 ± 148.23 ng/L vs 93.82 ± 22.15 ng/L; 31.36 ± 23.26 kU/L vs 21.00 ± 9.47 kU/L; respectively, P < 0.05), IL-18 level showed no difference among different types of H. pylori infection and erosion scores.

CONCLUSION: The decrease in IL-18 level after H. pylori eradication may play a crucial role in the treatment of patients with chronic erosive gastritis.

Correlations of serum nitric oxide, interleukin-6, interleukin-10 and tumor necrosis factor levels with the prognosis of patients with liver cirrhosis

AIM: To study the roles of serum nitric oxide (NO), interleukin-6 (IL-6), interleukin-10 (IL-10) and tumor necrosis factor (TNF) in the prognosis of patients with liver cirrhosis.

METHODS: Nitrate reductase assay and double-antibody sandwich enzyme-linked immunosorbent assay were used to examine the serum levels of NO, IL-6, IL-10 and TNF in 56 patients with liver cirrhosis before and after treatment, and 30 healthy individuals served as controls.

RESULTS: High levels of NO, IL-6, and TNF and low level of IL-10 were observed in patients with cirrhosis. After treatment, the serum levels of NO (129.21 ± 27.32 mmol/L vs 92.18 ± 25.68 mmol/L, P < 0.05), IL-6 (198.5 ± 23.2 mg/L vs 147.0 ± 19.1 mg/L, P < 0.05), and TNF (179.2 ± 23.5 pg/dL vs 121.4 ± 17.5 pg/dL, P < 0.05) were significantly elevated while the level of IL-10 (33.4 ± 7.2 mg/L vs 51.6 ± 18.5 mg/L, P < 0.05) was markedly decreased in patients with aggravated hepatic function as compared with those before therapy. However, the levels of NO (58.63 ± 12.25 mmol/L vs 94.36 ± 23.45 mmol/L, P < 0.05), IL-6 (90.3 ± 12.7 mg/L vs 148.5 ± 15.8 mg/L, P < 0.05) and TNF (78.2 ± 14.3 pg/dL vs 124.9 ± 20.1 pg/dL, P < 0.05) were decreased while the level of IL-10 (89.3 ± 18.9 mg/L vs 48.8 ± 9.5 mg/L, P < 0.05) was elevated in patients with improved hepatic function after treatment in comparison with those before treatment.

CONCLUSION: The serum levels of NO, IL-6, IL-10 and TNF are correlated with the prognosis of patients with liver cirrhosis.

Effect of H2-receptor blocker combined with domperidone on the blood flow of portal venous system in patients with liver cirrhosis

AIM: To explore the effect of H2-receptor blocker combined with domperidone on the blood flow of portal venous system in patients with liver cirrhosis.

METHODS: A total of 60 patients with liver cirrhosis were randomly and averagely divided into group A, B, and C, treated with H2-receptor blocker, domperidone, and their combination, respectively. Twenty healthy subjects served as normal controls. Portal venous flow (PVF, mL/min), splenic venous flow (SVF, mL/min) and superior mesenteric venous flow (SMVF, mL/min) were determined using Doppler ultrasonography before and after treatment.

RESULTS: After treatment, PVF was significantly higher than that before treatment (850.23 ± 140.78 vs 695.22 ± 221.44, P < 0.01), while SVF and SMVF were lower (both P > 0.05) in group A. PVF was increased as compared with that before treatment in group B, but there was no significant difference (P > 0.05). However, SVF and SMVF were markedly decreased as compared with those before treatment in group B (SVF: 598.13 ± 272.33 vs 816.40 ± 279.61, P < 0.05; SMVF: 504.23 ± 188.54 vs 640.30 ± 200.12, P < 0.05). PVF was remarkably higher than that before treatment (876.76 ± 178.65 vs 705.34 ± 200.15, P < 0.05), while SVF and SMVF were lower (SVF: 605.33 ± 252.86 vs 798.33 ± 280.45, P < 0.01; SMVF: 503.43 ± 175.25 vs 650.19 ± 190.62, P < 0.01) in group C.

CONCLUSION: H2-receptor blocker and domperidone can improve the blood flow of portal venous system, and their combination is more effective.

Effect of 2-(8-hydroxy-6-methoxy-1-oxo-1H-2-benzopyran-3-yl) propionic acid in combination with carboplatin on gastric carcinoma growth in vivo

AIM: To investigate the effects of 2-(8-hydroxy-6-methoxy-1-oxo-1H-2-benzopyran-3-yl) propionic acid (NM-3) alone and in combination with carboplatin on tumor growth and apoptosis in mouse models of human gastric cancer constructed by subcutaneous implantation of histologically intact tumor tissue.

METHODS: Human gastric cancer SGC-7901 tissues were implanted into the dorsal subcutis of nude mice. One week after tumors reached to a volume of 50-100 mm³ for around 1 wk, these mice were randomly divided into 8 groups (n = 10). NM-3 was injected peritoneally at the dose of 10 mg/kg, 20 mg/kg or 40 mg/kg every other day for 5 wk, combined with carboplatin (5 mg/kg) every third day for 4 wk. As controls of combined treatment, another 4 groups of mice were injected with either NM-3 at 10 mg/kg, 20 mg/kg or 40 mg/kg, or with carboplatin alone (5 mg/kg). The control mice received normal saline. Tumor weight, tumor growth inhibition (TGI), and intratumoral microvessel density (MVD) were evaluated. Apoptosis of human gastric cancer was detected by TUNEL method and flow cytometry analysis, respectively.

RESULTS: The mean tumor volume (692.40 ± 58.43 mm³, 548.30 ± 66.02 mm³, 382.13 ± 43.52 mm³) after treatment with carboplatin combined NM-3 at the dose of 10 mg/kg, 20 mg/kg or 40 mg/kg was lower than that after treatment with either NM-3 at the dose of 10 mg/kg, 20 mg/kg or 40 mg/kg or with carboplatin alone. Compared with the normal saline group, NM-3 administered at 10 mg/kg, 20 mg/kg or 40 mg/kg significantly reduced the tumor weight in these groups (P < 0.05). Carboplatin used alone at 5 mg/kg showed minimal effects. But NM-3 in combination with carboplatin had greater effects of tumor weight than either NM-3 or carboplatin alone. NM-3 alone at the dose 10 mg/kg or in combination with carboplatin had no obvious effects on body changes. Two mice died of diarrhea in each of the two groups treated with 40 mg/kg NM-3 or with 40 mg/kg NM-3 in combination with carboplatin. A significant increase in apoptosis was observed in the NM-3 treated groups, and the effect was more significant in the groups treated with carboplatin in combination with NM-3 at 10 mg/kg, 20 mg/kg and 40 mg/kg, than in the control group. The induction of apoptosis was positively associated with the dose of NM-3. NM-3 significantly reduced the neo-microvascular formation of gastric cancer. The MVD was lower in the groups treated with NM-3 or with NM-3 in combination with carboplatin than in the group treated with carboplatin or in the normal saline group (P < 0.05).

CONCLUSION: The results suggest that the inhibitory effect of NM-3 on gastric cancer growth is mediated through decreased angiogenesis and the increased induction of apoptosis. Furthermore, NM-3 alone at the dose of 10 mg/kg or in combination with carboplatin has no obvious effects on body changes, indicating that NM-3 in combination with carboplatin may be effective in the treatment of gastric cancer. The toxicity of NM-3 needs further studies.

Effect of non-anticoagulant N-desulfated heparin on expression of vascular endothelial growth factor, angiogenesis and metastasis of orthotopic implantation of human gastric carcinoma

AIM: To investigate the effect of N-desulfated heparin on tumor metastasis and angiogenesis, and expression of vascular endothelial growth factor (VEGF) of orthotopic implantation of human gastric carcinoma in male severe combined immune deficiency (SCID) mice.

METHODS: Human gastric cancer SGC-7901 cells were orthotopically implanted into the stomach of SCID mice. The mice were randomly divided into normal saline group and N-desulfated heparin group. One week after operation, the mice in N-desulfated heparin group received i.v. injections of N-desulfated heparin (Shanghai Institute of Cell Biology, Chinese Academy of Sciences, 10 mg/kg.d) twice weekly for 3 wk. The mice in normal saline group received i.v. injections of normal saline (100 μL) twice weekly for 3 wk. The mice were sacrificed six weeks after implantation. Tumor metastasis was evaluated histologically for metastasis under microscope. Intratumoral microvessel density (MVD) and VEGF expression were evaluated immuohistochemically. VEGF mRNA expression in gastric tissue of SCID mice was detected by real time PCR.

RESULTS: The tumor metastasis rate was 80% in normal saline group and 20% in N-desulfated heparin group (P < 0.05). MVD was 8.0 ± 3.1 in normal saline group and 4.3 ± 1.8 in N-desulfated heparin group (P < 0.05). VEGF positive immunostaining was found in cytoplasm of cancer cells. The rate of VEGF positive expression was higher in normal saline group than in N-desulfated heparin treated group (90% vs 20%, P < 0.05). VEGF mRNA expression was significantly inhibited by N-desulfated heparin and was higher in normal saline group than in N-desulfated heparin group (Ct value 19.51 ± 1.01 vs 22.55 ± 1.36, P < 0.05). N-desulfated heparin significantly inhibited the expression of VEGF mRNA in cancer cells. No bleeding occurred in N-desulfated heparin group.

CONCLUSION: N-desulfated heparin can inhibit metastasis of gastric cancer by suppressing tumor VEGF expression and tumor angiogenesis, but has no obvious anticoagulant activity.

Clinical application of self-expanding metallic stent in the management of acute left-sided colorectal malignant obstruction

AIM: To summarize our experience with the application of self-expanding metallic stent (SEMS) in the management of acute left-sided colorectal malignant obstruction.

METHODS: A retrospective chart review of all patients undergoing placement of SEMS between April 2000 and January 2004 was performed.

RESULTS: Insertion of SEMS was attempted in 26 patients under fluoroscopic guidance with occasional endoscopic assistance. The sites of lesions were located in splenic flexure of two patients, left colon of seven patients, sigmoid colon of eight patients and rectum of nine patients. The intended uses of SEMS were for palliation in 7 patients and as a bridge to elective surgery in 19 patients. In the latter group, placement of SEMS allowed for preoperative systemic and bowel preparation and the following one-stage anastomosis. Successful stent placement was achieved in 22 (85%) of the 26 patients. The clinical bowel obstruction resolved 24 hours after successful stent placement in 21 (95%) patients. Three SEMS-related minor complications occurred, two stents migrated and one caused anal pain.

CONCLUSION: SEMS represents an effective and safe tool in the management of acute malignant colorectal obstruction. As a bridge to surgery, SEMS can provide time for systematic support and bowel preparation and obviate the need for fecal diversion or on-table lavage. As a palliative measure, SEMS can eliminate the need for emergent colostomy.

Inhibition of P-selectin L-EGF monoclonal antibody on metastasis of human gastric carcinoma in severe combined immunodeficient mice

AIM: To investigate the role of cell adhesion molecule P-selectin L-EGF monoclonal antibody (L-EGF Mab) in the inhibition of the metastasis of gastric cancer in sev-ere combined immunodeficient (SCID) mice.

METHODS: Human gastric cancer cell line SGC-7901 was orthotopically implanted into SCID mice to estab-lish metastatic model. At the 3^rd day after implantation, the mice were intravenously injected with normal saline (n = 11) or P-selectin L-EGF Mab (n = 9). At the end of the 6^th wk, pathological examinations were performed on the tissues from stomach and other possible invad-ed organs. Meanwhile, polymerase chain reaction was performed on the gastric cancer tissues.

RESULTS: The metastatic rate in the mice treated with normal saline was 81.8% (9/11), and that in the mice treated with P-selectin L-EGF Mab was 11.1% (1/9). There was significant difference between them (P <0.05). The level of P-selectin mRNA expression in the gastric can-cer with metastasis was markedly increased in com-parison with that without metastasis, and P-selectin mRNA expression in the mice treated with P-selectin L-EGF Mab was significantly lower than that in the ones treated with normal saline (cycle threshold: 20.54±2.20 vs 17.09±1.40, P <0.05).

CONCLUSION: CONCLUSION: P-selectin adhesion molecule is related to tumor metastasis, and P-selectin L-EGF Mab can inhibit the metastasis by down-regulating the express-ion of P-selectin mRNA..

Effect of N-desulfated heparin on angiogenesis and vascular endothelial growth factor expression in mice with severe combined immunodeficiency

AIM: To investigate the effect of N-desulfated heparin on tumor metastasis, angiogenesis, and expression of vascular endothelial growth factor (VEGF) after ortho-topic implantation of human gastric carcinoma in mice with severe combined immunodeficiency (SCID).

METHODS: The SCID mice metastasis model was established by in situ implantation of human gastric carcinoma tissue, then the mice were randomly divided into two groups: the normal saline group (treated with normal saline) and NNH group [treated with N-desulfat-ed heparin, 10 mg/(kg·d) iv, 2/wk, for 3 wk]. The mice were sacrificed 6 wk after the implantation. The tumor metastasis, intratumoral microvessel density (MVD), and VEGF expression were evaluated respectively..

RESULTS: The tumor metastasis rates were significan-tly different between normal saline and NNH group (80% vs 20%, P < 0.05). No side effect such as hemorrhage was observed in the mice. The MVD was 8.0 ± 3.1 in the normal saline group and 4.3 ± 1.8 in the NNH group, and there was significant difference between those 2 groups (P < 0.05). The positive rate of VEGF expressi-on was significantly higher in the normal saline group than that in the NNH group (90% vs 20%, P < 0.05).

CONCLUSION: N-desulfated heparin can inhibit the metastasis of gastric cancer through inhibiting the ex-pression of tumor VEGF and angiogenesis with no ob-vious side effect such as hemorrhage

Comparative observation on different intervention procedures in benign stricture of gastrointestinal tract

AIM: To determine the most effective intervention procedure by evaluation of mid and long-term therapeutic efficacy in patients of stricture of the gastrointestinal tract (GIT).

METHODS: Different intervention procedures were used to treat benign stricture of GIT in 180 patients including pneumatic dilation (group A, n = 80), permanent (group B, n = 25) and temporary (group C, n = 75) placement of expandable metallic stents.

RESULTS: The diameters of the strictured GIT were significantly greater after the treatment of all procedures employed (P < 0.01). For the 80 patients in group A, 160 dilations were performed (mean, 2.0 times per patient). Complications in group A included chest pain (n = 20), reflux (n = 16), and bleeding (n = 6). Dysphagia relapse occurred in 24 (30%) and 48 (60%) patients respectively during 6-and-12 momth follow-up periods in group A. In group B, 25 uncovered or partially covered or antireflux covered expandable metallic stents were placed permantly, complications included chest pain (n = 10), reflux (n = 15), bleeding (n = 3), and stent migration (n = 4), and dysphagia relapse occurred in 5 (20%) and 3 patients (25%) during the 6- and -12 month follow-up periods, respectively. In group C, the partially covered expandable metallic stents were temporarily placed in 75 patients and removed after 3 to 7 days via gastroscope, complications including chest pain (n = 30), reflux (n = 9), and bleeding (n = 12), and dysphagia relapse occurred in 9 (12%) and 8 patients (16%) during the 6-and-12 month follow-up periods, respectively. The placement and withdrawal of stents were all successfully performed. The follow-up of all patients lasted for 6 to 96 months (mean 45.3 ± 18.6 months).

CONCLUSION: The effective procedures for benign GIT stricture are pneumatic dilation and temporary placement of partially-covered expandable metallic stents. Temporary placement of partially-covered expandable metallic stents is one of the best methods for benign GIT strictures in mid and long-term therapeutic efficacy.

Complications of stent placement for benign stricture of gastrointestinal tract

AIM: To observe the frequent complications of stent placement for stricture of the gastrointestinal tract and to find proper treatment.

METHODS: A total number of 140 stents were inserted in 138 patients with benign stricture of the gastrointestinal tract. The procedure was completed under fluoroscopy in all of the patients.

RESULTS: Stents were successfully placed in all the 138 patients. Pains occurred in 23 patients (16.7%), slight or dull pains were found in 21 patients and severe chest pain in 2 respectively. For the former type of pain, the patients received only analgesia or even no treatment, while peridural anesthesics was conducted for the latter condition. Reflux occurred in 16 of these patients (11.6%) after stent placement. It was managed by common antireflux procedures. Gastrointestinal bleeding occurred in 13 patients (9.4%), and was treated by hemostat. Restenosis of the gastrointestinal tract occurred in 8 patients (5.8%), and was apparently associated with hyperplasia of granulation tissue. In 2 patients, the second stent was placed under X-ray guidance. The granulation tissue was removed by cauterization through hot-node therapy under gastroscope guidance in 3 patients, and surgical reconstruction was performed in another 3 patients. Stent migration occurred in 5 patients (3.6%), and were extracted with the aid of a gastroscope. Food-bolus obstruction was encountered in 2 patients (1.4%) and was treated by endoscope removal. No perforation occurred in all patients.

CONCLUSION: Frequent complications after stent placement for benign stricture of the gastrointestinal tract include pain, reflux, bleeding, restenosis, stent migration and food-bolus obstruction. They can be treated by drugs, the second stent placement or gastroscopic procedures depend on the specific condition.

Follow-up evaluation for benign stricture of upper gastrointestinal tract with stent insertion

AIM: To determine the best mothod for benign stricture of the upper gastrointestinal tract (UGIT) with stent insertion by follow-up evaluation.

METHODS: A total of 110 stents insertions were performed in 110 cases of benign stricture of the UGIT. Permanent (group A) and temporary (group B) placement of an expandable metal stent in 30 cases and 80 cases respectively. All cases were completed under fluoroscopy.

RESULTS: In group A, 30 uncovered or antireflux covered or partially covered expandable metal stents were placed permanently. In group A, 5 cases (16.7%) in 3-months, 5 cases (20.0%) in 6-months, 6 cases (25%) in the 1st year, 6 cases (50%) in the 3^rd year, and 4 cases (80%) in the 5^th year exhibited dysphagia relapse. In group B, a partially-covered expandable metal stent was temporarily placed in each patient and removed after 3-7 d via gastroscopy. Follow-up data in this group showed that 8 cases (7.5%) in 3-months, 9 cases (12.0%) in 6-months, 10 cases (15.4%) in the 1^st year, 6 cases (20%) in the 3^rd year, and 3 cases (25%) in the 5^th year exhibited dysphagia relapse. The placement and withdrawal of all stents were all performed successfully. The follow-up of all cases lasted for 3-99 mo (mean 41.6 ± 19.7 mo).

CONCLUSION: The best mothod for benign stricture of UGIT with stent insertion is temporary placement of a partially-covered expandable metal stent.

Temporary partially-covered metal stent insertion in benign esophageal stricture

AIM: To study the therapeutic efficacy of temporary partially-covered metal stent insertion on benign esophageal stricture.

METHODS: Temporary partially-covered metal stent was inserted in 83 patients with benign esophageal stricture. All the patients had various dysphagia scores.

RESULTS: Insertion of 85 temporary partially-covered metal stents was performed successfully in 83 patients with benign esophageal stricture and dysphagia was effectively remitted in all the 83 cases. The dysphagia score was 3.20 ± 0.63 (mean ± SD) and 0.68 ± 0.31 before and after stent insertion, and 0.86 ± 0.48 after stent removal. The mean diameter of the strictured esophageal lumen was 3.37 ± 1.23 mm and 25.77 ± 3.89 mm before and after stent insertion, and 16.15 ± 2.96 mm after stent removal. Follow-up time was from 1 week to 96 months (mean 54.26 ± 12.75 months). The complications were chest pain (n = 37) after stent insertion, and bleeding (n = 12) and reflux (n = 13) after stent removal.

CONCLUSION: Temporary partially-covered metal stent insertion is one of the best methods for treatment of benign esophageal stricture.

Selection and evaluation of three interventional procedures for achalasia based on long-term follow-up

AIM: To determine the best method out of the three types of interventional procedure for achalasia based on a long-term follow-up.

METHODS: The study cohort was comprised of 133 patients of achalasia. Among them, 60 patients were treated under fluoroscopy with pneumatic dilation (group A), 8 patients with permanent uncovered or antireflux covered metal stent dilation (group B), and 65 patients with temporary partially covered metal stent dilation (group C).

RESULTS: One hundred and thirty dilations were performed on the 60 patients of group A (mean 2.2 times per case). The mean diameter of the strictured cardia was 3.3 ± 2.1 mm before dilation and 10.6 ± 3.8 mm after dilation. The mean dysphagia score was 2.7 ± 1.4 before dilation and 0.9 ± 0.3 after dilation. Complications in group A were chest pain (n = 30), reflux (n = 16), and bleeding (n = 6). Thirty-six patients (60%) in group A exhibited dysphagia relapse during a 12-month follow-up, and 45 patients (90%) out of 50 exhibited dysphagia relapse during a 36-month follow-up. Five uncovered and 3 antireflux covered expandable metal stents were permanently placed in the 8 patients of group B. The mean diameter of the strictured cardia was 3.4 ± 1.9 mm before dilation and 19.5 ± 1.1 mm after dilation. The mean dysphagia score was 2.6 ± 1.3 before dilation and 0.4 ± 0.1 after dilation. Complications in group B were chest pain (n = 6), reflux (n = 5), bleeding (n = 3), and hyperplasia of granulation tissue (n = 3). Four patients (50%) in group B exhibited dysphagia relapse during a 12-month follow-up, and 2 case (66.7%) out of 3 patients exhibited dysphagia relapse during a 36-month follow-up. Sixty-five partially covered expandable metal stents were temporarily placed in the 65 patients of group C and withdrawn after 3-7 d via gastroscopy. The mean diameter of the strictured cardia was 3.3 ± 2.3 mm before dilation and 18.9 ± 3.5 mm after dilation. The mean dysphagia score was 2.4 ± 1.3 before dilation and 0.5 ± 0.2 after dilation. Complications in group C were chest pain (n = 26), reflux (n = 13), and bleeding (n = 8). 6 patients (9.2%) out of 65 exhibited dysphagia relapse during a 12-month follow-up, and 8 patients (14.5%) out of 55 exhibited dysphagia relapse during a 36-month follow-up. All the stents were inserted and withdrawn successfully. The follow-up in groups A-C lasted 12-96 months.

CONCLUSION: Temporary partially covered metal stent dilation is one of the best methods with interventional procedure for achalasia in terms of long-term follow-up.

Effect of P-selectin monoclonal antibody on metastasis of gastric cancer and immune function

AIM: To investigate the effect of cell adhesion molecule P-selectin monoclonal antibody (Mab) on metastasis and immune function of mice orthototopically implanted with human gastric cancer tissue.

METHODS: SCID mice were implanted orthotopically with SGC-7901 human gastric carcinoma tissue. Starting from day 3 after operation, animals were given intravenously PBS or P-selectin Mab (100 μg/injection) (for both normal mice and tumor-implanted mice with tumors), twice weekly for 3 wk. Two animals in each group were sacrificed randomly at the 1st, 2nd, 4th week and 6th week. While T cell and B cell transformation indices were determined with the ³H TdR infiltration method, the NK cell activity was detected by the LDH release method.

RESULTS: The metastatic rate in the P-selectin Mab treated group was lower than that in the PBS treated group (with tumors). The NK activity of normal mice increased over time. The immune functions (T, B cell function, NK activity) of the tumor group in the 6th week were significantly lower than those in the 4th week, but the change was attenuated by P-selectin Mab.

CONCLUSION: P-selectin Mab could suppress the metastasis of gastric cancer with no adverse effect on host immune function.

Effect of tetramethylpyrazine on P-selectin and hepatic/renal ischemia and reperfusion injury in rats

AIM: To investigate the effect of tetramethylpyrazine on hepatic/renal ischemia and reperfusion injury in rats.

METHODS: Hepatic/renal function, histopathological changes, and hepatic/renal P-selectin expression were studied with biochemical measurement and immunohistochemistry in hepatic/renal ischemia and reperfusion injury in rat models.

RESULTS: Hepatic/renal insufficiency and histopathological damage were much less in the tetramethylpyrazine-treated group than those in the saline-treated groups. Hepatic/renal P-selectin expression was down regulated in the tetramethylpyrazine-treated group.

CONCLUSION: P-selectin might mediate neutrophil infiltration and contribute to hepatic/renal ischemia and reperfusion injury. Tetramethylpyrazine might prevent hepatic/renal damage induced by ischemia and reperfusion injury through inhibition of P-selectin.

A comparison of enzyme immunoassay and gas chromatography/mass spectrometry in forensic toxicology

A series of 137 urine samples were analyzed for drugs of abuse by enzyme immunoassay (EMIT) and by gas chromatography/mass spectrometry (GC/MS). Agreement between these methods was excellent and ranged from 93.4% for benzodiazepines to 98.5% for propoxyphene. EMIT false negative were traced to the presence of elevated endogenous lysozyme or other interfering materials. In the case of moderate amounts of lysozyme the use of a blank would lead to correct results. Disagreement in the identification of nine benzodiazepine samples was found to be due to a low recovery of benzodiazepine metabolites from urine. Recovery could be improved by incubation of the urine sample with the enzyme beta-glucuronidase.