Table of Content

05 November 2017, Volume 32 Issue 11

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Treatment of complications after endoscopic submucosal dissection for early digestive tract cancer

Liu Yong， Wang Guiqi

2017, 32(11):  921-924.  doi:10.3969/j.issn.1004-583X.2017.11.001

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Endoscopic submucosal dissection( ESD) is a diagnosis and treatment technique based on endoscopic mucosal resection（EMR）. At present， ESD is widely used in the treatment for early digestive tract cancer. The advantage of ESD is the ability of excising lesions completely. But，  this technique presents the higher technology difficulty and needs longer operating time， so the incidence rate of complications became higher. The usual complication includes bleeding， perforation and stricture. Realizing these complications completely and treat them effectively in time is very important for successful ESD.

Endoscopic ultrasonography  in diagnosis of early gastrointestinal carcinoma

Yang Jielin1， Peng Na1， Zhao Dongqiang2

2017, 32(11):  925-928.  doi:10.3969/j.issn.1004-583X.2017.11.002

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Endoscopic ultrasonography has dual functions of endoscopic and ultrasonic exploration. With the continuous emergence and application of EUS related technologies， endoscopic ultrasonography has brought new methods for the diagnosis and staging of early gastrointestinal  cancer.

Application progress of magnifying endoscopy in early gastrointestinal cancer

Wang Kaiyue， Liu Li

2017, 32(11):  929-933.  doi:10.3969/j.issn.1004-583X.2017.11.003

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Early diagnosis and treatment of gastrointestinal cancer is related with survival rate and curing rate. Endoscopy examination has become an important method for screening early gastrointestinal cancer. Narrowbanding imaging can limit the light in the superficial tissue and make the mucosa and submucosa imaging clearly. Magnifying endoscopy can benefit the doctor to magnify the superficial construction.Magnifying endoscopy with narrowbanding imaging(MENBI)  is a new technique that can find early lesions which can not be found by conventional endoscopy.The goal is to treat the early stage gastrointestinal cancer and increase the survival rate．

Chromoendoscopy in diagnosis of gastrointestinal early carcinoma

Dong Huan， Wang Xin， Wang Na

2017, 32(11):  934-938.  doi:10.3969/j.issn.1004-583X.2017.11.004

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Diagnosis of gastrointestinal early cancer  is crucial to improve its cure rate， survival rate and prognosis. With development and improvement of modern medical technology， diagnosis and treatment of gastrointestinal early cancer by minimal invasive method has entered into a new era.  A  variety of supplementary endoscopic diagnostic techniques have improved the detection and cure rate markedly. Here， we reviewed the application of chromoendoscopy in the diagnosis of early cancer in the digestive tract.

Pathologic diagnosis advance of precancerous lesions and early cancer in digestive tract

Cui Jinfeng， Zhang Xianghong， Li Yuehong， Wu Wenxin

2017, 32(11):  939-942.  doi:10.3969/j.issn.1004-583X.2017.11.005

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Epithelial malignant tumor in digestive tract  includes esophageal， gastric and colorectal cancer， all of which have precancerous lesions (intraepithelial neoplasia/dysplasia).In recent years， with the development of endoscopic techniques，more and more attention focuses at early esophageal cancer， early gastric cancer and colorectal intramucosal neoplasia/intramucosal carcinoma. Pathologic diagnosis is a  critical factor affecting early diagnosis and treatment of early cancer in digestive tract.However， the differences between Japan and the West in the diagnosis of early cancer  in digestive tract are still significant.This summary involves  the pathologic diagnosis terminology， diagnostic criteria and pathologic diagnosis progress of precancerous lesions and early cancer of digestive tract carcinoma.

Cooperation and nursing during endoscopic submucosal dissection for early gastrointestinal carcinoma

Tian Hui， Sun Chang， Wang Ce

2017, 32(11):  943-945.  doi:10.3969/j.issn.1004-583X.2017.11.006

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With the fast development of endoscopic technique and the acknowledge about the  gastrointestinal neoplasms， the detection rate of early gastrointestinal carcinoma in China shows an increasing trend.  Endoscopic submucosal dissection(ESD) is a kind of minimal invasive therapy to early gastrointestinal carcinoma and precancerous lesions. By ESD，  the lesions can be resected completely and the gastrointestinal carcinoma can be cured. We discussed  the cooperation and the nursing method during ESD for early gastrointestinal carcinoma and precancerous lesions. The goal is to increase the professional level of endoscopy nursing intervention.

Interpretation of AASLD Practice Guidance for Diagnosis and Management of  Nonalcoholic Fatty  Liver  Disease 2017

Luo Yuxin， Yin Fengrong， Zhang Xiaolan

2017, 32(11):  946-948.  doi:10.3969/j.issn.1004-583X.2017.11.007

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In June 2017， American Society for the Study of Liver Diseases (AASLD) published online the Diagnosis and  Management of  Nonalcoholic Fatty  Liver  Disease (NAFLD) Guidance in Hepatology. The progress of NAFLD was updated on the basis of 2012 guideline， providing canonical diagnosis and normative treatment for the medical personnel. The authors will focus on definition， screening， assessment， treatment plans and management of children and adolescents， the aim is to make the physicians learn about the recent advances.

Prognostic value of monitoring Btype natriuretic peptide and  relation to hemodynamic changes in septic shock patients

Yan Fengdi， Xu Xiaolan， Zhang Wenjuan， Zheng Ruiqiang， Lin Hua

2017, 32(11):  949-952.  doi:10.3969/j.issn.1004-583X.2017.11.008

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Objective  To explore the prognostic value of plasma Btype natriuretic peptide (BNP) and  relationship with hemodynamic change in patients with septic shock. Methods  A retrospective study was conducted. Clinical data of 58 mechanically ventilated septic shock patients admitted in the Department of Critical Care Medicine in Subei People's Hospital from January 2015 to December 2016 were   analyzed．Cardiac index (CI)， stroke volume index (SVI) and globat end diastolic volume index(GEDI) were detected by pulse indicator continuous cardiac output (PiCCO) technology for 3 days.  Acute  Physiology and Chronic Health Evaluation Ⅱ（APACHEⅡ）  score， sequential organ failure assessment (SOFA) score， arterial blood lactate levels (Lac) and BNP were conducted after admission. According to the 28day mortality after admission in intensive care unit (ICU)， the patients were divided into survival group (n=36) and death group (n=22). The BNP， APACHEⅡ， SOFA and Lac in two groups were analyzed， and their relationships and outcome were analyzed. The receiver operating characteristic (ROC) curve was plotted to assess the value of BNP for predicting the outcome.  Results   Threeday BNP kinetics demonstrated a decline trend over time in survival group while no downtrend was found in death group， and there was significant difference in plasma BNP levels between  two groups. ROC curves demonstrated that the area under ROC curve (AUC) of BNP was 0.679（P=0.031）. As the cutoff point of BNP， the sensitivity and specificity of BNP predicting the survival of patients was 66.7% and 76.7%， respectively. Conclusion  Serum BNP could be a useful diagnostic indicator for septic shock. Prolonged BNP elevation and inability to reduce BNP after proper treat may imply increased mortality.

Protective effect of ulinastatin on intestinal epithelial cell barrier

Li Yongsheng1， Ma Xiaofeng2

2017, 32(11):  953-956.  doi:10.3969/j.issn.1004-583X.2017.11.009

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Objective  To investigate the protective effect and mechanism of ulinastatin (UTI) on intestinal epithelial cell barrier. Methods  Caco2 cells were cultured， epithelial cells monolayer models induced by  tumor necrosis factorα（TNFα ）  were established and were randomly divided into blank control group， TNFα model group， lowdose UTI group (50  000 U/kg)， middledose UTI group (100  000  U/kg) and highdose UTI group (200 000  U/kg). The transepithelial electrical resistance (TER) and fluoresce  in isothiocyanate marked dextran FITCdextran in all groups were determined by Millicell electrical resistance meter and multifunctional plate reader.  Interleukin 6 (IL6) and  IL10 were determined by enzymelinked immunosorbent assay (ElISA). The apoptosis rate was measured by flow cytometry， and the expression of tight junction protein occludin and ZO1 were measured by Western blot. Results  The expression of TER， FITCdextran， occludin and ZO1 were significantly lower in TNFα model group than those in blank control group， while IL6， IL10 and apoptosis rate were significantly higher (P<0.05). After  UTI  treatment，  TER， FITCdextran， occludin and ZO1 were significantly higher than those in  TNFα model group， while IL6， IL10 and apoptosis rate were significantly lower (P<0.05).  UTI  change  in highdose group was the most significant (P<0.05). Conclusion   UTI may protect the intestinal epithelial cell barrier injury induced by TNFα through inhibiting the release of inflammatory mediators and regulating the expression of tight junction associated proteins.

Epidermal growth factor receptor mutations in nonsmall cell lung cancer and clinical background

Wang Weia， Jiang Jianga， Rong Guanga， Huang Honga， Zhang Yongshengb， Shi Yizhena

2017, 32(11):  957-960.  doi:10.3969/j.issn.1004-583X.2017.11.010

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Objective   To investigate the relationship between epidermal growth factor receptor (EGFR) mutations and different clinical backgrounds in patients with nonsmall cell lung cancer (NSCLC). Methods  EGFR mutations in the tumor tissues of 257 NSCLC patients were analyzed by TaqManARMS (TaqManamplification refractory mutation system). The mutation of EGFR was explored in correlation with the clinicopathological features， TNM stage， gender， age and habits of patients. Results   99(38.5%) EGFR mutations， which were mainly located in exon 19 with the pattern of deletion mutation and exon 21 with the point mutation， were identified among 257 NSCLC patients. The mutation rate was higher in patients with adenocarcinoma and adenosquamous carcinoma than that in patients with  squamous cell carcinomas and other subtypes(all P<0.01). Mutation rate in female was higher than that in male(P<0.01). However， no evident association was found between EGFR mutation and age(P>0.05). EGFR gene mutations occurred more frequently in nonsmokers compared with smokers (P<0.01).  EGFR mutation was not associated with smoking years， but significantly correlated with daily smoking (P<0.01). There was no significant difference between EGFR gene mutation and clinical TNM stage of NSCLC(Ⅰ，Ⅱ， Ⅲ  and  Ⅳ).  EGFR mutation rates in patients with different pathological characteristics， to some extent， were different. Mutation was significantly different between low differentiation and middle or high differentiation (P<0.01). Conclusion  EGFR gene mutation in NSCLC was significantly correlated with gender， histological type， tumor differentiation， smoking and daily smoking amount but not with age， lymph node metastasis， TNM stages and smoking years.

Initial dose of argatroban in patients with hemorrhage tendency undergoing continuous renal replacement therapy

Li Yingping， Ma Zhigang， Huang Wenhui， Huang Junyue， Xue Rong， Lu Shouyan

2017, 32(11):  961-964.  doi:10.3969/j.issn.1004-583X.2017.11.011

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Objective  To investigate the anticoagulant effect of different initial dose of argatroban in patients with hemorrhage tendency undergoing continuous renal placement therapy (CRRT).Methods  One hundred and fortyone patients of hemorrhage tendency undergoing CRRT were divided into four groups according to the different initial dose: 0  μg/kg group， 20  μg/kg  group， 30 μg/kg group and 40 μg/kg group， each group maintenance was 24  μg/(kg·h). The activated partial thromboplastin time（APTT）  was observed before， during  and after treatment. The coagulation hemofilter and blood pipeline were observed during and after treatment. Results  The change of APTT in  30  μg/kg group kept relatively stable and APTT maintained between 1.5 and 2.5  times than before argatroban， venous pressure was stable and anticoagulant was effective. Conclusion  The initial dose in 30  μg/kg group with CRRT is successful withnot coagulation and bleeding trends.

Impact of exenatide combined with metformin on islet function in newly diagnozed  type 2 diabetes mellitus

Zhou Ruifeng1， Zhong Shuang1， Guo Ying2， Sun Yujin1， Shao Zhuxiang1

2017, 32(11):  965-968.  doi:10.3969/j.issn.1004-583X.2017.11.012

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Objective  To explore the impact of  exenatide  combined with metformin on islet function in patients with newly diagnozed type 2 diabetes mellitus. Methods  A total of 120 patients with newly diagnozed T2DM were randomly divided into four groups: diet and exercise group 30 cases（group A），  metformin group  30  cases （group B），exenatide group 30 cases（group C）  and metformin and exenatide group 30  cases （group D）. Blood glucose， insulin， glucagon (GC) and glucagonlike peptide1  （GLP1） were measured. Insulin secretion index（HOMAβ） and insulin resistance index（HOMAIR）  were calculated. Results  HOMAIR after treatment was significantly reduced in group B， C and D (P＜0.05)， HOMAβ  was significantly increased in group B， C and D (P＜0.05). After treatment， group B showed no significant difference compared with group A; the HOMAIR in group C and D after treatment was significantly decreased (P<0.05)， and the HOMAβ  was significantly increased (P<0.05); Compared with group B， the HOMAIR in group C and D after treatment was significantly decreased (P<0.05)， and the HOMAβ  was significantly increased (P<0.05); Compared with group C， the HOMAIR in group D after treatment was significantly decreased (P<0.05)， and the HOMAβ  was significantly increased (P<0.05). Conclusion   Exenatide combined with metformin could effectively improve the islet function in newly diagnozed T2DM， and the effect was better than monotherapy of exenatide or metformin.

β-endorphin expression and immune function  in patients with ulcerative colitis

Liu Lin1，2， Liu Li1， Zhang Rui1， Zhao Dongqiang1， Liu Xuechen1， Zhang Di1

2017, 32(11):  969-973.  doi:10.3969/j.issn.1004-583X.2017.11.013

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Objective  To explore the  immune mechanism of βendorphin(βEP) in  ulcerative colitis(UC) patients.Methods  Thirty  UC  patients were enrolled， including  mild activity 8 cases， moderate activty 10 cases  and  severe activity 12 cases.  In the same period，15 patients with colon polyps served as control group.  Blood  βEP and interleukin1β(IL1β)   were measured by radioimmunoassay. After peripheral blood lymphocyte separation， CD3+ T cells， CD4+ T cells and CD4+/CD8+ T cells percentage were detected by flow cytometry.  βEP  and  IL1β in colon mucosa were measured by immunohistochemistry.  Results  Plasma expressions of βEP， IL1β， CD4+ T cells， CD4+/CD8+ T cells percentage in patients with UC were significantly higher than those of control group (P<0.05).  And the expressions  showed significant difference with the disease severity: patients with mild UC<patients with moderate UC<patients with severe UC (P<0.05). Colonic expressions of βEP， IL1β in patients with UC were significantly higher than those in control group (P<0.05).  Plasma βEP between the active phase and the remission phase was positively correlated with the change of IL1β，CD4+ T cells，CD4+/CD8+ T cells percentage(r=0.522，P<0.01；r=0.532，P<0.05；r=0.964，P<0.01). Conclusion   βEP may play a role in the immunological mechanism of UC by regulating the leukomonocyte subgroup and the secretion of IL1β，in a certain way，βEP reflects the severity of UC patients.

Hypertension risk factors in Guanping residents

Peng Guangze， Wang Siting， Yang Chuanpeng， Chen Hongxia， Ke Juan， Wang Lixia

2017, 32(11):  974-976.  doi:10.3969/j.issn.1004-583X.2017.11.014

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Objective  To investigate the hypertension risk factors among residents in Guanpingvillages， and to provide evidence for the prevention and treatment of hypertension in local area.Methods  Three hundred and fiftyresidents were selected randomly from local hypertensive patients. Standard questionnaires and physical examination were used to collect information on risk factors. SPSS system was used for data management and analyses. Logistic regression analysis was used to calculate the odds ratio for hypertension.Results  Men (OR=1.42， P<0.05)， age (OR=1.44，P<0.05)， obesity (OR=1.50，P<0.05)， hypertension family history (OR=1.47，P<0.05)， high salt diet (OR=1.42，P<0.05)， psychological factors (OR=1.48，P<0.05)， intensive labor work
(OR=1.77，P<0.05)  were risk factors for hypertension. Conclusion  Male gender， ageing， obesity， hypertension family history， high salt intake， psychological factors， and intensive labor work were risk factors of hypertension.

Urine screening results of junior middle school students in heavy industry area of Lanzhou

Liu Shurao1， Gao Xia2， Lei Xiaoyan2， Chen Junhui2， Sai Yipa2， Cao Xiaofeng2， You Wenping2

2017, 32(11):  977-980.  doi:10.3969/j.issn.1004-583X.2017.11.015

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Objective  To investigate the prevalence of kidneyrelated diseases， distribution characteristics and risk factors by screening the urine screening of the seventh grade students in the heavy industrial area of Lanzhou. Methods  Urine was collected from the seventh grade students(n=1 969) in Xigu District of Lanzhou and screened by urine reagent papers. The first abnormalities of urine check were reviewed. Patients with double abnormal results of urinary erythrocytes， hematuria， proteinuria， albuminuria and urinary white blood cells were followed up. Results  The abnormal ratio of urine was up to 15.4%  for the 1969 seventh grade students (1214 years old) in Xigu District of Lanzhou. Of these abnormalities， positive urinary occult blood， positive urine protein and positive white blood cell urine accounted for 301 cases， 200 cases and 39 cases， respectively. The ratio of total urinary abnormalities in local resident students was significantly higher than that of rural migrant students (P<0.05); The abnormality rate of white blood cells in female urine was significantly higher than that in male (P<0.05). The proportion of total urinary abnormalities， urinary occult blood and proteinuria in male students in local urban areas were significantly higher than those in rural migrant students (P<0.05). Positive rate in urinary occult blood with proteinuria in female students was significantly higher in local urban than in rural area (P<0.05). Conclusion  The urine abnormality of the seventh grade students in Xigu District of Lanzhou  is higher than that of the reported domestic data， and the abnormalities of the resident population in the local population were higher than those of the rural students.

Metformin and overall survival benefit in pancreatic cancer patients: a meta analysis

He Yong， Ran Lingrong， Li Li， He Qing

2017, 32(11):  981-985.  doi:10.3969/j.issn.1004-583X.2017.11.016

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Objective  To evaluate the effect of metformin on the overall survival of pancreatic cancer patients. Methods  A systematic search was conducted  in the  published literature on studies on the association between  metformin and overall survival benefit in pancreatic cancer patients up to June 2017 from EMBase and PubMed. The identified articles were reviewed for additional references. The most adjusted risk estimates were extracted by two authors and summarized using random effects metaanalysis. The quality of the study was assessed by the NewcastleOttawa Scale (NOS)， and the study with score ≥6 was taken as the highquality study.Results  Eleven articles were included.The metaanalysis showed that  metformin treatment  can  increase the overall survival  （OS） of patients with pancreatic cancer compared with nonmetformin treatment (HR=0.85，95%CI=0.750.95，P=0.006)，and in subgroup analysis Asian countries and high quality articles also supported  this results. Conclusion  Metformin increased  the overall survival of pancreatic cancer patients compared with nonmetformin treatment.