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OBJECTIVES: To evaluate the effectiveness of a pilot smoking cessation service in an emergency department (ED) clinical observation unit.STUDY DESIGN: A descriptive case series review was undertaken of smoking cessation service patients in the short-stay unit of an acute hospital in Singapore from July 1, 2018, to December 31, 2019.METHODS: Upon admission, ED nurses screen all patients regarding their current smoking status and implement the 5 A's framework, which involves the steps of Ask-Advise-Assess-Assist-Arrange. Patients in the "contemplation" and "preparation" stages were offered the following components: (1) a bedside counseling session by a pharmacist and (2) a follow-up appointment at an outpatient smoking cessation clinic. Postdischarge follow-up telephone calls at 1, 6, and 12 months were carried out as part of the study data collection to obtain abstinence information.RESULTS: Forty-seven patients were included in the study; the majority were male (n = 41; 87.2%). The median numbers of cigarettes smoked per day at baseline, 1 month, 6 months, and 12 months were 14, 5, 3, and 5, respectively. The overall point-prevalence abstinence rates over the same follow-up time points were 26.5%, 38.7%, and 31.3%, respectively. The proportions of patients lost to follow-up at 1 month, 6 months, and 12 months were 27.7%, 34.0%, and 31.9%, respectively.CONCLUSIONS: Given the small sample and high number of uncontactable patients, more research is needed to assess whether the trend toward increasing point-prevalence abstinence rate over time and the trend toward decreasing median number of cigarettes smoked are observed in a larger sample. Refereed/Peer-reviewed

Introduction Low body weight in Parkinson's disease (PD) is poorly understood despite the associated risks of malnutrition, fractures, and death. Sarcopenia (loss of muscle bulk and strength) and frailty are geriatric syndromes that are likewise associated with adverse health outcomes, yet have received scant attention in PD. We studied body composition, sarcopenia, frailty, and their clinico-biological correlates in PD. Methods 93 patients and 78 spousal/sibling controls underwent comprehensive assessment of diet, clinical status, muscle strength/performance, frailty, body composition (using dual-energy X-ray absorptiometry), and serum levels of neurogastrointestinal hormones and inflammatory markers. Results PD patients were older than controls (66.0 ± 8.5 vs. 62.4 ± 8.4years, P = 0.003). Mean body mass index (24.0 ± 0.4 vs. 25.6 ± 0.5kg/m2, Padjusted = 0.016), fat mass index (7.4 ± 0.3 vs. 9.0 ± 0.3kg/m2, Padjusted Conclusions We found reduced body fat with relatively preserved skeletal muscle mass, and a high prevalence of frailty, in PD. Further studies are needed to understand the patho-mechanisms underlying these alterations.

The destruction of calcium homeostasis is an important factor leading to neurological diseases. Store-operated Ca(2+) (SOC) channels are essential for Ca(2+) homeostasis in many cell types. However, whether SOC channels are involved in astrocyte activation induced by lipopolysaccharide (LPS) still remains unknown. In this study, we used LPS as an exogenous stimulation to investigate the role of SOC channels in astrocyte activation. Using calcium imaging technology, we first found that SOC channels blockers, 1-[h-[3-(4-methoxyphenyl)propoxy]-4-methoxyphenethyl]-1H-imidazole (SKF-96365) and 2-aminoethyldiphenyl borate (2-APB), inhibited LPS induced [Ca(2+)]i increase, which prompted us to speculate that SOC channels may be involved in LPS induced astrocyte activation. Further experiments confirmed our speculation shown as SOC channels blockers inhibited LPS induced astrocyte activation characterized as cell proliferation by MTS and BrdU assay, raise in glial fibrillary acidic protein expression by immunofluorescence and Western Blot and secretion of interleukin 6 (IL-6) and interleukin 1β (IL-1β) by ELISA. So, our studies showed that SOC channels are involved in LPS-induced astrocyte activation.

Background: The 7 th TNM staging is the first authoritative standard for evaluation of effectiveness of treatment of gastric cancer worldwide. However, revision of pN classification within TNM needs to be discussed. In particular, the N3 sub-stage is becoming more conspicuous. Methods: Clinical data of 302 pN3M0 stage gastric cancer patients who received radical gastrectomy in Tianjin Medical University Cancer Institute and Hospital from January 2001 to May 2006 were retrospectively analyzed. Results: Location of tumor, depth of invasion, extranodal metastasis, gastric resection, combined organs resection, lymph node metastasis, rate of lymph node metastasis, negative lymph nodes count were important prognostic factors of pN3M0 stage gastric cancers. TNM stage was also associated with prognosis. Patients at T2N3M0 stage had a better prognosis than other sub-classification. T3N3M0 and T4aN3aM0 patients had equal prognosis which followed the T2N3M0. T4aN3bM0 and T4bN3aM0 had lower survival rate than the formers. T4bN3bM0 had worst prognosis. In multivariate analysis, TNM stage group and rate of lymph node metastasis were independent prognostic factors. Conclusions: The sub-stage of N3 may be useful for more accurate prediction of prognosis; it should therefore be applied in the TNM stage system.

To elucidate the clinical significance of the methylated status of CpG site count of PCDH10 promoter in the survival prediction in gastric cancer (GC).In the previous study, we demonstrated that the methylated CpG site count was significantly associated with the overall survival (OS) of GC patients by using the bisulfite genomic sequencing (BGS) with no less than five clones per sample. It was so complex and expensive for patients to undergo the BGS clones. In this study, we detected the different CpG site counts (hypermethylated and hypomethylated) of PCDH10 DNA promoter in GC samples of 471 patients by directly bisulfite genomic sequencing (D-BGS) without any clone. Furthermore, we evaluated the relationships between the methylated status of PCDH10 promoter and OS.Two hundred and fifty-seven of 471 (54.6%) GC patients were identified to present with PCDH10 promoter methylation by D-BGS. Patients who presented with 5 or more methylated CpG site counts of PCDH10 promoter had significantly poorer prognosis than patients who with less than 5 methylated CpG site counts of PCDH10 promoter (p= 0.039). With the multivariate survival analysis, we demonstrated that T stage, N stage and the hypermethylated CpG site counts of PCDH10 DNA promoter were the independent predictors of OS of GC patients. In addition, the hypermethylated CpG site counts of PCDH10 DNA promoter had smaller Akaike information criterion (AIC) and Bayesian information criterion (BIC) values than the other two independent predictors of the OS, indicating the hypermethylated CpG site counts of PCDH10 DNA promoter as the best prognostic predictor of GC.Our present findings suggested that the hypermethylated CpG site counts of PCDH10 DNA promoter for evaluating the prognosis of GC was reasonable by using the D-BGS.

Behcet's disease (BD) accompanied by intestinal involvement is called intestinal BD. Although recent studies have attained positive feedback with the administration of anti-TNF-α agents in patients with BD, only a few reports on the study of etanercept in intestinal BD have been found. In this study, 35 cases of intestinal BD were treated with conventional therapy (prednisone or methotrexate) for a minimum period of 3 months (group 1). Another 19 patients who failed to respond to conventional therapy were then treated with etanercept (25 mg twice a week for 3 months). During each subsequent relapse, the patients were given the same treatment. The main outcome measures were the four criteria for diagnosis of BD (buccal ulcers, genital ulcers, ocular lesions, and skin lesions), the manifestation of intestinal involvement (abdominal symptoms, double-balloon enteroscopy), laboratory examinations of the acute phase reactants (erythrocyte sedimentation rate) and C-reactive protein, and relapses. As a result of the administered therapy, the healing rate of buccal and genital ulcers, the remission rate of ocular lesions, skin lesions, and abdominal symptoms, the healing rate of intestinal ulcers, and the recovery rate of ESR and CRP were significantly higher in group 2 than those of group 1. The relapse rate in the etanercept therapy was reduced significantly when compared with conventional therapy group. In conclusion, etanercept treatment, in contrast to the conventional therapy, can result in better curative effect and less adverse reactions in intestinal BD.

To compare post-operative long-term complications and quality of life of two digestive reconstruction procedures after total gastrectomy.A total of 109 gastric cancer patients in Tianjin Medical University Cancer Hospital from March 2012 to February 2013 were prospectively enrolled and randomly divided into functional jejunal interposition (FJI) group (52 cases) and Roux-en-Y (R-Y) group (57 cases). The post-operative complications, nutritional status, and the quality of life were compared between two groups.One, 3 and 6 months after operation, the incidence of R-S syndrome in FJI group was lower as compared to R-Y group[13% (6/45) vs. 37% (18/49), 3% (1/30) vs. 42% (14/33), 5% (1/21) vs. 48% (11/23), all P0.01], while 3 months after operation, the incidence of reflux and heartburn in FJI group was higher[53% (16/30) vs. 21% (7/33), P0.01; 37% (11/30) vs. 12% (4/33), P0.05]. There were no significant differences in quality of life questionnaire QLQ-C30 between R-Y and FJI groups. QLQ-STO22 stomach module revealed in FJI group, the eating score was better, but reflux score was worse as compared to R-Y group 3 months after operation (all P0.01).Functional jejunal interposition keeps intestinal continuity preserving and food duodenal passing, which is a reasonable digestive reconstruction procedure.

AIM: To investigate the impact of prognostic nutritional index (PNI) on the postoperative complications and long-term outcomes in gastric cancer patients undergoing total gastrectomy. METHODS: The data for 386 patients with gastric cancer were extracted and analyzed between January 2003 and December 2008 in our center. The patients were divided into two groups according to the cutoff value of the PNI: those with a PNI ≥ 46 and those with a PNI < 46. Clinicopathological features were compared between the two groups and potential prognostic factors were analyzed. The relationship between postoperative complications and PNI was analyzed by logistic regression. The univariate and multivariate hazard ratios were calculated using the Cox proportional hazard model. RESULTS: The optimal cutoff value of the PNI was set at 46, and patients with a PNI ≥ 46 and those with a PNI < 46 were classified into PNI-high and PNI-low groups, respectively. Patients in the PNI-low group were more likely to have advanced tumor (T), node (N), and TNM stages than patients in the PNI-high group. The low PNI is an independent risk factor for the incidence of postoperative complications (OR = 2.223). The 5-year overall survival (OS) rates were 54.1% and 21.1% for patients with a PNI ≥ 46 and those with a PNI < 46, respectively. The OS rates were significantly lower in the PNI-low group than in the PNI-high group among patients with stages II (P = 0.001) and III (P < 0.001) disease. CONCLUSION: The PNI is a simple and useful marker not only to identify patients at increased risk for postoperative complications, but also to predict long-term survival after total gastrectomy. The PNI should be included in the routine assessment of advanced gastric cancer patients.

To investigate the effects of extended lymphadenectomy and postoperative chemotherapy on gastric cancer without lymph node metastasis.Clinical data of 311 node-negative gastric cancer patients who underwent potentially curative gastrectomy with more than 15 lymph nodes resected, from January 2002 to December 2006, were analyzed retrospectively. Patients with pT4 stage or distant metastasis were excluded. We analyzed the relationship between the D2 lymphadenectomy and the 5-year survival rate among different subgroups stratified by clinical features, such as age, tumor size, tumor location and depth of invasion. At the same time, the relationship between postoperative chemotherapy and the 5-year survival rate among different subgroups were also analyzed.The overall 5-year survival rate of the entire cohort was 63.7%. The 5-year survival rate was poor in those patients who were: (1) more than 65 years old; (2) with tumor size larger than 4 cm; (3) with tumor located in the upper portion of the stomach; and (4) with pT3 tumor. The survival rate was improved significantly by extended lymphadenectomy only in patients with pT3 tumor (P = 0.019), but not in other subgroups. Moreover, there was no significant difference in survival rate between patients with and without postoperative chemotherapy among all of the subgroups (P0.05).For gastric cancer patients without lymph node metastasis, extended lymphadenectomy could improve the survival rate of those who have pT3-stage tumor. However, there was no evidence of a survival benefit from postoperative chemotherapy alone.

To investigate the clinicopathological characteristics and prognostic factors of patients with pathological stage pN3 gastric cancer.A retrospective study of 310 patients with histologically confirmed pN3 stage gastric cancer undergoing radical gastrectomy from January 2000 to December 2006 in our department was performed. The Kaplan-Meier method was used to analyze the survival. Log-rank test and Cox regression model were carried out for univariate and multivariate analyses.All the patients were followed up for 2 to 103 (mean 35.7) months. The overall 5-year survival rate was 14.6%. There were 201 cases with stage pN3a and 109 cases with stage pN3b, and the 5-year survival rates were 16.8% and 10.3% respectively (P=0.013). Univariate analysis showed that tumor location, Borrmann type, depth of tumor invasion, surgical method, metastatic lymph node ratio, and pN stage were associated with postoperative survival (all P0.05). The multivariate analysis revealed that depth of tumor invasion, surgical method and metastatic lymph node ratio were independent prognostic factors, while the pN stage was not. The difference of 5-year survival rate between pN3a and pN3b subgroups was significant in pT4a patients (16.1% vs. 12.8%, P=0.001), while such difference was not significant in pT4b patients (8.6% vs. 3.1%, P=0.137).Prognosis of patients with pN3 stage gastric cancer after radical resection is poor. Depth of tumor invasion and surgical method are independent prognostic factors for pN3 stage gastric cancer. Metastatic lymph node ratio is valuable to predict the prognosis of pN3 stage patients. The pN3 staging of the 7th UICC provides a more accurate prediction of prognosis.

To investigate the clinicopathological characteristics and prognostic factors of bone metastasis in gastric cancer patients.Clinicopathological data of 66 gastric cancer patients with bone metastasis, who were treated at the Tianjin Medical University Cancer Institute and Hospital from October 1997 to September 2011, were analyzed retrospectively. The clinicopathological characteristics of the primary cancer and bone metastasis were summarized and the prognosis was analyzed.Of 66 patients, 4 underwent operation, 28 chemotherapy, 32 inhibitors of bone resorption,8 local treatment and 23 symptomatic treatment alone. The median survival time of these 66 patients was 5 months (95%CI:3.3-6.7 months). The 1-, 2- and 3-year survival rates were 9.1%, 3.0% and 1.5%, respectively. Univariate Log-rank test indicated that gender, bone metastasis combined with other distant metastasis and chemotherapy were significant prognostic factors (all P0.05). Multivariate analysis revealed bone metastasis combined with other distant metastasis was an independent prognostic factor (P=0.011, RR=2.067, 95%CI:1.178-3.626).Prognosis of patients with bone metastasis from gastric cancer is poor. Chemotherapy-based comprehensive treatment may improve the prognosis of these patients.

Recently, stathmin 1 has been proposed to function as an oncogene based on some relevant studies in multiple types of human cancers. However, the role of stathmin 1 in gastric cancer carcinogenesis has not been elucidated yet. The aim of this study was to investigate the expression of stathmin 1 as well as its association with overall survival of gastric cancer patients. The expression of stathmin 1 was detected by real-time quantitative reverse transcription polymerase chain reaction and Western blotting in gastric cancer and adjacent nontumor tissues. In addition, stathmin 1 expression was analyzed by immunohistochemistry in paraffin samples from 210 primary gastric cancer patients. The expression levels of stathmin 1 mRNA and protein in gastric cancer tissues were both significantly higher than those in adjacent nontumor tissues. In addition, the expression of stathmin 1 is correlated with Lauren's classification, depth of invasion, lymph node metastases, and tumor node metastasis (TNM) stage (all P < 0.05). Univariate analysis showed that high stathmin 1 expression was associated with poor prognosis in gastric cancer patients (P = 0.040). Multivariate analysis demonstrated that only lymph node metastasis and TNM stage were the independent prognostic indicators for gastric cancer. Stathmin 1 expression status is not an independent prognostic factor for patients with gastric cancer. Further subgroup analysis revealed that stathmin 1 expression was significantly correlated with prognosis in diffuse type gastric cancer. This research showed that the stathmin 1 overexpression might play an important role in the pathogenesis and subsequent progression of gastric cancer. Stathmin 1 could also be a potential therapeutic target in gastric cancer, especially for diffuse type gastric cancer.

To explore the prognostic factors and to compare chemotherapy alone versus surgical resection plus chemotherapy for early stage primary gastric diffuse large B-cell lymphomas (DLBCL).Clinical data of 75 patients who were diagnosed as primary gastric DLBCL between January 1993 and August 2008 in Cancer Institute and Hospital of Tianjin Medical University were reviewed retrospectively.Among these 75 patients, 20 patients received chemotherapy alone and 55 underwent surgical resection plus chemotherapy. Complete remission rates were 65.0% (13/20) and 83.6% (46/55), effective rates were 75.0% (15/20) and 92.7% (51/55), and 5-year survival rates were 86.9% and 78.7% respectively in chemotherapy alone group and resection plus chemotherapy group, while the differences were not statistically significant (all P0.05). Multivariate Cox regression model showed that international prognosis index (IPI) was the only independent prognostic factor (P0.05, HR=11.350, 95%CI:1.011-127.371).In early stage of DLBCL, IPI is the only independent prognostic factor. The clinical outcomes are comparable between chemotherapy alone and surgical resection plus chemotherapy.

To explore the clinicopathological characteristics and prognostic factors of primary gastric lymphoma (PGL).The clinical data of 204 patients with PGL was reviewed and analyzed. There were 106 males and 98 females, their age were 19 to 85 years (average age was 53.7 years). The Focal areas included gastric fundus lesions 41 cases (20.1%), stomach body lesions 127 cases (62.3%), distal gastric lesions 105 cases (51.5%), cardia lesions 13 cases (6.4%), duodenal bulb lesion 1 cases (0.5%). The clinical characteristics and the outcomes in patients with influence were analysed.In 204 PGL patients, the most common complaints were abdominal pain (62.3%) and weight loss (52.9%). Most of the PGL patients appeared ulcerative (76.0%) and results showed that 62.7% patients involved single location. As to the factors of cellulate grading and pathological characteristics, most patients (87.7%) show low-grade or intermediate-grade lymphoma, Musshoff stages I and II (74.0%). In 186 patients with complete follow-up data, survival rates of 1-, 3- and 5-year were 75.8%, 63.4% and 60.2% respectively. The median overall survival time was 50.0 months. In univariate survival analysis, age (χ(2) = 5.030), level of LDH (χ(2) = 40.084), cellulate grading (χ(2) = 35.238), Musshoff stage (χ(2) = 71.601), tumor diameter (χ(2) = 12.018) and option of managements (χ(2) = 14.140) were obviously correlated with the prognosis (all P0.05). Musshoff stage (RR = 2.230, 95%CI: 1.372 - 3.625) and cellulate grading (RR = 1.892, 95%CI: 1.010 - 3.543) were independent prognostic factors in multivariable analysis (both P0.05). There was no prognostic difference between surgery and chemotherapy in stage I and II (χ(2) = 1.223, P = 0.542).Musshoff stage and grade malignancy are independent prognostic factors. For patients with stage I and II, surgical resection is not the first-choice for clinical therapy.

To explore the risk factors for early recurrence (recurrence within 2 years) of proximal gastric cancer after radical resection.The clinical data of 367 proximal gastric cancer patients who underwent radical resection in the Cancer Institute and Hospital of Tianjin Medical University between January 2000 and May 2006 were reviewed. Among them, there are 71 patients (19.3%) with early recurrence. Univariate analysis and multivariate analysis were applied to investigate risk factors for early recurrence.Univariate analysis showed that Borrmann type (P0.01), histology type (P0.01), depth of invasion (P0.05), negative lymph nodes count (P0.05) were risk factors for early recurrence of proximal gastric. On multivariate analysis, histology type (P0.05), depth of invasion (P0.05), negative lymph nodes counts (P0.05) were independent risk factors for early recurrence of proximal gastric cancer. Negative lymph nodes in early recurrence patients were 8.4 ± 7.2, which were significantly less as compared to patients without early recurrence (10.7 ± 8.7) (P0.05).For T3 proximal gastric adenosquamous cancer, extended resection and lymphadenectomy should be considered. Intraoperative or postoperative adjuvant treatment should be administered as routine.

To study the effect o f Bushen Huoxue Decoction (BHD) on neurobiochemical markers in the hippocampus of female rats with repeated immobilization stress.Sixty female rats were randomly divided into the normal group, the model group, the positive control group (treated with Liuwei Dihuang Pill at the dose of 3.3 g crude drug/kg), and the high, middle, and low BHD treated groups (at the dose of 8, 4, 2 g crude drug/kg), ten in each group. Chronic psychological stress was induced using repeated immobilization stress in rats. Medication was conducted by gastrogavage while modeling once a day for twenty successive days. The hippocampal neurohumoral levels were detected with high-performance liquid chromatography. The expression levels of BDNF and its receptor in the hippocampus were detected by Westem blot. Effect of BHD on neurobiochemical markers in the hippocampus of rats with repeated immobilization stress was observed.The levels of Glu, GABA, and BDNF in the hippocampus of the normal group were 1280.0 +/- 258.3 ng/mg, 588.3 +/- 115.1 ng/mg, and 13.26 +/- 2.57 gray value, respectively. But the hippocampal neurohumoral levels and the expression of BDNF in the model group obviously decreased when compared with the normal group, being 1016.9 +/- 215.9 ng/mg, 485.1 +/- 71.0 ng/mg, and 7.23 +/- 0.61 gray value, respectively. The levels of Glu (ng/mg) in hippocampus of the three BHD treated groups were 1459.1 +/- 413.5, 1894.7 +/- 542.8, and 1373.3 +/- 345.7, respectively. GABA levels (ng/mg) inthe hippocampus were 631.6 +/- 161.4, 899.1 +/- 262.1, and 656.4 +/- 140.8, respectively. BDNF levels (gray value) were 16.57 +/- 1.52, 29.85 +/- 1.37, and 24.44 +/- 3.81, respectively, significantly higher than that of the model group (P0.05, P0.01). The level of Glu in the positive control group (1216.5 +/- 193.8 ng/mg) was significantly higher than that of model group (P0.05).BHD showed significant accommodation on the hippocampal neurohumoral levels and the expression of BDNF in the female rats with repeated immobilization stress.

To investigate nourishing-yin effect and mechanism of different parts of Cornu Elaphuri Davidiani in rats.The model of yin asthenia rats was built by thy roxine. The substance metabolism, pain threshold, hormone levels and biochemical indicators in serum were measured.The ethanol extract of Cornu Elaphuri Davidiani could regulate the substance metabolism and raise the pain threshold in yin asthenia model rats. Furthermore, it could regulate the hormone levels, biochemical indicators in serum and it could improvte the antioxidant ability.The ethanol extract of Cornu Elaphuri Davidiani showed significant nourishing-yin effect in rats and the possible mechanism is correlated with regulating the neuroendocrine network.

To evaluate the clinical efficacy of uncut Roux-en-Y reconstruction after distal gastrectomy for gastric cancer.Clinical data of 419 patients who underwent distal gastrectomy for gastric cancer with complete follow-up data between March 2005 and March 2008 in the Cancer Institute and Hospital of Tianjin Medical University. Patients were divided into B I (138 cases with Billroth I reconstruction), M-B II (108 cases with modified Billroth II reconstruction), RY (46 cases with Roux-en-Y reconstruction) and Uncut RY (127 cases with uncut Roux-en-Y reconstruction) according to reconstructive methods.Patients in the Uncut RY group had a larger tumor diameter, more T3, and poorer stage of disease compared to those in the B I (P0.05). In Uncut RY group, the operative time and postoperative hospital stay were(132.6±19.2) minutes and (10.4±1.2) days respectively, shorter than those in RY group (142.5±11.7) minutes and (12.1±3.7) days(both P0.05), alkaline reflex gastritis rate was 3.2%, lower than that in B I group (24.6%, P0.05) and M-B II group (25.9%, P0.05). Marginal ulcer rate in uncut RY group was lower compared to M-B II group (P=0.019), and incidence of Roux-en-Y stasis syndrome was less compared to RY group (P=0.000).The uncut Roux-en-Y reconstruction is both feasible and safe. It can prevent alkaline reflex gastritis and Roux-en-Y stasis syndrome. It may be the preferred technique for reconstruction after distal gastrectomy.

To explore the clinicopathological characteristics and prognostic factors of gastric stump cancer(GSC).The clinical data of 138 patients with GSC treated from January 1992 to July 2008 were reviewed and analyzed. The patients included 122 males and 16 females with a mean age of 61.5 years, and the mean interval between the initial operation and second diagnosis was 21.9 years.The endoscopy and pathological examination showed Borrmann III/IV in 127 (92.7%) patients and undifferentiated carcinoma in 115 (83.3%) patients. The resectability and radical resectability rate were 72.4% and 59.4%. The 1-, 3- and 5-year survival rates was 59.2%, 30.1% and 14.2%, respectively. The median overall survival time was 19.4 months. Univariate Log-rank test indicated that Borrmann type, histological type, tumor diameter, TNM stage, depth of invasion, number of metastatic lymph node, distant metastasis and option of treatment were significant prognostic factors for GSC. While TNM stage, depth of invasion, distant metastasis and option of treatment were prognostic factors on multivariable analysis. The median survival time of patients underwent radical resection was significantly longer (36 months) than that of patients received palliative resection (8 months, P0.05) and chemotherapy only (5 months, P0.05). Among patients with a tumor of T4 stage, the median survival time was statistically prolonged by combined evisceration (18.6 months) when compared with the patients received palliative surgery.TNM stage, depth of invasion, distant metastasis and option of treatment are independent prognostic factors for GSC. Early diagnosis and radical resection may play an important role in improving the prognosis of GSC.

To investigate the risk factors for the prognosis in patients with node-negative gastric cancer.Clinicopathological characteristics of 138 patients with node-negative gastric carcinoma undergoing curative gastrectomy from January 2000 to December 2005 were retrospectively analyzed.The overall 5-year survival rate was 62.4%. The univariate analysis revealed that tumor size, tumor location, cell differentiation, invasive depth, operative type and Lauren histologic type had significant effects on the survival. The independent prognostic factors of these patients were tumor size, cell differentiation, and serosal involvement in multivariate analyses.For node-negative gastric cancer patients, tumor size, poor differentiation and serosal involvement are important markers to evaluate prognosis.

To investigate the clinical features and prognosis of recurrent gastric cancer.Clinical data of 163 patients with recurrent gastric cancer from Jan. 2001 to Jan. 2005 were reviewed. Patients were compared between those with and without symptoms.Seventy-two patients(44.2%) were symptomatic, while 91(55.8%) were asymptomatic. There were significant differences in lymph node metastasis between the two groups(P0.05). The median overall survival was significantly longer in asymptomatic patients (19.8 vs. 15.7 months, P0.05). Post-recurrence survival was also longer in the asymptomatic group (9.5 vs. 4.8 months, P0.01). The median recurrence-free interval in asymptomatic patients was 10.0 months, which was significantly longer than that in the symptomatic patients (9.2 months, P0.05). On univariate survival analysis,post-gastrectomy chemotherapy (P0.05), symptoms of recurrence(P0.01), TNM staging(P0.01), recurrence-free interval (P0.01), and reoperation(P0.01) were associated with the prognosis. On multivariable analysis, TNM staging(P0.01), symptoms of recurrence(P0.01), recurrence-free interval (P0.05), and reoperation(P0.05) were independent risk factors.Patients with recurrent gastric cancer have poor prognosis. Close monitoring and active follow-up of patients with gastric cancer should be conducted during the first two years after operation. Reoperation may improve survival in patients with recurrent gastric cancer.

To evaluate the prognostic significance of preoperative serum albumin in patients with gastric cancer undergoing radical resection.A total of 146 patients with gastric cancer underwent radical resection from January 2001 to December 2003. Clinicopathological data were analyzed retrospectively. Patients were divided into two groups, including patients with a normal preoperative serum albumin level(35 g/L, n=115) and patients with hypoalbuminemia (≤35 g/L, n=31).Patients with a low albumin level were associated with a higher postoperative recurrence rate(90.3% vs. 43.5%, P0.01). The overall 5-year survival rate in patients with a normal serum albumin level was significantly higher than that in patients with a low serum level(57.4% vs. 9.7%, P0.01). On multivariate analysis, preoperative serum albumin level was an independent factor associated with survival(P0.01). When stratified by nodal metastasis, normal serum albumin level was still associated with higher survival rate(P0.05). Prognostic significance was found in patients with lower stomach cancer(P0.01), but not in patients with cancer in the upper and middle stomach(P0.05).Hypoalbuminemia is associated with worse survival in patients with cancer in the lower stomach and adjuvant therapy should be considered.

To investigate the optimal reconstruction technique after total gastrectomy.A total of 159 patients with gastric cancer undergoing total gastrectomy in Tianjin Cancer Hospital between January 2005 and December 2007 were divided into 4 groups according to the reconstruction technique: group A(functional jejunal interposition with a pouch, n=46), group B(modified Braun type II(, n=38), group C (P pouch with Roux-en-Y esophagojejunostomy, n=25), group D(Roux-en-Y esophagojejunostomy, n=50). Quality of life(QOL), nutritional status 1 year after surgery, and perioperative complications were analyzed.There were no significant differences in perioperative complications(P0.05). One year after operation, QOL(Visick index) was better in group A than that in group B, C and D(P0.05), and group D was inferior to group A, B and C(P0.05). The increase in food intake, weight gain, hemoglobin and total protein were better in group A than those in group B, C and D(P0.05) and group D was inferior to group A, B and C(P0.05). The prognostic nutrition index ratio of the four groups were 1.21±0.15, 1.14±0.97, 1.15±0.16, and 1.10±0.16, respectively. Group A was better than that in group B, C and D (P0.05) and group D was inferior to group A, B and C(P0.05). The incidences of dumping syndrome, reflux esophagitis, Roux-en-Y stasis syndrome in group A were 4.3%(2/46), 2.2%(1/46) and 2.2%(1/46), respectively, which were significantly lower than those in other groups (P0.05).Functional jejunal interposition with a pouch is associated with improved nutritional condition and quality of life, and less perioperative complications. It is a reasonable reconstruction method after total gastrectomy.

To analyze the clinical and pathologic influencing factors of early recurrence in patents with gastric cancer after radical gastrectomy.Clinicopathological data of 141 patients with recurrence after curative gastrectomy for gastric cancer from January 2001 to December 2004 were analyzed retrospectively. Risk factors correlated with tumor early recurrence and survival difference between early recurrence group (1 year, 82 cases) and control group (1 year after, 59 cases) were assessed.The 1- and 3-year survival rates of in early recurrence group and control group were 36.6%, 2.4% and 100%, 45.8%, respectively (P0.05). The median survival time after recurrence in the two groups was 3, 5 months, respectively (P0.05). Univariate analysis showed that the age, tumor Borrmann type, tumor site, invasive depth, lymph node metastasis, pTNM stage, metastatic lymph node ratio, surgical procedure and intraperitoneal hyperthermic perfusion chemotherapy (IHPC) were significant factors associated with early recurrence after curative gastrectomy for gastric cancer (P0.05). Lymph node metastasis, metastatic lymph node ratio and IHPC were independent factors associate with early recurrence after curative gastrectomy on multivariate analysis (P0.05).The patients with early recurrence after the radical gastrectomy have a poorer survival compared with cases recur later. Lymph node metastasis, metastatic lymph node ratio and IHPC are independent factors associate with early recurrence after curative gastrectomy for gastric cancer.

To investigate the clinicopathological characteristics, diagnosis, treatment and prognostic factors of gastric gastrointestinal stromal tumors(GIST) in the stomach.The clinicopathological data of 132 patients with gastric GIST between January 1998 and December 2008 were analyzed retrospectively, and the prognostic factors were evaluated.Tumor locations were the cardia or fundus (50, 37.9%), the stomach body (62, 47%),the antrum (13, 9.8%), and two regions were found in 6 cases (4.5%), three regions in 1 cases (0.8%). Tumor size ranged from 1.0 to 27.0 cm with an average of 9.4 cm. All the patients underwent complete tumor resection, including multi-organ resection in 41 cases. Thirty-four cases underwent lymph node dissection. All the lymph nodes were negative. The positive rate was 93.2% (23/132) for CD 117 and 82.6% (109/132) for CD34. The 1-,3- and 5-year survival rates of the 118 cases with follow up were 94.7%, 80.2%, and 56.6%, respectively. Univariate analysis revealed that the differences in Fletcher classification, tumor size, infiltration to surrounding tissue, preoperative metastasis, and adjuvant postoperative therapy with imatinib were related to the survival rates. Multivariate analysis demonstrated that Fletcher classification, preoperative metastasis and adjuvant postoperative therapy with imatinib were independent poor prognostic factors for survival.Preoperative metastasis is an independent factor predicting poor prognosis of gastric GIST. Fletcher classification can be used to evaluate the biological behaviors and prognosis, while surgery is the main therapy and targeted therapy can improve survival of gastric GIST.

To investigate the prognostic factors of primary duodenal adenocarcinoma.The medical records of 67 patients with primary duodenal adenocarcinoma treated in our hospital from January 1990 to December 2005 were retrospectively analyzed. Prognostic factors were analyzed by univariable and multivariable analysis.Of the 67 patients, 38 underwent curative resection and 29 underwent palliative resection. The overall 5-year survival rate was 22.4%. The survival was significantly higher in patients who underwent curative resection (5-year survival 39.5%) than that in those who underwent palliative resection(5-year survival 0) (P0.05). Univariable analysis showed that T-stage, nodal metastasis and tumor stage had significant negative effects on the survival of patients who underwent curative resection. However, multivariable analysis revealed that T-stage and nodal metastasis were significantly associated with survival.Curative resection may improve the survival. T-stage and lymph nodes metastasis are associated with decreased survival.

To investigate the pattern of solitary lymph node metastasis in order to offer more suitable treatment for patients with gastric cancer.Sixty-five patients received operation between July 1999 and June 2004 with only 1 metastatic lymph node identified by postoperative pathological examination were included in the study. Data were analyzed using the statistical software SPSS 13.0.Univariable analysis showed that only the tumor diameter differed significantly between patients with skipping metastatic (SM) lymph node and those without SM (chi(2)=4.447, P=0.035). No clinicopathological factors showed statistically differences between patients with lymph node transverse metastasis (TM) and those without TM. However, both of two comparative groups showed statistically differences in long-term survival (P=0.000, P=0.000).Most lymph node metastasis in gastric cancer follows the rule of "near-to-far", but some special metastasis patterns (SM, TM) are not rare. Proper lymph node dissection especially for patients with high risk should be performed to reduce tumor recurrence and improve long-time survival.

To investigate the clinicopathological features and prognosis of metastatic ovarian tumors from gastric cancer.Clinical data of 68 patients with metastatic ovarian carcinoma were reviewed retrospectively.The median age was 46 years. The majority of these patients was in the premenopausal state (67.6%) and had bilateral ovarian involvement (64.7%). Pathological type was signet-ring cell carcinoma in 52.9% of the cases. Most of them underwent surgical treatment or chemotherapy or both. The median overall survival was 14.1 months, and the median progression-free survival was 6.7 months. The survival rates in 1-, 3- and 5-year were 54.8%, 14.9% and 0, respectively. Univariable analysis revealed that resection of gastric cancer, lymphatic metastasis, pathologic type of metastatic ovarian tumor, extent of metastatic lesion, cytoreductive surgery and chemotherapy for metastatic ovarian carcinoma were associated with the prognosis. Multivariable analysis revealed that cytoreductive surgery and extent of metastatic lesion were independent factors. Patients with metastatic lesion confined to the ovaries had a median overall survival of 16.0 months as compared to 8.6 months for those with more extensive metastases (P0.01), and had a median progression-free survival of 8.2 months as compared to 4.1 months for those with more extensive metastases (P0.05). Patients who underwent optimal cytoreduction(residual lesionor =2 cm) had a median overall survival of 16.0 months as compared to 9.7 months for those who received suboptimal cytoreduction (residual lesion2 cm) ( P0.01). Optimal cytoreduction was also associated with a significantly longer median progression-free survival (11.0 months) as compared to suboptimal cytoreduction median progression-free survival (3.1 months) (P0.01).Prognosis of patients with metastatic ovarian carcinoma from gastric cancer is quite poor. Extent of metastatic lesion is an independent factor. Optimal cytoreduction is associated with improved survival.

To observe restoration of the wrist function and complications of Colles fracture treated with different kinds of external fixation.Two hundreds and seventy-five patients with Colles fracture during March 1998 to Oct 2006 which were fixed with three kinds of external fixation were analyzed retrospectively. Group A: there were 95 patients, 61 male, 34 female, with an average age of (26.2 +/- 0.4) years, fixed by the small moulding plywood on the wrist in mild dorso-extend or neutral position; Group B:90 patients, 61 male, 29 female, with an average age of (24.0 +/- 1.5) years, fixed by the small moulding plywood on the wrist in mild palmar flexion; Group C: 90 patients, 65 male, 25 female, with an average age of (25.0 +/- 2.1) years, fixed by plaster on the wrist in mild dorso-extend or neutral position. According to the Frykaman typing,number of type I to VIII in group A was 25, 31, 20, 11, 3, 2 ,2, 1 in turn,type I to VIII in group B was 22, 30, 17, 9, 4, 4, 2, 2 in turn; type I to VIII in group C was 24, 30, 18, 9, 4, 3, 1, 1 in turn. Comparing the age, sex and the type of fracture, there were no statistical significant differences among three groups. After 6 to 18 months following-up survey, the restoration of the wrist and complication incidence were statistically analyzed.To compare the restoration of the wrist joint and complication incidence after various fixation, there were significant differences between group A and B and C (P0.05) in statistics.The treatment of the Colles fracture by the small moulding plywood fixation on the wrist in mild dorso-extend or neutral position is benefit to restore the wrist joint function and has fewer complications..

To compare the correlation of prognosis with UICC or JGCA lymph node staging criteria for gastric cancer and evaluate the value of application of those two TNM staging systems in prognosis prediction.From January 1996 to December 2005, 395 gastric cancer patients who underwent D2 or D2 plus radical gastrectomy withor = 15 lymph nodes removed were enrolled into this study. The data were analyzed by both UICC and JGCA lymph node staging criteria, respectively. Kaplan-Meier method was applied to analyze the survival rates, and Log-rank test was performed to assess the statistical significance among groups.Compared with the survival curve based on JGCA lymph node staging criteria, UICC lymph node staging system showed a much more significant difference among N subgroups, and similar result was also found in the patients with T3 disease. The N subgroups stratified by UICC criteria were re-staged with JGCA, while the N subgroups by JGCA criteria with UICC. Though the difference among subgroups were not statistically significant in either group, it was greater based on UICC criteria than that based on JGCA. No significant difference was found in the 5-year survival rates of stage I , II, III and IV based on either UICC or JGCA TNM staging criteria.Our results show that UICC staging system is more predictive and relevant to prognosis than JGCA staging system for gastric cancer, and D2 or D2 plus radical gastrectomy with at least or more than 15 lymph nodes removed is required when UICC-TNM gastric cancer staging criteria is applied.

To investigate the protective effects of estrogen on the mitochondria in human umbilical vascular endothelial cells (HUVECs).HUVECs were exposed to H2O2 at 250 micromol/L for 4 h with or without pretreatment with 17-estradiol (E2) and ICI182780. Complex IV activity of the cells was measured with chromometry, and 2, 7-dichlorofluorescein diacetate (DCFH-DA) was used to determine intracellular reactive oxygen species (ROS). Intracellular adenosine triphosphate (ATP) level was quantified with a luciferin- and luciferase-based assay.Compared to the blank control group, H2O2 caused a decrease in complex IV activity, intracellular ATP level, and the cell viability, but elevated intracellular ROS. E2 pretreatment of cells significantly attenuated these effects of H2O2 exposure. ICI182780 administered prior to E2 pretreatment antagonized the protective effects of E2 against H2O2 exposure.E2 offers mitochondrial protective effects on HUVECs, which is mediated by the estrogen receptors.

To analyze the risk factors for interval time, number and pattern of hepatic metastases from gastric cancer after radical gastrectomy, and provide evidence for predicting and preventing hepatic metastasis from gastric cancer after radical gastrectomy.A retrospective study of 87 patients with hepatic metastasis who underwent radical gastrectomy for gastric cancer from 1996 to 2001. The data was analyzed to evaluate significant risk factors for interval time, number and pattern of hepatic metastases originating from gastric cancer after radical gastrectomy.The size of gastric cancer and lymph node metastases were independently correlated with the interval time of hepatic metastases; the depth of invasion was independently correlated with the number of hepatic metastases; while the depth of invasion and Lauren classification were independently correlated with the pattern of hepatic metastases.We evaluated the interval time of hepatic metastases with the size of gastric cancer and lymph node metastases. The depth of invasion could be used to evaluate the number of hepatic metastases, while the depth of invasion and the Lauren classification could be used to evaluate the pattern of hepatic metastases in patients who underwent radical gastrectomy.

To elucidate the prognostic factors of liver metastasis in gastric cancer patients with radical gastrectomy.Clinicopathological data of 87 liver metastasis patients, undergone radical gastrectomy for gastric cancer from 1996 to 2001, were retrospectively analyzed.Of these 87 patients, the 1-, 3- and 5-year survival rates were 28.8%, 3.6% and 0 respectively and the average survival time after gastrectomy was (11.3+/-1.1) months. By univariate analysis, tumor location, tumor size, histologic differentiation, invasive depth, Lauren classification, metastasis of lymph nodes from lymphadenectomy, vascular invasion, nervous invasion, peritoneal metastasis, number of liver metastasis, liver metastatic distribution and resection of liver metastasis were found to be significant factors associated with the prognosis of liver metastatic patients after radical gastrectomy. By multivariate analysis, location, the Lauren classification, liver metastatic distribution and resection of liver metastasis were found to be independent factors associated with hepatic metastasis after radical gastrectomy.Location of gastric cancer, Lauren classification, liver metastatic distribution and resection of liver metastasis are important factors to evaluate the prognosis of liver metastasis in gastric cancer patients with radical gastrectomy.

To examine the relationship between the dissected lymph-node number and the prognosis in D(2) gastrectomy for gastric cancer.From January 1996 to January 2005, 457 patients with primary gastric cancer undergone gastrectomy with different extent of lymphadenectomy in our hospital were followed-up in term of prognostic benefit.In lymph-node metastasis group, the 1-, 3-, 5-year survival rates were 82.4%, 49.0%, 33.4% with dissection of20 nodes and 71.5%, 49.7%, 40.1% with dissection of 16-20 nodes. In the group without lymph-node metastasis, the 1-, 3-, 5-year survival rates were 98.2%, 92.7%, 84.7% with dissection of20 nodes and 94.0%, 89.7%, 81.4% with dissection of 16-20 nodes. Whether or not it had lymph-node metastasis, the survival curve failed to show any significant difference with regard to the extent of lymph node dissection.As to lymphadenectomy for gastric cancer, it is enough to excise the lymph node between 16 and 20. The number of excised lymph node should not be overemphasized unless it is metastasized.

To examine the relationship of biologic behavior and prognosis in patients with gastric carcinoid.A total of 26 gastric carcinoid patients proven by pathology from Jan. 1964 to Jan. 2005 were enrolled. All the patients survived after operations. Tumor size, invasion depth, regional lymph node metastasis, liver metastasis, adjuvant chemotherapy and 5-year survival were analyzed retrospectively. A univariate analysis of survival rate with respect to gastric wall infiltration, regional lymph node metastasis, liver metastasis, and adjuvant chemotherapy were accomplished by Kaplan-Meier estimation method. The Log-rank test was used to evaluate the level of significance.The average age of 26 patients was 58 years. Infiltration beyond the serosa occurred in 18 patients (69.2%), and regional lymph node metastases in 12 patients (46.2%). During the follow-up period, liver metastases occurred in 14 patients (53.8%). Tumor size was not associated with gastric serosa invasion, regional lymph node metastasis, liver metastasis and 5-year survival (P0.05). Analysis of cumulative survival showed different survival time depending on gastric serosa invasion, regional lymph node metastasis and liver metastasis. The difference was significant (P0.05). In patients with gastric serosa invasion, regional lymph node metastasis and liver metastasis, estimated 5-year cumulative survivals were 16.7%, 16.7% and 0 respectively. Their prognosis was poor. Adjuvant chemotherapy was administrated in 10 patients (38.5%) and was not beneficial to prolong the survival time and increase the 5-year survival rate. The difference was not statistically significant (P0.05).Surgical resection is the major strategy for the treatment of gastric carcinoid, and adjuvant chemotherapy is not proved to produce obvious effects. The prognosis of gastric carcinoid depends on the tumor infiltration of gastric wall, regional metastasis and liver metastasis.

To evaluate the correlations between extranodal metastasis(EM)and clinicopathologic features of gastric cancer and the relationship between EM and prognosis of gastric cancer.Data of patients with histologically proven adenocarcinoma were studied retrospectively to evaluate the prognostic factors in gastric cancer by univariate and multivariate analyses of Cox regression with SPSS 13.0 software. Two hundred and seventy-six patients with primary gastric cancer undergone operation in Tianjin Cancer Hospital from Jan. 2001 to Dec. 2001 were studied and followed up until Dec. 2006 or death.EMs were found in 58(21.0%) of the 276 patients. The overall 2-, 3-, and 5-year survival rates of the patients without EM were 71.2%, 55.4%, and 45.1% respectively. The overall 2-, 3-, and 5-year survival rates of the patients with EM were 24.1%, 15.5%, and 8.0% respectively. Postoperative overall survival rates were significantly lower for patients with EM than those without EM(P=0.000). EM was correlated with differentiation (r=0.163, P=0.008), invasive depth (r=0.215, P=0.003), lymph node metastasis (r=0.368, P=0.000), distant metastasis (r=0.375, P=0.000), advanced stage(r=0.441, P=0.000), and tumor size (r=0.167, P=0.007). Multivariate analysis identified EM as an independent prognostic factor.EM is correlated with many clinicopathological features of gastric cancer. EM is an independent prognostic factor of gastric cancer.

To identify prognostic factors predicting survival after radical resection of ampullary carcinoma.Clinical data of sixty- five patients with cancer of the ampulla of Vater underwent pancreaticoduodenectomy and regional lymphadenectomy were analyzed retrospectively.A total of 1380 lymph nodes dissected from the resected specimens was examined to detect the presence of metastasis. The median follow- up period was 83 months. Univariate analysis revealed that factors associated with poor survival included the number and the location of positive nodes. Thirty- three of the 65 patients had a total of 116 positive lymph nodes, of whom 20 had 1- 3 positive regional nodes lymph and 13 hador = 4 positive regional lymph nodes. Multivariate analysis revealed that the number of positive nodes lymph was an independent prognostic factor (P=0.007), while the locations of lymph nodes failed to remain as an independent variable. The survival rate in patients withor = 4 positive lymph nodes was significantly lower than that in those with 1- 3 positive lymph nodes. The median survival time was 49 months with a 5- year survival rate of 43% in patients with 1- 3 positive lymph nodes, whereas all patients withor = 4 positive nodes died of the disease within 23 months after resection (P=0.0001).The number of positive regional lymph nodes is an independent prognostic factor in patients with ampullary carcinoma after resection.

Aim To evaluate effects of reconstruction procedures on post-operative outcomes and nutritional status after total gastrectomy. Methods The study group comprised 704 consecutive patients with gastric cancer who underwent total gastrectomy between December 1985 and December 2003. Six alimentary reconstruction procedures were performed, including jejunal continuity [Braun, modified Braun I and II and functional jejunal interposition (FJI)] and jejunum transection [“P” Roux-en-Y and “P” jejunal interposition (PJI)]. The duodenal food passage was maintained only by FJI and PJI. We evaluated the time interval to restore food intake after surgery and the incidence of complications and nutritional status for 12 months. Results Patients who received jejunum transection required 7.8 ± 2.5 days and 11.9 ± 4.9 days to restore liquid and semi-liquid food intake, respectively, which reduced to 3.9 ± 2.1 days for liquid and 7.9 ± 3.9 days for semi-liquid food intake by jejunum continuity. The incidence rates of reflux esophagitis and Roux-en-Y syndrome in patients receiving jejunum transection were 23.5% and 42.4%, respectively, which were decreased to 9.35% and 14.7%, respectively, by jejunal continuity. Furthermore, prognostic nutrition index score of patients receiving the procedures maintaining duodenal food passage (52.9 ± 10.9) was higher than that of patients without the duodenal food passage (46.7 ± 8.2). Conclusion Jejunal continuity and duodenal food passage showed beneficial effects on clinical outcomes after surgery. Among these six procedures, FJI was the only procedure to combine the benefits of jejunal continuity and maintaining the duodenal food passage, indicating that FJI has potential clinical application to improve the quality of patient's life after total gastrectomy.

To investigate determinants of long-term survival for carcinoma of ampulla of Vater treated by local resection.The clinical and pathological data of 38 such patients treated by local resection from 1983 to 2003 were retrospectively analyzed. According to UICC staging system, there were T1 30, T2 7 and T3 1. Lymph nodes were involved in 4 during operation which was present in primary lesions larger than 2 cm across. All patients were treated by local resection. At first, external palpation was carried out to ascertain accessibility. Then with the duodenum opened, direct exploration was carried out. On deciding for resection, the common bile duct was probe explored which guided the circumferential ring resection 1 cm, away from the tumor, including all layers of duodenum, ampula and partial bile and terminal pancreatic ducts and the posterial wall of duodenum was completed in steps. Meticulous care was taken not to suture the pancreatic duct and endotheliation was ensured at the mouth of common bile duct and duodenum. The basal tissue was frozen sectioned to ensure negative stumps. The gall bladder of 6 patients was also resected. SPSS 10.0 software was used in data processing, log-rank test used in univariate analysis and Cox equation for multivariate analysis and Kaplan-Meirer method for the survival rates.Thirty-eight patients received local resection giving an operative mortality of 0% and morbidity of 13.2%. The 1-, 5- and 10-year survival rate was 83.5%, 51.4%, and 38.9%, respectively, with a median survival of 3.35 years. Up to now, 13 patients have survived for more than five years and 2 patients beyond ten years. The tumour size, tumour grading, lymph node status and UICC stage were significant prognostic factors in univariate analysis. However, only lymph node status was a statistically independent predictor of prognosis in multivariate analysis.Local excision is safe giving low morbidity and good survival in carefully selected cases. Preferably it is indicated only in high risk patients with a pT1 and well differentiated ampullary cancer smaller than 1 cm in diameter.

Objective The aim of this study was to investigate the prognostic value of metastatic lymph node ratio (LNR) in patients having radical resection for stage III gastric cancer. Methods A total of 365 patients with stage III gastric cancer who underwent radical resection between 2002 and 2008 at Tianjin Medical University Cancer Institute and Hospital were analyzed. The cut-point survival analysis was adopted to determine the appropriate cutoffs for LNR. Kaplan–Meier survival curves and log-rank tests were used for the survival analysis. Results By cut-point survival analysis, the LNR staging system was generated using 0.25 and 0.50 as the cutoff values. Pearson's correlation test revealed that the LNR was related with metastatic lymph nodes but not related with total harvested lymph nodes. Cox regression analysis showed that depth of invasion and LNR were the independent predictors of survival (p