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BACKGROUND: Lymph node metastasis (LNM) status is an important prognostic factor that strongly influences the treatment decision of early gastric cancer (EGC). This study aimed to evaluate the pattern and clinical significance of LNM in EGC. METHODS: A total of 354 patients with carcinoma in situ (n = 42), EGC (n = 312) who underwent radical gastrectomy were enrolled. Their clinicopathological features, pathological reports, and prognostic data were collected and analyzed. RESULTS: The incidence of LNM in all patients was 18.36% (65/354). The rates of D1 and D2 station metastases were 12.10% (43/354) and 6.21% (22/354), respectively. The rates of LNM in absolute indication of endoscopic resection and expanded indication were 3.27% (2/61) and 28.55% (4/14), respectively. Skip LNM was observed in 3.67% (13/354) of patients. For those with middle-third tumor, the metastasis rate of the No. 5 lymph node was 3.05% (5/164). The independent risk factors for LNM were tumors measuring > 30 mm, poorly differentiated tumors, and lymphovascular invasion (all P < 0.05; area under the curve, 0.783). The 5-year disease-free survival rates of patients with and without LNM were 96.26 and 79.17%, respectively (P = 0.011). Tumors measuring > 20 mm and LNM were independent predictive factors for poor survival outcome in all patients. CONCLUSIONS: Patients with EGC conforming to expanded indications have a relatively high risk of LNM and may not be suitable for endoscopic submucosal dissection. Pylorus-preserving gastrectomy for patients with middle-third EGC remains controversial due to the high metastasis rate of the No. 5 lymph node.
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Carcinoma in Situ , Metástasis Linfática , Tratamientos Conservadores del Órgano , Píloro , Neoplasias Gástricas , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Carcinoma in Situ/patología , Carcinoma in Situ/cirugía , Supervivencia sin Enfermedad , Femenino , Gastrectomía/métodos , Gastroscopía , Humanos , Incidencia , Ganglios Linfáticos/patología , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , Carga Tumoral , Adulto JovenRESUMEN
Objective:To assess the characteristics change of sleep architecture in drug naive patients with schizophrenia,compared with healthy control.Methods:The key words including schizophrenia and sleep architecture (or sleep structure or sleep disturbance or polysomnogram and so on) were used to search literatures in MEDLINE,Embase,Springer,PsychINFO,google scholar,Wanfang data,published from 1980 to 2015.Fifteen studies that compared sleep architecture in drug naive patients with schizophrenia and healthy control were included.Literature quality evaluation was performed with the Newcastle-Ottawa Scale.The meta-analysis was performed by using Stata13.0 software.Results:Compared to healthy control,the total sleep time decreased (P ＜ 0.01),the sleep latency increased (P ＜ 0.01),the sleep efficiency decreased (P ＜ 0.01),and the rapid-eye-movemem (REM) sleep latency increased (P ＜ 0.01) significantly in drug naive patients with schizophrenia.The proportion of stage1 was increased,and the proportions of stage4 and slow wave sleep stage were decreased,the differences between case and control were statistically significant.Conclusion:In the control of drug effects,patients with schizophrenia may have poorer sleep quality of be poorer than healthy controls,such as the decreased total sleep time,specifically slow wave sleep,prolonged sleep latency and decreased sleep efficiency.
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Objective To discuss the standard of endoscopic diagnosis of duodenal white spot syndrome and to test its accuracy by pathological diagnosis standard. Methods A total of 6,995 patients undergoing gastroscopy were detailedly examined through gastrofiberscope or electrogastroscope and endoscopic diagnosis were made by the standard of endoscopic diagnosis of duodenal white spot syndrome. Then, pathological examination was done to test and verify the accuracy of the standard of endoscopic diagnosis. Results There were 533 patients suffering from duodenal white spot pathological changes, accounting for 7.62%. And duodenal mucositis was confirmed by pathological findings in all 90 cases of the patients undergone their biopsy at the same time. Conclusions The appropriate standard of endoscopic diagnosis can improve the detection rate of duodenal white spot syndrome and there is a high coincidence rate between endoscopic diagnosis and pathological diagnosis.
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Pseudomonas aureofaciens grown on octanoate or gluconate synthesized medium-chain-length polyhydroxyalkanoates (mcl-PHAs). To clone the PHA synthase gene(s) (phaC), the genomic library of P. aureofaciens was constructed using a cosmid vector. The recombinant cosmids that clone phaC were detected by the complementation with a PHA-negative mutant, P. putida GPp104. The resulting recombinant cosmid, named pVK6, contained a 13-kbp DNA insert. Genetic analysis of the pha locus in pVK6 revealed the presence of six ORFs, genes encoding two PHA synthases, 1 and 2 (phaC1 and phaC2), PHA depolymerase (phaZ), two PHA granule-associated proteins (phaF and phaI), and an unknown protein (phaD). The heterologous expression of pha genes from P. aureofaciens was confirmed. P. putida GPp104 regained the ability to accumulate PHA on introduction of pVK6. Wild-type strains P. oleovorans and P. fluorescens, which were unable to accumulate PHA when grown on gluconate, acquired the ability to accumulate PHA from gluconate when they possessed pVK6.
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Aciltransferasas/genética , Pseudomonas/genética , Aciltransferasas/metabolismo , Secuencia de Bases , Clonación Molecular , Biblioteca de Genes , Prueba de Complementación Genética , Datos de Secuencia Molecular , Poliésteres/metabolismo , Pseudomonas/enzimología , Análisis de Secuencia de ADNRESUMEN
The crux of medical moral education into training the medical moral concept of medical students. From psycholgical aspect,this paper analyzes the levels and structures of medical concept,and suggests its corresponding training method.