Objective To investigate the safety and efficiency of a blood glucose control method in diabetic patients with gastrointestinal neoplasm who were subjected to postoperative early enteral nutrition (EEN). Methods Thirty-seven diabetic patients with gastrointestinal neoplasm received enteral nutriment——Glucerna SR through nasojejunal tubes 24 hours after operation. The blood glucose level was safely controlled through injecting insulin intravenously and subcutaneously. Meanwhile, any change of blood and urine glucose level was monitored and the indexes representing the levels of nutrition, biochemistry and immunity were measured before the implementation of EN, 5 d and 8 d of EN after operation, respectively. Results All the patients were able to bear EEN and there was no severe complications occurred. Significant increase of serum levels of albumin, prealbumin and transferrin were observed after EEN support （P＜0.05）, as well as the serum levels of IgG， IgA and IgM （P＜0.01）. However, body weight， HGB and the serum levels of ALT and TBIL showed no significant changes （Pgt;0.05）. There were 81.1%（30/37） of patients whose blood glucose levels were controlled steadily within the range of (7.8±1.1) mmol/L. Conclusion Injecting insulin intravenously and subcutaneously after operation may be a safe and effective method to control blood glucose level. And the postoperative implementation of EEN can be considered as the first choice of nutrition support for diabetic patients with gastrointestinal neoplasm.
Objective To discuss the CT appearances and clinicopathologic features of gastrointestinal neuroendocrine neoplasms (GI-NENs). Method The clinical and CT materials of 33 cases of GI-NENs who treated in our hospital from Jan. 2013 to Dec. 2015 were retrospectively analyzed. Results Of the 33 cases, 25 males and 8 females were enrolled. The median age was 62-year old (27–78 years), and the age at diagnosis mainly focused in the 50–70 years period. GI-NENs situation: 12 cases in the stomach, 11 cases in the rectum, 3 cases in the esophagus and colon respectively, 2 cases in the duodenum and appendix respectively. The main clinical symptoms included: abdominal pain in 13 cases, dysphagia and obstruction in 9 cases, hematemesis and hematochezia in 8 cases, abdominal distention in 5 cases, stool and bowel habits change in 5 cases, subxyphoid pain in 3 cases, belching in 2 cases, diarrhea in 1 case, protrusion of the neoplasm when defecation in 1 case, obstructive jaundice in 1 case. Seven cases of G1 grade, 6 cases of G2 grade, 15 cases of G3 grade, and 5 cases of mixed adenoneuroendocrine carcinomas were found according to pathologic grading. The immunohistochemical marker: synaptophsin was positive in 31 cases, cytokeratin A was positive in 23 cases, and cytokeratin was positive in 9 cases. The CT appearances of GI-NENs were mainly thickening of the walls and formation of nodules or masses in local area. Moderately homogeneous enhancement (in 20 cases) and irregularly heterogeneous enhancement (in 13 cases) were both commonly seen. In addition, 13 cases of lymphadenophathy, 6 cases of liver metastasis, and 3 cases of lung metastasis were also detected by CT. Conclusions GI-NENs have a preference for elderly male. The most common site of onset is the stomach. Its clinical symptoms and CT appearances are nonspecific, however, the enhancement pattern of the tumors has a certain characteristic.
ObjectiveTo analyze the reasons for misdiagnosis of gastrointestinal metastatic ovarian cancer, in order to increase the rate of correct diagnosis and treatment, and to investigate the prognostic factors. MethodsWe retrospectively analyzed the clinical features, pathological features and prognostic factors of 43 cases of metastatic ovarian carcinoma from gastrointestinal tract treated between 2004 and 2014. ResultsGastrointestinal metastatic ovarian cancer was characterized by the diversity of clinical manifestations and lack of specific symptoms. The common initial symptom was pelvic mass, frequently accompanied with gastrointestinal symptoms of ascites, anemia or weight loss, abdominal pain, bloating, gastrointestinal obstruction and bleeding. Signs and symptoms of primary and secondary tumor sites often coexisted with each other, leading to misdiagnosis. Univariate analysis showed that primary site, histological type, surgical treatment, the residual tumor debulking size, lymph node metastasis, tumor invasion and standard chemotherapy had significant impacts on the prognosis (P < 0.05). ConclusionsGastrointestinal metastatic ovarian cancer occurs in premenopausal women, often with ascites, abdominal pelvic masses as the first symptom. Primary tumor site is often ignored, and the initial correct diagnosis rate is low. Metastasis from stomach cancer is the most common, followed by colorectal cancer and esophageal cancer. Prognosis is correlated with the primary site, histological type, degree of differentiation, depth of invasion, lymph node metastasis and other factors. Radical surgery and chemotherapy can improve survival.
Objective to determine the modulus of elasticity (E) of small intestinal submucosa (SIS), a new biological graft material. Methods The longitudinal tensile testing was performed on 21 specimens of canine jejunum with the electronic material test machine. Results Stress (σ)strain (ε) data were obtained. It was found that the stress (σ)strain (ε) data fitted the expressionσ＝Kεα very well, the mean correlation coefficients R2 was0.991 6.Then the expression of the modulus of elasticity (E) of SIS was E=K1/ασ1-1/α. The mean values of α and K were 3.966 9 and 374.55，so E=4.3992σ0.75. Conclusion The modulus of elasticity was found to increase with increasing stress. The variations law is similar to that of the vessels. Furthermore when σ is 001333 MPa(100 mmHg),E is about 0.16 MPa, which is similar to that of the vessels.
Objectives To summarize the regulation of glucagon-like peptide-1（GLP-1） level by metabolism of gastrointestinal nutrients. Methods Domestic and international publications online involving regulation of GLP-1 level by metabolism of gastrointestinal nutrients in recent years were collected and reviewed. Results GLP-1 influenced insulin secretion and sensitivity， and played a leading role in recovery of glucose metabolism. Metabolism of gastrointestinal nutrients regulated GLP-1 level. Studies had shown that GLP-1 was a candidate mediator of the effects of gastric bypass （GBP） for type 2 diabetes mellitus（T2DM）. Conclusions It plays an important role in anti-T2DM effects of GBP that metabolism of gastrointestinal nutrients regulated GLP-1 level. The corresponding studies can provide a novel clinical field to treat T2DM.
Objective To investigate the medication advancement of gastrointestinal polyposis in patients with Peutz-Jeghers syndrome (PJS). Methods Literatures about the medication advancement on gastrointestinal polyposis of PJS were reviewed and analyzed. The recent development of targeting drugs, especially the data of cyclooxygenase-2 selective inhibitors and rapamycin, were emphatically summarized. Results With the deep investigation of PJS and application of selective drugs, the medication of gastrointestinal polyposis in cases of PJS has got more advancement. The extensive use of synthetic cyclooxygenase-2 inhibitors and rapamycin in clinic developed a new way to treat gastrointestinal polyposis of PJS. Conclusion The cyclooxygenase-2 selective inhibitors and rapamycin have the following features: noninvasive, high selectivity and good curative effects. They have splendid prospects in the clinical treatment of gastrointestinal polyposis in patients with PJS and are bring the treatment of gastrointestinal polyposis in cases of PJS into a targeting therapy phase.
Objective To summarize the important role of sirtuin type 1 (SIRT1) in the development of gastrointestinal tumors. Methods Domestic and international publications related to biological functions of SIRT1 and its role in gastrointestinal tumors in recent years were collected and reviewed. Results SIRT1 had a significant high expression in esophageal cancer, gastric cancer, colorectal cancer, liver cancer, and pancreatic cancer tissues, by associating with long noncoding RNA (LncRNA), microRNA, and autophagy. It affected the occurrence and development of gastrointestinal tumors. Conclusions Abnormal expression of SIRT1 is closely related to the occurrence and development of gastrointestinal tumors.
【Abstract】Objective To introduce the current studies of the role of vascular endothelial growth factorC (VEGFC) and VEGFD in lymphangiogenesis and lymph node metastasis of gastrointestinal neoplasma. Methods The related literatures in recent 5 years were reviewed. Results The growth factors VEGFC and VEGFD enhance lymphangiogenic metastasis of gastrointestinal neoplasma with the property of angiogenesis and lymphangiogenesis. In gastric adenocarcinoma, VEGFC mRNA and tissue protein expression correlate with lymphatic invasion, lymph node metastasis, venous invasion and reduced 5year survival rates. The role of VEGFC in esophageal squamous cancer and colorectal cancer and VEGFD in colorectal cancer is not certain, with conflicting reports in the published literatures.Conclusion The VEGFC, VEGFD/VEGFR3 signal pathway may become the ideal target for inhibition of tumor proliferation and metastases, antilymphangiogenesis therapy may be a novel potential strategy in tumor biological therapy.
Objective To study the construction feasibility of a biodegradable artificial esophagus by the squamous epithelial cells and the myoblast cells seeded on the small intestinal submucosa(SIS) and to investigate the growth patternand angiogenesis of the co-cultured human embryonic squamous epithelial cells and the skeletal myoblasts in vivo. Methods The squamous epithelial cells and the myoblast cells were obtained from the 20-week aborted fetus. Both of their cellswere marked by 5-BrdU in vitro.The isolated cells were then seeded on the SIS and co-cultured in vitro for 24 hours, and then the compound of the cells and the SIS was transplanted into the subcutaneous tissue of the athymismus mice. The observation on the morphology and the cytokeratin AE3 and α-actin specified immunohistochemistry of the squamous epithelial cells and the myoblastcells was performed at each of the following time points: 3 days, 1 week, 2 weeks, and 3 weeks after transplantation. Results The morphological observation indicated that the cultured cells could penetrate into the small intestinal submucosa and form several-layered cell structures, and that the compound of the cells and the SIS could have angiogenesis within 2-3 weeks. The 5-BrdU specified immunohistochemical observation suggested that the cells growing in the small intestinal submucosa scaffold might be the cells transplanted.The cytokeratin AE3 specified and α-actin specified immunohistochemical studies demonstrated that the transplanted cells could differentiate in vivo. Conclusion It is possible to fabricate the framework of a biodegradable artificial esophagus with the epithelial cells and the myoblast cells seeded on the small intestinal submucosa.
摘要:目的: 探讨早期肠内营养支持在胃肠道恶性肿瘤术后患者中应用的临床效果。 方法 :54 例胃肠道恶性肿瘤行根治手术的患者,随机分为对照组和研究组,分别接受肠外营养支持(PN)和肠内营养支持(EN)。比较两组治疗前后的血清白蛋白、前白蛋白和转铁蛋白水平,肝肾功能指标,胃肠功能恢复时间以及并发症的发生率。 结果 :经过术后7 d 的营养支持治疗,EN组术后血清前白蛋白、转铁蛋白水平升高程度明显大于PN组,胃肠功能较PN组更快恢复。在术后并发症的发生率和肝肾功能指标方面两组没有显著性差异。 结论 :早期肠内营养支持能够安全有效地促进胃肠道肿瘤术后患者的恢复。Abstract: Objective: To investigate the clinical effect of early enteral nutrition (EN) support on postoperative patients with gastrointestinal malignancy. Methods : A total of 54 postoperative patients with gastrointestinal malignancy were randomly divided into EN group and parenteral (PN) group. Both groups received isocaloric and isonitrogen nutrition support. The serum albumin, transferrin, prealbumin and liver and renal function were measured using standard techniques. The gastrointestinal function and postoperative complications were evaluated. Results : After nutrition support, serum albumin was not significantly different between two groups. Compared with PN group, serum transferrin and prealbumin level significantly increased in EN group (P＜005). The gastrointestinal function in EN group resumed earlier than that in PN group. There was also no difference in liver and renal function and postoperative complications between two groups. Conclusion : The application of early enteral nutrition support is beneficial to the recovery of the gastrointestinal cancer patients after surgery.