Objective To investigate the expressions of Ki67 and PTEN protein in human gastric atypical hyperplasia and carcinoma, and to explore their relations with gastric canceration and the possibility of being early biological markers. Methods The expressions Ki67 and PTEN protein were detected by using immunohistochemical staining SP method in 22 cases of normal gastric tissues and 80 cases of atypical hyperplasia and 60 cases of gastric carcinoma. Results The positive expression level of PTEN in normal gastric tissue was higher than that in atypical hyperplasia tissue, with the lowest level in gastric carcinoma, whereas, it was opposite for the expressions of Ki67 in these samples. The positive expression rates of PTEN and Ki67 were both well related with pathological grading of gastric tissues (r=-0.461 and 0.301， respectively， P＜0.01). The expression of PTEN was not obviously related with Lauren type, infiltration degree and differentiation level of gastric carcinoma, but it was associated with lymph node metastasis. For Ki67, it was found that there were correlations between the expression of Ki67 and Lauren type， lymph node metastasis， but not with infiltration degree， differentiation level of gastric carcinoma. Negative correlation was found between the expressions of PTEN and Ki67 protein in gastric carcinoma (r=-0.316， P＜0.05). Conclusion Abnormal expressions of Ki67 and PTEN protein were associated with canceration in stomach. Therefore, both of them may act as useful biomarkers for early detection of gastric carcinoma.
Objective To investigate the relationship of p53 codon 72 polymorphism and susceptibility to gastric cancer in high incidence area of Hexi area of Gansu province. Methods The Arg/Pro polymorphism of p53 gene was detected by real-time PCR in 140 patients with gastric cancer, 110 patients with gastric precancerous lesion and 125 healthy controls; Helicobacter pylori (Hp) infection was detected by Warthin-Starry silver method． Results The Pro allele frequencies of p53 gene in gastric cancer cases (0.543) were higher than those in gastric precancerous lesion (0.482) and controls (0.472). The Pro genotype had a more than 1.846 fold increased risk of gastric cancer 〔OR=1.846; 95% 〗CI (1.006-3.387); P =0.046〕． With statistical analysis， the genotype of p53 gene was correlated with location and Laurens histological type （ P ＜ 0.05）. A significantly higher risk of gastric cancer was also seen in cases with p53 Pro genotype, food, Hp infection, positive mind factor and positive family history． Conclusion There is a b correlation between the p53 gene codon 72 Arg/Pro polymophism and susceptibility to gastric cancer in Hexi area of Gansu province and the Pro/Pro genotype may be one of the major risk factors in patients with gastric cancer.
Objective To analyze the preoperative diagnosis and the operative methods for different types of Mirizzi syndrome (MS). Methods Eighty-six cases of MS confirmed by operation were enrolled from March 1990 to December 2008. Their laboratory examination results and X-ray appearances of endoscopic retrograde cholangiopancreatography (ERCP) were analyzed as well as B-ultrasonography (B-us), CT scan and magnetic resonance cholangiopancreatography (MRCP). According to the Csendes typing, different operative methods were adopted. Results The final diagnosis rate by ERCP for MS attained approximately 85.71% (48/56) in contrast with 17.44% (15/86) by B-us, with 9.52% (4/42) by CT scan and with 71.88%（23/32） by MRCP. Twenty cases were Csendes type Ⅰ, 43 cases were type Ⅱ, 17 cases were type Ⅲ, and 6 cases were type Ⅳ. According to the Csendes typing, the cases of type Ⅰ were treated by for the cholecystectomy or partial resection for reserving the neck of gallbladder, type Ⅱ by fistula reparation and laying up the T type drainage-tube under the fistula, and type Ⅲ and type Ⅳ by the hepaticocholangiojejunostomy and hepaticoduodenostomy. Conclusion The preoperative diagnosis for MS is very difficult, B-us may be acted as an accessory diagnostic method. ERCP and MRCP can improve the rate of preoperative diagnosis for MS strikingly. The best reasonable method of the operative therapy is selected according to the different pathologic type of MS.
Objective To investigate clinical application and safety evaluation of sedative demulcent anesthesia in therapeutic endoscopic retrograde cholangiopancreatography (ERCP).Methods Totally 1660 patients underwent ERCP at the First Hospital of Lanzhou University were prospectively divided into two groups: venous sedative demulcent group (n=800, using sufentanil and midazolam and propofol continuing infusion) and conventional sedative demulcent group (n=860, using common medicine). The heart rate (HR), respiration (R), blood pressure (BP) and peripheral oxygen saturation (SpO2) of pre-anesthesia, post-anesthesia, during operation and after analepsia in every group were detected. The narcotism was evaluated by Ramsaymin grading method and the related adverse reactions such as cough, restlessness, harmful memory, and abdominal pain after operation were recorded. Results Compared with conventional sedative demulcent group, vital signs of patients in venous sedative demulcent group were more stable. For postoperative adverse reactions, abdominal pain, abdominal distension and nausea and vomiting were respectively 4.4%(35/800), 2.6%(21/800) and 3.6%(29/800) in venous sedative demulcent group, which were respectively higher of the incidence of 36.3%(312/860), 49.0%(421/860) and 53.0%(456/860) in conventional sedative demulcent group (P＜0.01). The postoperative satisfaction and adverse reactions recall between venous sedative demulcent group and conventional sedative demulcent group was respectively significant different (96.9% vs. 2.9%, 4.8% vs. 97.9%, P＜0.01). Conclusion Sufentanil and midazolam and propofol continuing infusion have good effect of sedative demulcent anesthesia, which can be widely used.