Diagnosis of poorly differentiated adenocarcinoma of the stomach by confocal laser endomicroscopy:A case report

BACKGROUND In recent years,confocal laser endomicroscopy(CLE)has become a new endoscopic imaging technology at the microscopic level,which is extensively performed for real-time in vivo histological examination.CLE can be performed to distinguish benign from malignant lesions.In this study,we diagnosed using CLE an asymptomatic patient with poorly differentiated gastric adenocarcinoma.CASE SUMMARY A 63-year-old woman was diagnosed with gastric mucosal lesions,which may be gastric cancer,in the small curvature of the stomach by gastroscopy.She consented to undergo CLE for morphological observation of the gastric mucosa.Through the combination of CLE diagnosis and postoperative pathology,the intraoperative CLE diagnosis was considered to be reliable.According to our experience,CLE can be performed as the first choice for the diagnosis of gastric cancer.CONCLUSION CLE has several advantages over pathological diagnosis.We believe that CLE has great potential in the diagnosis of benign and malignant gastric lesions.

Risk stratification for radioactive iodine refractoriness using molecular alterations in distant metastatic differentiated thyroid cancer

Objective: Patients with radioactive iodine-refractory differentiated thyroid cancer(RAIR-DTC) are often diagnosed with delay and constrained to limited treatment options. The correlation between RAI refractoriness and the underlying genetic characteristics has not been extensively studied.Methods: Adult patients with distant metastatic DTC were enrolled and assigned to undergo next-generation sequencing of a customized 26-gene panel(Thyro Lead). Patients were classified into RAIR-DTC or non-RAIR groups to determine the differences in clinicopathological and molecular characteristics. Molecular risk stratification(MRS) was constructed based on the association between molecular alterations identified and RAI refractoriness, and the results were classified as high, intermediate or low MRS.Results: A total of 220 patients with distant metastases were included, 63.2% of whom were identified as RAIRDTC. Genetic alterations were identified in 90% of all the patients, with BRAF(59.7% vs. 17.3%), TERT promoter(43.9% vs. 7.4%), and TP53 mutations(11.5% vs. 3.7%) being more prevalent in the RAIR-DTC group than in the non-RAIR group, except for RET fusions(15.8% vs. 39.5%), which had the opposite pattern. BRAF and TERT promoter are independent predictors of RAIR-DTC, accounting for 67.6% of patients with RAIR-DTC. MRS was strongly associated with RAI refractoriness(P<0.001), with an odds ratio(OR) of high to low MRS of 7.52 [95%confidence interval(95% CI), 3.96-14.28;P<0.001] and an OR of intermediate to low MRS of 3.20(95% CI,1.01-10.14;P=0.041).Conclusions: Molecular alterations were associated with RAI refractoriness, with BRAF and TERT promoter mutations being the predominant contributors, followed by TP53 and DICER1 mutations. MRS might serve as a valuable tool for both prognosticating clinical outcomes and directing precision-based therapeutic interventions.

Highly Differentiated Target Detection under Extremely Low-Light Conditions Based on Improved YOLOX Model

This paper expounds upon a novel target detection methodology distinguished by its elevated discriminatory efficacy,specifically tailored for environments characterized by markedly low luminance levels.Conventional methodologies struggle with the challenges posed by luminosity fluctuations,especially in settings characterized by diminished radiance,further exacerbated by the utilization of suboptimal imaging instrumentation.The envisioned approach mandates a departure from the conventional YOLOX model,which exhibits inadequacies in mitigating these challenges.To enhance the efficacy of this approach in low-light conditions,the dehazing algorithm undergoes refinement,effecting a discerning regulation of the transmission rate at the pixel level,reducing it to values below 0.5,thereby resulting in an augmentation of image contrast.Subsequently,the coiflet wavelet transform is employed to discern and isolate high-discriminatory attributes by dismantling low-frequency image attributes and extracting high-frequency attributes across divergent axes.The utilization of CycleGAN serves to elevate the features of low-light imagery across an array of stylistic variances.Advanced computational methodologies are then employed to amalgamate and conflate intricate attributes originating from images characterized by distinct stylistic orientations,thereby augmenting the model’s erudition potential.Empirical validation conducted on the PASCAL VOC and MS COCO 2017 datasets substantiates pronounced advancements.The refined low-light enhancement algorithm yields a discernible 5.9%augmentation in the target detection evaluation index when compared to the original imagery.Mean Average Precision(mAP)undergoes enhancements of 9.45%and 0.052%in low-light visual renditions relative to conventional YOLOX outcomes.The envisaged approach presents a myriad of advantages over prevailing benchmark methodologies in the realm of target detection within environments marked by an acute scarcity of luminosity.

Role of TSH Inhibition Therapy in the Postoperative Management of Patients with Differentiated Thyroid Cancer

Objective:To investigate the effect of TSH inhibition therapy in the postoperative management of patients with differentiated thyroid cancer.Methods:Seventy patients diagnosed with differentiated thyroid cancer were selected for the study.TSH inhibition therapy was administered to the research group,while thyroxine replacement therapy was provided to the control group during the postoperative management phase.This allowed for a comparative analysis between the two groups.Results:In comparison with the control group,the research group exhibited significant decreases in serum TSH,T3,and T4 levels after treatment,while FT4 and FT3 levels significantly increased(P<0.05).Additionally,significant decreases in Tg,VEGF,TSGF,CD44V6,and sIL-2R levels were observed in the research group after treatment(P<0.05).No significant differences were found in pre-treatment thyroid function between the two groups(P>0.05).Conclusion:The application of TSH inhibition therapy in the postoperative management of patients with differentiated thyroid cancer demonstrates promising outcomes.

Multiple factors to assist human-derived induced pluripotent stem cells to efficiently differentiate into midbrain dopaminergic neurons

Midbrain dopaminergic neurons play an important role in the etiology of neurodevelopmental and neurodegenerative diseases.They also represent a potential source of transplanted cells for therapeutic applications.In vitro differentiation of functional midbrain dopaminergic neurons provides an accessible platform to study midbrain neuronal dysfunction and can be used to examine obstacles to dopaminergic neuronal development.Emerging evidence and impressive advances in human induced pluripotent stem cells,with tuned neural induction and differentiation protocols,makes the production of induced pluripotent stem cell-derived dopaminergic neurons feasible.Using SB431542 and dorsomorphin dual inhibitor in an induced pluripotent stem cell-derived neural induction protocol,we obtained multiple subtypes of neurons,including 20%tyrosine hydroxylase-positive dopaminergic neurons.To obtain more dopaminergic neurons,we next added sonic hedgehog(SHH)and fibroblast growth factor 8(FGF8)on day 8 of induction.This increased the proportion of dopaminergic neurons,up to 75%tyrosine hydroxylase-positive neurons,with 15%tyrosine hydroxylase and forkhead box protein A2(FOXA2)co-expressing neurons.We further optimized the induction protocol by applying the small molecule inhibitor,CHIR99021(CHIR).This helped facilitate the generation of midbrain dopaminergic neurons,and we obtained 31-74%midbrain dopaminergic neurons based on tyrosine hydroxylase and FOXA2 staining.Thus,we have established three induction protocols for dopaminergic neurons.Based on tyrosine hydroxylase and FOXA2 immunostaining analysis,the CHIR,SHH,and FGF8 combined protocol produces a much higher proportion of midbrain dopaminergic neurons,which could be an ideal resource for tackling midbrain-related diseases.

Differentiated Paths of Regional Green Development Driven by Industrial Enterprise Innovation

A fundamental shift in the regional development pattern is crucial to achieving a comprehensive green transformation in China.Currently,innovation-driven green development is a significant strategic option for regional development.As the main body of innovation and the basic unit of regional composition,enterprises have a profound impact on the development of regional economy,society,ecology,and other aspects.However,considering China’s vast territory and significant regional differences in natural environment and industrial structure,it’s necessary to further explore the specific impact paths of regional green development driven by enterprise innovation.Therefore,taking industrial enterprises as an example,based on the panel data of 30 provinces in China from 2016 to 2020,this study verifies the impact of industrial enterprise innovation on the regional green development level by constructing a parallel multiple mediating effect model and dividing the economy into eastern,central,and western regions to discuss the specific impact paths.The results show that industrial enterprise innovation has a significant positive effect on regional green development level,via different influencing paths in each region:(1)The eastern region improves the regional green development level by narrowing the urban-rural income gap;(2)The central region improves the regional green development level by reducing resource dependence;and(3)The western region raises the regional green development level by improving the rationalization of industrial structure.

Exploring the Mechanism of CircRNA-vgll3 in Osteogenically Differentiated Human Bone Marrow Mesenchymal Stem Cells

Objective:To explore the mechanism of circRNA-vgll3 in osteogenic differentiation of human bone marrow mesenchymal stem cells.Methods:BMSCs cells were transfected with circRNA-vgll3,and divided into circRNA-vgll3 high-level group,circRNA-vgll3 low-level group,and negative control group(circRNA-vgll3 not transfected)according to the amount of transfection.The proliferation and apoptosis of BMSCs osteoblasts in each group were analyzed,and the alkaline phosphatase(ALP)activity,type I collagen gray value,bone morphogenetic protein 2(BMP-2),Runx2 protein,and mRNA expression levels were detected.Results:The circRNA-vgll3 low-level group had a significant inhibitory effect on the proliferation of BMSCs osteoblasts,and the apoptosis rate of the circRNA-vgll3 low-level group was significantly higher than that of the circRNA-vgll3 high-level group(P<0.05);ALP activity,type I collagen gray value,BMP-2,Runx2 protein,and mRNA expression levels in the high-level circRNA-vgll3 group were significantly higher than those in the low-level circRNA-vgll3 group,and the difference was statistically significant(P<0.05).Conclusion:Overexpression of circRNA-vgll3 can promote the osteogenic differentiation ability of BMSCs,while low expression of circRNA-vgll3 can inhibit the osteogenic differentiation ability of BMSCs.The main mechanism of action is that circRNA-vgll3 can affect osteogenic differentiation by regulating the Runx2 protein.

Research on Instruments of Formative Assessment for Differentiated Language Teaching

Formative assessment is crucial to differentiated language teaching.To ensure the quality of differentiated teaching,some assessment instruments should be adopted during formative assessment,such as differentiated learning portfolios and group activity journal.The effective application of these instruments can also improve the students' autonomous language learning ability.

Sector Capacity Estimation Based on Differentiated Routes and Busy Levels

Sector capacity estimation plays an important role in applied research of airspace management.Previous researches manifest that sector capacity should be influenced by its standard flow,or routes in that sector.However,if air traffic controller(ATCO)workload busy levels(level of proactivity of an ATCO)are ignored,the estimated sector capacity may not be accurate.There is a need to compare the estimated sector capacity with and without busy levels consideration,both with differentiated routes consideration.This paper proposes a method for sector capacity estimation based on ATCO workload considering differentiated routes and busy levels.Firstly,the main routes in the sector are identified,and for each route,the ATCO workload per flight is determined.Secondly,the workload for each route at three busy levels is determined.Regression analysis is then applied to determine the relationship between workload and the number of flights(with and without considering busy levels)in 15 min and 1h time slices.Sector capacity is then determined on the basis of a specified workload threshold,for the two cases with and without considering busy levels.Comparing the two scenarios and following validation by ATCO survey,it is found that capacity estimation considering busy levels is a more realistic and accurate approach.The validated capacity values for the Zhengzhou approach(ZHCC AP)airspace sector accounting for the busy levels were determined accurately as 10 and 33 flights for the 15 min and 1h slices,respectively.The corresponding results without considering busy levels were 12 and 41 flights for the 15 min and 1h time slices,respectively.

Chinese Society of Clinical Oncology (CSCO) diagnosis and treatment guidelines for persistent/recurrent and metastatic differentiated thyroid cancer 2018 (English version)

Contents1. Diagnosis and dynamic assessment of persistent/recurrent and metastatic differentiated thyroid cancer (prmDTC)1.1 Basic principles of diagnosis1.2 Diagnostic methods1.3 Ongoing assessment of response to therapy2. Multidisciplinary treatment of prmDTC2.1 Basic principles of treatment2.2 Surgical management2.2.1 Preoperative clinical assessment2.2.2 Principles of surgical treatment for prmDTC.

Pilot Study of Molecular Mechanism on Vasculogenic Mimicry in Bi-directional Differentiated Malignant Tumors

Objective: To investigate the role of collagen IV and PAS positive substancesecreted by tumor cells in vasculogenic mimicry (VM) and the effects of VM on tumor cells expressingVEGF. Methods: 158 cases of bi-direction differential malignant tumor specimens withparaffin-embedded were enrolled into our study and made tissue microarray which were dual-stainedwith CD31-PAS and stained with collagen IV. The difference of the areas and distribution withpattern surrounded by between CD31 and PAS positive respectively were identified via grid-counting,as well as the difference of VEGF expression with VE absent and present. Results: The basementmembrane of VM was both PAS and collagen IV positive. VEGF expression in the bi-directiondifferential malignant tumor was higher VM-absent than VM-present and the difference wasstatistically significance in malignant melanoma and alveolar rhabdomyosarcoma (P 【 0.05).Conclusion: PAS positive substance and collagen IV compose the wall of VE and VE could provide theoxygen and nutrition for tumor growth and progression.

Undifferentiated liver embryonal sarcoma in adults: A report of four cases and literature review

AIM: To evaluate the undifferentiated embryonal sarcoma of liver (UESL) in adults in order to improve its diagnosis and treatment. METHODS: Four primary and one recurrent cases of UESL were clinicopathologically evaluated and immunohistochemically investigated with a panel of antibodies using the EnVision+ system. Relevant literature about UESL in adults was reviewed. RESULTS: Three males and one female were enrolled in this study. Their chief complaints were abdominal pain, weight loss, or fever. Laboratory tests, imaging and pathological features of UESL in adults were similar to those in children. Immunohistochemistry showed evidence of widely divergent differentiation into mesenchymal and epithelial phenotypes. The survival time of patients who underwent complete tumor resection followed by adjuvant transcatheter arterial chemoembolization (TACE) was significantly longer than that of those who underwent surgical treatment alone.CONCLUSION: UESL in adults may undergo pluripotential differentiation and its diagnosis should be made based on its morphological and immunohistochemical features. Complete tumor resection after adjuvant TACE may improve the survival time of such patients.

Predictive factors for lymph node metastasis in poorly differentiated early gastric cancer and their impact on the surgical strategy

AIM:To identify the predictive clinicopathological factors for lymph node metastasis (LNM) in poorly differentiated early gastric cancer (EGC) and to further expand the possibility of using endoscopic mucosal resection (EMR) for the treatment of poorly differentiated EGC. METHODS: Data were collected from 85 poorly- differentiated EGC patients who were surgically treated. Association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses. RESULTS: Univariate analysis showed that tumor size (OR = 5.814, 95% CI = 1.050 - 32.172, P = 0.044), depth of invasion (OR = 10.763, 95% CI = 1.259 - 92.026, P = 0.030) and lymphatic vessel involvement (OR = 61.697, 95% CI = 2.144 - 175.485, P = 0.007) were the significant and independent risk factors for LNM. The LNM rate was 5.4%, 42.9% and 50%, respectively, in poorly differentiated EGC patients with one, two and three of the risk factors, respectively. No LNM was found in 25 patients without the three risk factors. Forty-four lymph nodes were found tohave metastasis, 29 (65.9%) and 15 (34.1%) of the lymph nodes involved were within N1 and beyond N1, respectively, in 12 patients with LNM. CONCLUSION: Endoscopic mucosal resection alone may be sufficient to treat poorly differentiated intramucosal EGC (≤ 2.0 cm in diameter) with no histologically-confirmed lymphatic vessel involvement. When lymphatic vessels are involved, lymph node dissection beyond limited (D1) dissection or D1+ lymph node dissection should be performed depending on the tumor location.

Dedifferentiated fat cells:A cell source for regenerative medicine

The identification of an ideal cell source for tissue regeneration remains a challenge in the stem cell field. The ability of progeny cells to differentiate into other cell types is important for the processes of tissue reconstruction and tissue engineering and has clinical, biochemical or molecular implications. The adaptation of stem cells from adipose tissue for use in regenerative medicine has created a new role for adipocytes. Mature adipocytes can easily be isolated from adipose cell suspensions and allowed to dedifferentiate into lipidfree multipotent cells, referred to as dedifferentiated fat(DFAT) cells. Compared to other adult stem cells, the DFAT cells have unique advantages in their abundance, ease of isolation and homogeneity. Under proper condition in vitro and in vivo, the DFAT cells have exhibited adipogenic, osteogenic, chondrogenic, cardiomyogenc, angiogenic, myogenic, and neurogenic potentials. In this review, we first discuss the phenomena of dedifferentiation and transdifferentiation of cells, and then dedifferentiation of adipocytes in particular. Understanding the dedifferentiation process itself may contribute to our knowledge of normal growth processes, as well as mechanisms of disease. Second, we highlight new developments in DFAT cell culture and summarize the current understanding of DFAT cell properties. The unique features of DFAT cells are promising for clinical applications such as tissue regeneration.

Reflection and operationalization of the common but differentiated responsibilities and respective capabilities principle in the transparency framework under the international climate change regime

“Common but differentiated responsibilities and respective capabilities”(CBDRRC) is the most significant guiding principle in the international climate change regime, created by the United Nations Framework Convention on Climate Change in 1992 and inherited by the Paris Agreement 24 years later. This paper examines the operationalization of the CBDRRC principle in one of the cornerstone rules of the regimedits transparency provisions, both in existing practice under the convention and possible evolvement in negotiations under the Paris Agreement, from the perspectives of both international rule-making and domestic implementation. The authors have found a continuous enhancement of the transparency framework since the 1990s, and gradual consolidation of a bifurcated system between developed and developing countries into a common one. The authors argue that the transparency framework, as part of the procedural rules, should be designed to facilitate transparent information sharing in accordance with substantive commitments under international climate change laws. Thus, it indirectly reflects historical responsibilities for climate change, while the framework should also be designed as feasible and reflective of the respective capabilities of nations. Finally, the evolution of the transparency framework will aim to enact common and enhanced provisions while differentiating between developed and developing countries in the near term, and greater transparency-related capacity-building for developing countries.

Clinicopathological characteristics and prognosis of 232 patients with poorly differentiated gastric neuroendocrine neoplasms

BACKGROUND Poorly differentiated gastric neuroendocrine neoplasms(PDGNENs)include gastric neuroendocrine carcinoma(NEC)and mixed adenoneuroendocrine carcinoma,which are highly malignant and rare tumors,and their incidence has increased over the past few decades.However,the clinicopathological features and outcomes of patients with PDGNENs have not been completely elucidated.AIM To investigate the clinicopathological characteristics and prognostic factors of patients with PDGNENs.METHODS The data from seven centers in China from March 2007 to November 2019 were analyzed retrospectively.RESULTS Among the 232 patients with PDGNENs,191(82.3%)were male,with an average age of 62.83±9.11 years.One hundred and thirteen(49.34%)of 229 patients had a stage III disease and 86(37.55%)had stage IV disease.Three(1.58%)of 190 patients had no clinical symptoms,while 187(98.42%)patients presented clinical symptoms.The tumors were mainly(89.17%)solitary and located in the upper third of the stomach(cardia and fundus of stomach:115/215,53.49%).Most lesions were ulcers(157/232,67.67%),with an average diameter of 4.66±2.77 cm.In terms of tumor invasion,the majority of tumors invaded the serosa(116/198,58.58%).The median survival time of the 232 patients was 13.50 mo(7,31 mo),and the overall 1-year,3-year,and 5-year survival rates were 49%,19%,and 5%,respectively.According to univariate analysis,tumor number,tumor diameter,gastric invasion status,American Joint Committee on Cancer(AJCC)stage,and distant metastasis status were prognostic factors for patients with PDGNENs.Multivariate analysis showed that tumor number,tumor diameter,AJCC stage,and distant metastasis status were independent prognostic factors for patients with PDGNENs.CONCLUSION The overall prognosis of patients with PDGNENs is poor.The outcomes of patients with a tumor diameter>5 cm,multiple tumors,and stage IV tumors are worse than those of other patients.

Use of lectin microarray to differentiate gastric cancer from gastric ulcer

AIM: To investigate the feasibility of lectin microarray for differentiating gastric cancer from gastric ulcer. METHODS: Twenty cases of human gastric cancer tissue and 20 cases of human gastric ulcer tissue were collected and processed. Protein was extracted from the frozen tissues and stored. The lectins were dissolved in buffer, and the sugar-binding specificities of lectins and the layout of the lectin microarray were summarized. The median of the effective data points for each lectin was globally normalized to the sum of medians of all effective data points for each lectin in one block. Formalin-fixed paraffin-embedded gastric cancer tissues and their corresponding gastric ulcer tissues were subjected to Ag retrieval. Biotinylated lectin was used as the primary antibody and HRP-streptavidin as the secondary antibody. The glycopatterns of glycoprotein in gastric cancer and gastric ulcer specimens were determined by lectin microarray, and then validated by lectin histochemistry. Data are presented as mean +/- SD for the indicated number of independent experiments. RESULTS: The glycosylation level of gastric cancer was significantly higher than that in ulcer. In gastric cancer, most of the lectin binders showed positive signals and the intensity of the signals was stronger, whereas the opposite was the case for ulcers. Significant differences in the pathological score of the two lectins were apparent between ulcer and gastric cancer tissues using the same lectin. For MPL and VVA, all types of gastric cancer detected showed stronger staining and a higher positive rate in comparison with ulcer, especially in the case of signet ring cell carcinoma and intra-mucosal carcinoma. GalNAc bound to MPL showed a significant increase. A statistically significant association between MPL and gastric cancer was observed. As with MPL, there were significant differences in VVA staining between gastric cancer and ulcer. CONCLUSION: Lectin microarray can differentiate the different glycopatterns in gastric cancer and gastric ulcer, and the lectins MPL and VVA can be used as biomarkers. (C) 2014 Baishideng Publishing Group Co., Limited. All rights reserved.

Characteristics of highly differentiated granite and metallization of tungsten-tin, rare and rare earth metal in the eastern Nanling region, China

1 Introduction Massive tungsten-tin,rare and rare earth metals ore deposits were formed with the widespread granite magmatic activity in early Yanshanian period in the eastern Nanling region.Recent studies indicate that the Yanshanian highly differentiated-granite formation is closely related to the deposits of tungsten and tin,rare and rare earth metals mineralization in the region(Xiao

Risk clinicopathological factors for lymph node metastasis in poorly differentiated early gastric cancer and their impact on laparoscopic wedge resection

AIM:To investigate the predictive factors of lymph node metastasis(LNM) in poorly differentiated early gastric cancer(EGC),and enlarge the possibility of using laparoscopic wedge resection(LWR).METHODS:We retrospectively analyzed 85 patients with poorly differentiated EGC who underwent surgical resection between January 1992 and December 2010.The association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses.Odds ratios(OR) with 95%CI were calculated.We further examined the relationship between the positive number of the three significant predictive factors and the LNM rate.RESULTS:In the univariate analysis,tumor size(P = 0.011),depth of invasion(P = 0.007) and lymphatic vessel involvement(P < 0.001) were significantly associated with a higher rate of LNM.In the multivariate model,tumor size(OR = 7.125,95%CI:1.251-38.218,P = 0.041),depth of invasion(OR = 16.624,95%CI:1.571-82.134,P = 0.036) and lymphatic vessel involvement(OR = 39.112,95%CI:1.745-123.671,P = 0.011) were found to be independently risk clinicopathological factors for LNM.Of the 85 patients diagnosed with poorly differentiated EGC,12(14.1%) had LNM.The LNM rates were 5.7%,42.9% and 57.1%,respectively in cases with one,two and three of the risk factors respectively in poorly differentiated EGC.There was no LNM in 29 patients without the three risk clinicopathological factors.CONCLUSION:LWR alone may be sufficient treatment for intramucosal poorly differentiated EGC if the tumor is less than or equal to 2.0 cm in size,and when lymphatic vessel involvement is absent at postoperative histological examination.

Predictive factors for lymph node metastasis and defining a subgroup treatable for laparoscopic lymph node dissection after endoscopic submucosal dissection in poorly differentiated early gastric cancer

AIM To investigate the predictive factors of lymph node metastasis(LNM)in poorly differentiated early gastric cancer(EGC);to guide the individual application of a combination of endoscopic submucosal dissection(ESD)and laparoscopic lymph node dissection(LLND)in a suitable subgroup of patients with poorly differentiated EGC.METHODS We retrospectively analyzed 138 patients with poorly differentiated EGC who underwent gastrectomy with lymphadenectomy between January 1990 and December 2015.The association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses.Odds ratios(OR)with 95%confidence interval(95%CI)were calculated.We further examined the relationship between the positive number of the significant predictive factors and the LNM rate.RESULTS The tumor diameter(OR=13.438,95%CI:1.773-25.673,P=0.029),lymphatic vessel involvement(LVI)(OR=38.521,95%CI:1.975-68.212,P=0.015)and depth of invasion(OR=14.981,95%CI:1.617-52.844,P=0.024)were found to be independent risk factors for LNM by multivariate analysis.For the 138 patients diagnosed with poorly differentiated EGC,21(15.2%)had LNM.For patients with one,two and three of the risk factors,the LNM rates were 7.7%,47.6%and 64.3%,respectively.LNM was not found in 77 patients that did not have one or more of the three risk factors.CONCLUSION ESD might be sufficient treatment for intramucosal poorly differentiated EGC if the tumor is less than or equal to2 cm in size and when LVI is absent upon postoperative histological examination.ESD with LLND may lead to the elimination of unnecessary gastrectomy in poorly differentiated EGC.