Chronic active and atrophic gastritis as significant contributing factor to the development of gastric cystica profunda

Gastric cystica profunda(GCP)is an uncommon but underestimated gastric lesion.Its precancerous potential determines its significance.In addition to previous mucosa injury due to operations,biopsy or polypectomy,chronic active and atrophic gastritis may also lead to the development of GCPs.By carefully examining the stomach and taking biopsy samples from the susceptible regions,the stage of atrophy can be determined.Chronic atrophic gastritis is a risk factor for cancer evolvement and it can also contribute to GCPs formation.GCPs frequently occur close to early gastric cancers(EGCs)or EGC can arise from the cystic glands.Endoscopic resection is an effective and minimally invasive treat-ment in GCP.

Operative link on gastritis assessment stage is an appropriate predictor of early gastric cancer

AIM: To assess the predictive value of Operative Link on Gastritis Assessment(OLGA) and Operative Link on Gastric Intestinal Metaplasia Assessment(OLGIM) stages in gastric cancer.METHODS: A prospective study was conducted with 71 patients with early gastric cancer(EGC) and 156 patients with non-EGC. All patients underwent endoscopic examination and systematic biopsy. Outcome measures were assessed and compared, including the Japanese endoscopic gastric atrophy(EGA) classification method and the modified OLGA method as well as the modified OLGIM method. Helicobacter pylori(H. pylori) status was determined for all study participants. Stepwise logistic regression modeling was performed to analyze correlations between EGC and the EGA, OLGA and OLGIM methods.RESULTS: For patients with EGC and patients with non-EGC, the proportions of moderate-to-severe EGA cases were 64.8% and 44.9%, respectively(P = 0.005), the proportions of OLGA stages Ⅲ-Ⅳ cases were 52.1% and 22.4%, respectively(P < 0.001), and the proportions of OLGIM stages Ⅲ-Ⅳ cases were42.3% and 19.9%, respectively(P < 0.001). OLGA stage and OLGIM stage were significantly related to EGA classification; specifically, logistic regression modeling showed significant correlations between EGC and moderate-to-severe EGA(OR = 1.95, 95% CI: 1.06-3.58, P = 0.031) and OLGA stages Ⅲ-Ⅳ(OR = 3.14, 95%CI: 1.71-5.81, P < 0.001), but no significant correlation between EGC and OLGIM stages Ⅲ-Ⅳ(P = 0.781). H. pylori infection rate was significantly higher in patients with moderate-to-severe EGA(75.0% vs 54.1%, P = 0.001) or OLGA/OLGIM stages Ⅲ-Ⅳ(OLGA: 83.6% vs 55.8%, P < 0.001; OLGIM: 83.6% vs 57.8%, P < 0.001).CONCLUSION: OLGA classification is optimal for EGC screening. A surveillance program including OLGA stage and H. pylori infection status may facilitate early detection of gastric cancer.

Comparison of operative link for gastritis assessment, operative link on gastric intestinal metaplasia assessment, and TAIM stagings among men with atrophic gastritis

BACKGROUND Gastric cancer is the world’s third most lethal malignancy. Most gastric cancers develop through precancerous states of atrophic gastritis and intestinal metaplasia. Two staging systems, operative link for gastritis assessment(OLGA)and operative link on gastric intestinal metaplasia assessment(OLGIM), have been developed to detect high gastric cancer risk. European guidelines recommend surveillance for high-risk OLGA/OLGIM patients(stages Ⅲ–Ⅳ),and for those with advanced stage of atrophic gastritis in the whole stomach mucosa. We hypothesize, that by combining atrophy and intestinal metaplasia into one staging named TAIM, more patients with increased gastric cancer risk could be detected.AIM To evaluate the clinical value of the OLGA, OLGIM, and novel TAIM stagings as prognostic indicators for gastric cancer.METHODS In the Helsinki Gastritis Study, 22346 elderly male smokers from southwestern Finland were screened for serum pepsinogen I(PGI). Between the years 1989 and1993, men with low PGI values(PGI < 25 μg/L), were invited to undergo an oesophagogastroduodenoscopy. In this retrospective cohort study, 1147 men that underwent gastroscopy were followed for gastric cancer for a median of 13.7 years, and a maximum of 27.3 years. We developed a new staging system, TAIM,by combining the topography with the severity of atrophy or intestinal metaplasia in gastric biopsies. In TAIM staging, the gastric cancer risk is classified as low or high.RESULTS Twenty-eight gastric cancers were diagnosed during the follow-up, and the incidence rate was 1.72 per 1000 patient-years. The cancer risk associated positively with TAIM [Hazard ratio(HR) 2.70, 95%CI: 1.09–6.69, P = 0.03]. The risk increased through OLGIM stages 0-Ⅳ(0 vs Ⅳ: HR 5.72, 95%CI: 1.03–31.77, P for trend = 0.004), but not through OLGA stages 0–Ⅳ(0 vs Ⅳ: HR 5.77, 95%CI:0.67–49.77, P for trend = 0.10). The sensitivities of OLGA and OLGIM stages Ⅲ–Ⅳ were low, 21% and 32%, respectively, whereas that of TAIM high-risk was good, 79%. On the contrary, OLGA and OLGIM had high specificity, 85% and81%, respectively, but TAIM showed low specificity, 42%. In all three staging systems, the high-risk men had three-to four-times higher gastric cancer risk compared to the general male population of the same age.CONCLUSION OLGIM and TAIM stagings show prognostic value in assessing gastric cancer risk in elderly male smokers with atrophic gastritis.

Fuzzy Comprehensive Assessment of Transnational Operation Environment for Chinese Oil Companies

A comprehensive method was developed to assess the transnational operation environment in host countries for Chinese oil companies. This method includes an assessment criterion system of the environment, which is to be scored by the experts. Analytical Hierarchy Process （AHP） and fuzzy mathematical methods were used to make evaluation and get the assessment result and ranking of three host countries.

Operational Risk Assessment for Integrated Transmission and Distribution Networks

To satisfy the requirements of accurate operationalrisk assessment of integrated transmission and distribution networks (I-T&D), an integrated operational risk assessment (IORA) algorithm is proposed. Specific cases demonstrate thatan I-ORA is necessary because it provides accurate handlingof the coupling between transmission and distribution networks,accurate analysis of power supply mode (PSM) changes ofimportant users and helps to improve security and stability ofpower grid operations. Two key technical requirements in theI-ORA algorithm are realized, i.e., integrated topology analysisand integrated power flow calculation. Under a certain contingency, integrated topology analysis is used to assess the risksof substation power cuts, network split and PSM changes ofimportant users, while the integrated power flow calculation,based on the self-adaptive Levenburg-Marquard method andNewton method, can be implemented to assess risks of heavyload/overload and voltage deviation. In addition, the graphicsprocessing unit is used to parallelly process some computationintensive steps. Numerical experiments show that the proposedI-ORA algorithm can realize accurate assessment for the entireI-T&D. In addition, the efficiency and convergence are satisfying,indicating the proposed I-ORA algorithm can significantly benefitreal practice in the coordination operation of I-T&D in the future.

Lamb’s tripe extract and vitamin B12 capsule plus celecoxib reverses intestinal metaplasia and atrophy:A retrospective cohort study

BACKGROUND Chronic atrophic gastritis(AG)with intestinal metaplasia(IM)significantly increases the risk of gastric cancer.Some medicines have showed definite therapeutic effects in AG and IM regression.AIM To validate the efficacy of Lamb’s tripe extract and vitamin B12 capsule(LTEVB12)initial therapy and celecoxib rescue therapy for IM and AG.METHODS A total of 255 patients were included to receive LTEVB12 initial therapy(2 capsules each time,three times daily for 6 mo)in hospital in this study.The patients with failure of IM regression continued to receive celecoxib rescue therapy(200 mg,once daily for 6 mo).After each therapy finished,the patients underwent endoscopy and biopsy examination.The regression efficiency was assessed by the operative link on gastritis assessment(OLGA)and the operative link on the gastric intestinal metaplasia assessment(OLGIM)staging system.Logistic regression analysis was applied to identify factors associated with the curative effect.RESULTS For LTEVB12 initial therapy,the reversal rates of IM and AG were 52.95%and 48.24%,respectively.Analogously,for celecoxib rescue therapy,the effective rates for IM and AG were 56.25%and 51.56%,respectively.The IM regression rate of complete therapy was up to 85.03%.In different OLGA and OLGIM stages of IM patients,therapeutic efficiency showed a significant difference in each group(P<0.05).For both therapies,patients with high stages(III or IV)of both the OLGA and OLGIM evaluation systems showed a higher IM or AG regression rate than those with low stages(I or II).Among patients with high stages(OLGIM III and IV),the IM regression rate was above 70%for each therapy.Eating habits,fresh vegetable intake,and high-salt diet were identified as independent factors for the IM reversal effect of LTEVB12 therapy,especially high-salt diet(odds ratio=1.852,P<0.05).CONCLUSION Monotherapy could reverse IM and AG.LTEVB12 initial therapy and celecoxib rescue therapy significantly increase the regression effect.IM may not be the point of no return among gastric precancerous lesions.

Association of serum pepsinogen with degree of gastric mucosal atrophy in an asymptomatic population

BACKGROUND Atrophic gastritis is a precancerous lesion of the stomach.It has been reported that pepsinogen(PG)can reflect the morphology and function of the gastric mucosa,and it is therefore used as a marker for the early diagnosis of atrophic gastritis.AIM To evaluate the diagnostic value of serum PG for degree of gastric mucosal atrophy in asymptomatic Chinese upon physical examination.METHODS Medical data were collected from subjects who underwent transnasal gastroscopy between October 2016 and October 2018.For each study subject,serum PG levels and presence of Helicobacter pylori(H.pylori)infection were investigated.Pathology was evaluated using the Operative Link for Gastritis Assessment(OLGA)classification and Operative Link on Gastric Intestinal Metaplasia Assessment(OLGIM)systems.All statistical analyses were carried out using SPSS statistical software.RESULTS A total of 2256 subjects were enrolled and 1922 cases were finally included in the study.Based on the OLGA grading system,the levels of PGI were slightly decreased,while those of PGII were slightly increased.The PGI/PGII ratio(PGR)was reduced with increasing atrophy.The association between PG and OLGA grading was higher compared with that between PG and the OLGIM grading system.Compared with the OLGA-0 group,a statistically significant difference was observed in the mean age of OLGA-Ⅰ,Ⅲ,and Ⅳ groups(P<0.05).In the H.pylori-positive subjects,the PGR levels were notably lower in the OLGA-Ⅰ,Ⅱ,and Ⅲ groups compared with the OLGA-0 group(P<0.05).H.pylori-positive subjects exhibited significantly higher PGI and PGII serum levels and a significantly lower PGR compared with H.pylori-negative patients in different OLGA groups(P<0.05).CONCLUSION Serum PG levels may represent a non-invasive screening marker for gastric mucosal atrophy in asymptomatic subjects.

Cardiopulmonary exercise testing in the evaluation of high risk patients with lung cancer

Background It is still unclear whether pulmonary function tests （PFTs） are sufficient for predicting perioperative risk,and whether all patients or only a subset of them need a cardiopulmonary exercise test （CPET） for further assessment.Thus, this study was designed to evaluate the CPET and compare the results of CPET and conventional PFTs to identify which parameters are more reliable and valuable in predicting perioperative risks for high risk patients with lung cancer.Methods From January 2005 to August 2008, 297 consecutive lung cancer patients underwent conventional PFTs （spirometry ＋ single-breath carbon monoxide diffusing capacity of the lungs （DLCOsb） for diffusion capacity） and CPET preoperatively. The correlation of postoperative cardiopulmonary complications with the parameters of PFT and CPET was retrospectively analyzed using the chi-square test, independent sample t test and binary Logistic regression analysis.Results Of the 297 patients, 78 did not receive operation due to advanced disease stage or poor cardiopulmonary function. The remaining 219 underwent different modes of operations. Twenty-one cases were excluded from this study due to exploration alone （15 cases） and operation-related complications （6 cases）. Thus, 198 cases were eligible for evaluation. Fifty of the 198 patients （25.2%） had postoperative cardiopulmonary complications. Three patients （1.5%）died of complications within 30 postoperative days. The patients were stratified into groups based on VO2max/pred respectively. The rate of postoperative cardiopulmonary complications was significantly higher in the group with cardiopulmonary complications were significantly correlated with age, comorbidities, and poor PFT and CPET results.used to stratify the patients＇ cardiopulmonary function status and to predict the risk of postoperative cardiopulmonary predicting perioperative risk. If available, cardiopulmonary exercise testing is strongly suggested for high-risk lung cancer patients in addition to conventional pulmonary function tests, and both should be combined to assess cardiopulmonary function status.