Rationale:Glomus tumors (GTs) are a rare disorder originating from the glomus of the anastomoses of small arteries, usually occurring in the subungual region of the fingertips or toes and seldom occurring in the stomach. We unintentionally found a case of a gastric glomus tumor (GGT) without any upper abdominal discomfort. The diagnosis of this disease was mainly by immunohistochemistry.Patient concerns:The patient presented to our hospital with intermittent right abdominal pain for 1 month. Abdominal computed tomography showed a nodular enhancement lesion in the gastric antrum.Diagnoses:The patient was diagnosed with an ileocecal tumor and a gastric stromal tumor.Interventions:Surgical resection of the ileocecal and gastric tumors was performed.Outcomes:Pathologic examination of gastric masses revealed GT. The operation was effective, and the patient was discharged from our hospital 7 days after surgery. Upon follow-up at 3 months, the patient was asymptomatic.Lessons:GTs are submucosal tumors rarely found in the stomach. Surgical resection is a good choice of treatment. The GGT lacked specific clinical and imaging features, and immunohistochemistry was essential in the diagnosis of GGT.

BackgroundTo compare the clinical efficacy and radiographic analysis of oblique lumbar interbody fusion (OLIF) and traditional posterior lumbar interbody fusion (PLIF) in treating degenerative lumbar spondylolisthesis (DLS).MethodsGrade I DLS patients admitted to the Third Hospital of Hebei Medical University were retrospectively reviewed. In sum, 78 patients that underwent OLIF (n = 31) and PLIF (n = 47) treatment of DLS were recruited. Clinical data including clinical and radiological evaluations were collected pre-operatively and at each follow-up. Japanese Orthopaedic Association (JOA) scores, Oswestry Disability Index (ODI), lumbar lordosis (LL), disc height (DH), and fusion rates were compared between the OLIF and PLIF groups.ResultsThe operation time for both groups was 131.3 ± 14.6 min in the OLIF group and 156.9 ± 37.4 min in the PLIF group (P < 0.001). The intraoperative blood loss was 163.6 ± 63.9 ml in the OLIF group and 496.8 ± 122.6 ml in the PLIF group (P < 0.001). The length of the surgical incision was 4.63 ± 0.57 cm in the OLIF group and 11.83 ± 1.37 cm in the PLIF group (P < 0.001). The number of intraoperative and post-operative complications for both groups was 10 in the OLIF group and 20 in the PLIF group. Significant clinical improvement (P < 0.05) was observed in JOA scores and ODI when comparing pre-operative evaluation and final follow-up. After statistical analysis, there was no significant difference in the preoperative JOA scores between the two groups. There was no significant difference when comparing pre-operative LL and DH for either group. Post-operative reexamination was improved as compared to pre-operative exams. And the improvement of DH was better in the OLIF group as compared to the PLIF group.ConclusionsFor DLS patients, both OLIF and PLIF can achieve good results. Furthermore, OLIF displays marked advantages including smaller surgical incisions, shorter anesthesia times, decreased intraoperative blood loss, and post-operative pain better relieved.

Background Radical gastrectomy with D2 lymphadenectomy is recognized as the standard treatment for resectable advanced gastric cancer. Preoperative fibrinogen and albumin measurements may bring clinical benefits in terms of providing advanced notice of a poor prognosis or recurrence in patients undergoing radical resection. The aim of this study was to identify markers that are predictive of a poor prognosis prior to surgery. Methods Eight hundred forty-two consecutive patients who underwent curative radical gastrectomy at our hospital between 2008 and 2012 were retrospectively reviewed. Based on plasma fibrinogen and serum albumin levels, preoperative fibrinogen and albumin scores (Fib-Alb scores) were investigated, and the prognostic significance was determined. Results The patients were classified according to a Fib-Alb score of 0 (n = 376), 1 (n = 327), or 2 (n = 139). When the correlation between the response rate and the change in the Fib-Alb score was investigated, the response rate was significantly lower in patients with an increased Fib-Alb score than in the other patients. In the survival analysis, patients in the Fib-Alb high-score group exhibited significantly worse recurrence-free survival (RFS) (P = 0.030) than patients in the other groups. A multivariate analysis using clinical stage and the change in the Fib-Alb score as covariates revealed that a change in the Fib-Alb score (Fib-Alb score 1, HR: 1.31, 95% CI: 1.03-1.66, P = 0.028; Fib-Alb score 2, HR: 1.61, 95% CI: 1.20-2.17, P = 0.001) was a significant independent predictive factor for RFS. Conclusions The prognosis of patients with high fibrinogen and low albumin levels is poor. The Fib-Alb score was shown to be an independent prognostic factor for postoperative recurrence in gastric cancer patients who underwent radical gastrectomy.

The aim of our study was to explore risk factors of cage nonunion after anterior cervical discectomy and fusion (ACDF). 295 patients underwent ACDF in our hospital between Jan. 2014 and Jan. 2017. Of them, 277 patients suffered cage union (union group, UG) after 6-month follow-up and 18 did not (nonunion group, NG). We collected possible factors including gender, history of smoking, alcohol, hypertension, heart disease, diabetes, body mass index, diagnose, and preoperative visual analog scale -neck, visual analog scale-arm, neck disability index (NDI) and Japanese Orthorpaedic Association, surgical duration, blood loss, fusion levels, superior fusion segment, angle of C2–C7, range of motion for C2–C7, C2–C7 sagittal vertical axis and T1 slope. We performed univariable and multivariable analysis to compare data in 2 groups. The rate of cage nonunion after ACDF was 6.1% (18 of 295) in our study. The outcome of univariable analysis showed that age (63.5 ± 10.1), angle of C2–C7 (18.0 ± 4.6), range of motion of C2–C7 (32.5 ± 7.7), C2–C7 sagittal vertical axis (17.9 ± 4.3) and T1 slope (22.1 ± 5.3) were higher in NG than these (59.4 ± 9.2, 16.2 ± 4.5, 30.2 ± 6.9,16.1 ± 4.0, 20.9 ± 4.9) in UG. Additionally, patients with osteoporosis had markedly higher rate of cage nonunion after ACDF than those without. What's more, the multivariable analysis implied the same results with univariable analysis. Many factors could predict cage nonunion after ACDF. Cervical sagittal parameters play an important role in cage nonunion after ACDF. We hope that we can provide some guidance for spine surgeon before performing ACDF.

Background: Adult intussusception is less common than paediatric intussusception. The aim of this study was to explore the clinical presentation, aetiology, diagnosis and treatment of adult intussusception. Methods: Adults (>18 years) with intussusception treated by surgical or conservative measures were included from January 2005 to January 2018, and the manifestation, types, diagnosis and treatment of adult intussusception in our centre were reviewed. Results: A total of 150 patients with adult intussusception were included in this study. The clinical manifestations included 111 cases (74%) of abdominal pain, 38 cases (25.3%) of bloody stool, 37 cases (24.7%) of bowel obstructions, 33 cases (22%) of abdominal distension, 29 cases (19.3%) of nausea and vomiting, 19 cases (12.7%) of an abdominal mass, and 12 cases (8.0%) of diarrhoea. The types of intussusception were classified into 36 cases (24%) of enteric intussusception, 87 cases (58%) of intestine-colon intussusception and 27 cases (18%) of colonic intussusception. Surgical intervention was applied in 139 cases (92.7%), including 115 patients who underwent open surgery, and laparoscopy-assisted surgery was performed in 24 patients. The main pathogenesis of intussusception was malignant tumors in 51 cases (36.7%) and benign tumors and polyps in 49 cases (35.3%). Conclusion: Malignant and benign tumors are the main causes of adult intussusception. Abdominal CT is the preferred evaluation method for the preoperative diagnosis of this condition. The choice of surgical procedure depends on the location and type of intussusception.

The natural phenolic substance, 18β-glycyrrhetinic acid (GRA), has shown enormous potential in the chemoprevention of cancers with rich resources and biological safety, but the GRA-regulated genetic and epigenetic profiles are unclear. Deregulated mitochondrial cellular energetics supporting higher adenosine triphosphate provisions relative to the uncontrolled proliferation of cancer cells is a cancer hallmark. The Toll-like receptor 2 (TLR2) signaling pathway has emerged as a key molecular component in gastric cancer (GC) cell proliferation and epithelial homeostasis. However, whether TLR2 influenced GC cell energy metabolism and whether the inhibition effects of GRA on GC relied on TLR2 signaling were not illustrated. In the present study, TLR2 mRNA and protein expression levels were elevated in gastric tumors in the K19-Wnt1/C2mE (Gan) mice model, GC cell lines and human GCs, and the overexpression of TLR2 was correlated with the high histological grade and was a poor prognostic factor in GC patients. Further gain and loss of function showed that TLR2 activation induced GC cell proliferation and promoted reactive oxygen species (ROS) generation, Ca2+ accumulation, oxidative phosphorylation and the electron transport chain, while blocking TLR2 inhibited mitochondrial function and energy metabolism. Furthermore, GRA pretreatment inhibited TLR2-activated GC cell proliferation, energy metabolism and carcinogenesis. In addition, expression of TLR2 was found to be downregulated by GRA through methylation regulation. Collectively, the results demonstrated that GRA inhibited gastric tumorigenesis through TLR2-accelerated energy metabolism, suggesting GRA as a promising therapeutic agency targeting TLR2 signaling in GC.

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Accumulating epidemiological and clinical evidence shows that inflammation is an important risk factor for gastrointestinal diseases. Glycyrrhiza glabra, a traditional Chinese medicine, has been shown to safely suppress gastric cancer; however, the anti-inflammatory mechanisms in gastric tumorigenesis have been poorly investigated. Therefore, this study is committed to demonstrate the in vivo anti-inflammatory effect of 18β-glycyrrhetinic acid (GRA), the main active component of G. glabra. The lymphocytes and macrophages were heavily infiltrated in the transgenic mice that highly expressed cyclooxygenase (COX)-2 and microsomal prostaglandin E synthase (mPGES)-1; however, a significant reduction was observed after treatment with GRA. In addition, GRA downregulated the protein levels of COX-2, GαS, EP2, and β-catenin, which were involved in the arachidonic acid pathway. In conclusion, our study showed the potential protective effects of GRA against inflammatory environment that might be involved in gastric tumorigenesis in vivo through the PGE2-EP2 receptor-mediated arachidonic acid pathway.