Objective To evaluate the clinical characteristics,pathology,treatment and prognosis of gastrointestinal stromal tumors.Methods A retrospective analysis was made on clinical data of 469 patients with gastrointestinal stromal tumors (GIST) admitted between January 2010 and August 2016.Results There were 231 males and 238 females,the median age was 57 years old.The tumor was located in the esophagus in 6 cases (1.3％),in the stomach in 295 cases (62.9％),in the duodenum in 23 cases (4.9％),in the small intestine in 69 cases(14.7％),in the colorectum in 26 cases (5.5％).There were altogether 50 cases (10.6％) in this group with a final diagnosis of extra-gastrointestinal stromal tumors.Tumor invasion depth,risk of ulcer caused bleeding and NIH classification varied with its locations (all P ＜ 0.05).Conclusions The clinical characteristics of gastrointestinal stromal tumors can be used to preliminarily predict its malignant degree.Surgical resection is the treatment of choice,and postoperative recurrence or metastases of gastrointestinal stromal tumors can be treated by imatinib.

OBJECTIVE To investigate the clinical feature of nosocomial infection and the type of pathogens in general hospital, and provide the scientific theory basis in order to prevent and control the nosocomial infection. METHODS An analysis was made on the basis of the survey, the data came from hospitalized cases from 2000 to 2006. RESULTS Their prevalence rate was 3.8%. The highest infected rate was in ICU (16.9%). The main infection site was respiratory tract. Among pathogens isolated from nosocomial infection cases, 45.65% were Gram-negatives, 31.9% were fungi, and 20.58% were Gram-positives. The formation rate of the Enterococcus gradually increasesd from year to year. CONCLUSIONS There are many effective actions to reduce the nosocomial infection, such as strengthening the medical training, carrying out the aseptic technology strictly, reducing the invasive operation, raising the executable rate of hand hygiene, and using the antibacterial drug reasonably.

OBJECTIVE To evaluate the clinical application of the two surgical hand antisepsis methods on hand sterilizing effect. METHODS Totally 123 medical staff of operating theater were divided into Avagard surgical washing liquid (60) and orthodox surgical hand antisepsis (63) groups at random. The samples were derived from fingers and cultured before,just after and 2h after sterilization. RESULTS The colony counts were 4.64?4.87,0.05?0.16 and 0.02?0.10 CFU/cm2,respectively in avagard surgical washing liquid group;vs 4.10?4.03,0.08?0.26 and 0.49?1.31 CFU/cm2,respectively,in orthodox surgical hand antisepsis group. There were statistical differences of the cultures of the two groups (P

Objective To study the risk values of glycosylated hemoglobin ( HbA1c) screening patients with diabetes mellitus(DM) and pre-diabetes(PreD) in different age and sex.Methods HbA1c results from10 840 in Taizhou Hospital in 2012 were retrospectively collected , and CHAID analysis of decision tree was used in preliminary hierarchy .Age was further divided into five groups according to the preliminary results , then one-way ANOVA and linear regression were utilized to determine the differences between age groups and the prediction intervals (PI) of HbA1c,respectively.The upper limit value of 95%PI of HbA1c was set as diabetes risk values ( DRVs).By comparison of the sensitivity of DM patients screening by DRVs in 1 889 cases whose HbA1c were between 6.0%to 6.5%and the upper limit value of traditional HbA1c reference intervals to verify the screening value ofDRVs .Then the DRVs of HbA1c were utilized to screen DM in the population whose HbA 1c is were 6.0%-6.5% in 2008,and followed their re-examination records toverify the screening value of the DRVs toin PreD patients. Results (1) On the basis of the initially root of decisiontree by age , the populationwas divided into 9 groups ( P =0.000, F =231.462).By calculatingthe 95% confidence interval(CI) of each group and merging reasonably,it was finally divided into 5 groups:20-30years,31-40years,41-50years,51-60years and >60years (F=434.342, P=0.000).(2)Using the method of linear regression , the 95% PI of HbA1c of the 5 groups showed as following:20-30 years, males 4.6%-5.9%, females 4.6%-5.9%.31-40 years, males 4.8%-6.0%, females 4.7%-6.0%.41-50 years, males 4.9%-6.2%, females 4.8%-6.1%.51-60 years, males 5.0%-6.3%, females 4.9%-6.2%.>60 years, males 5.1%-6.4%, females 5.0%-6.3%.The traditional HbA1c reference interval was4.8%-6.3%.(3) The screening sensitivity of DM by the upper limit value of traditional HbA1c reference interval and DRVs in group which HbA1c was between 6.0%-6.5% were 34.5%and 48.1%,respectively.(4) Reviewing of the group with HbA1c between 6.0%-6.5% and not diagnosed as DM in 2008, 49 hadnegative DM screening results by using the upper limit value of traditional HbA1c reference interval but were positive in our setting DRVs , and 13 have developed to DM now , which accounted for 26.5%.Conclusion HbA1c DRVs need to be set hierarchically between different age and sex groups as a supplement to the traditional reference interval , which has a great significance for the diagnosis and treatment of DM and also forthe screening and intervention of PreD patients.

Objective To evaluate the diagnostic value of Human Epididymal Protein 4(HE4) and HE4/Cancer Antigen 125 (CA125) parallel detection for ovarian cancer by meta-analysis.Methods The databases,such as Pubmed,Embase and China National Knowledge Infrastructure (CNKI),were employed to search for the studies related to diagnostic value of HE4 and HE4/CA125 parallel detection for ovarian cancer.The screening,data extraction and quality assessment were conducted in accordance with the inclusion and exclusion criteria by two reviewers independently.The software Meta-disc 1.4 was used to perform meta-analysis and draw the forest plots and the Summary Receiver Operating Characteristic (SROC) curves.The AUCs of HE4,HE4/CA125 parallel detection were detected by Z test.The Egger's regression test was applied to evaluate the publication bias by Stata11.0.Results A total of 14 studies with benign control and/or healthy control were included.In the studies with healthy control.The AUCs of HE4,HE4/CA125 parallel detection were 0.9502 ± 0.0137 and 0.9588 ± 0.0113 respectively,but there was no significant difference between them (Z =0.484,P ＞ 0.05) ;In the studies with benign control.The value of cutoff was the most important cause of heterogeneity.The AUCs of HE4,HE4/CA125 parallel detection were 0.9153 ± 0.0095 and 0.9323 ± 0.0082 respectively,but with no significant difference (Z =1.350,P ＞ 0.05).In the subgroup with cut-off value divided by 150 pmoL/L,the AUCs of HE4,HE4/CA125 parallel detection were 0.9032±0.0174 and 0.9267 ±0.0176 respectively,but there was no significant difference between them (Z =0.950,P ＞ 0.05).Conclusions Both HE4 and HE4/CA125 parallel detection had meaningful values for the diagnosis of ovarian cancer.The detection of HE4 had a higher specificity,while the HE4/CA125 parallel detection had a higher sensitivity.But there was no statistical difference between them in diagnosis value of ovarian cancer.

Objective To investigate the feasibility,safety and effectiveness of percutaneous biliary stenting combined with brachytherapy in treating unresectable Klatskin's tumor,and to discuss the effect of this combination treatment on jaundice recurrence and survival.Methods The clinical data of 21 patients with unresectable Klatskin's tumor (combination group),who were admitted to Department of Interventional Oncology,Shanghai Renji Hospital during the period from February 2014 to December 2015 to receive percutaneous biliary stenting combined with brachytherapy,were retrospectively analyzed;and other 28 patients,who were admitted to hospital to receive pure biliary drainage or bare metal stent implantation during the same period,were collected and used as the control group.The success rate of operation,the effect of reducing jaundice and postoperative complication rate were calculated,and the differences in survival time and jaundice recurrence time were compared between the two groups.Results A total of 32 bare metal stent sand 580 125I seeds were implanted in the 21 patients of the combination group,the success rate of operation was 100％,and the effective rate of treatment was 85.7％.The early postoperative complication rate was 9.5％,and no procedure-related death occurred.The median jaundice recurrence time in the combination group was 344 days,while it was 193 days in the control group (P=0.035).The median survival time in the combination group was 387 days,which was strikingly longer than 256 days in the control group (P=0.022).Conclusion For the treatment of unresectable Klatskin's tumor,percutaneous biliary stentingcombined with brachytherapy,used as a palliative therapeutic regimen,is safe,effective and feasible,it can delay the recurrence of jaundice and prolong the survival time.(J Intervent Radiol,2017,26:243-248)

Objective To investigate the clinicopathological and immunohistochemical expression in 8 cases with synchronous occurrence of digestive tract cancer and GIST. Methods Clinical and pathologic data of 8 out of 70 cases of GIST coexisted with gastrointestinal cancer were recorded, and immunohistochemical stain ( Envision method) was used to detect the expressions of CD117, CD34 ,Vimenlin etc. Results In 8 cases of GIST (4 benign, 3 borderline, 1 malignant) coexisted with GI carcinoma, of which 6 cases featured the simultaneous occurrence of GIST and adenocarcinomas (5 cases in slomach and 1 case in colon) , whereas the other 2 cases associated with squamus cell carcinoma of esophagus. In 4 cases, tumors arose from the same organ, in the other 4 cases they developed from different sites of digestive tract. In all of the cases two kinds of neoplasms were developed in different areas without any connection, preoperative endoscopy and biopsy showed adenocarcinomas and squamous cell carcinoma, but histologic and clinical diagnosis of coexisted tumors were not achieved in any case. All GIST expressed Vimentin and CD34; 7 cases expressed CD117; 2 cases were focally positive for S-100 protein and 1 each for SMA and Desmin. Conclusion The simultaneous occurrence of epithelial tumor and GIST in digestive tract is not less than that usually expected, in clinical practice we should pay much attention on the diagnosis of this entity. Endoscopic biopsy conjugated with profound inspection during operation and pathological examination of specimen postoperatively can improve the possibility of early diagnosis.

Objective:To explore whether the mRNA expression of TNFRSF12 in peripheral blood leukocytes of SLE patients is abnormal and to determine whether the TNFRSF12 gene is susceptibility gene to SLE.Methods:The level of mRNA expression of TNFRSF12 in peripheral blood leukocytes was detected by TaqMan one-step RT-PCR method.Results:The mRNA expression pattern in SLE patients is different to that of normal control.The mRNA in SLE consists of 2 types of isoforms of TNFRSF12,encoding membrane bound glycoprotein and potentially secreted molecules respectively,whereas only the latter in normal control.After PHA treatment,the mRNA expression pattern in normal control becomes the same as that of SLE patients.Overall TNFRSF12 mRNA expression was significantly decreased in active SLE group and significantly increased in lupus nephritis group.Conclusion:The results indicated that TNFRSF12 may play a role in the pathogenesis of SLE and was susceptibility gene to SLE.

Purpose:To identify clinical predictors of stage ⅢA-N2 in patients with non-small cell lung cancer. Methods:From March 1995 to February 1998, 118 patients with pathological stage ⅢA-N2 non-small cell lung cancer who underwent a resection by Shanghai Chest Hospital were analysed. Prognostic factors were estimated from the date of operation using the Kaplan-Meier and log-rank analysis. The Cox regression model evaluated the influence of factors on the survival. Results:The overall of 3-year and 5-year survivals of the 118 patients were 40.5% and 18.4%. Margin, the number of N2 lymph nodes and stations, the cycles of adjuvant chemotherapy were associated with survival. In a multivariate analysis, the number of N2 lymph nodes and the cycles of adjuvant chemotherapy significantly influenced survival. Conclusions:The number of N2 lymph nodes and the cycles of adjuvant chemotherapy were important prognostic factors of stage ⅢA-N2 non-small cell lung cancer.

[Objective]To analyze the results of distal tibial pilon fractures treated with individual management based on severity of soft tissue injury.[Method]From January 2005 to September 2008,29 Pilon fractures were treated.There were 22 males and 7 females aging from 23 to 63,with an average of 41.4.According to Ruedi-Allgower classification system of Pilon fracture,16 cases were type Ⅱ,13 type Ⅲ.According to Tscherne-Gotzen graduation system of soft tissue injury,22 cases were close fracture,8 grade 0,4 grade 1,8 grade 2,2 grade 3,and 7 cases were open fracture,3 grade 1,2 grade 2,2 grade 3.Individual management was based on severity of soft tissue injury.[Result]All patients were available for follow-up at an average of 28.6 months(range,12 to 56 months) after surgery.There were 10 excellent,13 good,4 fair,and 2 poor results according to the ankle score of Mazur.The complications occurred in 5 patients(17.2%),including wound superficial infection(n=2),skin necrosis(n=1),deep infection(n=1),and pin tract infection(n=1) with external fixation.[Conclusion]Individual management based on severity of soft tissue injury for Pilon fracture has advantages of fewer complications and good function.