Objective To study the prognostic factors of gastrointestinal stromal tumors (GIST).Methods A total of 144 GIST patients treated at the First Affiliated Hospital of Guangxi Medical University between January 1996 and December 2011 were analyzed restrospectively.Kaplan-Meier,log-rank test and Cox regression model were used.Results The overall 5-year survival was 59.6％.Log-rank univariate survival analysis showed that the primary location,tumor size,metastasis,operational method,type of tumor cells,invasion of the surrounding organs and tissues,invasion of the smooth muscle,cellularity of the tumor,mitotic counts of the tumor cells,Ki-67 labeling index,P53 expression and targeting therapy were significant prognostic factors (P ＜ 0.05).Cox regression model showed that tumor size,metastasis,operational method,surrounding organs and tissues invasion,cellularity of the tumor,mitotic counts of the tumor cells,P53 and targeting therapy were essential to improve the survival.Conclusions The study suggests that early diagnosis and comprehensive treatment consisting of operation and targeting therapy can significantly improve the survival of GIST.

Objective To investigate the status and significance of KIT,PDGFRA and DOG1 gene mutation in gastrointestinal stromal tumors (GIST).Methods 100 GIST patients treated in the First Affiliated Hospital of Guangxi Medical University between May 2002 and May 2013 were analyzed restrospectively.DNA was isolated and amplified for the all exons of KIT,PDGFRA and DOG1.Each PCR product was sequenced to find the position and type of mutation.Results KIT mutations were identified in 75 cases (75％).PDGFRA mutations were found in 16 cases (16％).No DOG1 mutations were found.The overall 5-year survival was 58.8％.Log-rank univariate survival analysis showed that the primary location,tumor size,metastasis,operational mode,type of tumor cells,invasion of the smrounding organs,invasion of the smooth muscle,mitotic counts of the tumor cells,deletions in exon 11 KIT and targeting therapy were significant prognostic factors (all P ＜ 0.05).COX regression model showed that tumor size,metastasis,operational method,invasion of the surrounding organs,mitotic counts of the tumor cehs,deletions in exon 11 KIT and targeting therapy were related to prognosis.Conclusion KIT and PDGFRA mutations are mutually exclusive.The overexpression mechanism of DOG1 is not related to DOG1 gene mutation.The related gene mutations affect the prognosis of GIST.

Objective To evaluate recurrent laryngeal nerves exposure during thyroid resection. Methods Nineteen case-control clinical trials were collected from relevant studies published in different Chinese databases, and 9269 cases were collected for analysis OR (odds ratios). 95% confidence intervals using the Mantel-Haenszel method for a fixed-effects model, and the Mantel-Haenszel method for a random-effects model were summarized. Both fixed effect model and random effect model were applied to analyze the results and heterogeneity. Results The injury rate of the recurrent laryngeal nerves was significantly lower in exposure group ( OR 0.29, 95% CI 0.16～0.54, P

Objective To investigate the clinical effects of a modified splenocaval shunt combined with pericardial devascularization ( PCDV ) in the treatment of gastroesophageal variceal bleeding. Methods From 1997 to 2007, 168 patients with gastroesophageal variceal bleeding caused by portal hypertension were treated at the People's Hospital of Shaanxi Province. Among all the patients, 90 received a splenocaval shunt + PCDV(combined group) and the remaining 78 received PCDV (PCDV group). Changes in intra- and postoperative hemodynamics of the portal venous system were detected by Doppler color flow imaging, and free portal pressure was measured intraoperatively. All data were analysed using analysis of variance, the paired t test and chi-square test.Results The mortality was 3% (3/90) in the combined group and 5% (4/78) in the PCDV group, with no significant difference between the two groups (x2 = 0.038, P ＞0.05 ). The postoperative rebleeding rate was 6%(5/79) in the combined group, which was significantly lower than 13% (8/60) in the PCDV group (x2 =4.824,P ＜ 0.05 ). The incidence of hepatic encephalopathy was 6% (5/79) in the combined group and 7% (4/60) in the PCDV group, with no significant difference between the two groups ( x2 = 0.072, P ＞ 0.05 ). The 1-, 3-, 5-,and 10-year survival rates were 97% (77/79), 92% (55/60), 80% (16/20) and 60% (3/5) in the combined group, and 97% (58/60), 83% (40/48), 73% (22/30) and 53% (8/15) in the PCDV group, respecitvely,with no significant difference between the two groups ( x2 = 0.731, P ＞ 0.05 ). The intra- and postoperative portal pressures in the combined group were (38.8±4.2) cm H20 ( 1 cm H2O =0. 098 kPa) and (33.1 ± 1.5) cm H2O,with a significant difference ( t = 8. 574, P ＜ 0.05 ). The intra-and postoperative portal pressures in the PCDV group were (38.9±2.5) cm H2O and (34.6±2.6) cm H2O, with a significant difference (t =6. 530, P ＜0.05 ). There was also a significant difference in postoperative portal pressure between the two groups ( t = 2. 859,P ＜ 0.05 ). The intra-and postoperative diameters of the portal vein in the combined group were (1.40 ± 0.41 )cm and ( 1.22 ± 0. 15) cm, respectively, with a significant difference ( t = 2. 608, P ＜ 0.05 ). The intra-and postoperative portal venous flows in the combined group were (1280 ±350) ml/min and (830±360) ml/min, with a significant difference ( t = 5. 668, P ＜ 0. 05 ). The intra-and postoperative diameters of the portal vein in the PCDV group were ( 1.41 ±0.32) cm and ( 1.27 ±0.32) cm, respectively, with no significant difference between the two groups (t = 1. 637, P ＞ 0.05 ). The intra-and postoperative portal venous flows in the combined group were ( 1350 ± 380) ml/min and (980 ± 290) ml/min, with a significant difference ( t = 4. 096, P ＜ 0.05 ). There was no significant difference in postoperative portal venous flow between the two groups ( t = 1.871, P ＞ 0.05 ).Conclusions The modified splenocaval shunt combined with PCDV is safe and effective with a low rate of recurrent rebleeding. The clinical outcome and rational hemodynamic changes show that the combined procedure of splenocaval shunt and PCDV is a good choice for treatment of gastroesophageal variceal bleeding.

Objective To explore the clinical characteristics of portal vein thrombosis(PVT) after splenocaval shunt plus devascularization in treatment of portal hypertension and find Out ways for its prevention.Methods The formation,diagnosis,treatment of PVT and variceal rehemorrhage in 110 patients with portal hypertension who received splenocaval shunt plus devascularization procedures (Combined Group)and 92 patients subjected to pericardial devascularization operation(PCDV Group) were retrospectively analyzed.Meanwhile,the effect of two procedures on PVT was compared.Results The incidence of PVT was 10.0%in combined group and 22.8%in PCDV group (P<0.05).The rebleeding rate from esophagogastric varices because of PVT in combined group was 3.6%,which was significantly lower than that of 10.8%in PCDV group(P<0.05).Conclusion Splenoeaval shunt plus devascularization is a better choice to decrease the incidence of PVT.The postoperative anti-coagulation therapy in the early stage is important for the prevention of PVT.

Objective To evaluate the effects,hemodynamies and hepatic functional reserve of a combined procedure of modified pmximal splenocaval shunt and pericardial devascularlzation (PCDV) in the treatment of portal hypertension.Methods From 1997 to 2007,a total of 255 patients with cirrhotic portal hypertension received combined (135 cases) or PCDV procedure (120 cases,) in our hospital.The clinical results were retrospectively analyzed.Changes of hemodynamics of the portal venous system were studied by Doppler color flow imaging and intraoperative free portal pressure (FPP) measurement.The hepatic functional reserve was evaluated by indocyanine green (ICG) retention ratio and functional hepatic flow(FHF).Results Postoperative mortality was 2.2% in combined group and 4.3% in PCDV group.The long term rebleeding rate was 5.5%as revealed by follow-up in combined group,which was significantly lower than that in PCDV group of 14.1%(P<0.05).The incidence of encephalopathy was 6.4%and 5.4%in combined group and PCDV group respectively(P>0.05).The 1-,3-,5-and 10 year-survival rates were 96.4%,90.0%,81.3%and 62.5% in combined group and 95.7%,86.7%,75.0%,57.1%in PCDV group.In combined group,the FPP、PVF and FHFwere(32.0±1.5)cm H_2O、(880±260)ml/min and(430±1 80)ml/min respectively,a significant decrease when compared with preoperative parameters (P<0.05),while R_(15) (30%±4%)increased (P<0.01).The similar results were observed in PCDV group postoperatively (P<0.05).Compared to PCDV group,the decrease of FPP in combined group was more significant(P<0.05),but the PVF,FHF and R_(15) were not significantly different (P>0.05).Conclusions The combined procedure is safe and effective in treatment of portal hypertension with better clinical outcome,moderate homodynamic changes and good maintenance of hepatic functional reserve.

Background: Hepatocyte nuclear factor 4α (HNF4α) plays an important role in the development of liver,and studies demonstrate that it is correlated with the pathogenesis of hepatocellular carcinoma (HCC).However,the regulatory effect of HNF4α on expression of vascular endothelial growth factor (VEGF) in human HCC cell lines and tube formation of human umbilical vein endothelial cell (HUVEC) is not yet clear.Aims: To investigate the effect of HNF4α on expression of VEGF in human HCC cell lines and tube formation of HUVEC.Methods: Lentiviral vector overexpressed HNF4α was constructed,and then transfected into HepG2 and SMMC-7721 cells (experimental group),cells transfected with lentiviral blank vector and cells without transfection were served as negative control group and blank control group,respectively.The mRNA and protein expressions of HNF4α,VEGF were detected by qRT-PCR and Western blotting,respectively.The conditioned media of HepG2 and SMMC-7721 cells were co-cultured with HUVEC,and number of HUVEC tube formation was measured.Results: HepG2 and SMMC-7721 cells with stable overexpression of HNF4α were successfully established.Compared with negative control group and blank control group,mRNA and protein expressions of VEGF in experimental group were significantly decreased (P＜0.05),and number of HUVEC tube formation was significantly decreased (P＜0.05).Conclusions: HNF4α can significantly inhibit the expression of VEGF in HepG2 and SMMC-7721 cells and tube formation of HUVEC.

Objective To observe the therapeutic effects of end-to-side and side-to-side portal vein-hepatic artery shunts (P-H shunt) in pigs with liver cirrhosis and portal hypertension.Methods There were 15 pigs in each group (control and experimental),and the P-H shunt was made in each animal to observe the process of blood flow into the liver and the reduction of portal vein blood pressure.Results The portal vein pressures before the P-H shunt of pigs in the control and experimental group were (20.51±0.74) cm H2O (1 cm H2O=0.098 kPa) and (30.82±2.53) cm H2O respectively (P＜0.05).Portal vein pressures 30 days after the P-H shunt were(19.75±0.84) cm H2O and (20.84± 1.36) cm H2 O respectively (P＞0.05).The portal vein pressure differences of pigs in the control and experimental group before P-H shunt were (7.20±0.34) cm H2O and (17.34±0.62) cm H2O respectively (P＜0.05).Pressures differences 30 days after the P-H shunt were (6.40±0.21) cm H2O and (7.84 ± 1.32) cm H2O respectively (P＜0.05).Splenic vein injection of methylene blue after the P-H shunt operation stained the liver well.No necrosis and hepatic encephalopathy occurred for 30 days after the P-H shunt,and the splenomegaly gradually returned to normal.Liver function was most affected after the operation and other biochemical markers were least affected.Conclusions The P-H shunt changed the channel of blood flow into the liver,the portal hemodynamic was not affected,and a new balanced mechanism was established to maintain the portal hemodynamic stability.However,further treatment was needed for liver function recovery.

Objective To determine if using a soft-tipped guidewire to cannulate the common bile duct may ameliorate development of PEP(post-ERCP pancreatitis)and facilitate cannulation of the CBD(common bile duct).Methods A total of 78 patients treated treateed in our hospital underwent ERCP through conventional direct cannulation(52 diagnostic ERCPs,26 therapeutics ERCPs)from 1998 to 2001 were randomly selected as group A while 112 patients underwent ERCP through guide wire-directed cannulation(21 diagnostic ERCPs,91 therapeutics ERCPs)from 2007 to 2008 as group B.Then we retrospectively studied and compared the following parameters between the two groups:1)Success rate of biliary access;2)visualization rate of pancreatic duct;3)the level of serum amylase,severity of abdominal pain and the rate of PEP.Meanwhile,the correlation between grading of pancreatic duct visualization and PEP was analyzed.Results The success rate of biliary access of the guidewire group(106/112 cases)was significantly greater than the conventional group(33/78 cases)(94.64%vs.42.30%,P<0.01).In group A,about61.53%(16/26)of the 26 cases could not continue the next therapeutics ERCP because of unsucceasful carmulation. The visualization rate of pancreatic duct of group A and B were 58.97%(46/78 cases)and 8.04%(9/112 cases)(P<0.01) respectively.On occurrence rate of PEP,group A(17/78 cases)was significantly higher than group B(4/112 cases)(21.79% vs.3.57%,P<0.01),and severe pancreatitis occurred in 3 patients in conventional group.However,there was no severe pancreatitis in the guide wire group.There were no significant differences (P>0.05) in terms of the rate of hyperamylasemia between the two groups.The significant correlation was found between the grading of pancreatic duct visualization and the occurrence of PEP.Condusion Guidewire-directed selective access to the bile duct lowers likdihood of PEP by facilitating cannulation and lowering the visualization rate of pancreatic duct.The occurrence of PEP could be predicted by the grading of pancreatic duct visualization,which is a very important but not the unique factor leading to PEP.

Objective To investigate the effect of bicalutamide on migration and invasion of androgen receptor(AR) positive breast cancer cells and related mechanism, and the effect of mTOR inhibitor everolimus combined with bicalutamide on the proliferation of MDA-MB-453 cells. Methods Western blot was used to detect the expression change of mTOR, p-mTOR and p-S6 in breast cancer cell lines before and after bicalutamide treatment. Transwell assay was used to detect the cell viability. MTT assay was used to detect the proliferation of MDA-MB-453 cells treated by the combination of bicalutamide and everolimus. The combined effect of the two drugs was calculated by Jin Zhengjun's method. Results After six days of bicalutamide treatment, the expression of mTOR, p-mTOR and p-S6 were decreased in MDA-MB-453 cells (Ρ =0.034, 0.05, 0.03). The invasion and migration were inhibited in MDA-MB-453 cells (migration: t =4.88, P =0.001, invasion: t =2.684, P =0.028). The proliferation of MDA-MB-453 cells was inhibited after the treatment of bicalutamide combined with everolimus, and the Q value were all greater than 1.15. Conclusion Bicalutamide could inhibit the invasion and migration of MDA-MB-453, and the inhibition effect is affected by the expression level of AR. The combination of bicalutamide and everolimus could synergistically inhibit the proliferation of AR positive breast cancer cells.