Objective To investigate the clinical characteristic and surgical treatment of MGIST. Methods 40 cases MGIST surgical meterials were retrospectively analyzed. Results All cases were used surgery,the situation of the tumor is clear and most of them are not coated clearly. The diameter of the tumor is 5～16cm, in average (8.6±2.4)cm ;no lymph nodes metastasis during the surgery. No serious postoperative complications. Follow-up the pa-tients for 8～68 months, 14 of them died. Conclusion There is no specific characteristic on MGIST clinical perform-ance, pathological examination is the basis for the diagnosis. Surgical resection is the main treatment method.

ObjectiveTo understand knowledge level about chronic obstructive pulmonary disease (COPD)of medical doctors practising at district hospitals and community health service and impact of different models of continuing medical education on their knowledge level.MethodsKnowledge of COPD was investigated with a close-book examination in 372 medical doctors working at the grassroots of 10 urban copies of finished examination papers were returned in this investigation.with an average score of 50.1 and pass rate of 42.5%.About 67.7%and 67.5%of medical doctors passed the examination of knowledge on definition,risk factors and non.pharmacological treatment for COPD.respectively,and 19.9%of them passed the examination on pharmacological treatment for COPD.Different modes of continuing medical education made varied impacts on their acquisition of COPD knowledge.with an average score of 67 and pass rate of 73.3%in the intensified education group,respectively,significantly higher than those in general education group and non-education group.ConclusionsClinical knowledge and skills of COPD for medical doctors working at the grassroots in Beijing Was not so satisfactory and education should be strengthened urgently to raise their knowledge on COPD prevention and control.

Objective To investigate the clinical manifestation, biochemically detected data, and radiographic features of a pedigree with suspected mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome, and to explore the correlations between the clinical features and the mutant heteroplasmy levels of mitochondrial genome. Methods The personal details, histories of stroke-like episodes and seizures within the proband and 11 members in the maternal lineage of the family were collected. Routine blood examinations and plasma lactate levels before and after movements of these family members were detected, followed by cephalic MRI examinations. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and DNA sequencing were used to detect and validate the A3243G point mutation in mitochondrial genome, and real-time PCR were used to quantify the mutation proportion of A3243G. Results Typical symptoms of MELAS such as seizures, stroke-like episodes and hyperlactacidemia and atypical symptoms such as growth failure, exercise intolerance, fevers and migraines were observed on several members in the pedigree. Cephalic MRI findings performed during episode periods were in accord with the typical radiographic features of MELAS and cerebellar atrophy was commonly observed. Family members on the maternal side all harbored the point mutation on 3243 site in mitochondrial genome. Meanwhile, patients with higher heteroplasmy levels relatively manifested more typically and severely according to the clinical observation. Conclusions The pedigree is diagnosed with maternal inheritance of MELAS syndrome. The main cause can be attributed to a mitochonorial A3243G mutation.The mutant heteroplasmy levels of hemocytes in peripheral blood are positively associated with genetic relationship, seizure anticipation, plasma lactate data and other clinical features.

Objective To evaluate the saf ety and efficiency of phacoemulsificatio n combined with intraocular lens implant and trabeculectomy in patients with glau coma and cataract after filtrating surge ry failure. Methods Thirty-two cases （32 eyes） patients underwent phacoemulsific ation combined with intraocular lens imp lant and trabeculectomy after filtrating surgery failure. Outcome measures inclu ded intraocular pressure （IOP） and visua l acuity. The followed-up periods rang ed from 6 months to 2 years. Results In 21 of the 32 eyes（66％），postoperative vi sual acuity were above 0.5. In 6 of the 32 eyes（18％），postoperative visual acuity were between 0.1 to 0.4. In 27 of 32 e yes（84.3％）， postoperative IOP were between 12.23 to 20.55 mmHg. Conclusion phac oemulsification combined with intraocula r lens implant and trabeculectomy in patients with glaucoma and cataract after f iltrating surgery failure is a safe and effective treatment for these patients.

Objective To detect the expression of Id1 and p53 in human breast cancer and study their relationship. Methods To choose 80 cases of breast cancer from the surgical department of Tangshan people's hospital. All patients didn't get radiotherapy and chemotherapy before surgery. The expression of Idl and p53 of breast cancer were studied by using SABC immunohistochemistry. Results The expressions of Id1 were found in cytoplasm, while the expression of p53 was found in cell nucleus. The positive rates of Id1 and p53 were 87.5 %(70/80)and 90.0%(72/80) respectively in breast cancer tissues. The expression of Id1 and p53 were significantly higher in breast cancer tissue than those in adjacent non-tumor breast tissues,benign tumor tissues and normal breast tissues(P ＜0.05). The positive rates and expression intensity of Id1 in breast cancer had significant correlation with lymph node metastasis and pTNM stage of the tumor, but had no significant correlation with age, histological differentiation and tumor size. The positive rates and expression intensity of p53 in breast cancer had significant correlation with lymph node metastasis of the tumor, but had no significant correlation with age, histological differentiation,tumor size and pTNM stage. Conclusion Expression of Id1 in human breast cancer is up-regulated. Its expression is associated with lymph node metastasis and TNM stage and represents an independent marker for prognosis of breast cancer. To reduce the expression of Id1 will become the strategy of curing breast cancer. Expression of Id1 and p53 in human breast cancer have the same clinic significance. Each of them can represent an independent marker for prognosis of breast cancer.

Objective To investigate the effectiveness of intensive sit-to-stand training in improving the balance and walking of hemiplegic stroke patients. Methods Sixty hemiplegic stroke patients were randomly divided into an observation group and a control group with 30 cases in each.Both groups were treated with routine rehabilitation.The observation group also underwent extensive sit-to-stand training.The training lasted for 15 min/time,6 times/week for 4 weeks.All of the patients were assessed with respect to their body weight distribution,Berg balance scale (BBS) scores,timed up & go test (TUGT) times and using footprint gait analysis,before the treatment and 4 weeks post treatment. Results After 4 weeks of treatment body weight distribution,BBS scores,TUGT times and gait improved significantly in both groups.The BBS,TUGT and gait improvements were significantly greater in the observation than in the control group.There was no significant difference between the two groups in terms of body weight distribution. Conclusions Extensive sit-to-stand training combined with routine rehabilitation can distinctly improve the balance and walking of hemiplegic stroke survivors.

Objective To investigate the resilience of primary caregivers of cancer patients undergoing chemotherapy and explore the influencing factors. Methods General information questionnaire and Cornor-Davidson resilience scale (CD-RISC) were used in the survey among 173 cancer patients undergoing chemotherapy as well as their primary caregivers. Results The score of resilience of primary caregivers was (70.76 ±13.34), at middle or above level. Multiple linear regression analysis showed that caregivers'resilience was affected by gender, age, family income and religious belief (all P<0.05). Conclusion The resilience among primary caregivers of cancer patients undergoing chemotherapy is at a relatively high level. Clinically, we should pay more attention to female and young patients with lower family income and no religious beliefs.

Objective To investigate the method of handmade microwire lasso device for the management of coil migration during intracranial aneurysm embolization. Methods Two migration coils were removed from intracranial arteries using handmade microwire lasso rings. The first coil prolapsed completely from an aneurysm sac and flowed to the middle cerebral artery M2 segment. The second coil partially prolapsed out into a parent artery. The microwire lasso device was made of 4-0 silk thread and fixed using 0. 36 mm (0. 014 inch)microwire and 0. 43 mm (0. 017 inch)microcatheter. Results After removing 2 migration coils from intracranial arteries,angiography did not reveal vascular injury and thrombosis. There was no aneurysm rupture. After awaking from anesthesia,the patient did not have neurological deficit. The patient was followed up for 3 months after procedure. MR angiography confirmed the patency of related arteries. Conclusion The handmade microwire lasso device for the management of coil migration in the process of aneurysm embolization is a simple,effective,and economical method.

[Objective]To explore clinical class,surgical treatment and clinical results of clavicle fracture with internal fixation.[Method]A retrospective analysis of 146 cases of clavicle fracture was reported.Totally 146 cases of clavicle fracture accepted by our department from January of 1996 to June of 2006 were carried out the operation using plate shaft.There were 98 males and 78 females.Aged from 8 to 84 years,average of 38.6 years.The average age of the patients at surgery were 38.6 years(ranged 8 to 84 years).There were 9 cases in proximal 1/3,115 cases in middle 1/3 and 12 cases in distal 1/3 of clavicle,accompanied by 7 cases of brachial-plexus injury,4 cases of vascular injury,16 cases of another fracture.There were 7 cases of old clavicle fracture.Surgical methods: Both proximal 1/3 and middle 1/3 of clavicle fracture were treated by AO reconstruction plate or similar plate.Fracture pieces of clavicle were enlaced with screws or steel wire before fixation with plate.The distal of clavicle fracture should be fixed with 3 screws.The distal 1/3 of clavicle fracture with acromioclavicular luxation was treated by reconstruction plate or c clavicle hook plate.Patient could exercise their shoulder joint at 48 hours postoperatively.Post operative evaluation: Clinical results of clavicle fracture with internal fixation were evaluated with appearance,fracture healing time, shoulder joint function and living quality around fracture.[Result]Patients were followed up more than 6 months after operation.Adopt Neer standard to evaluate the patient's function after the operation.There were excellent results in 96 cases and good in 50 without injury of subclavicular nerve and blood vessel,infection,loose and prolapse of internal fixation devices and fracture disunion and malunion and macrosis bony callus.X-ray shows clavicle fracture healing completely.The patients can get painless free-running.[Conclusion]Internal fixation for treatment of clavicle fracture is characterized by little wound,firm fixation and early movement of the joint and is an effective method to cure clavicle fracture.

Objective To investigate the biological effect of GM-CSF on splenic dentritic cells (DCs)when used to treat severe sepsis and the influence on the prognosis.Methods All 160 male Kunming mice were randomly(random number)divided into four groups:control group(n =50),the mice didnt receive special treatment; CLP group(n =42),the mice underwent cecal ligation and puncture;conventional treatment group(n =34),the mice received intraperitoneal injection of 5 mg/kg ceftriaxone at 12,24,36,48,60,72 and 84 h after surgery; GM-CSF treatment group(n =34),the mice received hypodermic injection of 20 μg/kg GM-CSF besides ceftriaxone at 12,36,60,and 84 h after surgery.The mice were sacrificed at 0,12,24,48 and 72 h after CLP by cervical dislocation.The amount of splenic DCs and apoptosis rate were measured by flow cytometry,and the serum concentrations of IL-12 were detected by ELISA in each group.Meanwhile the survival prognosis was observed at 96 h.Results At every time point,the apoptosis of splenic DCs increased and the amount markedly reduced in severe sepsis(P ＜0.05),the serum concentration of IL-12 increased on an one-way curve type(P ＜0.05).The treatment of cephalosporin exacerbated the loss of DCs(P ＜ 0.05),while hadnt any effect on IL-12(P ＞ 0.05).GMCSF treatment increased the amount of DCs(P ＜ 0.05),and decreased IL-12 concentrations(P ＜ 0.05).The OR of GM-CSF was 0.079 computed by Logist regression analysis.Conclusions GM-CSF treatment severe sepsis can increase the amount of splenic DCs,decrease serum levels of IL-12,and improve prognosis.