Objective:To investigate the feasibility,moderate-and short-term efficacies of laparoscopic surgery in the resection of the gastric gastrointestinal stromal tumors(GIST)with the tumor diameter more than 5 cm.Methods:The clinicopathological data of 26 gastric GIST patients with the diameter more than 5 cm underwent laparoscopic complete resection were retrospectively analyzed.The postoperative recovery,complications and moderate-and short-term prognosis of the patients were observed.Results:All the patients underwent laparoscopic surgery resection without open operation.According to the location and growth types of tumors,the total gastrectomy was performed in 1 case,the approximal gastrectomy was performed in 2 cases,the distal gastrectomy was performed in 2 cases,and the gastric local resection was performed in the rest 20 cases.The mean diameter of tumors was (5.94±1.28) cm,the mean operational time was (84.23±27.02) min,and the mean blood loss was (72.38±34.24) mL.The postoperative recovery time of bowel function was (2.77±0.65)d and the mean length of postoperative hospitalization time was (7.04±2.24) d.There was 1 case of intraperitoneal hemorrhage and 1 case of anastomotic stenosis;they recovered after conservative therapy.The postoperative pathology results(according to the modified NIH standard) indicated the number of moderate-risk patients was 18(69.23%),and the number of high-risk patients was 8(30.77%).A total of 12 cases accepted the adjuvant therapy with imatinib.There was 1 case of hepatic multimetastasis,and there was no local recurrence or death in the other patients.Conclusion:The moderate-and short-term efficacies of laparoscopic surgery in the gastric GIST patients with the tumor diameter more than 5 cm is safe and feasible.

Objective · To observe the vascular structure before autogenous arteriovenous fistula (AVF) construction in patients with end-stage renal disease (ESRD) and analyze the risk factors of the pre-existing venous neointimal hyperplasia. Methods · The 8 vein samples were screened from 20 ESRD patients at their first time of the AVF construction (non-stenosis group), and the other 8 vein samples were screened from 15 ESRD patients at their at least second time of the AVF repair operation (stenosis group). Sections were prepared and stained with hematoxylin & eosin (H-E) or Masson's trichrome for observation. The intimal thickness was measured by the cellSens software, and its correlation with patients' renal function, calcium-phosphorus metabolism, iron metabolism and inflammatory reaction in the non-stenosis group were analyzed. Results · In the non-stenosis group, there were varying degrees of intimal hyperplasia in 5 (62.5%) cases, loss of endothelial cell layer in 3 (37.5%) cases, and vascular wall replacement by collagenous with atrophy or loss of muscle layer in 5 (62.5%) cases. In the stenosis group, almost all vein samples showed general thickening of the wall and 2 (25.0%) totally lost the muscle layer. Avg It of those two groups were statistically significant (P<0.01). In the non-stenosis group, both of average I/M thickness and average I/M area were negatively related to glomerular filtration rate (GFR) (P<0.05) and positively related to serum phosphorus and calcium-phosphorus product (P<0.05). Conclusion · Some apparently normal vein of ESRD patients showed varying degrees of intimal hyperplasia before AVF construction. The intimal hyperplasia had a remarkable correlation with GFR or calcium-phosphorus metabolism. Early intervention of the intimal hyperplasia prior to AVF construction may be a new prevention and control means.

Objective To observe the complications in children after percutaneeus closure of atrial septal defect (ASD). Methods 192 children,who successfully received percutaneous closure of ASD in our hospital were enrolled in this study. Diameter of ASD was 8.0 ～ 33.0( 16.7± 8.0) mm, the diameter of occluder was 8.0 ～ 38.0 ( 18.9 ± 8.2) mm. The follow-up term ranges from 1 month to 4 years, with a mean of 19.0 ± 4.5 months. Standard 12-lead electrocardiography (ECG) and transthoracic echocardiography (TIE) were performed before closure, 24 including: minimal-moderate residual shunt in 3 patients ( 1.6% ), atrial-ventricle block (AVB) in 1 ( 0.5 % ), sinus There were 184 cases of single-hole ASD, with complication rate of 2.7% (5/184) , including the complication rate in diameter of siagle-hole ASD less than 10mm was 0% , that in ASD between 10 mm and 20 mm was 1.7% (2/119) ,that in ASD more than 20 mm was 5.0% (3/60) ,while there were 8 cases of two- and multi-hole ASD, clusion, including 3 cases of minimal-moderate residual shunt, 1 case of atrial-ventricle block, 1 case of sinus brady-cardia, and 1 case of device-micro-malplesition. 2 days to 2 weeks after procedure, 1 case developed pelade ( 1/192 ). completely recovered (57. 1% ), including 1 case of residul shunt, 1 case of atrial-ventricle block, sinus bradycardia and 1 case of pelade. 2 cases of minimal residual and 1 case of device-micro-malposition were not recov-ered. Conclusions Transeatheter closure of ASD is safe and effective with few complications, most of which disapp-eare completely during follow up term. Long-term follow-up is needed to evaluate the progress of some rare complica-tions.

AIM: To investigate the expression of vascular endothelial growth factor (VEGF) and tumor necrsis factor-alpha (TNF-?) in synovium of rats with adjuvant arthritis (AA) and the relationship between the pathological score and the expression of VEGF and TNF-? protein. METHODS: AA was produced in Wistar rats by inoculating complete Freund's adjuvant (CFA). The arthral pathological score was calculated, production of VEGF and TNF-? protein were assayed by histoimmunochemical staining at different stage after CFA inoculation. RESULTS: In AA group, the pathological score and expression of VEGF protein in synovium increased significantly (P

Objective To investigate the association of tumor necrosis factor (TNF)-α, heat shock protein (HSP)70-2 gene polymorphisms and susceptibility of acute pancreatitis(AP). Methods Using case-control method,The gene polymor?phism of TNF-α and HSP70-2 was detected by PCR-RLFP in 72 patients with AP and 71 healthy controls. Results There were no significant differences in proportion of TNF-αgenotype and alleles between AP and control groups (P>0.05). There were no significant differences in TNF-αgenotype and alleles between severe acute pancreatitis (SAP) and light acute pancreatitis (MAP) of AP group (P>0.05). There were no significant differences in white blood cell count, C-reactive pro?tein (CRP), amylase, three acyl glycerin and glucose between TNF-a and HSP70-2 gene of AA type and GA+GG type pa?tients (P>0.05). The HSP70-2 genotype GA+GG proportion was significantly higher in AP group than that of control group (69.4%vs 49.3%). The ratio of patients with G allele was significantly higher in AP group than that of control group(46.5%vs 31.7%). The ratio of patients with GA+GG type AP was significantly higher in SAP patients than that of MAP patients of AP group(81.0% vs 53.3%). There was no significant difference in G allele between SAP and MAP patients (P>0.05). Conclusion TNF-α polymorphisms is not associated with acute pancreatitis. There is an association between HSP70-2 polymorphisms and acute pancreatitis. Carrying the G allele increases the possibility of a severe acute pancreatitis ,which is one of the genetic susceptibility factors of severe acute pancreatitis.

Objective:To retrospectively analyze and summarize the clinical characteristics of 15 glioma cases that led to leptomenin-ges and spinal cord metastases in Department of Glioma, Beijing Shijitan Hospital, Capital Medical University since 2011. Methods:A total of 15 cases were considered, including 5 patients with World Health Organization gradeⅡ, 6 patients with gradeⅢ, and 4 pa-tients with gradeⅣ. One patient had a tumor at the brain stem, two patients had tumors at the spinal cords, and the other patients had tumors at the hemispheres. One case received biopsy, 4 cases received subtotal resection, and 10 cases received complete resec-tion. Results: Symptoms included low back pain, sensory and motor dysfunction, incontinence, and seizures. After the metastases spread to the cerebrospinal region, patients were treated with chemotherapy, whole spine radiotherapy, intrathecal chemotherapy, and target therapy. The median time of leptomeninges and spinal cord metastasis dissemination appearance was 10 months (1.5-80 months) since surgery. The median overall survival time of the 15 patients was 20 months (9-83 months), and the median survival time was 6 months (2-48 months) after leptomeninges and spinal cord metastases. Conclusion:The prognosis of glioma patients with lepto-meninges and spinal cord metastases was poor, and a proportion of the patients who received appropriate treatment might have a better survival.

Objective To evaluate the safety and efficacy of percutaneous balloon pulmonary valvuloplasty (PBPV)in the treatment of the children with pulmonary stenosis (PS),and to observe the long - term prognosis and analyze the influencing factors. Methods The total of 230 children were collected,who had been diagnosed with pul-monary valve stenosis and had undergone percutaneous balloon pulmonary valvuloplasty between November 1987 and November 2015 in Shandong Provincial Hospital Affiliated to Shandong University. Their ages ranged from 4 months to 17 years,and the follow - up duration lasted from 1 month to 29 years. The data included clinical data and long - term follow - up data of hospitalized children,and the echocardiography data from the healthy peers in the same period. Then the data were analyzed statistically. Results In this study,228 cases of children were successfully performed PBPV, and the success rate was 99％(228 / 230 cases). The pulmonary transvalvular gradient (△P)of preoperation,24 hours postoperatively,half a year postoperatively,2 years postoperatively,5 years postoperatively,and 10 years postope-ratively was (63. 5 ± 23. 8)mmHg (1 mmHg = 0. 133 kPa),(26. 2 ± 11. 1)mmHg,(24. 8 ± 9. 8)mmHg,(20. 9 ± 8. 9)mmHg,(18. 1 ± 8. 7)mmHg,(15. 3 ± 7. 3)mmHg and (15. 3 ± 7. 3)mmHg,respectively. The immediate post-operative △P was significantly lower than that of preoperation (P < 0. 01),and the △P of the most children decreased in the long - term follow - up. The results of Logistic regression analysis showed that valve dysplasia with right ventricu-lar outflow tract stenosis and the immediate postoperative residual transvalvular gradient degree were the risk factors for long term curative effect of PBPV in children who could not reach the best standard. The restenosis rate was 4. 6％(3 /65 cases)with children followed up for more than 10 years. The incidence of long - term follow - up pulmonary valve regurgitation (83％)was significantly higher than that before operation (58％)and short term (68％)after operation, and the degree of regurgitation also increased (P < 0. 05),while the degree of regurgitation of the tricuspid regurgitation decreased gradually during the follow - up (P < 0. 05);the right ventricular diastolic diameter of the patients at 10 years or more after the operation was measured as (19. 27 ± 3. 03)mm,which was significantly higher than that (15. 24 ± 2. 89)mm of the healthy children of at the same term healthy age (P < 0. 05). Conclusions The PBPV has a high success rate in the treatment of children with PS,and it has good medium - long - term curative effect,less com-plications and lower restenosis rate. Therefore,PBPV can be used as the first choice for PS. However,the incidence and degree of pulmonary regurgitation has an increasing trend after PBPV and the right ventricular diastolic diameter is still larger than that of the healthy children. Therefore,the long - term follow - up is necessary out of the hospital.

Objective To observe the levels of four bisphenols (bisphenol A,B,S and F) and their correlation with renal function in chronic kidney disease (CKD) patients.Methods Patients with CKD were identified according to Kidney Disease:Improving Global Outcomes (KDIGO) criteria.Sixty-three CKD patients and eleven healthy controls were enrolled.CKD patients were further classified as mild renal injury group (CKD stage 1 and 2,n=30),moderate renal injury group (CKD stage 3,n=19) and severe renal injury group (CKD stage 4 and 5,n=14).The levels of four bisphenols in serum were determined by high performance liquid chromatography (HPLC).The correlation between concentrations of four bisphenols and estimated glomerular filtration rate (eGFR) was assessed by Spearman's rank correlation analysis.The associations of four bisphenols with coronary heart disease,diabetes and hypertension in CKD patients were estimated by binary multivariate logistic regression.Results (1) Four bisphenols were not detected in serum of healthy control.In the mild renal injury group the bisphenol A and bisphenol S were not detected,and patients had 5.24 (5.24,9.38) μg/L bisphenol B and 0.74 (0.74,0.74) μg/L bisphenol F.In the moderate renal injury group bisphenol S was not detected,and patients had 2.79 (1.01,4.53) μg/L bisphenol A,5.24 (5.24,5.24) μg/L bisphenol B and 0.74 (0.74,0.74) μg/L bisphenol F.In severe renal injury group patients had 14.30 (7.97,18.17) μg/L bisphenol A,0 μg/L bisphenol B,23.73 (23.73,136.59) μg/L bisphenol S and 0.74 (0.74,1.42) μg/L bisphenol F.The levels of bisphenol A and bisphenol S in severe renal injury group were higher than those in the healthy control group,mild renal injury group and moderate renal injury group (all P ＜ 0.05).Bisphenol B and bisphenol F were not statistically different among four groups.(2) Bisphenol A and bisphenol S were negatively correlated with eGFR (r=-0.779,P ＜ 0.001;r=-0.546,P ＜ 0.001).(3) Among CKD patients,bisphenol A was correlated with diabetes (OR=4.951,95％CI 1.603-15.294,P=0.005),and bisphenol S was correlated with hypertension (OR=4.466,95％ CI 1.575-12.666,P=0.005).Conclusions CKD patients have a variety of bisphenol compounds,especially bisphenol A and bisphenol S.Bisphenol A and bisphenol S have high levels,and their exposures are correlated with renal function.