Objective To investigate the expression of interleukin-6(IL-6),high mobility group protein B1 (HMGB1)and Survivin in patients with gastrointestinal stromal tumors (GISTs)and the relationship between them.Methods 43 patients with GISTs and 30 healthy controls from Jan.2009 to Dec.2012 in Nanchong Central Hospital was enrolled.Expressions of IL-6,HMGB1 and Survivin in serum were assessed with enzyme linked immunosorbent assay(ELISA) and the correlation among IL-6,HMGB1 and Survivin was analyzed.Results The serum levels of IL-6,HMGB1 and Survivin in patients with GISTs((0.61 ±0.05)ng/ml,(3.54 ±0.74) ng/ml,(0.15 ± 0.04)ng/ml,respectively)were higher those that in the healthy controls((0.32 ± 0.03)ng/ml,(1.81 ± 0.06)ng/ml,(0.07 ±0.02)ng/ml,respectively).Among the 43 GISTs,the expressions of IL-6,HMGB1 and Survivin in benign,potentially malignant and malignant group increased gradually.The expressions of IL-6 in each group were (0.55 ± 0.02) ng/ml,(0.59 ± 0.02) ng/ml,(0.64 ± 0.03) ng/ml,respectively,The expressions of HMGB1 in each group were (2.82 ± 0.55) ng/ml,(3.46 ± 0.16) ng/ml,(4.00 ± 0.61) ng/ml,respectively.The expressions of Survivin in each group were (0.10 ± 0.01) ng/ml,(0.15 ± 0.02) ng/ml,(0.18 ± 0.03) ng/ml,respectively.Expressions of IL-6 and HMGB1,IL-6 and Survivin,and HMGB1 and Survivin were positively correlated(r =0.699,P ＜0.05;r =0.774,P ＜0.05;r =0.595,P ＜0.05,respectively).Conclusion The high expression of IL-6,HMGB1 and Survivin may together contribute to the malignancy,invasion and metastasis of GIST.Detection of these three markers may be useful in judging the malignancy degree and predicting the prognosis of GIST.

Objective To investigate the significance of combined vascular resection and reconstruction in surgery for pancreatic cancer.Methods The clinical data of 231 patients with pancreatic canccr who received pancreaticoduodenectomy at the Southwest Hospital from January 2006 to December 2011 were retrospectively analyzed.All the patients were divided into the combined vascular resection and reconstruction group (97patients) and non-vascular resection and reconstruction group (134 patients).Effects of operation,results of pathological examination,prognosis and lymph node metastasis on the prognosis of the patients in the 2 groups were compared.Two independent samples t test was used to analyze the measurement data,and the count data were analyzed using the chi-square test.The survival curve was drawn by the Kaplan-Meier method,and the survival was analyzed using the Log-rank test.Results The operation time and intraoperative volume of blood loss were (554 ± 136)minutes and (1110 ± 939)rnl in the combined vascular resection and reconstruction group,and (445 ±106)minutes and (623 ±349)ml in the non-vascular resection and reconstruction group,with significant difference between the 2 groups (t =6.552,4.873,P ＜ 0.05).The mortality,morbidity and positive rate of lymph node metastasis of were 8.2％ (8/97),20.6％ (20/97) and 32.0％ (31/97) in the combined vascular resection and reconstruction group and 3.0％ (4/134),8.2％ (11 / 134) and 16.4％ (22/134) in the non-vascular resection and reconstruction group.There was no significant difference in the mortality between the 2 groups (x2=3.164,P ＞ 0.05),while significant differences in the morbidity and positive rate of lymph node metastasis were detected between the 2 groups (x2 =7.458,7.687,P ＜ 0.05).A total of 223 patients were followed up till September 2012,53 patients were with lymph node metastasis,and their median survival time was 8.4 months (range,6.9-10.0 months) ; 170 patients were with negative lymph node metastasis,and their median survival time was 18.6 months (range,15.8-21.5 months),which was significantly longer than that of patients with positive lymph node metastasis (x2=17.045,P ＜ 0.05).Of the 53 patients with lymph node metastasis,31 were in the combined vascular resection and reconstruction group,and their median survival time was 8.5 months (range,6.3-10.7 months) ; 22 were in the non-vascular resection and reconstruction group,and their median survival time was 8.3 months (range,6.1-10.5 months),with no significant difference between the 2 groups (x2 =0.022,P ＞ 0.05).Of the 178 patients with negative lymph node metastasis,64 were in the combined vascular resection and reconstruction group,and their median survival time was 13.2 months (range,9.2-17.1 months) ; 106 were in the non-vascular resection and reconstruction group,and their median survival time was 21.7 months (range,18.1-25.3 months),with significant difference between the 2 groups (x2 =11.908,P ＜ 0.05).Conclusions Although pancreaticoduodenectomy combined with vascular resection and reconstruction increases the incidence of postoperative complications,it could achieve the complete removal of tumors without significantly increasing the mortality rate.For patients with lymph node metastasis,pancreaticoduodenectomy combined with vascular resection and reconstruction has no influence on the postoperative survival time,while it might have influence on the patients without lymph node metastasis.

Objective　To study the diagnosis and treatment of perforated gastric cancer(PGC). Methods　The clinical data of 43 patients with PGC proved pathologically were analysed retrospectively; Results　The diagnosis rate preoperatively was 30.2%(13 cases), misdiagonsis rate 69.8% (30 cases, including 2 misdiagonsed intraoperatively); 21 underwent simple suture closure of the perforation, among whom, 4 died (19.1%), 8 had hematemesis and melanorragia (38.1%), 3 reperforation (1.4%) after operation; mean survival period was 5 months. 9 cases had palliative gastrectomy, 1 died, while 1 had hematemesis after operation; mean survival period 18 months. 13 cases had radical gastrectomy, none of them had postoperative complication or death, mean survival period 27 months, 3 surrived for 5 years（23.1%）. 2 delyed diagnosis underwent simple suture closure at first, but had extensive metastasis at reoperation. Conclusions　Comprehensive analysis of clcnical data made before operation and attenton paid to the signs of PGC during operation can enhance the diagnosis rate of PGC. Simple suture closure of the perforation has more complications, and the survival time is shorter . Once PGC gastric cancer is diagnosed , radical or palliative gastrectomy should be performed.

Objective To investigate the diagnosis and treatment of functional pancreatic endocrine tumors (PETs). Methods The clinical data of 45 patients with functional PETs who were admitted to the Southwest Hospital from January 1998 to December 2008 were retrospectively analyzed. Etiologic and localization diagnosis were made preoperatively according to the manifestation and the results of color doppler ultrasound and computed tomography, respectively. Eight patients received resection of the body and tail of the pancreas and spleen, 32 received tumor enucleation, one received resection of the pancreaticobiliary junction and four received pancreaticoduodenectomy. All patients received chemotherapy after the operation. Results Thirty-four cases of the PETs were benign and the rest eleven cases were malignant. Eight cases of the PETs were in the head of the pancreas,26 in the tail of the pancreas, seven in the body of the pancreas and four cases were with multiple PETs. The diameters of the PETs were 0. 3-5.0 cm, and the diameters of the PETs in 19 cases were above 2.0 cm. Eight patients were complicated with pancreatic leakage, two with incision infection and one with abdominal infection. Of the 33 patients with insulinoma, the blood glucose of five patients with multiple PETs was still abnormal after the operation, three patients underwent reoperation and the other two were treated by diazoxide to control the blood glucose in the normal range. The clinical symptoms of the seven patients with gastrinoma disappeared after the operation, and the gastric ulcer was healed, the 12-hour gastric juice volume and the level of the gastric acid were in the normal range after a continuous treatment with proton pump inhibition agents for 6 months. Necrotizing or migratory rash and diabetes of the four patients with glucagonoma were cured three weeks later, and the level of the amino acid was back to normal. Diarrhea and electronic disturbance of one patient with vasoactive intestinal peptide tumor were alleviated after the operation. Thirty-nine patients were followed up for 20-120 months. Of the 32 patients with benign PETs, two patients had tumor recurrence, and three patients died of other diseases. Of the seven patients with malignant PETs, two patients survived, and three patients died of hepatic metastasis or tumor recurrence, two patients died of other diseases. Conclusions Surgical treatment is effective for the treatment of functional PETs. Palliative resection of the tumor also can obviously improve the life quality of patients with fuctional PETs.

Objective:To evaluate the clinical efficacy of maintenance chemotherapy for patients who had local advanced non-small cell lung cancer (NSCLC) and was responsive to primary radiotherapy and chemotherapy. Methods:One hundred and twenty patients with stage ⅢA or ⅢB NSCLC received 4 cycles of chemotherapy combined with radiotherapy. The 63 patients who achieved certain remission were randomly divided into maintenance chemotherapy group(n=33) and control group(n=30). The patients in maintenance chemotherapy group (treatment group) received vinorelbine (20 mg/m2, d 1 and d 8, per 28 d a cycle) and those in control group were not given maintenance chemotherapy. The clinical efficacy, survival rate and adverse reaction of the two groups were evaluated. Results:There are a longer median time to progression(TTP) in treatment group compared with control group (8.5 month vs 5.0 month, P<0.05). The 1-and 2-year survival rates were 66.7% and 36.4% in the treatment group and 60.7% and 32.1% in the control group, respectively. The difference between the survival rates of two groups was not significant (P>0.05). Conclusion:Maintenance vinorelbine-based chemotherapy prolonged the median time to progression but had no effect on survival time in patients with local advanced NSCLC who responded to induction chemotherapy.

Objective To evaluate the efficacy and safety of fully covered self-expandable metal stents (FCSEMS) implanted by endoscopic retrograde cholangiopancreatography (ERCP) for patients with benign biliary stricture (BBS).Methods The clinical data of 38 patients with BBS underwent ERCP and FCSEMS placement between January 2012 and January 2016 were retrospectively recorded.Success rate of BBS,adverse events related to ERCP and stricture recurrence were analyzed.Results A total of 38 patients underwent FCSEMS placement with a mean time of stent in dwelling for 8 months (range:3-13months).During follow-up after the stent was removed,death of 1 patient after liver transplantation was due to unrelated cause.The mean follow-up time was 13 months (range:2-52 months) for other patients.Stricture recurrence occurred in 6 patients,including 2 cases of gallstone-related biliary strictures,1 case of chronic pancreatitis-related biliary strictures,2 cases of liver transplantation-related biliary strictures,and 1 case of post surgical-related biliary strictures.Stricture resolution occurred in 31 cases with 83.8％ (31/37) success rate,including 90.0％ (18/20) gallstone-related biliary strictures,75.0％ (3/4) chronic pancreatitis-related biliary strictures,80.0％ (8/10) liver transplantation-related biliary strictures,and 66.7％ (2/3)post surgical-related biliary strictures.The incidence of post-ERCP complications was 21.1％ (8/38),including mild pancreatitis in 5 case,hyperamylasemia in 2 cases,cholangitis in 1 case.All patients were cured by conservative treatment.Conclusion FCSEMS are effective and safe for BBS.Further studies are needed to assess the indwelling time of FCSEMS,whether FCSEMS are superior to multiple plastic stents and the different efficacy of FCSEMS for BBS caused by different etiology.

The kinetics of nicotine degradation by O.intermedium DN2 and its application in tobacco waste were investigated. The results showed that the optimum temperature of nicotine degradation by O.intermedium was 30 ℃, the pH value was 6.5 and a mount of inoculum was 5 %. Under above conditions, the kinetics of nicotine degradation of initial concentration 500 mg/L was studied. The results indicated that the degradation process of nicotine with no-induced strain DN2 followed inverse S-shaped curve, and degradation process of nicotine with induced cells of DN2 followed Eckenfelder mode. The half life of nicotine degradation was 17.43 h and 4.10 h, respectively. And the results also showed that tolerance of O.intermedium DN2 to nicotine was up to 5000 mg/L when 0.1 % of glucose was added. Nicotine (2 220 mg/L) in extract of tobacco wastes degraded about 95.22 % by strain DN2 in 60 h incubation, indicating that strain DN2 was of application value in treatment nicotine pollution.

Objective To evaluate the clinical application of Vater ampulla-duodenal conjunction resection in the treatment of periampullary carcinoma. Methods From January 2005 to July 2006, 15 patients underwent this modus operandi, including carcinoma of duodenal papilla (6 cases), Vater ampulla (5 cases) and lower part of common bile duct (4 cases). The descending part of duodenum, Vater ampulla, head of pancreas and common bile duct were excised en bloc followed by reconstruction of GI conduit. Result One patient died of stress ulcer 2 months postoperatively, the 14 patients recovered uneventfully without any major complications, and 3-16 months follow-up found no tumor recurrence. Conclusion Vater ampulla-duodenal conjunction resection as a new surgical procedure provides enough tumor margin clearance while causing less trauma than standard pancreatoduodenectomy in selected cases of periampullary carcinoma.

OBJECTIVETo determine the safety and efficacy of the enhanced radiofrequency ablation (RFA) new technology for treatment of giant hepatic hemangiomas.

METHODSFrom August 2010 to September 2011, 30 patients with giant hepatic hemangiomas (average diameter: 7.7+/-1.9 cm, range: 5.0 to 12.8 cm) were treated with enhanced RFA. The original lesion diameter, enhanced radiofrequency duration, and cases of RFA-induced burning were recorded. Cases requiring a second RFA treatment were also recorded. Correlation analysis was carried out to determine the association of enhanced RFA with adverse events and change in lesion diameter.

RESULTSThe rate of completely destroyed lesions by enhanced RFA was 70.96%, and the total rate of reduced lesions was 87.1%. No severe adverse events occurred. The duration of enhanced radiofrequency correlated positively with the original lesion diameter (r=0.687, P less than 0.01). The enhanced RFA treatment significantly reduced the average lesion diameter (follow-up: 6.2+/-1.8 cm; t=6.417, P less than 0.01).

CONCLUSIONThe new minimally-invasive technology of enhanced radiofrequency ablation is effective and safe for treating giant hepatic hemangiomas and produces an obvious, short-term curative effect.

Adult ; Catheter Ablation ; methods ; Female ; Hemangioma, Cavernous ; surgery ; Humans ; Liver Neoplasms ; surgery ; Male ; Middle Aged ; Treatment Outcome ; Ultrasonography, Interventional

OBJECTIVETo observe the clinical efficacy and mechanism of Zhuyu Tongfu (ZYTF) Serial Recipe combined with acupuncture and massotherapy in treating hypertensive cerebral hemorrhage (HCH).

METHODSOne hundred and eighteen patients with hypertensive cerebral hemorrhage, on the basis of conventional Western medicine treatment, were randomly divided into ZYTF combined with acupuncture and massotherapy group (treated group) and simple Western medicine group (control group); the clinical efficacy, neurofunction deficit scoring (NDS) alterations and hematoma absorption rate of both groups were observed, and also the plasma superoxide dismutase (SOD) activity, plasma lipid peroxidase (LPO) content, erythrocyte glutathion peroxidase (GSH-Px) activity, hematocrit (Ht) and the whole blood viscosity (Va) change were also observed.

RESULTSIn the treated group, the clinical efficacy, NDS improvement and hematoma absorption rate were superior to that of the control group; comparison between the two groups after treatment showed that plasma SOD activity and GSH-Px activity got more elevated and plasma LPO content, Ht and Va more lowered in the the treated group than those in the control group.

CONCLUSIONZYTF combined with acupuncture and massotherapy has better effect, its therapeutic mechanism was possibly correlated to the elevation of plasma SOD activity, GSH-Px activity and lowering of plasma LPO content, Ht and Va.

Acupuncture Therapy ; methods ; Adult ; Aged ; Aged, 80 and over ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Intracranial Hemorrhage, Hypertensive ; therapy ; Male ; Massage ; methods ; Medicine, Chinese Traditional ; methods ; Middle Aged ; Treatment Outcome