Objective To evaluate the effect of neoadjuvant chemotherapy on lymph node micrometastasis and DC cell number in stage Ⅲ gastric cancer patients.Methods Lymph node micrometastases in pathologically negative lymph nodes from 76 stage Ⅲ gastric cancer patients [56 cases with neoadjavant chemotherapy (NCT) and 20 cases without],were assessed by cytokeratin-20 antibody.Dendritic cells (DC) in HE positive lymph nodes,HE negatives near tumor foci and HE negatives far foci were assessed by CD83 antibody respectively.Patients were divided into four groups:group 0 (20 cases without NCT),group 2 (two courses of NCT in 29 patients),group 3 (three courses of NCT in 16 patients),group 4 (four courses of NCT in 11 patients).Results In NCT group there were two patients with micrometastases (2/56).All the patients were with micrometastases in control group (20/20).Difference was statistically significant (P =0.000).In HE-positive lymph node group:the number of CD83-positive DC in 2 times group,3 times group,and 4 times group when compared with no chemotherapy group were statistically significant (P20 =0.001,P30 =0.000,P40 =0.000).In HE-negative lymph node near foci group:the number of CD83-positive DC in 3 times group,and 4 times group compared with 0 group were statistically significant increased (P30 =0.001,P40 =0.001).In HE-negative lymph node far foci group:the number of 4 times group was significantly higher than 0,2 and 3 group (P40 =0.000,P42 =0.000,P43 =0.001).Conclusions Neoadjuvant chemotherapy is effective in the prevention of lymph node micrometastases in stage Ⅲ gastric carcinoma and it increases the number of mature dendritic cells in lymph nodes.

Objective To explore the serum level of Glucagon like peptide-1 in late-onset Alzheimer′s patients and its clinical significance.Methods Case control study.Collecting cerebral vascular disease fifty-five cases, diagnosed with late-onset Alzheimer′s disease sixty-one cases, type 2 diabetes mellitus fifty-one cases , type 2 diabetic patients combined with late-onset Alzheimer′s disease thirty-seven patients from the Shanghai East Hospital and partly Pudong area elderdly hospital during October 2013 to March 2014, and forty healthy persons as normal control from physical examination center of Shanghai East Hospital during September 2013 to February 2014.Measuring the concentrations of GLP-1,β-amyloid, Tau protein and other routinely used clinical tests in the serum of patients from the normal controls , cerebrovascular disease , late-onset Alzheimer′s disease, type 2 diabetes and type 2 diabetes mellitus combined with late-onset Alzheimer′s disease by ELISA method developed in our laboratory.The blood samples were also collected at three fixed time including fasting time ,1 hour after taking glucose , 2 hour after taking glucose, the concentrations of GLP-1 were determined in the LOAD group , T2DM group and the T2DM combined with LOAD group and normal control group.The concentrations of serum GLP-1 among groups were compared with single factor analysis of variance , and the concentrations of serum GLP-1 between the two groups were compared using LSD-t test.Analysing the correlation between GLP-1 and other indicators with Pearson analysis.Results The fasting GLP-1 levels of LOAD group were ( 123.4 ±20.8 ) nmol/L, and they were highest between the normal control group (78.6 ±6.0) nmol/L and the cerebral blood vessel disease group(89.0 ±8.7)nmol/L (F values were 3.46 and 1.98, P<0.05).The fasting GLP-1 levels of T2DM combined with LOAD group (157.9 ±28.6) nmol/L were higher than the LOAD group (123.4 ± 20.8) nmol/L (t =1.63,P <0.05), but there were no difference of the fasting GLP-1 levels between T2DM combined with LOAD group (157.9 ±28.6) nmol/L and T2DM group(153.8 ±18.0)nmol/L(t=0.96,P>0.05).Deficient secretion of GLP-1 after taking glucose 1 hour in most of the patients of T2DM combined with LOAD group (99.1 ±14.2) nmol/L, LOAD group(73.9 ±6.6 ) nmol/L and T2DM group (96.3 ±7.0 ) nmol/L could be concluded .The GLP-1 levels of T2DM combined with LOAD group after taking sugar 2 hour were (115.4 ±18.6)nmol/L ,and were higher than that of normal levels (63.3 ±6.2) nmol/L after taking sugar 2 hour(t=4.49,P<0.05).There were no difference between the GLP-1 levels of the LOAD group (73.6 ±5.8 )nmol/L and the GLP-1 levels of the normal group(63.3 ±6.2)nmol/L after taking sugar 2 hour (t=0.94,P>0.05).Pearson correlation analysis showed that the relationship of the levels of GLP-1 with Aβ( 1-42 ) and the levels of GLP-1 after taking glucose 1 h and 2 h were positively relative, and its coefficients of correlation were 0.401,0.436,0.722.Conclusions LOAD and T2MD are similar, and they have GLP-1 secretion shortage phenomenon after taking glucose , so monitoring dynamic change of GLP-1 after taking glucose may contribute to the auxiliary diagnosis of LOAD.

Objective To compare the difference of kidney function evaluated by using 3 different estimated glomerular filtration rate(GFR) equations in populations .Methods Retrospectively analyzed 65 856 patients who measured serum creatinine and Cysta‐tin C at the same time ,and come from the outpatients or inpatients of the hospital .The estimated GFR (eGFR) were calculated through 3 equations ,then compared the eGFR in the population and among different groups according to different kidney functions , and then grouped the people enrolled in the study again according to the eGFR calculated by using the 3 different equations and compared the differences among groups .Results Compared with the eGFR calculated by using Creatinine equation ,the correlation coefficients of the eGFRs calculated by using the other two equations were 0 .81 and 0 .90 ,respectively ,both P<0 .05 ;The differ‐ence between the means of eGFR were 6 .19 and 1 .79 mL/(min × 1 .73 m2 ) respectively with obvious significance (P<0 .01) ,in consistency analysis .There were obvious overestimation of kidney function when using Creatinine equation to calculate eGFR .Con‐clusion There is consistence and obvious difference by using the 3 CKD‐EPI′s eGFR equations .Physicians should choose suitable equations to evaluate kidney function in different populations .

Objective To investigate the clinical value of serum lipoprotein ( a ) concentration in evaluation of plaques characteristics for patients with coronary atherosclerotic heart diseases ( CAHD ) . Methods Using case-control method, Patients with suspicious CAHD, received coronary computed tomography angiography in the Shanghai East Hospital during October 2013 to June 2015 were enrolled.According to the results of coronary artery CTA, the patients were divided into two groups : the CAHD group (352 cases) and control group(438 cases) , the particle concentrations and mass concentration of lipoprotein(a), triglyceride, total cholesterol, HDL-C, LDL-C, glucose, HBA1c and hs-CRP and other tests were measured, the patients of CAHD group were divided into three subgroups by characteristics of coronary artery plaques including soft plaque (176 cases), calcified plaque (90 cases) and mixed plaque (86 cases), analysis were made with all these data.Using T test or variance analysis to compare the means between or among groups, the risk for CAHD was analyzed by logistic regression, the relationship between LP (a) -P and LP( a) -M were explored by linearly egression analysis, Conformance test were analyzed using kappa test.Results Compared with control group, the mean results of the CAHD group are significantly higher than that of control group, including LP (a) -P 18.5(8.3 -43.0))nmol/L vs.13.6 (7.6-32.4)nmol/L( t =-2.110), LP(a)-M 183(71 -361)mg/L vs.126(67 -293)mg/L(t =-2.063), age (62 ±9)years vs.(52 ±9)years(t=-7.691), hs-CRP 0.86(0.44-1.97) )mg/L vs.0.70(0.38-1.64)mg/L(t=-2.236), glucose (6.1 ±2.29 )mmol/L vs.(5.36 ±1.32 )mmol/L(t=-4.914), BA1c (6.13 ±0.98) % vs.(5.81 ±0.58) %(t=-4.842), APO(B) (1.09 ±0.33) g/L vs.(1.03 ±0.29) g/L( t=-2.407), all of the P values <0.05;The relative risk(RR)of age, glucose, LP( a)-P and LP ( a)-M are 1.067, 2.377, 1.384 and 1.342 respectively; Among the three types of plaques groups,the mean differences of age, TC, HDL-C, LDL-C and LP ( a)-P are statistically significant ( F=6.276,3.060,3.127,4.723,2.878;all of the P<0.05);The median of LP ( a)-P in the soft plaque group 20.3(8.3-48.2)nmol/L is higher than that of the mixed plaque group 15.7(7.3-26.0)nmol/L(P<0.05 ) and calcified plaque group 15.6 ( 8.1 -23.1 ) nmol/L ( P <0.05 ).The linearly regression equation of LP ( a) -M and LP( a)-P is Y=6.646X, r=0.939; Consistency test indicate the two methods are not consistent when used for grouping ( Kappa value is 0.557 ).Conclusions Serum concentration of lipoprotein(a) is an independent risk factor of CAHD, and the particle concentration of LP(a) is closely related to the characteristics of the plaques, especially to the soft plaque.

Objective To understand the status of knowledge,attitude and behavior on malaria of residents in endemic areas of Yunnan Province.so as to provide evidences for implementation of Global Fund MaIaIia Control Program.Methods The subjects were selected by the method of multi-level sampling in 47 countries and were investigated by questionnaire.Results A toatl of 40 940 households in 883 natural villages were investigated.39 234 questionnaires were effective with an effective rate of 95.83%.A total of 60.32%interviewees knew malaria symptom and signs,22.41%of them knew the route of transmission,17.65% knew the preventive measures.57.61% had the willing to use insecticide-treated bed nets(ITNs),and 8.68%of the households owned ITNs.Conclusion Health edueion and promotion regarding critical malria interventions should be strengthened in the following implementation.

Objective To evaluate efficacy and safety of intravenous chemotherapy combined with TACE in the treatment of gastric cancer with hepatic metastasis.Methods In this study 60 gastric cancer patients with hepatic metastasis were divided into two groups randomly,the trial group (30 cases) took intravenous chemotherapy consisted of docetaxel 60 mg/m2 intravenous drip d1,oxaliplatin 80 mg/m2 intravenous drip d1 followed by 5-fiuorouracil 500 mg/m2 intravenous drip d1-5 after TACE.The control group (30 cases) took the same chemotherapy protocol and one treatment cycle covering 4 weeks.Results The overall response rate in trial group was 53％ and the increase rate of Karnofsky was 70％ while that was 37％ and 40％ respectively in the control group (P ＜ 0.05).The median overall survival of trial group was 13 months and which was 8 months in the control group (P ＜ 0.05),meanwhile the toxicities and side reactions of trial group didn't increase notably.Conclusions Intravenous chemotherapy combined with TACE is safe and more effective in the treatment of gastric cancer with hepatic metastasis.

Objective To compare the efficacy and safety of modified FOLFOX4 program with docetaxel-oxaliplatin-5-fluorouracil (DOF) program as neoadjuvant chemotherapy in stage Ⅲ gastric cancer patients.Methods In 86 cases of stage Ⅲ gastric cancer patients,42 received modified FOLFOX4 chemotherapy,44 cases were treated by DOF program.After two cycles of chemotherapy,the treatment effect and adverse reactions were evaluated.Results The total effectiveness in modified FOLFOX4 group and DOF group was 60％ (25/42) and 68％ (30/44) respectively (P ＞ 0.05).Tumor control rate was 83％ (35/42) and 89％ (39/44) respectively (P ＞ 0.05).The incidence of nausea,vomiting and leukopenia was higher in DOF group than modified FOLFOX4 group (P ＜ 0.05).The D2 lymph node dissection rate between modified FOLFOX4 group and DOF group was 80％ (20/25) and 87％ (26/30) respectively (P ＞ 0.05),the R0 resection rate was 72％ (18/25) and 83％ (25/30) respectively (P ＞ 0.05).In 43 R0 resection patients using FOLFOX4 the median survival time was 38.7 months,1-,3-year survival rate was 90％,and 60％ ; while that in DOF group the median survival time was 39.6 months,1-,3-year survival rate was 95％,and 75％.Multivariate analysis showed that postoperative TNM stage only was an independent risk factor for prognosis.Conclusions TNM stage was the independent risk factor for prognosis of gastric carcinoma patients after radical gastrectomy.

Objective To investigate the prognostic value of preoperative neutrophil lymphocyte ratio (NLR) in patients with gastrointestinal stromal tumors (GIST).Methods The clinical-pathological data from 85 GIST cases were collected from the Second Affiliated Hospital of Wenzhou Medical University and retrospectively analyzed from June 2009 to December 2013.According to the exclusion criteria,79 cases were enrolled.Preoperative neutrophil and lymphocyte count was collected and NLR was calculated.According to the receiver operating characteristic (ROC) curve of NLR,GIST patients were divided into low NLR group (NLR ＜ 2.30) and high NLR group (NLR ≥ 2.30).Clinic-pathological features and five year disease free survival (DFS) were compared between the two groups.Results There was a statistical significant difference in tumor size and tumor risk between high NLR group and low NLR group (respectively,x2 =9.517,12.411,all P ＜ 0.05).Univariate analysis showed that the five year disease free survival rate of low NLR and high NLR group were 78％ and 32％ (x2 =18.749,P =0.000).By multivariate analysis a high NLR was identified as an independent risk factor of poorer prognosis for patients with GISTs (RR:3.516,95％CI:1.453-8.506,P=0.005).Conclusion A high preoperative NLR is an independent risk factor for the prognosis of GISTs.

ObjectiveTo investigate the diagnostic value of single balloon enteroscopy (SBE) for obscure gastrointestinal bleeding.MethodsA total of 78 SBE procedures was conducted on 72 patients with obscure gastrointestinal bleeding,with 40 via oral route and 38 via anal route.The procedure time,insertion depth and rate of positive finding were recorded.ResultsFor 40 SBE procedures performed via oral route,the mean procedure time was 60 minutes ( 15-110 minutes),and the mean insertion depth was 195 cm at the distal end of Trentz ligament (30-240 cm).For 38 SBE procedures performed via anus,the mean procedure time was 75 minuets (30-120 minutes),and the mean insertion depth was 160 cm at the proximal end of ileocecal valve (50-200 cm ).The whole diagnostic yield of obscure gastrointestinal bleeding was 62.5％.ConclusionSBE is a safe and useful tool for the diagnosis of obscure gastrointestinal bleeding.

Objective To investigate the early diagnosis and treatment of primary gastrointestinal malignant lymphoma( PGIML). Methods The clinical materials of 33 cases with PGIML from 1997 to 2005 were retrospectively studied. Results The diagnosis rate of gastroenteroscopy was 44. 4% . The most common immune phenotype was B-cell lineage (90. 9% ). Of the 33 PGIML patients, 30 were treated with operation, 2 with H. poli elimination and 1 gave up treatment. Among the operation cases and operation plus chemotherapy cases 19/21 cases (90. 5% )and 6/9 cases (66. 7% ) survived more than 2 years respectively, the other 6 cases died. Conclusion It is hard to diagnose PGIML in early stage. The effectiveness of surgery on treating PGIML should be further confirmed by profound prospective randomized trials.