Except common histologic type,some special histological types and clinico-pathological features of gastric cancer,such as neuroendocrine carcinoma,hepatoid adenocarcinoma,lymphoepithelioma-like gastric carcinoma and hereditary diffuse gastric cancer,etc,because of there special diagnosis and treatment measures and prognosis,should be taken into account in our clinical work.This article reviews the clinical progress of diagnosis,treatment and prognosis of the four special kinds of gastric cancer mentioned above.

Objective To investigate the diagnosis/misdiagnosis reason/treatment of residual gallbladder stone with choledocholithiasis.Methods The clinical data of 34 patients with residual gallbladder,16 cases of them suffered from choledocholithiasis additionally were retrospective analyzed.Results 14 cases were treated by residual cholecystectomy +choledochotomy +T -tube drainage,2 cases were were treated by choledochotomy + T -tube drainage.Preoperative misdiagnosis of residual gallstones rate was 56.3% (9 /16 ),7 cases were found residual gallstones during operation.The other 2 cases were misdiagnosed residual gallstones.The rate of intraoperative and postoperative misdiagnosis was 12.5% (2 /16 ).18 cases with residual gallstones,16 cases underwent residual cholecystectomy,2 cases who were suspected with choledocholithiasis underwent residual cholecystectomy +choledo-chotomy,T -tube drainage.18 cases had no preoperative and postoperative misdiagnosis.Conclusion The clinical symptom of residual gallbladder stone with choledocholithiasis was similar to residual gallstones,often characterized by upper abdominal pain,fever,chills,jaundice,abdominal distension and other symptoms.It is difficult for preoperative imageological diagnosis that less than 3 cm residual gallbladder and small stones.When choledocholithiasis at the same time,needing more intraoperative careful dissect cystic duct and common bile duct,completes the cystic duct and common bile duct exploration,reducing misdiagnose residual gallstones.

Objective To investigate the effect of nimodipine (ND) injecting into cisterna magna on the mitochondrial pathway in hippocampus in rabbit model of subarachnoid hemorrhage (SAH). Methods Eighteen New Zealand white rabbits were randomly allocated to Sham group, SAH group and ND group, six in each group. All the animals underwent operation under anaesthesia. One mL/kg autologous non-heparinized arterial blood was injected into cisterna magna in SAH group and ND group, and the same dosage of saline was injected into cisterna magna in Sham group. Thirty minutes after injection, 1 mg/kg nimodipine was injected into cisterna magna in ND group, and equal-volume of saline was injected into cisterna magna in Sham group and SAH group. All the animals were assessed for the grade of food intake and neurological impairment, and rats were killed 72 hours after SAH. Their hippocampus were processed for detecting the expressions of Bcl-2, Bax, Caspase-3 and Cyt-C mRNA by qRT-PCR. The protein expressions of Caspase-3 and Cyt-C were detected by Western blot assay. Results Compared with the Sham group, there were lower grade of food intake, varying degrees of neurological impairment and lower ratio of Bcl-2/Bax, while the mRNA levels of Bcl-2, Bax, Caspase-3 and Cyt-C and protein levels of Caspase-3 and Cyt-C showed elevated expressions in SAH group and ND group (P<0.05). Compared with SAH group, there were no significant differences in the score of food intake and neurological impairment in the ND group ( P>0.05). There were higher ratio of Bcl-2/Bax and expression levels of Bcl-2 mRNA and lower expression levels of Bax mRNA, Caspase-3 and Cyt-C mRNA and proteins in ND group than those in SAH group (P<0.05). Conclusion Nimodipine plays a protective role in inhibiting the activity of mitochondrial pathway in hippocampus after subarachnoid hemorrhage.

Objective To investigate the application of improving prolene hernia system(PHS) tensionfree repair for inguinal hernia under ultrasound-guided local nerve block anesthesia.Methods Retrospective analysis the clinical data of 40 patients with improving prolene hernia system(PHS) tension-free repair for inguinal hernia under ultrasound-guided local nerve block anesthesia from January 2013 to January 2014 in Gulou Hospital of Nanjing University.Results In group of ultrasound-guided local nerve block anesthesia , the average anesthesia time was (8.9 ± 1.5) min, the time to get out of bed was (5.6 ± 1.1) h, the length of stay was (2.9 ± 0.7) d,There were (12.4 4± 2.2) min, (10.2 ± 1.6) h and (3.7 ±± 0.7) d in general anesthesia group, and significant difference(P ＜0.05), the average operation time of two groups were (22.6 ± 2.0) min, (22.1 ± 2.4) min,the average duration of postoperative analgesia was (6.4 ± 1.6) h, (6.1 4± 1.5) h, and no significant difference (P ＞ 0.05).Conclusions Improving prolene hernia system(PHS) tension-free repair for inguinal hernia under ultrasound-guided local nerve block anesthesia is simple , easy and safe to be performed with mild pain, faster recovery and less bleeding.It is worthy of popularization and application.

Objective To discuss the relationship between echogenicity and fat content in renal tumor.Methods 52 renal tumors were examined with preoperative ultrasonography,all tumors were 3 cm in diameter or less.The tumor echogenicity was classified as echogenicity increasement type (including hyperechoic and slightly hyperechoic) and echogenicity decreasement type (hypoechoic).The relationship between echogenicity and adipose staining in tumor were analyzed.Results In 18 cases pathologically proved benign renal tumor,14(77.8 ％) of the tumors were hyperechoic and were angiomyolipoma(AMLs),4(22.2％) of the tumors were hypoechoic including 2 poor fat AMLs and 2 rare benign tumors,slightly hyperechoic case was not detected.In 34 cases malignant renal tumors,27(79.4％) of the tumors were slightly hyperechoic including 22 clear cell renal cell carcinomas (RCCAs) and 5 papillary RCCAs,7 (20.6％) of the tumors were hypoechoic including 2 clear cell RCCAs,3 papillary RCCAs and 2 chromophobe RCCAs.Hyperechoic case was not detected.The adipose staining of 41 cases of echogenicity increasement type was all positive,in the 11 cases of echogenicity decreasement type,9 tumors were adipose staining negative,while the other 2 tumors were positive,and there were statistically significant between two groups (P ＜0.05).Conclusions Echogenicity was obviously correlate with fat content in renal tumor.Tumors containing rich fat appear to be increased in echogenicity,tumors without fat content appear to be decreased in echogenicity.

Objective To study the roles of abnormal expressions of Caspase-8 and protein kinase C(PKC)-β of cardiomyocytes in the development of the apoptosis of cardiomyocyte in diabetic rat. Methods Rats were divided into 4 groups:(1)normal control (NC, n=37),(2)rats given STZ injection and normal diet(STZ,n= 42), (3) rats fed with high fat and high sngar ( HFS, n= 37), (4)rats given STZ injection and high fat and high sugar diet (type 2 DM, n=64). Plasma glucose, insulin and lipids were detected. At the end of experiment, the animals were sacrificed, and their hearts were examined. Pathological changes were observed and the expressions of Caspase-8, PKC-β mRNA were determined by real time-PCR method; apoptosis was analyzed by flow cytometry. Results (1)The body weight was higher in HFS group than in other three groups, and progressively decreased in type 2 diabetes group. The glucose level was highest in diabetic group, and was similar between groups of HFS and NC. (2)The apoptosis showed tendency to ascend during course of disease in diabetes model group. (3)The expressions of Caspase-8 and PKC-β mRNA were significantly enhanced in diabetes model group than in normal control group, and had a tendency to ascend during the course of disease.(4)The myocardial cells of the diabetic rats were rarified and swelling, fibrosis was observed. (5)At the 16th week, the level of plasma glucose was correlated positively with the expressions of Caspase-8 and PKC-β mRNA. Conclusions The enhancement of expressions of Caspase-8 amd PKC-β may play iportat rols in the pathogenesis of diabetic cardiomyopathy,in which apoptosis of the cardiomyocytes increased.

Objective To study the development of cardiomyopathy complicated with type 2 diabetes mellitus in the rats. Methods The 120 health male Sprague-Dawley rats, weighing 180-220 g, were divided into 4 groups: (1)STZ-modeled diabetes, fed with high-carbohydrate plus high-fat diet (n=40);(2)fed with regular diet (n=30);(3)and (4)SD rats with citrate buffer instead of STZ injection, fed with high-carbohydrate and high fat diet (n= 25);and fed with regular diet (n= 25); At the 4th, 8 th, 12 th and 16 th week after the intra-peritoneal injection of STZ solution or citrate buffer solution, rats from each group were scarified and examined. Results There were no significant differences in body mass and blood glucose among those groups after one week of feeding (P＞0. 05).After 4 weeks of feeding before injection, the body mass, fasting insulin (FINS) and insulin sensitive index (ISI) were obviously increased in diabetes group and high-carbohydrate plus high-fat control group as compared with STZ control group and normal control group (P＜ 0. 05). There were no significant differences between diabetes group and high-carbohydrate plus high-fat control group,between STZ control group and normal control group (P＞0. 05). After injection, the blood glucose,body mass, ventricular mass, TG and TC were higher in diabetes group and high-carbohydrate plus high-lipid control group than in STZ control group and normal control group (P＜0.05). The above parameters were much higher in diabetes group than in high-carbohydrate plus high-lipid control group, but there was no difference between STZ control group and normal control group (P＜0. 05).Pathological examination showed that the weight of the heart was significantly increased, the myocardial cells were hypertrophied accompanying degenerative changes and apoptosis, the interstitial collagen fibers were hyperplasia in the diabetic rats. The ultrastructures also presented severe damage.These changes indicated that cardiomyopathy was induced in the diabetes rats. Although similar changes were found in the rats fed with high-carbohydrate plus high-fat diet, they were much less significant than those in the diabetic rats. Conclusions Cardiomyopathy developes frequently in the rats with type 2 diabetes mellitus induced by feeding high-carbohydrate plus high-lipid diet and single intra-peritonial injection of 30 mg/kg STZ solution.

Objective To study the significance of level changes of serum hydrogen sulfide(H2 S) and interleukin-6(IL-6)in children with hand,foot and mouth disease(HFMD).Methods Nity-two cases with HFMD were enrolled and divided into severe HFMD group(48 cases)and common HFMD group(44 cases).Forty-six healthy children were enrolled as healthy control group.The serum H2 S and IL-6 were detected.Results Acute phase:compared to the healthy control group[H2 S(55.76 ±7.80)μmol /L,IL-6 (61.31 ±13.43)ng /L],the level of serum H2 S significantly reduced and the level of IL-6 significantly increased in severe HFMD group[H2 S(21.72 ±7.52)μmol /L;IL-6(131.33 ±17.82)ng /L]and common HFMD group[H2 S(31.86 ±8.41 )μmol /L;IL-6(95.48 ±15.07)ng /L](P ﹤0.01 ),and there was signifi-cantly difference between the severe HFMD group and common HFMD group(P ﹤0.01 ).Recovery phase:compared to the healthy control group,the serum H2 S level[(34.54 ±13.21 )μmol /L]was lower and IL-6 [(92.73 ±15.25)ng /L]was higher in severe HFMD group(P ﹤0.01 ).The serum H2 S level was negatively correlated with IL-6 in severe HFMD group and common HFMD group(r =-0.31 ,P ﹤0.01 ;r =-0.45, P ﹤0.01 ).Conclusion The serum H2 S and IL-6 participate in the pathological process of HFMD,and the level change can be used as one of indicators of early diagnosis.

Objective:To investigate of AIDET communication model in caring for type 2 diabetes mellitus of hospitalized patients.Methods:A total of 113 patients with type 2 diabetes mellitus treated in our department from January 2018 to November 2019 were enrolled, and divided into the control group(receiving a conventional communication mode)and the observation group(receiving an AIDET communication mode)according to a time order in the selecting of the research patients.The changes of self-care behavior and glucose metabolism index were evaluated and analyzed between the two groups.Results:On admission, the fasting blood glucose, 2-h postprandial blood glucose and glycosylated hemoglobin were(9.1±1.7)mmol/L, (13.8±2.9)mmol/L and(8.4±3.5)% in the observation group, and(9.4±2.1)mmol/L, (14.1±3.2)mmol/L and(8.1±2.9)% in the control group, respectively, with no statistically significances( P>0.05). At discharge, the observation group versus the control group showed a statistically significantly improved levels in FPG of(5.9±1.5)mmol/L vs.(7.8±1.9)mmol/L, in 2h-PBG of(10.1±3.7)mmol/L vs.(12.8±3.9)mmol/L and in glycosylated hemoglobin of(6.3±1.2)% vs.(7.5±0.9)%, respectively( P<0.05). The scores of management of poor blood glucose, foot care, blood glucose monitoring, medication compliance, regular exercise and diet control were higher in the observation group than in the control group at discharge( P<0.05). Conclusions:The application of AIDET communication mode can effectively enhance the self-care behavior of patients and help improve the glucose metabolism in hospitalized patients with type 2 diabetes mellitus.It has very positive effects on controlling the development of type 2 diabetes mellitus and improving the quality of life.

Objective To study the dynamic changes of injury and apoptosis of liver induced by lipid metabolic disturbance in the rats with diabetes mellitus and their correlation with the expressions of sterol regulatory element binding protein-1c(SREBP-1c)and c-Jun N-terminal kinase(JNK).Methods Experimental animals were randomly divided into 4 groups:diabetesgroup(n=64)induced by high-carbohydrate and high-fat diet plus intra-peritoneal streptozeotocin(STZ)injection,normal control(n=37)fed regular diet and receiving citric buffer solution injection,STZ group(n=42)fed regular diet and receiving STZ injection,high gluaxeard fat group(n =37)receiving citric buffer solution injection.Body weight,liver weight,fasting plasma glucose(FPG),fasting insulin(FINS),triglyceride(TG),total cholesterole(TC),alanine transaminase(ALT),asparate transaminase(AST)were detected at various time intervals.The changes of liver histopathology and ultrastructure were observed by ES and Sudan Ⅲ stanings,transmission electrom microscope.The expressions of SREBP-1c and JNK mRNAs and proteins were determined by real time-PCR methods.Apoptosis was analyzed by flow cytometry.Results The diabetic rats showed much lower body weight(P＜0.05)and higher liver weight than controls,STZ group and high-carbohydrate and fat group(P＜0.05),while showed higher levels(P＜0.05)of serum FPG,FINS,TG,TC,ALT,AST.Diabetic rats exhibited fatty degeneration of liver cells accompanied by inflammatory infiltration and fibrosis.Organelle structures were more disturbed and apoptosis was more obviou along with longer course of disease.The expressions of SREBP-1c,JNK proteins and mRNA were significantly enhanced.The rats fed high-carbohydrate and fat diet also showed similar liver lesions and enhanced SREBP-1c,J NK proteins and mRNA expressions but not as severe as in diabetes group Conclusions Insulin resistance and high blood glucose may induce diabetic hepatopathy.The high expressions of JNK and SREBP-1c may play important roles in liver lipid metabolism disorders and cell apoptosis.