Objective The purpose of this study is to investigate the expression of human epidermal growth factor receptor-2(HER-2)in gastric carcinoma tissue and normal gastric tissue of these patients,and its relationship with the clinical pathological characteristic,the microvessel density( MVD) and early post-operative recurrence,and to analyze the clinical significance of expression of HER-2 in gastric carcinoma,in order to lay the theoretical foundation of effective therapy for gastric carcinoma.Methods The clinical data of 398 cases of gastric cancer and 363 cases of their adjacent non tumorous gastric tissue of Liaoning Cancer Hospital from March 2012 to July 2013 were analyzed retrospectively.The expression of HER-2 gene was detected by IHC method and Fish method.The expressive rate of HER-2 in gastric carcinoma tissue and normal gastric tissue of these pa-tients were compared,and its relationship with the clinical pathological characteristic,MVD and early post opera-tive recurrence were also analyzed.Results (1)Expressive rate of HER-2 in 398 cases of gastric cancer tissue was 14.07%(56/398),which was higher than that in all the adjacent non tumorous gastric tissue presented none expression 0(0/363)(P<0.05);(2)In gastric cancer tissue of 398,the expression of HER-2 was related with Lauren type,tumor site,vessel invasion status,TNM stage,lymph node metastases(P<0.05),and it had no cor-relation with age,sex,tumor size,histological differentiation degree,growth patterns of cancer(P>0.05).Expres-sive rate of HER-2 in T4 stage was higher than( T1 +T2 +T3 ) stage,but the difference was not statistically sig-nificant( P>0.05).(3)The value of MVD in HER-2 expressive group(58.63 ±19.97)was significantly higher than those in HER-2 non expressive group(49.04 ±19.25).A positive significant correlation was found be-tween HER-2 and MVD expression using the rank correlation matrix(P<0.001,r=4.33).(4)1 year and 1.5 year of early post operative recurrence rate in HER-2 expressive group were 16.00%、38.00%,in HER-2 non expressive group were 8.81%,25.53%,the difference was not statistically significant(P>0.05).Conclusion There is excessive expression of HER -2 in gastric cancer tissue,excessive expression of HER -2 patients withgastric cancer is correlated with Lauren type,tumor location,vessel invasion status,TNM stage,lymph node metastases;it displays no correlation with age,sex,tumor size,histological differentiation degree,growth patterns ofcancer.HER -2 expression is positively associated with MVD value.Excessive expression of HER -2 is possibleto be correlative with early post operative recurrence,and it must have further follow up to confirm.

2～3 cm). MVC of preoperative bioptic specimens will help to choose the length of distal clearance.

Objective:To observe the influence of parenteral nutrition support on nutritional status and immune function in patients with neoadjuvant chemotherapy for gastric cancer.Methods:60 patients with locally advanced gastric cancer were randomly divided into PN group and control group,30 cases in each group.The nutritional status and immune function were compared.Results:Adverse reaction of chemotherapy in PN group was less than in control group (P ＜ 0.05).ALB,TF.PA and IgA,IgG,IgM,CD4+ and CD4+/CD8+ were all higher in PN group than in control group 7 days after surgery (P ＜ 0.05).Conclusion:Parenteral nutrition support is helpful to improve patients' nutritional state during chemotherapy and operation.

Objective To evaluate long-term changes in health-related quality of life (QOL) of patients with local advanced prostate cancer after intensity modulated radiotherapy (IMRT) combined with androgen deprivation therapy.Methods The patients who met the criteria for this study were enrolled and were treated with IMRT combined with androgen deprivation.The total dose of radiation was 68.2Gy(2.2Gy per fraction).QOL was evaluated before and 3,12,36,48 and 60 months after treatment using the Expanded Prostate Cancer Index Composite(EPIC),a validated tool that assesses four primary domains (urinary,bowel,sexual and hormonal).Results From 2002 to 2007,87 patients were enrolled.At each follow-up time point,the number of cases was 87,87,86,81,75,65,56 and 47,respectively.The median follow-up time was 76.8 months.Compared with baseline assessment,all of four domain scores were declined in follow-up assessments.The mean score of urinary,bowel and hormonal domains were significantly reduced.At 3 months after treatment,the scores of bowel domain were lowest,in which the total,function and symptom scores were 75.7,78.4 and 72.8,respectively.However,there was no statistically significant difference in the mean sexual domain score.The mean change scores in urinary incontinence and obstructive were-13.0±8.3 and-6.12±3.9,respectively.Conclusions IMRT combined with androgen deprivation therapy was well tolerated in patients with local advanced prostate cancer.QOL was decreased in urinary,bowel and hormonal toxicity,most of which could be tolerated in five years.

Objective To investigate the effects of heparanase and E-cadherin on the invasion and metastasis of gastric cancer. Methods Fifty specimens of gastric cancer which had been resected at Cancer Hospital of Liaoning Province from February 2005 to May 2007 were collected. The expression of heparanase mRNA and E-cadherin mRNA in these gastric cancer specimens was detected by RT-PCR, and the expression of E-cadherin in these gastric cancer specimens was detected by immunohistochemistry. Data were analyzed by t-test and variance analysis, and the enumeration data analyzed by chi-square test. Results There were significant differences in the expression of heparanase and E-cadherin between gastric cancer cells with high and low differentiation, presence and absence of metastasis, and TNM stages Ⅰ and Ⅱ versus Ⅲ and Ⅳ (t = 1.999, 4.258, 1.735 ; 1.286, 6.794, 3.091; χ~2 =6.273, 9.397, 5.640, P <0.05). The co-expression of heparanase (+) and E-cadherin (-) was correlated with tumor undifferentiation, lymph node metastasis and advanced TNM staging (χ~2 =11.306, 10.208, 8.420, P <0.05). Conclusions Heparanasc shows high expression while E-cadherin shows low expression in gastric cancer tissue. There is a synergistic effect between the abnormal expression of heparanase and E-cadherin, and the gastric cancer cells with coexpression of heparanase and E-cadherin have more malignant potential.

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.

Objective To evaluate the effect of domestic wire-reinforced epidural catheter on the occurrence of adverse events during epidural block.Methods Three hundred ASA Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,weighing 41-78 kg,scheduled for elective operations under combined spinal-epidural anesthesia,were randomly divided into 3 groups (n =100 each):polyvinyl chloride epidural catheter group (group A),imported wire-reinforced epidural catheter group (group B) and domestic wire-reinforced epidural catheter group (group C).Combined spinal-epidural anesthesia was performed routinely.The corresponding epidural catheter was inserted in each group.The catheterization without difficulty,paresthesia during catheterization,the number of patients in whom blood or cerebrospinal fluid was withdrawn from the epidural catheter,intravascular catheter insertion,injection obstruction,easiness during removal of the catheter,bleeding after removal,postoperative paresthesia and epidural hematoma within 1 week after operation were recorded.Results Compared with A group,the incidences of paresthesia during catheterization,the number of patients in whom blood or cerebrospinal fluid was withdrawn from the epidural catheter,injection obstruction and postoperative paresthesia were significantly decreased (P ＜ 0.05),and no significant change was found in the other parameters in B and C groups (P ＞ 0.05).There was no significant difference in all the parameters between B group and C group (P ＞ 0.05).Conclusion Domestic wire-reinforced epidural catheter can decrease the occurrence of catheterization-induced damage to the nerve and blood vessels and the efficacy is comparable with that of imported wire-reinforced epidural catheter.

Microsatellite instability(MSI)was defined according to the frequency of positive findings in a panel of MSI markers.High frequency MSI(MSI-H)was the phenotype in which repeat sequences were extraordinarily unstable, and was considered to be the bona fide phenotype of DNA mismatch repair defection. However base substitutions in some well studied oncogenes or tumor suppressors were reported to be uncommon in MSI-H tumors. To explore this obvious contradiction, the relationship between MSI and KRAS gene mutations were studied in a panel of 76 human colorectal carcinomas, the whole exon of MLH1 and MSH2 were sequenced for MSI-H tumors. KRAS gene mutation was confirmed by similar frequencies in tumors of different MSI status. Intriguingly, all of the KRAS mutant MSI-H tumors harbored sequence alterations in MLH1gene, which was a key player in DNA mismatch repair system. This implied that in MSI-H tumors carrying MMR mutations, KRAS mutation were frequently and almost exclusively occurred. Furthermore, these MMR mutants were uniformly carrying a unique modification + jumping type MSI, which was different to MSI-H tumors without MLH1 or MSH2 gene mutations. This study shaded lights on the heterogeneity of MSI-H tumors, and implied the connection between modification type MSI and DNA mismatch defection.

AIM: To investigate the expression and function of apoptosis-related protein, Fas, FasL, and Bcl-2 in the pathogenesis of autoimmune thyroiditis. METHODS: Immunohistochemical staining was performed on 20 Hashimoto's thyroiditis (HT), 20 Graves' disease (GD), and 20 thyroid follicular adenoma (TFA, as control). RESULTS: All the cases expressed Fas, mainly on the cell surface and cytoplasm. FasL was found in all except 3 of the TFA. Bcl-2 in 15 of HT, 19 of GD, 17 of TFA. In TFA follicular cells expressed moderate Fas and minimal or absent FasL. In HT, follicles adjacent to infiltrating lymphocytes showed a increased levels of Fas and FasL, but infiltrating lymphocytes exhibited weaker staining of Fas and FasL than thyrocytes. In GD, thyrocytes and lymphocytes showed nearly similar Fas with HT, but rather weaker for FasL than HT. Bcl-2 was nearly similar in GD and TFA, but follicular cells in vicinity of lymphocytes and lymphocytes located in germinal centers of HT tissues exhibited significantly weaker. CONCLUSION: The expression of Fas, FasL and Bcl-2 in Hashimoto's thyroiditis and Graves' disease was nearly similar. Strong FasL expression and weak Bcl-2 expression on the follicles in HT may induce apoptosis. These results provide further proof that the functions of Fas and its ligand and Bcl-2 may play an important part in the pathogenesis of autoimmune thyroid diseases. The lymphocytes do not seem to be directly engaged in the process with their own FasL, but they may provide some cytokines that, in turn, up-regulates Fas and/or FasL leading to apoptosis.

Objective To investigate the effect of ultrasound-guided paravertebral nerve block on stress reaction in patients undergoing esophageal resection. Methods Eighty patients scheduled to do the operation of esophageal resection were randomly divided into two groups with 40 cases in each group. The patients in group A were given the general anesthesia combined with ultrasound-guided paravertebral block, and the patients in group B were given the general anesthesia only. Both of two groups received postoperative patient controlled intravenous analgesia (PCIA). The amount of propofol and remifen-tanil used were recorded. The data of blood pressure, heart rate (HR) and pulseoxygen saturation (SpO2) before anesthesia (T1), before induction (T2), after intubation (T3), in 2 h of surgery (T4), after surgery (T5), 1 h after surgery (T6), 8 h after surgery (T7), 24 h after surgery (T8), 48 h after surgery (T9)were recorded. The analgesic effect was measured by VAS scores and Ramsay sedation scores were also recorded at T6-T10. The levels of blood glucose, epinephrine (E), norcpincphrinc (NE) and dopamine (DA) were also detected at T1, T4, T5, T9. Results The amount of propofol and remifentanil used in group A were lower than those in group B: (960.0 ± 216.9) mg vs. (1 242.5 ± 200.2) mg, (1.5 ± 0.4) mg vs. (2.3 ± 0.4) mg, P<0.05. The patients in two groups successfully completed surgery, and intraoperative vital signs was stable. The quiet and active VAS scores at T6-T9 in group A were significantly lower than those in group B (P<0.05). The Ramsay sedation scores at each time point in two groups had no significant differences (P>0.05). The levels of blood glucose and NE at T9 were significantly higher than those at T1, T4 or T5 of same group, P<0.05.The level of E at T4 and T5 was significantly lower than that at T1 and T9 of same group, P<0.05. The level of DA at T9 was significantly higher than that at T1, T4 and T5 in group B (P<0.05). The levels of blood glucose, NE, E and DA at T9 in group B were significantly higher than those in group A (P<0.05). Conclusions General anesthesia combined with ultrasound-guided paravertebral nerve block could offer favorable anaesthesia effect. It could decrease stress reaction and anesthetics requirements in patients undergoing esophageal resection.