Objective To investigate the surgical treatment of gastrointestinal stromal tumor (GIST) based on the clinical characteristics of GIST in different locations.Methods The clinical data of 486 GIST patients who received surgical treatment at the Peking Union Hospital from January 2003 to December 2012 were retrospectively analyzed.There were 461 patients with primary GIST and 25 with secondary GIST.The clinical characteristics and surgical treatment methods were analyzed.All data were analyzed using the chi-square test.Results Of the 461 patients with esophageal stromal tumors,6 received partial esophagectomy.Of the 234 patients with gastric stromal tumors,183 received partial gastrectomy,23 received proximal gastrectomy + cardiectomy,23 received distal gastrectomy,2 received total gastrectomy and 3 received exploratory laparotomy.Of the 51 patients with duodenal stromal tumors,34 received partial duodenectomy,9 received pancreatico-duodenectomy,5 received pylorus-preserving pancreaticoduodenectomy,3 received palliative surgery.Of the 116 patients with small intestinal stromal tumors,110 received partial small intestinal resection and 6 received palliative surgery.Of the 29 patients with rectal stromal tumors,13 received posterial transsphincteric surgery of the rectum,12 received transanal local resection of rectal tumors and 4 received abdominoperineal resection; laparotomy was performed on 25 patients with GIST in other positions.Of the 25 patients with secondary GIST,10 patients with liver metastasis of GIST received hepatic segmentectomy,1 received hepatobiopsy; 6 received abdominopelvic tumor resection; 5 received portial resection of the small intestine or colon; 1 received sigmoid colostomy; 1 received splenectomy and 1 received intracranial tumor resection.Of the 461 patients with primary GIST,patients who received combined devisceration accounted for 12.58％ (58/461),and the ratio of combined cholecystectomy was the highest,which was 34.5％ (20/58).Combined devisceration was considered for patients with duodenal stromal tumors,gastric stromal tumors and small intestinal tumors.Laparoscopic surgery accounted for 20.39％ (94/461) of all the surgery,and the ratio of laparoscopic surgery which carried out in recent 5 years was 28.52％ (77/270),which was significantly higher than 8.90％ (17/191) of the earlier 5 years (x2=36.67,P ＜ 0.05).Conclusion Different surgical treatment methods including minimally invasive surgery could be adopted according to different clinical characteristics of GIST in different locations,and radical resection of GIST is the main objective.

Objective To investigate the effect of Unaccompanied Ginseng decoction joint Xuanfu Daizhe decoction on complications in patients with gastric cancer adjuvant chemotherapy, and select the best method to reduce the incidence of complications.Methods 80 patients of gastric cancer with postoperative adjuvant chemotherapy from May 2010 to May 2015 were divided into two groups, 40 cases in each group.The control group received Western medicine treatment and observation group received Unaccompanied Ginseng decoction joint Xuanfu Daizhe decoction , with a consecutive of one week.The clinical efficacy, adverse reactions and quality of life were compared between two groups.Results There was no significant difference in total efficacy between observation group and control group(77.5% vs.75.0%; χ2 =0.069,P>0.05).The KPS score, symptom and physical sign score, alanine aminotransferase, serum creatinine and systolic pressure in observation group post-treatment improved more than those in control group ( P<0.05).The adverse reaction rates of thrombocytopenia and myelosuppression in observation group was significantly lower than that in control group , respectively(P<0.05).Conclusion Unaccompanied Ginseng decoction joint Xuanfu Daizhe decoction could decrease the complications in gastric cancer patients with postoperative adjuvant chemotherapy.

3 cm,66.67%,18/27) than those in smaller tumors(

Objective To investigate the effect of sleeve gastrectomy on the intestinal barrier of obesity rats fed with high-fat diet.Methods Thirty obesity rats fed with high-fat diet were randomly divided into three groups including common diet group (CD,n=10),sham operation group (SO,n=10) and sleeve gastrectomy group (SG,n=10).The lactulose/mannitol ratios (L/M) in 24-hour urine and endotoxin in portal vein were evaluated four weeks after surgery.The levels of tight junction proteins including claudin-1 and occludin in intestinal mucosa were analyzed by western blot.Results The body weight of SG group was significantly decreased than those of CD group (P<0.001) and SO group (P<0.001) four weeks after surgery.The L/M ratio in 24-hour urine of SG group was significantly lower than those of CD group (P<0.001) and SO group (P<0.01).The endotoxin level in portal vein of SG group was significantly lower than those of CD group (P<0.01) and SO group (P<0.05).The claudin-1 level in intestinal mucosa of SG group was significantly higher than those of CD group (P<0.001) and SO group (P<0.01) four weeks after surgery.The occludin level in intestinal mucosa of SG group was significantly higherthan those of CD group (P<0.001) and SO group (P<0.001).Conclusions Sleeve gastrectomy can reduce body weight,L/M ratio in 24-hour urine and endotoxin level in portal vein of obesity rat fed with high-fat diet and increase the levels of claudin-1 and occludin in intestinal mucosa.

Objective To investigate the multidisciplinary modality for obesity treatment and evaluate the safety and long-term efficacy of laparoscopic adjustable gastric banding(LAGB) on weight loss and obesity related metabolic diseases in obesity patients.Methods The clinical and follow-up data of 28 consecutive morbid obesity patients receiving LAGB in Dept.General Surgery of PUMC hospital in a multidisciplinary modality from Oct 2009 to May 2012 were retrospectively analyzed.The strategy of perioperative and follow-up management was summarized and the safety and long-term efficacy of LAGB on weight loss and comorbidity were evaluated.Results Mean body weight of the subjects was 129.1kg and mean body mass index(BMI)44.9 kg/m2.All patients underwent LAGB successfully without perioperative mortality.Early postoperative complications included 1 case (3.6％) of pulmonary infection and long-term complications included 2 cases (7.1％)of port infection.Mean body weight and BMI decreased gradually after LAGB.The mean percentage of excess weight loss(％ EWL)at postoperative 24 months was 41.3％.％ EWL of the group with regular follow-up and good compliance was significantly better than the other group.Complete or partial remission was observed in obesity related metabolic diseases at the last follow-up.Conclusions LAGB is safe and has good long-term efficacy on weight loss and comorbidity improvement of obesity patients.Better services can be provided for obesity patients in a multidisciplinary modality,It is important for the patients to follow up regularly after surgery in order to maintain long-term weight loss.

Objective To investigate the correlation between the prognostic nutritional index (PNI) and clinicopathological features and long-term prognosis of gastric cancer patients after radical gastrectomy.Methods The clinical data of 135 gastric cancer patients who underwent radical gastrectomy in this hospital from 2002 to 2006 was analyzed retrospectively.The PNI value was calculated by serum albumin (g/L) + 5 x lymphocyte count (× 109/L).The receiver operating characteristic (ROC) curve and Youden index was used to determine the cutoff value of the PNI.Survival curves were described by the Kaplan-Meier method and compared by the Log-rank test.The univariate and multivariate analyses were performed with the Cox proportional hazard model to identify the prognostic factors.Result The mean PNI value was 47.3 ± 5.9.The mean values of the PNI in age (t =2.909,P =0.004),tumor size (t =2.227,P =0.028),tumor depth (t =3.314,P =0.001),negative lymph node (t =2.381,P =0.019),negative lymphovascular invasion (t =2.781,P =0.006) were significantly higher than those in patients without such factors.When the PNI was 47,the Youden index was maximal,with a sensitivity of 70％ and specificity of 63％.The mean age in high PNI group was significantly lower than that in low PNI group (x2 =6.443,P =0.011).Tumor infiltration depth in high PNI group was less than in low PNI group (x2 =7.394,P =0.007).The proportion of lymphovascular invasion in high PNI group was significantly lower than in low PNI group (x2 =4.540,P =0.033).The overall survival rate in high PNI group was higher than in low PNI group (P =0.002).The univariate and multivariate analyses showed that tumor location (OR,2.144 ; 95 ％ CI 1.239-3.712 ; P =0.006),lymph node metastasis (OR,4.887 ; 95 ％ CI 1.856-12.866 ; P =0.001),lymphovascular invasion (OR,1.842 ; 95％ CI 1.078-3.145 ; P =0.025) and the PNI value (OR,2.282 ; 95 ％ CI 1.344-3.874 ; P =0.002) were independent factors for predicting overall survival rate.Conclusions The PNI value is a simple and useful tool to predict the prognosis of patients with gastric cancer.

Objective To investigate the therapeutic effect of Xingnaojing in treatment of hypertensive cerebral hemorrhage.Methods 90 patients diagnosed as cerebral hemorrhage patient hospitalized were randomly divided into treatment group and control group,treatment group 45 cases,control group 45 cases,including 23 males and 22 females aged 52～75 years(71 ±4).Results Treatment group:After 14 days treatment,neurological deficits had been greatly improved,the total effective was 97.3％ ;Control group:Aftenr treatment,the improvement of neurological deficit was worse,the total effective was 77.3％.Hematoma volume in the two groups did not change significantly after one week treatment,but significant changed after two weeks treatment.There was significant difference between the two groups.Conclusion Xingnaojing had significant effect in treatment of hypertensive cerebral hemorrhage.

Objective To investigate the risk factors of reoperation in patients with Crohn's disease recurrence.Methods The clinical data of 108 patients with Crohn's disease who were admitted to the Peking Union Medical College Hospital from March 2004 to September 2013 were retrospectively analyzed.Of the 108 patients,82 received single operation and 26 received reoperation.Twenty-five factors which might influence the reoperation were analyzed,which were gender,age,blood type,preoperative levels of white blood cells,neutrophils,lymphocytes hemoglobin,albumin,prealbumin,high sensitive-C reactive protein (hs-CRP),anti-saccharomyces cerevisiae antibody (ASCA),anti-neutrophil cytoplasmic antibody (ANCA),location and type of the lesions,extraintestinal manifestation,perianal lesions,history of smoking,appendectomy,course of the disease before the first operation,pre-operative administration of immunosuppressants,body mass index (BMI) before the first operation,onodera prognostic nutrition index (OPNI),enteral nutrition,emergent operation,complications after the first operation.The univariate analysis was done using the chi-square test or Fisher exact probability,and the multivariate analysis was done using the Logistic regression model.Results The results of univariate analysis showed that the level of preoperative prealbumin,hs-CRP,location and type of the lesion,the history of smoking,preoperative administration of immunosuppressants,enteral nutrition before the first operation were the risk factors of reoperation in patients with Crohn's disease (x2=5.928,4.805,7.491,12.363,5.229,9.026,16.506,P ＜ 0.05).The results of multivariate analysis showed that the lesion located at the ileocolon,administration of immunosuppressants prior to the first operation for 1 year and energy provided by enteral nutrition under 500 kcal/d before the first operation were the independent risk factors of reoperation (OR =1.908,3.535,5.489,95％ confidence interval:1.035-3.518,1.087-11.494,1.816-16.590,P＜0.05).Conclusions Patients with lesions located at the ileocolon,administration of immunosuppresants prior to the first operation for 1 year and energy provided by enteral nutrition under 500 kcal before the first operation have higher risk of Crohn's disease recurrence and reoperation.

Objective To know the stability of 3 kinds of traditional Chinese drug injection with different solvent under different temperature and different storage time,and then reference to safty of clinical durgs. Methods Use particle analyzer,UV SpectropHotometer,pH Determination of three traditional Chinese medicine injection,at different temperatures and different times,the nuanber of particles,pH value,the value of UV absorbance Observe changes. Results The records of experimental data by repeated measures analysis of statistics: Ciwujia Injection,Aidi injection combined with normal saline solution after the particles of ≥ 10μm excess pharmacopoeia standards; ≥ 2μm number of particles is considerable,in the 32～35℃,Ciwujia at T=O min Aidi at T=I80 min ,the number of particles are smaller and with statistical significance,its pH value of the standard range. Xuesaitong injection with glucose injection ≥ 10μm particulate mixture at a higher temperature in excess of pH annacopoeia standards,number of ≥ 2 μm particles in the 4～8℃ and 20～23℃,T=30 min and 60 min time less with statistical significance,and its range of pH value less than pHarmacopoeia. Three kinds of Chinese medicine in the Department's largest UV absorbance peak value and appearance almost unchanged. Conclusions Different drugs in their relative Suggestions of temperature,time and place under intravenous drug use,or better terminal filter,in order to improve the safety of clinical medication.

Objective To investigate the relationship between apparent diffusion coefficient (ADC)value of rectal adenocarcinoma on DWI and its pathological grading.Methods The ADC values of 46 rectal adenocarcinomas were measured and compared with their histopathological grades.Results The 46 rectal adenocarcinomas included well differentiated adenocarcinomas in 14,moderate-ly differentiated ones in 20,and poorly differentiated ones in 12.The ADC values of well,moderately and poorly differentiated ade-nocarcinomas were (1.125±0.103)×10 -3 mm2/s,(1.030±0.098)×10 -3 mm2/s and (0.922±0.091)×10 -3 mm2/s,respective-ly,exhibiting a statistical difference (χ2 =1 7.35 1,P =0.000).Mann-Whitney U test showed that difference in ADC value between different histopathological grades was statistically significant.Conclusion ADC value of rectal adenocarcinoma can be used as a bio-marker for cell grading to guide treatment decision and prognosis assessment.