Objective To study the correlation between homocysteine levels and MTHFR C677T gene polymorphism of cerebral infarction.Methods Four hundred and fifty patients with cerebral infarction in our hospital were selected as the study group from February 2012 to August 2015,including 181 diabetes patients and 269 non-diabetic patients.Also 285 cases of physical examination healthy people in the outpatient department were selected as the control group.The MTHFR C677T polymorphism and the correlation between genotype and Hcy levels were analyzed by pyrosequencing.Results The difference of distributions of MTHFR genotype between the study group and the control group was statistically significant (P ＜ 0.05).The frequency of the T gene in the study group was significantly higher than the control group,the difference was statistically significant (x2 =13.67,P =0.00).The Hcy concentrations of the study group was significantly higher than the control group,and the difference was statistically significant (t =12.71,P =0.00).The Hcy levels of different MTHFR genotype in the cerebral infarction patients were statistically significant (F =17.68,P =0.00).Hcy levels in non-diabetic patients with cerebral infarction was significantly higher than in diabetic patients with cerebral infarction,and the difference was statistically significant (t =2.97,P =0.00).Hcy concentrations of TT genotype of non-diabetic group was significantly higher than the TT genotype of the diabetic group,CC type Hcy concentration significantly lower than the diabetic group,and the differences were statistically significant (t =5.67,2.18;P =0.00,0.03).In cerebral infarction patients both with non-diabetic and diabetic,the Hcy levels of MTHFR gene TT genotype were significantly higher than those of CC and CT genotype,and the differences were statistically significant (P ＜ 0.05),and the differences of Hcy levels between the genotype of CT and CC was not statistically significant (P ＞ 0.05).Conclusion The T allele frequency of MTHFR C677T in the cerebral infarction patients is much higher than healthy people.MTHFR TT genotype is related to serum Hcy levels.Maybe it is a risk factor for cerebral infarction.

Objective To explore the clinicopathological and immunohistochemical features, diagnosis and treatment,prognosis of hepatoid adenocarcinoma of the stomach with neuroendocrine tumor.AFP, Syn, CgA, Ki-67, P53 were stained by immunohistochemistry and follow-up was conducted by telephone.Methods Hepatoid adenocarcinoma of the stomach with coexisting neuroendocrine tumor was identified in 13 cases from June 2004 to June 2014 in Ren Ji Hospital.Results Among the 13 cases of hepatoid adenocarcinoma of the stomach coexisting with neuroendocrine tumor patients, there were 7 males and 6 females, with an median age of 62 years.Tumors located in the gastric cardia in 2 cases, in the gastric antrum in 8 cases and in the gastric body in 3 cases.Tumor ranged from 1-19 cm.The follow-up rate was 100％.The median overall survival rate was 12 months, two patients died of liver metastasis and one patient died of anastomotic recurrence.Serum AFP increased in 10 patients with hepatoid adenocarcinoma of the stomach coexisted with neuroendocrine tumor.The structure consisted of hepatoid cell differentiation and adenocarcinoma differentiation and neuroendocrine differentiation area by histological microscope examination.Immunohistochemical staining showed that tumor regional AFP, Syn, CgA, Ki-67, P53 were positive.Conclusions Hepatoid adenocarcinoma of the stomach coexisting with neuroendocrine tumor is very rare, it is made up of three structures : hepatoid cell differentiation, adenocarcinoma differentiation and neuroendocrine differentiation area.Diagnosis relies on immunohistochemical and histological examination.

Objective To evaluate two different histopathological classification systems (Fletcher and Miettinen) for the risk in cases of gastrointestinal stromal tumors (GIST). Methods One hundred and sixty-five GIST cases with complete clinicopathologic and follow-up data were evaluated for their biologic potential by the histopathological classification systems of Fletcher, and among those, 164 cases GIST were evaluated by the histopathological classification systems of Miettinen. The implication of two classification systems were compared by survival analysis. Results Evaluated by Fletcher histopathological classification system, 59 cases (35. 8%) were graded as high risk, 49 cases (29. 7%) as intermediate risk, 43 cases (26. 1%) as low risk and 14 cases (8. 5%) were very-low risk. Evaluated by Miettinen's system, 68 cases (41.5%) were as high risk, 23 cases (14. 0%) were intermedatie risk, 60 cases (36. 6%) were low risk and 13 cases (7. 9%) were very-low risk. Evaluated by both two systems, the survival time and disease-free survival time of high risk GIST were lower than those of very-low, low and intermediate risk GIST(P <0. 05), the survival time and disease-free survival time of intermediate risk GIST were lower than those of low risk GIST(P<0. 05). According to Fletcher's system, in the high risk GIST, the disease-free survival time of small intestinal, colonic and rectal GIST was lower than that of gastric GIST(P = 0. 022), and in the intermediate risk GIST, the survival time of small intestinal, colonic and rectal GIST was lower than that of gastric GIST(P =0. 032). According to Miettinen's system, in the risk subgroup of GIST, the survival time and disease-free survival time of gastric, small intestinal, colonic and rectal GIST has no statistical difference(P > 0. 05). Conclusions Fletcher histopathological classification system is simple and easy to use, while Miettinen's system for evaluating biological potential by anatomic site is more accurate and predictive in the selection of high risk patients for target adjuvant treatment.

Objective To investigate the relationship between tumor subclassifieation and the clinicopathologic features and prognosis of patients with gastrointestinal diffuse large B-cell lymphoma (DLBCL). Method From June 2000 to June 2007, 63 gastrointestinal DLBCL cases were enrolled. Immunohistochemical staining was performed to detect CDIO, Bcl-6 and MUM1 expression. Tumors were subclassified according to CDIO, Bcl-6 and MUM1 expression. Results CD10 expression was positive in 13 cases. Bcl-6 expression was positive in 53 cases. MUM1 expression was positive in 52 cases. According to the expression of CD10, Bcl-6 and MUM1, 17 cases(27%) were of germinal center B cell-like (GCB) DLBCL and 46 cases (73%) were of non-GCB. There was a significant difference in local lymph node metastasis between GCB group and non-GCB group, but there was no significant difference in terms of tumor size and infiltrate depth between the two subgroups. The survival time of patients in GCB group(76 months) was significantly longer than that of non-GCB group (28 months). Among cases receiving postoperative chemotherapy (CHOP), the survival of GCB group (76 months) was longer than non-GCB group (24 months). All 4 GCB cases and 4 non-GCB cases under R-CHOP chemotherapy are alive (22 ～ 47 months). Conclusion Gastrointestinal DLBCL subclassification is closely correlated with local lymph node metastasis, and this in combination with the expression of CD10 could be used to predict the prognosis of patients with gastrointestinal DLBCL.

Objective To analyze the clinico-pathological characteristics and prognostic factors of patients with gastric neuroendocrine carcinoma(G-NEC).Methods Clinical data of 40 cases of G-NEC form January 2003 to August 2013 at Ren Ji Hospital of Shanghai Jiaotong University were analyzed.Tumors were classified into different grades and stages according to the 2010 WHO classification and the 2006 European neuroendocrine tumor society (ENETS).Follow-up was conducted by telephone.The survival curves were drawn using Kaplan-Meier method.Univariate analysis was performed by the Log-rank test and multivariate analysis was performed by the COX proportional hazards model.Results Among the 40 G-NECs patients,29 were male(72％) and 11 were female(28％),with an median age of 61 years.Tumors located in the gastric cardia in 20 cases,in the gastric antrum in 11 cases and in the gastric body in 9 cases.Tumor ranged from 1 cm-20 cm.All patients were G-NEC (G3).Follow-up rate was 100％ (40/40).The median overall survival rate was 12 months,and one-year survival rate was 82％.Immunohistochemically G-NEC cells were positive for CgA and Syn in 11 cases.Gender (x2 =5.673,P ＜ 0.05),Ki-67 index (x2 =8.612,P ＜ 0.05),and lymphnode involvement (x2 =0.559,P ＜ 0.05) were prognostic factors of G-NEC patients.Conclusions The symptoms of G-NEC are nonspecific.Its diagnosis relies on pathological examination and immunohistochemistry.Syn and CgA are the most important markers.Female gender,lower Ki-67 index and lower lymph node metastasis predict a survival advantage.

Objective To summarize the stomach via laparoscopic and natural orifice transluminal endoscopic surgery (NOTES) Clinical application of abdominal exploration and peritoneal biopsy unexplained ascites. Methods A retrospective analysis of our hospital clinical datum of unexplained ascites patients, 20 cases were undergone single port laparoscopic operation from January 2014 to October 2015 and 11 cases were undergone NOTES from May 2015 to July 2016. Operation time, hospitalization expenses, intraoperative bleeding, postoperative hospital stay, postoperative abdominal pain score, fever and leukocyte on the 3rd postoperation were compared in tow groups. Results Laparoscopy group 20 cases, 11 cases diagnosed as tuberculous ascites, 8 cases malignant ascites, 1 case was still unknown;NOTES group 11 cases, 9 cases diagnosed as tuberculous ascites, 1 case malignant ascites and 1 case liver cirrhosis. In two groups, 30 cases were accurate diagnosed (96.8%), tuberculous ascites 20 cases (64.5%), malignant ascites nine cases (29.0%). Laparoscopy group compared with NOTES group, operation time was longer and hospitalization expenses was more, there were statistical signiifcant differences (P<0.05);postoperative hospital stays were higher (P < 0.05); intraoperative bleeding, postoperative abdominal pain score, fever and leukocyte on the 3rd postoperation were no statistical difference (P>0.05). Conclusion The two methods were able to quickly and accurately diagnose ascites reason, in order to facilitate treatment and surgical trauma, less serious complications. Comparison of laparoscopy, NOTES may be more advantageous in ascites diagnosis.

Objective To compare the clinical efficacy of Freka trelumina (FT) vs.feeding jejunostomy (FJ) in carrying out postoperative early enteral nutrition (EEN) in old patients with gastric cancer.Method 168 old gastric cancer cases were derided into FT group (n =54) with EEN, FJ group (n =50) with gastric tube and EEN, and total parenteral nutrition (TPN) group (n =64).Results Compared with TPN group, postoperative body weight, serum albumin and prealbumin level in FT and FJ groups were significantly higher, intestinal function recovery time, days of postoperative hospitalization and costs were significantly lower.The incidence of cough, sputum and sore throat of patients in FT group were significantly higher than those in FJ and TPN groups (P ＜ 0.05).Conclusions Postoperative EEN through FT and FJ was effective to improve nutritional parameter, accelerate intestinal function recovery, reduce the number of days of postoperative hospitalization, total costs, anastomotic stomal leak and gastroparesis rate.

Aim To evalute the effects of losartan on the cardiac function and secretion of nitric oxide(NO) and endothelin(ET) in patients with congestive heart failure(CHF) .Methods Sixty patients with class Ⅱ～Ⅳ CHF were randomised to receive a 12 weeks of routine therapy either with losartan(n ＝ 30)to be added from 25 mg to 50 mg daily or with enalapril(n ＝ 30) to be added from 2.5 mg to 5 mg daily. The cardiac systolic and diastolic funtion and the levels of NO and ET were observed before and after therapy respectively, with 30 normal control subjects seving as control. Results The abnormal cardiac systolic and diastolic function parameter were present in patients with CHF. The ET and NO levels in CHF patients were significantly higher than those in the control group(P＜0.05) . NYHA function class was improved in 85% of losartan-treated patients and in 84% of enalapril-treated patients after 12 weeks, as compared with cardiac function at baseline. ET and NO levels were significantly reduced(P＜0.01), NO/ ET ratio was increased (P＜0.05) after 12 weeks of therapy in two active groups. Conclusion The systolic and diastolic functions of patients with CHF are greatly improved by losartan treatment, which reverses the imbalance of NO/ET and it is suspected that this action may be another important mechanism of its treating heart failure.

Objective To explore the clinical value of transgastric natural orifice transluminal endoscopic surgery(NOTES)in diagnosing unexplained ascites.Methods The clinical data in 12 cases of unexplained ascites diagnosed by adopting transgastric approach NOTES and performed abdominal exploration and peritoneal biopsy in our hospital from November 2015 to July 2016 were retrospectively analyzed.The operative risk and clinical application value were evaluated by statistically analyzing the postoperative complications occurrence and the diagnosis rate of disease.Results The definite diagnosis rate reached 100％ verified by pathology after abdominal exploration and peritoneal biopsy,in which 8 cases(66.7％)were tuberculous peritonitis,2 cases(16.7％)were liver cirrhosis,1 case(8.3％)was peritoneal mesothelioma,1 cases(8.3％)was peritoneal metastatic carcinoma;2 cases appeared abdominal pain after operation,including 1 case of neutrophil ratio increase,symptoms and persistent time of abnormal laboratory indexes did not exceed 24 h,the incidence rate was 8.3％;no complications of abdominal cavity infection,incision bleeding and puncture site fistula occurred.Conclusion The transgastric NOTES for conducting abdominal exploration and peritoneal biopsy in the diagnosis of unexplained ascites has the advantages of small trauma,less complications and rapid postoperative recovery,possesses an important clinical application value.

OBJECTIVETo study the lignans components in rat serum after oral administration of Fuzheng Huayu decoction (FZHY), and to investigate the active ingredients in vivo.

METHODA rapid, sensitive and selective method using liquid chromatography-electrospray ionization tandem mass spectrometry (HPLC-ESI-MSn) was established. The serum samples were extracted with ethyl acetate (EtOAc)for three times. The chromatographic separation was achieved on a Waters Atlantis T3 column by gradient elution using methanol and water containing 5 mmol x L(-1) ammonium acetate as mobile phase, at a flow rate of 0.2 mL x min(-1). Mass spectra were acquired in positive ion mode. Identification and structural elucidation of the components in FZHY and dosed serum were performed by comparing their retention time and MSn spectra with those of reference compounds and reported data in the literatures.

RESULTSchisandrin, schisandrol B, schisantherin A and schisandrin B were found in FZHY and dosed serum, but schisandrin C and deoxyschizandrin were only found in FZHY.

CONCLUSIONSchisandrin, schisandrol B, schisantherin A and schisandrin B can be directly absorbed into the blood after oral administration of FZHY, and the four lignans components from Schisandra chineisis might play a key role as the ingredient basement of FZHY for anti-liver fibrosis.

Administration, Oral ; Animals ; Blood Chemical Analysis ; methods ; Chromatography, High Pressure Liquid ; methods ; Drugs, Chinese Herbal ; administration & dosage ; chemistry ; Lignans ; blood ; Male ; Mass Spectrometry ; methods ; Rats ; Rats, Wistar