Objective To explore the occurrence site, clinical manifestations, endoscopic and radiographicfeatures, pathologiccharacteristics, diagnosis, treatmentandprognosisof gastroenteropancreatic neuroendocrine neoplasm (GEP-NEN).MethodsFrom January 2000 to June 2010,medical records of 87 GEP-NEN patients in the First Affiliated Hospital of Sun Yat-sen University were collected. The neuroendocrine properties of the tumors were determined by immunohistochemistry staining of neuroendocrine markers Syn and CgA.Then according to histology and proliferation activity, the GEP-NEN tumors were classified as neuroendocrine tumor (G1 and G2 grade), neuroendocrine carcinoma (G3 grade) and mixed adenoendocrine carcinoma (G3 grade).Results36 cases (41.4％) of GEP-NEN tumors were in pancreas, followed by 18 cases in rectum (20.7％), 9 cases in stomach (10.3％) and 6 cases in duodenum (6.9％).Total 69 of 87 GEP-NEN cases (74.7％) were nonfunctional tumors, a variety of gastrointestinal symptoms or symptoms caused by local tumor compression were the most first symptoms, and no one case presented carcinoid syndrome.The manifestations of endoscopy and radiographic image were tumor occupying lesion.Of 87 GEP-NEN cases, 69 cases were neuroendocrine tumor (79.7％), 13 cases were neuroendocrine carcinoma (14.9％) and 5 cases were mixed adenoendocrine carcinoma (5.4％).The percentage of grade G1, G2 and G3 tumors were 64.9％、 14.9％ and 20.2％ respectively.Muscularis or serosa infiltration were found in 22 GEP-NEN patients (47.8％) at the first visit, lymphatic metastasis was in 18 cases (20.7％) and distant metastasis were in 18 cases (20.7％), mostly migrated to liver.Immunohistochemistry staining positive rates of CgA and Syn were 74.2％ and 88.1％.A total of 79 patients (90.8％) were underwent surgery.The 1-, 3-and 5-year survival rates were 76.9％, 54.2％and 41.7％ during follow-up.ConclusionsGEP-NEN may occur at any part of the digestive system,the clinical manifestations are variable.Endoscopy and radiographic examination play an important role in tumor diagnosis, but final diagnosis is mainly based on pathological detection, and surgery is the main treatment option.The prognosis of the tumor is correlated with the pathological classification,grading and condition of distant metastasis.

Objective:To study the role of phospholipase A 2 in the pathomechanism of low back and leg pain. Methods:Phospholipase A 2 was injected into rats′ cavum epidurale, then the pathologic changes of cauda equina was viewed under light microscopy and electronic microscopy. The substance P(SP) in the dorsal root ganglia(DRG) and spinal cord was determined by immunohistochemistry. Results:After phospholipase A 2 injection, the nerve fibers of cauda equina displayed significant degeneration and demyelination. In L 4 to L 6 segment, the number and area of SP positive neurons in the DRG increased significantly. The relative density of positive nerve endings in the dorsal horn of spinal cord was also increased significantly. There were significant difference compared to the normal solution control group by statistic analysis. Conclusion:Phospholipase A 2 is a nocuous substance to cauda equina. It may play an important role in the pathomechanisms of low back and leg pain related to lumbar disc herniation.

To observe the relationship between positive rate of β1-adrenergic and AT1 receptors autoantibodies with serum concentration of cystatin C in 371 patients with diabetic nephropathy patients,107 patients with type 2 diabetes,and 47 subjects as healthy control.In patients with diabetic nephropathy,the positive rates of the β1 and AT1 receptors autoantibodies were significantly higher than those in patients with type 2 diabetes and normal controls.The titers of β1 and AT1 receptors autoantibodies in diabetic nephropathy patients with abnormal cystatin C were significantly higher than those with normal cystatin C concentration.These findings suggested that β1 and AT1 receptors autoantibodie may play important roles in the pathogenesis of diabetic nephropathy.

Objective To set up the measurable Clinical Research Implementation Quality As sessment System in Top Three Hospitals.Methods The literature analysis,brain storm and Delphin Method were adopted to establish the evaluation indicators and related index weight,the assessment procedures and method were used in real clinic research for verification.Results An Assessment System,which was made up by five primary indexes,including research progress,ethical review,informed consent,case study and budget,as well as ten secondary indexes were established.Conclusions The Assessment System plays an important role in the evaluation of clinical research and appropriate for the process management of research implementation.

Objective: To investigate the relationship between cervical curvature (CC) and spinal drift distance after laminectomy with lateral mass screw fixation and the influence on the operative effect. Methods: From October 2016 to December 2017, a total of 85 patients with cervical spondylotic myelopathy (CSM) underwent laminectomy with lateral mass screw fixation in handan central hospital, and 78 patients were followed up completely.After the operation, according to the Harrison method, they were divided into 2 groups(Group A (43 cases, 0°≤CC≤16.5°); Group B (35 cases, CC>16.5°)). The spinal drift distance, nerve recovery, axial symptoms and C5 palsy in the groups were recorded and analyzed. Results: The CC was 8.5°±3.8° in group A and 19.6°±3.0° in group B (t=14.071, P=0.000). The laminectomy width in group A was (22.1±1.7) mm, in group B was (21.8±1.5) mm, the difference between the two groups was not statistically significant (P>0.05). The distance of spinal cord backward movement was (1.7±0.4) mm in group A and (3.2±0.7) mm in group B. There was significant difference between the two groups (t=11.879, P<0.001). At the end of one year, the improvement rates of nerve function in the two groups were (63.3±13.1)% and (65.1±13.9)% respectively, there was no significant difference between the two groups (t=0.587, P=0.559). The VAS score of group A was (5.2±1.3) at one week and (3.5±0.6) at one month after operation, and that of group B was (3.8±0.8) and (2.4±0.4) respectively.There were statistically significant differences between groups at different time points (t=5.567, P<0.001; t=9.289, P<0.001). The incidence of C5 paralysis was 7.0% (3/43) in group A and 11.4% (4/35) in group B. There was no significant difference between the two groups (P>0.05). Conclusion The greater the curvature of cervical spine is, the more fully the spinal cord moves backward.The loss of curvature of cervical spine is related to the occurrence of axial symptoms.The curvature of cervical spine is not related to the recovery of nerve function and the occurrence of C5 nerve paralysis.

In China, the malignant tumor with the highest incidence and motality is lung cancer (LC). As screening and early detection and treatment are effective in reducing LC mortality, formulating a guideline in line with China′s national conditions for the screening and early detection and treatment of LC will greatly promote the homogeneity and accuracy of LC screening, and result in an improvement of the effectiveness of LC screening. Commissioned and directed by the Disease Prevention and Control Bureau of the National Health Commission of the People′s Republic of China, the guidline was initiated by the National Cancer Center of China and formulated with joint effort by experts from different disciplines. Following the principles and methods in WHO Handbook for Guideline Development, the guidline integrates the latest development in LC screening and early diagnosis and treatment worldwide while fully considering China′s national conditions and practical experience in LC screening. It provides detailed evidence-based recommendations for different aspects of LC screening, such as the targeted population, the technologies and the procedures, to regulate the practices of LC screening and early diagnosis and treatment and enhance the effectiveness of the prevention and control of LC in China.

OBJECTIVETo examine the effect of post-discharge nutrition management on the growth speed of neonates after bowel surgery.

METHODSNutrition feeding guidance was carried out in 133 post-discharge infants after surgery through nutrition clinic. The growth speed was detected every month and compared with the normal standards, then the time to accelerate growth speed was evaluated.

RESULTSThe growth speed of neonates in the first postoperative month was lower than the normal standards, especially in males(weight P=0.000; length P=0.041; circumference P=0.010). While during two to three months, male infants showed acceleration in length growth speed [(4.53±1.22) cm vs. (3.1±0.4) cm, P=0.013], and female infants showed acceleration in weight [(1.51±0.76) kg vs. (0.83±0.39) kg, P=0.028] and circumference growth speed [(2.50±0.93) cm vs. (1.2±0.7) cm, P=0.021].

CONCLUSIONSScientific post-discharge nutrition management helps neonates grow faster after bowl surgery. The two to three months after operation is the key period of growth speed acceleration.

Objective To evaluate the feasibility and significance of establishing quantitative evaluation indicators in the project closure quality control by quantitative evaluation criteria .Methods To establish the evaluation index and corresponding index weight according to literature analysis ,brainstorming and Delphy's expert consultation methodologies ,research data were analyzed by radar chart .Results A total of five first grade indicators and twenty-three second level indicators were established ,and the implementation evaluation system was established from five aspects :ethical requirements ,informatization ,program implementation ,quality control and scientific research output .Conclusions The evaluation system can effectively evaluate the quality of clinical research ,identify the weak links of the study quality management .It is a suitable method for the quality management of clinical research problems .

To systematically construct a guideline to provide a methodological guide for researchers to develop patient decision aids.

OBJECTIVE: To evaluate whether adjuvant simple hysterectomy after concurrent chemoradiotherapy (CCRT) improves progression-free survival (PFS) compared with current standard care in locally advanced cervical adenocarcinoma (LACAC). METHODS: We reviewed a cohort of 55 patients with LACAC (International Federation of Gynecology and Obstetrics [FIGO] stage IB2, IIA2, IIB, III without distant metastasis) diagnosed and treated with radical CCRT at Peking Union Medical College Hospital between January 2004 and October 2014. We compared 34 patients who underwent adjuvant extrafascial hysterectomy with 21 patients with standard care after CCRT. The primary outcome was PFS. Overall survivals (OS) between the two groups were also compared. Surgery feasibility, operative complications, and pathologic features after radiation therapy were also analyzed. RESULTS: PFS was significantly improved in surgery group (log-rank p=0.0097; hazard ratio [HR], 0.3431; 95% CI, 0.152 to 0.772), as were OS (log-rank p=0.0419; HR, 0.3667; 95% CI, 0.139 to 0.964). Analysis of stage IIB demonstrates a similar result. There were no severe complications related to postradiation surgery in this series. The mean blood loss was less in laparoscopic group than those in the open group (87 mL vs. 208 mL, p=0.036, Mann-Whitney U-test). Approximately 47% patients (16/34) had pathologic residue tumor on hysterectomy specimens. About 94% patients (32/34) got complete remission after adjuvant surgery. CONCLUSION: Adjuvant hysterectomy after CCRT improves survival outcome for patients with LACAC compared with current standard care. Extrafascial hysterectomy is sufficient in tumor reduction and laparoscopic procedure may be more promising with lower blood loss and expedite recovery.
Adenocarcinoma/mortality/*therapy ; Adult ; *Chemoradiotherapy ; Cohort Studies ; Disease-Free Survival ; Female ; Humans ; Hysterectomy/*methods ; Middle Aged ; Uterine Cervical Neoplasms/mortality/*therapy