ObjectiveTo analyze the clinical characteristics,effects of adjuvant therapy and influential factors of gastrointestinal stromal tumors (GIST).MethodsA retrospective and multiple factor Cox model analysis on 216 cases of primary GIST diagnosed by surgery and pathology was conducted.Results The total survival rates of patients at one to five years were 94.4 ％ (204/216),90.2 ％ (129/143),88.3 ％(68/77),87.5 ％ (35/40) and 85.0 ％ (17/20),respectively.The statistically significant prognostic factors for survival rates of patients with GIST included age,location of tumor,local or total tumor resection,rupture of tumor,adjuvant treatment,recurrence,mitotic rate,and tumor size (P ＜ 0.05).Due to those influence factors,the greater of the values,the higher of the risk of death.Among those factors,whether having grass total resection played a decisive role in the prognosis of patients with GIST.Other factors,such as sex,CD117,biopsies,endoscopic mucosal erosion,and operation cutting margin had no significant relevance with the survival rate of patients (P ＞0.05).Postoperative adjuvant therapy could significantly improve the survival rate of patients with GIST,especially for patients with high risk.ConclusionSurgical treatment should be given priority to treatment of GIST,and the choice of the surgery strategies depends mainly on the location and size of tumors.The complete resection or extensive resection could improve survival rates.Age,location,total tumor resection,rupture of tumor,adjuvant treatment,recurrence,mitotic rate,and tumor size are important factors affecting prognosis and survival rate of patients with GIST,which could guide standardized clinical treatment.

Objective To analyze the clinical characters,therapeutic effect of gastrointestinal stromal tumors (GIST),the effects of surgical approach and imatinib adjuvant therapy on it.Methods From January 2004 to April 2010,the clinical data of 214 patients with primary GIST were retrospectively analyzed.The effects of surgical approach and imatinib on the survival of the GIST patients were compared.Count data were analyzed by chi-square test,and the survival rates were analyzed with the life table method and Kaplan-Meier curve.Results A total of 214 GIST patients'survival rates of 1-year,3-year,5-year were 93.0％,87.0％ and 80.0％.According to the risk classification of National Institutes of Health,the differences of overall survival rates after surgery were statistically significant (x2 =22.058,P＜0.05).The differences of survival rate among different nuclear division number were statistically significant (x2=26.599,P＜0.05).The survival rate of pathological nuclear division number over 10/50 high power field (HPF) was the lowest.The overall survival rate of patients with gastrointestinal GIST was higher than patients with extragastrointestinal GIST,and the difference was statistically significant (x2 =68.139,P ＜ 0.05).After complete resection of the tumor,the survival rate of patients with local recurrence was higher than those with widely recurrence,and the difference was statistically significant (x2 =4.409,P＜ 0.05).After complete resection of the tumor,the survival rate of patients taking imatinib was higher than that of patients not taking imatinib.Conclusions The surgical treatment was the main therapy for GIST.Complete resection of the tumor and taking imatinib after surgery could improve the prognosis and the survival rate of the GIST patients.

Objective:To provide reference for clinical pharmacists through pharmaceutical care for patients with hyponatremia en-cephalopathy caused by pituitrin. Methods: Clinical pharmacists provided pharmaceutical care for one patient with hyponatremia en-cephalopathy caused by pituitrin. It was suggested by clinical pharmacists that 3% hypertonic saline and 20% mannitol be used in the patient with sodium ions and renal function monitoring. The patient was also told to increase salt in diets and limit water uptake. Re-sults:The ion levels of the patient returned to normal after the pharmaceutical care. Conclusion:Clinical pharmacists play an impor-tant role in the prevention and treatment of hyponatremia encephalopathy caused by pituitrin.

The paper introduces the definition of smart phone,operating mobile communication network and hidden danger about safety,and definition and advantages of SSL VPN,states the application of SSL VPN technology in the direct network report of epidemic situation information of infectious diseases combining with SSL VPN technology and remote connection,analyzes the work principle and specific operation process,achieves safety login to the China Information System for Disease Prevention and Control with smart phones,and completes normal business data processing.

Objective To study the necessity of alimentary tract examinations before laparoscopic cholecystectomy (LC). Methods Alimentary tract examinations were carried out in 130 cases in preparation for LC. In addition, the clinical records of 4 cases with missed diagnosis of gastrointestinal cancer during LC were also retrospectively analyzed. Results Out of the 130 cases, alimentary tract examinations found 11 cases of gastric and duodenal ulcer, 1 case of paraesophageal hernia, 4 cases of duodenal diverticulum, 4 cases of gastric cancer and 3 cases of colon cancer. Afterwards the surgery was temporarily canceled in 10 cases, and the rest of the 13 cases received open surgery. Missed diagnosis in the 4 cases included 3 cases of gastric cancer and 1 case of colon cancer. Conclusions Gastrointestinal diseases are often concurrent with gallbladder diseases. It is necessary to consummate alimentary tract examinations before LC for determining the indication of the operation and avoiding the misdiagnosis of other diseases.

Objective To explore the imaging characteristics of SAPHO syndrome in 11 cases.Methods Clinical features and imaging findings from 11 patients (6 male,5 female, 28 to 68 years old)with SAPHO syndrome were analyzed retrospectively Including DR in 9 cases, CT in 10 cases, MRI and radioisotope scanning in 3 cases. Results Multi-bones of anterior chest wall disorders were shown in 9cases on DR images including superior sternum , anterior first rib and clavicle hyperostosis. Bony fusion and bony bridge were also seen in these cases. Hyperostosis osteosclerosis, bone destruction and bony fusion of sternoclavicular articulation and first rib were shown on CT images in 9 cases. Osteosclerosis of the joint between manubrium and midsternum was seen in 1 case on CT image. Thc sign of flying sea gull was seen in 2 cases on axial anterior chest wall CT images. The disorders of anterior chest wall were bilateral in 8 cases and unilateral in 2 cases. Sacroiliitis and osteomyelitis of ilium were found accompanied in 1 case.Osteomyelitis of thoracic vertebrae were found in 2 cases, while sclerosing osteitis of lumbar vertebrae and ostearthritis of bilateral hands were observed respectively in 1 case. The thicken soft tissue surround clavicle head, thoracic vertebra disease with long T1 ,jumbly T2 and high fat suppression signal ,long T1 and short T2signal under sacroiliac joint were shown on MRI. Radioisotope scanning displayed higher radioactive uptake of radionuclides, with T shape in sternoclavicular area in 3 cases. Conclusions Multi-bones of anterior chest wall involvement was the common imaging characteristics in 11 patients. Sacroiliitis, osteomyelitis of vertebrae and ilium, sclerosing osteitis, ostearthritis of hand could be seen in some cases.

Objective To analyze the survival rates of gastrointestinal stromal tumors (GISTs),and the influence of surgical treatment and imatinib to the survival times.Methods The clinical data of 132 patients with GIST who were admitted to Peoples Liberation Army Hospital from January 2003 to December 2013 were retrospectively analyzed.Results All the patients were followed up with a median time of 22 months (1-83 months).The survival rates of 1-year,3-year,5-year were 99 ％,96 ％,92 ％ in this study.The tumor located at cardiac part,fundus of stomach,greater curvature,lesser curvature and pylorus part was 19 cases (14.4 ％),34 cases (25.8 ％),38 cases (28.8 ％),38 cases (28.8 ％) and 3 cases (2.3 ％),respectively.The positive rates of CD117,CD34 and Ki-67 was 116 cases (87.9 ％),119 cases (90.2 ％),51 cases (38.6 ％).According to Fletcher risk classification,the patients of high-low risk,low risk,intermediate risk,and high risk were 10 cases (7.6 ％),34 cases (25.8 ％),14 cases (10.6 ％),and 74 cases (56.1％),respectively.The differences of survive rates in the different excision method and imatinib treatment had statistics significance (P =0.000).The differences of survive rates in Fletcher risk classification had statistics significance (P =0.028).However,the differences of survive rates in location of gastric GIST showed no significant difference (P ＞ 0.05).Conclusions GIST in different parts of gastric have not obviously different survival rates,respectively.The total resection and imatinib treatment could raise the survival rates of patients with GIST.

Objective To evaluate the effect of different preparation processes on preparation of the glial cell line-derived neurotrophic factor(GDNF)loaded microspheres and observe the biological activity of GDNF.Methods With polylactide-co-glycolide(PLGA)as the coating material,the GDNF-loaded microspheres were prepared by using double emulsion(W1/O/W2).Two-factor factorial design variance analysis was done to analyze the effects of the composition proportion of lactic acid(LA)and glycolic acid(GA)in PLGA and the stirring speed of multiple emulsion on particle size,entrapment efficiency,burst release and in vitro release characteristics of the GDNF-loaded microspheres.PC-12 bioassay was employed to detect the biological activity of the released GDNF so as to determine the optimal preparation process.Results The composition proportion of PLGA could affect the microspheres'burst release(P ＜ 0.05),with no effect on particle size and entrapment efficiency.with the higher.With higher proportion of GA,the release speed of GDNF in the microspheres was increased.When the stirring speed of multiple emulsion was increased from 1 000 r/min to 3 000 r/min,the particle size of the microspheres was decrease significantly(P ＜ 0.01),the burst release was increased markedly(P ＜ 0.01)and the in vitro release rate was accelerated.The activity of GDNF in the microspheres could last for about 20 days at 37℃,which was 10 days longer than that of single GDNF.Conclusions Double emulsioncan prepare the GDNF-loaded microspheres with high entrapment efficiency and suitable in vitro release time.In the meantime,the microspheres can extend the validity of GDNF.

Objective To investigate the effects of short hairpin RNA (shRNA) expression plasmid targeting vascular endothelial growth factor-C (VEGF-C) on the proliferation and invasion of HepG2 cells. Methods The VEGF-C shRNA plasmid vector labeled with green fluorescent protein was constructed and stably transfected into HepG2 cells. The transfected cells were sorted by G418 and visualized by fluorescent microscope and assayed by flow cytometry. Expression of VEGF-C in transfected cells was determined by RT-PCR and Western blot. The inhibition rates of the cell proliferation and invasion were determined by MTT assay and reconstituted basement membrane invasion assay, respectively. Results VEGF-C shRNA effectively downregulated VEGF-C mRNA and protein expression in HepG2 cells, and it also effectively inhibited the proliferation of HepG2 cells in a time-dependent manner. The invasion capacity of HepG2 cells was inhibited by VEGF-C shRNA, and the inhibition rate was 51.54%. Conclusions VEGF-C plays an important role in tumor proliferation, invasion and metastasis. RNA interfering technology that targets VEGF-C may serve as a potential therapeutic intervention in the treatment of human hepatic cancer.

Objective To evaluate the effect of 6% hydroxyethyl starch 130∕0. 4 on acute kidney injury in elderly patients in a prospective, multicenter, randomized, double?blind, controlled clinical tri?al. Methods A total of 120 patients of both sexes, aged 65-82 yr, weighing 56-83 kg, of American So?ciety of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective orthopaedics and hernia surgery, were divided into either hydroxyethyl starch group ( group HES) or lactated Ringer′s solution group ( group LR) , with 60 patients in each group. Hydroxyethyl starch and lactated Ringer′s solution were infused intra?venously at a rate of 7. 5 ml∕kg during 1st hour of surgery in HES and LR groups, respectively. Lactated Ringer′s solution was then infused at a rate of 5 ml∕kg starting from 2nd hour of surgery until the end of sur?gery in both groups. Before surgery, at the end of surgery and at 1, 3 and 5 days after surgery, blood sam?ples and urine specimens were collected for determination of the concentrations of neutrophil gelatinase?asso?ciated lipocalin, interleukin?18 (IL?18), plasma creatinine, urine β2 microglobulin and urine albumin.
The estimated glomerular filtration rate was calculated. Results The level of urine IL?18 was significantly higher at each time point after surgery than before surgery and immediately after the end of surgery ( P<0.05) . There were no significant differences between the two groups in the levels of urine IL?18, plasma creatinine, plasma and urine neutrophil gelatinase?associated lipocalin, plasma IL?18, urineβ2 microglob?ulin and urine albumin and estimated glomerular filtration rate at each time point ( P>0.05) . Conclusion Compared with lactated Ringer′s solution, 6% hydroxyethyl starch 130∕0.4 does not aggravate acute kidney injury in elderly patients.