In recent years,minimally invasive surgery has become the mainstream trend of modern surgery with the rapid development of endoscopic and laparoscopic techniques.However,there are limitations when either technique is used alone.The laparoscopic and endoscopic cooperative surgery (LECS),which combines the advantages and makes up the deficiencies of these two techniques,has expanded the application field of minimally invasive surgery.Laparoscopic wedge resections are increasingly applied for gastric stromal tumor.Base on clinical experience of 43 patients who underwent laparoscopic wedge resections for surgical treatment of gastric stromal tumor,we conclude that this procedure is feasible and safe.

Gastrointestinal stromal tumors (GISTs) is a subset of mesenchymal tumors and represents the most common mesenchymal neoplasm of gastrointestinal tract.In the last decade,GISTs has become well known because of the effectiveness of imatinib mesylate.The molecular targets for tyrosine kinase receptor inhibitor are not only of importance for the treatment of patients but also useful for the development of a novel drug modalities and new strategies in basic cancer therapy.The improved understanding of the molecular mechanism of GISTs has made its diagnosis standardized.Many multicenter phase Ⅱor phase Ⅲ clinical trials have been completed to establish the role of adjuvant and neoadjuvant therapy.It is important to select the correct management strategy,which is multidisciplinary,integrated,and individualized.This paper provides an overview of the rational treatment of GISTs at present.

AIMTo investigate the role of serine/threonine protein phosphatases in regulation of cell signal transduction on voltage-dependent sodium channels in rat trigeminal ganglion (TRG) neurons. METHODSWhole-cell patch clamp techniques were used to record the total sodium current (INa-T) and the tetrodotoxin-resistant sodium current (INa-TTX-R) before and after okadaic acid, a potent inhibitor of the serine/threonine protein phosphatases 1 and 2A, perfusion on adult rat TRG neurons. RESULTS1μmol*L-1 okadaic acid inhibited INa-T by (20±13)% (n=9, P<0.05) and INa-TTX-R by (4±3)% (n=6, P<0.05), respectively. The inhibition on INa-T was significantly greater than that on INa-TTX-R (P<0.05). Furthermore, 1μmol*L-1 okadaic acid produced significant 3-4 mV hyperpolarizing shifts in the conductance-voltage curves of INa-T, while it had no effect on that of INa-TTX-R. CONCLUSIONThe serine/threonine protein phosphatases take part in the regulation of total and TTX-R sodium channels on rat TRG neurons. In addition, small-diameter TRG neurons express various voltage-gated sodium channel with different sensitivity to okadaic acid.

China ; Congresses as Topic ; Fatty Liver ; Humans

Objective To investigate the clinicopathologic features of epithelioid angiomyolipoma of renal(REAML). Methods Six cases of REAML were analyzed by histopathological and clinical characteristics.Of the 6 cases,4 cases were solitary tumors and 2 cases were multiple lesions.The diameter of tumors was about 9 cm in average.One case had a family history of nodular sclerosis.Three cases were found adipose tissue in CT scan and diagnosed for RAML,the other 3 cases were diagnosed for renal cancer.All cases were undergone surgical approach,3 cases were undergone resection of tumors only and the other 3 were performed nephrectomy. Results Pathological characters:tumor was mainly composed of epithelioid cells presented with invasive hyperplasia of atypical pleomorphism,hyperchromatic nuclei with frequent mitotic figures,giant neoplasic cells and extensive hemorrhagic necrosis immunohistochemcial staining showing a positive HMB45 and negative of EMA,CK in most neoplasic cells.All cases were followed up for 10 to 44 months,5 cases did not recurrence and metastases;the other had lung metastasis after operation 18 months later,without any treatment the patient died 10 months later. Conclusions Most of REAMLs are benign and often misdiagnosed for renal cancer by CT scan.HMB45 is positive in immunohistochemcial staining available for diagnose.The minority of REMAL is malignant potentially and should be followed up closely.Operation is major method.

0.05).ConclusionThe neoadjuvant radiochemotherapy can improve the sphincter-saving rate,probably can improve the resection rate and reduce the recurrence rate for the middle-lower rectal carcinoma.

OBJECTIVE To investigate enhanced immune function of methionine encephalin (MENK) and its anti-tumor mechanism in CT26 colon cancer mouse model. METHODS 3×106 CT26 cells were implanted subcutaneously in BALB/c mice. Four days after, MENK was peritoneally administrated at the concentration of 20 mg·kg-1 for 14 d. The percentage of MDSCs in bone marrow, spleen, blood, tumor and liver were detected by flow cytometry. Non- esterified fatty acid (NEFA), triglycerides (TG) and total cholesterol (T-CHO) in liver homogenate were tested by a NEFA test kit, a TG test kit and a T- CHO test kit respectively. qRT- PCR and Western blot were used to measure mRNA and protein levels of inflammation-, glycometabolsim- and lipometabolsim-associated indexes in liver. RESULTS MENK decreased percentages of MDSCs in bone marrow, spleen, blood and tumor in colon cancer mice. MENK-treated mice displayed elevated ratio of CD4+T and CD8+T cells in spleen as well as increased T and B lymphocytes proliferation. Meanwhile, MENK also ameliorated liver damage reflected by lower levels of GPT and GOT in serum and reduced risks of cancer- associated index including inflammation, high lipid and high glucose. Furthermore, MENK lowered down the levels of NEFA, TG and T- CHO in liver homogenate. MENK treatment decreased expression of p- STAT3, increased expression of p-AKT, IRS1 and Glut4 at protein level as well as reduced lipogenesis-associated genes and elevated glycolysis-associated genes in liver of tumor bearing mice. Also, abated expression of genes associated with MDSCs generation (M-CSF, GM-CSF, IL-6, IL-1β) and migration (S100A9, KC) was observed within shrunken subcutaneous tumor by MENK intervention. CONCLUSION MENK has the ability to strength immune function against colon cancer by reducing MDSCs and improving liver metabolism.

The role of general practitioners in the UK was analyzed and we found that in the UK, there was normalized general medical education system, perfect general practitioner training sys-tem, specific responsibilities and assessment index, close liaison group between primary and secondary care, strong economic supporting measures and high degree of recognition. Therefore, to deepen med-ical reform and improve basic medical service, we must accelerate general practitioners training, im-prove practice ability of general practitioners, establish the first-treatment system in community, reit-erate role of gatekeeper, enhance the payment of general practitioner and increase their sense of iden-tity. At the same time, we must strengthen the informatization construction, set up the first-treatment in the community and the patency of two-way referral system.

Objective To study the risk factors related to recurrence of gastrointestinal stromal tumor (GIST) after discontinuing postoperative adjuvant imatinib mesylate (IM) treatment.Methods We retrospectively analyzed our clinical database of 138 GIST patients who received radical resection and subsequent IM adjuvant treatment at the Renji Hospital,Shanghai Jiaotong University School of Medicine between January 2006 and January 2014.Results For the entire Multivariate analysis study group,the overall 5-year recurrent free survival (RFS) rate was 54.5％.There were two tumor characteristics which were independent prognostic factors of GIST treated by postoperative IM:Ki67 index (P =0.005),and serosal invasion (P =0.026).The accuracy of comprehensive evaluation based on the two weighted variables was better than NIH staging criteria(AUC:0.714 vs.0.631).Furthermore,two risk groups were created according to the risk model with 5-year RFS of 81.3％ and 31.1％ as low-risk and high-risk groups,respectively (P ＜0.05).Conclusions For patients with intermediate or high risk in NIH classification,if there was tumor serosal invasion,or if there was no local invasion but Ki67 index ＞ 8％,extended continuous IM adjuvant treatment should be recommended after the primary tumor was radically resected.

Objective To investigate the influence of pregnancy and delivery on maternal graft and newborns after renal transplantatior.Method Two cases of successful pregnancy and delivery after renal transplantation were retrospectively analyzed and the literatures were reviewed.Result The first recipient received the immunosuppressive treatment,which was based on the mycophenolate after renal transplantation.Three years after transplantation,the recipient had the requirement of pregnancy,but there was no pregnancy without contraception for over one year.On the next month after the myocphenolate-based immunosuppressive regimen changed to the purine-based,B ultrasound revealed follicular growth,ovulation and pregnancy.Caesarean section was performed at 37 gestational weeks and a body was delivered.The weight of the boy was 2 750 g,and the Apgar scores of the newborn were 10.The second recipient received triple immunosuppressive therapy (cyclosporin A + azathioprine + methylprednisolone),and got natural pregnancy 4 years after renal transplantation.The recipient was hospitalized due to the increased blood pressure and reduced fetal heart rate at 33 W+2 gestational weeks,and discharged after treatment.Caesarean section was performed at 38 W+1 gestational weeks,the weight of the boy was 3 000 g,and the Apgar scores of the newborn was 10.After follow-up for 8 years old,there was on abnormity of the function of the transplanted kidney and the growth of the newborns.Conclusion Successful pregnancy and delivery are possible in renal transplant recipients with normal renal function.Regulating the immunosuppressive regimen appropriately,and treating the complications of pregnancy effectively can obtained the satisfactory outcome of pregnancy.