OBJECTIVETo investigate the angiographic feature and its diagnostic value in gastrointestinal stromal tumor (GIST).

METHODSTwelve patients with pathologically proved GIST underwent angiography using PUCK and DSA one week before operation. The origin, size, morphology and angiographic appearance of the lesion were retrospectively analyzed.

RESULTSIt was found that two tumors originated from stomach, eight from jejunum, and two from ileum. Seven cases were benign but five malignant. Obviously thickened and enlarged feeding artery was detected in eight tumors, and early-developed vein was found in three. Two types of angiographic changes of GIST were observed: 1) twisted irregular neoplastic vessels with partially coarse and indistinct margin were found in four cases, which were all malignant; 2) ball-like neoplastic vessels with homogeneous stain in tumor were found in eight cases, seven of them were benign but one was malignant.

CONCLUSIONAngiography may be helpful in localization and diagnosis as well as defining the size of GIST, and especially in patients with melena of unknown origin.

Adult ; Aged ; Angiography ; methods ; Female ; Gastrointestinal Stromal Tumors ; blood supply ; diagnostic imaging ; Humans ; Jejunal Neoplasms ; blood supply ; diagnostic imaging ; Male ; Mesenteric Arteries ; diagnostic imaging ; Middle Aged ; Stomach Neoplasms ; blood supply ; diagnostic imaging

OBJECTIVETo study differences of multifidus muscle injury between Wiltse intermuscular approach and intramuscular stripping approach in one-level small incision transforaminal lumbar interbody fusion (TLIF) surgery.

METHODSA total of 46 patients with unilateral lumbar degenerative disease underwent small incision TLIF from August 2009 to February 2011 by one group of surgeons at a single institution. The decompression side of all patients adopted intra-muscular stripping approach; for the non-decompression side, 22 patients adopted Wiltse intermuscular approach (group A),and 24 patients adopted intra-muscular striping approach (group B). In group A, there were 13 males and 9 females, ranging in age from 36 to 74 years old,averaged 52.7 +/- 9.2; 1 patient had disease in L3, 4 12 in L4,5 and 9 in L5S1. In group B,there were 11 males and 13 females,ranging in age from 32 tio 72 years old, averaged 51.8 +/- 8.7; two patients had disease in L3,4, 14 in L4,5, and 8 in L5S1. The following data were compared between the 2 groups: surgical time from skin incision to completion of pedicle screw placement, suturation time, blood loss. Clinical effects were evaluated by VAS score pre-operatively, as well as 1, 6 and 12 months post-operatively. At the latest follow-up, all the patients were evaluated by MRI. This enabled the cross-sectional area (CSA) of lean multifidus muscle, and the T2 signal intensity ratio of multifidus to psoas muscle, to be compared at the operative level.

RESULTSThere was no obvious difference in suturation time, but less surgical time from skin incision to completion of pedicle screw placement, less blood loss, less postoperative back pain in Wiltse intermuscular approach group. For the comparison between the two groups or paired comparison between sides in the Wiltse group, the reduction of lean CSA and increase in the multifidus:psoas T2 signal intensity ratio were all significant lower in Wiltse intermuscular approach group or side.

CONCLUSIONThe Wiltse intermuscular approach is an easy way for pedicle screw placement, and caused less paraspinal muscle damage than intra-muscular stripping approach, and had positive effects on less back pain.

Adult ; Aged ; Case-Control Studies ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Muscle, Skeletal ; injuries ; Spinal Fusion ; adverse effects ; methods

Common bile duct (CBD) stones are a frequent problem in Chinese populations, and their incidence is particularly high in certain areas (Wang et al., 2013). In recent years, laparoscopic common bile duct exploration (LCBDE) and endoscopic retrograde cholangiopancreatography (ERCP) have been the main surgical procedures for CBD stones, although each has different advantages and disadvantages in the treatment of choledocholithiasis (Loor et al., 2017; Zhou et al., 2017). For patients with large stones, a dilated CBD, especially concurrent gallstones, LCBDE is the preferred and most economical minimally invasive procedure (Koc et al., 2013). However, a T-tube is often placed during LCBDE to prevent postoperative bile leakage; this is associated with problems such as bile loss, electrolyte disturbance, and decreased gastric intake (Martin et al., 1998). In addition, the T-tube usually must remain in place for more than a month, during which time the patient's quality of life is seriously compromised. Many skilled surgeons currently perform primary closure of the CBD following LCBDE, which effectively speeds up rehabilitation (Hua et al., 2015). However, even in sophisticated medical centers, the incidence of postoperative bile leakage still reaches ≥10% (Liu et al., 2017). Especially for a beginner, bile leakage remains a key problem (Kemp Bohan et al., 2017). Therefore, a safe and effective minimally invasive surgical approach to preventing bile leakage during primary closure of the CBD after LCBDE is still urgently needed.
Aged ; Aged, 80 and over ; Choledocholithiasis ; Common Bile Duct Diseases ; Drainage/methods* ; Female ; Gallstones ; Gastroscopy ; Humans ; Laparoscopy ; Male ; Middle Aged

OBJECTIVEThis study aimed to review the available literature on fertility-preserving treatment and pregnancy outcomes in patients with early-stage endometrial carcinoma who desired to preserve their fertility.

DATA SOURCESThe PubMed database (1992-2012) was searched for the words "conservative "OR" fertility sparing "OR" fertility preserving" AND "endometrial neoplasms" (MeSH). All relevant articles in English and the relevant references were collected.

STUDY SELECTIONData from published articles about fertility-preserving treatment of endometrial cancer, including the response and recurrence rate of conservative treatment, strategies of infertility treatment, pregnancy, and obstetric outcomes, were selected. Data were mainly extracted from 41 studies, which are listed in the reference section of this review.

RESULTSHormone therapy was the most common method used for early-stage endometrial carcinoma in patients who wished to preserve fertility. Sixty percent of the patients became pregnant after remission of the carcinoma. The percentage of patients who conceived in the assisted reproductive technology group was higher than that of the natural pregnancy group (80.0% vs. 43.2%, P < 0.01). A higher rate of preterm labor and multiple pregnancies was observed in the assisted reproductive technology group than that in the natural pregnancy group. The majority of pregnancies (71.4%) in the assisted reproductive technology group were achieved by in vitro fertilization-embryo transfer. The clinical pregnancy rate of transfer cycles in patients with endometrial carcinoma was 34.1%.

CONCLUSIONSAssisted reproductive technology is a good option in well-selected patients with early-stage endometrial carcinoma who have completed conservative treatment. In vitro fertilization-embryo transfer offers an opportunity to achieve an immediate pregnancy.

Endometrial Neoplasms ; therapy ; Female ; Fertility Preservation ; methods ; Humans ; Neoplasm Staging ; Pregnancy ; Pregnancy Complications, Neoplastic ; Pregnancy Outcome ; Reproductive Techniques, Assisted

Conservative treatment with high doses of progestin is an alternative to standard hysterectomy for young patients with early-stage endometrial adenocarcinoma who desire to preserve their fertility. Here we report a patient with well-differentiated early-stage endometrial adenocarcinoma and poor fertility potential who failed to become pregnant in two in vitro fertilization-embryo transfer cycles and suffered a relapse after conservative treatment. This case illustrates that assessment of fertility potential is critical at the time of initial evaluation and conservative treatment planning for patients with endometrial adenocarcinoma.
Adenocarcinoma ; drug therapy ; metabolism ; Adult ; Antineoplastic Agents, Hormonal ; Endometrial Neoplasms ; drug therapy ; metabolism ; Female ; Follicle Stimulating Hormone ; therapeutic use ; Gonadotropins ; therapeutic use ; Humans ; Infertility ; Pregnancy ; Progesterone ; therapeutic use ; Reproductive Techniques, Assisted

OBJECTIVETo construct hu-PBL/SCID chimeras and to investigate the development of lymphoma and oncogenicity of the Epstein-Barr virus (EBV).

METHODSHuman peripheral blood lymphocytes (PBLs) were isolated from healthy adult donors and transplanted intraperitoneally into severe combined immunodeficient (SCID) mice. Mice with hu-PBL engraftment from healthy EBV seronegative donors were injected intraperitoneally with EBV-containing supernatant from suspension culture of B95-8 cell line (active infection), whereas mice receiving lymphocytes from healthy EBV seropositive donors were not re-infected with B95-8 derived EBV (latent infection). Pathological examination and molecular analysis were performed on experimental animals and induced neoplasms.

RESULTSIn the early stage of this experiment, 12 mice died of acute graft-versus-host disease, mortality was 34.3% (12/35 mice) with an average life span of 17.5 days. In 19 survival hu-PBL/SCID chimeric recipients from 12 healthy donors, tumor incidence was 84.2% (16/19 mice). The average survival time of tumor-bearing mice was 65.5 days. EBV-related neoplasms in SCID mice were nodular tumors with aggressive and fatal features. Histological morphology of tumors exhibited diffuse large cell lymphomas. Immunohistochemistry revealed that LCA (CD45) and L26 (CD20) were positive, but both PS1 (CD3) and UCHL-1 (CD45RO) were negative, and EBV products ZEBRA, LMP1, and EBNA2 were expressed in a small number of tumor cells. EB virus particles were seen in the nuclei of some tumor cells by electron microscopy, and EBV DNA could be amplified in the tumor tissues by PCR. In situ hybridization indicated that the nuclei of tumor cells contained human-specific Alu sequence.

CONCLUSIONSEBV-induced tumors were human B-cell malignant lymphomas. We obtained direct causative evidence dealing with EBV-associated tumor deriving from normal human cells.

Adult ; Animals ; Antigens, CD20 ; metabolism ; Chimera ; Epstein-Barr Virus Infections ; immunology ; virology ; Graft vs Host Disease ; prevention & control ; virology ; Herpesvirus 4, Human ; physiology ; Humans ; Leukocyte Common Antigens ; metabolism ; Leukocyte Transfusion ; methods ; Lymphoma, B-Cell ; immunology ; virology ; Lysosomal-Associated Membrane Protein 1 ; metabolism ; Mice ; Mice, SCID

AIMTo study the relationships between dyspnea and respiratory drive or respiratory muscle function in COPD.

METHODSThirty-one patients with COPD and 26 normal subjects were involved in the study. Routine pulmonary function, pulmonary diffusing capacity, P0.1, PI(max) were measured at rest. Oxygen consumption (VO2), carbon dioxide production (VCO2), minute ventilation (VE) etc were observed during exercise test. Dyspnea was assessed with Borg Scale (BS) simultaneously. Arterial blood gas measured before and after exercise.

RESULTS(1) PI(max) of COPD (5.33 +/- 1.95) kPa decreased compared with the normal subjects (7.02 +/- 2.53) kPa, P < 0.05, P0.1 of COPD (0.37 +/- 0.12) kPa increased compared with the normal subjects (0.26 +/- 0.09) kPa, P < 0.05, inspiratory drive efficacy (V(T)/P0.1) of COPD (1.6 +/- 0.31) L/kPa decreased than that of the normal subjects (2.1 +/- 0.53) L/kPa, P < 0.05. P0.1/PI(max) of COPD (0.069 +/- 0.021) was higher than that of the normal individuals (0.037 +/- 0.009), P < 0.01. (2) Peak exercise dyspnea was correlated with dyspnea at rest and P0.1/PI(max) (r = 0.41, P < 0.05 and r = 0.48, P < 0.05, respectively), and P0.1/PI(max) was also positively correlated with the change in BS from rest to maximal exercise (deltaBS) (r = 0.44, P < 0.05) in COPD patients.

CONCLUSIONIn COPD, breathlessness during exercise is not simply related to hyperinflation and the damaged gas exchange, but also to the relatively increased respiratory drive and dysfunction of respiratory muscle.

Adult ; Case-Control Studies ; Dyspnea ; etiology ; physiopathology ; Exercise Test ; Female ; Humans ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive ; physiopathology ; Respiratory Function Tests

OBJECTIVETo study the relationship of nonsyndromic cleft lip and/or palate (NSCL/P) and poliovirus receptor-related 1 exon3 (PVRL1exon3) polymorphisms in Han People of Jiangzhe area.

METHODSPVRL1exon3 was examined by polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) technique in the 50 patients with NSCL/P and 85 healthy parents.

RESULTSNo W185X mutation was found in the PVRL1exon 3.

CONCLUSIONIt indicates that there is no relationship between NSCL/P and PVRL1exon3 in Han People in Jiangzhe area.

Asian Continental Ancestry Group ; genetics ; Cell Adhesion Molecules ; genetics ; Child, Preschool ; Cleft Lip ; genetics ; Cleft Palate ; genetics ; Exons ; Female ; Gene Frequency ; Genotype ; Humans ; Infant ; Male ; Nectins ; Pedigree ; Polymorphism, Genetic ; Receptors, Virus ; genetics

BACKGROUNDGenerally, intracytoplasmic sperm injection (ICSI) may be the preferable method to treat partial globozoospermia, but whether there exist some correlations between ICSI fertilization rate and the proportion of round-headed sperm or morphologically normal sperm remains open. This study was to explore the correlation between ICSI fertilization rate and the sperm morphology in patients with partial globozoospermia.

METHODSThirty-four patients diagnosed with partial globozoospermia accepted the following assisted fertilization treatments - 2 cases accepted in-vitro fertilization (IVF) alone, 26 cases accepted ICSI alone, and 6 accepted split IVF/ICSI. Detailed morphological characteristics were described using Diff-Quik rapid staining. Sixty cases accepting IVF or ICSI treatment in our reproductive center were considered as the control group after being matched by relevant criteria. Fertilization rate, embryo quality, embryo implantation rate and clinical pregnancy rate were calculated.

RESULTSBesides very high proportion of round-headed sperm, partial globozoospermia also showed very high proportion of small-acrosomal sperm and very low proportion of morphologically normal sperm. Fertilization rate of IVF (IVF alone plus split IVF) was very low in partial globozoospermia (25.4% ± 17.4%), but ICSI (ICSI alone plus split ICSI) achieved satisfying fertilization rate compared with the control group (66.2% ± 22.5% vs. 68.8% ± 29.4%, P > 0.05). In patients with partial globozoospermia, there were no correlations between ICSI fertilization rate and the proportion of round-headed sperm, small-acrosomal sperm, or morphologically normal sperm.

CONCLUSIONSThere was high proportion of small-acrosomal sperm in partial globozoospermia. For patients with partial globozoospermia, ICSI is more preferable than IVF. ICSI fertilization rate does not depend on the proportion of round-headed sperm, small-acrosomal sperm, or morphologically normal sperm.

Adult ; Female ; Fertilization in Vitro ; Humans ; Infertility, Male ; therapy ; Male ; Pregnancy ; Sperm Injections, Intracytoplasmic ; Spermatozoa ; abnormalities ; cytology ; physiology

BACKGROUNDThe regulation of endometrial physiology and morphogenesis by the paracrine effectors has been well established using in vivo studies. A more complete understanding of the endometrial function has been delayed due, in part, to a lack of appropriate culture models. In this study, we aimed to simulate the in vivo three-dimensional (3-D) growth pattern of endometrial cells using a 3-D in vitro culture system.

METHODSIsolated endometrial epithelial cells, stromal cells and RL95-2 cells were seeded into culture chambers coated with the extracellular matrix Matrigel and observed using light microscopy. Fluorescence staining and immunohistochemistry were used to assess the morphology.

RESULTSDepending on the culture conditions, epithelial cells and RL95-2 cells formed multicellular structures on Matrigel; stromal cells remained individually distinguishable or grew together to form 3-D lattice-like structures.

CONCLUSIONSMatrigel provided a good microenvironment for culturing endometrial cells. The cells cultured in the Matrigel-coated chambers closely resembled those seen in vivo.

Cell Culture Techniques ; methods ; Cell Line ; Cells, Cultured ; Endometrium ; cytology ; Female ; Humans ; Immunohistochemistry