Objective To analyze the clinicopathological features of gastric stromal tumor with primary gastrointestinal carcinoma.Methods 469 cases of gastrointestinal stromal tumor (GIST) from January 2011 to December 2014 admitted to PLA General Hospital were retrospectively analyzed.Gastric stromal tumor patients with primary gastrointestinal carcinoma were screened.The concomitant gastrointestinal cancer site,stromal tumor size,mitotic activity,immunohistochemistry were also detected.Results The gastric stromal tumor with primary gastrointestinal carcinoma accounted for 14.7 ％ (69/469) of all the GIST,in which the small gastric stromal tumor accounted for 65.2 ％ (45/69) of the total and 9.59 ％ (45/469) of all the GIST.The diameter of all tumors was ＜ 5 cm,and the mitotic was ＜ 5/50 HPF.The positive rates of CD117,CD34,DOG-1 were 92.8 ％ (64/69),92.8 ％ (64/69),94.1％ (65/69).The Fletcher was classified as low-risk and extreme low-risk.Conclusions Gastric stromal tumor with primary gastrointestinal carcinoma has no specific clinical features and pathological immunohistochemical markers.Its malgnant degree is lower than GIST.Its prognosis is associated with primary gastrointestinal cancer staging.

Objective To evaluate the effect of acupuncture on the quality of recovery during the early period after gynecological laparoscopic surgery using the Quality of Recovery?40 questionnaire ( QoR?40). Methods Sixty patients, aged 20-60 yr, with body mass index of 18.5-28.0 kg∕m2, of American Society of Anesthesiologists physical status ⅠorⅡ, scheduled for elective gynecological laparoscopic surgery, were equally and randomly divided into either control group ( group C ) or acupuncture group (group Acu) using a random number table. Bilateral Neiguan (PC6) and Hegu (L14) acupoints were stimulated for 30 min starting from the time point before skin incision and immediately after the end of surgery. The quality of recovery was assessed using the QoR?40 on 1 day before surgery, and at 24 and 48 h after surgery. The patient′s cognitive function was assessed using Mini?Mental State Examination. The requirement for rescue analgesics was recorded. The occurrence of nausea and vomiting was also recorded. Results Compared with group C, the global QoR?40 and Mini?Mental State Examination scores were significantly increased, and the incidence of nausea and vomiting and requirement for rescue analgesics were decreased at 24 and 48 h after surgery in group Acu ( P<0. 05 ) . Conclusion Acupuncture can improve the quality of recovery during the early period after gynecological laparoscopic surgery using the QoR?40.

OBJECTIVE:To promote the development of hospital clinical pharmacy.METHODS:The measures which promoted the development of hospital clinical pharmacy after established by Jiangsu quality control system for pharmacy management were introduced.Through collecting clinical pharmacy indexes (the number of clinical pharmacists,the range of clinical pharmacy practice,the number of clinical pharmaceutical practice,the number of therapeutic drug monitoring (TDM),the number of reported ADR,etc.) in Jiangsu Province Pharmacy Management Quality Control Network Reporting System established by Quality Control Center during Jan.2014-Dec.2016,the development of clinical pharmacy in Jiangsu hospital were analyzed.RESULTS:The measures formulated and adopted by Quality Control Center included expanding the scale of clinical pharmacists training,strengthening the training of rational use of antibiotics,formulating provincial rational drug use standard,carrying out pharmaceutical quality control circle activities,etc.The data of clinical pharmacy indexes were collected from 61 hospitals.The results showed that,compared with Jan.2014,the number of clinical pharmacists in sample hospitals increased from 4.72 to 5.86 in Dec.2016;the number of involved special departments increased slightly;clinical pharmacy practice (weekly rounds number,medication history writing,case analysis,medication guidance,drug counseling) increased significantly;the number of beds managed by clinical pharmacists reached 289 beds;the types of TDM increased from 7.38 to 7.87,the number of yearly monitoring was 1 293;the number of monthly reported ADR increased from 14.71 to 19.34,but the number of consultation,new/severe ADR decreased slightly.CONCLUSIONS:Both service ability and service level of clinical pharmacy in 61 hospitals in Jiangsu have been improved by the establishment of the provincial quality control system for pharmacy management.

Objective:To study the clinical features and risk factors of death in patients with infected pancreatic necrosis (IPN) caused by multidrug-resistant bacteria (MDRB).Methods:The clinical data of 219 IPN patients who were managed at the Department of General Surgery of Xuanwu Hospital, Capital Medical University from January 1, 2016 to December 31, 2021 were retrospectively analyzed. There were 142 males, and 77 females, with a median age [ M( Q1, Q3)] of 51(38, 62) years old. Based on the pre-sence or absence of MDRB infection, these patients were divided into the MDRB-infected group ( n=117) and the non-MDRB-infected group ( n=102). Clinical features and outcomes were compared between the two groups, and the risk factors resulting in death in patients with MDRB infection were analyzed. Logistic regression analysis was used to determine the risk factors for poor outcomes in patients with MDRB. Results:There were significant differences in etiologies, distribution characteristics of necrosis and degrees of pancreatic necrosis between the two groups (all P<0.05). When compared with the non-MDRB-infected group, the CT severity index, the levels of procalcitonin and interleukin-6 were significantly higher in the MDRB group on admission, while the hematocrit was significantly lower (all P<0.05). Furthermore, when compared with the non-MDRB infection group, patients with MDRB infection were significantly more likely to have fungal infections [37.6%(44/117) vs. 21.6%(22/102)] and extrapancial infections [75.2%(88/117) vs. 58.8%(60/102)], more patients underwent surgery [89.7%(105/117) vs. 67.6%(69/102)], and more surgical procedures were performed [3(2, 4) times vs. 2(1, 3) times], with a higher incidence of postoperative complications [36.2%(38/117) vs. 18.8%(13/102)], an increase in a new-onset organ failure after surgery [37.1%(39/117) vs. 21.7%(15/102)], a higher in-hospital mortality rate [25.6%(30/117) vs. 10.8%(11/102)], longer hospitalization [39(28, 67) d vs. 29(18, 35) d] and ICU stays [22(10, 42) d vs. 11(6, 18) d], and a longer need for parenteral nutrition [19(9, 37) d vs. 15(7, 25) d, all P<0.05]. On multivariate regression analysis, the risk factor for death in the MDRB-infected group was co-fungal infection ( OR=1.199, 95% CI: 1.025-1.402). On the other hand, receiving therapy containing tigacycline ( OR=0.831, 95% CI: 0.715-0.965) and minimally invasive surgery ( OR=0.698, 95% CI: 0.562-0.868) reduced the risk of death in the MDRB-infected group (all P<0.05). Conclusions:IPN patients with MDRB infection had higher levels of inflammation, more serious pancreatic necrosis, longer treatment time, and increased need for surgical treatment. Measures involving fungal infection control and the use of tigacyclin and minimally invasive surgery reduced the risks of death in patients with MDRB infection.

Objective To observe the differences in the expression levels of the hypoxia-induc-ible factor-1α/heme oxygenase-1/vascular endothelial growth factor A(HIF-1α/HO-1/VEGF-A)signaling pathway under different maturation outcomes of arteriovenous fistula(AVF)in patients with stage 5 chronic kidney disease,and explore the regulatory mechanism of the HIF-1α/HO-1/VEGF-A signaling pathway in the maturation process of AVF.Methods A total of 45 patients with AVF sur-gery for stage 5 chronic kidney disease were selected as research objects,vascular specimens were col-lected during the AVF surgery,and the patients were divided into AVF maturation group(n=35)and AVF poor maturation group(n=10)based on the AVF maturation outcomes within 8 weeks after surgery.Reverse transcription-polymerase chain reaction(RT-PCR)was used to detect the gene ex-pression levels of HIF-1α,HO-1 and VEGF-A in the HIF-1α/HO-1/VEGF-A signaling pathway;the Western blotting was used to detect the protein expression levels of HIF-1α,HO-1 and VEGF-A;the enzyme-linked immunosorbent assay(ELISA)was used to detect the expression levels of downstream inflammatory factors such as interleukin-1β(IL-1β),interleukin-8(IL-8),and transforming growth factor-β(TGF-β).Results The expression levels of HIF-1α mRNA,HO-1 mRNA,and VEGF-A mRNA in the AVF maturation group were significantly higher than those in the AVF poor maturation group(P＜0.01);the protein expression levels of HIF-1α,HO-1 and VEGF-A in the AVF maturation group were significantly higher than those in the AVF poor maturation group(P＜0.01);the ex-pression levels of IL-1β,IL-8 and TGF-β in the AVF maturation group were significantly lower than those in the AVF poor maturation group(P＜0.01).Conclusion The upregulation of the HIF-1α/HO-1/VEGF-A signaling pathway is conducive to the early maturation of AVF.The measurement of the expression levels of the HIF-1α/HO-1/VEGF-A signaling pathway has a certain predictive sig-nificance for the early maturation outcome of AVF.

Objective To observe the differences in the expression levels of the hypoxia-induc-ible factor-1α/heme oxygenase-1/vascular endothelial growth factor A(HIF-1α/HO-1/VEGF-A)signaling pathway under different maturation outcomes of arteriovenous fistula(AVF)in patients with stage 5 chronic kidney disease,and explore the regulatory mechanism of the HIF-1α/HO-1/VEGF-A signaling pathway in the maturation process of AVF.Methods A total of 45 patients with AVF sur-gery for stage 5 chronic kidney disease were selected as research objects,vascular specimens were col-lected during the AVF surgery,and the patients were divided into AVF maturation group(n=35)and AVF poor maturation group(n=10)based on the AVF maturation outcomes within 8 weeks after surgery.Reverse transcription-polymerase chain reaction(RT-PCR)was used to detect the gene ex-pression levels of HIF-1α,HO-1 and VEGF-A in the HIF-1α/HO-1/VEGF-A signaling pathway;the Western blotting was used to detect the protein expression levels of HIF-1α,HO-1 and VEGF-A;the enzyme-linked immunosorbent assay(ELISA)was used to detect the expression levels of downstream inflammatory factors such as interleukin-1β(IL-1β),interleukin-8(IL-8),and transforming growth factor-β(TGF-β).Results The expression levels of HIF-1α mRNA,HO-1 mRNA,and VEGF-A mRNA in the AVF maturation group were significantly higher than those in the AVF poor maturation group(P＜0.01);the protein expression levels of HIF-1α,HO-1 and VEGF-A in the AVF maturation group were significantly higher than those in the AVF poor maturation group(P＜0.01);the ex-pression levels of IL-1β,IL-8 and TGF-β in the AVF maturation group were significantly lower than those in the AVF poor maturation group(P＜0.01).Conclusion The upregulation of the HIF-1α/HO-1/VEGF-A signaling pathway is conducive to the early maturation of AVF.The measurement of the expression levels of the HIF-1α/HO-1/VEGF-A signaling pathway has a certain predictive sig-nificance for the early maturation outcome of AVF.

Objective To investigate the effect of Gegen Qinlian Decoction on liver energy metabolism and free fatty acid(FFA)in rats with insulin resistance(IR).Methods IR rat model was established by feeding 60%fat high-fat diet for 13 consecutive weeks.SD rats were randomly divided into normal group,model group,Rosiglitazone(5 mg·kg-1)group and Gegen Qinlian Decoction low-,medium-and high-dose groups(1.65,4.96,14.86 g·kg-1),with 6 rats in each group.Intragastric administration was given once a day,continuous administration intervention lasted for 16 weeks.Determination of IR-related indicators:serum fasting insulin(FINS),fasting blood glucose(FPG),calculate the IR index;HPLC method was established for the determination of adenosine triphosphate(ATP),adenosine diphosphate(ADP)and adenosine monophosphate(AMP)in rat liver tissue;ELISA was used to determine the content of FFA in rat liver tissue.The contents of serum total cholesterol(TC)and triglyceride(TG)were detected by automatic biochemical analyzer.The pathological changes of liver tissue were observed by HE staining.Results(1)After the model replication,compared with the normal group,the FINS,FPG levels and IR index of the model group were significantly increased(P＜0.05).(2)Compared with the normal group,the levels of FINS,FPG and IR index in the model group were significantly increased(P＜0.01),the contents of ATP,ADP and AMP in liver tissue were significantly decreased(P＜0.01),the content of FFA was significantly increased(P＜0.01),and the levels of TC and TG in serum were significantly increased(P＜0.05).Liver cells arranged in disorder,fatty degeneration,and there are a large number of lipid droplets.Compared with the model group,the FINS level and IR index of rats in each administration group were significantly decreased(P＜0.05,P＜0.01),and the FPG level of rats in the Rosiglitazone group was significantly decreased(P＜0.05).The contents of ADP and AMP in liver tissue of rats in each administration group were significantly increased(P＜0.05,P＜0.01),and the contents of ATP in liver tissue of rats in low-,medium-and high dose-groups of Gegen Qinlian Decoction were significantly increased(P＜0.05,P＜0.01).The content of FFA in liver tissue of rats in Rosiglitazone group and Gegen Qinlian Decoction low-and high-dose groups was significantly decreased(P＜0.01).The serum TC level of rats in the low-and high-dose groups of Gegen Qinlian Decoction was significantly decreased(P＜0.05,P＜0.01),and the serum TG level of rats in the Rosiglitazone group and the low-dose group of Gegen Qinlian Decoction was significantly decreased(P＜0.05,P＜0.01).The steatosis of hepatocytes in rats of each administration group was alleviated to varying degrees,and the lipid droplets were reduced,and the pathological damage was improved.Conclusion Gegen Qinlian Decoction may improve liver lipid metabolism disorder and restore lipid and energy balance by regulating energy metabolism and reducing FFA level,thus improving IR.