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 investigate the clinicopathologic and immunohistochemical features of gastric stromal tumors.Methods A total of 105 cases with gastric stromal tumors were included in the study.The expression of cluster of differentiation 117 (CD117),cluster of differ entiation 34 (CD34),smooth muscle actin (SMA),S-100 protein and Ki-67 in gastric stromal tumors specimens was detected by immunohistochemistry.The clinico-pathologic features of gastric stromal tumors were also analyzed.Results Of 105 gastric stromal tumors specimens,90 were positive for CD117 [85.7 ％ (90/105)],98 positive for CD34 [93.3 ％ (98/105)],21 positive for SMA [20.4 ％ (21/105)],60 positive for Ki-67 [56.1％ (60/105)],13 positive for S-100 [12.4 ％ (13/105)].Conclusion Combined detection of CD117 and CD34 can improve the diagnostic accuracy of gastric stromal tumors.The expression of Ki-67 can be used as a prognostic parameter for gastric stromal tumors as it is correlated with tumor size,risk and mitotic.

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 explore the surgical indication, the operative procedure and effect of breast-conserving surgery plus combined treatment for the patients with early breast cancer. Methods 51 patients with early breast cancer were treated with breast-conserving surgery (BCS) plus radiotherapy, chemotherapy and hormonotherapy postoperatively. The result of breast-conserving group was compared with 56 patients treated by modified radical mastectomy (control group). Results 25 patients underwent quadrant resection plus axillary lymph node dissection (ALND), 15 patients were subjected to local resection plus ALND, and 11 patients received quadrant resection only. All patients were followed-up for an average of 16.9 months. In BCS group, one patient was found to have local recurrence, and the distant metastasis rate was 0%. In the control group, no patient had local recurrence and the distant metastasis rate was 3.6%. The operative complication rate in BCS group and control group was 13.7% and 33.9% respectively (p﹤0.05). Conclusion Breast-conserving surgery plus combined treatment is safe and satisfactory for early breast cancer. It can be considered as the first choice for the treatment of patients with breast cancer in early stage.

Objective To evaluate the feasibility and predictive ability of the sentinel node localization technique for patients with oral squamous cell carcinoma and determine whether the pathology of the SLN reflected the status of all the neck lymph nudes. Methods Perioperative use of a gamma probe identified radioactive SLNs. The pathology of the SLN was compared with that of the remaining neck dissection. Results Sentinel lymph node biopsy was performed on 20 cases. SLNs were found in 16 necks, among them 6 were found to be subclinical metastases. The SLN was the only lymph node containing tumor in 5 of 6. Conclusions Our preliminary investigation shows that sentinel node localization is technically feasible and predictive of cervical metastasis. SLN biopsy may aid in identifying the clinically N0 patient with occult lymph node metastasis and has the potential to decrease the number of neck dissections performed in clinically negative necks.

Objective:To explore the effects of necroptosis specific inhibitor-1 (Nec-1) on brain injury in rats after cardiac arrest and its mechanism.Methods:A total of 24 Sprague-Dawley (SD) rats were divided into Sham group, model group and Nec-1 group ( n = 8 per group) according to random number table method. In the Sham group, only general surgical procedures were underdone without inducing cardiac arrest. In the model group, the rats were subjected to asphyxial cardiac arrest followed by cardiopulmonary resuscitation (CPR) at 6 minutes after cardiac arrest. In the Nec-1 group, Nec-1 of 1 mg/kg was administered after cardiac arrest, and CPR was performed at 6 minutes after cardiac arrest. At 72 hours after CPR, neurological deficit scores (NDS) were assessed, serum S100B levels were measured by enzyme linked immunosorbent assay (ELISA), receptor-interacting protein 3 (RIP3) expression in cerebral cortex and hippocampus was observed under immunofluorescence and positive rate was calculated, and the levels of RIP3 protein expression in brain were analyzed by Western blotting. Results:At 72 hours after CPR, the rats in the model group showed obvious necroptosis and injury in brain. Compared with the Sham group, the NDS scores in the model group were significantly decreased [57.0 (52.7, 60.0) vs. 80.0 (80.0, 80.0), P < 0.05], the serum S100B was significantly increased (ng/L: 44.9±4.5 vs. 18.6±1.5, P < 0.05), the percentages of RIP3 positive cells in cerebral cortex and hippocampus were significantly elevated [cerebral cortex: (31.7±4.8)% vs. (11.6±3.2)%, hippocampus: (28.4±0.8)% vs. (10.9±0.6)%, both P < 0.05], and the levels of RIP3 protein expression in brain were significantly increased [RIP3 protein (RIP3/GAPDH): 0.708 (0.642, 0.722) vs. 0.408 (0.253, 0.504), P < 0.05]. After Nec-1 intervention, necroptosis and injury in brain were obviously improved. Compared with the model group, the NDS scores at 72 hours after CPR in the Nec-1 group were significantly increased [70.5 (68.5, 71.7) vs. 57.0 (52.7, 60.0), P < 0.05), the serum S100B was significantly decreased (ng/L: 31.9±2.7 vs. 44.9±4.5, P < 0.05), the percentages of RIP3 positive cells in cerebral cortex and hippocampus were significantly lowered [cerebral cortex: (23.7±4.1)% vs. (31.7±4.8)%, hippocampus: (20.4±0.4)% vs. (28.4±0.8)%, both P < 0.05], and the levels of RIP3 protein expression in brain were significantly declined [RIP3 protein (RIP3/GAPDH): 0.437 (0.379, 0.507) vs. 0.708 (0.642, 0.722), P < 0.05]. Conclusion:Nec-1 attenuated necroptosis of brain cells by inhibiting the expression of RIP3 protein, so as to reduce brain injury after cardiac arrest in rats.

[Objective]To analyze the advantages of transparent cap assisted endoscopy in the diagnosis and treatment of duode-nal diseases.[Methods]From September 2014 to December 2015,62 cases with suspicious duodenal diseases in the endoscopy cen-ter of our hospital randomly divided into transparent cap group(n=31)and routine group(n=31)according to the time sequence. The visual field resolution,success rate of image capture and operating time were compared in 2 groups.[Results]Thirty cases in transparent cap group had clear visual field definition ,which was obviously higher than 9 cases in conventional group (96.8% vs 29%,P < 0.001). Twenty-three cases in transparent cap group and 8 cases in routine group were successfully captured(90.3% vs 25.8%,P < 0.001). The average operating time of the transparent cap group was significantly shorter than that of the conventional group(150+58 vs 95+36 seconds,P=0.004).[Conclusion]Transparent cap endoscope examination is more effective in the treat-ment of duodenal diseases,and the image capture is higher and the operation time is shorter.

Objective To analyze the clinical characters,treatment effects and influential factors of gastrointestinal stromal tumor patients with hepatic metastases,and to explore the reasonable clinical treatment protocols.Methods The clinical data of 24 gastrointestinal stromal tumor patients with hepatic metastases who were admitted to Peoples Liberation Army Hospital from April 2007 to April 2010 were retrospectively analyzed.Results The 1-,2-,3-and 4-year cumulative survival rates of hepatic metastases patients with gastrointestinal stromal tumors were 91％,72 ％,22 ％ and 6 ％,respectively.The 1-,2-and 3-year survival rates of the patients treated with imatinib after operation were 91％,70 ％,28 ％,respectively,the median survival time was 26 months,the mortality rate was 27.3 ％ (3/11),and 9 cases got the tumor complete elimination.The 1-,2-and 3-year survival rates of the patients treated without imatinib after operation were 90 ％,68 ％,18 ％,respectively,the median survival time was 24 months,the mortality rate was 14.3 ％ (2/13),and 12 cases got the tumor complete elimination.The recurrence rate after complete resection was 28.6 ％(4/14),and the mortality rate was 7.1％ (1/14).The mortality rate after incomplete resection was 40 ％ (4/10).Conclusion Surgical treatment of eliminating the primary and metastatic lesion,and adjuvant therapy of imtinib could prolong the survival time,reduce postoperative recurrence rate and improve the quality of life,which are the effective methods for the treatment of the gastrointestinal stromal tumor patients with hepatic metastases.

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 investigate clinical and pathological features of gastrointestinal stromal tumors,the frequency and type of mutation of c-kit and platelet-derived growth factor receptor α (PDGFRA)genes.Methods 340 patients underwent surgical resection and diagnosed as gastrointestinal stromal tumors by postoperative pathology from Junuary 2012 to December 2014 were enrolled,and their tumor tissues were collected.The direct sequencing method was applied to detect the mutation status of c-kit gene (exon 9,11,13 and 17) and PDGFRA gene (exon12 and 18).Results There were 138 males and 192 females,and their median age was 58 years old (37-81 years old).There were 178 patients (52.4 ％) with gastric stromal tumors,21 cases (6.2 ％) with duodenal stromal tumors,82 cases (24.1％) with small intestinal stromal tumor,10 cases (2.9 ％) with colon stromal tumor,15 cases (4.4 ％) with rectal stromal tumors,30 cases (8.8 ％) with parenteral stromal tumor (from the peritoneum,mesentery,retroperitoneum or attachment),4 cases (1.2 ％) of liver tissues (gene detection tissues from the liver biopsy or surgical resection specimens).In the mutation analysis of all 340 patients with gastrointestinal stromal tumor,the total mutation rate was 89.4 ％ (304/340),including 81.2 ％ (276 cases) of c-kit,8.2 ％ (28 cases) of PDGFR and 10.6 ％ (36 cases) of wild type.Among 125 cases underwent the detection of the gene mutation sequences,there were 49 cases of exon11 deletion mutation,4 cases of exon11 insertion mutation,12 cases of exon 11 missense mutation,8 cases of exon9 insertion mutation,1 case of 3xon13 missense mutation,1 case of exon17 missense mutation,24 cases of exon12 synonymous mutation and 20 cases of exon18 synonymous mutation.Conclusions Gene detection is becoming more and more obvious in predicting the therapeutic effect of molecular targeted therapy,the mechanism of drag resistance and the clinical treatment,c-kit exon11 mutation is one of the most common gene mutation types related to the choice of targeted medicine.