Objective To evaluate the value of covered self-expending metallic stent in the management of malignant esophageal and duodenal strictures or fistulas and explore the treatment for the associated common complications.Methods With interventional procedure under fluoroscopic guidance,95 self-expending mesh stents were implanted in 87 patients,including esophageal carcinoma(50 cases),esophagogastric anastomotic stenosis(23 cases),gastroduodenal malignant stenosis(5 cases),esophagobronchial fistula(3 cases),esophagogastric anastomotic fistula(6 cases).Results Stent placement was successful in all patients at the first trial,having no instant complication except one acute bleeding during the procedure and all of them with relief of stenostic complaint,restoration of clictelic function and closure of fistulas.The long-term curative effect showed something to do with different kind of disease,and the related treatment.Conclusion Self-expending metallic covered mesh stent is safe,effective and less complication;and could be further promoted with addition of radiotherapy and(or)chemotherapy.

Objective To investigate the multi factor for type 2 diabetes with hyperuricemia and metabolic syndrome for preven‐tion cardiovascular disease .Methods 672 cases diagnosed type 2 diabetes were selected in Beijing Anzhen and Cuigezhuang com‐munities to measure height ,weight ,neck circumference ,waist ,BMI ,blood pressure ,fasting plasma glucose ,HbA1c and lipid pro‐file .Results The prevalence of HUA in 672 cases is 8 .04% .It was significantly lower than coastal area population in Shandong Province .BMI ,neck circumference ,waist ,DBP ,FBG ,2 hPG ,HbA1c ,GLT ,BUN ,blood uric were significantly higher than NUA group .The prevalence of MS and fatty in HUA group is 75 .93% ,77 .78% .While in NUA group is 58 .9% ,56 .8% respectively P=0 .014 ,0 .003 .Logistic regression analysis showed that BMI ,HbA1c ,ALT ,BUN were associated with hyperuricemia in T2DM . Conclusion The prevalence of HUA in Beijing diabetic patients was lower than coastal area population ,but complicated MS and cardiovascular risk factor were high and seriously .

Objective To investigate the keratin 9 gene mutation in epidermolytic palmoplantar keratoderma (EPPK) and its relationship with clinical manifestations. Methods Three Chinese pedigrees with EPPK were studied. Polymerase chain reaction (PCR) was performed to amplify the seven exons encoded by keratin 9. Denaturing high-performance liquid chromatography (DHPLC), DNA sequencing and allele-specific PCR were used to reveal the sequence variation in the PCR products. Results An insertion-deletion mutation in the exon 1 of keratin 9 497delAinsGGCT, was revealed in all 3 EPPK families, resulting in the keratin 9 change from tyrosine166 to tryptophan and leucine (Y166delinsWL). Allele-specific PCR confirmed that the mutation was not a commonly seen polymorphism, but a novel mutation which has not been reported in The Human Intermediate Filament Mutation Database (http://www.interfil.org). Conclusions A new keratin 9 gene mutation, 497delAinsGGCT, is found in these Chinese EPPK pedigrees, which may be the genetic basis of EPPK.

Objective To evaluate the diagnostic and therapeutic value and safety of transcatheter arterial angiography and embolization in patients with endoscopic refractory gastrointestinal bleeding.Methods Thirty-one cases of endoscopic refractory gastrointestinal bleeding were performed DSA and treated with transcatheter arterial angiography and embolization.The safty and efficacy was evaluated.Results Angiographic positive rate of bleeding was 80.65％ (25/31);28 cases was treated with embolization.The success rate of first embolization was 75.00％ (21/28),and the total success rate was 82.14 ％ (23/28) by the second embolization.Seven patients received surgical resection after interventional therapy,including 2 cases of jejunal stromal tumors and 5 cases of gastric malignant tumors.Four cases of gastric cancer patients underwent rebleeding within 30 days after interventional therapy,of which 2 died of heart or lung function failure due to basic diseases.Except for 1 patient of anastomotic bleeding after gastrointestinal anastomosis occurred anastomotic fistula after embolization,who recovery with the support treatment,no other cases occurred serious gastrointestinal ischemic necrosis.Conclusion Interventional diagnosis and treatment for gastrointestinal bleeding hemostasis is effective and safety,and also can achieve good results especially for malignant gastric tumor hemorrhage,which can be used for endoscopic refractory gastrointestinal bleeding patients.

ObjectiveThis clinical study is aimed to investigate whether levetiracetam (LEV) can improve electrocorticogram (EEG) in epileptic children epilepsy patients with better clinical manifestation but abnormal EEG findings.MethodsTotally 39 children from our neurological clinic with partial or complex partial epilepsy seizure were included in present study and assigned equally into three groups receiving different treatment:control group,sodium valproate (VPA) group,and LEV group.Their clinical symptoms had been controlled for over one year by carbamazepine ( CBZ),but EEG results showed clearly abnormal.Epileptiform discharges were observed in routine EEG exams half a month before recruiting.After recruiting,they continued to receive CBZ alone (control group) or co-treated with VPA ( VPA group) or LEV (LEVgroup),respectively.Six months later,EEG was taken again and results were analyzed.ResultsImprovement rate were 9.1％ ( control group),23.1％ ( VPA group),and 66.7％ (LEV group),respectively;Overall statistical difference was reached among three groups ( P＜0.01 ) and between control group and LEV group( P＜0.012 5 ),but no statistical difference between control group and VPA group was reached ( P＞0.0125).ConclusionCo-treatment of LEV in child epilepsy patients receiving CBZ can significantly decrease abnormal EEG discharge frequency during interictal period.

Objective To establish a high performance liquid chromatography method for the determination of matrine in Lefu oral liquid .Methods The HPLC method was performed on a Diamonsil Platisil NH2 column (4 .6 mm × 250 mm ,5μm) with the mobile phase of acetonitrile-isopropyl alcohol-3% phosphoric acid solution (84 ∶ 4 ∶ 12 ) . The flow rate was 1 .2 ml/min .The sample injection volume was 5 μl .The detective wavelength was 205 nm .Results The calibration curve of matrine showed good linear response ranged from 54 .50 to 872 .00 μg/ml with r=0 .999 1 .The average recovery of spiked samples for matrine was 99 .82% while the relative standard deviation for repetitions was 1 .12% .Conclusion The method was simple ,reliable and repeatable ,which could be used for the quantitative determination of matrine of Lefu oral liquid .

Objective: To investigate the molecular genetic and clinicopathologic characteristics, immunophenotypes, diagnostic and differential diagnostic features of myxoid angiomatoid fibrous histiocytoma (MAFH). Methods: Three cases of MAFH were collected from the archives of Zhejiang Provincial People′s Hospital between January 2015 to August 2018. The clinical and radiologic features, histomorphology, immunohistochemistry, molecular genetics and prognosis were analyzed. Results: Patients consisted of 2 women and 1 man aged 37 years, 46 years, and 57 years, respectively. The clinical manifestations of 3 patients were presented as a painless, slowly-enlarged mass with a duration ranging of 2 weeks, 2 months and 50 years. These tumors were located at the deep somatic soft tissue of extremities or limbs (right hip, left forearm, left wrist, respectively) and 2 were preoperatively considered as ganglion cyst or giant cell tumor of tendon sheath by imaging examinations. The diameter of circumscribed mass lesion was ranged from 3.0 to 7.5 cm, which exhibited a gray white to tan and gelatinous cut surface. Extensive hemorrhage and cystic changes were observed in 2 cases. Under low magnification, all tumors showed a dense fibrous pseudo-capsule with a peritumoral lymphoplasmacytic cuff and a multi-nodular growth pattern. Blood-filled cystic spaces were observed in 2 tumors. The myxoid stroma occupied 60.0%, 80.0% and 90.0% area of the entire tumor, respectively. Within the myxoid areas, tumor cells were oval to stellate and arranged in cord-like, microcystic and reticular growth patterns. Transitions of myxoid tumor components to more solid areas with typical histology of angiomatoid fibrous histiocytoma (AFH) were observed at least focally in all the three cases. The tumor cells exhibited minimal atypia and scarce mitoses (1 to 2/50 HPF) without necrosis, and prominently focal intracytoplasmic vacuoles were identified in one case. The results of immunohistochemistry staining showed that, 2/3 cases focally expressed desmin, 2/3 focally expressed epithelial membrane antigen (EMA), and 1/3 focally expressed CD99. The positive index of Ki67 was approximately 1% to 5%. Fluorescence in situ hybridization analysis showed that EWSR1 gene rearrangement occurred in all of the three cases. During the period of follow-up, one case showed local recurrence at 15 months, one case showed postoperative recurrence at 24 months, and the recurrent tumor slowly grew for 120 months until the second resection, without recurrence at the following 2 months. The left case showed a disease-free survival at 32 months. Conclusions MAFH is a rare subtype of AFH with a low-grade behavior and may lead to diagnostic confusions. Carefully searching for the typical AFH histomorphology and combining with EWSR1 gene rearrangement test can help to distinguish MAFH from other mimickers.

To investigate the effectiveness and safety of diverticular peroral endoscopic myotomy (D-POEM) for mid-esophageal diverticulum. Data of consecutive patients in the prospective database with mid-esophageal diverticulum who received D-POEM in West China Hospital, Sichuan University between April 2014 to September 2019 were collected. The modified Eckardt scoring system for mid-esophageal diverticulum was used to evaluate the severity of diverticular symptoms. The effectiveness and safety of D-POEM were evaluated in terms of clinical success, technical success, complications and recurrence. A total of 7 patients with mid-esophageal diverticulum were included. Clinical and technical success was achieved in all patients with operation time of 16-70 minutes. No serious complications (2 cases with minor complications) or recurrence occurred. The follow-up time was 2-16 months. The median modified Eckardt score decreased from 3 points before operation to 0 points after operation. It is preliminarily believed that D-POEM ensures a complete septotomy between normal esophageal lumen and esophageal diverticulum. It is a safe and effective technique for mid-esophageal diverticulum. The modified Eckardt scoring system is suitable for symptom evaluation before and after treatment of mid-esophageal diverticulum.

Objective To investigate the clinical and histopathologic characteristics, diagnosis, differential diagnosis and prognostic features of anastomosing hemangioma.Methods Five cases of anastomosing hemangioma of the kidney and adrenal gland were collected, the clinical and radiologic features, histomorphology, immunophenotype and prognosis were analyzed with review of literature.Results Three patients were male and two were female with ages ranging from 47 to 77 years; three were located in adrenal gland and 2 originated from the kidney.Clinically, 4 tumors were incidentally identified, 1 presented as edema of lower extremity.By radiography, all presented as a well-demarcated, oval, solid and low-density mass.Grossly, the tumors ranged in maximum diameter from 1.6 to 2.5 cm ( mean 2.1 cm) .Microscopically, the tumors consisted of anastomosing sinusoidal capillary-sized vessels lined by a single layer of flattened, cubical to hobnail endothelial cells, setting in an pauci-cellular stroma of edematous and hyaline changes.Other commonly seen features included vaguely lobular growth pattern ( 3/5 ) , hemorrhage and thrombosis ( 5/5 ) , intravascular growth pattern ( 5/5 ) , eosinophilic intracytoplasmic hyaline globules ( 1/5 ) and extramedullary hematopoiesis ( 3/5 ).The tumor cells were typically bland-appearing and mitoses were scarce, with 1 case demonstrating cellular foci of tumor with slight pleomorphism and increased mitoses ( 2/50 HPF ).Immunohistochemical studies showed the tumor cells expressed endothelial cells markers.Follow-up information was available for all 5 patients and showed no evidence of tumor recurrence or metastasis within 6 to 52 months ( mean 30 months).Conclusions Anastomosing hemangioma is a rare, benign subtype of capillary hemangioma that predominantly affects the urologic organs and adrenal glands;it is needed to distinguish it histologically from a series of benign or malignant tumors that feature a richly vascular stroma.Careful attentions to its characteristic morphology with the judicious use of immunohistochemistry can help distinguish this tumor from its many mimickers.