Gastrointestinal stromal tumor (GIST) is a group of tumors which is independently derived from the mesenchymal stem cells of the digestive tract,and consists of undifferentiated or multi-functional spindle or epithelioid cells.Most of the rectal stromal tumor located at the middle or lower part of the rectum,and presented with exogenous growth outside of the rectum cavity.Rectal stromal tumor accounted for 5％ of GIST.Rectal stromal tumor is easily missed or misdiagnosed because of insidious onset and non-typical clinical manifestations.The diagnosis of rectal stromal tumor relies on immunohistochemical staining (CD117 and CD34) and pathological examination.Surgical resection is the first choice for the treatment of local primary rectal stromal tumor.Protection of the integrity of the tumor is important during operation,and routine lymph node dissection is not recommended.Molecular targeted drug mesylate imatinib is adopted in the pre-and postoperative adjuvant therapy.However,due to the rarity of rectal stromal tumor,the treatment strategies need further investigation.

Objective　To investigate p16 gene expression in salivary adenoid cystic carcinoma (ACC) and the relation between p16 gene expression and lung metastasis. Methods　p16 gene protein was detected in 36 cases of ACC by ABC immunohistochemical method. Results　58.3 % (21/36) cases showed positive staining. Higher incidence for positive staining was found in ACC without lung metastasis 76 % (19/25) than those with lung metastasis 36.6 % (4/11) with remarkable statistical difference. Expression of p16 was correlated with the P-TNM stageing (P＜0.05), but was not with pathologic pattern (P＞0.05). Conclusion　The p16 gene may play an important role in suppressing the expression of metastatic potential in human salivary ACC.

Objective To evaluate the prognostic value of microsatellite instability (MSI) in stage Ⅱ colon cancer patients.Methods 120 stage Ⅱ colon cancer patients underwent radical resection in the Department of Colorectal Surgery,Beijing Cancer Hospital from 2000 to 2007.Tissue samples were collected and DNA was extracted for MSI determination using PCR following the Pentaplex panel.Clinical parameters were also combined and analyzed statistically to explore the association between MSI status and clinical parameters.Results The incidence of high frequency of microsatellite instability (MSI-H) was 20.8％ in these 120 stage Ⅱ colon cancer patients.There was a significant correlation between the status of MSI and tumor differentiation (x2 =9.69,P =0.021);However MSI status was demonstrated to be a prognostic factor for disease free survival or overall survival (all P ＞ 0.05).Nor was MSI status associated with tumor relapse or metastasis.Age and preoperative serum CEA level were identified as independent factors for DFS by Cox regression.Conclusion In stage Ⅱ colon cancer patients,MSI status correlates with tumor differentiation,but is not a prognostic factor.

Objective To discuss the interactive management mode (IMM) of preventive treatment on osteoporosis self-rehabilitation of rural elderly residents.Methods IMM was used to manage osteoporosis patients in the community of Changshu,and general self-efficacy scale was adopted for evaluation.Results Self-efficacy score (34.2) increased comparing with before(23.5 ) the medical management,the difference was statistically significant ( P＜0.05 ).Conclusion IMM of preventive treatment can effectively improve the rural community general self-efficacy level.

Objective To investigate the number, distribution and metastatic rule of lymph nodes in the mesorectum of rectal cancer specimen after processing the recta] cancer specimen with modified fat clearance technique. Methods Sixty patients with mid-low rectal cancer who had been admitted to Peking University School of Ontology from 2003 to 2008 were assigned to test group. All the 60 patients who denied neo-adjuvant therapy were treated with total mesorectal excision, and the rectums resected were processed with the modified fat clearance technique. Rectums from another 50 patients with mid-low rectal cancer in control group were fixed in formalin solution for 24 hours. The mesorectum was divided into anterior, posterior, left and right quadrants, and each quadrant was further divided into upper, middle and lower parts. The numbers of lymph nodes harvested and metastatic rate of lymph nodes between the 2 groups were analyzed by t test and chi-square test. Results (1) The numbers of lymph nodes harvested in the test and control groups were 1436 and 525, with statistical difference between the 2 groups (t =- 12. 153, P <0.05). The number of small lymph nodes(diameter≤5 mm) harvested in test group was 985. (2) The numbers of lymph nodes harvested in the anterior, posterior and bilateral mesorectum were 125,696 and 615, respectively. The numbers of lymph nodes harvested in the upper, middle and lower part of the mesorectum were 395,534 and 507, respectively. The metastatic rate of lymph nodes in the upper part of the mesorectum was 18.5% (37/200), which was significantly lower than in the middle [43.5% (87/200)] and lower [38.0% (76/200)] part of the mesoreetum (X2= 9. 414, 6.406, P < 0.05). Two hundred metastatic lymph nodes in 33 patients were harvested, 48.0% (96/200) of which with a diameter of ≤ 5 mm. Twenty percent patients had their TNM stage changed after the retrieval of metastatic small lymph nodes. Conclusions Modified fat clearance technique significandy improves the retrieval of lymph nodes, and more small lymph nodes retrieved can increase the accuracy of staging. Rectal cancer cells have strong tendency to disseminate to the distal mesorectum. Adequate excision of the distal mesorectum is key in controlling the local recurrence.

Objective To identify if intraoperative injecting carbon nanoparticles (CNP) is a feasible,precise and safe method of sentinel lymph node mapping (SLNM).Methods In this study,63 colon cancer patients from July 2009 to March 2011 were included.1 ml (50 mg) CNP was locally injected into subserosa around the neoplasm intraoperatively.In comparison 90 colon cancer patients underwent radical resection without CNP injection (control group).After operation both SLN and non-SLN were collected and analyzed compared with the lymphnodes collected in control group.Clinical feasibility,detection rate,and sensitivity of the method were analyzed.The categorical variables were analyzed with the Pearson Chi-square or Fisher's exact test,whereas the continuous variables were analyzed with t test,significance was determined as P ＜ 0.05.Results 1640 lymph nodes were detected in 63 patients(with an average 26.0 per case),SLNs were identified in all cases(100％),481 SLNs were collected (with an average 7.6).Totally 198 metastatic lymph nodes were detected in 31 patients (average 3.1),including 34 metastatic SLNs.Total number of lymph nodes and number of metastatic lymph nodes detected in CNP group were higher than those of control group (P =0.000,P =0.001).The sensitivity,accuracy,specificity and false negative rate were 52％,76％,100％ and 48％ respectively.The sensitivity,accuracy,specificity and false negative rate were adjusted to 79％,90％,100％ and 21％ respectively if all T4 stage patients were excluded.Conclusions SLN detection can increase the number of lymph nodes harvested and improve the detection rate of lymph node metastasis.

Objective To summarize the clinical features of pancreatic injury in children,and to explore the suitable methods for its diagnosis and treatment.Methods A retrospective analysis of children with pancreatic injury within the 15 years was carried out.Clinical injury severity and following-up data were collected.Correlationship between injury severity,treatment method and successful rate was analyzed.Results Eleven children aged 4 to 14 years old were diagnosed as pancreatic injury:two had GradeⅠinjury,three GradeⅡ,five GradeⅢ,and one GradeⅣ.CT scan was used in 7 children,and 5 had positive sign.Patients with GradeⅠand GradeⅡinjuries were successfully cured without surgery.Three children with GradeⅢinjury were initially treated without operation,but two developed a large symptomatic pseudocyst and were cared through operation,and another one died.The other two children with GradeⅢwho underwent a distal pancreatectomy cured without complications.A patient with GradeⅣinjury was treated by Berne operation and died. Conclusion The management of pancreatic injury in children should be individualized depending on diagnosis time and injury type.A repetitive CT scan was helpful within 24h after injury.Distal pancreatectomy was a safe and effective for those with GradeⅢinjury.

Carrying out researches in urban community health service centers can effectively promote the improvement of management system, the cultivation of talents and the formation of characteristic service, leading to the institutional development.This paper summarizes the role and significance of researches in promoting the overall development of urban community health service center in order to provide reference for the relevant medical institutions based on the experiences in Shanghai Fenglin Community Health Service Center.

Objective:To investigate mechanisms underlying the signal crosstalk of VEGF-IL-6-STAT3 between cutaneous melanoma cells and vascular endothelial cells.Methods:EC-304 vascular endothelial cells were divided into 3 groups: control group cultured in conventional endothelial cell-conditioned medium, vascular endothelial growth factor (VEGF) group cultured in endothelial cell-conditioned medium containing 50 μg/L VEGF 165, A375 co-culture group co-cultured with a melanoma cell line A375. After 24-, 48- and 72-hour treatment, the culture medium was collected, and enzyme-linked immunosorbent assay was performed to detect the level of interleukin-6 (IL-6) . Cultured A375 cells were divided into 4 groups: control group receiving conventional culture in Dulbecco′s modified Eagle′s medium (DMEM) , A375+ EC-304 group co-cultured with EC-304 cells, A375+ EC-304+ IL-6 group co-cultured with EC-304 cells in DMEM containing 50 μg/L IL-6 (an agonist of the signal transducer and activator of transcription-3 [STAT3] pathway) , A375+ EC-304+ JSI-124 group co-cultured with EC-304 cells in DMEM containing 1 μmol/L JSI-124 (a STAT3 pathway inhibitor) . After 24-, 48- and 72-hour treatment, cells were collected, and Western blot analysis, cell counting kit-8 (CCK8) assay and Transwell invasion assay were performed to determine the protein expression of STAT3 and phosphorylated (p) -STAT3, cellular proliferative activity and invasive activity, respectively. Two-way analysis of variance and t test were used for statistical analysis. Results:The level of IL-6 significantly increased in the culture medium of EC-304 cells in the VEGF group and A375 co-culture group compared with the control group ( FVEGF = 29.63, P < 0.001; FA375 = 11.09, P = 0.020) . Compared with the control group, the A375+ EC-304 group showed significantly enhanced protein expression of p-STAT3 in A375 cells ( P < 0.001) , increased cell activity ( P < 0.001) , and increased number of invasive cells (152.66 ± 16.04 vs. 86.13 ± 7.24, t= 4.43, P < 0.001) ; compared with the A375+ EC-304 group, the A375+ EC-304+ IL-6 group showed significantly increased protein expression of p-STAT3 ( P < 0.001) , enhanced cell activity ( P < 0.001) , and increased number of invasive cells (187.34 ± 14.38, t= 2.17, P < 0.001) ; compared with the A375+ EC-304 group, the A375+ EC-304+ JSI-124 group showed significantly decreased protein expression of p-STAT3 ( P < 0.001) , decreased cell activity ( P < 0.001) , and decreased number of invasive cells (124.92 ± 8.72, t=-1.86, P < 0.001) . Conclusion:There is a signal crosstalk of VEGF-IL-6-STAT3 between cutaneous melanoma cells and vascular endothelial cells, which may play an important role in the proliferation and invasion of A375 cells.