Objective The purpose of this study is to investigate the expression of human epidermal growth factor receptor-2(HER-2)in gastric carcinoma tissue and normal gastric tissue of these patients,and its relationship with the clinical pathological characteristic,the microvessel density( MVD) and early post-operative recurrence,and to analyze the clinical significance of expression of HER-2 in gastric carcinoma,in order to lay the theoretical foundation of effective therapy for gastric carcinoma.Methods The clinical data of 398 cases of gastric cancer and 363 cases of their adjacent non tumorous gastric tissue of Liaoning Cancer Hospital from March 2012 to July 2013 were analyzed retrospectively.The expression of HER-2 gene was detected by IHC method and Fish method.The expressive rate of HER-2 in gastric carcinoma tissue and normal gastric tissue of these pa-tients were compared,and its relationship with the clinical pathological characteristic,MVD and early post opera-tive recurrence were also analyzed.Results (1)Expressive rate of HER-2 in 398 cases of gastric cancer tissue was 14.07%(56/398),which was higher than that in all the adjacent non tumorous gastric tissue presented none expression 0(0/363)(P<0.05);(2)In gastric cancer tissue of 398,the expression of HER-2 was related with Lauren type,tumor site,vessel invasion status,TNM stage,lymph node metastases(P<0.05),and it had no cor-relation with age,sex,tumor size,histological differentiation degree,growth patterns of cancer(P>0.05).Expres-sive rate of HER-2 in T4 stage was higher than( T1 +T2 +T3 ) stage,but the difference was not statistically sig-nificant( P>0.05).(3)The value of MVD in HER-2 expressive group(58.63 ±19.97)was significantly higher than those in HER-2 non expressive group(49.04 ±19.25).A positive significant correlation was found be-tween HER-2 and MVD expression using the rank correlation matrix(P<0.001,r=4.33).(4)1 year and 1.5 year of early post operative recurrence rate in HER-2 expressive group were 16.00%、38.00%,in HER-2 non expressive group were 8.81%,25.53%,the difference was not statistically significant(P>0.05).Conclusion There is excessive expression of HER -2 in gastric cancer tissue,excessive expression of HER -2 patients withgastric cancer is correlated with Lauren type,tumor location,vessel invasion status,TNM stage,lymph node metastases;it displays no correlation with age,sex,tumor size,histological differentiation degree,growth patterns ofcancer.HER -2 expression is positively associated with MVD value.Excessive expression of HER -2 is possibleto be correlative with early post operative recurrence,and it must have further follow up to confirm.

Objective:To observe the influence of parenteral nutrition support on nutritional status and immune function in patients with neoadjuvant chemotherapy for gastric cancer.Methods:60 patients with locally advanced gastric cancer were randomly divided into PN group and control group,30 cases in each group.The nutritional status and immune function were compared.Results:Adverse reaction of chemotherapy in PN group was less than in control group (P ＜ 0.05).ALB,TF.PA and IgA,IgG,IgM,CD4+ and CD4+/CD8+ were all higher in PN group than in control group 7 days after surgery (P ＜ 0.05).Conclusion:Parenteral nutrition support is helpful to improve patients' nutritional state during chemotherapy and operation.

2～3 cm). MVC of preoperative bioptic specimens will help to choose the length of distal clearance.

Standard gastric cancer D2 radical surgery has become a global consensus. However,selective augmentation of lymph node dissection(D2+)surgery for a particular patient may increase their survival. D2 combined with No. 8p,No. 10,No. 12b,No. 13, No. 14v,No. 16a2/b1 lymph node dissection may lead to corresponding surgery-related complications. Therefore,we recommend that patients should be performed appropriate D2+ radical surgery at a medical treatment center with sufficient clinical experience.

Objective To investigate the prognostic value of preoperative neutrophil lymphocyte ratio (NLR) in patients with gastrointestinal stromal tumors (GIST).Methods The clinical-pathological data from 85 GIST cases were collected from the Second Affiliated Hospital of Wenzhou Medical University and retrospectively analyzed from June 2009 to December 2013.According to the exclusion criteria,79 cases were enrolled.Preoperative neutrophil and lymphocyte count was collected and NLR was calculated.According to the receiver operating characteristic (ROC) curve of NLR,GIST patients were divided into low NLR group (NLR ＜ 2.30) and high NLR group (NLR ≥ 2.30).Clinic-pathological features and five year disease free survival (DFS) were compared between the two groups.Results There was a statistical significant difference in tumor size and tumor risk between high NLR group and low NLR group (respectively,x2 =9.517,12.411,all P ＜ 0.05).Univariate analysis showed that the five year disease free survival rate of low NLR and high NLR group were 78％ and 32％ (x2 =18.749,P =0.000).By multivariate analysis a high NLR was identified as an independent risk factor of poorer prognosis for patients with GISTs (RR:3.516,95％CI:1.453-8.506,P=0.005).Conclusion A high preoperative NLR is an independent risk factor for the prognosis of GISTs.

Microsatellite instability(MSI)was defined according to the frequency of positive findings in a panel of MSI markers.High frequency MSI(MSI-H)was the phenotype in which repeat sequences were extraordinarily unstable, and was considered to be the bona fide phenotype of DNA mismatch repair defection. However base substitutions in some well studied oncogenes or tumor suppressors were reported to be uncommon in MSI-H tumors. To explore this obvious contradiction, the relationship between MSI and KRAS gene mutations were studied in a panel of 76 human colorectal carcinomas, the whole exon of MLH1 and MSH2 were sequenced for MSI-H tumors. KRAS gene mutation was confirmed by similar frequencies in tumors of different MSI status. Intriguingly, all of the KRAS mutant MSI-H tumors harbored sequence alterations in MLH1gene, which was a key player in DNA mismatch repair system. This implied that in MSI-H tumors carrying MMR mutations, KRAS mutation were frequently and almost exclusively occurred. Furthermore, these MMR mutants were uniformly carrying a unique modification + jumping type MSI, which was different to MSI-H tumors without MLH1 or MSH2 gene mutations. This study shaded lights on the heterogeneity of MSI-H tumors, and implied the connection between modification type MSI and DNA mismatch defection.

Objective To evaluate long-term changes in health-related quality of life (QOL) of patients with local advanced prostate cancer after intensity modulated radiotherapy (IMRT) combined with androgen deprivation therapy.Methods The patients who met the criteria for this study were enrolled and were treated with IMRT combined with androgen deprivation.The total dose of radiation was 68.2Gy(2.2Gy per fraction).QOL was evaluated before and 3,12,36,48 and 60 months after treatment using the Expanded Prostate Cancer Index Composite(EPIC),a validated tool that assesses four primary domains (urinary,bowel,sexual and hormonal).Results From 2002 to 2007,87 patients were enrolled.At each follow-up time point,the number of cases was 87,87,86,81,75,65,56 and 47,respectively.The median follow-up time was 76.8 months.Compared with baseline assessment,all of four domain scores were declined in follow-up assessments.The mean score of urinary,bowel and hormonal domains were significantly reduced.At 3 months after treatment,the scores of bowel domain were lowest,in which the total,function and symptom scores were 75.7,78.4 and 72.8,respectively.However,there was no statistically significant difference in the mean sexual domain score.The mean change scores in urinary incontinence and obstructive were-13.0±8.3 and-6.12±3.9,respectively.Conclusions IMRT combined with androgen deprivation therapy was well tolerated in patients with local advanced prostate cancer.QOL was decreased in urinary,bowel and hormonal toxicity,most of which could be tolerated in five years.

Objective To investigate the effect of ultrasound-guided paravertebral nerve block on stress reaction in patients undergoing esophageal resection. Methods Eighty patients scheduled to do the operation of esophageal resection were randomly divided into two groups with 40 cases in each group. The patients in group A were given the general anesthesia combined with ultrasound-guided paravertebral block, and the patients in group B were given the general anesthesia only. Both of two groups received postoperative patient controlled intravenous analgesia (PCIA). The amount of propofol and remifen-tanil used were recorded. The data of blood pressure, heart rate (HR) and pulseoxygen saturation (SpO2) before anesthesia (T1), before induction (T2), after intubation (T3), in 2 h of surgery (T4), after surgery (T5), 1 h after surgery (T6), 8 h after surgery (T7), 24 h after surgery (T8), 48 h after surgery (T9)were recorded. The analgesic effect was measured by VAS scores and Ramsay sedation scores were also recorded at T6-T10. The levels of blood glucose, epinephrine (E), norcpincphrinc (NE) and dopamine (DA) were also detected at T1, T4, T5, T9. Results The amount of propofol and remifentanil used in group A were lower than those in group B: (960.0 ± 216.9) mg vs. (1 242.5 ± 200.2) mg, (1.5 ± 0.4) mg vs. (2.3 ± 0.4) mg, P<0.05. The patients in two groups successfully completed surgery, and intraoperative vital signs was stable. The quiet and active VAS scores at T6-T9 in group A were significantly lower than those in group B (P<0.05). The Ramsay sedation scores at each time point in two groups had no significant differences (P>0.05). The levels of blood glucose and NE at T9 were significantly higher than those at T1, T4 or T5 of same group, P<0.05.The level of E at T4 and T5 was significantly lower than that at T1 and T9 of same group, P<0.05. The level of DA at T9 was significantly higher than that at T1, T4 and T5 in group B (P<0.05). The levels of blood glucose, NE, E and DA at T9 in group B were significantly higher than those in group A (P<0.05). Conclusions General anesthesia combined with ultrasound-guided paravertebral nerve block could offer favorable anaesthesia effect. It could decrease stress reaction and anesthetics requirements in patients undergoing esophageal resection.

AIM: To investigate the changes in nNOS and iNOS expression of hippocampal CA3 pyramidal neurons and NO - 2/NO - 3 level of hippocampal homogenate of rats induced by stress, and to explore the effect of phenytoin on them. METHODS: Rats were subjected to forced-swimming stress, phenytoin was administered(ip) at 30 min before stress. Using the immunohistochemistry and the computerized image technique, the expression levels of nNOS and iNOS of rat hippocampal CA3 pyramidal neurons were assayed quantitatively, and the NO - 2/NO - 3 level of hippocampal homogenate was also measured using nitric acid deoxidize enzyme method. RESULTS: The nNOS average grey degree of hippocampal CA3 pyramidal neurons was significantly lower in stress group (155 42?3 77)than that in control group(164 54?4 62)and in stress plus phenytoin group(164 27?2 55)( P

OBJECTIVE:To observe the efficacy and safety of edaravone combined with nimodipine in the treatment of acute large area cerebral infarction. METHODS:78 patients with acute large area cerebral infarction were randomly divided into control group (38 cases) and observation group (40 cases). Control group received aspirin platelet aggregation,reduced intracranial pres-sure,maintained water and electrolyte balance,decreased cerebral edema,Xuesetong for injection,Ginkgobiloba injection,lipid and blood pressurelowering,maintained blood sugar and other conventional treatment;observation group additionally received 30 mg Edaravone injection,adding into 100 ml 0.9% Sodium chloride injection by intravenous infusion (drip completed within 30 min),twice a day+12 mg Nimodipine injection,adding into 500 ml 0.9% Sodium chloride injection by intravenous infusion,once a day,with drip rate of 0.5-1 mg/h,for continuous 10 d,then received 40 mg Nimodipine tablet,orally,3 times a day. The treat-ment course for both groups was 15 d. Clinical efficacy,blood oxygen saturation (SpO2),hemoglobin (Hb),total hemoglobin (HbT),reduced hemoglobin(MHb)before and after treatment,and the incidence of adverse reactions in 2 groups were observed. RESULTS:The total effective rate in observation group was significantly higher than control group,the incidence of adverse reac-tions was significantly lower tahn control group,the differences were statistically significant (P<0.05). Before treatment,there were no significant differences in SpO2,Hb,HbT and MHb in 2 groups (P>0.05). After treatment,the SpO2,HbT and MHb were significantly higher than before,and observation group was higher than control group,the differences were statistically signifi-cant(P<0.05);Hb was significantly lower than before,the differences were statistically significant(P<0.05),but there was no significant difference between 2 groups (P>0.05). CONCLUSIONS:Based on the conventional treatment,edaravone combined with nimodipine shows significant efficacy in the treatment of acute large area cerebral infarction,it can effectively recovery neuro-logical function damage and protect the brain tissue,which can reduce the incidence of adverse.