Purpose:To study the expression of uPA in gestational trophoblastic cells and the relationship between uPA and the invasiveness of malignant trophoblastic tumor. Methods:73 samples from patients with gestational trophoblastic disease were harvested.In situ hybridization was employed to detect uPA expression in all of these samples. Results:① There was significant difference in the expression of uPA in cytotrophblasts among hydatidiform mole,invasive mole and choriocarcinoma(P

Objective To investigate the effects of peroral endoscopic myotomy (POEM) on esophageal dynamics in patients with achalasia (AC) and appraise the role of high resolution manometry (HRM)in assessment of POEM therapy.Methods From July 2011 to September 2012,20 patients with achalasia underwent POEM in the department of gastroenterology,Tianjin Medical University General Hospital.Preoperation esophageal dynamics of all the patients were evaluated by high resolution manometry (HRM) system and one month after POEM operation the test was repeated.Data of lower esophageal sphincter (LES)and esophageal body were analyzed,with 15 healthy volunteers as a contrast study.Results Mter POEM,the LES pressure (LESP) and 4-second integrated relaxation pressure (4sIRP) significantly decreased:LESP [pre-operation (24.5 ± 13.1) mm Hg vs.post-operation (8.5 ± 3.1) mm Hg,P ＜ 0.05] ; 4sIRP [pre-operation (20.7 ± 6.8) mm Hg vs.post-operation (5.0 ± 3.4) mm Hg,P ＜ 0.05].The LES relax rate (LESRR) significantly elevated [pre-operation (12.7 ± 9.8) ％ vs.post-operation (39.6 ± 18.1) ％,P ＜ 0.05].However,the esophageal aperistalsis remained after POEM.The total of 20 patiems were all type Ⅰ achalasia and responded well to POEM therapy.Post-operation data on the symptom scores markedly decreased and a significant correlation was found between the decreasing level of symptom scores and LESP,as well as the scores 4sIRP in the 20 patients (LESP:r =0.751,P ＜ 0.05 ; 4sIRP:r =0.500,P ＜ 0.05).Conclusion POEM can significantly improve esophageal dynamics in patients with achalasia and the treatment outcome is definite.HRM plays an important role in evaluation of POEM therapy on achalasia.

This study aimed to induce the differentiation of isolated and purified adipose-derived stromal cells (ADSCs) into myoblasts, which may provide a new strategy for tissue engineering in patients with stress urinary incontinence (SUI). ADSCs, isolated and cultured ex vivo, were identified by flow cytometry and induced to differentiate into myoblasts in the presence of an induction solution consisting of DMEM supplemented with 5-azacytidine (5-aza), 5% FBS, and 5% horse serum. Cellular morphology was observed under an inverted microscope. Ultrastructural changes occurring during the differentiation were observed by transmission electron microscopy and confocal laser scanning microscopy. Cellular immunohistochemical staining was applied to determine the expression of desmin protein in cells with and without induced differentiation. Reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting were used to detect mRNA and protein expression, respectively, of sarcomeric and desmin smooth muscle proteins. The results showed that ADSCs were mainly of a spindle or polygon shape. Flow cytometry analysis revealed that ADSCs did not express CD34, CD45, and CD106 but high levels of CD44 and CD90, which confirmed that the cultured cells were indeed ADSCs. After induction with a 5-aza-containing solution, morphological changes in ADSCs, including irregular cell size, were observed. Cells gradually changed from long spindles to polygons and star-shaped cells with microvilli on the cell surface. Many organelles were observed and the cytoplasm was found to contain many mitochondria, rough endoplasmic reticulum (rER), and myofilament-like structures. Cell immunohistochemical staining revealed different levels of desmin expression in each phase of the induction process, with the highest expression level found on day 28 of induction. RT-PCR and Western blot results confirmed significantly higher desmin gene expression in induced cells compared with control cells, but no significant difference between the two groups of cells in sarcomeric protein expression. It was concluded that under specific induction setting, ADSCs can be induced to differentiate into myoblasts, providing a potential new option in stem cell transplantation therapy for SUI.

Objective To investigate the pathologic morphology and immunohistochemical phenotypes of sarcomatoid carcinoma(SC) of the fallopian tube.Methods One case of SC of the fallopian tube was studied under the light microscopy for morphology.Immunohistochemistry was used to detect the expression of CK,EMA,S-100,Desmin,SMA,Leu-7,CD68,actin,and Vimentin in SC tissues.Pathologic features and biological behaviors of SC were analyzed in combination with the review of literature.Results Microscopically carcinomatous and sarcomatous elements co-existed.Usually the sarcomatous element formed the bulk of the lesion.In the sarcomatous tissues,there was no distinguishable bone,cartilage,rhadomyosarcoma,etc. Immunohistochemically the strong expression of CK7,EMA and Vimentin,and the partial expression of S-100,SMA,Leu7,CD68 and actin were detected.Conclusion SC of the fallopian tube is lack of specific symptoms,and its preoperative diagnosis is difficult.B-ultrasonography,CT and MRI are helpful to the staging of SC.Final diagnosis of SC depends on pathological examination and immunohistochemistry.SC is rare,and undergoes blood metastasis in early stage.Prognosis of SC is worst.Early detection of SC is the key to improve the prognosis.

ObjectiveTo review the clinical characteristics of patients with gastric mucosa-associated lymphoid tissue(MALT) lymphoma and to investigate the effects of Helicobacter pylori (Hp) eradication therapy in these patients.MethodsClinical data of ninety-five patients with gastic MALT lymphoma were reviewed with respect to their clinical manifestations,endoscopic features,histopathological features and Hp infection.The follow-up data of patients treated by Hp eradication therapy were analyzed.The survival curve was calculated with Kaplan-Meier,while the predictive factors for resistance to Hp eradiation were then analyzed by using Cox proportional hazards model.ResultsThe clinical manifestations and endoscopic features of 85 patients with gastric MALT lymphoma were non-specific.Hp positive was found in 97.9％ (93/95) patients at presentation,and 36 patients were treated by Hp eradication with a median follow-up duration of ( 58.1 ± 29.9) months.Total remission was achieved in 94.4％ ( 34/36),including 24 complete remission 10 partial remission.Therapy failure occurred in 2 patients.3-year survival rate of patients treated by Hp eradication were 86.2％ (25/29). Cox multivariate analysis showed that age ( ≥60 years),multiple lesions and non-superficial lesions were independent predictors of resistance to Hp eradication therapy.ConclusionGastric MALT lymphoma is associated with Hp infection.Eradication of Hp can effectively induce remission in these patients.

Objective To investigate the efficacy and safety of endoscopic submucosal dissection (ESD) for removal of gastrointestinal stromal tumors (GISTs). Methods Data of 22 patients with GISTs,who underwent ESD, were reviewed in terms of personal situation, location and size of lesions, clinical manifestation, managements, pathology, complications and follow-up findings. Results The procedure was successfully performed in all patients and all lesions were removed by one procedure. The lesion size ranged from 0. 8 to 4. 0 cm and the operation time was 35-150 min ( mean 64. 5 min). Mild bleeding occurred in all cases, which was successfully managed by argon plasma coagulation, hot biopsy probe or endoclip. Perforation occurred in 4 patients (18. 1%), which were closed with endoclip. Abdominal distension was relieved with decompression, acid suppression with proton pump inhibitors and antibiotics in 3 cases, additional trans-abdominal puncture was needed in the other case. No severe hemorrhage occurred. The average length of hospitalization was 4. 5 days (3-10 d). The patients were followed up for 3 to 18 months, and no tumor residue or recurrence was observed. Conclusion ESD is an effective and safe endoscopic procedure to remove GISTs. The main complications are bleeding and perforation, which, however, can be cured.

Objective To explore the effect of covered endoesophageal stent in treatment of terminal esophageal carcinoma complicated with malignant esophageal fistula in the elderly. Methods The covered endoesophageal stent was placed at the focus of lesion for each elderly patient in guidance by the iron wire and the stent-transporter under the endoscopy or X-ray. Results All of the stents were successfully implanted in 225 elderly patients without technical failure. The fistula was fully closed in all 19 patients. The symptoms of dysphagia and bucking were relieved obviously in 184cases (81.8%). The 176 cases (78.2%) of patients could have semi-fluid food in first week after stent implant, then have full meal. The inspiration pneumonia caused by fistula was brought under control. Conclusions For elderly patients with esophageal carcinoma, when they lose the operative opportunity or can not tolerate an operation, the treatment with covered endoesophageal stent is effective and safe.

Objective To evaluate the outcome of unconstrained shoulder arthroplasty in treatment of se- vere damages of shoulder and proximal humerus.Methods Eleven cases of unconstrained shoulder arthroplasty were carried out in our department from 1999 to 2004.The average age of the 11 patients was 65 years.Nine cases underwent hemi-arthroplasty for their complex fractures of proximal humerus with unstrained protheses and two cases received total shoulder arthroplasty for their shoulder osteoarthritis.Cemented prostheses were used in all the cases. Results Follow-ups averaged 2.3 years.Two cases of four-part fractures reported slight pain and limited external rotation of the shoulder after operation,while there was no pain or loosening of prosthesis in all the other cases who recovered full range of motion.Conclusion Unconstrained shoulder arthroplasty is a satisfactory and safe tech- nique for severe damages of proximal humerus.

Objective To estimate the safety and efficacy of submucosal tunneling endoscopic resection (STER) on treatment of large esophageal submucosal tumors (SMTs) originating from muscularis propria layer.Methods The data of patients with large esophageal SMTs (diameter ≥ 3.5 cm) undergone STER (n=17) or endoscopic submucosal dissection (ESD,n =15) at the Endoscopy Center of Tianjin Medical University General Hospital from December 2009 to March 2016 were retrospective analyzed.The therapeutic effects,hospitalization times,post-operation expenses,and occurrence of complications were evaluated and compared between the two groups.Results All the endoscopic treatments of the 32 patients were successfully completed.The operating time of the STER group was significantly longer than that of the ESD group (t =2.595,P =0.015).There was no statistical difference on the en bloc resection rate,complete resection rate and complication rate between STER group and ESD group (P＞0.05).The mean post-operative hospital stay of the STER group was significantly less than that of the ESD group (3.8± 1.0days VS 6.7±1.8 days,t=5.644,P=0.000).The mean hospital cost of the STER group was significantly less than that of the ESD group (22 456.1±5 232.0 yuan VS 27 392.5±5 747.9 yuan,t =2.543,P =0.016).The wound healing rates at 1 month after operation in the STER group was significantly higher than that of the ESD group [94.1％ (16/17) VS 20.0％ (3/15),P=0.000].No recurrence and metastasis occurred in the STER group and ESD group during the 41.2±20.6 months follow-up.Conclusion STER is a safe and effective technique for treating large esophageal SMTs originating from the muscularis propria layer,with earlier wound healing,shorter hospital stay and lower cost compared with those of the traditional method of ESD.

Objective To study the clinical value of double balloon endoscopy (DBE) in diagnosis and treatment of intestinal diseases. Methods Clinical data of 344 patients suspected of small bowel lesions from March 2006 to April 2014 was retrospectively analyzed. All the patients clinical manifestations including varying degrees of abdominal pain, bloating, nause and vomiting, diarrhea. The 344 patients underwent DBE for 397 times. Results The incidence of adverse reactions in checking was only 4.53%, and there was no complications occurred after checking. Positive results shown in 214 cases by DBE, the other 130 patients shown negative results. While 28 of the other 130 patients were found small bowel lesions by capsule endoscopy and CT scans, the remaining 102 cases had no obvious abnormalities. The misdiagnosis rate of DBE was 8.13%, and mainly focuses on polyps and vascular malformation. 242 of the 344 patients were diagnosed with intestinal diseases, and mostly of them were tumor, ulcers and polyps. The detect rate of DBE examination for tumor and ulcer diseases was greater than that of small intestinal polyposis, the difference was statistically significant (P < 0.05). Conclusion DBE in diagnosis and treatment of intestinal diseases is a relatively safe and effective way. It is worthy being popularized and applied.