Gastrointestinal stromal tumors (GIST) are the most common mesenchymal-derived tumors of the gastrointestinal tract. Tyrosine kinase inhibitors (TKIs) are the cornerstone of GIST therapy, but mutations in resistance genes pose many problems for treatment, especially the heterogeneity of KIT resistance mutations. In recent years, with the release of a number of GIST related drug research and experimental results, the great potential of targeted therapy, immunotherapy and combination therapy to treat GIST in different directions has been revealed, providing more therapeutic directions for GIST. This article will review the experimental research and future direction in recent years.

Objective To investigate the distribution of B cells in both tumor and non-tumor tissues of gastric cancer patients,analyze their phenotypic characteristics and explore the impact on T cell proliferation.Methods Immunohistochemical staining was utilized to detect the expression of B cell surface marker CD 19 in tumor and non-tumor tissues from 33 gastric cancer patients.The expression levels of chemokine receptors and immunoglobulin molecules on B cells in both tumor and non-tumor tissues were measured using flow cytometry.Chemotaxis experiments were conducted to examine the role of the CXCL12-CXCR4 axis in B cell chemotaxis.B cells isolated and purified from both tissue types were co-cultured with autologous peripheral T cells to assess their effect on T cell proliferation.Results There were significantly more B cells infiltrated in tumor tissues than those infitrated in the non-tumor tissues of gastric cancer patients(P＜0.01),and CXCR4 was highly expressed on tumor-infiltrating B cells compared with B cells derived from non-tumor tissues(P＜0.05).The Cancer Genome Atlas(TCGA)analysis indicated that the expression level of CXCL12 in tumor tissues was positively correlated with the expression level of CD19 in gastric cancer patients(r=0.15,P＜0.01).And the expression level of CXCL12 in tumor tissues of the gastric cancer patients was also positively correlated with the number of B cells infiltrated in tumor tissues.Chemotaxis experiments confirmed that the CXCL12-CXCR4 axis was involved in promoting B cell chemotaxis(P＜0.05).Although B cells in tumor and non-tumor tissues had similar levels of IgM,IgG,and IgA expression,tumor-infiltrating B cells significantly inhibited the proliferation of T cells when compared with B cells derived from non-tumor tissues(P＜0.01).Conclusion There are more B cells infiltrated in gastric cancer tissues,which may be recruited to tumor tissues through the CXCL12-CXCR4 axis,and then inhibit T cell proliferation to promote the progression of gastric cancer.

Tumor has become the major reasons cause of death,and its vaccine has become the effective tracts of treatment and prevention by enhancing the immune response of patients.However,most vaccines which are recombination subunit protein antigens are poorly immunogenic and difficult to induce a robust immune response in patients with compromised immune systems,resulting in poor marketing approval.The core component of the vaccine adjuvant can greatly enhance the strength,speed and duration of the immune response,thus becoming the key to the development of an ideal tumor vaccine.Most tumor vaccines are combined with tradition adjuvant such as aluminum,MF59 and AS adjuvant,but their products and patents are monopolized by large foreign companies.We found that natural adjuvants have many unique advantages,such as good biocompatibility and biodegradability,promoting the maturation of dendritic cell and the secretion of immune cytokines,significantly enhancing the tumor vaccine immune response,etc.In this paper,the application and future development of natural polysaccharides,saponins,flavonoid and plant virus-like particles in cancer vaccines were reviewed,which may lay a solid foundation for the development of the original and innovative adjuvants with domestic independent intellectual property rights.

Objective:To examine the outcome of endovascular treatment in patients of isolated abdominal aortic dissection.Methods:From February 2012 to June 2020, 61 patients (44 males, 17 females) with an age of (60.2±11.4) years (range: 43 to 87 years) of isolated abdominal aortic dissection who underwent the endovascular treatment, including bifurcated and straight aortic stent graft, in the Department of Vascular Surgery, the Second Xiangya Hospital, Central South University were enrolled. There were 47 patients treated with bifurcated aortic stent grafts and 14 patients with straight aortic stent grafts. Patient demographic, preoperative, intraoperative, perioperative data were collected. Clinical follow-up data, including mortality, relative complications and aortic remodeling, were obtained. Kaplan-Meier method and Log-rank test was used to calculate and compare the rates of survival and freedom from all adverse events.Results:The operative time was (142.4±47.9) minutes (range:70 to 310 minutes) and (95.7±23.7) minutes (range: 70 to 150 minutes) in bifurcated stent group and straight stent group, respectively. The perioperative mortality was 0. One patient had partial occlusion of the left renal artery, and 3 patients had type Ⅰa endoleak post-operation. The follow-up period was (37.1±22.1) months (range: 3 to 91 months). Three patents suffered from type B aortic dissection; one of them progressed into type A aortic dissection and died, another one was treated with secondary endovascular operation, and the remaining one was treated conservatively. One patient had type A aortic dissection and was treated conservatively for 57 months without any discomfort. Stent grafts in iliac artery occlusion happened in 2 patients treated with a bifurcated graft, one of them was treated with a secondary operation because of severe symptom. Aortic remodeling was well with the treatment of bifurcated and straight grafts. There was no difference in the cumulative survival ( P=0.584) and freedom from all adverse events ( P=0.309) between the two different endovascular treatment strategies. Conclusion:Endovascular aortic repair is an effective and safe treatment strategy for isolated abdominal aortic dissection with reliable mid-term result and excellent aortic remodeling.

Objective:To examine the outcome of endovascular treatment in patients of isolated abdominal aortic dissection.Methods:From February 2012 to June 2020, 61 patients (44 males, 17 females) with an age of (60.2±11.4) years (range: 43 to 87 years) of isolated abdominal aortic dissection who underwent the endovascular treatment, including bifurcated and straight aortic stent graft, in the Department of Vascular Surgery, the Second Xiangya Hospital, Central South University were enrolled. There were 47 patients treated with bifurcated aortic stent grafts and 14 patients with straight aortic stent grafts. Patient demographic, preoperative, intraoperative, perioperative data were collected. Clinical follow-up data, including mortality, relative complications and aortic remodeling, were obtained. Kaplan-Meier method and Log-rank test was used to calculate and compare the rates of survival and freedom from all adverse events.Results:The operative time was (142.4±47.9) minutes (range:70 to 310 minutes) and (95.7±23.7) minutes (range: 70 to 150 minutes) in bifurcated stent group and straight stent group, respectively. The perioperative mortality was 0. One patient had partial occlusion of the left renal artery, and 3 patients had type Ⅰa endoleak post-operation. The follow-up period was (37.1±22.1) months (range: 3 to 91 months). Three patents suffered from type B aortic dissection; one of them progressed into type A aortic dissection and died, another one was treated with secondary endovascular operation, and the remaining one was treated conservatively. One patient had type A aortic dissection and was treated conservatively for 57 months without any discomfort. Stent grafts in iliac artery occlusion happened in 2 patients treated with a bifurcated graft, one of them was treated with a secondary operation because of severe symptom. Aortic remodeling was well with the treatment of bifurcated and straight grafts. There was no difference in the cumulative survival ( P=0.584) and freedom from all adverse events ( P=0.309) between the two different endovascular treatment strategies. Conclusion:Endovascular aortic repair is an effective and safe treatment strategy for isolated abdominal aortic dissection with reliable mid-term result and excellent aortic remodeling.

Objective To study the effect of Yiqihuoxue Paishiyin combined with levofloxacin on renal calculus and inflammatory state. Methods 76 patients with kidney stones in our hospital from February 2015 to September 2016 were selected as the study object,and they were divided into control group 38 cases and observation group 38 cases by the method of random number table,then the control group were treated with levofloxacin, the observation group were treated with supplementing qi,promoting blood circulation and removing stones combined with levofloxacin,then the clinical effective rates,serum fever and pain related inflammatory factors before and after the treatment of two groups were analyzed .Results The total effective rates of observation group with different stone diameters and stone locations were all higher than those of control group,the serum fever and pain related inflammatory factors at different time after the treatment were all lower than those of control group , the differences were all significant ( P <0.05 ) . Conclusion Yiqihuoxue Paishiyin combined with levofloxacin treatment of kidney stones in patients with significant effect , can effectively control the body's inflammatory state, improve the level of inflammatory factors.

Objective To investigate the efficacy and safety of 6-month and 12-month oral dual-antiplatelet therapy This work was supported by the National Key Technology Research and Development Program in the Twelfth Five-year Plan of China (2011BAIl1B07) and the Military Clinical Key Technology and Development Program (2010gxjs001)(DAPT) on patients implanted with biodegradable polymer-coated and drug-eluted long stents (BP-DES).Methods In the I-LOVE-IT 2 trial,574 patients implanted with biodegradable polymer-coated and sirolimus-eluted long stent (BP-SES) (total stent length ≥50mm) were randomized to accepting either 6-month (n=270) or 12-month (n=304) DAPT.The primary endpoint of present study was 12-month target lesion failure (TLF),including cardiac death,target vessel myocardial infarction and clinically indicated target lesion revascularization (CI-TLR).The major secondary endpoint was 12-month net adverse clinical events (NACE),including all-causes of death,myocardial infarction,stroke,all revascularization (CI-TLR plus clinically indicated nontarget lesion revascularization) and bleeding.Results For the patients implanted with BP-SES of total stent length≥ 50mm,the total stent length was 73.0 ± 22.5mm and 69.8 ± 19.4mm in the 6-month DAPT group and 12-month group,respectively (P=0.07).No significant difference existed in the incidence of 12-month TLF between 6-month DAPT group and 12-month DAPT group (11.1％ vs.9.2％,P=0.47).The incidence of NACE was similar between the 2 groups (21.9％ vs.19.7％,P=0.57).The incidence of revascularization was lower in 12-month DAPT group (5.6％) than in 6-month DAPT group (11.1％,P=0.01).Furthermore,6-month landmark analysis showed that 12-month DAPT was associated with significantly lower risk of TLF (2.6％ vs.6.3％,P=0.03) at a cost of slightly increased risk of all bleeding events (1.6％ vs.0.7％,Log-rank P=0.32) between 6 and 12-months compared to 6-month DAPT.Conclusions In patients treated with BP-SES of total stent length ≥ 50mm,12-month DAPT have similar impacts on 12-month clinical outcomes except for all revascularization.However,12 months DAPT decreased the incidence of TLF and total revascularization between 6 months to 12 months after PCI.

To observe the mid- and long-term result of intentional coverage of celiac artery in thoracic endovascular aortic repair (TEVAR) surgery for aortic dissection.
 Methods: We retrospectively analyzed 21 cases who received TEVAR with celiac artery coverage during the operation. The existence of collaterals between celiac artery (CA) and superior mesenteric artery (SMA) was confirmed by preoperative CT angiography (CTA) or digital substract angiography (DSA) for each patient. We used the stent-graft precisely above the orifice of SMA. Follow-ups were carried out at 2 weeks, 1 month, 3 months, 6 months, 1 year after the operation, and once per year thereafter.
 Results: No signs of visceral artery ischemic syptoms such as liver dysfunction, abdominal pain or distention were observed after the operation. There was no signs of spinal cord ischemia (SCI). Seven cases showed type II endoleak upon completion DSA but stopped automatically within 3 months. CTA in follow-ups showed thrombosis formation in false lumen.
 Conclusion: The intentional coverage of CA during the TEVAR for aortic dissection is safe and effective. The incidence of post-operative SCI or visceral artery ischemia is low. Type II endoleak is a major complication but it can be ceased automatically after medication.
Aneurysm, Dissecting ; surgery ; Angiography, Digital Subtraction ; Angioplasty ; methods ; Aorta, Thoracic ; surgery ; Aortic Aneurysm, Thoracic ; surgery ; Blood Vessel Prosthesis Implantation ; adverse effects ; methods ; Celiac Artery ; surgery ; Computed Tomography Angiography ; Endoleak ; etiology ; Endovascular Procedures ; adverse effects ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Mesenteric Artery, Superior ; surgery ; Postoperative Complications ; epidemiology ; Retrospective Studies ; Stents ; adverse effects ; Thrombosis ; etiology ; Treatment Outcome

OBJECTIVETo evaluate and report surgical management and experience of atypical ruptured abdominal aortic aneurysm (RAAA).

METHODSClinical data of 52 RAAA patients from May 2002 to February 2015 were retrospectively collected and analyzed. Thirty-three cases were included into this study based on atypical clinical presentation and etiology, including 6 infected RAAA, 5 inflammatory RAAA, 1 traumatic aortic rupture, 6 tuberculotic RAAA, 2 aoritc-vena cava fistula, 3 intestinal fistula and 5 spine erosion cases. Two of them refused operation during preparation, 19 of them received emergency open repair and 13 of them received endovascular aortic repair (EVAR) with 1 case converted to open surgery.

RESULTSThe systolic blood pressure of atypical RAAA before operation was (88±16) mmHg (1 mmHg=0.133 kPa), duration time from admission to diagnosis making was (17±10) hours. Perioperative death occurred in 1 patient because of hemorrhagic shock induced acidosis. During follow-up for 3 to 72 months, no operation related complications occured, such as artificial graft infection.

CONCLUSIONSEmergent operation including open surgery and EVAR is crucial for RAAA treatment. Early diagnosis, excellent operative techniques and comprehensive perioperative management are measures conducive to reduce the mortality rate of RAAA.

Aortic Aneurysm, Abdominal ; surgery ; Aortic Rupture ; surgery ; Humans ; Postoperative Complications ; Retrospective Studies ; Treatment Outcome ; Vascular Surgical Procedures

BACKGROUNDThe occurrence of contrast induced acute kidney injury (CIAKI) has a pronounced impact on morbidity and mortality. The aim of the present study was to appraise the diagnostic efficacy of age, estimated glomerular filtration rate (eGFR) and ejection fraction (AGEF) score (age/EF(%)+1 (if eGFR was <60 ml × min(-1)× 1.73 m(-2))) as an predictor of CIAKI in patients with diabetes mellitus (DM) and concomitant chronic kidney disease (CKD).

METHODSThe AGEF score was calculated for 2 998 patients with type 2 DM and concomitant CKD who had undergone coronary/peripheral arterial angiography. CIAKI was defined as an increase in sCr concentration of 0.5 mg/dl (44.2 mmol/L) or 25% above baseline at 72 hours after exposure to the contrast medium. Post hoc analysis was performed by stratifying the rate of CIAKI according to AGEF score tertiles. The diagnostic efficacy of the AGEF score for predicting CIAKI was evaluated with receiver operating characteristic (ROC) analysis.

RESULTSThe AGEF score ranged from 0.49 to 3.09. The AGEF score tertiles were defined as follows: AGEFlow ≤ 0.92 (n = 1 006); 0.92 1.16 (n = 992). The incidence of CIAKI was significantly different in patients with low, middle and high AGEF scores (AGEFlow = 1.1%, AGEFmid = 2.3% and AGEFhigh = 5.8%, P < 0.001). By multivariate analysis, AGEF score was an independent predictor of CIAKI (odds ratio = 4.96, 95% CI: 2.32-10.58, P < 0.01). ROC analysis showed that the area under the curve was 0.70 (95% CI: 0.648-0.753, P < 0.001).

CONCLUSIONThe AGEF score is effective for stratifying risk of CIAKI in patients with DM and CKD undergoing coronary/peripheral arterial angiography. (Clinical Trial identifier: NCT00786136).

Acute Kidney Injury ; physiopathology ; Contrast Media ; Female ; Glomerular Filtration Rate ; physiology ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Renal Insufficiency, Chronic ; physiopathology