Clinical characteristics and prognosis of primary gastrointestinal stromal tumors with PDGFRα mutation / 中华普通外科杂志

Objective:To investigate the clinicopathological characteristics of primary gastrointestinal stromal tumors (GIST) with PDGFRα mutation and analyze the prognosis of different subtypes.Methods:From Jun 2010 to Jun 2019, the clinicopathological data of 35 patients with primary PDGFRα mutation GIST, who underwent surgical therapy in the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, were analyzed retrospectively.Results:The main symptoms was abdominal pain (28 cases, 80%), followed by abdominal mass (6 cases, 17%), and hemafecia (1 case, 3%). 31 primary lesions (89%) were located in the stomach and 4 (11%) in other than stomach. 13 cases (37%) were of epithelioid cells, 14 cases (40%) were of spindle cells and 8 cases (23%) were of mixed cells. 27 cases (77%) were CD117 positive , 28 cases (80%) CD34 positive , and 30 cases (86%) were DOG-1 positive. 19 cases (54%) had D842V mutation and 16 cases (46%) had non-D842V mutation. Complete surgical resection was performed in all patients, with no perioperative death. The 3-year recurrence-free survival rate of the D842V mutation group was lower than that of the non-D842V mutation group (84% vs. 100%, P=0.045). Conclusions:The mutation rate of PDGFRα gene was low, mostly derived from the stomach. PDGFRα mutation GIST presents inert biological behavior and the overall prognosis was good.

Isolation, identification and heavy metals biosorption of a lead and cadmium-tolerant strain / 生物工程学报

Adding biological passivation agent during composting is one of the most effective ways to reduce the toxicity of heavy metals in contaminated livestock manure. To further improve biological passivation, we obtained a strain with high-heavy metal compounds tolerance to passivate heavy-metal contaminated manure and to characterize heavy-metal biosorption. High-tolerance microorganisms for lead and cadmium were isolated and screened from swine manure composting samples. The strain was identified by its morphology and molecular biology. After the influence of different pH, temperature and salt concentrations on growth of the strain were investigated, the optimal growth conditions were obtained for further analysis of its biosorption characteristics of lead and cadmium. The bacterium with tolerance to lead and cadmium termed SC19 was obtained, whose lead resistance was 600 mg/L and cadmium resistance was 120 mg/L. The isolate was further identified as Cedecea sp., and then its optimum pH was 7.0, temperature was 37 °C, and salt concentration was 0.5%. Lead removal was highest after 30 min of adsorption by the SC19 strain cultured for the stationary phase 36 h, and the maximum removal rate and biosorption capacity of lead were 60.7% and 329.13 mg/g, respectively. Meanwhile, cadmium removal was highest after 30 min of adsorption by the strain cultured for the logarithmic phase 8 h, and the maximum removal rate and biosorption capacity of cadmium were 51.0% and 126.19 mg/g, respectively. Fourier Transform InfraRed (FT-IR) results revealed that the biosorption process mainly happened on the surface of SC19 cell and many active groups on the cell surface could chelate the Pb²⁺ and Cd²⁺. By comprehensive comparison, it was showed that strain SC19 shared a certain capacity of Pb²⁺ and Cd²⁺ biosorption, and the bacterium provided precious microbial germplasm resources for biological passivation of heavy metal contaminated manure.

Minimally invasive coronary artery bypass grafting single-center experience in 50 patients with multi-vessel lesion / 中华胸心血管外科杂志

Objective To compare the perioperative outcomes between patients who underwent multivessel off-pump coronary artery bypass graft(OPCABG) via single left intercoastal space and sternotomy,and to explore the perioperative outcomes and technigues about minimally coronary artery bypass grafting with multi-vessel lesion.Methods From January 2017 to July 2018,100 patients were recruited using both left internal mammary artery and vein graft.They were divided into minimal invasive coronary artery bypass grafting(MICS) group and control group.Perioperative outcomes were analyzed and surgical techniques were summarized.Results There was no statistical difference in preoperative profiles,mean grafts and postoperative complications(P ＞0.05).Compared with control group,MICS group had statistical benefits in length of operation incision [(8.2 ± 1.2) cm vs.(25.3 ± 3.5) cm,P =0.000],i ntraoperative washed blood loss [(301 ± 188) ml vs.(444 ± 331) ml,P =0.01],postoperative ventilation duration [(16.18 ± 5.90) h vs.(19.60 ± 3.92) h,P =0.001] and length of ICU stay [(19.19±6.85)hvs.(23.44±4.64)h,P=0.001].Conclusion There is a learning process for surgeons to perform minimal invasive OPCABG via single left intercoastal space.Surgery is feasible for patients with multiple coronary lesions.Mid and long term following up need to be studied.

Early postoperative complications and risk factors in laparoscopic D2 radical gastrectomy for gastric cancer / 中华胃肠外科杂志

Objective@#To investigate the morbidity and treatment of early postoperative complications after laparoscopic D2 radical gastrectomy for gastric cancer, and to explore the risk factors.@*Methods@#A case-control study was performed to retrospectively collect clinicopathological data of 764 patients undergoing laparoscopic D2 radical gastrectomy for gastric cancer at our department between January 2015 and December 2017. Patient inclusion criteria: (1) gastric cancer diagnosed by preoperative electronic gastroscopy and biopsy, and confirmed by postoperative pathology; (2) without invasion into adjacent organs by preoperative evaluation of tumors; (3) tumors without definite liver and distant metastasis; (4) R0 resection of gastric cancer and standard D2 lymph node dissection; (5) patients with informed consent. Exclusion criteria: (1) unperformed laparoscopic D2 radical resection; (2) other types of gastric tumor confirmed by pathology; (3) cases with incomplete clinical data. Complication occurring within two weeks after laparoscopic D2 gastrectomy was defined as early postoperative complication. Patients were divided into two groups: non-complication group (693 cases) and complication group (71 cases) according to the occurrence of complications after operation. The clinicopathological data of two groups were analyzed and compared with t test and χ2 test, and the factors of P < 0.2 were included in the multivariate logistic regression model to analyze the risk factors of postoperative complications.@*Results@#Of 764 patients, 71 (9.3%) developed early postoperative complications, with median onset time of 3 (1 to 11) days. Surgical complications accounted for 7.9% (60/764), including 13 cases (1.7%) of abdominal hemorrhage, 12 cases (1.6%) of anastomotic leakage, 10 cases (1.3%) of incision infection, 8 cases (1.0%) of anastomotic bleeding, 7 cases (0.9%) of gastric stump weakness, 4 cases (0.5%) of abdominal infection, 4 cases (0.5%) of duodenal stump leakage and 2 cases (0.3%) of small intestinal obstruction. Non-surgical complications accounted for 1.4% (11/764), including 6 cases (0.8%) of pulmonary infection and 5 cases (0.7%) of cardiovascular disease. Two cases (0.3%) died of sepsis caused by severe abdominal infection; 9 cases (1.2%) recovered after receiving the second operation, among whom 5 cases were abdominal hemorrhage, 2 cases were anastomotic leakage and 2 cases were duodenal stump leakage; the remaining patients were healed with conservative treatment. Compared with patients without complications, patients with complications had higher proportions of BMI ≥24 kg/m2 [42.3% (30/71) vs. 24.2%(168/693), χ2=10.881, P=0.001], comorbity [64.8% (46/71) vs. 33.5% (232/693), χ2=27.277, P<0.001], combined organ resection [70.4% (50/71) vs. 20.5% (142/693), χ2=85.338, P<0.001], and pTNM stage of III [70.4% (50/71) vs. 40.1% (278/693), χ2=24.196, P<0.001], meanwhile had longer time to postoperative flatus [(4.2±2.1) days vs. (2.9±1.2) days, t=4.621, P=0.023], longer hospital stay [(34.6±12.6) days vs. (14.2±6.2) days, t=9.862, P<0.001] and higher hospitalization cost [(126.8±64.5) thousand yuan vs. (85.2±35.8) thousand yuan, t=11.235, P<0.001]. Multivariate analysis showed that BMI ≥24 kg/m2 (OR=3.762, 95% CI: 1.960-8.783, P=0.035), accompanying disease (OR=8.620, 95% CI: 1.862-29.752, P<0.001), combined organ resection (OR=6.210, 95% CI: 1.357-21.568, P=0.026), and pTNM stage (OR=4.752, 95% CI: 1.214-12.658, P<0.001) were the independent risk factors of postoperative complications.@*Conclusions@#Laparoscopic D2 radical gastrectomy is a safe and effective approach for gastric cancer. Most early postoperative complications can obtain satisfactory efficacy after conservative treatment. Perioperative management should be strengthened for those patients with high BMI, accompanying diseases, combined organ resection, and advanced pTNM stage.

Analysis of the effect of double incision double plate internal fixation in the treatment of complex fractures of tibial plateau / 中国基层医药

Objective To study the clinical efficacy and safety of double incision double plate internal fixation in the treatment of complex fractures of tibial plateau .Methods According to the different treatment methods , 83 patients with tibial plateau complex fractures were divided into double plate group ( 51 cases ) and locking plate group ( 32 cases ) .The surgical indicators , treatment efficacy and complications were compared between the two groups .Results The time of implantation ,hospital stay and fracture healing time in the observation group were signif-icantly shorter than those in the control group [(9.36 ±2.14) d vs.(13.24 ±2.99) d;(11.71 ±1.32) d vs. (13.41 ±2.23)d;(13.27 ±1.83)weeks vs.(15.82 ±2.18)weeks],the differences were statistically significant (t=6.813,4.368,5.736,all P<0.05).The excellent rates of HSS score in the observation group and the control group were 94.12％and 93.75％,respectively,and there was no statistically significant difference (χ2 =0.746,P>0.05).The incidence rate of complications in the observation group was significantly lower than that in the control group(5.88％vs.21.88％) (χ2 =4.746,P<0.05).Conclusion Double-incision plate internal fixation surgery for tibial plateau complex fractures is effective ,has fast postoperative recovery ,high safety,and it is worthy of clinical application in a wide range of popularization .

MSCT characteristics of gastroenteropancreatic neuroendocrine neoplasm in different pathological grades / 实用放射学杂志

Objective To describe the MSCT manifestations of different pathological grading of gastroenteropancreatic neuroendocrine neoplasm(GEP-NEN)and to improve the understanding of CT characteristics of this disease.Methods MSCT images and pathological results of 38 GEP-NEN proved by surgical pathology were analyzed retrospectively in our hospital.All of the tumors were graded as G1 to G3.Measured respectively the CT value of the same location of each tumor in the noncontrast enhanced phase, arterial and venous phase.And divided them into mild,moderate and obvious.Statistically analyzed the number of tumors with different degree of enhancement.Results In arterial and venous phase of G1 group,the number of mild enhancement was respectively 3 and 0 case, the number of moderate enhancement was respectively 6 and 8 cases,and the number of obvious enhancement was respectively 7 and 8 cases.In arterial and venous phase of G2 group,the number of mild enhancement was respectively 2 and 0 case,the number of moderate enhancement was respectively 4 and 6 cases,and the number of obvious enhancement was respectively 4 and 4 cases.In arterial and venous phase of G3 group,the number of mild enhancement was respectively 9 and 4 cases,the number of moderate enhancement was respectively 3 and 8 cases,and the number of obvious enhancement was respectively 0 and 0 case.Kruskal-Wallis rank sum test was performed for the number of tumor enhancement,the result was P<0.05.Conclusion MSCT multi-phase enhancement is valuable in judging the pathological grade of GEP-NEN.Arterial phase usually shows moderate to obvious enhancement in G1 group.The enhancement of tumors with higher grade shows a trend of decrease in arterial phase,while shows mild to moderate enhancement in venous phase.

Radial head replacement with metal prosthesis and reduction with stabilization of the distal radio-ulnar joint as a treatment of established Essex-Lopresti injury / 中华骨科杂志

Objective To investigate the effect of radial head replacement with metal prosthesis and reduction with stabilization of the distal radio-ulnar joint as a treatment of established Essex-Lopresti injury.Methods From March 2012 to December 2015,5 patients with established Essex-Lopresti injury,whose radiuses had moved proximally since radial head had been resected in the earlier operation,were operated in our department,including 4 males and 1 female,aged from 25 to 50 years (average,38.8 years).The interval from the radial head resection to the operation in our department was 2 to 7 months (average,4.6 months).All the 5 patients were operated with radial head replacement with metal prosthesis under no longitudinal stress,and 4 of them got distal ulnar shortening for reduction of the distal radio-ulnar joint.2 of the 5 cases acquired distal radial-ulnar joint stability after reduction,and the other 3 could not acquired stability and needed open reduction and repairing ligament structure of the wrist and pinning fixation for 4-6 weeks.The Mayo elbow and wrist function score were used to evaluate pre-and post-operative function,with recording the range of motion of the elbow,forearm and wrist.Results All the 5 patients were followed-up for 24 to 60 months (average 45 months).The Mayo elbow function score was improved from preoperative 62 (range,45-75) to 96 (range,80-100) at the latest follow-up.The Mayo wrist functional score was improved from 54 (range,15-65) to 81 (range,55-90) at the latest follow-up.All patients got significant improvement of involved upper extremity function,without proximal shifting of radius,radial head prosthesis failure or instability of the distal radio-ulnar joint.Conclusion It is effective for treatment of established Essex-Lopresti injury to replace radial head with metal prosthesis and to reduce and stabilize the distal radio-ulnar joint with distal ulnar shortening while necessary.

Diagnosis and treatment of bipolar fracture-dislocation of the forearm / 中华创伤骨科杂志

Objective To investigate diagnosis and surgical treatment of bipolar fracture-dislocation of the forearm.Methods A retrospective study was conducted of 16 patients with forearm bipolar fracture-dislocation who had been treated and completely followed up at Department of Orthopaedic Trauma,Beijing Jishuitan Hospital from March 2011 to September 2017.They were 14 males and 2 females,aged from 17 to 48 years (average,35.8 years).Their injury involved 7 left and 9 right sides,and 10 dominant and 6 non-dominant sides as well.Their proximal injury was divergent elbow dislocation in 4 cases,convergent elbow dislocation in one case,Monteggia fracture-dislocation in 9 cases (2 ones of type Ⅰ,2 ones of type ⅡB,4 ones of type ⅡC and one of type Ⅳ),and upper radioulnar dislocation in 2 cases.Their distal injury was distal radial fracture (intra-articular) + lower radioulnar dislocation in 7 cases,distal radioulnar fracture + lower radioulnar dislocation in 2 cases,Galeazzi fracture (1/3 distal humeral shaft) in 3 cases,and middle and upper middle radial fracture + lower radioulnar dislocation in 4 cases.Open reduction and internal fixation was performed for all the shaft fractures and most of the distal radial fractures.One distal radius fracture was treated with closed reduction and external fixation,one case with external fixation,one case with needle insertion and external fixation,3 radial head fractures with internal fixation,3 cases with radial head replacement,2 cases untreated,5 cases with open ligament repair because their primary closed reduction failed,and 2 cases with hinged external fixation of the elbow.Their functional exercise started according to judgment of joint stability after surgery.At the last follow-up,the overall function of the forearm was evaluated according to the Anderson's scoring.Results The 16 patients were followed up for an average of 26.0 months (from 6 to 60 months).All fractures healed at the internal fixation sites after operation with no abnormality affecting the function.No infection occurred.All the elbow joints and upper and lower radioulnar joints were stable.All the radial head replacements were in good position.The range of elbow flexion and extension averaged 123.2° (from 60° to 140°),the range of wrist flexion and extension 150.3° (from 120° to 160°),and the rotational mobility of the forearm 144.4° (from 70° to 170°).At the last follow-up,according to the Anderson's scores,11 cases were rated as excellent,3 cases as satisfactory,one case as unsatisfactory and one case as failure.Conclusions Most of the forearm bipolar fractures and dislocations are high-energy injury.The key to treatment is to achieve good reduction of distal and proximal dislocations and to start rehabilitative exercise as early as possible.Intraoperative fixation of fractures should be based on stable reduction of the dislocation.Fine reduction of bipolar dislocations and early rehabilitation can lead to good functional recovery.

Application of sigmoid colon anatomy to laparoscopic surgery / 中华胃肠外科杂志

Laparoscopic sigmoidectomy for cancer is considered as a simple surgical approach, which is suitable for primary laparoscopic surgery. However, the success of laparoscopic sigmoidectomy is closely related to the anatomical characteristics of the sigmoid colon. The length, adhesion and morphology of the sigmoid colon vary greatly. The differences of the length, width, adhesion and morphology of the mesentery are large. The distribution of vessels is diversified. The high ligation or the low ligation is still controversial. The location of the sigmoid colon cancer is also not constant. These problems have great influence on the operation. Before operation, the tumor must be accurately located and the anatomical characteristics of the sigmoid colon must be fully evaluated. The operation can be carried out smoothly and the complications during and after the operation can be reduced.

Correlation between the interauricular septum diseases and cryptogenic ischemic stroke on double source CT / 实用放射学杂志

Objective To investigate the association and difference between patent foramen ovale(PFO), atrial septal aneurysm(ASA), atrial septal defect(ASD) in normal controls and cryptogenic ischemic stroke(CS) in youth diagnosed by double source CT.Methods A total of 168 CS patients and 180 controls matched age and gender were included in the present study.The two groups were diagnosed by double source CT and clinical materials.The incident rate of PFO, ASA, ASD, the degrees of PFO, ASD,the lengths of PFO and difference between CS in two groups were analysed.Results The incident rates of PFO, ASA, ASD were 40.6%,10.7%,6.5% and 15.6%,3.3%,2.2% in CS groups and controls respectively(P0.001).Conclusion PFO,ASA and ASD are important to CS.While PFO,ASA and ASD can accurately be diagnosed by double source CT.

Comparative study of single lateral incision and combined lateral and medial incisions for treatment of terrible triad of the elbow / 中华创伤杂志

Objective To investigate the clinical outcomes of terrible triad of the elbow treated with single lateral incision versus combined lateral and medial incisions.Methods This retrospective cohort research involved 57 patients with terrible triad of the elbow operated between July 2010 and June 2013.According to the surgical approaches,the patients were assigned to single lateral incision (Group A,n =32) and combined lateral and medial incisions (Group B,n =25).Group A consisted of 21 males and 11 females,with a mean age of (40.2 ± 3.3) years.Group B consisted of 18 males and seven females,with a mean age of (39.1 ± 2.6) years.Operation time,blood loss,postoperative complications,elbow range of motion,Mayo elbow performance score (MEPS) and Hastings and Graham heterotopic ossification classification were compared between groups.Results There were no significant differences in operation time and blood loss between Group A and B (P ＞ 0.05).Incidence of ulnar nerve injury and strength decrease were higher in Group A than Group B (P＜0.05).Mter a mean follow-up of 25.9 months,elbow extension-flexion and forearm pronation-supination in Group A [(123.4 ± 6.5) ~,(167.5 ± 6.0) °] were better than those in group B [(84.9 ± 27.2) °,(136.5 ± 8.5)°] (P ＜ 0.01),and MEPS in Group A [(95.8 ± 1.2) points] was also better than that in Group B [(84.9 ± 3.1) points] (P ＜ 0.01).Heterotopic ossification was more serious in Group B than Group A (P ＜ 0.01).Conclusion Single lateral incision is associated with better function and lower rate of heterotopic ossification than combined lateral and medial incisions in treating terrible triad of the elbow.

Comparative study on effect of coronoid fixation with lateral collateral ligament repair versus hinged external fixator in treatment of elbow varus posteromedial rotational instability / 中华创伤杂志

Objective To compare the effect of coronoid fixation combined with lateral collateral ligament repair versus hinged external fixator in treatment of elbow varus posteromedial rotational instability.Methods This retrospective cohort research included 34 patients with elbow varus posteromedial rotational instability operated between January 2011 and June 2015.All patients had coronoid process fractures of O'Driscoll type Ⅱ[(six with subtype 1,24 with subtype 2 and four with subtype 3).Fifteen of the 34 patients were operated by coronoid fixation combined with lateral collateral ligament repair (Group A) and other 19 patients were operated by coronoid fixation combined with placing hinged external fixator (Group B).Interval between injury and operation,operation time and blood loss were recorded.At final follow-up,elbow range of motion,Mayo elbow performance score (MEPS) and Hastings and Graham heterotopic ossification classification were measured.Results There were no significant differences in the interval between injury and operation,operation time and blood loss between the two groups (P ＞0.05).Median period of follow-up was 30 months in Group A and 40 months in Group B.Last follow-up showed flexion of the affected elbow in Group B [145° (135°-150°)] was better than that in Group A [140° (130°-145°)] (P ＜ 0.05),while between-group differences were insignificant in elbow extension,elbow extension-flexion,forearm pronation-supination and heterotopic ossification classification (P ＞ 0.05).MEPS in Group A scored 100 in 10 patients,90 in three,85 in one and 70 in one;MEPS in Group B scored 100 in 13 patients,90 in one,85 in four and 80 in one.There was no significant difference in MEPS between the two groups (P ＞ 0.05).Conclusion For treating elbow varus posteromedial rotational instability,either lateral collateral ligament repair or hinged external fixation after anatomic reduction and coronoid fixation can achieve good results.

Clinical characteristics and prognostic analysis of 307 patient with high-risk gastrointestinal stromal tumors / 中华普通外科杂志

Objective To investigate the clinical characteristics,diagnosis and treatment as well as prognostic factors of high-risk gastrointestinal stromal tumors (GIST).Methods Clinical data of 307 patients with high risk GIST treated in the Union Hospital from Jan 2005 to Dec 2016 were retrospectively analyzed.Results There were 172 males and 135 females with median age of 51 (20-84) years.Tumors located in the stomach in 88 (28.7％) cases,in the small intestine in 141 (45.9％),in the colon and rectum in 27 (8.8％) and outside the gastrointestinal tract (mesentery,retroperitoneum,abdominal cavity,and pelvic) in 51 (16.6％).All underwent surgical resection,including R0 resection of 299 cases (97.4％),R1 resection of 6 cases (2.0％) and R2 resection of 2 case (0.7％).68 cases (22.1％) received postoperative imatinib 400 mg/d for 3 to 84 months.The 1-,3-,5-year overall survival rates of high-risk GIST were 95％,86％,76％,the 1-,3-,5-year recurrence-free survival rates were 92％,83％,71％.By multivariate analysis the 5-year RFS were related only to mitotic count while,there was no significant difference in the RFS in patients gender,tumor site,tumor size.Conclusions Complete surgical excision is the effective treatment for high-risk GIST.Mitotic count is the most important prognostic factor.

Laparoscopic resection of metachronous colorectal carcinoma / 中华普通外科杂志

Objective To evaluate laparoscopic radical resection of metachronous colorectal carcinoma.Methods A total of 13 patients with metachronous colorectal carcinoma undergoing laparoscopic resection in Department of Gastrointestinal Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2013 to December 2015 were analyzed retrospectively.Results The mean time of surgery was (156 ± 9) min.Tumors were located in the right hemicolon in 3 cases,in the transverse colon in one,in the left hemicolon in 2,in the sigmoid colon in four and in the rectum in 4.The mean blood loss was (66 ± 21) ml.There was no conversion to open surgery.Two patients were done with protective ileostomy.Postoperative gastrointestinal function recovery time was (2.5 ± 0.7) days.One postoperative intra-abdominal bleeding was successfully controlled laparoscopically.Posteperative length of hospital stay was (26.2 ± 2.9) days.The median follow-up was 12 months (5-30 months) with no cancer recurrence.Conclusions Laparoscopic radical resection of metachronous colorectal carcinoma has good curative effect,and high success rate in spite of previous history of laparotomy.

Clinical characteristics and prognosis analysis of 119 cases with giant gastrointestinal stromal tumor / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical characteristics, diagnosis and treatment as well as prognostic factors of the giant gastrointestinal stromal tumor (GIST).</p><p><b>METHODS</b>Clinical data of 235 patients with high risk GIST treated in the Union Hospital, Tongi Medical College, Huazhong University of Science and Technology between January 2005 and July 2015 were retrospectively analyzed. Patients were divided into giant GIST group (diameter equal to or larger than 10 cm, 119 cases) and high risk group (diameter less than 10 cm, 116 cases) according to tumor size. Clinical characteristics and prognosis of two groups were compared and the clinical features of giant GIST were summarized. Multivariate analysis was performed to evaluate the prognostic factors of giant GIST with Cox regression model.</p><p><b>RESULTS</b>Of the 119 patients with giant GIST, which accounted for 50.6%(119/235) of all the high risk patients, there were 63 male and 56 female patients with a median age of 53(20-82) years. Primary giant GIST of 43(36.1%) located in the stomach, of 39(32.8%) in the small intestine, 5(4.2%) in the colon and rectum, and of 32 (26.9%) outside the gastrointestinal tract (mesentery, retroperitoneum, abdominal cavity, etc) and pelvic. Compared to high risk group, age of onset was younger [ratio of ≤50 years, 44.5%(53/119) vs. 31.9%(37/116), P = 0.046] and incidence of outside the gastrointestinal tract was significantly higher [26.9%(32/119) vs. 9.5%(11/116), P=0.000] in giant GIST group. All the giant GIST patients underwent surgical resection, including 115 cases(96.6%) of R0 resection, 3 cases(2.5%) of R1 resection and 1 case(0.9%) of R2 resection, besides, 32 cases(26.9%) underwent expanded resection (namely, underwent lymphadenectomy or combined organ resection simultaneously). Thirty-nine giant GIST cases(32.8%)accepted imatinib 400 mg/d for targeted therapy after operations, which was not significantly different with high risk group (46 cases, 39.6%, P=0.232). Relapse and metastasis occurred in 8 cases in giant GIST group. The 1-, 3-, 5-year overall survival rates of giant GIST group were 94.5%, 89.3%, 79.4% respectively and of high risk group were 99.1%, 92.9%, 85.1% respectively, and no significant difference was found (P=0.788). The 1-, 3-, 5-year recurrence-free survival rates of giant GIST group were 93.6%, 85.1%, 72.8% respectively and of high risk group were 99.1%, 91.7%, 84.2% respectively, and no significant difference was found as well (P=0.932). Multivariate analysis revealed that gender (P=0.047, RR=0.383, 95%CI:0.149-0.987), mitotic count (P=0.001, RR=0.216, 95%CI:0.087-0.538) and targeted therapy(P=0.019, RR=5.719, 95%CI:1.324-24.695) were prognostic risk factors of overall survival (OS), moreover, tumor size (P=0.024, RR=0.368, 95%CI:0.155-0.875) and mitotic count(P=0.007, RR=0.357, 95%CI:0.169-0.755) were prognostic risk factors of RFS.</p><p><b>CONCLUSIONS</b>Giant GIST is not unusual in GIST and more likely occurs outside gastrointestinal tract. Complete surgical excision combined with targeted therapy can improve the prognosis significantly. The prognosis of giant GIST and common high risk GIST is similar. Mitotic count is the most important prognostic factor.</p>

Effect of radiotherapy and indomethacin together in the prevention of recurrence of ectopic ossification around the elbow after resection / 北京大学学报(医学版)

Objective:To discuss the effect of single low dose local radiotherapy and indomethacin to-gether in the prevention of recurrence of ectopic ossification around the elbow after resection.Methods:From Jun.2009 to Dec.2011,we performed excision of ectopic ossification around the elbow in 78 stiff elbows.For each case,we used both medial and lateral approaches,and we performed both anterior and posterior capsulectomies and removal of ectopic ossification.In the lateral approach,we started proximal-ly,the lateral supracondylar ridge of the humerus was exposed from the interval between extensor carpi radialis longus (ECRL)and triceps,and then distally passed the interval between ECRL and extensor carpi radialis brevis (ECRB).With the medial approach,after releasing the ulnar nerve,the pronator teres muscle origin was reflected from the medial epicondyle,and then the common flexor-pronator tendon was split longitudinally distally and the brachalis and the anterior portion of the flexor-pronator group were dissected off the anterior humerus.If there was forearm rotation dysfunction,we used extensive lateral ap-proach,the anconeus muscle was reflected from the ulna and the scar tissue and ectopic ossification around the proximal radioulnar joint were resected.The important structures,such as the lateral ulnar collateral ligament (LUCL)and the anterior part of the medial collateral ligament (AMCL),should be carefully protected,because they were important for the elbow stability.Anterior transposition of the ulnar nerve depended on the patients’condition.We performed low dose radiotherapy 4 hours before opera-tion,and we used indomethacin for 6 weeks after operation.In these patients,there were 46 males and 32 females,whose age averaged (35.8 ±7.9)years (16 -65 years).According to Hastings-Graham classification,there were 56 ⅡA,5 ⅡB,6 ⅡC and 1 1 Ⅲ before operation.Results:We followed up these patients for 26 months with an average of 24-36 months,all the patients improved their elbow func-tion,and no recurrence of ectopic ossification appeared except for 1 patient.For this patient,his elbow function was excellent,and according to Hastings-Graham classification,his ectopic ossification was of typeⅠ.Conclusion:Single low dose local radiotherapy and indomethacin together are effective in the prevention of recurrence of ectopic ossification around the elbow after excision.

Effects of nerve growth factor on serum S100 and IL-6 in acute brain injury / 中国生化药物杂志

Objective To investigate the effect of nerve growth factor on the levels of serum S100 protein and interleukin-6 (IL-6) in patients with acute brain injury.Methods 70 cases with acute craniocerebral injury from March 2013 to May 2015 in department of cerebral surgery of Tianjin port hospital were selected and divided into two groups according to random number method.The control group (35 cases) received conventional symptomatic treatment, the study group (35 cases) received conventional treatment on the basis of mouse nerve growth factor for injection, with a consecutive treatment of two weeks.On admission, one and two weeks after admission, the Glasgow coma scale ( GCS) score was recorded, serum S100 beta protein and IL-6 levels were measured by enzyme-linked immunosorbent assay ( ELISA ) and the clinical curative effect of cerebral edema eliminate was compared.Results After two weeks’ treatment, the total efficacy in control group was lower than that in study group (77.14% vs.94.29%) ( P<0.05).The GCS score of two weeks after admission in study group was lower than that in control group, serum levels of neuron-specific enolase (NSE), myelin basic protein ( MBP) , S100βprotein and IL-6 of one and two weeks after admission in study group were lower than those in control group ( P<0.05).Conclusion The nerve growth factor could decrease the levels of serum S100βand IL-6 and alleviate inflammation in patients with acute craniocerebral injury and the effect is obvious.

Progress in research on acceptance strategy coping with chronic pain / 中华行为医学与脑科学杂志

Objective Chronic pain has brought great suffering to patients,as well as a heavy burden to the society.More attention has been paid on the efficiency of psychological intervention as supplementary means.Among the treatments,acceptance strategy shows its superiority and gradually enters people's field of vision.However,researches in this area are still very scarce.This study intends to review relevant research to provide reference to clinical work and research.Methods Theacceptance andchronic pain as the keywords were searched from the American Psychological Association (APA),China National Knowledge Infrastructure (CNKI),Wanfang data from 1994 to 2014 in English and Chinese articles,and the articles were chosen according to the criteria:① chronic pain and its current situation;②acceptance strategy or acceptance-based therapy;③intervention to chronic pain based on acceptance strategy;④to explore the intervention mechanism of aueptance strategy.Results Eventually,7 Chinese articles and 42 English articles were adopted.Conclusion Acceptance strategy shows some advantages in clinical pain improvement:it can significantly improve the psychological and social function of patients,but it is not always efficient in reducing the pain intensity.There are still some limitations in the present study.It is necessary to develop an acceptance-based therapy with Chinese culture to treat the domestic patients.

A 6-week mindfulness-based training on aggression and sleep quality in long-term incarcerated males / 中国心理卫生杂志

Objective:To investigate whether the mindfulness training can reduce the aggression level and im-prove the sleeping quality among incarcerated people.Methods:Fifty-four male criminals were recruited into the study.They were divided into mindfulness training group (n =25)and control group (n =29).The training group took mindfulness exercise once a week for 6 weeks.While the participants in waiting list control group waited for 6 weeks without intervention.After 6-week mindfulness training for training group and post-assessment for all partici-pants,the waiting list control group went into 6-week mindfulness training.The Five Facet Mindfulness Question-naire (FFMQ),Aggression Questionnaire (AQ)and Pittsburgh Sleep Quality Index (PSQI)were assessed before and after the intervention.Results:There were 19 valid data in training group,and 21 in control group.After 6-week training,the score difference between pre-and post-assessment of FFMQ (P <0.01 )was higher in the training group than in the control group,and the difference of AQ (P <0.01)and PSQI (P <0.01)was lower in training group than in the control group.Conclusion:The results suggest that 6-week mindfulness training could effectively reduce the aggression level and improve the sleep quality in the long-term incarcerated males.

Effectiveness of 8-week mindfulness training improving negative emotions / 中国心理卫生杂志

Objective:To investigate the effectiveness of mindfulness training improving negative emotions, furthering to explore the mediating effect of the improvement of mindfulness levels for the training effects.Methods:Randomized control trail was used in this research.Ninety participants who suffered negative e-motions and resolved to alleviate stress by mindfulness training were recruited by lecture.They were randomized in-to mindfulness training group or waitlist control group,and 79 of them completed the intervention (38 in mindful-ness training group and 41 in waitlist control group).Participants in mindfulness training group received an 8-week mindfulness training,while participants in waitlist control group received no intervention.Participants were assessed with the Five Facet Mindfulness Questionnaire (FFMQ,measuring mindfulness level)and Brief Profile of Mood State (POMS,measuring emotion)before and after intervention.Results:After 8-week intervention,participants in mindfulness training group got significantly higher total scores of FFMQ compared with baseline [(125.9 ±11.9) vs.(121.2 ±12.5),P0.05 ).The improvement of total scores of FFMQ mediated the reduction of total scores of POMS (95%CI=-6.24--0.73),and the intensity-anxiety (95%CI=-1.65 ~-0.12),depression-frustration (95%CI=-1.63--0.14),and fatigue scores (95%CI=-1.72--0.20)of POMS caused by mindfulness training.Conclusion:Mindfulness training could improve participants'negative emotions,and the enhanced mindfulness levels caused by mindfulness training will play a very important role for the improvement of negative emotions.