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<p><b>OBJECTIVE</b>To summarize the treatment status of gastric gastrointestinal stromal tumor (GIST) in Shandong province,by analyzing the clinicopathological features and prognostic factors.</p><p><b>METHODS</b>Clinicopathological and follow-up data of 1 165 patients with gastric GIST between January 2000 and December 2013 from 23 tertiary referral hospitals in Shandong Province were collected to establish a database. The risk stratification of all cases was performed according to the National Institutes of Health(NIH) criteria proposed in 2008. Kaplan-Meier method was used to calculate the survival rate. Log-rank test and Cox regression model were used for univariate and multivariate prognostic analyses.</p><p><b>RESULTS</b>Among 1 165 cases of gastric GIST, 557 were male and 608 were female. The median age of onset was 60 (range 15-89) years. Primary tumors were located in the gastric fundus and cardia in 623 cases(53.5%), gastric body in 346 cases(29.7%), gastric antrum in 196 cases(16.8%). All the cases underwent resection of tumors, including endoscopic resection (n=106), local resection (n=589), subtotal gastrectomy(n=399), and total gastrectomy(n=72). Based on the NIH risk stratification, there were 256 cases (22.0%) at very low risk, 435 (37.3%) at low risk, 251 cases (21.5%) at intermediate risk, and 223 cases (19.1%) at high risk. A total of 1 116 cases(95.8%) were followed up and the median follow-up period was 40 (range, 1-60) months. During the period, 337 patients relapsed and the median time to recurrence was 34 (range 1-60) months. The 1-, 3-, and 5-year survival rates were 98.6%, 86.1% and 73.4%, respectively. The 5-year survival rates of patients at very low, low, intermediate, and high risk were 93.1%, 85.8%, 63.0% and 42.3% respectively, with a statistically significant difference (P=0.000). Multivariate analysis showed that primary tumor site (RR=0.580, 95%CI:0.402-0.835), tumor size (RR=0.450, 95%CI:0.266-0.760), intraoperative tumor rupture(RR=0.557, 95%CI:0.336-0.924), risk classification (RR=0.309, 95%CI:0.164-0.580) and the use of imatinib after surgery (RR=1.993, 95%CI:1.350-2.922) were independent prognostic factors.</p><p><b>CONCLUSIONS</b>The choice of surgical procedure for gastric GIST patients should be based on tumor size. All the routine procedures including endoscopic resection, local excision, subtotal gastrectomy and total gastrectomy can obtain satisfactory curative outcomes. NIH classification has a high value for the prediction of prognosis. Primary tumor site, tumor size, intraoperative tumor rupture, risk stratification and postoperative use of imatinib are independent prognostic factors in gastric GIST patients.</p>
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[ABSTRACT]OBJECTIVETo explore the basic characters of the airflow-field in Chinese people's nasal cavity by computational fluid dynamics.METHODSThe three-dimensional, finite-element mesh were developed from Spiral CT imaging scans of nose of the 40 healthy Chinese people. Given the following spatial boundaries of the flow field: no-slip condition was imposed at the surface of the nasal airway walls; a standard atmosphere pressure condition was established at the inlet; a velocity vector was specified at the outlet (nasopharynx), which was obtained under the condition of aspiratory flow rate (12 L/min), the full Navier-Stokes and continuity equations were solved to obtain the airflow pattern.RESULTS1. The airflow passed mainly through left or right side of the nasal airway in the whole 40 cases (left 33, right 7),and the volume of air through the main-side is (320±28) ml while non-main-side (180±45) ml. 2. Airflow velocity: airflow of anterior nostrils, internal nostrils, the middle and inferior parts of the total meatus in the main-side were (5.01±2.12) m/s, (7.00±1.75) m/s, (5.08±1.55) m/s, (4.12±1.40) m/s respectively, and those in non-main-side were (2.01±0.94) m/s, (2.40±0.34) m/s, (1.99±1.0) m/s, (2.01±0.65) m/s respectively, which differences between the both sides were of statistical significance (allP0.05); 3. The airflow form appeared to be linear in the middle and inferior parts of the nasal cavity. 4. Velocity in maxillary sinus cavity was almost 0 m/s.CONCLUSIONThe airflow passes mainly through the middle and inferior parts of the meatus with higher velocity in laminar form and airflow of middle meatus, inferior meatus and olfactory cleft are low and the velocity were slow. Besides, airflow in maxillary sinus cavity diffuses free mainly.
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Objective To analyze the airflow characteristics and investigate the relationship of the structure and the function of nasal cavity by the three?dimensional reconstruction of nasal airway of patients with structural abnormalities(nasal septum deviation)and healthy people and the estab?lishment of finite element model by computer. Methods On the basis of CT imaging of the nasal cavity in patients with structural abnormalities(na?sal septum deviation,n=20)and healthy people(n=20),three?dimensional reconstruction of nasal airway was conducted by resurfacing finite ele?ment subdivision to simulate the characteristics of airflow in nasal cavity. Results The airflow mainly went through the commodious side of the nose in patients with nasal septum deviation and the maximum fluence appeared in the middle part of meatus nasi communis. The airway pressure de?creased most significantly in the most flank?curvature part of nasal septum deviation,accounting approximately 79.65%of the total pressure. In healthy people,the bilateral airflow was affected by nasal cycle and was mainly characterized by one nasal cavity,and the maximum fluence was ob?served in the middle and the inferior part of meatus nasi communis. The airway pressure decreased most significantly in limen nasi,accounting ap?proximately 58.78%of the total pressure. Conclusion Numerical modeling of nasal cavity can be used to analyze the relationship between the nasal structural abnormalities and the airflow characteristics,which is a scientific method to analyze the association of nasal structure and function with dis?ease and can be used for pre?and post?operative individual evaluation of operative therapeutic regimen targeting at optimizing airway and altering air?flow distribution.
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OBJECTIVE@#To investigate the nasal airflow-field in relation with the structure and function of the human nose.@*METHOD@#The 3-D finite-element mesh is developed from Spiral- CT imaging scans of the 25 healthy volunteers' noses. Given three preconditions, the nasal air-flow is described by the Navier-Stokes and continuity equations at the inspiratory flow rate of 10 min, then the whole airflow patterns are obtained for further analysis.@*RESULT@#(1) In 5 cases, the airflow passes mainly through the middle medial region in both sides in the nasal airway. In remaining 20 cases, the airflow passes mainly through the middle and ventral medial regions in one side in the nasal cavity while little air passes through middle medial regions in another the other side through which little air passes. (2) The differences of velocity in the nasal valve, middle and ventral medial regions of the nasal airway between mainly side and non maingnot-mainly side are of statistical significance, while those in the olfactory split, middle and inferior meatuses in both sides are of no statistical significance. (3) In the mainly side, the most rapid air speed occurred in the nasal valve , the second rapid velocity in the middle medial region and the third in the ventral medial regions, the slowest velocity in the olfactory split, middle and inferior meatuses. In notion- mainly side, the velocity in all regions is slow without statistical significance.@*CONCLUSION@#(1) At the inspiratory flow rate of 10 L/min, the middle and ventral medial regions act as the main airways in nasal cavity. (2) The airflow in nasal cavity can be directed effectively and reasonably by nasal valve, inferior turbinate, middle turbinate in turn, which may be consistent with the nasal cycle functionally.