目的探讨胃肠道间质瘤（GISTs）的临床表现、病理特点及诊断、治疗和预后。方法回顾性分析2002年1月至2004年3月期间收治的21例GISTs患者的临床和病理资料。结果主要临床表现为腹部不适或疼痛、消化道出血、腹部包块和贫血。术前无一例确诊。均接受手术治疗，术中均未见淋巴结肿大转移。肿瘤直径＜5 cm者有9例，5～10 cm者有 9例，＞10 cm者3例。常规病理检查见梭形细胞，最终依靠免疫组化染色确诊。良性5例，低度恶性14例，恶性2例； 免疫组化检测CD117阳性18例，CD34阳性13例，而CD117阳性和（或）CD34阳性20例。随访3～30个月，平均11.5个月，随访率为100%，1例于术后13个月死亡，1例术后7个月出现肝转移，其余均无瘤生存。结论GISTs术前确诊非常困难，病理检查时发现非上皮性的梭形细胞肿瘤应作常规免疫组化染色以确诊，手术切除为主要治疗方法。
Objective To evaluate the associations of 16 variants in clopidogrel-relevant genes with early neurological deterioration (END) in acute ischemic stroke (AIS) patients receiving clopidogrel treatment. Methods AIS patients admitted to the Department of Neurology of three hospitals between June 2014 and January 2015 were included. The 16 variants in clopidogrel-relevant genes were examined using mass spectrometry. Gene-gene interactions were analyzed by generalized multifactor dimensionality reduction (GMDR) methods. The primary outcome was END within the 10 days of admission. Results A total of 375 patients with AIS were included. Among the 375 patients, 95 (25.33%) patients developed END within the first 10 days of admission. Among the 16 variants, only CYP2C19*2 rs4244285 AG+AA was associated with END using single-locus analytical approach (P<0.001). GMDR analysis revealed that there was a synergistic effect of gene-gene interactions among CYP2C19*2 rs4244285, P2Y12 rs16863323, and GPⅢa rs2317676 on risk for END (P=0.019). Cox regression analysis showed that the high-risk interactive genotype was independent predictor for END [hazard ratio=2.184, 95% confidence interval (1.472, 3.238), P=0.004]. Conclusions END is very common in patients with AIS. Interactions among CYP2C19*2 rs4244285, P2Y12 rs16863323, and GPⅢa rs2317676 may confer a higher risk for END. It may be very important to modify clopidogrel therapy for the patients carrying the high-risk interactive genotype.
Objective To explore the relationship between neurofilament light chain (NfL) level and early neurological deterioration (END) after acute cerebral infarction (ACI). Methods The means of multi-center observational study were adopted to include patients with ACI within 72 hours of onset in 4 hospitals in Deyang between March 31, 2019 and July 31, 2021, to explore the risk factors of END. Results A total of 339 patients with ACI were included in this study, including 131 women and 208 men, aged (68.1±11.6) years. END occurred in 80 patients within 7 days after admission, and the incidence of END was 23.6%. The National Institute of Health Stroke Scale score and NfL level of patients without END were lower than those with END (P<0.05). Cox proportional risk model showed that NfL level [hazard ratio (HR)=1.037, 95% confidence interval (CI) (1.025, 1.050), P<0.001], admission National Institute of Health Stroke Scale score [HR=1.202, 95% CI (1.127, 1.282), P<0.001], initial blood glucose [HR=1.068, 95% CI (1.006, 1.133), P=0.030] were related to the occurrence of END. Conclusion The level of NfL, the severity of stroke, and the bloodglucose at admission are related to the occurrence of END in patients with ACI. Measures can be taken to control the above problems as soon as possible to prevent the occurrence of END.
Objective To analyze data for 1950 injured patients in the People’s Hospital of Deyang City following the Wenchuan earthquake, to provide relavent evidence to inform future decision-making in relation to establishing and improving frontline hospitals in disaster areas. Methods The basic situation of the wounded inpatients and the total situation of medical rescue were analyzed with data provided by the Department of Information at the hospital from May 12th to July 12th 2008. Microsoft EXCEL was used for data input and SPSS 11.0 was used for statistical analysis. Results By July 12th, a total of 1950 injured patients and 1378 inpatients had been treated in the hospital. Most inpatients were treated during the first week after the earthquake (about 65.6%), with the number of the inpatients reaching a peak of 703 on the first day, May 12th. The majority of the wounded inpatients were from the Mianzhu, Shifang and Jingyang districts of Deyang city. The diagnosis on admission included fracture (45.9%), craniocerebral injury (20.9%) and thoracoabdominal injury (14.7%). There were 48 deaths including 30 pre-hospital deaths, 10 emergency deaths and 8 inpatient deaths. There were 441 patients who were transported and transferred to the 2nd and 3rd hospitals from the People’s Hospital of Deyang City, which was the first hospital to organize the large-scale transporting of patients in the whole province. There were 1378 inpatients from the disaster area and 726 healthcare workers were sent to the disaster area to provide medical rescue. Psychological treatment was provided to more than 5000 inpatients, inhabitants, healthcare workers and army members. Conclusion The People’s Hospital of Deyang City successfully has accomplished a difficult task as the hospital nearest to the disaster area and played an important role during emergency medical rescue.