Objective To establish a rat model of chronic atrophic gastritis and investigate the factors inducing gastric atrophy. Methods According to the repeated orthogonal design of L 8(2 7), 60% alcohol and 20 mmol/L sodium deoxycholate (served as factor A), 0.05%～0.1% ammonia water (factor B) and 0.05% indomethacin (factor C) were given, alone or in combination, to rats in three experiments for 3 months, 6 months and 9 months, respectively. Then the rats were sacrificed and pathologic changes of the gastric mucosa were studied by gross appearence and microscopy. Results Typical appearance of CAG, which could maintain over one month, were found in all rats treated with factor A,B,C alone or in combination for 6 or 9 months. Conclusion 60% alcohol, 20 mmol/L sodium deoxycholate, 0.05%～0.1% ammonia water and 0.05% indomethacin given to SD rats for 6 months could establish animal model of CAG with a 100% successful rate.

[Objective]To discuss the diagnosis and surgical treatment of spinal myeloma.[Method]To make a retrospective analysis of cliniacal history and operation results of 13 patients with spinal myeloma from 1999 to 2004.There were 5 males and 8 females with average age of 47.67 years.They were diagnosed by X-ray,CT,MRI,ECT and biopsy.Resection of tumor was performed in all cases,of which 7 cases was through anterior approach,4 cases through posterior approach,2 cases through combined approach.[Result]The pain was decreased and neurological function was improved in all cases after the surgery.Three death and one recurrence was found during the follow-up time.[Conclusion]X-ray,CT and MRI are essential for diagnosis,ECT may help found multiple lesions,biopsy is reliable diagnosable method.Surgery can relived the symptoms obviously,but should be associated with adjuvant treatments.

[Objective]To approach the clinical characteristic,diagnosis and method of treatment of malignant fibrous histiocytoma of bone.[Method]The clinical data of 52 patients of malignant fibrous histiocytoma of bone were analyzed retrospectively,including sites of tumor,preoperative imageology,puncturing biopsy,surgical staging of tumor,methods of treatment,results of follow-up,and so on.[Result]In all 52 cases of malignant fibrous bistiocytoma of bone,32 cases were in periphery of knee joint,14 cases in periphery of shoulder joint,3 cases in the proximal femur,1 case in calcaneus,1 case in lumbar and 1 case in ilium.The preoperative imageelogy and puncturing biopsy were made as usual.There were 20 cases in staging of ⅡA and 32 cases in in staging of ⅡB according to Ennekings surgical staging of tumor.All cases were performed operation except of 1 case.The operation were made salvage limb mosfly and the ratio of limb salvage was 74.5 %(38/51).The preoperative and postoperative chemotherapy and radiotherapy were performed at the same time.Thirty-six of all cases were in long-time follow-up and the ratio of follow-up was 69.2%(36/52).Nine cases were recurred in the region,6 cases had distant metastasis and survival rate of 5 years was 61.1%(22/36).[Conclusion]Preoperative puncturing biopsy and imageology can help the diagnosis of malignant fibrous histiocytoma of bone.Surgery is the primary method and radiotherapy and chemotherapy can prevent the recurrence of the tumor.The resection of the tumor thorough is the key point of healing of malignant fibrous histiocytoma of bone.

Objective To study the relationship between expressions of E-cadherin and syndecan-1 in hepatocellular carcinoma(HCC) and the invasive characters of HCC. Methods The expression of E-cadherin and syndecan-1 were observed in 47 HCC cases using immunohischemistry. Results Most HCC cases showed decreased expression of E-cadherin and syndecan-1 (55%, 60%). Their expressions decreased more significantly in HCC larger than 3*!cm in diameter than in HCC less than 3*!cm (P

Objective To investigate the effects of loop electrosurgical excision procedure (LEEP) on pregnancy and delivery outcomes of patients with cervical epithelial neoplasia (GIN). Method The delivery data of 27 pregnant women who had LEEP from May 1995 to April 2002 were retrospectively collected and analysed. Results The mean age of the 27 women was 30. 3 years ( range 23 -40 years). Ten women underwent artificial abortion. One ectopic pregnancy and two spontaneous miscarriages occurred at 6 to 8 weeks of gestation. There were 14 term pregnancies, 9 of them via vaginal delivery and 5 via caesarean section. The birth weight of newborns ranged from 2905 to 4000 g. All of newborns had a high Apgar score. No asphyxia occurred. Conclusions LEEP is a safe and effective treatment for patients with CIN. It will not increase the risk of pregnancy and delivery of the patients.

BACKGROUND: Many studies have shown that different types of anterior cervical surgery in the treatment of two-level contiguous cervical disc herniation can obtain satisfactory results, but which method is the best has not yet reached a consensus. OBJECTIVE: To compare the efficacy and safety of three types of anterior cervical surgery for treating two-level contiguous cervical disc herniation. METHODS: We retrospectively analyzed clinical data of 62 patients with two-level contiguous cervical disc herniation who underwent anterior decompression and fusion. These patients were assigned to three groups. Bone graft group received anterior cervical discectomy with autogenous iliac bone graft fusion. Titanium mesh group received anterior cervical corpectomy with titanium mesh fusion. Cage group received anterior cervical discectomy with cage fusion. Fusion rate of bone graft and improvement of neurological function (Japanese Orthopaedic Association Scores) were evaluated and compared after treatment in the three groups. Cervical vertebra anteroposterior and lateral images were used to measure height of anterior and posterior margin of vertebral body and Cobb angle changes of fusion segment. RESULTS AND CONCLUSION: Al 62 patients were fol owed up and the fol ow-up time was ranged from 8 to 30 months. Operation time was significantly longer in the bone graft group than in the titanium mesh and Cage groups (P < 0.05). Intraoperative blood loss was larger in the bone graft group than in the titanium mesh and Cage groups (P < 0.05). Japanese Orthopaedic Association Scores were significantly improved after treatment (P < 0.05). No significant difference was found at different time points (P > 0.05). The fusion rate of bone graft was higher in the bone graft group than in the titanium mesh and Cage groups (P < 0.05) at 3 months after treatment, and bone union was found in the final fol ow-up. Height of anterior and posterior margin of vertebral body was significantly increased after treatment (P < 0.05). No significant difference in the increase of the height of anterior margin was detected among the three groups (P > 0.05). The increase in the height of posterior margin was higher in the Cage group than in the bone graft group and titanium mesh group (P < 0.05). Vertebral height loss of the anterior margin was higher in the bone graft group than in the titanium mesh and Cage groups, but vertebral height loss of the posterior margin was highest in the bone graft group, fol owed by titanium mesh group and Cage group at 3 months after treatment (P < 0.05). The increase value of Cobb angle was higher in the titanium mesh group than in the bone graft group and Cage group (P < 0.05). At 3 months after treatment, the altered value of Cobb angle was highest in the bone graft group, fol owed by titanium mesh group and Cage group (P < 0.05). No significant difference in the height of anterior and posterior margins of the vertebral body and Cobb angle was detectable between final fol ow-up and 3 months post-treatment (P > 0.05). These findings indicated that the three kinds of fusion method for treating two-level contiguous cervical disc herniation could obviously lessen nervous systems and improve cervical vertebra functions. In the bone graft group, operation time was long. Intraoperative blood loss was more. Postoperative height loss of the posterior margin of the vertebral body was visible. Cervical lordosis could be easily induced. Compared with the bone graft group, titanium mesh and Cage groups could better maintain the height and curvature of the cervical vertebra, but the Cage group had apparent advantages.

BACKGROUND:Currently, discectomy, fusion or decompression is considered an effective and conventional method for the treatment of spinal disease. Although there have been many reports on the adverse effects of diabetes on spinal surgery, but there are stil some differences. OBJECTIVE:To systematical y evaluate the observational studies and case-control studies about the effect of diabetes on the complications of spinal surgery. METHODS:The control ed and comparative studies regarding the effect of diabetes on the results and complications of spinal surgery were searched from the database according to the inclusion criteria. The observed indicators including mortality, revision rate, surgical site infection, the incidence of venous thrombosis, blood loss, operative time and hospitalization time. Two authors participated in extracting the data and evaluating the methodology and quality of the included studies. Meta-analysis was conducted according to the guidelines of epidemiological observational studies (MOOSE). The risk assessment of the extracted data was conducted using RevMan 5.2 software. RESULTS AND CONCLUSION:Eighteen literatures, involving 2 824 063 patients, were eventual y enrol ed. The experimental result showed that the mortality, surgical site infection, incidence of venous thrombosis of diabetic patients after the spinal surgery were significantly higher than those of non-diabetic patients;the hospital stay was significantly longer than that of non-diabetic patients (P<0.05). There were no significant differences in the risk of revision, intraoperative blood loss and operation time between diabetic patients and non-diabetic patients (P>0.05). These results suggest that diabetic patients take a higher risk once accepting the spinal surgery than the non-diabetic patients. Diabetes increases the risks of postoperative mortality, surgical site infection, venous thrombosis and hospitalization time after spinal surgery.

Objective:To study the health equity and explore the influencing factors of health inequities among those insured in New Rural Cooperative Medical System and to provide theoretical and factual basis for improvement of medical insurance system through .Method:Using concentration index decomposition to explore the sources of inequity in health outcomes and the degree of horizontal inequity in health outcomes .Results:Economical level leads that the concentration indexes of two week prevalence favor the poor , i.e.the worse the health outcome of the rich is.Economical level leads that the concentration indexes of chronic disease prevalence and self -reported health defective rate favor the rich , i.e.the worse the health outcome of the poor is .Conclusion:Economic level is the primary factors affecting two weeks prevalence , age, culture level, the employment situation is the factors al-leviate health outcomes unfair .Increase people′s economic level and cultural level , improve the situation of em-ployment is important to the health equity .

Objective To study the effects of ePTFE-covered stents versus bare stents on portal hemodynamics in portal hypertensive patients receiving TIPS. Methods Sixty patients with portal hypertension underwent TIPS with 8 mm diameter bare stents and ePTFE-covered stent from April 2007 to April 2009. The clinical outcomes were observed after TIPS, and the hemodynamics of potal vein system were studied before and after TIPS and during the follow up using direct portography and color Doppler ultrasound technique. Results TIPS procedures were successful in all patients without major complications. The follow-up of patients with bare stents were (8 ± 4) months and follow-up of ePTFEcovered stents group were (6 ± 4) months. Immediately after the TIPS the portosystemic pressure gradient of the two groups decreased by 60% and 58%, respectively(t =0.79, P >0.05). During the follow-up,portosystemic pressure gradient of bare stents group increased gradually, while that in ePTFE-covered stents group maintained low portosystemic pressure gradient (13.2 ± 1.2) mm Hg vs. (9. 5 ± 2. 9) mm Hg, P =0. 015. The blood velocity and volume of venous return of potal vein system were significantly higher in ePTFE-covered stents group than in bare stents group during the follow-up using color Doppler ultrasound method. The blood velocity and volume of the shunts were significantly higher in covered stents group than in bare stents group after 1 year, (125 ±20) cm/s vs. (88 ±13) cm/s, and (1816 ±380) ml/min vs.(1074 ±239) ml/min, respectively P<0. 01. Conclusions In TIPS patients with ePTFE-covered stents high blood velocity and low portosystemic pressure gradient sustained in contrast with those using bare stents.

Objective To investigate the diagnosis and surgical management of adult choledochal cyst.Methods The clinical data of 58 adult patients with congenital choledochal cyst who were admitted to the First Affiliated Hospital of Nanjing Medical University from January 1997 to December 2010 were retrospectively analyzed.All patients were diangosed by the B ultrasonography,computed tomography (CT),Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). Surgical procedures were selected according to the diagnosis and Todani classification.All data were analyzed using the t test or chi-square test.Results The accurate rates of B sonography,CT,MRCP and ERCP were 78％ (45/58),92％ (23/25),9/9 and 5/5,respectively.Forty-one patients underwent complete excision of the cyst + hepaticojejunostomy (2 patients were converted from laparotomy due to abdominal adhesions),2 underwent resection of the cyst and involed hepatic segments + hepaticojejunostomy,8 underwent laparoscopic excision of the cyst + hepaticojejunostomy,1 underwent left hemihepatectomy,3 underwent pancreaticoduodenectomy ( including partial hepatectomy in 1 patient),2 underwent common bile duct exploration + cholecystectomy due to acute obstructive suppurative cholangitis,1 underwent external drainage of choledochal cyst due to advanced malignance.The mean operation time and postoperative duration of hospital stay of patients who received open and laparoscopic excision of the cyst and hepaticojejunostomy were (235 ± 70) minutes,(320 ± 50) minutes,and ( 10.0 ± 2.3 ) days,( 12.6 ±6.6) days,respectively,with significant differences between the 2 groups (t =3.157,2.162,P ＜ 0.05).The postoperative morbidities of patients who received open and laparoscopic excision of the cyst and hepaticojejunostomy were 18％ (7/39) and 3/8,respectively,with no significant difference (x2 =1.515,P ＞ 0.05 ).Canceration of the choledochal cyst was observed in 6 patients( 10％ ).No perioperative mortality was observed,and the operative complication rate was 24％ (14/58).The duration of the follow up ranged from 1 to 15 years,no severe long-term complications were observed in patients with benign lesions.Four of the 6 patients with malignancy died in 1 year after operation,the other 2 patients survived for 3 years and 5 years,respectively.Conclusions Abdominal B ultrasonography should be the first choice for diagnosing adult congenital choledochal cyst,while MRCP is the gold standard.Surgical intervention should be timely considered once diagnosed. Complete excision of the cyst combined with Roux-en-Y hepaticojejunostomy is the first choice of treatment.