Objective To evaluate the effect of early goal-directed fluid therapy with fresh frozen plasma in severe acute pancreatitis(SAP). Methods From January 2010 to June 2014,79 SAP patients were enrolled according to the continuous sampling method. All the patients were randomly divided into a control group who accept the traditional fluid therapy(group A),an experimental group 1 who accept early goal-directed fluid therapy(group B),and an experimental group 2 who accept the early goal-directed fluid therapy with fresh frozen plasma(group C). There were no significant differences of general conditions a-mong groups. The differences of ICU admission,mortality and occurrence rate of abdominal compartment syndrome(ACS)and MODS were compared among groups. Results Compared with group A,group B and C have a shorter length of ICU admission,a lower mortality and a lower occurrence rate of ACS and MODS (P < 0. 05). Compared with group B,group C have a shorter length of ICU admission,a lower mortality and a lower occurrence rate of ACS and MODS(P < 0. 05). Conclusion The method of early goal-direct-ed fluid therapy with fresh frozen plasma will contribute to shorten the length of ICU admission and reduce mortality and occurrence rate of ACS and MODS for patients with SAP.

ObjectiveTo study the expression of Twist in invasive ductal carcinoma of breast and its relationship with cell proliferation and angiogenesis.MethodsThe expression of Twist and Ki-67 was detected in 60 cases with invasive ductal carcinoma of breast by immunohistochemistry.Ki-67 index and microvascular density(MVD) were calculated.ResultsThe positive expression rate of Twist was 56.7％ (34/60) in invasive ductal carcinoma of breast.Ki-67 index and MVD in the patients with positive expression of Twist was higher than those in the patients with negative expression of Twist[(57.05 ± 16.37)％ vs.(25.32 ± 16.16)％,(34.30 ± 12.25)％ vs.(23.04 ± 10.45)％,P＜ 0.05 ].ConclusionsThe overexpression of Twist is found in invasive ductal carcinoma of breast.To stimulate cell proliferation and angiogenesis may be one of the pathways of Twist to contribute to the invasion and metastasis of breast cancer.

Objective To analyze the therapeutic effects of different meth ods in operative treatment of intertrochanteric fractures of femur. Methods 106 cases were treated with operation and their average age was 72 year old. 39 case s of them were treated with external fixation, 3 cases with steeliness, 13 cases with Metanghin nail, 45 cases with DHS, and 6 cases with proximal femoral nail( PFN). Results The therapeutic effects of the dynamic hip screw(DHS) and PFN trea tment were the best among these methods. The excellent and good rates of DHS, PF N, external fixation, steeliness, and Metanghin were 100%, 87.2%, 33.3%, 69. 2%, respectively. Conclusion For the intertrochanteric fracture of lemur,DHS or PFN is recommendable to the patients who can tolerate an operation, whereas uni lateral external fixation is preferable to those who cannot or will not receive an operation.

Objective To observe the enhancement pattern and time-intensity curve of endometrial carcinomas by using contrast-enhanced ultrasound(CEUS). Methods Altogether 30 endometrial carcinomas were evaluated with real-time gray-scale CEUS, using pulse inversion harmonies technique. The enhancement patterns were observed. Twenty tumors were compared for the size between traditional ultrasound and CEUS. In 21 cases, the parameters of time-intenaity curve were compared between the endometrial lesion and un-involved myometrium. Results The contrast agent arrived at the feeding vessels firstly and then branched into the endometrial tumors. All of the endometrial tumors were enhanced completely except for the necrosis area. In 73.3 % (22/30) of cases, the tumors washed out earlier than the un-involved myometrium. By using CEUS 76. 7% (23/30) of cases showed the feeding vessels of tumor. 43.3% (13/30) of cases showed more clearly than traditional ultrasound in tumor base, position and boundary. The mean enhancement sizes of tumor were bigger than the size showed by traditional ultrasound in 85% of cases by (0. 62±0.50)cm. More than 90% cases showed the tumors start to enhance and wash-out earlier than or at the same time as myometrium. The arrival time and peak time of cancer group were significantly earlier than myometrium group. The peak intensity, enhancement intensity and the rising rate of the tumor group were significantly higher than those of the myometrium group. Conclusions There are some characteristic points in CEUS of endometrial carcinomas. CEUS can provide richer information in tumor imaging than traditional ultrasound and has certain clinical value.

Objective To investigate the effects of remote limb ischemic preconditioning (RLIP) on the lung injury in patients undergoing abdominal aortic aneurysm repair.Methods Sixty-two ASA Ⅱ or Ⅲ patients of both sexes,aged 54-72 yr,with body mass index 21-36 kg/m2,undergoing elective abdominal aortic aneurysm repair,were randomly divided to 2 groups ( n =31 each):control group (group C) and RLIP group.RLIP consisted of two 5-min cycles of left upper limb ischemia induced by a blood pressure cuff placed on the left upper arm and inflated to 200 mm Hg,with an intervening 5 min of reperfusion,during which time the cuff was deflated.RLIP was performed after anesthesia induction and before the start of surgery.Arterial and venous blood samples were taken at 10 min after intubation (T0),and 30 min and 4,8,12 and 24 h after aortic unclamping (T1-5) for blood gas analysis and determination of the concentrations of serum interleukin (IL)-6,tumor necrosis factor (TNF)-α,and plasma malondialdehyde (MDA) and superoxide dismutase (SOD) activity.The alveolar-arterial oxygen pressure difference (PA-aO2 ) and respiratory index (RI) were calculated.The peak airway pressure (Ppeak),plat airway pressure (Pplat) and positive end expiratory pressure (PEEP) were recorded at the same time points mentioned above to calculate dynamic lung compliance (Cd) and static lung compliance (Cs).The incidence of hypoxemia,extubation time and duration of stay in intensive care unit (IGU) were also recorded.Results Compared with group C,PA-aO2,RI and the concentration of IL-6 were significantly decreased at T3-5,Cs,Cd and SOD activity were significantly increased at T2-5,and the concentrations of TNF-α and MDA were significantly decreased at T2-5 in group RLIP ( P ＜ 0.05).Compared with group C,the incidence of hypoxemia was significantly decreased,and extubation time and duration of stay in ICU were significantly shortened in group RLIP ( P ＜ 0.05).Conclusion RLIP can reduce the lung injury through inhibition of the inflammatory response and lipid peroxidation in patients undergoing abdominal aortic aneurysm repair.

Objective To analyze the etiology of pseudoachalasia.Methods Patients who were diagnosed as having pseudoachalasia in Endoscopy Center of The Affiliated Zhongshan Hospital of Fudan University from September 2010 to June 2015 were retrospectively analysed.Results A total of 12 patients were enrolled in this study,6 males and 6 females.The median age,median disease duration and median Eckcardt score was 54.5(24.0～71.0) years old,2.5(0.2～ 10.0) years and 4(3～9),respectively.Seven cases were caused by malignant tumors,2 had benign tumors,and 3 peptic stricture.Conclusion The most common cause of pseudoachalasia is malignant tumors.Accurate diagnosis relies on the comprehensive medical history and complete examinations.

CCL20 and CCR6 are chemokines produced by a variety of cells. CCL20 and CCR6 combine to stimulate a series of downstream pathways, participate in the occurrence and development of various malignant tumors, and also play an important role in the invasion and metastasis of breast cancer and the process of chemotherapy resistance. Epithelial-mesenchymal transformation (EMT) is a key step in the process of tumor cell metastasis, which is characterized by loss of cell adhesion, down-regulation of E-cherherin expression, up-regulation of mesenchymal markers and fibrinectin expression, and enhancement of cell motor ability and invasion ability. This article reviews the research of CCL20-CCR6 biological axis and EMT on invasion and metastasis of breast cancer cells.

Objective: To explore a predictive nomogram for the result of prostate biopsy based on Prostate Imaging Reporting and Data System version 2(PI-RADS v2)combined with prostate specific antigen (PSA) and its related parameters, and to assess its ability to diagnose prostate cancer by internal validation. Methods: We retrospectively analyzed the clinical data of 509 patients who underwent transrectal prostate biopsy guided by ultrasound during the period from January 2014 to December 2018 in the Department of Urology, First Affiliated Hospital of Xiamen University. In 509 cases, the mean age was (68.1±7.2) years. The mean prostate volume(PV) was (55.8±30.7) ml. The mean tPSA value was (19.86±18.94) ng/ml. The mean value of fPSA was (2.63±3.60) ng/ml and the mean f/tPSA was 0.14±0.08. The mean PSAD was (0.46±0.52) ng/ml2. Based on the PI-RADS v2, score 1 point have 37 cases, score 2 point have 131 cases, score 3 point have 152 cases, score 4 point have 102 cases, score 5 point have 87 cases. Of these patients, we randomly selected 80% (407 cases) as development group, and the other 20% (102 cases) as validation group. Univariate and multivariate logistic regression analysis of the development group was performed to identify the independent influence factors that can predict prostate cancer (PCa), thereby establishing a predictive model for the result of prostate biopsy. In the development group, validation group and tPSA was between 4.1-20.0 ng/ml, the model was evaluated by analyzing the receiver operating characteristic (ROC) curve, calibration curve and decision curve, and compared to PSA, fPSA, f/tPSA, PSAD, PI-RADS v2. Results: Among the 509 patients enrolled in the study, the detection rate of PCa was 43.0% (219/509). In the development group, the logistic regression analysis demonstrated that patient age (OR=1.113), f/tPSA (OR=0.004), PV (OR=0.986), PSAD (OR=11.023), digital rectal examination (DRE) texture (OR=2.295), transabdominal ultrasound (TAUS) with or without hypoechoic (OR=2.089), and PI-RADS v2 (OR=1.920) were independent factors for PCa (P<0.05). The nomogram based on all variables was established. In the development group, the area under the curve (AUC) of the model (0.883) was greater than those of tPSA (0.686), fPSA (0.593), f/tPSA (0.626), PSAD (0.777), PI-RADS v2 (0.761). In the validation group, the area under the curve of the model (0.839) was greater than those of tPSA (0.758), fPSA (0.666), f/tPSA (0.648), PSAD (0.832), PI-RADS v2 (0.803). In patients whose tPSA was between 4.1-20.0 ng/ml, the area under the curve of the model (0.801) was greater than those of tPSA (0.570), fPSA (0.426), f/tPSA (0.657), PSAD (0.707), PI-RADS v2 (0.701). The calibration curve of the nomogram indicated that the prediction curve was basically fitted to the standard curve, and the Hosmer-Lemeshow showed thatχ²=5.434, P=0.710, both suggested that the prediction model had better calibration ability. The decision curve showed that the model based on PI-RADS v2 had high clinical application value. Conclusions The nomogram based on PI-RADS v2 had a high predictive value for prostate cancer and could significantly improve the diagnostic performance. It had better diagnostic value than PSA and its related parameters. It also provided important guidance for the prostate cancer on clinical treatment of patients to some extent.

Endoscopic resection (ER) has been a preferred treatment for early gastric cancer (EGC) based on the guidelines. In recent years the technique is developing rapidly. Surgical operation, a traditional treatment, still has its advantages such as complete tumor removal and low recurrence rate. In this review, a long-term outcome comparison of these two methods in EGC is discussed.