The metabolic syndrome is a complex disorder of several metabolic abnormalities,which represents a risk factor of type 2 diabetes mellitus and cardiovascular diseases.Insulin resistance seems to play a significant role in pathoyenesis of metabolic syndrome.Many issues concerning definition,pathophysiology and optimal treatment of metabolic syndrome are reviewed in this article.

Scoliosis surgery includes fusion and non-fusion techniques.Fusion technique includes posterior fusion technique and video-assisted anterior thoracoscopic fusion.Non-fusion technique is suitable for children patients with growing potential of the spine.It includes growing rod,vertical expandable prosthetic titanium rib(VEPTR),U-shape screw,and multi-vertebral wedged osteotomy(for severely rigid scoliosis).Short term outcome from these techniques has been encouraging,but medium and long term outcomes are still need investigation.

Objective To observe whether peripheral blood mononuclear cells (PBMCs) from patients with active systemic lupus erythematosus (SLE) can induce the adhesion of T lymphocytes to endothelial cells. Methods Sera and PBMCs were obtained from patients with active SLE and normal human controls. PBMCs were cultivated and culture supematants were harvested. Human umbilical vein endothelial cells (HUVECs) were cultured in vitro with or without the presence of the sera or culture super-natants of PBMCs. Some cells were pretreated with the antibody to IL-17 before the treatment with the sera or supematants. After another 48-hour culture, RT-PCR and real-time PCR were used to detect the mRNA expressions of adhesion molecules, including intercellular adhesion moleeule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and E-cadherin in HUVECs, wound healing assay to estimate the motility of HUVECs. Additionally, T lymphocytes were added to HUVECs 48 hours after stimulation with the sera or supematants, the adhering of T lymphocytes to HUVECs was observed by microscopy. Results After stimulation with supematants of PBMCs from patients with active SLE, the mRNA expressions of ICAM-1, VCAM-1 and E-cadherin were significantly increased in HUVEC, while the increase could be inhibited by the antibody to IL-17. The elevation of adhesion molecule expression subsequently promoted the motility of HUVEC, mediated the adhesion of T lymphocytes to HUVEC, and the antibody to IL-17 could suppress the adhesion of T lymphocytes and motility of HUVEC. Conclusion The culture supematants of PBMCs from patients with active SLE can induce the expression of vascular cell adherin molecules and promote the adherin of T lymphocytes, which may in turn mediate the development of lupus vasculitis.

ObjectiveTo investigate the efficacy and safety of the self-expandable metal stent for treatment of gastric outlet and duodenal obstruction.MethodsData of 24 patients with symptomatic gastric outlet and duodenal obstruction diagnosed from January 2005 to February 2011 were retrospectively studied.All patients were measured by gastric outlet obstruction scoring system ( GOOSS ) before and one week after the placement of self-expandable metal stent.ResultsStent placement was succeeded in all patients with a mean operation time of 25.90 ± 11.03 min.Twenty patients (83.3％) were able to intake liquid food after the procedure.The GOOSS (P50 =0) before and after stent placement were 0.14 (P50 =0) and 1.42( P50 =2),respectively,with significant difference (P ＜0.01 ).Minor digestive bleeding occurred in 3 patients,but no severe complications including perforation or aspiration were observed.ConclusionPlacement of a self-expandable metal stent in patients with gastric outlet or duodenal obstruction is safe and effective for resolving obstructive symptoms.

Objective To compare the anti-hemorrhage effect and safety of hemocoagulase and epinephrine (1∶10 000) during endoscopic mucosal resection (EMR) or polyps electrocautery. Methods Between April and November 2007,totally 60 patients received EMR or endoscopic piecemeal mucosal resection (EPMR) in our hospital because of local lesions in the esophagus,stomach or colon. The patients were randomly divided into hemocoagulase and epinephrine groups (30 cases in each) before receiving the operation. After the resection,the hemorrhage at the surgical area was measured. During the operation,the blood pressure,heart rate,and adverse effects including palpitation,dizziness,pain,and nausea were recorded. Results Immediate hemorrhage was detected in 1 case of hemocoagulase group (1/30,3%),and 6 cases of epinephrine group (6/30,20%,?2=2.588,P=0.108). No hemorrhage was observed at 24 hours in both the groups. No significantly difference was noticed in the injection volume between the two groups [(11.0?6.0) ml (5-30 ml) in hemocoagulase group vs. (11.9?7.0) ml (5-28 ml); t=-0.535,P=0.595]. In epinephrine group,the mean artery blood pressure and heart rate increased significantly after the injection [(96.9?7.9) mm Hg vs. (99.9?8.1) mm Hg,t=-3.005,P=0.005; 79.8?7.9/min vs. 84.3?8.1/min,t=-3.585,P=0.001]. Whereas,no such differences were noticed in hemocoagulase group. Five cases in epinephrine group showed transient dizziness and palpitation,and 2 patients who had esophageal lesions complained of pain at the injection site. None of the hemocoagulase group had postoperative complications. Conclusions Hemocoagulase shows same anti-hemorrhage effect as epinephrine during EMR without leading to adverse effect.

ObjectiveTo observe clinical features and identify causative genes of reticulate pigmented anomaly of the flexures in a pedigree.Methods A survey was conducted in a pedigree with reticulate pigmented anomaly of the flexures.Clinical manifestations were recorded in details for each patient in this pedigree.Tissue specimen was obtained from the proband for histopathological examination and ultrastructural observation.Mutation scanning was carried out by PCR and direct sequencing in 3 patients in the family.ResultsAll the patients in this pedigree presented with reticular pigmentation of the flexures and idiopathic guttate hypomelanosis on the abdomen and back.Histopathological and ultrastructural study revealed epidermal hyperpigmentation with an increase in melanin content in epidermal keratinocytes but no changes in the number of melanocytes.No mutation was found in the KRT5 gene in this family.ConclusionsThis is the first case report of reticulate pigmented anomaly of the flexures associated with idiopathic guttate hypomelanosis.No mutation is identified in the KRT5 gene of patients with reticulate pigmented anomaly of the flexures in this family,indicating the existence of other causative genes.

Objective To explore the safety and efficacy of endoscopic retrograde cholangiopancreatography(ERCP)by using carbon dioxide for malignant biliary obstruction.Methods A total of 60 patients with malignant biliary obstruction, hospitalized from September 2008 to February 2010, were randomly divided into 3 groups to receive ERCP by using carbon dioxide, contrast agent or magnetic resonance cholangiopancreatography(MRCP)without any agent.The safety and efficacy of 3 contrast methods were compared.Results Successful stent or drainage tube insertion was achieved in all patients.Carbon dioxide was superior to contrast agent in terms of lowering postoperative infection rate(P ＜ 0.05), and it was also superior to MRCP for more effective drainage(P ＜ 0.05).There was no significant difference in occurrence of postoperative pancreatitis and hyperamylasemia between 3 groups.Conclusion Using carbon dioxide during ERCP, safe and effective, is superior to use of contrast agent in less leukocyte increase, and to MRCP in more adequate drainage in patients with malignant biliary obstruction.Furthermore, there is no more risk of pancreatitis and hyperamylasemia.

Objective To analyze the type of acid-base disturbance caused by severe pneumonia in newborn infants .Methods Venous blood of neonate with severe pneumonia(SP group) were collected to detect serum electrolyte and blood gas analysis 12 hours before and after oxygen therapy .The results of serum electrolyte and blood gas were compared 12 hours before and after oxygen therapy ,and the results of acid-base disturbance between SP group and control groups were compared.Results There were mostly metabolic acidosis incorporated respiratory acidosis in all neonate in SP group,which were with increased anion gap (AG) and obviously higher than that of control group(t=1.27 P

Objective To evaluate the relationship of peripheral blood Th17 and regulatory T (Treg) cells with disease activity in patients with systemic sclerosis (SSc).Methods This study recruited 21 patients with active SSc,24 patients with inactive SSc and 24 normal human controls with informed consent.Peripheral blood samples were obtained from these subjects.Flow cytometry was used to detect the percentages of Th17 and Treg cells in peripheral blood CD4+ cells,a fluorescence-based quantitative PCR to determine the levels of interleukin (IL)-17A,retinoid-related orphan receptor gamma t (RoRγt),forkhead box P3 (FoxP3) mRNA in peripheral blood mononuclear cells (PMBCs),and enzyme linked immunosorbent assay to measure the serum level of IL-17.Results Increased percentage of Th17 cells in peripheral blood CD4+ cells was observed in patients with active SSc compared with those with inactive SSc and normal human controls (2.34％ ± 1.19％vs.0.68％ ± 0.39％ and 0.57％ ± 0.49％,respectively,both P ＜ 0.05).No statistical difference was noted in the percentage of Treg cells in CD4+ cells or the mRNA expression levels of FoxP3 between the patients with active SSc,inactive SSc and normal human controls (all P ＞ 0.05).There was a significant increase in the mRNA expression of IL-17A,RoRγt in PBMCs and serum levels of IL-17 in patients with active SSc compared with patients with inactive SSc and normal human controls ( 11.73 ± 0.80 vs.9.77 ± 1.30 and 10.79 ± 0.74,respectively,both P ＜ 0.05; 18.48 ± 1.09 vs.15.89 ± 1.48 and 17.77 ± 1.64,respectively,both P ＜ 0.05; 53.60± 9.90 pg/ml vs.15.18 ± 3.24 pg/ml and 15.53 ± 4.12 pg/ml,respectively,both P ＜ 0.05).The percentage of Th17 cells in CD4+ cells and serum IL-17 levels were both positively correlated with disease activity in patients with active SSc (r =0.675,0.644,respectively,both P ＜ 0.05).Conclusions Th17 cells are highly proliferative in patients with active SSc,which may be closely correlated with the activity of SSc.

Objective To study the independent risk factors of early rebleeding after endoscopic variceal ligation (EVL) and/or endoscopic injection of fibrin tissue adhesive.Methods Data of 370 patients who had cirrhosis and accepted 396 procedures of EVL and/or endoscopic injection of fibrin tissue adhesive were retrospectively studied.Independent risk factors for early rebleeding were determined by Logistic regression analysis.Results Results of all the factors that were significantly different between the re-bleeding and non-rebleeding patients,the portal vein diameter,ascites volume,Child-Pugh score and serum albumin were independent ones of early rebleeding after EVL and/or endoscopic injection of fibrin tissue adhesive ( P ＜ 0.05).Larger volume of ascites,wider portal vein diameter,reduced albumin,Child-Pugh score greater than 10 were indicative factors of rebleeding.Conclusion The early rebleeding rate after EVL and/or endoscopic injection of fibrin tissue adhesive is determined by portal vein diameter,ascites volume,ChildPugh score,and serum albumin.