Intestinal ischemia is a severe and life-threatening acute abdomen. Although its incidence is low,early diagnosis remains relatively difficult. The efficiencies of conventional laboratory biochemical tests are low. In recent years, many new markers for the early diagnosis of intestinal ischemia have been developed. In this article,we summarize their diagnostic efficiencies and relevant factors.

Intestinal immunologic barrier plays an important role in preventing the bacterium and endotoxin.Lymphocyte homing to the intestine is one of the normal intestinal immunologic functions,and has the theoretical significance and clinical value for the balance of intestinal immunologic barrier.The basic and clinical researches of lymphocyte homing to the intestine are reviewed.

Objective To investigate the clinical values of serum histidine decarboxylase(HDC),intestinal fatty acid binding protein(I-FABP),and diamine oxidase(DAO)for diagnosing intestinal mucosal injury (IMI)in patients with intestinal obstruction.Methods The expression levels of serum HDC,I-FABP,and DAO in 28 patients with strangulated intestinal obstruction,19 patients with simple intestinal obstruction,17 patients with acute simple appendicitis,and 20 healthy control were determined by enzyme-linked immunosorbent assay (ELISA)before clinical treatment,and then the areaa under receiver operating characteristic curves(AUC)of these diagnostic indicators were compared.In addition,the incidences of systemic inflammatory response syndrome (SIRS)and infectious complications were closely observed.The difference of the expressions of HDC,I-FABP,and DAO and their relationship with SIRS and infectious complications were compared among these patients and controls.Results The expression levels of serum HDC, I-FABP, and DAO were the highest in patients with strangulated intestinal obstruction (all P < 0.001), and the expression levels of these three indicators were significantly higher in patients with simple intestinal obstruction than in those with acute simple appendicitis or healthy controls (all P<0.05).The AUC of HDC (0.913) was significantly larger than that of I-FABP (0.877, P =0.000) and DAO (0.873, P = 0.000).When the cut-off value of HDC ≥31.00 ng/ml, the sensitivity, specificity, false negative rate, and false positive rate of HDC were 74.5% , 94.6% , 25.5% , and 5.4% , respectively,which were all better than those of I-FABP and DAO.There were significant differences of the incidence of SIRS ( P = 0.046) and abdominal infection (P = 0.027) among patients with strangulated intestinal obstruction, patients with simple intestinal obstruction, and patients with acute simple appendicitis, while lung infection showed no such significant difference (P = 0.728).The expression level of serum HDC was significantly higher in patients with strangulated intestinal obstruction who were also suffered from SIRS ( P = 0.000) or abdominal infection ( P =0.002) than that of uninfected patients.Meanwhile, the expression levels of serum I-FABP and DAO were significantly higher in the SIRS patients with strangulated intestinal obstruction than that of uninfected patients ( P = 0.027, P=0.017, respectively).The expression levels of HDC, I-FABP, and DAO were significantly correlated with the incideces of SIRS and abdominal infection ( all P < 0.05 ) , among which the level of HDC and the incidence of SIRS had the highest correlation (R = 0.608, P = 0.001).Conclusion HDC can be an effective indicator for diagnosing IMI in patients with intestinal obstruction.

Objective To evaluate and analyze the effect of treatment on fractures of the clavicle with reconstruction plate or with Kirschner wire.Methods Of 56 clavicular fracture cases for treatment with surgical procedures,22 cases were fixated with reconstruction plate.34 cases were fixated with Kirschner wire.Results All 56 cases were followed up for 10~48 months,on average 21 months.Reconstruction plate fixation group:2 cases concomitant with delayed fracture healing were multiple trauma patients.The mean union time in this group was 3.6 months(range from 3 to 5 months).Kirschner wire fixation group:3 cases with wires migration.The mean union time in this group was 2.3 months(range from 2 to 3 months).According to Kalarsson's shoulder function evaluating criteria,all cases were excellent.Conclusion Surgical technique with Kirschner wire is simple and credible treatment for clavicular uncomminuted fractures.,it complys with the conception of minimally invasive technique and is a recommendable way.

Bone Diseases, Infectious ; microbiology ; pathology ; Cryptococcosis ; complications ; pathology ; Forearm ; Humans ; Soft Tissue Infections ; microbiology ; pathology

OBJECTIVE: To explore the significance of the combination of factor analysis and systematic cluster analysis in classification of traditional Chinese medical syndromes in patients with posthepatitic cirrhosis, and to provide a scientific basis for the criterion of the classification. METHODS: We designed a clinical questionnaire according to the clinical characteristics and the demands of traditional Chinese medical information collection for patients with posthepatitic cirrhosis. By means of clinical epidemiological research, with the four diagnosis methods for clinical information collection of traditional Chinese medicine, symptoms, physical signs, tongue conditions and pulse conditions in 310 patients with posthepatitic cirrhosis were collected, and the characteristics of traditional Chinese medical syndromes in these patients were explored with statistical methods, such as factor analysis, varimax and systematic cluster analysis. RESULTS: Analyzed by factor analysis and systematic cluster analysis with SPSS 11.0, the traditional Chinese medical syndromes in 287 of the 310 cases (92.58%) of posthepatitic cirrhosis could be classified. The syndromes could be divided into 7 categories, which were internal accumulation of damp-heat (55 cases), insufficiency of the spleen with overabundance of dampness (74 cases), accumulation of blood stasis plus deficiency of liver-yin and kidney-yin (73 cases), accumulation of blood stasis plus deficiency of both blood and qi (40 cases), deficiency of both blood and qi (16 cases), deficiency of yin and blood heat (6 cases) and stagnation of the liver-qi and deficiency of the spleen (23 cases). The traditional Chinese medical syndromes in the other 23 cases could not be classified. CONCLUSIONS: The clinical information collected with the four diagnostic methods of traditional Chinese medicine can be classified into different categories with the factor analysis and systematic cluster analysis. The factor analysis and systematic cluster analysis can reveal the characteristics and regularity of traditional Chinese medical syndromes in patients with posthepatitic cirrhosis in a way, and have value in researching the syndromes of traditional Chinese medicine.

An analysis of medical liability insurance practice at the hospital in the past 6 years found that medical liability insurance failed to work as expected in medical dispute prevention and risk sharing.The analysis also found that such an insurance will take a greater role in risk sharing,exposure to conflicts,cause discovery,and responsibility,with enhanced government role in guidance and intervention.Thus medical liability insurance is highly advocated by such means as compulsory execution,coordinating mechanism of insurance funding,prevention“medical dispute profiteers”,and adaptation to new approaches in medical dispute settlement.

Objective To study the influence of fluorine on signaling pathway of osteoprotegerin(OPG)/ receptor activator of NF-κB ligand(RANKL) in cultured rat osteoblasts.Methods Osteoblasts were isolated from skull of neonatal rats(＜ 24 hours) by enzyme digestion,and fluorine of different concentrations [0 (control),1 × 10-3,1 × 10-4,1 × 10-5,1 × l0-6 and 1 × 10-7 mol/L] were added into the culture medium of second generation of osteoblasts.The expressions of OPG and RANKL mRNA were determined using real-time PCR 24 and 48 hours after culturing.The expressions of OPG and RANKL protein were measured by Western blotting.Results ① After exposed to fluorine for 24 hours,the differences of RANKL and OPG mRNA expression had statistical significance between groups(F =30.95,22.62,all P ＜ 0.01),the expression of RANKL mRNA(5.99 ± 0.39) in the 1 × 10-5 mol/L group and the expressions of OPG mRNA(3.52 ± 0.09,4.81 ± 0.15,3.68 ± 0.04) in the 1 × 10-4,1 × 10-5 and 1 × 10-6 mol/L groups were higher than those of the control group(3.20 ± 0.19,3.09 ± 0.58,all P ＜ 0.05),but in the 1 × 10-3 mol/L group,RANKL mRNA(2.29 ± 0.18) was lower than that of the control group(P ＜ 0.05).After exposed to fluorine for 48 hours,the differences of RANKL and OPG mRNA expression had statistical significance between groups(F =26.62,5.72,all P ＜ 0.01),the expressions of RANKL and OPG mRNA(6.67 ± 0.49 and 5.05 ± 0.51) in the 1 × 10-5 mol/L group were higher than those of the control group(4.29 ± 0.07 and 4.34 ± 0.12,all P ＜ 0.05),and in the 1 × 10-3 mol/L group the expression of OPG mRNA(3.63 ± 0.49) was lower than that of the control group(P ＜ 0.05).② The expression of RANKL protein was not statistically significant between 24 hours and 48 hours groups (F =0.07,0.49,all P ＞ 0.05) ; the differences of OPG protein expression had statistical significance between groups(F =3.26,P ＜ 0.05),the expression of OPG protein in the 1 × 10-5 mol/L group(1.45 ± 0.10) was higher than that of the control group(1.05 ± 0.06,P ＜ 0.05) at the 24 hours.After 48 hours,the expression of OPG protein was not statistically significant(F =0.44,P ＞ 0.05).Conclusions At lower fluorine concentrations,bone formation is the main activity.But when fluorine concentration increased and time prolonged,the osteoclast differentiation and maturation are promoted,and the bone resorption is the main thing.

Objective To investigate the effects and mechanism of hypoxia on the growth and invasion of human cervical cancer Hela cells. Methods Hypoxia microenvironment was mimicked by cobalt chloride (CoCl2), in which the growth of Hela cells were determined by MTT method, the migration ability was detected by scratch test, and the expressions of HIF-1αand Vimentin protein were measured by immunofluorescence. Results The growth of Hela cells treated with 150 μmol/L of CoCl2 for 6 h was promoted. The migration ability in hypoxia group at 48 h was significantly higher than that in ordinary oxygen group. The expressions of HIF-lαand Vimentin in Hela cells in hypoxia group were significantly higher than those in ordinary oxygen group. There was significantly positive correlation between the expressions of HIF-1α and Vimentin (P < 0.05). Conclusion Hypoxia could promote the expression of HIF-lα, which then could up-regulate the expression of Vimentin , and finally enhanced the ability of invasion and metastasis of Hela cells.