Objective To analyze clinical characteristics of patients with gastrointestinal bleeding (GIB)and the death-related risk factors.Methods A retrospective analysis Was conducted in 414 patients hospitalized for GIB during a 16-year period of 1994 to 2009.Logistic regression analysis identified predictors of mortality.Results The mean age of the 414 patients is 83.5 years old,ranging from 65 to 96years old.The main causes of GIB were peptic ulcer(33.1%,137/414),gastroduodenal mucosal erosion (28.5%,118/414)and tumor(21.0%,87/414).The main symptom was melena(71.0%,294/414).Drugs that induced GIB were mainly non-steroidal anti-inflammatory drugs,including aspirin(11.1%,46/414),acetaminophen(8.9%,37/414)and indomethacin(1.9%,8/414).14%of patients(58/414) died of GIB in 30 days.The proportion of drug-induced GIB and gastroduodenal mucosal erosion caused GIB had increased significantly during the period of 2004 to 2009(P<0.05).Analysis of 30-day mortality risk showed advanced age,low diastolic blood pressure,high heart rate,low hemoglobin levels at presentation and hemorrhage volume in dead GIB elderly patients were significantly different compared with GIB elderly patients alive.Presence of severe comorbidity(heart failure and renal failure)and caused by cirrhosis and portal hypertension in GIB elderly patients were the only independent predictors of 30-day mortality (P<0.001).Conclusion Death of GIB patients occurred predominantly in elderly patients with severe comorbidities and systemic conditions at presentation.

ObjectiveTo assess the differential diagnostic value of serum intestinal fatty acid binding protein (I-FABP)in distinguishing intestinal ischemia patients from acute abdomen patients.MethodsA total of 151 patients with acute abdomen and 17 healthy controls from the PLA General Hospital were enrolled from November,2009 to August,2011. Serum I-FABP levels were measured by ELISA.According to the ROC curve,the cut-off value,sensitivity,specificity,positive likelihood ratio (PLR),negative likelihood ratio ( NLR),positive predietive value (PPV) and negative predictive value (NPV) were calculated. ResultsOf the 151 acute abdomen patients,there were 24 intestinal ischemia patients and 127 without intestinal ischemia.Serum I-FABP level in intestinal ischemia group [( 109.67 ±48.82) μg/L]was significantly higher than those in patients without intestinal ischemia [(36.78 ± 11.25) μg/L]and healthy controls[(8.33 ±6.25) μg/L]( all P values ＜0.01 ).The serum I-FABP cut-off value for the diagnosis of intestinal ischemia was 87.52 μg/L.Serum I-FABP was efficient in terms of sensitivity (0.762),NPV(0.963),PLR(3.05) and NLR (0.24) in the diagnosis of intestinal ischemia.ConclusionI-FABP is potentially useful for discriminating intestinal ischemia from acute abdomen.

Target cells K562 were labeled using two different isotopes,~(51)Cr and ~(125)I-UdR,for detecting NK activity of peripheral blood mononuclear cells in normal subjects.The NK activity was higher in ~(51)Cr release assay in comparison with ~(125)I-UdR release assay. After six-hour incubation,the percentage release of ~(51)Cr was around 60% whereas that of ~(125)I-UdR was only 30% in 20 hours. ~(125)I-UdR release could be enhanced by trypsin treatment.

Objective To study the relationship between ophthalmic changes and intracranial aneurysms.Design Retrospective case series.Participants 91 patients with intracranial aneurysms.Methods We analyzed retrospectively patients with intracranial a- neurysms hospitalized in Department of Neurosurgery,PLA General Hospital from Jan.2005 to Dec.2007.Patients with ophthalmic changes underwent digital subtraction angiography,and were treated by surgery or intervention therapy.Main Outcome Measures Dif- ferent locations,sizes of aneurysms and directions of its tops,situation of ophthalmic changes.Result 23 patients (25.27%) had oph- thalmic changes in 91 patients with intracranial aneurysms.12 cases(52.17%)harbored posterior communicating aneurysms.Aneurysms of petrosal segment internal carotid artery and paraclinoid internal carotid artery were both 2 cases(8.70%).Aneurysm of ophthalmic in- ternal carotid artery,anterior cerebral artery,middle cerebral artery,posterior inferior cerebellar artery,intracavernous primary trigemi- nal artery,carotid bifurcation was all 1 case (4.35%).The main ophthalmic demonstration of posterior communicating aneurysms was various degrees of oculomotor nerve palsy.Aneurysm of paraclinoid usually was accompanied by visual acuity decreasing,aneurysm of primary trigeminal artery by abducens nerve palsy and aneurysm of petrosal segment internal carotid artery by paroxysmal diplopia re- spectively.All patients before treatment lacked detailed ophthalmic examinations.The longest follow-up after treatment was 1 year.No improvement appeared in patients underwent intervention therapy.Patients underwent neck clipping had no or limited improvements. Conclusion Half of intracranial aneurysms patients with ophthalmic changes are posterior communicating aneurysms,and its main oph- thalmic change is oculomotor nerve palsy.The patients with intracranial aneurysms should be consultated by oculists in time.

Objective To explore the effects of iPS cells-derived chimeric thymus transplantation on T cells reconstitution and graft versus host disease of murine after allo-BMT. Methods iPS cells-derived chimeric thymus was grafted under the renal capsules of mice after allogeneic IBM-BMT. The mice were divided into three groups:IBM-BMT group, IBM-BMT+TT group and IBM-BMT+DLI group. Four weeks after BMT, T lymphocyte subsets in the peripheral blood were analyzed by flow cytometry, the degree and pathological examination of GVHD were observed, respectively. Results Percentage of CD8+T cells in IBM-BMT group, IBM-BMT+TT group and IBM-BMT+DLI group was(5.52 ± 0.83)%,(11.10 ± 1.49)%and(8.49 ± 0.82)%respectively, there was signifi-cant difference between pairwise comparisons(P<0.05), and percentage of CD4 + T cells of the peripheral blood in IBM-BMT+TT group(9.60 ± 0.69)%was significantly higher than IBM-BMT group(6.42 ± 1.40)%and IBM-BMT+DLI group(8.07 ± 0.65)%(P<0.05) . IBM-BMT group and IBM-BMT+TT group showed less clinical and histopathological scoring of GVHD than IBM-BMT + DLI group. Conclusion iPS cells-derived chimeric thymus transplantation could effectively accelerate T cells reconstitution and prevent GVHD after allo-BMT.

Objective To investigate the value of advanced virtual monoenergetic technique(mono-plus) of dual-energy CT (DECT) in improving imaging quality of the lliofemoral arteries.Methods Forty consecutive patients underwent DECT scan.Mono-plus images (40 keV),optimal monoenergy images and mixed energy images were obtained by using Siemens Syngo.via VB10A workstation.CT values,signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and subjective image quality were calculated in the abdominal aorta,iliac artery,external iliac artery,femoral artery,profound femoral artery, lateral circumflex femoral artery,transversal branch of lateral circumflex femoral artery,medial circumflex femoral artery and profound branch of medial circumflex femoral artery and compared among the three groups.Results Compared with the optimal monoenergy and mixed energy groups,CT value and CNR of the 9 arteries were significantly higher in the mono-plus group (P<0.003).SNR of the transversal branch of lateral circumflex femoral artery and the profound branch of medial circumflex femoral artery showed no significant difference (P>0.05) among the threegroups,whereas SNR of the arties bigger than the 6th grade branch were significantly lower in the mono-plus group (P<0.05).The subjective image quality in the mono-plus group was significant better than the other two groups(P<0.001).Conclusion 40 keV mono-plus technique in DECT can improve the display of lliofemoral arteries especially the small and distal branches.

OBJECTIVE:To determine serum concentrations of western medicines in patients treated with "traditional Chinese antiepileptic medicine" alone and to evaluate the curative effects.METHODS:A total of 60 epileptic patients who visited our hospital between Feb.1997 and June 2006 were subjected to plasma drug level monitoring and during which the patients were treated with "traditional Chinese antiepileptic drugs" alone.Plasma concentrations of 4 kinds of western medicin-es were determined by FPIA.RESULTS:Of the 60 cases,valproic acid,carbamazepine,phenytoin and phenobarbitone were detected in 18,40,41,and 47 cases/times,respectively.On average,more than two kinds of western medicines were detected in every patient,and the blood concentrations were mostly beyond effective plasma drug concentration.The total curative effects were unsatisfactory.CONCLUSION:The fact that western medicine ingredients detected in these traditional Chinese antiepileptic medicines is inconformity with medication principle of epilepsy.Traditional Chinese antiepileptic medicines should be used with caution in the clinic in the treatment of epileptic patients.

Objective To investigate the clinical utility of dual-energy virtual non-contrast CT(VNCT)of dual source CT in the di-agnosis and differential diagnosis of solitary pulmonary nodule(SPN).Methods Thirty-six patients with suspected SPN underwent chest plain single energy CT and dual-phase contrast enhanced CT (DECT)(25 and 90 s).The images of dual energy were sent to a commercial workstation for VNC image generation.CT values of SPN on VNC and true non-contrast(TNC),as well as signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)were compared.The accuracy of calcification detection was compared according to the diameter and density of the calcification.The TNC images were used as the reference.Results CT values,SNR and CNR of VNC had no statistical difference among TNC and VNC at 25 s and 90 s(P >0.05).DECT VNC(5mm slice)could accurate detected calci-fication(diameter>2 mm,CT value>1 50 HU)in SPN.The 2 mm slice performed significantly better than 5 mm slice VNC images. Conclusion The VNC could provide consistent diagnostic information with TNC.The thin slice DECT VNC images can be used in clinical practice to replace TNC without losing small calcification in SPN,which has potential to reduce the patient radiation dose.

Objective To investigate the clinical manifestations and mortality related risk factors in patients with acute superior mesenteric artery embolism (ASMAE).Methods Clinical data of forty-three confirmed ASMAE patients in the PLA General Hospital from June 2002 to June 2012 were retrospectively analyzed.All patients were classified into the survival group (28 cases) and the death group (15 cases)according to the prognosis.The prognosis associated factors were further analyzed.Results The study group consisted of 31 men (72.1％)and 12 women (27.9％),with average age of (63 ± 11) years.The majority patients with ASMAE in our study had history of atherosclerotic diseases.The main clinical manifestationsincluded abdominal pain [100％ (43/43)],nausea and vomitting [55.8％ (24/43)],hematochezia [32.6％ (14/43)].Abdominal CT scan was performed in 74.4％ (32/43) patients with a high positive result of 96.9％ (31/32).Weight loss occurred more frequently in survival group than in death group [32.1％ (9/28) vs 6.7％ (1/15),P =0.001].Moreover,weight loss has been shown as a protective factor for ASMAE survival (OR =0.75,P =0.038) by logistic analysis.Compared with the death group,the incidence of either peritoneal irritation sign or ascites was significantly lower in survival group [respectively 7.1％(2/28) vs 66.7％ (10/15),14.3％ (4/28) vs 73.3％ (11/15),P ＜0.05],which were two independent risk factors of mortality(OR =8.51,P =0.014 ; OR =3.07,P =0.028).The incidence of main artery embolism of superior mesentery artery (SMA) in death group was higher than that in survival group [93.3％ (14/15) vs 60.7％ (17/28),P =0.023].Main artery embolism of SMA was also an independent mortality risk factor of ASMAE patients (OR =5.05,P =0.039).A total of 18 patients were treated with enterectomy.Intestine excision length was shorter in survival group than in death group [(82.8 ± 25.2) cm vs (141.0 ± 18.1)cm,P =0.017].The time from onset to operation in survival group was shorter than that in death group [(44.8 ±29.7) h vs (69.1 ±28.0) h,P =0.013].Conclusions Patients with ASMAE based on chronic ischemia have a relative good prognosis for survival.Peritoneal irritation sign,ascites and main artery embolism of SMA were independent risk factors for death in ASMAE.Intestine excision length and the interval from onset to operation may affect the mortality of ASMAE patients.

Objective To examine an in vivo method for the differentiation of induced pluripotent stem cells (iPSCs) into thymic epithelial cells (TECs) in mice. Methods Green fluorescent protein-expressing iPS cells, derived from C57BL/6 mice, were injected into blastocysts from ICR mice. Chimeric blastocysts were then transferred into uteri of E2.5 pseudopregnant mice. Chimeric mouse could be identified by coat color 10 days after birth. The chimeric thymus was transplanted under the renal capsule of BALB/c nude mice. The spleen was cut out from the thymus-transplanted nude mice and the cells were dispersed and analyzed by a flow cytometer 4 weeks after transplantation. Results Chimeras were born 17 days after embryo transfer and 13 live-born chimeras were obtained. The contribution of iPSC-derived cells in the chimeras ranged from 5% to at most 90%. Typical thymic epithelium structure consisted of green fluorescent protein-expressing cells in chimera. The iPSCs-derived thymic epithelial cells could support the generation of new T cells. Conclusion The results indicate that mouse iPS cells can differentiate in vivo towards normally functioning TECs.