Objective To investigate the diagnostic value of chromoendoscopy combined with EpCAM detection in Barrett′s e-sophagus .Methods 95 patients diagnosed BE under routine endoscopy were recruited in the study ,and in which 49 patients were stained by 2% Lugol′s solution and undergone biopsy as group A ;46 patients were undergone biopsy by routine endoscopy as group B .The expressions of EpCAM were also detected by immunohistochemical SP methods in biopsies of group A .Results 39 patients were diagnosed BE by routine histology in group A ,in which 15 Colonic type metaplasia of BE were found ,an EpCam expression was observed in 28 Barrett′s esophagus patients conformed by histology with HE staining .And 23 patients were diagnosed BE by routine histology in group B ,in which 8 Colonic type metaplasia of BE were found .Both diagnostic rate of BE and colonic type meta-plasia of BE were significantly different between group A and B .Conclusion Targeted biopsies directed by Lugol′s solution staining can improve the diagnostic rate of Barrett′s esophagus ,and diagnostic rate of colonic type metaplasia of BE can be improved fatherly by detecting the expression of EpCAM .

[Objective]To discuss incidence of nerve root stretch injury and threshold value of traction injury in lumbar interbody fusion from posterior rout approach. [Method]Totally patients were treated by lumbar interbody fusion performed with posterior approach using the safe nerve root retractor,the force of dragging nerve root and the retracting time were showed on the display device,while the latency and amplitude of the DSEP wave were measured with Keypoint to monitor the status of the neural function.JOA scores were followed up 10 days,1 month,3 months and 12 months after operation respectively.[Result]Nineteen cases occurred latency prolongation and wave amplitude digression during the operation,when the tensile strength to nerve root was(4.1? 0.45) N and accumulating strength was(42.89?2.96) N*min.The tensile force of aggravation groups exceed stable and improvement groups obviously,incidence of FBSS was higher than the other two groups.[Conclusion]Stretch injury of nerve root during operation is the main cause of earlier period FBSS after interbody fusion.Master single tensile force less than(4.1? 0.45) N or accumulating strength less than(42.89?2.96) N*min is presumed safety.

in the period from Lanuary, 1983 to June, 1990, a total of 980 cases of cor pulmonale were hospitaluzed in this institute. Among the 980, 154 cases were complicated with multiple organ failure (MOF), and 114 cases out of the 154 died with a mortality rate of 74%. Besides the heart and the lungs, the organs involved were the brain, the liver, the gastrointestinal tract, the kidneys and the blood system. It was found that MOF more often occurred in elderly persons. The older the patient is, the more the organs will be involved and the higher the mortality rate will be. Infection especially that of gram negative bacilli was the main factor to induce MOF. The combined administration of penicillin and the antibiotics of cephalosporin group was quite helpful to control the infections, which is the key step in the management of such cases, when the antibiotics of aminoglycoside group were used, special attention must be paid to the prevention of their toxic effects on the kidneys High-frequency jet ventilation is not suitable to treat cor pulmonale complicated with MOF.

Objective To investigate the clinicopathological characteristics and prognosis in patients with node-negative gastric cancer.Methods Between January 2004 and December 2013,clinicopathological characteristics of 300 patients with node-negative gastric cancer who underwent radical gastrectomy in Tianjin Medical University General Hospital were retrospectively analyzed.Results The 1-,3-,and 5-year overall survival rates for patients with node-negative gastric cancer was 80％,69％ and 63％ respectively.The univariate analysis showed that tumor size,histologic type and depth of invasion had significant effects on the survival (P ＜ 0.05).Multivariate analysis for these factors showed that tumor size (RR:1.800,95 ％ CI:1.120-2.891,P =0.015),histologic type (RR:1.982,95 ％ CI:1.291-3.042,P =0.002) and depth of invasion (RR:1.464,95％ CI:1.213-1.767,P =0.000) were independent prognostic survival factors.Conclusions Tumor size,histologic type and depth of invasion are important prognostic factors of patients with node-negative gastric cancer.

BACKGROUND:Bladder acellular matrix graft (BAMG) is frequently used for domains of tissue engineering scaffold due to its great biocompatibility and cell adhesion. OBJECTIVE:To verify the biological characteristics of BAMG after frozen and lyophilized processing. DESIGN,TIME AND SETTING:A biocompatibility experiment was performed at Shanghai Tissue Engineering Research and Development Center and Experimental Animal Department of the Sixth People's Hospital of Shanghai between May and November 2008. MATERIALS:Two New Zealand rabbits were used in this study for BAMG preparation. METHODS:After midsection of rabbit bladder,mucous membrane of urinary bladder was isolated and dipped in three-distilled water for 24 hours. Thereafter,the samples were incubated with acellular solution containing 0.1% Triton X-100 and 0.15% aqueous ammonia for 14 days. The culture medium was changed regularly. The samples in the control group were stored in 75% ethanol,while samples in the experimental group were frozen for 24 hours at -80 ℃,vacuum-dried for 24 hours,and stored in 75% ethanol. MAIN OUTCOME MEASURES:Biological characteristics of BAMG were detected using hematoxylin and eosin staining,Masson staining,and scanning electron microscopy; biological characteristics were compared between the two groups using cell adhesion test,MTT assay,and subcutaneously embedding test. RESULTS:Hematoxylin and eosin staining and Masson staining revealed that no residual cells were detected in the BAMG,and collagen was intact. Scanning electron microscopy demonstrated that cells exhibited a slit-shaped structure mainly containing collagen which was beneficial for cell adhesion. Mechanical test revealed that the BAMG after frozen and lyophilized processing not only reserved the mechanical properties of the raw BAMG,but also had a great elongation. MTT assay confirmed that cytotoxicity was grade 0,and BAMG had a good compatibility to smooth muscle cells. After subcutaneously embedding for one month,BAMGs had good adhesions to subcutaneous tissues,and muscular adhesion and vascular proliferation were observed. CONCLUSION:BAMG after frozen and lyophilized processing reserves original biocompatibility and has great elongation; therefore,it will become a useful and ideal biomaterial for tissue engineering scaffold.

Objective To investigate the feasibility,safety and clinical efficacy of acute iutestinal obstruction by laparoscopic surgery.Methods We selected 47 patients with acute intestinal obstruction implementation from August 2012 to August 2014,and used laparoscopic surgery on these cases.Results Forty-one cases of laparoscopic surgery were successfully completed,the successful implementation of the enterolysis;due to severe adhesions,laparotomy cannot be separated in three cases;two cases due to intraoperative exploration found in the tumor;one case due to surgery bleeding and laparotomy cannot be completed;no cases with serious complications and no deaths.Conclusion Laparoscopic surgery for acute intestinal obstruction is feasible and safe,with less trauma,quicker recovery,especial ly in the abdominal exploration in significant advantage,it is worthy of further promotion in clinic.

Objective To investigate the application value of perioperative enhanced recovery after surgery (ERAS) combined with laparoscopic common bile duct exploration (LCBDE) in the treatment of choledocholithiasis.Methods The clinical data of 84 patients with choledocholithiasis who were admitted to the Yijishan Hospital from January 2011 to December 2013 were prospectively analyzed.A single-blind,randomized,controlled study was performed in the 75 patients who were allocated into the control group and the enhanced recovery after surgery group (ERAS group) based on a random number table.All the patients underwent LCBDE,the patients in the control group received conventional perioperative management and the patients in the ERAS group received perioperative management according to enhanced recovery rehabilitation program.All the patients were followed up by outpatient interview till postoperative month 6.The clinical features,liver function and residual stones in the patients were observed.The operation time,postoperative complications,postoperative intestinal function recovery,duration of hospital stay and hospital expenses in the two groups were compared.Measurement data with normal distribution were presented as x ± s.Comparison between groups were evaluated with an independant sample t test.Count data were analyzed using the chi-square test.Results All the 75 eligible patients undergoing successful operation were randomly divided into the control group (35 patients) and the ERAS group (40 patients).The operation time and volume of intraoperative blood loss in the control group and the ERAS group were (185 ±46)minutes and (124 ±28)mL,(178 ±37) minutes and (114 ±32)mL,respectively,with no significant difference (t =0.729,1.431,P ＞ 0.05).There were 12,14 and 10 patients in the control group and 5,6 and 4 patients in the ERAS group with postoperative incision pain,vomit and infection,showing a significant difference (x2=5.054,5.966,4.241,P ＜ 0.05).The level of white blood cell,alanine aminotrausferase and direct bilirubin in the control group and in the ERAS group were (11.4 ± 3.5) × 109/L,(128 ± 33)U/L,(38 ±14) μmol/L and (10.6 ± 3.0) × 109/L,(135 ± 35) U/L,(44 ± 16) μmol/L at postoperative day 1,compared with (7.8 ±2.9) × 109/L,(48 ± 14) U/L,(21 ± 8) μmol/L and (6.9 ±2.1) × 109/L,(43 ± 13) U/L,(20 ±7) μmol/L in the 2 groups at postoperative day 4,respectively,showing no significant difference between the 2 groups (t =1.018,-0.872,-1.767,1.553,1.836,1.044,P ＞ 0.05).The postoperative first flatus day,time of food intake,time of postoperative infusion and duration of hospital stay were (42 ± 13)hour,(45 ±14) hours,(6.8 ±2.3)days and (11.3 ±4.5)days in the control group,and (35± 11)hours,(19 ±7)hours,(4.2 ± 1.8) days and (9.6 ± 2.4) days in the ERAS group,with a significant difference between the 2 groups (t =2.741,10.524,5.485,2.077,P ＜ 0.05).The total hospital expenses was (18 729 ± 3 127) yuan in the control group,which was significantly greater than (16 981 ±2 756) yuan in the ERAS group (t =2.574,P ＜ 0.05).The liver function of all the patients was recovered at the postoperative month 1.Four patients with residual stones in the 2 groups were detected by T-tube cholangiography,and were cured by removal of gallstones by choledochoscopy.There were no complications of the abdominal pain,jaundice and fever in all the patients till the end of follow-up.Conclusion ERAS combined with LCBDE for the treatment of choledocholithiasis is safe and feasible,with the advantages of low morbidity,quick recovery,short duration of hospital stay and less hospital expenses.

Objective To explore the use of the right hepatic pedicle to guide classification of liver neoplasms on medical imaging and the type of liver resection.Methods From January 2009 to December 2012,32 patients with a single liver neoplasm surrounding the right hepatic pedicle,including 17 patients with primary liver cancer and 15 patients with cavernous hemangioma of liver,were recruited into this study in our hospital.Using the position of the neoplasm in relation to the right hepatic pedicle on CT or MRI,these liver neoplasms were divided into 4 types:type A neoplasms which infiltrated or surrounded the right hepatic pedicle; type B neoplasms which were in the front of the right hepatic pedicle; type C neoplasms which were at the back of the right hepatic pedicle,and type D neoplasms which were between the two branches of the right hepatic pedicle.Before surgery,a simulated plan was designed on the different hepatic vascular inflow obstruction and types of hepatectomy based on the classification in medical imaging.Results The locations of the liver neoplasm were completely in line with the preoperative imaging classification.Boththe vascular flow obstruction and the types of hepatectomy correlated with the preoperative surgery simulation planning.Five patients with type A neoplasms underwent right hemihepatectomy or extended right hepatectomy; 8 with type B tumors underwent right anterior sectionectomy or mesohepatectomy; 9 with type C neoplasms underwent segment Ⅴ,Ⅵ resection; 10 with type D tumors underwent right anterior or right posterior sectionectomy.Pringle maneuver,total hepatic blood inflow obstruction and selective right hepatic blood inflow obstruction were applied according to the operation and the regional anatomical structures.All operations were smoothly carried out with an average operation time of 145 min.The average blood loss was 320 ml and 18 patients required intraoperative blood transfusion with an average blood transfusion amount of 460 ml.Postoperative complications included bile leakage (n =3),right pleural effusion (n =2) and hemorrhage (n =1).They all responded to conservative treatment.Conclusion This classification using preoperative medical imaging of the right hepatic pedical could provide important information for liver resection,and it is helpful for formulating more refined operation scheme.

Objective To investigate the prevalence of cervical human papillomavirus (HPV)infection in women with and without cervical lesions in Zhejiang province.Methods Cervical exfoliated cell samples were collected in 865 women with cervical lesions and 630 women with normal cytology from Zhejiang Provincial People's Hospital,Red Cross Hospital of Hangzhou,Maternal and Child Health Hospital of Fuyang City,and the Department of Basic Medical Sciences of Zhejiang Medical College of Zhejiang province.The flow-through hybridization technique (HybriMax) was used to detect 21 kinds of HPV genotypes.x2 and exact test were used for the comparison of HPV infection rates and genotype distributions between women with cervical lesions and those with normal cytology.Results The prevalenceof HPV infection in women with cervical lesions (27.28％,236/865) was significantly higher than that in women with normal cytology (10.32％,65/630) (x2 =65.2,P ＜0.01).In cervical lesion group,60 out of 236 HPV-positive patients (25.42％) were infected with multiple HPVs,including 42 patients infected with 2 genotypes of HPV,12 with 3 types of HPV,5 with 4 types of HPV and 1 with 5 types of HPV ; while in HPV-positive women with normal cytology,only 1 case was infected with multiple HPVs,with a rate of 1.54％ (1/65) (x2 =18.0,P ＜ 0.01).Totally 321 strains (covering 19 HPV genotypes) of HPV were obtained in cervical lesion group,including 188 (58.57％) strains of high-risk,114 (35.51％) strains of low-risk,and 19 (5.92％) strains of other types,and the most prevalent high-risk genotypes were HPV-16,HPV-58,HPV-33,HPV-52 and HPV-39.While in normal cytology group,66 strains (covering 16 HPV genotypes) of HPV were obtained,and the most prevalent genotypes were HPV-52,HPV-16,HPV-31,HPV-58 and HPV-ep8304.Conclusion The prevalence of HPV infection in women with cervical lesions is significantly higher than that in women with normal cytology,and the most prevalent genotypes of infection are HPV-16,HPV-58,HPV-33,HPV-52 and HPV-39.

Objective To observe and assess the clinicopathological significance of smooth muscle differentiation in breast cancer stromal fibroblasts. Methods A monoclonal antibody recognizing ? smooth muscle actin was used to determine the smooth muscle differentiation of fibroblasts in 69 breast cancer(BC) tissues, compared with 8 breast tissues which were removed more than 5cm from the cancer margin comfirmed without cancer cells. The relationship between the smooth muscle differentiation and clinicopathological parameters including age, tumor size, lymph node metastatic status, histological grade and ER receptor status in invasive BC were analyzed. Results Stromal fibroblasts smooth muscle differentiation was defined in 55.0% of the invasive breast cancer tissues,whereas no immunostain was demonstrated in histological normal samples. Twenty eight of the 41 cases(68.3%) with matastatic lymph nodes showed stromal fibroblasts smooth muscle differentiation,which more than that of without lymphatic metastasis group (26.3%,P