Objective To improve the accuracy of early diagnosis and choose suitable management for duodenal injury. Methods Clinical experience was summerized during recent 25 years. Results Of the 19 patierts, 14(74%) had multiple injuries. All patients were treated by operations, including 10 with primary repair , 3 with repair plus duodenumcele, and 3 with Roux-en-y duodeno-jejunostomy, 1 with pancreatoduodenectomy, 2 with modified Cogbill's method. Seventeen patients were cured successfully,and 2 died of multiple organs injuries, septic shock and multiple organ failure. Conclusions Correct treatment and appropriate operation are essential for duodenal rupture in severe multiple injuries.

Objective To evaluate surgical mangement of femoral pseudoaneurysm caused by injection of addictive drugs. Methods The clinical data of 13 cases with femoral pseudoaneurysm resulted from drugs injection were retrospectively analyzed. All cases underwent operation treatment. 1 case received aneurysmectomy and lacerative repair, and 13 cases received aneurysmctomy and vascular grafting. The grafts included autogenous saphenous vein, artificial blood vessel and so on. Results The postoperative color ultrasound Doppler detection showed that all of the vascular grafts were patent, and the limbs of all the 13 patients were salvaged. Conclusion Complete debridement,vascular reconstruction and proper treatment of complications were the key factors of treating successfully the femoral pseudoaneurysm resulted from drugs injection.

Objective To understand the effectiveness of peroral endoscopic myotomy(POEM)for achalasia and secondary severe malnutrition in children and the effectiveness of nutrition support before and after POEM.Method Treatment of POEM,nutrition support(tube feeding by percutaneous endoscopic gastrostomy three months before operation)in one case were recorded and analyzed.Results POEM was successful without any complication such as perforation,bleeding,and pneumoderm.The child suffered from fever after surgery,which was dissolved after symptomatic treatment three days later.Chest pain was relieved after changing position.The diet was changed from liquid to semifluid,and then to normal diet.The child did not have dysphagia.During the 6-month follow-up,the patient had normal diets by oral route.The weight was 32 kg before achalasia and decreased to 18 kg after 9 months(at admission);it then increased to 29 kg after short-time(12 days)parenteral nutrition and long-time(3 months)enteral nutrition by percutaneous endoscopic gastrostomy,and then the patient received POEM.His weight was 30,31,31,29,and 31 kg 1,4,6,9,and 13 months,respectively,after POEM.Conclusion POEM can effectively cure achalasia in pediatric patients and improve the quality of life.Rational enteral nutrition can improve nutrition status and facilitate a successful POEM.

Objective: To explore the effects of miR-149-3p on the proliferation, apoptosis, invasion and migration of cervical cancer HeLa cells and the possible mechanisms. Methods: HeLa cells were randomly divided into five groups, including untransfected (HeLa) group, mimic-scramble group (the negative control of miR-149 mimic), miR-149 mimic group, FOXP3 over-expression (pc-FOXP3) group, and co-transfection (mimic+pc-FOXP3) group. The targeted relationship of miR-149-3p and FOXP3 was verified by luciferase assay. The expressions of miR-149-3p and FOXP3 mRNA were tested by quantitative real-time reverse transcription PCR (qRT-PCR). The protein levels of FOXP3 were measured by Western blotting. The proliferation was detected by CCK-8; the apoptosis was tested by flow cytometry, the cell invasion was measured by transwell invasion assay and cell migration was detected by scratch assay. Results: The luciferase assay showed that miR-149-3p could target combine with FOXP3. Compared with untransfected group, the expression of miR-149-3p was increased while mRNA level of FOXP3 was decreased in miR-149 mimic group (all P<0.01). Moreover, the protein level of FOXP3 in miR-149 mimic group was lower than that in untransfected group (P<0.01), while the protein level of FOXP3 in pcFOXP3 group was higher than that in untransfected group (P<0.01); Compared with pc-FOXP3 group, the protein levels of FOXP3 in mimic+pc-FOXP3 group were reduced (P<0.01). The proliferation in miR-149 mimic group was lower than that in untransfected group (P<0.01), while the proliferation in pc-FOXP3 was higher than that in untransfected group (P<0.01); compared with pc-FOXP3 group, the proliferation in mimic+pc-FOXP3 group was decreased (P<0.01). The apoptosis rate of HeLa cells in miR-149 mimic group was higher than that in untransfected group (P<0.01), while the apoptosis rate in pc-FOXP3 was lower than that in untransfected group (P< 0.01); compared with pc-FOXP3 group, the apoptosis in mimic+pc-FOXP3 group was elevated (P<0.01). The number of invasive cells per field and wound healing rate in miR-149 mimic group was lower than those in untransfeccted group (P<0.01) while the invasive cells and wound healing rate in pc-FOXP3 group was higher than those in untransfeceted group (P<0.01); compared with pc-FOXP3 group, the number of invasive cells per field and wound healing rate in mimic+pc-FOXP3 group was reduced (P<0.01). Conclusion: miR-149-3p inhibits proliferation, invasion and migration and promotes apoptosis of cervical cancer HeLa cells via targeting FOXP3.

Objective:To explore the application of home nutrition support in children with intestinal failure.Methods:Children with intestinal failure admitted to Division of Pediatric Gastroenterology and Nutrition and Department of Pediatric Surgery in Xinhua Hospital were retrospectively enrolled since January 2009. The details of home nutrition support, nutritional status and home parenteral nutrition (HPN) associated complications were collected.Results:A total of 10 children received HPN support, 7 of whom were with short bowel syndrome (SBS) and the other 3 with pediatric intestinal pseudo-obstruction. The average length of remnant small bowel in 7 SBS children was (36.7±32.4) cm. The average age at HPN onset was (5.4±4.7) years. The average duration of follow-up was (3.1±2.1) years. The average duration of HPN was (619.5±669.1) days after (391.8±340.1) days of parenteral nutrition support in our hospital. All 10 cases started home enteral nutrition (HEN) with tube feeding (3 cases transited to oral feeding during treatment). The average duration of HEN was (536.1±429.6) days. Daily calorie intake was 104.0%±39.0% of the recommended intake according to the guideline, with 46.5%±21.3% via HPN and 57.5%±29.2% via HEN. During follow-up, 3 cases were found with severe malnutrition, 5 with moderate malnutrition and 2 with mild malnutrition. Four children suffered from catheter-related thrombosis and five children were identified with catheter-related blood stream infection. No intestinal failure associated liver disease was observed.Conclusions:HPN is feasible but needs the support of national medical insurance policy. At present, there are still frequent nutritional deficiencies and complications in HPN. Nutrition support team (NST) should provide guidance for more scientific nutrition screening and nutrition management.

OBJECTIVETo explore the effect of down-regulation of astrocyte elevated gene-1 (AEG-1) expression on cell proliferation and cell cycle of gastric carcinoma cells, and its possible molecular mechanism.

METHODSControl siRNA and AEG-1 siRNA were transfected into gastric carcinoma SGC-7901 cells. 48 h after transfection, the cells were divided into 3 groups including untransfected, siRNA control and AEG-1 siRNA transfection groups. Expressions of AEG-1 mRNA and protein in the 3 group cells were detected by real-time quantitative PCR and Western blot. The changes of cell proliferation were examined using CCK-8 kit, and the cell cycle distribution was detected by flow cytometry. Finally, expressions of cell proliferation and cell cycle related proteins were detected by Western blot.

RESULTSReal-time quantitative PCR and Western blot demonstrated that compared with the untransfected and siRNA control groups, expressions of AEG-1 mRNA and protein were significantly down-regulated in the AEG-1 siRNA transfection group (P < 0.05), but there was no significant difference between the untransfected and siRNA control groups (P > 0.05). Furthermore, in vivo experiment confirmed a significant down-regulation of AEG-1 protein in the AEG-1 siRNA transfection group (P < 0.05). In addition, AEG-1 siRNA obviously inhibited the proliferation of SGC-7901 cells at different time points after transfection with AEG-1 siRNA. The percentage of cells in G0/G1 phase in the AEG-1 siRNA transfection group [(61.26 ± 1.25)%] was significantly higher than those in the untransfected group [(46.17 ± 1.91)%] and siRNA control group [(46.46 ± 1.96)%], and there was a significant difference between them (all P < 0.001). Furthermore, the result of Western blotting revealed that down-regulation of AEG-1 expression evoked the down-regulation of cdk2 and cyclin D1 expressions and elevation of p21 expression in vitro and in vivo.

CONCLUSIONSThe inhibition of cell proliferation and cell cycle arrest mediated by down-regulation of AEG-1 expression may be closely associated with the changes of expression of cell cycle related proteins including cdk2, cyclin D1 and p21.

Animals ; Cell Adhesion Molecules ; biosynthesis ; genetics ; Cell Cycle Checkpoints ; Cell Line, Tumor ; Cell Proliferation ; Cyclin D1 ; metabolism ; Cyclin-Dependent Kinase 2 ; metabolism ; Cyclin-Dependent Kinase Inhibitor p21 ; metabolism ; Down-Regulation ; Female ; Humans ; Mice ; Mice, Inbred BALB C ; Mice, Nude ; Neoplasm Transplantation ; RNA Interference ; RNA, Messenger ; metabolism ; RNA, Small Interfering ; genetics ; Stomach Neoplasms ; metabolism ; pathology ; Transfection

ObjectiveTo determine the seroprevalence of anti-Streptococcus pneumoniae immunoglobulin G （IgG） antibody and its risk factors in the elderly attending physical examination. MethodsTwo communities were randomly selected， in which the elderly aged over 60 years attending physical examination in the community health care centers were included in the study. A questionnaire survey was conducted， companied by examination for serum anti-Streptococcus pneumoniae IgG antibody. In addition， data of physical examination was collected. Chi-square test and multivariate logistic regression were utilized to determine the risk factors associated with seroprevalence of anti-Streptococcus pneumoniae antibody. ResultsA total of 635 participants were included. The average age was （73.2±7.4） years old. Forty-nine （7.72%） participants tested positive for anti-Streptococcus pneumoniae IgG antibody. The seroprevalence differed by gender （6.49% in male and 8.86% in female）， smoking （5.48% in smokers and 8.01% in non-smokers）， history of pneumonia （7.89% in those suffered from pneumonia in the past year and 7.71% in those didn^’t have pneumonia）， history of common cold （10.38% in those had common cold in the past year and 5.87% in those didn’t have cold）， obesity （15.62% in those with obesity and 6.83% in those without obesity）. Further multivariate logistic regression showed the seroprevalence of anti-Streptococcus pneumoniae IgG significantly increased in the elderly with history of common cold （OR： 2.24； 95%CI： 1.21‒4.14）and obesity （OR： 2.81； 95%CI： 1.26‒6.26）. ConclusionSeroprevalence of anti-Streptococcus pneumoniae IgG antibody is low in the elderly attending physical examination. It warrants improving the vaccination of pneumococcal polysaccharide vaccine for the elderly with obesity and susceptibility to common cold.