Objective　To study the clinical features, diagnosis and treatment of multiple primary cancer of digestive tract (MPCDT). Methods　The clinical data of 33 cases of MPCDT were analysed retrospectively. Results　The incidence of MPCDT was 2.7% in all patients with primary cancer of digestive tract. 24 cases was synchronous carcinoma (SC), of whom, 20 was misdignosis. All the cases of SC received comprehensive treatment, including radical resection, traditional medicine and radiotherapy respectively. 9 cases were metachronous carcinoma (MC), of them, only 1 case misdiagnosed. All the MC cases received radical resection, palliative resection and radiotherapy. The 5-year survival rate in cases of MPCDT, SC and MC were 45.4%, 37.5% and 55.5% respectively. Conclusions　The incidence of MPCDT is low, but misdiagnosis rate is hight. For MPCDT, comprehensive treatment, and radical resection and re-operation should be done. It is advisable not to diagnose MC as recurrence or metastasis.

[Objeetive]To report the repairing offect of cancellous bone defect with calcium sulphate.[Method]A defect 5mm in diameter and 12 mm in deep,which was drilled in the lateral aspect of rabbit lateral femoral condyle,was filled with CCaS(Citrated Calcium Sulphate)cylinder or Osteoset tablets respectively.Rabbits were killed 3,6,13 weeks after surgery.And then general oberservations and mechanical analyzing were conducted.[Result]After surgery,rabbits had good movements,spirits and eating,good healing of incision.There was no arthroedema and inflammatory response around the joints.Mechanical analyzing reports:both anticompressive strength and elasticity coefficient in the artificial bone repair bone defect area 3 weeks after surgery,were higher than in that of normal femur condyle;Anti-compressive strength and elasticity coefficient in the defect area 6 weeks,which drop comparing to 3 weeks,was lower than that of normal femur condyle;Anti-compressive strength and elasticity coefficient 13 weeks,which is higher than 6 weeks,is approaching normal.Mechanics intensity of two groups in the different time had no significant difference,but was significantly higher than one of the same time blank group.[Conclusion]To some extent,Calcium Sulphate has mechanical supportive effects on cancelloues bone defect in spite of the absorption and degradation of Calcium Sulphate.There is no significant difference between Citrated Calcium Sulphate and Osteoset tablets.

Objective Approaching characteristic of syndrome of type 2 diabetes mellitus affiliated metablic syndrome, usage of herbs based on the theories of relationship between formula (herbs) and syndrome. Methods Gathering 265 cases coming from multicentric clinic cases, feature of syndrome and classify would be approached by means of free-scale networks. Result Herbs of supplementing Qi and nourishing Yin is its foundation, effectiveness of herbs showed tendency in eliminating heat nourishing yin, then supplementing Qi and nourishing yin, eliminating heat, and invigorate vital energy promoting blood flow, warming yang, dissipating hygrosis for diuresis. Honey-fried radix astragal, pseudostellariae are important herbs, rehmannia dried rhizome, fructus schizandrae, chuanxiong, angelicae sinensis paeoniae rubra ophiopogonis tuber, anemarrhenae are correlation with them. Conclusion Deficiency of vital energy, Yin asthenia are fundamental syndrome of type 2 diabetes mellitus affiliated metablic syndrome. Early, Yin asthenia and excessive heat are cardinal. Intermediate stage, deficiency of vital energy Yin asthenia are fundamental. Meanwhile excessive heat, phlegmatic hygrosis and stagnated blood existed together. Advanced stage, deficiency of vital energy and stagnation of blood are main syndrome. Yang asthenia, phlegmatic hygrosis, retention of fluid in the body are affiliated syndrome frequently. Drug for invigorating blood circulation and eliminating stasis penetrated through the courses all the while.

Objective_To investigate the effect of estrogen(E2) on different age rat groups of Parkinson’s disease (PD) models induced by Rotenone and its mechanism.Methods_24-month-old SD rats(high age group)and 12-week-age SD rats( low age group ) were divided into control group ( saline ) , Rotenone treatment group ( Rotenone 2 mg/kg), Estrogen treatment group(Rotenone 2 mg/kg and E2 1 mg/kg)and Tamoxifen treatment group(Rote-none 2 mg/kg, E2 1 mg/kg and Tamoxifen 1 mg/kg).Behavior tests were carried out to observe the change of movement function, Immunohistochemistry and Western blot were used to assess the changes of TH and LC-3. HPLC-ECD was used to detect possible changes of monoamine neurotransmitters in striatum.Results_1) Rotenone reduced significantly old age rat’s rotarod latencies and prolonged the climbing pole time(P<0.05).E2 ameliorated this effect, Tamoxifen reduced the effect of E2.2) Rotenone significantly reduced the number of TH positive cells in
high age rats(P<0.05), E2 partly restored TH positive cell loss, Tamoxifen reduced this effect of E2, so did the ex-pression of TH protein.3)Rotenone increased the expression of LC-3(P<0.05), E2 did not affect the expression of LC-3, so did Tamoxifen.4)Rotenone significantly decreased the level of DA and its metabolite DOPAC(P<0.05), elevated the level of 5-HT especially in old rats(P<0.05).E2 downregulated the influence, and Tamoxifen reduced the effect of E2.5)Rotenone increased the number of autophagosomes, but E2 increased the proportion of autolyso-somes/autophagosomes.Conclusions_Old age rat PD model was more reliable.Estrogen promoted autophagy ma-ture, and had obvious therapeutic effect on rat PD model induced by rotenone.

Cardiopulmonary resuscitation is the most comonly used method facing cardiac arrest.The 2010 CPR guidelines emphasized high quality chest compressions and recommended continuous compression for 2 minutes after defibrillation to minimize interruptions in compressions.However,starting chest compressions immediately after a defibrillation shock may be harmful,if the heart is providing spontaneous beats and being subjected to external compressions at the same time.So it is very important to recognize ROSC during CPR,the methods of which include touching the pulse,amplitude spectral area,partial pressure end-tidal carbon dioxide,coronary perfusion pressure,central venous oxygen saturation,chest compression fraction,regional cerebral oxygen saturation,photoplethysmography,conjunctival oxygen tension,transthoracic-impedance plethysmography and echocardiography.This paper gives a review of the ROSC prognosis and recognition methods during CPR.

ObjectiveTo evaluate the value of modified early warning score (MEWS) in predicting mortality of critically ill patients admitted to emergency department.Methods A prospective cohort study was conducted. Clinical data of emergency patients admitted to resuscitation room of Peking Union Medical College Hospital from Feburary 13rd, 2014 to April 20th, 2014 were collected, and their MEWS were calculated based on medical records and their clinical outcomes was followed. Incidence of primary outcome (3-day mortality) and secondary outcome [all deaths and composite outcome of intensive care unit (ICU) transfer, cardio-pulmonary resuscitation, and death] were compared between MEWS positive (MEWS≥5) or negative (MEWS 0-4) patients, and multi-regression logistic analysis was done to look for the impact factors of primary outcome in these patients.Results 176 patients, among them 98 (55.68%) were male, were enrolled in the study. Their mean age was (56.86±21.46) years old. Mean MEWS was 4.30±2.74. There was 74 cases in MEWS positive group, and 102 in negative group. Primary endpoint occurred in 41 patients, and the 3-days mortality in MEWS positive group was significantly higher than that in MEWS negative group [37.84 (28/74) vs. 12.74% (13/102), odds ratio (OR) = 4.167, 95% confidence interval (95%CI) = 1.973-8.804,P< 0.001]. At the meantime, incidence of all death [54.05% (40/74) vs. 17.65% (18/102),OR = 5.490, 95%CI = 2.770-10.883,P< 0.001] and the incidence of ICU transfer, cardio-pulmonary resuscitation and death [64.86% (48/74) vs. 25.49% (26/102),OR = 5.396, 95%CI = 2.809-10.366,P< 0.001] were also significantly higher in MEWS positive group as compared with negative group. Multi-regression logistic showed abnormal mental status (OR = 3.606, 95%CI = 1.541-8.436,P = 0.003) but not MEWS≥5 (OR = 1.672, 95%CI = 0.622-4.494,P = 0.308)was the predictor of 3-day mortality in emergency admitted critically ill patients.Conclusions Although the incidence of severe adverse events is significantly increased in patients with MEWS≥5 compared with those with MEWS 0-4, MEWS≥5 cannot be an efficient predictor for 3-day mortality. Abnormal mental status shows some predictive value for early mortality in critically ill patients seen in emergency department.

BACKGROUND: Seed cell exerting its function is required to depend on the extracellular matrix in tissue engineering, so that biocompatible material is important to be selected. OBJECTIVE: To prepare a novel composite scaffolds of chitosan/collagen/nano-hydroxyapatite (HA-CS/Col/nHAP) and to optimize the technology of tissue engineered-stents according to the circumstances of cell adhesion.METHODS: Chitosan was modified by hyaluronate acid. The structure was observed by differential scanning calorimetry and the Fourier transformed infrared spectroscopy. Three composites of HA-CS/Col/nHAP according to different ratio of chitosan and collagen solution (1: 2; 1: 1 and 2: 1) were prepared. The composite scaffolds were co-cultured with osteoblast MC3T3-E1, and the proliferation and cell growth curve were measured by CCK-8 method. RESULTS AND CONCLUSION: Hyaluronic acid and chitosan were crosslinked with amide linkage. Pore size was on the range from 50 μm to 250 μm. Porosity was increased with increased collagen level and elastic modulus, but density was reduced. Increased collagen content was beneficial for cell adhesion and proliferation on stent in the primary phase of cell co-culture. However, from day 10, no significant difference was determined among three samples. At the beginning of cell culture, cells adhered to the airspace insides the composite scaffolds. In the following days, cells grew in a colony manner, and cell-cell junction could be easily observed. These indicate that HA-CS/Col /nHAP composite scaffolds can improve the adhesion and proliferation of osteoblast. The ratio of chitosan to collagen volume at 1: 1 was optimal.

Objective To investigate the effect of hypercapnia on hypoxic-ischemic brain injury in rats.Methods Forty-eight adult male SD rats were randomly divided into three groups: sham group (group S), hypoxic ischemic group (group HI) and hypercapnia group (group HP), n=16 in each group.Levine`s model was used to cause hypoxic-ischemic brain injury.In group S, the left common carotid artery was separated without ligation for 1 h, then ventilation with air maintaining the normal levels of PaO2 and PaCO2 for 3 h.In group HI, the left common carotid artery was separated and ligated for 1 h, PaO2 was maintained at 30-49 mm Hg by ventilating with low concentration (11%-13%) O2 for 3 hours.Based on group HI, PaCO2 in group HP was maintain at 60-80 mm Hg by inhalation of mixture gas containing (11%-13%) O2-8%CO2-N2 for 3 hours.FITC-dextran was used to measure the permeability of blood-brain barrier, TUNEL staining were used to observe the changes in the structure of the cerebral cortex.The expressions of aquaporin AQP4 and RECA-1 in cerebral cortex were detected by immunofluorescence and western blot.Results The level of brain water content, permeability of blood brain barrier and AQP4 expression were significantly increased in group HP as compared with group S and group HI (P<0.05).The histopathologic damage,as well as neuronal apoptotic index were aggravated in group HP as compared with group HI (P<0.05).Conclusion Hypercapnia may aggravate the brain damage during severe hypoxic-ischemic brain injury.This may associate with the increased expression AQP4 and the damage of blood-brain barrier.

BACKGROUND: The presence of ischemic penumbra in hypertensive cerebral hemorrhage is the hot spot and still controversial. The value of 4,9-diaza-2, 3, 10, 10-tetramethydodecan-2, 11-dione dioxime (HL91) tagged with 99Tcm on detecting the hypoxic brain tissue surrounding the hypertensive cerebral hemorrhage nidus, which represents the penumbra is still waited for confirmation.OBJECTIVE: To investigate the value of 99Tcm-HL91 single photon emission computed tomography (SPECT)/CT imaging on detecting hypoxic tissue in the patients with hypertensive cerebral hemorrhage.DESIGN: Control study.SETTING: Department of Neurology, Jiangmen Municipal Central Hospital, Guangdong Province.PARTICIPANTS: This series included 22 patients with hypertensive cerebral hemorrhage examined between March 2004 and March 2005 in Jiangmen Municipal Central Hospital. All cases revealed sudden onset of the disease, presented with the history of hypertension. These patients were diagnosed with hypertension after admission. The hemorrhage occurred in the anterior circulation territory in all cases and the volume of hemorrhage ranged from 10 mL to 63 mL. Minimally invasive stereotaxic aspiration was performed in 3 cases, craniotomy debridement in 1 case, and expectant treatment in the remaining cases. The period of time from the symptom onset to the examination was form 12 hours to 1.5 years, including more than 1 month in 5 cases. Control group consisted of 6 cases were clinically diagnosed with melancholia and anxiety disorders. Cerebral hemorrhage and acute cerebral infarction were ruled out by integrated CT scan in these 6 cases.METHODS: All 22 patients with hypertensive cerebral hemorrhage and 6 normal controls underwent 99Tcm-HL91 SPECT imaging and combined with CT scan.MAIN OUTCOME MEASURES: ① Identification of radioactive concentrations at one side of the peripheral zone of the lesions by visual analysis on two consecutive slices at two different axial directions were considered aspositive hypoxic imaging. ② The other was ROI semi-quantification measuring radiocounting ratio (R) between the region of visible radioactive concentrations, the center of the nidus, and their contralateral mirror region. R ＜ 0.8 or R ＞ 1.2 was considered to be abnormal. ③ Hypoxic region was defined by integrated CT fused imaging, and its volume was calculated using Xelerix workstation. The volume of the hypoxic tissue and hemorrhage was computed by Duotian formula: length of the maximum cross-section of the hemorrhage × width × slice number × 1/2.RESULTS: All 28 patients were involved in the final analysis. ① Perihemorrhagic radioactive concentrations which represented positive hypoxic imaging was revealed on 99Tcm-HL91 SPECT imaging in 18 cases out of 22 patients with cerebral hemorrhage, and positive rate was 77.78%. Bilateral cerebral hemisphere showed symmetric negative imaging in 6 cases of the control group. ② The fused SPECT/CT images revealed hypoxic region was around the intracerebral hemorrhage, small portion was within the nidus of hemorrhage with irregular shape. R value was 1.75±0.10 in perihemorrhagic hypoxic region in 18 cases with positive imaging, and R value was 1.05±0.11 in the basal ganglia in the control group. There was statistically significant difference between the two groups (P ＜ 0.01). ③ There was a positive linear correlation between maximum volume of hematom and hypoxia volume (correlation coefficient: r=0.7517, P ＜ 0.01).CONCLUSION: Relying on the mechanism about demonstrating the hypoxic tissue on fused SPECT/CT imaging, the hypoxic tissue would represent the penumbra may exist in the territories located around the cerebral hemorrhage. The positive territories may be reversible, I.e. The important portion of the penumbra. 99Tcm-HL91 SPECT/CT imaging can detect the hypoxic tissue surrounding the cerebral hemorrhage. The volume of hypoxic tissue is correlated with the hemorrhagic volume. The procedure is promising and could be applied in clinic.

Objective To prepare a novel bioactive and degradable scaffold with mineralized collagenpolyose based composite by biomimetic synthesis for bone tissue engineering and explore the compatibility of osteoblast culturing on the scaffold.Methods Using the cross-linking product of collagenⅠ and sodium hyaluronate as the template,the calcium phosphate was deposited on it to produce a mineralized composite.The 3-D porous scaffolds were prepared by liquid phase separation after the mineralized composite combining with polylactic acid (PLA) and NaCl.The materials and scaffolds were investigated by x-ray diffraction (XRD),scanning electronic microscopy (SEM) and universal testing machine.In addition,inverted microscope,fluorescence microscope,SEM,Cell Counting Kit-8 assay and alkaline phosphatase (ALP) assay were introduced to analyze the growth,function and compatibility(morphology,proliferation and differentiation ) of osteoblast-like cell on the scaffolds.Results The degree of hydroxyapatite (HA) crystals in the composite was low and the size was tiny,which were similar to that of nature bone.The SEM micrographs showed that the scaffolds possessed 82% of porosity and the pore size was about 200 μm to 650 μm.Cells on the scaffolds spread well and presented a high proliferation rate and differentiation level.Conclusion The novel scaffolds are simiar to nature cancellous (spongy) bone both on structure and in property and might be used as one of the optimal scaffolds material for bone tissue engineering.