Objective To determine the detection rate of duodenal papilla and the diagnostic rate of small bowel diseases by capsule endoscopy(CE)and its possible influencing factors.Methods A total of 369 cases with suspected small bowel disease who had undergone CE were retrospectively reviewed. The de- tection rate of duodenal papilla and that of small bowel disease were calculated respectively. The detection rate of duodenal papilla in another 369 patients having received gastroscopy was also counted in order to findout the miss detection rate of forward-viewing endoscopy. The CE findings were reviewed at the rate of 1 im-age and 15 images per second by hand-motion respectively. The detection rate of duodenal papilla was calcu-lated,and the number of frames showing duodenal papilla was counted. Differences of detection rate of duo-denal papilla were also analyzed by different age and gender groups. In addition,the potential difference in detection rate of duodenal papilla between different bowel preparations before CE of two different reviewing approaches was also investigated respectively. Results The miss detection rate of duodenal papilla with for-ward-viewing gastroscopy was 22. 0%. The detection rate of duodenal papilla reviewed at the rate of 1 image by hand-motion,where less frames were needed to visualize duodenal papilla(3. 7vs7. 0),was significantly higher than that at the rate of 15 images per second(32. 2%vs13. 6%,P=0. 001). The diagnostic rate of small bowel diseases was also significantly higher than that of duodenal papilla by CE(67. 2%vs32. 2%,P=0. 000). Age and gender were not significantly correlated with the detection rate of duodenal papilla. No significant correlation was found between various kinds of bowel preparation before CE at different viewing rate and the detection rate of duodenal papilla. Conclusion It iS relatively difficult to identify duodenal pa- pilla by CE,as they are peculiarly positioned in anatomy,so the detection of duodenal papilla does not nec- essarily represent the detection rate of small bowel diseases. The major factors that influencing the detection of duodenal papilla by CE include local anatomy,viewing rate and technical limitations of CE.

objective To analyse the incidence of technical breakdown and clinical problem leading to the failure of capsule endoscopy examination and their influence on the diagnosis and to evaluate its feasibility and safety in special patient population.Methods A retrospective study of 300 consecutive patients referred to Renji Hospital for evaluation of suspected small bowel diseases between May 2002 and May 2006 was done.This included 300 consecutive patients.The median age of the patients was 51y (range,3～91Y).The young children group was defined as less than 10 years and the elderly group as more than 80 years.Technical problems were those related to the functioning of the equipment and clinical problems were those related to the patient.The incidence and the type of above-mentioned events and their influence on the diagnosis were analyzed.The safety and feasibility of the capsule endoscopy procedure were evaluated in the young children group,elderly group and patients with pacemakers,gastrectomy and Billroth Ⅱ gastrojejunostomy,intestinal diverticula,Crohn's disease and polyp of small intestine.Results A total of 300 patients were involved.The incidence of technical problems was 1.3%.including one case of failing in activating the capsule,one case of failing in loading the data and two cases of short life of battery.Failure of diagnosis was encountered in two cases.The incidence of clinical problems was 33.0%(99 cases)and they caused 35.4%(35 cases)failure of diagnosis in the 99 cases.Three patients in the young children group were unable to swallow the capsule and endoscope-guided overtube technique was used with success in all.In the elderly group.the incidence of capsule retaining in the oesophagus and stomach was as high as 23.0%.In two patients with pacemaker no interference between pacemaker and capsule was detected.In two patients with Billroth Ⅱ gastrojejunostomy uo capsule retention occurred.In 16 patients with diverticulum,capsule retention occurred in 1 case(6.0%).In 42 patients with Crohn's disease,capsule retention occurred in 5 cases.No acute gastrointestinal obstruction was found in the 42 patients with Crohn's disease and in 5 patients with polyp of small intestine.Conclusions With capsule endoscopy technical mistakes causing failure were very rare.The majority of the clinical problems were related to the inability capsule to reach the colon during the recording time.Capsule endoscopy provides a well-tolerated,safe and effective tool to investigate the gastrointestinal diseases.especially some small bowel diseases.

Objective To evaluate the safety and effectiveness of capsule endoscopy(CE) in a large cohort of the elderly patients with obscure gastrointestinal bleeding(OGIB). Methods The demographic, clinical and diagnostic data of all geriatric patients with obscure gastrointestinal bleeding who underwent CE between May 2002 and February 2007 were retrospectively analyzed. For comparison, non-geriatric patients with obscure gastrointestinal bleeding who underwent CE during the same period were selected as the control group. Results Ninety-seven geriatric patients [40men/57 women, mean age (70.84-6.8) yrs]and ninety-nine non-geriatric patients [61 men/38women, mean age (44. 4±10. 3) yrs)were retrospectively reviewed. Eighty-nine patients presented with overt OGIB while eight patients had occult OGIB in the geriatric group. The section in the nongeriatric group was ninety-one and eight respectively. No significance was seen in the gastric transit time, completion rate and delay rate between two groups. The small bowel transit time was significantly longer in the geriatric group than that in the non-geriatric group (P<0. 05). Sixty-two patients in the geriatric group obtained positive diagnosis and angiodysplasia was the most frequent lesion;while sixty-seven patients in the non-geriatric group obtained positive diagnosis and Crohn's disease was the most frequent lesion. No significance was seen in the positive diagnostic rate between two groups (P>0. 05). However, the constituent ratio of the positive diagnosis was significantly different between two groups (P<0. 01). Conclusions CE is a safe and effective procedure for geriatric patients with obscure gastrointestinal bleeding. Angioectasia accounts for the majority of positive findings in geriatric group.

Objective To evaluate the Chinese decoction prescriptions combined with incision drainage operation in treatment of perianal abscess after leukemia chemotherapy.Methods One hundred cases of perianal abscess after leukemia chemotherapy were randomly divided into two groups,treatment group (Chinese decoction prescriptions combined with incision drainage operation) and control group (potassium permanganate combined with incision drainage operation).Observe and record the efficacy and ache alleviated after treatments,recurrences were followed up in and 3 years.Results After the treatments,the total effective rate was 90.0％ in the treatment group,significantly more than control group(72.0％),the difference was significant(x2 =10.52,P ＜ 0.05).And treatment after a week the VAS score in the treatment group and control group were(2.2 ± 0.4) and(4.7 ± 1.2),(t =14.62,P ＜0.05).The healing time were(13.4 ±9.3) d and(19.8 ±11.6) d,(t =4.95,P ＜ 0.05).After 3 years follow-up the recurrence rate and fistula formation rate in the treatment group and control group were 2.0％ and 2.0％,22.0％ and 26.0％,(x2 =18.93 and 23.92,P ＜ 0.01).Conclusion Chinese decoction prescriptions could collaborative incision drainage operation treatment of perianal abscess after leukemia chemotherapy,effective and safe,suitable for extensive application and promotion.

Objective To investigate iron deposition level in patients with ischemic cerebrovascular disease and its correlation with cerebral small vessel disease (CSVD) imaging markers.Methods A total of 74 patients with first-ever transient ischemic attack (TIA) (median age:69 years old;30 males,44 females) and 77 patients with positive ischemic stroke history (median age:72 years old;43 males,34 females) were studied retrospectively.On phase image of susceptibility weighted imaging (SWI),regions of interest (ROIs) were manually drawn at the bilateral head of the caudate nucleus (CN),lenticular nucleus (LN),thalamus (TH),frontal white matter (FWM),and occipital white matter (OWM).The correlation between iron deposition level and the clinical and imaging variables was also investigated.Results Iron deposition level at LN was significantly higher in patients with previous stroke history (P ＜ 0.05).It was linearly correlated with the presence and number of cerebral microbleed (CMB) but not with white matter hyperintensity (WMH) and lacunar infarct.Conclusions Ischemia may cause iron deposition elevation at basal ganglia,and LN may be more susceptible to ischemia-induced alteration.CMB may be an independent risk factor for higher iron deposition.

目的观察脑血管病康复治疗的临床疗效。方法将244例急性脑血管病患者随机分成康复治疗组和药物治疗组各122例,药物治疗组给予常规药物治疗,康复治疗组在药物治疗的基础上实施康复治疗,疗程30天。治疗前后分别用简式FMA和改良Barthel指数评定患者的运动功能和日常生活活动能力(ADL)。结果康复治疗组患者运动功能和ADL的改善程度明显好于药物治疗组(P<0.01)。结论急性脑血管病在药物治疗的基础上,早期实施康复治疗可明显提高患者的运动功能和ADL。

Aim To establish method and main evaluation indexes of collagen induced arthritis ( CIA) model in DBA/1 mice. Methods CIA was induced by chicken type Ⅱcollagen ( C Ⅱ) in DBA/1mice. Arthritis was evaluated by arthritis index. X-ray of the paws was taken. Histology pathology of ankles and spleen was observed and scored. Results Immunization d31,the paws of CIA mice appeared red and swelling,the scores of arthritis index increased,the period of swelling peak was from d40 to d60; immunization d35,the weight of CIA mice began to decrease. X-ray of paws showed that the paw joints of CIA mice deformed,and there was osteophyte formation associated with osteolysis. Histo-logical pathology of ankle joints showed that the synovium of CIA mice were hyperplasia,cartilage was destroyed,pannus was formed,and inflammatory cells infiltrated into synovium. Histological pathology of spleen showed more germinal centers and lymphoid follicular hyperplasia were observed,cell density of lymphatic sheath increased,scores of ankle joints and spleen histological pathology in CIA mice were higher than those in normal mice significantly. Conclusions The methods of CIA model induced by chicken C Ⅱ in DBA /1 mouse were reliable and reproducible. CIA incidence was high. Arthritis index,X-ray of paws,ankle joints and spleen histological pathology and so on were the principal indexes of evaluation for CIA model.

OBJECTIVE To investigate the situation of prevalence for extended spectrum ?-lactamases(ESBLs)genes in multidrug-resistant Pseudomonas aeruginosa(PA). METHODS Antimicrobial susceptibility test was performed by agar dilution method and 7 kinds of ESBLs genes were detected by PCR methods in 35 strains of PA. RESULTS In 35 strains of PA, the positive rates of genes of TEM, OXA, PER and GES were 51.4%, 42.8%, 31.4%, and 22.9%, respectively, and genes of SHV, VEB, and CTX-M-1 were all negative. CONCLUSIONS This study shows that there are high positive rates of TEM, OXA, PER and GES genes in PA in our hospital. The GES genes in PA are first reported in China.

Objective To evaluate the correlation of ADC values on 3.0 T MR with the pathological grades in pT1b clear cell renal cell carcinoma(CCRCC).Methods Conventional MR images,ADC values and Fuhrman pathological grading of pT1b CCRCC were performed in 30 patients.Grade Ⅰ and Ⅱ were defined as low-grade group; grade Ⅲ and IV were defined as high-grade group.The differences of ADC values among four different pathologic grades were compared with a one-way analysis of variance. The comparison of ADC values of two different grade groups was performed with t test,and the ROC curve was performed to evaluate the diagnostic efficacy of ADC value. Correlation between pathological gradings and ADC values was assessed with Spearman rank correlation analysis. Results ( 1 ) The mean ADC value of grading Ⅰ ( 10 patients ), Ⅱ ( 8 patients ),Ⅲ ( 7 patients ),IV ( 5 patients ) was ( 0.94 ± 0.11 ) ×10-3 mm2/s,(0.82 ±0.13) × 10-3 mm2/s,(0.68 ±0.09) × 10-3 mm2/s,(0.59 ±0.03) × 10-3 mm2/s,respectively.Significant differences of ADC values among the four grades were present (F =16.422,P =0.000 ).( 2 ) The mean ADC value of the low-grade group was significantly higher than that of the high-grade group(t =5.738,P =0.000).Sensitivity and specificity of diagnosing the low-grade group was 88.9％ and 83.3％ respectively.There was a negative correlation between pathological grading and ADC value ( r =-0.807,P ＜ 0.05). Conclusions The ADC values of pT1b CCRCC have close correlation with pathological gradings.They can be used to predict the degree of tumor malignancy preoperatively and guide surgical planning.

Objective To investigate the risk factors for conversion of laparoscopic cholecystectomy (LC) to laparotomy.Methods In 1020 LC patients,36 patients with conversion of LC to laparotomy were chosen as the case group,108 patients with successful LC were chosen as the control group.Univariate analysis and Logistic multivariate regression model were used to analyze the risk factors for conversion of LC to laparotomy.Results Age ＞ 65 years (0R=3.234,95％ CI:0.532-6.853),course of disease ＞ 72h (OR =2.342,95％ CI:0.568 ～ 5.656),history of upper abdominal operation (OR =2.453,95％ CI:0.345-7.453),thickness of gallbladder wall ≥ 6 mm (OR =2.453,95％ CI:0.453-6.343),white bloodcell count ＞ 15.0 × 109/L (OR =4.532,95％ CI:0.535-8.329) were risk factors for conversion of LC to laparotomy.Conclusion Preoperative comprehensive evaluation the risk factors and selecting suitable program have important clinical significant in reducing the rate of conversion LC to laparotomy.