Objective To explore the use of gastroscopy and CT for staging and clinical guiding to the surgical therapy of advanced gastric cancer.Methods The preoperative gastroscopic and CT classification and the results of operative classfication of 182 cases of advanced gastric carcinoma were compared.Results The resection rate for low and undifferentiated adenocarcinoma and mucinous carcinoma on gastroscopic biopsy was low(64.1%),and the rate for diffuse infiltrative gastric carcinoma(6.7%)was significantly lower than that of mass tumor type(66.7%)and ulcerative type(61.8%).The total accuracy rate of CT staging was 91.21%.Sensitivity rate of CT diagnosis of perigastric invasion and/or metastasis was 72.22%.For lymph node staging the accuracy rate of CT was 74.2%,sensitivity rate was 74.1% and specificity rate was 74.3%.CT diagnosis of lymph node groups was blur.Conclusions Gastroscopy has an unreplaceable role in the final diagnosis of advanced gastric cancer and has significance for gross tumor grading,histologic biopsy diagnosis can be as a guide to dicide the treatment modality of advanced gastric cancer.CT has high degree of value for accuracy of clinical staging,and diagnosis of invasion of adjacent organs and lymph node metastasis.CT is superior to gastroscopy for judgement of resectability.Therefore,preoperative CT is a valuable guide for surgical treatment of advanced gastric cancer.

Objective To assess the relationships among the autologous serum-induced skin wheal-andflare reaction,ex vivo serum-induced basophil histamine release, and serum levels of IgG anti-FcεRI autoantibodies in patients with chronic idiopathic urticaria (CIU).Methods Sixty patients with CIU collected from the Renmin Hospital of Wuhan University were recruited for this study.Sera were obtained from the subjects,and ASST was performed in all of the subjects.The results of ASST were determined according to a recommended criterion described by Sabroe et al,and the positive results were further subclassified into wheal plus flare (W+F) pattern and wheal-only (W) pattern,negative results into flare-only (F) pattern and no response pattern.Enzyme linked immunosorbent assay was used to quantify the content of histamine released by autologous serum-induced basophils and serum levels of IgG anti-FcεRI autoantibodies.Results Of the 60 patients,19 (31.7％)were positive for ASST,including 16 (84.2％) presenting W+F pattern and 3 presenting W pattern; 41 were negative for ASST,including 3 (7.3％) giving F pattern and 38 giving no response pattern.The histamine release rate was significantly higher in ASST-positive patients than in ASST-negative patients (33.38％ ± 9.83％ vs.4.06％ ±1.44％,t =5.13,P＜ 0.01),and was nearly twice as high as that in basophils induced by 10 μmol/L formylmethionyleucylphenylalanine (Fmlp).The serum levels of IgG anti-FcεRI autoantibodies were high in only patients giving (W+F) pattern (757.64 ± 168.99 ng/L),but low in the normal human controls (43.25 ± 16.63 ng/L).Conclusions The positive ASST result of wheal plus flare pattern is associated with high serum levels of IgG anti-FcεRI autoantibodies,and is suggestive of a clinical diagnosis of autoimmune chronic urticaria (ACU).

Objective:To compare the clinical outcomes between pedicle screw internal fixation via the Wiltse approach and conservative treatment in young patients with thoracolumbar fracture with Thoracolumbar Injury Classification and Severity score (TLICS) ≤ 4 points.Methods:This retrospective study included 219 young patients with thoracolumbar fracture with TLICS score ≤ 4 points who had been treated from January 2014 to December 2018 at Department of Orthopaedics, The Second Hospital of Shanxi Medical University and obtained full follow-up. They were assigned into a surgery group of 126 patients subjected to pedicle screw internal fixation via the Wiltse approach and a conservative group of 93 patients subjected to conservative treatment. The surgery group included 65 males and 61 females, aged from 18 to 37 years, with a TLICS score of 1 point in 38 cases and of 2 to 4 points in 88 ones; the conservative group included 48 males and 45 females, aged from 19 to 38 years, with a TLICS score of 1 point in 29 cases and of 2 to 4 points in 64 ones. Patients in both groups underwent thoracolumbar X-ray, CT and MRI before treatment and regular thoracolumbar X-ray reexamination after treatment. Improvements in visual analog scale (VAS) for low back pain were compared between pre- and post-treatment. The 2 groups were compared in terms of VAS, anterior height of the injured vertebra and kyphosis cobb angle between pre-treatment, one month post-treatment and the last follow-up.Results:The 2 groups were comparable due to insignificant differences between them in the pre-treatment general data ( P>0.05). In the surgery group, patients were followed up for 24 to 72 months, the average VAS scores at one month post-treatment (2.5±1.2) and the last follow-up (2.3±0.8) were significantly improved compared to the pre-treatment value (6.8±2.1) ( P<0.05), and no serious surgical complications occurred. In the conservative group, patients were followed up for 30 to 65 months, the average VAS scores at one month post-treatment (3.9±1.9) and the last follow-up (3.5±0.9) were significantly improved compared to the pre-treatment value (6.2±2.0) ( P<0.05), and the rate of complications was 11.8% (11/93, including 3 cases of neural symptoms of the lower limb, 4 cases of bedsore and 4 cases of pulmonary infection). The VAS, anterior height of the injured vertebra and kyphosis cobb angle at one month post-treatment and the last follow-up in the surgery group were all significantly better than in the conservative group ( P<0.05). Conclusion:In young patients with thoracolumbar fracture with TLICS ≤ 4 points, pedicle screw internal fixation via the Wiltse approach can lead to better therapeutic outcomes than conservative treatment, especially in relief of postoperative low back pain.

Objective To evaluate the relationship between fatty liver disease and liver metastases from colorectal cancer.Methods Eight hundred and ninety patients with colorectal cancer,who were submitted to hospital from 1993 to 2002 and had complete clinical data,were retrospectively analyzed.Of 890 patients,127 were diagnosed as fatty liver(FL)by ultrasonography,and the other 763 who were without fatty liver were served as controls(NFL).The clinical data including pathology,liver matastasis or mortality after surgery were analyzed.The survival rate and liver matastasis after surgery were followed up and statistically analyzed.Results The liver metastases was lower in FL group than that in NFL group(7 cases vs 102 cases,P=0.012).The tumor size was smaller in FL group than that in NFL group[(4.15±1.80)crn vs(4.77±2.25)cm,P=0.0016].The Dukes B(247/732,33.74%)and C(232/732,31.83%)patients were more common in NFL group,whereas Dukes A(41/121,33.61 %)and B(40/121,32.77%)were more common in FL group with significant difference(P＜0.05).No significant difference was found in 7-year survival rate between two groups who had been followed up(P=0.3024).Conclusion The lower incidence of liver metastases is found in FL group,which indicate that fatty liver disease may inhibit liver metastases from colorectal cancer by underlying mechanisms.

BACKGROUND:Cel membrane microparticles CD31 and CD54 lead to microvascular injury in the femoral head by mediating vascular inflammatory response, promoting blood clotting, affecting vasomotion and promoting vascular endothelial injury. Studies have verified that membrane particles play an important role in steroid-induced necrosis of the femoral head, but there is no studies concerning relationship between microparticles and alcohol-induced avascular necrosis of femoral head. METHODS/DESIGN:This is a randomized control ed animal study. Healthy male Wistar rats wil be randomly assigned to two groups. In the model group, rats wil be intragastrical y administered hard liquor for 6 consecutive months to prepare models of alcohol-induced avascular necrosis of the femoral head. Blank controls wil be intragastrical y given an equal volume of physiological saline. In 1-6 months of intervention, six rats wil be randomly selected from each group every month. Blood wil be col ected separately. Flow cytometry wil be used to detect serum cel membrane particles CD31, CD54 levels. Bilateral femoral head wil be fixed, decalcified, embedded in wax, and then sections. After hematoxylin-eosin staining, empty bone lacuna wil be quantified under a light microscope to identify femoral head necrosis. Verhoff’s staining and MSB microthrombosis staining wil be used to observe microvascular injury and microvascular thrombosis in the femoral head, and to analyze the correlation of CD31 and CD54 levels with femoral head necrosis, vascular endothelial injury and microvascular thrombosis. DISCUSSION:This study wil investigate the effects of CD31 and CD54 on alcohol-induced avascular necrosis of the femoral head, explore the pathogenesis of alcohol-induced avascular necrosis of the femoral head, provide a new theoretical basis for early diagnosis and early treatment, and may provide a new target for its treatment. ETHICS APPROVAL:The protocol has been approved by the Animal Experimental Ethics Committee of Inner Mongolia Medical University (approval number YKD2016154). Experimental procedures and materials of rats wil be in accordance with the Guide for the Care and Use of Laboratory Animals, which is consistent with the guide of National Institutes of Health. Subject headings:Femur Head Necrosis;Membrane Proteins;Tissue Engineering

BACKGROUND:The relationship between long-term heavy drinking and alcohol-induced necrosis of the femoral head has long been clear, but thepathogenesis of alcohol-induced necrosis of the femoral head is currently not fuly understood.
OBJECTIVE:To establish a rat model of alcohol-induced avascular necrosis of femoral head and to study its pathogenesis.
METHODS: Eighty Wistar rats were randomly divided into experimental and control groups (40 rats per group). Rats in the experimental group were intragastricaly administered strong wine 10 mL/kg, once a day, for 6 consecutive days. Rats in the control group were given physiological saline 10mL/kg, once a day, for 6 consecutive days. Bilateral femoral heads were randomly colected from six rats every month for histomorphological observation.
RESULTS AND CONCLUSION:(1) Osteonecrosis: in the experimental group, at 3 months, trabecular bone became thin, arranged disorderly, and the number of empty lacuna began to increase. At 6 months, typical osteonecrosis appeared, and vacant lacunaes increased significantly. In the control group, trabecular bone was complete and neatly arranged. Osteocytes were visible in bone lacuna, and normal morphology of cels was seen. (2) Injury of blood vessels: in the experimental group, at 3 months, micro-intimal hyperplasia was observed. Elastic fibers of partial vascular endothelium were reduced. Elastic fiber andmiddle-layer smooth muscle breakage and proliferation were found. At 6 months, above manifestations were more remarkable. In the control group, arteriole film was not thickened, and vessel wal was normal. (3) Formation of microthrombus, in the experimental group, the number of microthrombus was increased at 3 months, and became significant at 6 months. In the control group, the number of microthrombus was not altered. (4) Results indicated that chronic alcohol intake can lead to microvascular endothelial injury in the rat femoral head. Abnormal blood microcirculation was detected in local region, and resulted in avascular necrosis of the femoral head. The degree of necrosis was associated with alcohol intake.

Objective:To explore the diagnostic value of 64‐slice spiral CT for in‐stent restenosis (ISR) after percuta‐neous coronary intervention (PCI) in patients with coronary heart disease (CHD) .Methods :A total of 120 CHD patients after PCI received 64‐slice spiral CT angiography and routine coronary angiography (CAG ) respectively . Then coronary ISR was assessed .Results:With CAG as the gold standard ,sensitivity ,specificity ,positive predictive value and negative predictive value were 87.5% ,95.3% ,80.0% and 97.3% respectively for 64‐slice spiral CT cor‐onary angiography in diagnosis of ISR .Conclusion :The 64‐slice spiral CT coronary angiography possesses high sensitivity and accuracy diagnosing coronary in‐stent restenosis ,which can be used as one of noninvasive measures for postoperative follow‐up after percutaneous coronary intervention .

Objective To observe and compare the changes of bone mass and microarchitecture in ovariectomized rat left tibia by dual energy X-ray absorptiometry(DXA)and microCT(μCT).Methods Forty seven-month-old SD rats were randomly divided into ovariectomized(OVX)and sham-operated(SHAM)groups,twenty in each group.After killed at 3 weeks and 15 weeks post-surgery,DXA scanning were performed in the left tibia in vitro.The images of left tibia were divided into seven isometric regions of interest(ROI1-7).When analysis finished,bone density(BD)of each ROI and the total bone were determined.The samples were fixed by 4% paraformaldehyde and then placed in the specimen holder filled with deionized water.The sensitive regions for bone mass changes were selected for scanning by Fluro.After scanning,the regions involving 0.4mm slice thickness and 2.5mm distance far end from tibial growth plate were selected as the ROI of cortical bone analysis.The regions selected as ROI of cancellous analysis,were involved in 1.2mm slice thickness and 0.7mm distance at the far end from tibial growth plate.After three dimension reconstruction.2D images of the maximum intensity projection and pictures of 3D microarchitecture were obtained.and BD and microarchitectural parameters were quantitatively identified.All data was statistically processed with SPSS for Windows.Results At the 3rd week,BD of ROI1 in rat left tibia in OVX(0.2346±0.0280)g/cm2 was much lower than that(0.2660±0.01990)g/cm2 in SHAM(P＜0.05).While at the 15th week,BD of ROI1(0.2527±0.0161)and ROI2(0.1862±0.0052)g/cm2 in OVX were both lower than SHAM(0.2793±0.0229)and(0.1986±0.0102)g/cm2 respectively,P＜0.01 for both).Compared wim SHAM rat[cortical area(Ct-Ar)=(0.3138±0.0621)mm2,marrow area(Ma-Ar)=(8.44±1.25)mm2,total area(T-Ar)=(8.75±1.26)mm2,moment of inertia(Mm)=(3.485±0.373)mm4],there were significant increases in Ct-Ar(0.4306±0.1308)mm2,Ma-Ar(10.31±1.98)mm2,T-Ar(10.74±2.05)mm2,and Mm(4.101±0.726)mm4 in OVX mice at the 3rd week(P＜0.05 for all).While at the 15th week,only cortical thickness(Ct-Th)(0.0235±0.0024)mm showed a decrease in OVX group(P＜0.05).In OVX group,Ct-Th(0.0235±0.0024)mm and Ct-Ar(0.2528±0.0367)mm at 15 weeks were lower than that[Ct-Th=(0.0377±0.0098)mm,Ct-Ar=(0.4306±0.1308)mm2 at 3 weeks(P＜0.01 for both)].In SHAM group,inner perimeter(In-Pm)(13.38±0.54)mm,outer perimeter(Ot-Pm)(13.59±0.56)mm and Mm(4.096±0.364)mm4 at 15 weeks were higher than that[In-Pm=(12.41±0.74)mm,Ot-Pm=(12.63±0.75)mm,Mm=(3.485±0.373)mm4 at 3 weeks(P＜0.01 for all)].OVX rats had much lower volume BD(vBD)(288.2±48.2)mg/mm3,tissue BD(tBD)(604.5±45.3)mg/mm3,bone volume fraction(BVF)(25.1±5.1)%,and trabecular mumeer(Tb-N)(6.04±2.94)mm-1(P＜0.01 for all),but higher structure model index(SMI)3.09±0.27 and trabecular separation(Tb-Sp)(0.186±0.129)mm than SHAM 2.63±0.21 and(0.078±0.038)mm respectively at the 3rd week(P＜0.01 and P＜0.05 respectively).At the 15th week,vBD(271.2±50.9)mg/mm3,BVF(21.6±5.2)%and Tb-N (3.21±1.92)mm-1 in OVX were still lower than SHAM[vBD=(389.8±77.0)mg/mm3,BVF=(30.9±6.0)%,Tb-N=(7.44±3.53)mm-1 respectively(P＜0.01 for all)],SMI 3.11±0.36 and Tb-Sp(0.370±0.215)mm in OVX were also higher than SHAM 2.58±0.36 and(0.141±0.104)mm(P＜0.01 for both),but no significant difference of tBD could be found.In OVX group.the scores of tBD(691.0±36.7)mg/mm,Tb-Th(0.040±0.009)mm,Tb-N(3.21±1.92)mm-1,Tb-Sp(0.370±0.215)mm in the 15th week were higher than that[tBD=(604.5±45.3)mg/mm,Tb-Th=(0.030±0.002)mm,Tb-N=(6.04±2.94)mm-1,Tb-Sp=(0.186±0.129)mm respectively]in the 3rd week (P＜0.05 for all),while there were no differences between the 3rd and the 15th week in SHAM group.Conclusions DXA is weak in detecting the tiny changes of BD though it is convenient and non-invasive.μCT is suitable to detect the changes of bone mass and microarchitecture.

Objective To investigate the expression of slit diaphragm proteins of glomerular podocyte,such as NEPH1 and Nephrin in type Ⅴ lupus nephritis (V-LN). Methods Twenty-five patients with V-LN and 18 patients with idiopathic membranous nephritis (IMN) were enrolled into the study, and 5 normal renal samples were the normal control group. Twenty-four hours urine protein excretion, serum albumin, creatinine, triglyceride, total cholesterol, serum C3, C4, urine C3 and NAG were tested respectively.Glomerular lesions were measured by light microscopy. The expressions of NEPH1 and Nephrin were determined by indirect immunofluorescent staining. The statistical treatment was used t-test. Results Compared to the IMN group, the 24 hours urine protein excretion and the concentrations of serum albumin, creatinine, urine C3 were not significantly different while the triglyceride, total cholestorel, serum C3, C4 were significantly decrease in the V-LN group (P<0.05). Urine NAG was increased in the V-LN group (P<0.01). By indirect immuno-fluorescent histochemitry examination, the glomerular expressions of NEPH1 and Nephrin were significantly decreased in both V-LN and IMN. Compared with the IMN group, the decrease of NEPH1 and Nephrin expression was more remarkable in the V-LN group. Conclusion The expression changes of NEPH1 and Nephrin may play an important pathogenic role in proteinuria of Ⅴ lupus nephritis. Renal tubular epithelial cell damage may play a role in proteinuria of V-LN.

Background and purpose: Renal-cell carcinoma (RCC) is susceptible to immune therapy including the use of the nonmyeloablative allogeneic transplantation(NAT). However, NST can produce severe toxicity, so it might not be appropriate for many patients with metastatic RCC. Other novel allogeneic immunotherapies have been designed to induce an autologous immune response directed against the malignancy. This study evaluated the efficacy and safety of infusions of partially HLA-matched irradiated allogeneic blood mononuclear cells for advanced renal-cell carcinoma. Methods: Patients with histologically proven diagnosis of advanced RCC received infusions of partially HLA-matched allogeneic blood mononuclear cells. Repeat infusions were given every 8 weeks. Treatment was continued until disease progressed, unacceptable toxicity, or patient (or donor) choice. Results: Eight patients were enrolled. After every infusion, 6 patients received an oral administration of thalidomide daily with 100-300 mg/d for 2 months. One patient had durable complete response. Five stable diseases and two progress diseases were observed. In eight patients, time to progression and survival were 320 and 879+days, respectively. Severe toxicity was not observed. Conclusion: Infusions of partially HLA-matcbed irradiated allogeneic blood mononuclear cells for advanced RCC may induce some antitumor effects and deserves further study.