Objective To compare the tracing effects of radionuclide and barium sulfate on lactulose hydrogen breath test (LHBT), and to explore the value of LHBT combined with radionuclide imaging in the diagnosis of small intestinal bacterial overgrowth (SIBO) in patients with irritable bowel syndrome (IBS).Methods From November 2010 to November 2012, 89 patients (47 males, 42 females;mean age (45.7±12.9) years) with IBS and 13 healthy volunteers (9 males, 4 females;mean age (43.3±8.6) years) were enrolled in this prospective study.All the subjects underwent LHBT combined with radionuclide imaging.Recording the time when the increment of H2 value >0.005‰ and the OCTT of the radionuclide.Four healthy volunteers also underwent LHBT combined with barium sulfate 1 week after radionuclide imaging.The location of barium sulfate was recorded when H2 value increment >0.020‰.Patients with SIBO received rifaximin treatment, and the effect was observed.χ2 test, Pearson correlation analysis and Wilcoxon rank sum test were used to analyze the data.Results (1)In LHBT combined with barium sulfate test, barium sulfate was found still stagnating in small intestine by abdominal X-ray when H2 value increment >0.020‰ in 4 healthy volunteers, and barium sulfate didn′t reach the colon in delayed imaging in 1 patient.(2) The rates of SIBO detected by LHBT in IBS patients and healthy volunteers were significantly different (43.8%(39/89) vs 5/13;χ2=0.133, P=0.716), and those detected by LHBT combined with radionuclide imaging were also significantly different (39.3%(35/89) vs 1/13;χ2=4.970, P=0.026).(3)The time of H2 value increased >0.005‰ correlated well with OCTT in 13 healthy volunteers ((73±31) and (50±19) min;r=0.871, P<0.001) and 54 IBS patients without SIBO ((83±34) and (66±28) min;r=0.735, P<0.001), but there was no correlation in 35 IBS patients with SIBO ((36±30) and (75±30) min;r=0.304, P=0.076).(4)A total of 34 SIBO-positive patients received a rifaximin treatment, with a significant improvement in the frequency of abdominal pain and abdominal distension after the treatment according to Rome Ⅲ diagnostic criteria: 5(4, 6) vs 4(3, 5), 4(1, 6) vs 0(0, 4)(z values:-4.842 and-5.388, both P<0.001).Conclusion LHBT alone is not a valid test for SIBO, and LHBT combined with radionuclide imaging is a good candidate for SIBO diagnosis.

Objective To study TCM pattem rules of primary hyperlipemia and its relation with sex,age,body mass index(BMI).Methods A total of 1 20 patients with primary hyperlipemia were divided into 5 groups by TCM syndrome differentiation:56 patients in a group of the turbid-phlegm stagnation syndrome,35 patients in a group of yang deficiency of spleen and kidney syndrome,13 patients in a group of yin deficiency of liver and kidney,7 patients in a group of hyperactivity of yang due to yin deficiency group,and 9 patients in a group of qi stagnation and blood stasis syndrome.Statistic analysis was made on factors that may affect these syndromes,and the correlations were discussed.Results Different age showed a closer relation to the onset of primary hyperlipemia than other factors(P＜0.01):sex,clinical classification,and accompanied diseases had no relation with the five-type syndromes(P＜0.01).Conclusion TCM syndromes had a certain relation with the age of patients with primary hyperlipemia.

Objective: To probe into TCM pattern of primary hyperlipemia and its relationship with gender, age, BMI, laboratory indices such as TC,TG, LDL-C, HDL-C, ApoAI, ApoB of the 120 patients with primary hyperlipemia. Methods: Logistic regression analysis wan used to analyze the associativity of TCM syndrome and objective indexes of primary hyperlipemia. Results: Logistic regression analysis showed that TCM syndromes of primary hyperlipemia had some relation with laboratory indices. Conclusion: TCM syndromes of primary hyperlipemia had some relation with laboratory indices. The lipemia laboratory indices can be one of the objective basis of TCM diagnosis. The main syndromes were stagnation of phlegm-turbid and syndrome of yang deficiency of both of spleen and kidney, the main pathogenesis were deficiency of spleen and kidney, intermingled phlegm and blood stasis. The main treatment methods were invigorating spleen and tonifying kidney, supplementing qi and nourishing heart, promoting blood flow and dissipating phlegm.

Objective To study the association between metabolic syndrome (MS) and prognosis of endometrioid carcinoma.Methods A total of 256 patients with endometrioid carcinoma at,Zhejiang Cancer Hospital between January,2001 and December,2008 were chosen.The deadline for follow up was December 2008.The general conditions(including age and body mass index),whether coupled with MS and it's risk factors(including waist circumference,fasting plasma glucose,triglycerides,high-densitylipoprotein,systolic and diastolic blood pressure) were analyzed.The outcome of 256 patients whether coupled with MS were analyzed using Kaplan-Meier curve.Relative risks were estimated using Cox proportional hazards regression model.Results A total of 256 cases were followed-up successfully.Sixtyfour (33.0％) cases coupled with MS among the 194 patients survived,while thirty-two (51.6％)coupled with MS from 62 cases died,there was significant difference between them (x2=6.953,P=0.008).The total fiveyear survival rate was 75.8％,the survival time was (78.0±3.4) months.The rate and the survival time of patients coupled with MS [66.7％,(67.0±2.4) months] were significatly lower than those coupled with no MS [81.3％,(85.0±4.0) months;P＜0.05].The Cox proportional hazards regression results showed that coupled with MS,body mass index ≥25 kg/m2,waist circumference＞80 cm,abnormol systolic and diastolic blood pressure,abnormal fasting plasma glucose and more than two components of definitions of MS were related to bad prognosis of endometrioid carcinoma(P＜0.05).Conclusion Metabolic syndrome may be lead to a bad prognosis of endometrioid carcinoma.

Despite the clinical and experimental concerns about the deleterious effects of neonatal seizures on brain development,the underlying mechanism of seizure-induced brain damage is still not clear.Moreover,early therapeutic intervention studies are also less available.For this reason,the study was performed to explore the long-term effects of neonatal seizures and physical exercise on learning,memory and the expression of calcium/calmodulin-dependent protein kinase Ⅱ(CaMKⅡ).Twelve neonatal rats for each group were assigned:the single-seizure group(SS),the recurrent-seizure group(RS) and the control group.The volatile agent flurothyl was used to induce 30 min seizure attack.At postnatal day 6(P6),the single seizures induced only once and recurrent seizures induced once per day for consecutive 6 days.Control rats were placed into the container for an equal amount of time to their counterpart without exposure to flurothyl.Morris water-maze test were performed at P27～P31,P58～P61 and P80～P82,meanwhile at P51～P56,the RS and SS groups were submitted to forced running exercise.In situ hybridization method was used to detect the expression of CaMKⅡ mRNA in hippocampus.The results are as follows:(1) Escape latency.In the first two Morris water-maze tests,there was a decreasing trend of escape latency in three groups,and the escape latency of RS group was much longer than that of control group.After physical exercise,in the last Morris water-maze tests,the diference of escape latency in three groups is not significant.(2) Searching strategy.In the first Morris water-maze test,there was a decreasing trend of marginal strategy and an increasing trend of taxis strategy in three groups,but the frequency of marginal strategy was higher and the frequency of taxis strategy was lower in RS group than that in SS and control group in the third and fourth day(P

Objective To investigate the clinical features,diagnosis and prognosis of solid pseudopapillary tumor of the pancreas(SPTP). Method The clinical data of SPTP cases that underwent surgical resection with a definitive histological diagnosis in Zhong Shan Hospital from 1999 to 2007 were retrospectively analyzed.Result There were 42 SPTP cases undergoing surgery in this period,including 37 females and 5 males:mean age was 37.6 years.Tumors located in the pancreatic head in 18 cases and in the body or tail in 24 cases.The most common symptom was abdominal discomfort(n=20),palpable mass (n=8).Preoperative diagnostic accuracy of MRI and CT were 93%and 31.8%,respectively.Ten cases underwent pancreaticoduodenectomy,20 cases received distal pancreatectomy,3 cases did spleen-preserving distal pancreatectomy.Tumors were simply enucleated in 8 cases.Average diameter of the tumors was 6.1 cm,34 lesions were solid,6 were solid-cystic,2 were cystic.The overall perioperative morbidity was 38.1%,10 cases developed postoperative pancreatic fistula.The mean follow-up time was 38.6 months.Except three cases that were lost to follow-up,all the other cases were alive.Four cases(2 cases had had tumor enucleation,2 had had distal pancreatectomy)developed hepatic metastases on 70、110、41、3 months after first surgery,respectively.A transarterial chemoembolization was employed in three cases,while right hemihepatectomy was performed in one case. Conclusion SPTP is an indolent tumor with low-grade biological aggressiveness.Patients had a favorable outcome after surgical treatment,but enucleation should be avoided.Patients with liver metastasis may benefit from chemoembolization and liver resection.

Objective To investigate the histological features,biological features,clinical treatment and prognosis of pancreatic acinar cell carcinoma.Methods A retrospective review of 10 patients with pancreatic acinar cell carcinoma treated in our hospital from 1999 to 2008 was conducted and the clinical features,imaging changes,pathologic feature,treatment course and follow-up data were collected.Results There were 9 men and 1 woman with a mean age of (62±8) years old.Tumors were located in the uncinate process in 1 patient,head of pancreas in 7,body and tail in 2.The median size of these tumors was 4.5 cm×4.7 cm;common bile duct and intrahepatic bile duct,pancreatic duct dilation was detected in 7 cases,and superior mesenteric vein was invaded in 2 cases.Of the 10 patients,8 received pancreaticoduodenectomy,among these 8 patients,3 had extended lymph node dissection,2 had portal vein resection and replacement;2received resection of pancreatic body and tail as well as splenectomy.Histologically,the size of these tumors were 4.0 cm×3.3 cm×3.4 cm.Macrescopically,duodenum was invaded in 5 patients,superior mesenteric vein was invaded in 2 patients and neural invasion was present in 7 cases.Lymph node metastasis was noted in 6 cases.Follow-up data was available in 9 patients and 1 patient was lost in follow-up.The survival ranged from 3 to 51 months with a median survival 18 months,and 9 patients died of tumor recurrence and metastasis after operation.Conclusions Pancreatic acinar cell carcinoma should be recognized as a distinct tumor entity and it may not be sensitive to radiotherapy or chemotherapy.The biological features of pancreatic acinar cell carcinoma should be investigated further.

Objective To promote the diagnostic accuracy of intrapancreatic accessory spleen (IPAS).Methods The clinical data of 10 cases of IPAS admitted in Fudan University Zhongshan Hospital from Apr 2005 to Dec 2013 were retrospectively analyzed.Results There were ten cases of IPAS confirmed pathologically.Only 1 of the ten cases was diagnosed correctly and definitely with IPAS preoperatively.The other 9 cases were misdiagnosed with benign or malignant pancreatic tumors,including nonfunctional neuroendocrine neoplasms in 5 cases,pancreatic neuroendocrine cancers in 3 and pancreatic intraductal adenocarcinoma in one.All the nine misdiagnosed patients has no specific symptoms or laboratory indexes.All the IPASs located in the tail of the pancreas with the mean diameter (1.3 ±0.2) cm(0.8-2.5 cm).7 cases of IPAS show strikingly similar dynamic enhancement to the spleen on the CT scans and/or MRI.Accessory spleen around the splenic hilum was found in five cases.Conclusions Morphological study plays an important role in the diagnosis and IPAS carries parallel dynamic enhancement to the spleen on CT scans and/or MRI.IPAS should be considered as a differential diagnosis while the lesion is no more than 2.5 cm in diameter and when other accessory spleens were shown around the splenic hilum.

Objective To analyze the clinical characteristics and treatment strategy of ankle supination fracture in children.Methods From January 2012 through July 2014,89 children were treated at our department for ankle fracture caused by supination sprain according to their medical history,physical examination,X-ray films and CT three-dimensional reconstruction of the ankle.Appropriate protocols were applied on the basis of Lauge-Hansen classification,type and displacement of their fractures.Of them,52 belonged to the supination-adduction type (the extramalleolus fracture was of Odgen type Ⅶ in 51 children whose epiphyseal plate of distal fibula had not been closed),35 to the supination-extorsion type (32 cases had tri-plane fracture and 3 Tillaux fracture),and the remaining 2 did not fit the Lauge-Hansen classification.Surgical treatment was applied in 32 cases and conservative treatment in 57 ones.Results All the children received outpatient follow-up from 12 to 24 months(mean,18 months).No bone nonunion,osteoarthritis,or fracture malunion was found.The American Orthopaedic Foot & Ankle Society scores averaged 92 points (range,from 88 to 100 points) at the last follow-ups.Conclusions In children whose epiphyseal plate is nearly closed,supination-adduction sprain likely causes an extramalleolus fracture of Salter-Harris type Ⅰ or type Ⅱ,but in children whose epiphyseal plate is unclosed,an epiphyseal fracture of Odgen type Ⅶ is inclined to happen.A Tillaux fracture or tri-plane fracture at the level of distal tibiofibular syndesmosis results often from supination-extorsion sprain in children.For fractures involving epiphysis or epiphyseal plate,anatomical reduction and proper fixation are critical to functional recovery and reducing complications.

Objective To investigate the biological features and treatment of pancreatic adenosquamous carcinoma. Methods A retrospective clinical analysis was conducted in 6 cases of pancreatic adenosquamous carcinoma treated in our hospital from 1995 to 2005. The clinical features, imaging findings, therapy and pathology were analyzed. Results Pancreatic adenosquamous carcinoma was found in 3 men and 3 women with a mean age of 51. 8?10. 8 years. Tumor was located in the head of the pancreas in 4 patients, body in 1 and tail in 1. Three cases received pancreaticoduodenectomy, two did distal pancreatectomy and splenectomy, one underwent palliative operation. The mean size of the tumor was 5. 2 cm ? 4. 1 cm ? 3. 0 cm, pathologically primary tumor and the liver metastasis were mixture of adenocarcinoma and squamous cell carcinoma. Tumor invaded the duodenal wall and common bile duct in 3 cases, portal vein was invaded in 1 case. Neural invasion was present in 4 cases. Lymphatic invasion was found in 3 cases. Postoperative mean survival time was 6. 7 months after the operation with patients finally dying of tumor recurrence and liver metastasis. Conclusions Pancreatic adenosquamous carcinoma is characterized by the mixture of adenomatous and squamous cell element with aggressive biological behavior. The prognosis of this tumor is poor demanding early diagnosis and proper surgical treatment.