OBJECTIVE:To observe the clinical efficacy and safety of low molecular heparin in the treatment of cancer-associ-ated acute pulmonary thromboembolism(APTE). METHODS:42 patients with cancer-associated APTE were randomly divided into combination group and simple drug group. All patients were given anti-cancer conventional treatment. Based on it,simple drug group was treated with Low molecular heparin injection 0.1 ml/kg by subcutaneous injection after embolism,q12 h;based on the treatment in simple drug group,combination group was additionally treated with Warfarin sodium tablet initial dose was 3 mg after 1-3 d of treatment,orally,qd. The dosage of warfarin was adjusted based on the international normalized ratio(INR),when INR was 2-3 for continuous 2 days,low molecular heparin was stopped,only warfarin was orally gave. The treatment course was 3 months. The clinic data was observed,including clinical efficacy,and pulmonary arterial blood gas indexes [blood oxygen pressure (pO2)and blood carbon dioxide partial pressure(pCO2)] before and after treatment. The fatality rate,re-embolism rate and bleed-ing rate in 6 months were followed-up,and the incidence of adverse reactions was recorded. RESULTS:The total effective rate in simple drug group was significantly higher than combination group,re-embolism and fatality rate were significantly lower than com-bination group,the differences were statistically significant(P<0.05). After treatment,the pulmonary arterial blood gas indexes in 2 groups were significantly higher than before and simple drug group,the differences were statistically significant(P<0.05). There were no significant differences in the bleeding rate and incidence of adverse reactions between 2 groups(P>0.05). CONCLU-SIONS:Based on conventional treatment,the low molecular heparin has better efficacy than sequential therapy in the treatment of APTE,with similar safety.

Objective To evaluate magnetic resonance imaging (MRI) in the diagnosis of deep anorectal abscess. Methods Twenty-one patients who were suspected of having deep anorectal abscess were admitted to the Affiliated Hospital of Nanjing University of Chinese Medicine from January 2006 to December 2007, and their clinical data were retrospectively analyzed. Phased-array coil MRI was applied to all patients before the operation. We compared the efficacy of MRI and rectal digital examination in the classification of deep anorectal abscess and the diagnosis rate of internal opening according to the postoperative results. All data were analyzed using the chi-square test. Results Nineteen patients were diagnosed with deep anorectal abscess, one patient had presacral cyst combined with infection and one patient had perianal mucinous adenocarcinoma. A total of 25 lesions were identified, including 14 ischiorectal abscesses, five pelvirectal abscesses, and six high intersphincteric abscesses. Thirteen patients had single space abscesses and six had multiple space abscesses. There were no significant differences in the diagnosis rate between MRI (12/19) and rectal digital examination for internal opening (13/19) (χ2 =0. 116, P>0.05). The accuracy rate was significantly different between MRI (25/25) and rectal digital examination (16/25) in the classification of deep anorectal abscess (χ2 = 10.970, P <0.05). Operative exploration revealed that there were 13 patients with single space abscesses and six with multiple space abscesses. The accuracy rate was significantly different between MRI (19/19) and the rectal digital examination (13/19) for detecting multiple space abscesses (χ2 =7. 125, P <0. 05). Conclusions MRI with a phased-array coil can accurately detect the extent of deep anorectal abscess and its relationship with anorectal sphincters. MRI examination is helpful in excluding potential lesions in the anorectal region.

Crohn's disease (CD) is a chronic nonspecific inflammatory disease.CD can affect any location in the digestive tract,and it also affect other organs,including the eyes,skin,liver and joints,which are termed extraintestinal manifestations (EIMs).The cutaneous manifestations of CD are common and occur in about one-third of patients.EIMs of CD have been divided into 3 categories.(1) Specific lesion,cutaneous manifestations of CD were the same as histopathologic findings of underlying gastrointestinal lesion.(2) Reactive lesion,it was also inflammatory lesion which was usually accompanied by underlying gastrointestinal disease while inflammatory injury was different from histopathologic findings of gastrointestinal lesion.(3) Associated lesion,it was caused by sequelae of human leucocyte antigen and chronic inflammation.In the current era of ever-expanding therapeutic options for CD,some investigators have proposed a fourth category of EIMs,namely those that are therapy-related lesion.The therapy-related lesion is closely related to disease-associated conditions in light of certain skin findings,and there is potential overlap between them.

Objective To evaluate the various patterns of hepatic perfusion disorders with multi-slice spiral CT and to emphasize the significance of recognition for them . Methods In a period of 1 year, the all CT images of 1568 patients received multi-slice spiral CT examination of upper abdomen were analyzed retrospectively. The CT findings, etiologies and mechanisms of different pattens of hepatic perfusion disorders were investigated. Results 103 cases were demonstrated to have hepatic perfusion disorders. 69 cases were associated with tumors and the other 34 cases were non-tumor associated. The etiologies of various hepatic perfusion disorders were classified as (1)arterioportal fistulae(41.7%), (2) portal venous inflow obstruction(23.3%), (3) inflammartory hyperemic changes(17.5%), (4) steal phenomenon by hypervascular tumors(6.8%), (5) hepatic venous outflow obstruction(4.9%), (6) aberrant hepatic blood supply (3.9%) and (7) uncertain causes(1.9%). There was significant correlation between the CT images of perfusion disorders in shape and distribution and the causes of them. Conclusion Multi-slice spiral CT provides a new effective technique for demonstrating and understanding various hepatic perfusion disorders. Familiarity with the spiral CT appearances of these perfusion disorders will result in more accurate evaluation for various pathologic or physiologic states reflected by them.

Objective To evaluate ligation of the intersphincteric fistula tract plus core-out fistulectomy for complex cryptoglandular anal fistulas.Methods Forty-one patients were divided into ligation and control group randomly.In ligation group (20 cases),patients underwent ligation of the intersphincteric fistula tract plus core-out fistulectomy procedure.While in control group (21 cases) fistulotomy on low sphincter with cutting-seton on high sphincter procedure was performed.The primary end points of the study were healing rate and continence by using the Wexner score.Secondary end points were postoperative pain in the third and seventh day with the use of the visual analog scale,length of hospital stay and followed measures for a recurrent fistula.Comparison of measurement data using independent samples t-test or paired samples t-test,compared with the count data using Fisher's exact test.Results There was no statistical difference in the healing rate between ligation group (90％) and control group (95％) (P ＞0.05).Postoperatively,one case in ligation group reported incontinence for gas,compared to 7 cases in control group,among these 7 cases 2 cases also had incontinence for watery stool.Statistical differences were found between two groups in Wexner scores,visual analog scale scores and length of hospital stay (P ＜0.05).Conclusion Ligation of the intersphincteric fistula tract plus core-out fistulectomy is an economical,safe,little painful,recovery enhanced and minimally invasive technique to treat complex anal fistulas.

Objective To explore the dynamic changes of endothelial barrier antigen (EBA) and vascular endothelial growth factor (VEGF) expressions in cerebral cortex under the condition of blood-brain barrier damage in rats following radi?ation-induced brain injury, which provided clinical references. Methods Forty-eight clean grade male SD rats were divid?ed into the control group and 7 d, 14 d, 28 d after brain irradiation group (n=12 for each group) by using stochastic indicator method. The radiation-induced brain injury model was established by using electronic computer X-ray tomography tech?nique. The 3%Evans blue (EB) was injected into rats according to the dose of 3 mL/kg via the tail vein, then the blood ves?sels of cerebral cortex were exposed after having a craniotomy. EB extravasation was detected by microcirculation micro?scope. The permeability of blood-brain barrier was evaluated by using microscope vascular camera device. The expressions of EBA and VEGF in the cerebral cortex were measured by immunohistochemistry staining in each group. Results Both of EB extravasation and VEGF expression in rat cerebral cortex were significantly increased in injury group at day 7, 14 and 28 after brain irradiation compared with those of control group (P<0.05), and which were gradually decreased from day 7 to day 28 after brain irradiation. There were significant differences in EB extravasation and VEGF expression between the injury subgroups (P<0.05). There was a positive correlation between EB extravasation and VEGF expression (r=0.898, P<0.001). The expression levels of EBA were decreased at different time points in injury groups compared with those of control group (P<0.05), and gradually increased from day 7 to 28 after injury. There were significant differences in expression levels of EBA between injury subgroups (P<0.05). The expression of EBA was negatively correlated with EB extravasation (r=-0.866, P<0.001). Conclusion The increases of blood-brain barrier permeability have important relation to the decreases of EBA expression and the increases of VEGF expression after radiation-induced brain injury.

Objective To establish a stable orthotopic model with high green fluorescent protein (GFP) expression in nude mice and observe its biological features.Methods Human HCT116 colon cancer cells transfected with GFP pLPCX retroviral plasmid were used to build a subcutaneous tumor model in nude mice.Fifteen BALB/C nude mice were selected to underwent orthotopic transplantation of colon when the GFP-labeled tumor grew to 10 mm × 10 mm as observed by in vivo fluorescent microscopy.The growth and metastasis of orthotopically implanted colon cancer cells were observed with fluorescent imaging system at different time points.The differences of the tumor size measured by peripheral vernier caliper and fluorescent imaging system were analyzed using the t test,and the differences in different groups were analyzed using the analysis of variance.Results GFP-labeled colon cancer models were successfully established in all the 15 nude mice,and there was no surgery-related complications or death.Tumors marked by GFP were observed under fluoroscope in week 3.The size of the tumors progressively increased with time.The volumes of the orthotopically transplanted tumors obtained from global measurement using fluorescent imaging system were greater than those measured by peripheral vernier calipers at postoperative week 3,4,5,6,7,while no statistically significant difference was observed (t =-1.280,-1.115,-0.718,-0.199,-0.386,P ＞0.05).There was a significant difference in the interation of measure method and different time points (F =29.546,P ＜ 0.05).Eight nude mice survived at the end of the experiment,and tumor metastasis was observed in 6 mice.Conclusions It is technically feasible to construct GFP-labeled colon cancer orthotopic transplantation model.The mice model could be used for real-time,in vivo,non-invasive and dynamic observation and analysis of the growth and metastasis of tumor cells.

Objective To investigate the effects of continuing nursing on quality of life in elderly with H type hypertensive caused cognitive impairment. Methods A total of 108 elderly with H type hypertension and cognitive impairment were randomized to control group and experimental group. The blood pressure, homocysteine, blood fat, blood coagulation indexes, and level of quality of life characteristics were assessed the baseline. The patients of control group underwent routine nursing and no intervention after discharge, while the patients of experimental group received continuing psychological and life care after discharge. We reexamined compared the above indicator after 12 months discharged. Results The blood pressure was (163. 7 ± 12. 9)/(96. 9 ± 10. 2) mmHg decreased to ( 134. 1 ± 7. 8 )/( 77. 5 ± 6. 0 ) mmHg, homocysteine decreasing from (18. 20 ± 8. 40)μmol/L to (11. 56 ± 4. 28)μmol/L, the total cholesterol declining from (5. 48 ± 0. 65)mmol/L to (4. 06 ± 0. 74) mmol/L, triacylglycerol from (2. 58 ± 0. 63) mmol/L to (1. 47 ± 0. 76) mmol/L, frbrinogen from (4. 83 ± 1. 46)g/L to (2. 78 ± 1. 46) g/L, prothrombin time from (13. 54 ± 1. 93) sec to (15. 10 ± 2. 38) sec with statistical significance (t=3. 267, 3. 487, 4. 483, 5. 031, 5. 327, 3. 467, 5. 082;P<0. 01) after treatment in experimental group. Compared with control group, there were statistical significance ( t=4. 986,3. 462, 3. 384, 3. 325, 4. 021;P <0. 01). The physiology, physiological function, physical pain, general health status, energy, social function, emotional function and mental health were (55. 92 ± 8. 40), (59. 48 ± 11. 65), (61. 44 ± 9. 75), (58. 03 ± 14. 72), (49. 83 ± 13. 46), (55. 58 ± 16. 18), (58. 44 ± 14. 33), (60. 46 ± 10. 96) score in the control group lower than (86. 56 ± 14. 28), (89. 26 ± 12. 74), (83. 44 ± 15. 75), (79. 21 ± 12. 66), (84. 20 ± 10. 48), (87. 55 ± 11. 71), (93. 19 ± 12. 38), (89. 32 ± 10. 57) in the experimental group (t =7. 893, 6. 934, 7. 351, 7. 214, 7. 359, 8. 254, 8. 657, 7. 536;P <0. 01). Conclusions The quality of life decreased in elderly with H type hypertensive and cognitive impairment. Comprehensive nursing for elderly with H type hypertensive patients and cognitive impairment can improve quality of life compared with patients without nursing.

OBJECTIVETo evaluate the efficacy of ligation of intersphincteric fistula tract (LIFT) in the treatment of complex fistula-in-ano.

METHODSClinical data of 24 patients with complex fistula-in-ano who treated with LIFT in the Affiliated Hospital of Nanjing University of Chinese Medicine from September 2009 to February 2012 were analyzed retrospectively. The operative efficacy and postoperative continence were evaluated.

RESULTSThe prime success rate of fistula healing was 66.7% (16/24) after the LIFT procedure. Two patients presented with intersphincteric incision infection which was successfully treated with topical of silver nitrate. Four patients had intersphincteric fistula with infection and managed with the complete laying open approach. The total clinical healing rate was 91.7% (22/24). Another 2 patients had persistent external opening with discharge. During follow-up of 6 to 44 (median 16) months, The Cleveland Clinic Florida Fecal Incontinence score revealed that no patient developed decreased continence.

CONCLUSIONLIFT is a safe and effective sphincter-preserve procedure for complex fistula-in-ano.

Objective: To analyze the association of cytogenetic abnormalities with the prognosis of chronic myeloid leukemia (CML) patients in tyrosine kinase inhibitors (TKI) era. Methods: Karyotype analysis of chromosome G-banding was carried out in 387 newly diagnosed CML patients by short-term culture of bone marrow cells. The correlation of cytogenetic abnormalities and CML progression was explored in combination with ABL tyrosine point mutations. Result: Of 387 patients with positive BCR-ABL fusion gene assayed by fluorescence in situ hybridization (FISH) technique, 94.1% (364/387) patients were Ph positive and 5.9% (23/387) Ph negative; 320 patients (87.9%) had a translocation t (9;22) (q34;q11) and 5 (1.4%) a variant translocation t (v;22) . Additional cytogenetic aberrations (ACA) at diagnosis were found in 10.7% (39/387) Ph⁺ patients, major route ACA in 22 (56.4%) cases and minor route ACA in 15 (38.5%) cases and 2 patients (5.1%) lacked the Y chromosome (−Y) ; 23.4% (71/303) patients occurred ACA during TKI treatment and the most frequent abnormalities were abnormal chromosome numbersd, which were likely associated with high proportion of disease progression (χ²=168.21, P<0.001) and ABL tyrosine point mutations (χ²=29.04, P<0.001) . Newly diagnosed CML-CP patients with t (9;22) (q34;q11) had a longer event-free survival (EFS) and disease-free survival (DFS) rates than that of patients with ACA (P=0.037; P=0.003) , while the overall survival (OS) had no significant differences (P=0.209) . As for CML-CP patients that occurred ACA during TKI therapy would have a marked low OS, EFS and DFS (all P<0.001) compared with no ACA occurred patients. Survival of advanced patients that occurred ACA were dramatically reduced. Conclusion ACA often emerged during the disease progress in CML patients, regular and timely detection of chromosomes karyotype and ABL tyrosine point mutations during TKI treatment was important for therapeutic evaluation, progress and prognosis of CML.