Objective To explore the causes and surgical management of acute gangrenous cholecvstitis(AGC)after endoscopic sphincterotomy(EST).Methods Clinical and pathological data of 1066 patients who underwent EST from June 2003 to January 2007 were analyzed retrospectively.ResultsAGC was complicated in 16 patients(16/1066,1.5%),who underwent emergency operations and no death occurred.During the follow-up period of 4 to 36 months,no infection or obstruction was found.Conclusion Difficuitv in EST manipulation and biliary obstrucion might play a leading role in AGC after EST,and early surgical intervention is effective.

Objective To investigate the diagnostic value of electrophysiological examination for tarsal tunnel syndrome (TTS).Methods Motor nerve conduction velocity (MCV),sensory nerve conduction velocity (SCV),F wave and electromyographic measurements were carried out with 26 clinically suspected TTS patients.Results Of the 26,22 patients were unilaterally affected and 4 were bilaterally affected,so 30 tarsal tunnels in total were affected.All received electrophysiological examination.Of the 30 affected tarsal tunnels,abnormal MCV was detected in 28 of the posterior tibial nerves (93.3％),while abnormal SCV was detected in 27 medial plantar nerves (90％) and 24 lateral plantar nerves (80％).Needle electromyography of 156 targeted foot muscles detected abnormal spontaneous potentials in 90 of them (57.7％),giant potential in 12 muscles (7.7％) and decreased recruitment in 76 (48.7％).Conclusions The distal posterior tibial nerve is impaired in TTS,presenting axonal damage in an electrophysiological examination.Such examinations should have an important role in the diagnosis and differential diagnosis of TTS.

Objective To explore the diagnosis and treatment of gastroparasis syndrome after abdominal operation. Methods Clinical data of 25 cases with gastroparasis syndrome after abdominal operation from Jan 1995 to June 2006 were analysed retrospectively. Results Gastrectomy and nongastrectomy amounted to 16 and 9 cases( portal-azygous vein disconnection in 4 cases, panceaticoduodenectomy in 1 case, partial small intestinectomy and adhesions lysis in 1 case, radical excision of colon carcinoma in 2 cases, choledocholithotomy in 1 case). Gastroparasis syndrome characterized by upper abdominal distension, nausea, vomiting after clipping the pipe or large quantity of gastric drainage after operations. Gastrointestinal series and gastroscopy confirmed functional delayed gastric emptying. All cases recoverd through non-operative therapy including fasting, continuous gastrointestinal decompression, total parenteral nutrition or enteral nutrition, adn administration of gastro-intestinal dynamic medicine. Conclusions Gastroparasis syndrome is the common complication after abdomianl operation, gastrointestinal series, gastroscopy are main diagnostic methods, conservative medication obtains good effect.

Objective To explore the effect on nutrient and immune function of glutamine-enriched enteral nutrition on patients after total gastrectomy. Methods 36 patients after total gastriecomy were randomly divided into EN(n=18) and GLN(n=18) group. Compared the index after total gastrectomy including nutrient status, immune function and lassitude degree in the 1st, 3rd, 7th day. Results GLN group showed more effective process than EN group in improving postoperative nutrient status, immune function, nitrogen balance and lassitude degree. All the indexes in GLN group changed significantly on the 7th day than that in EN group(P

Objective To explore the protective effect of Salvia miltiorrhiza on small intestinal ischemia reperfusion injury during intestinal transplantation induced by cytokines in rats.Methods Sixty Sprague Dawley rats were randomly divided into sham operation group,model group and low,mid,high doze treatment group,the superior mesenteric artery was occluded and then released to simulate the model of small intestinal ischemia reperfusion during intestinal transplantation.Tumor necrosis factor-?,interleukin-1?,interleukin-8 both in the plasm and small intestinal tissue were evaluated by ELISA 2 hours after reperfusion,changes of pathology in intestinal mucosa were observed.Results TNF-?,IL-1?,IL-8 were significantly higer(P

Objective:To investigate the effect of short-term intensive treatment with insulin on metabolic control,?-cell function and insulin resistance in newly diagnosed type 2 diabetic patients. Methods:Thirty-eight newly diagnosed type 2 diabetic patients were randomly divided into two groups and treated with continuous subcutaneous insulin infusion(CSII) or multiple daily insulin injection(MDI) for 1 month.Fasting blood glucose(FBG) and lipid profiles were measured,and oral glucose tolerance test(OGTT)was performed before and after the treatment.The second phase insulin and C peptide secretions were measured by calculating area under curve(AUC) in OGTT.HOMA model was used to evaluate ?-cell function((HOMA-?)) and insulin resistance. Results:Excellent control of FBG was achieved after 1 month intensive treatment.(HOMA-?) was improved significantly. Conclusion:The excellent metabolic control and ?-cell function improvement can be achieved by short-term intensive insulin therapies like CSII or MDI.

Objective To evaluate the application value of the micro movement sensitive mattress sleep monitoring system(MSMSMS) in the diagnosis of children with obstructive sleep apnea syndrome (OSAS).Methods One hundred and twenty-nine children aged from 3 to 14 years who visited the sleep center of Beijing Children's Hospital Affiliated to Capital Medical University from June 2013 to June 2015 due to sleep snoring were enrolled.Children with acute respiratory infection,cranial facial abnormalities,chronic lung diseases and neuromuscular diseases were excluded.According to the criteria,36 children were diagnosed as OSAS with average age of (7.3 ± 2.5) years,including 28 males and 8 females.Ninety-three non-OSAS children were recruited with average age of (6.3 ± 2.3) years,including 61 males and 32 females.Subjects were monitored with polysomnography(PSG) and MSMSMS simultaneously.Apnea/hypopnea index (AHI) ＞ 5 or obstructive apnea index (OAI) ＞ 1 were used to define whether OSAS existed.The consistency between MSMSMS and PSG in the diagnosis of OSAS and the determination of sleep efficiency were compared.Results The Kappa consistency coefficient of MSMSMS and PSG in the diagnosis of OSAS was 0.70(95％ CI:0.57-0.84),Z =7.99,P ＜ 0.000 1,which indicated the consistency between PSG and MSMSMS was good.The consistency of sleep efficiency of MSMSMS and PSG were compared.Bland-Altman results showed that there were 3％ (5/129 cases)points out of 95％ consistency bound and the interclass correlation coefficient (ICC) was 0.69 which indicated the consistency of 2 methods was good in determination of sleep efficiency.MSMSMS was able to detect respiratory event that was associated with sub-cortical arousals with no electroencephalogram arousal or blood oxygen reduction.Conclusions There is an adequate consistency between MSMSMS and PSG in the diagnosis of children with OSAS and determination of sleep efficiency.The MSMSMS has an advantage in detection of sub-cortical arousals and respiratory event.

Objective To compare the effectiveness and safety of central venous catheters inserted from the left side and right side during peripheral inserted central catheterizations (PICC). Methods Totally 458 adult patients undergoing PICC between May 2007 and May 2008 were enrolled in this study and divided randomly into right-sided group (n = 228)and left-slded group (n = 230). Chest X-ray was performed immediately after catheterization to identify the initial tip locations. Other parameters were evaluated during follow-up. Results The rate of difficult insertion was significantly lower in right-sided group than in left-sided group (14.9% vs 24. 8% , P =0.003). The rate of tip projection angle ＞40°was also significantly lower in right-sided group (2.2% vs 23.4% ,P = 0. 000). The rate of tips reaching the central veins was not significantly different between two groups (54.4%vs 53.0% , P = 0. 538). Compared with right-sided catheters, the tip positions in the left-sided group was significantly less frequently located in the inferior segment of superior vena cave in the central tip locations (6. 6% vs 21.0% , P =0. 001)and more commonly positioned in the nominate vein in non-central tip locations (66. 7% vs 48.1% , P = 0. 008). In addition, the catheter detaining time (P = 0. 617), incidence of local phlebitis after puncture (P = 0. 561), catheter obstruction rate (P = 0. 774), and catheter-related infection rate (P = 0. 854)showed no significant differences between two groups. The incidence of swollen limb was significantly lower inright-sided group than in left-sided group (4. 4% vs 8.3%, P = 0. 043). Conclusions Right-sided catheters provide better outcomes than left-sided catheters. PICC through the right elbow veins should be preferred in clinical practices.

Objective To compare the effects of different doses of amino acids and fat emulsions in parenteral nutrition on the incidence of complications and prognosis in very low birth weight infants (VLBWI). Methods The clinical data of 328 VLBWI who received nutrition support therapy for at least 5 days starting in 72 h after birth during January 2005 to December 2014 , were retrospectively analyzed. According to the dosage in parenteral nutrition, patients were divided into low-dose group and high-dose group. The incidence of complications and prognosis between two groups were compared. Results There were 204 cases in low-dose group and 124 cases in high-dose group. Compared with the low-dose group, the incidence of complications was lower in high-dose group during hospitalization and the incidence of intracranial hemorrhage was reduced most;the incidence of developmental retardation was lower at discharge;the overall incidence of metabolic complications of parenteral nutrition was higher, among which the incidence of high blood glucose, electrolyte disturbance and cholestasis were increased and the incidence of hypoglycemia was lower, and the differences were all statistically signiifcant (P??0 . 05 ). Conclutsions VLBWI can tolerate early aggressive parenteral nutrition which can reduce the incidence of extrauterine growth retardation and premature complications.

Objective To explore the mechanism of vessel endothelial dysfunction in rats under intermittent hypoxia (IH). Methods The respiratory simulation system was used to simulate IH. Sixty C57BL/6J rats (male) were randomized into control group and IH group. The rats of IH group were exposed to IH 8 hours per day for 6 weeks. The serum levels of hypoxia inducible factor (HIF)-1a and stromal cell derived factor (SDF)-1a were assessed by ELISA. The serum levels of reactive oxygen species (ROS) were detected in two groups. The serum expression of miR-199a-5p was detected by real-time fluorescent quantitative PCR in two groups. The dual luciferase report system and point mutation test were used to verify target gene for HIF-1a. Results The serum levels of HIF-1a and SDF-1a were significantly higher in IH group than those of control group (μg/L:1.60±0.02 vs. 1.19±0.02, 1 823.00±8.97 vs. 1 444.00±17.90, P<0.01). The serum level of ROS was significantly higher in IH group than that of control group (U/mL:487.66±35.73 vs. 211.57±23.82, P<0.01). The serum level of miR-199a-5p expression was significantly lower in IH group compared to that of control group (1.31±0.07 vs. 3.47± 0.17, P<0.01). The result of dual luciferase reporter gene detection confirmed that target gene of miR-199a-5p was HIF-1a. Conclusion The serum level of miR-199a-5p is decreased first due to IH, and then its target gene (HIF-1a) is increased. HIF-1a can induce the increased level of SDF-1a, and its receptor (CXCR-4 ) is also increased. Finally, HIF-1a can increase the serum level of ROS, resulting in the endothelial dysfunction.