Objective To investigate the causes,diagnosis and treatment of small intestinal bleeding.Methods The clinical datas of 34 cases of small intestinal bleeding confirmed by surgery and pathology were analyzed retrospectively.Results Tumor was the first cause of small intestinal bleeding(13/34),there was no significant difference between the number of benign and malignant tumor,other causes were inflammatory small intestinal diseases(9/34),small intestinal diverticulum(7/34),angiodysplasia(4/34) and heterotopic pancreas(1/34).There were 11,3 and 2 cases who were diagnosed by double contrast barium meal,angiography and radionucleide scanning respectively,18 cases were diagnosed by exploratory laparotomy.Most patients were treated by intestinal segmentectomy.Conclusion Neoplasia is the most common cause of small intestinal bleeding,other causes are inflammatory small intestinal diseases,small intestinal diverticulum andangiodysplasia.Acombination of double contrast barium meal,angiography,radionucleide scanning,exploratory laparotomy and/or enteroscopy are helpful to diagnose small intestinal bleeding.Medical or endoscopic thyrapy is the first choice for treating small intestinal bleeding,surgical procedure,mainly intestinal segmentectomy,is the second choice.

Objective To investigate the clinical and imaging characteristics of isolated pontine infarction as well as the influencing factors for early progressive motor deficits (PMD) and short-term prognosis.Methods A total of 86 patients with isolated pontine infarction who admitted in hospital within 24 hours of symptom onset were analyzed retrospectively.The patients were divided into paramedian pontine infarction (PPI) and lacunar pontine infarction (LPI) according to the maximal diameter of the lesions and the locations of infarction.They were divided into either a PMD group or a non-PMD group according to the early status of PMD.They were also divided into a poor outcome group (mRS score ＞ 2) and a good outcome group (mRS score ≤ 2) according to the modified Rankin Scale (mRS) scores at discharge.The clinical and imaging features of the different patient groups were compared.Results The patients' constituent ratios of hyperlipidemia (57.14％ vs.33.33％;x2 =4.80,P=0.028),hemiplegia (97.14％ vs.72.55％;x2 =8.718,P=0.003),basilar artery stenosis (45.71％ vs.17.65％;x2=7.930,P=0.005) and poor outcome at discharge (54.29％ vs.31.37％ ; x2 =4.515,P =0.034),and the baseline National Institutes of Health Stroke Scale (NIHSS) scores (6.00 ± 2.39 vs.4.61 ± 3.41; t =2.087,P =0.040) in the PPI group (n =35) were significantly higher than those in the LPI group (n =51).The constituent ratios of the baseline diastolic blood pressure levels (97.82 ± 15.61 mm Hg vs.89.55 ± 12.23 mm Hg,1 mm Hg=0.133 kPa; t =2.258,P =0.031),PPI (63.64％ vs.32.81％ ;x2 =6.445,P =0.011) and basilar artery stenosis (59.10％ vs.18.75％ ;x2 =12.922,P =0.000) in the PMD group (n =22) were significantly higher than those in the non-PMD group (n =64).The baseline NIHSS scores (6.80 ± 2.63 vs.3.73 ± 2.55; t =5.426,P =0.000),fasting blood glucose levels (9.40 ±5.15 mmol/L vs.6.56 ±2.69 mmol/L; t =2.985,P=0.004) and the constituent ratios of PPI patients (54.29％ vs.31.37％ ;x2 =4.515,P =0.034) in the poor outcome group (n =35) were significantly higher than those in the good outcome group (n =51).Multivariate logistic regression analysis showed that basilar artery stenosis was an independent risk factor for the onset of PPI (odds ratio [OR] 3.801,95％ confidence interval [CI] 1.357-10.646; P =0.011) and the early PMD of isolated pontine infarction (OR 4.571,95％ CI 1.214-17.214; P=0.025).The baseline NIHSS score ≥ 5 was its independent predictor for poor outcome (OR 4.277,95％ OR 1.505-12.151; P =0.006).Conelusions PPI is mainly associated with the lesions in the branches of basilar artery.The baseline NIHSS score ≥ 5 may be an independent predictor for short-term poor outcome of isolated pontine infarction.Its early PMD and short-term poor outcome may be associated with the basilar artery lesions.

BACKGROUND: The implanted cartilage calls can synthesize cartilage matrix as cartilage in cartilage tissue enginsedng, and the density of implanted cells is the key point.OBJECTIVE: To evaluate the effect of cell seeding concentration on the chondrogenic differentiation of the adipose dadved sromal cells (ADSCs).DESIGN, TIME AND SETTING: The in vitro cellular-scaffold observation was performed at the cytobiological laboratory of China Medical University from November 2007 to July 2008.MATERIALS: Six male SD rata with clean grade were supplied by the Experimental Animal Center of China Medical University.METHODS: Totally 5 g/L type ; collagen solution and 20 g/L chitosan was mixed in a mould with volume ratio of 7:3, after lyophillization, it was cut into pieces with 5 mm ～ 5 mm x 2 mm, followed by crosslinking with ethanol contained of 2% chondroitic acid at room temperature. After washing with double distilled water and freeze drying, the chitosan-collagen-chondroitin sulfate copolymar matrices scaffolds were harvested. ADSCs isolated from rat inguinal fat pads were digested with collagenase and trypsase. The prepared scaffolds were randomly divided into 3 groups, and the third passage cells with density of 2×10 9/L,2×10 109/L, and 2×10 11/L were seeded into chitosan-coflagen-chondroitin sulfate scaffolds, and cultured in chondrogenic medium for 3 weeks.MAIN OUTCOME MEASURES: The expression of cartilage specificity gene was detected by hematoxylin-eosin staining, type Ⅱ collagen immunohistochemical staining and RT-PCR.RESULTS: Hematoxylin-eosin staining showed that after 3 weeks of culture, the cell proliferated and differentiated well, especially in 2x101～/L group, more extrocelluer matrices were produced and cartilage lacuna-structure could be seen. The type Ⅱ collagen was positive expressed in each group, which showed a gradually increasing tendency with the cell seeding concentration increasing. RT-PCR showed that the expression of proteoglycen and type Ⅱ collagen mRNA were slowly increased. However the expression of Ⅹ collagen mRNA was decreased with increasing cell seeding concentration.CONCLUSION: The chitosan-collagen-chondroitin sulfate copolymer matrices can provide an appropdate environment for the generation of cartilage-like tissues and high call seeding concentration of 2×1010/L facilitate ADSCs to differentiate into cartilage.

Objective To evaluate the character of the collagen-chitosan-chondroitin sulfate scaffold seeded with rat adipose tissue-derived stromal cells. Methods A dipose tissue were harvested from 6 weeks old Wistar rats and the stromal cells were harvested by type Ⅰ collagenase and then cultured in vitro. Type Ⅰ collagen was fully mixed with chitosan, freeze-dried and cross-linked with chondroitin sulfate, then freeze-dried again and sterilized by ethylene oxide. The pore diameter, water content, porosity of the scaffold were tested. The adipose tissue-derived stromal cells were digested, seeded into the plates, scaffold, and cen-trifuged into pellet, and then induced into cartilage. MTT detection for cell proliferation was done. After 3 weeks, the cell morphology, and cell proliferation and adhesion were observed, and chondrngenic differenti-ation was also analyzed. Results The pore diameter, water content, porosity tested for the scaffold showed an appropriate form. Cell proliferation showed faster in the scaffold and pellet culture system after 5 day, there was still cell proliferation in the scaffold system after 14 days but no obvious changes in the pellet cul-ture system; ceils on the scaffold proliferated densely showed by histological staining, but there was a scaf-fold structure residues in the inner layer. The finding of type Ⅱ immunohistochemistry stain showed that cells express strong positive for type Ⅱ collagen in the scaffold and pellet culture system whereas it was weakly positive in the plate culture system; the specific mRNA for cartilage, type Ⅱ collagen, aggrecan and SOX-9 were expressed in all three systems showed by RT-PCR, but type X collagen was expressed continu-ously in the plate culture system and expressed after 21 days in the pellet culture system, whereas it was not detected in the collagen-chitosan-chondroitin sulfate scaffold system. Conclusion The parameters of the collagen-chitosan-chondroitin sulfate scaffold were suitable in our study. The results suggested that it can promote the adipose tissue-derived stromal cells proliferation and chondrogenic differentiation better than the plate and pellet culture systems and maintain the phenotype of chondrocytes well; it is the optimal choice for cartilage tissue engineering in the future.

OBJECTIVETo investigate the clinical application of free superficial iliac circumflex artery skin flaps, as well as the management of donor site defects.

METHODS17 free superficial iliac circumflex artery skin flaps were applied for the traumatic defects or deformities on face, neck, foot, hand, ankle and lower leg, respectively. The donor site defects were closed directly or covered by paraumbilical island flaps.

RESULTSThe 17 flap size ranged from 5 cm x 3 cm to 19 cm x 14 cm. 16 flaps survived completely except 1 flap with partial necrosis, which was closed by free skin graft. The donor site defects were closed directly in 10 cases, and covered by paraumbilical island flaps in 7 flaps without no flap necrosis. The abdomen had a good appearance.

CONCLUSIONSGood appearance can be achieved with free superficial iliac circumflex artery skin flaps for the defects on face, neck, foot, hand, ankle and lower leg. Paraumbilical island flap can be used for the donor site defects.

Arteries ; Foot ; Free Tissue Flaps ; blood supply ; transplantation ; Humans ; Reconstructive Surgical Procedures ; Skin ; Skin Transplantation ; Transplant Donor Site ; surgery ; Wounds and Injuries ; surgery

Objective To study the topoanatomy of anterior perineal plane and adjoining tissue structure in the preparation of ultra-low anterior resection of the rectum. Methods Dissection was performed on 16 male cadavers of semi-pelvis sectioned in the saggital plane. Eight indexes were measured and recorded. Results Anterior perineal plane was clearly found in all 16 cadavers. The median distance of rectum-urethra (R-U) was 14 mm (ranging 10 -17 mm). The contour of perineal body was trapezoid,which was narrow cranially and broad caudally. The median width of cranial perineal body was 8 mm (ranging 6 -9 mm), while the median width of caudal perineal body was 21 mm (ranging 18 -23 mm).The median numerus of thickness of perineal body (TPB), thickness of puborectalis (TPR), arrterior wall of rectum (aPR) -D, pPR-D and width of pelvic diaphragm (WPD) were 20. 5 mm ( ranging 17 - 23 mm),12 mm(ranging 10 -16 mm), 25 mm(ranging 21 -27 mm), 20 mm(ranging 16 -23 mm) and 8 mm (ranging 6 - 10 mm) respectively. Conclusions Anterior perineal plane clearly exists, through which about 20 mm more length of the distal rectum is available which could increase the sphincter-saving rate in cases of low rectal carcinoma.

Objective To study the effect of octreotide on patients with postoperative acute adhesive small bowel obstruction. Method In this study, 87 patients with postoperative acute adhesive small bowel obstruction were divided into 2 groups: experimental group (46 patients) and control group (41 patients). Patients in the control group were treated with routine therapy, including gastrointestinal decompression, intravenous infusion, antibiotic and enema. Patients in the experimental group were treated with routine therapy plus somatostatin analogue (octreotide) 0.1 mg. ih q8 h. for 72 hour. The alleviation of abdominal symptom and sign and the possibility of surgical intervention are observed and compared.Results Compared to the control group, the obstruction in the experimental group alleviated significantly,the abdominal pain relieved, the amount of draining decreased, and the passage of gas was earlier.Conclusions Based on the routine therapy, the use of octreotide significantly relieves the symptoms of obstruction and shortens the course of conservative therapy.

As the rapid development of economy necessitates a large number of oil, the contradiction between energy supply and demand is further exacerbated by the dwindling reserves of petroleum resource. Therefore, the research of the renewable cellulosic biomass resources is gaining unprecedented momentum. Because xylose is the second most abundant monosaccharide after glucose in lignocellulose hydrolyzes, high-efficiency bioconversion of xylose becomes one of the vital factors that affect the industrial prospects of lignocellulose application. According to the research progresses in recent years, this review summarized the advances in bioconversion of xylose, which included identification and redesign of the xylose metabolic pathway, engineering the xylose transport pathway and bio-based chemicals production. In order to solve the energy crisis and environmental pollution issues, the development of advanced bio-fuel technology, especially engineering the microbe able to metabolize xylose and produce ethanol by synthetic biology, is environmentally benign and sustainable.
Bacteria ; genetics ; metabolism ; Escherichia coli ; genetics ; metabolism ; Ethanol ; metabolism ; Fermentation ; Fungi ; genetics ; metabolism ; Industrial Microbiology ; methods ; Metabolic Engineering ; Metabolic Networks and Pathways ; genetics ; Saccharomyces cerevisiae ; genetics ; metabolism ; Xylose ; metabolism

Objective To compare the pros and cons of endoscopic papillary balloon dilation (EPBD) with those of endoscopic sphincterotomy (EST) in the treatment of common bile duct stones.Methods We searched The Cochrane library,Medline,Pubmed,Embase,CBM,CNKI,VIP and Wan Fang database in any language.RCTs that compared EPBD with EST for the removal of common bile duct stones were included from January 1983 to September 2012 and qualities of the trials were evaluated.Statistic analyses were carried out using RevMan 5.1 software.Results A total of 18 randomized trials with 2385 participants met our inclusion criteria.EPBD compared with EST resulted in similar outcomes with regards to stone removal on 1 st attempt,overall stone removal,perforation,total short-term complication,long-term cholangitis or mortality.EPBD carries a higher risk of pancreatitis (RR =1.99,95％ CI:1.41-2.81) and severe pancreatitis (RR =4.68,95 ％ CI:1.36-16.11),and requires higher rates of mechanical lithotripsy (RR =1.31,95％ CI:1.14-1.50).Conversely,EPBD not only has statistically significant lower rates of bleeding (RR =0.14,95％ CI:0.06-0.34),but also leads to significantly less long-term cholecystitis (RR =0.38,95％ CI:0.19-0.76),long-term stone recurrence (RR =0.67,95％ CI:0.47-0.96) and total longterm complications (RR =0.52,95 ％ CI:0.40-0.67).Conclusion On the basis of lower rates of bleeding or long-term complications,EPBD should be the preferred strategy over EST for endoscopic management of common bile duct stones,however,the rate of pancreatitis,especially the severe pancreatitis is higher with EPBD.

Objective To compare clinical effects of appendicectomy and conservative treatment of uncomplicated acute appendicitis.Methods Searched The Cochrane library,Medline,Pubmed,Embase,CBM,CNKI,VIP and Wan Fang database in any language.RCTs that compared conservative treatment with appendicectomy in patients with uncomplicated acute appendicitis were included from January 1983 to May 2013 and qualities of the trials were evaluated.Statistic analyses were carried out using RevMan 5.1 soft-ware.Results Four randomized trials met our inclusion criteria (821partiCI:pants).Antibiotics compared with appendicectomy resulted in similar outcomes with regards to the incidence of complicated appendicitis (RR:0.89,95％ CI:0.29-2.68) and intra-abdominal infection(RR:0.54,95％ CI:0.13-2.35).Antibiotics carries a lower risk of complications (RR 0.46,95％ CI:0.32-0.67),but requires more length of hospital stay (Mean Difference 0.52,95％ CI:0.16-0.88).Conclusions The effect of conservative treatment is safe and effective.But the recurrent uncomplicated appendicitis recommends operation.