Objective To explore the effect of tumor necrosis factor-α antagonist (Remicade) on the patients with active moderate to severe ulcerative colitis (UC) who failed to response to mesalazine or sulfasalazine Sah'cyloyl treatment for six months period.Methods The patients were collected in our hospital,who diagnosed by colonoscopy as moderate to severe ulcerative colitis and failed to response to mesalazine or sulfasalazine Salicyloyl treatment for six months period;These patients were randomly divided into control group(22 cases) and treatment group(28 cases) ;glucocorticoid was used alone in control group while it was combined with Remicade in treatment group.After treatment for six months,they were suffered from colonoscopy and clinical evaluation.Results There were significant differences between control and treatment group of the recover rate concerning the clinic symptoms such as abdominal pain,diarrhea,and mucous bloody stool.There were 7 cases complete remission,13 cases effective outcome and 9 cases ineffective,with complete remission rate of 31.67% .efficiency rate 59.09% in control group.There are 17 cases complete remission,25 cases effective outcome and 3 cases ineffective,with complete remission rate of 60.71% ,efficiency rate 89.28% in treatment group.There was significant difference (P<0.05) between two groups of complete remission rate and efficiency rate.There were 3 cases recurring in control group,with the recurrence rate of 13.67% ,while there were 2 cases recurring in treatment group with the recurrence rate of 7.14%.There was significant dif-ferene( P<0.05) between two groups with regards to recurrence rate;Besides,there were no significant adverse effect.Conclusion The combination with Remicade and glucocorticoids in the treatment of refractory severe ulcerative colitis was more effective and can also reduce the relapse rate.

ObjectiveTo observe the efficacy of simethicone, mosapride combined with flupentixol-meiltracen in the treatment for functional dyspepsia(FD). MethodsThe diagnosis of functional dyspepsia patients treated according to Zung Self-rating Anxiety Scale (SAS) ＞ 40, Hamilton Depression Scale(HAMD) ＞ 17 for inclusion criteria,a total of 64 patients were selected and randomly divided into two groups. The treatment group( simethicone,mosapride combined with flupeentixol-meiltracen) in 33 cases and the control group ( single flupenthixol melitracen) in 31cases. 2 groups of the period of treatment was 4 weeks. Evaluation before and after treatment with mood disorder scale score changes and syndrome efficacy and adverse reactions. ResultsThe treatment group after treatment, regardless of scale score change of mood disorders, syndrome treatment efficacy were significantly better than the control group,especially in the syndrome efficacy difference was significant( P ＜0.05 ,P ＜0.01 ) ;after the treatment without obvious adverse reaction. ConclusionThe simethicone, mosapride combined with flupentixol-meiltracen treatment with anxiety and depression in patients with functional dyspepsia could effectively relieve the symptoms of functional dyspepsia,and relieve the patient's psychological disorder;certainly result in fewer adverse reactions.

Objective:To study the effect of the cytokines, tumor necrosis factor-?(TNF-?), interferon-?(IFN-?), interferon-?(IFN-?), platelet-derived growth factor BB(PDGF-BB), basic fibroblast growth factor(bFGF),on promoter activity of human transforming growth factor-?1(TGF-?1) gene.Methods:A construct of phTGF2.14 containing sequence from -1 328 bp to +812 bp of human TGF-?1 gene,linking with chloramphenicol acetyltransferase(CAT) as reporter gene,was transiently transfected into rat hepatic stellate cell line nFSC. The cells were subsequently treated with TNF-?,IFN-?,IFN-?,PDGF-BB,bFGF, and the CAT activity was assessed 48 hours after stimulation with each cytokines.Results:TNF-? of 10 ng/ml can increased the CAT activity of phTGF2.14 to 3.24 fold compared to control. IFN-? and IFN-? at 1 000 U/ml decreased CAT activity to (42?12)% and (58?6)% of control respectively.PDGF-BB,bFGF of 10 ng/ml had no effect on promoter activity of human TGF-?1 gene;Combined application of IFN-?,IFN-? and TNF-?,the promoter TGF-?1 gene were 1.32 and 1.46 fold compared with control,respectively.Conclusion:These data indicate that TNF-? can increase the promoter activity of human TGF-?1 gene, but IFN-?,IFN? can downregulate the CAT activites of phTGF2.14, and IFN-?,IFN-? can interdict the upregulate effect of TNF-? on phTGF2.14. We did not find PDGF-BB,bFGF have any effect on TGF-?1 promoter. These provided an essential evidence for study the interaction mechanism of cytokines in fibrogenisis diseases.

Objective To research whether double antiplatelet drug combined with pantoprazole can reduce digestive tract damage,or aggravate cardiovascular system side effect.Methods 270 patients diagnosed as ischemic stroke received double antiplatelet drug were randomly divided into two groups.The treatment group received panto-prazole,the control group did not took any gastric drug.The side effect of the digestive and cardiovascular system was observed.Results 268 patients were followed up for 90 days,and digestive system side effect of the treatment group (136 cases)included indigestion in 26 cases(19.11%),stool occult blood(+)in 11 cases(8.08%),melena in 8 cases(5.89%),hematemesis in 0 case,and the control group (132 cases)included indigestion in 42 cases (31.82%),stool occult blood(+)in 23 cases(17.42%),melena in 19 cases(14.39%),hematemesis in 4 cases. There were significant differences between the two groups(χ2 =6.66,4.56,11.2 and 4.18,all P <0.05).Cardiovas-cular system side effect of the treatment group included palpitation or chest distress or chest pain in 4 cases (3.68%),myocardial ischemia diagnosed by electrocardiogram in 4 cases(2.94%),myocardial infarction and died of cardiovascular disease in 0 case,and the control group included palpitation or chest distress or chest pain in 4 cases (3.00%),myocardial ischemia diagnosed by electrocardiogram in 3 cases(2.27%),myocardial infarction and died of cardiovascular disease in 0 case.There were no statistical differences between the two groups(χ2 =6.66 and 4.56, both P >0.05 ).Conclusion Double antiplatelet drug combined with pantoprazole had a positive significance in reducing the digestive tract damage of ischemic stroke patients,and didn't increase the incidence of cardiovascular sys-tem side effect.

Objective To observe long-term follow-up results of in-stent restenosis by digital subtraction angiography(DSA) method after angioplasty and stenting with the Gateway-Wingspan stenting system in middle cerebral artery(MCA).Methods Consecutive patients with ischemic stroke and Wingspan stent placement were enrolled into our study.The proportion of in-stent restenosis and ischemic stroke associated with restenosis were evaluated by DSA after 6 and 12 months of stent placement.Results 30 patients with stenosis/occlusion of MCA underwent Wingspan Stent successfully.All of the patients finished follow-up except two patients(6.7％ ) who died in the first three months after stenting.At the sixth months follow-up,in-stent restenosis was observed in 7 patients( 23.3％ ) with average (69.0 ± 9.8 )％ in-stent restenosis degree.However,no additional in-stent restenosis was found at the twelfth month,two patients among the 7 with in-tent restenosis were suffered with artery occlusion in stent.Conclusion In-stent restenosis after Wingspan stenting in middle cerebral artery was more common during the first six months,and 85.7％ with ischemic stroke.It was worthy of paying attention to prevent in-stent restenosis at the first six months after stenting.

BACKGROUND:Currently, the enzymatic digestion combined with magnetic activated cel sorting for isolating microvascular endothelial cel s are cumbersome and do harm to cel s. Therefore, how to simplify the isolation and culture of human dermal microvascular endothelial cel s to obtain highly purified endothelial cel s in vitro becomes a hotspot.
OBJECTIVE:To explore a simple and effective cultivation method of microvascular endothelial cel s from diabetic patient skins in vitro, and to detect the cel growth.
METHODS:Diabetic patients with chronic foot wounds after amputation were enrol ed to col ect the limb proximal skin and topical skin around the wound superficial dermal tissue. Human dermal microvascular endothelial cel s were obtained using adherent method and trypsin method, fol oewd by purified utilizing trypsin digestion and repeated attachment method when passage culture.
RESULTS AND CONCLUSION:Human dermal microvascular endothelial cells were obtained successfully, Primary cultured endothelial cells completely adhered to the wall at 24 hours, entered the logarithmic phase at the 10th day, and the cell concentration reached 80%at the 12th-13th day. While the passage cells grew more actively than primary cells, and fully covered the bottom in a“cobblestone”arrangement after 5-7 days of culture. Immunohistochemical staining showed that cultured cells were positive for FVIII and CD31-associated antigens with 100%positive rate. MTT assay showed that cell growth curves of 2, 4, and 5 generations of dermal microvascular endothelial presented the invertedSshape. These results suggest that abundant highly purified human dermal microvascular endothelial cells can be obtained through the adherent method and a small amount of short-term trypsin method.

OBJECTIVETo evaluate the radical effect and postoperative anal function of total mesorectum excision (TME) combined with different intersphincter resection (ISR) in treatment of T1 and T2 stage ultra-low rectal cancer.

METHODSClinical data of 102 T1 and T2 stage ultra-low colorectal cancer patients who received TME combined with different ISR from January 2004 to December 2013 in our department, including 33 cases of complete internal anal sphincter excision ISR (complete ISR group), 39 cases of partial internal anal sphincter excision ISR (partial ISR), 30 cases of partial dentate line reservation ISR (dentate line group). All the operation procedures followed the principles of TME. Radical conditions were compared and similarly, postoperative anal function was evaluated by Williams classification standard among 3 groups.

RESULTSThe general information, such as gender, age, BMI, maximum diameter of tumor, distance of tumor edge to dentate line, TNM staging, degree of differentiation among 3 groups had no statistically significant differences (all P>0.05). The operation time, intraoperative blood loss, length of removed intestinal canal, resection margin, the harvested number of lymph nodes, and postoperative complications among 3 groups also had no statistically significant differences (all P>0.05). Twelve months after surgery, good anal function rate in part ISR group and dentate line group was 100%, significantly better than that in complete ISR group (75.8%) with significant difference (χ2=4.654, P=0.015).

CONCLUSIONTME combined with ISR surgery in treatment of T1 and T2 stage ultra-low rectal cancer is safe and effective, which, as far as possible to preserve partial internal sphincter and dentate line on the premise of the guarantee of radical condition, can help to improve the postoperative anal function.

Anal Canal ; Digestive System Surgical Procedures ; Follow-Up Studies ; Humans ; Lymph Nodes ; Neoplasm Staging ; Operative Time ; Postoperative Complications ; Postoperative Period ; Rectal Neoplasms

OBJECTIVETo compare the effect of rapid rehabilitation surgery (FTS) with the traditional operation method on postoperative immune function recovery, inflammatory reaction and the clinical efficacy in elderly patients with colorectal cancer.

METHODSA total of 144 elderly patients (older than 65 years) diagnosed as colorectal cancer in our department from February 2010 to August 2013 were prospectively enrolled in the study. According to the order of admission, patients were randomly divided into the fast track surgery group (72 cases, study group), and the traditional operation group (72 cases, control group). Preoperative and postoperative T cell subsets, inflammatory index and organ functional parameters were detected and compared.

RESULTBasal clinical data of the two groups had no significant differences (all P>0.05). Three days after operation, CD4+ and CD8+ in both groups increased compared to preoperative levels (P<0.05), while the study group had greater increasing amplitude of CD4+ (t=1.685, P=0.003), and lower CD8+(t=1.145, P=0.005) than the control group. CD4+/CD8+ increased in the study group compared to preoperation and significantly higher than that in the control group (P=0.001). Inflammatory stress indexes were significantly increased, while study group had smaller amplitude than the control group. Serum creatinine, B-natriuretic peptide and Troponin-T increased after operation, while the study group had smaller amplitude than the control group (P<0.05). The study group showed faster resumption of oral intake, quicker bowel function return, time to first defecation, hospital stay, lower incidences of nausea, vomiting, incision infection, and less cost of hospitalization. All the differences were significant (all P<0.05).

CONCLUSIONFast track surgery can effectively protect the perioperative organ function, increase postoperative immune function, decrease inflammation stress reaction, reduce perioperative morbidity of complication, improve efficacy for elderly colorectal cancer patients.

Aged ; Colorectal Neoplasms ; surgery ; Defecation ; Humans ; Inflammation ; immunology ; Length of Stay ; Postoperative Period

Objective To investigate the feasibility and safty of indocyanine green (ICG) fluorescence staining by laparoscopic ultrasound and three-dimensional (3D) visualization guided portal branch puncture approach in anatomical segmentectomy.Methods The retrospective cross-sectional study was conducted.The clinical data of 26 patients who underwent anatomical segmentectomy using ICG fluorescence staining by laparoscopic ultrasound and 3D visualization guided portal branch puncture approach in the Zhongshan Hospital of Fudan University between December 2016 and April 2018 were collected.The preoperative 3D visualization reconstruction and areas of portal branch perfusion were analyzed,laparoscopic ultrasound localization was intraoperatively applied to tumor and portal vein of targeted hepatic segment,and then portal branch puncture and staining were done under laparoscopic ultrasound and 3D visualization,finally laparoscopic anatomical segmentectomy was performed.Observation indicators:(1) intraoperative situations:success rate of portal vein puncture,targeted hepatic segment,effect of ICG fluorescence staining,intraoperative complications,operation time,volume of intraoperative blood loss,blood transfusion,conversion to open surgery,tumor diameter,the minimum resection margin to tumor;(2) postoperative situations:postoperative complications (Clavien-Dindo classification as a criteria) and duration of hospital stay;(3) follow-up situations:cases with follow-up,follow-up time and postoperative tumor recurrence.Follow-up using outpatient examination and telephone interview was performed to detect postoperative tumor recurrence up to April 2018.Measurement data with normal distribution and count data were respectively described as average (range) and percentage.Results (1) Intraoperative situations:a success rate of laparoscopic ultrasound and 3D visualization guided portal branch puncture in 26 patients was 100.0％ (26/26),and punctures in S8,S7,S2,S3,S6,S5 and S4 of the liver were respectively performed to 7,6,4,3,3,2 and 1 patients.Of 26 patients,22 achieved expected effect of ICG fluorescence staining,with a statisfaction of 84.6％ (22/26) and 4 failed to get expected effect,including 2 with uneven dying,1 with staining-uncovered partial areas of targeted liver segment and 1 with adjacent hepatic segmental staining induced to unclear boundary.All the 26 patients were not complicated with ICG injection induced to allergy.Average operation time and volume of intraoperative blood loss were 184 minutes (range,60-315 minutes) and 97 mL (range,10-400 mL),without intraoperative blood transfusion and conversion to open surgery.Average tumor diameter and average minimum resection margin to tumor in 26 patients were respectively 3.2 cm (range,1.2-10.0 cm) and 1.5 cm (range,0.4-3.0 cm).(2) Postoperative situations:of 26 patients,2 with grade Ⅰ-Ⅱ of Clavien-Dindo classification were improved by drug treatments (1 with deep venous thrombosis of the lower extremities and 1 with pleural effusion),no patient had grade Ⅲ and above complications,and there was no bile leakage,infection and hepatic dysfunction.Average duration of hospital stay in 26 patients was 6.9 days (range,5.0-14.0 days).(3) Follow-up situations:26 patients were followed up for 0.3-17.0 months,with a median time of 6.0 months.During the follow-up,1 patient with hepatocellular carcinoma had adrenal metastasis and 25 had tumor-free survival.Conclusion Laparoscopic anatomical segmentectomy with ICG fluorescence staining by laparoscopic ultrasound and 3D visualization guided portal branch puncture approaeh is safe and feasible,especially suitable in posterosuperior liver segments.