Objective To investigate the value of multi-slice spiral CT(MSCT)in diagnosis of the causes of intestinal obstruction.Methods 49 cases of intestinal obstruction confirmed by surgery or clinical diagnosis underwent abdominal MSCT plain and enhanced scanning,three-dimensional post-processing reconstruction was done in 5 cases.CT features were analysed blindly by two senior radiologists,including the thickness,density and degree of enhancement of intestinal walls at the "transition zone" area of intestine and surrounding mesenteric structure.The causes of intestinal obstruction were analysed in combination with clinical history of the patients.Results The causes of intestinal obstruction were suggested by MSCT in 46 cases(94%),including intestinal adhesion in 13 cases,tumor in 11,hernia in 4,ischemic bowel disease in 4,gallstone in 2,gastrolith in 2,Bezoar in 4.paralytic ileus in 3 and appendiceal abscess in 3.Three cases were misdiagnosed.Conclusion MSCT is of significant clinical value in diagnosis of intestinal obstruction,which should be used as the first means in clinic practice.

Objective To study the effects of costimulatory blockade with anti-inducible costim- ulator antibody(ICOS mAb)in combination with CTLA4Ig on prevention of islet allograft rejection. Methods Experimental animals were randomly divided into 4 groups(10 rats in each group).CT- LA4Ig + ICOS mAb group(group A):intraperitoneal injection of CTLA4Ig on day 0,2,4 and ICOS mAb on day 1,3,5 after islet transplantation;ICOSmAb group(group B):intraperitoneal injection of ICOS mAb on day 1,3,5 after islet transplantation;CTLA4Ig group(group C):intraperitoneal injection of CTLA4Ig on day 0,2,4 after islet transplantation;control group(group D):simple islet transplantation.The islet allograft survival and pathological changes in the transplanted islets after transplantation were observed.By using RT-PCR,the expression of IL-2 and IL-10 mRNA in the transplanted islets was detected.The expression of CD4~+ and CD8~+ T cell was detected by flow cy- tometry.Results In group A,the survival time was obviously prolonged as compared with other three groups and the transplanted islets were near normal under a light microscope.As compared with other three groups,the expression of IL-2 mRNA was significantly decreased in group A(P0.05).The expression of CD4~+ and CD8~+ T cell was not obviously up-regulated on the day 21 after transplantation.Conclusion The blockade of costimulatory signals with ICOS mAb in combination with CTLA4Ig has a favorable effects to restrain the rejection of islet transplantation.

Objective To investigate the clinical effects differences of two kinds of D2 lymphadenectomy in the treatment of patients with advanced gastric cancer including open operation and laparoscopy operation.Methods 90 patients with advanced gastric cancer were chosen in recent years in our hospital and were randomly divided into both group including group A (45 patients)with D2 lymphadenectomy by open operation and group B (45 patients) with D2 lymphadenectomy by laparoscopy operation;and the clinical indicators in peri-operation period,the dissec-tion number of lymph node,survival rate in 1 year with follow-up and postoperative complication incidence of both groups were compared.Results The clinical indicators in peri-operation period of group B was significantly better than that of group A (t=2.13,2.56,1.98,1.96,1.94,2.05,2.10,all P<0.05).The N2 dissection number of lymph node of group B was significantly fewer than that of group A (t=2.15,P<0.05).The survival rate in 1 year with follow-up of group A and group B were separately 88.89%and 91.11%,there was no significant difference in survival rate in 1 year with follow-up between the two groups(χ2 =1.67,P>0.05).The postoperative complication incidence of group A and group B were separately 20.00% and 8.89%,the postoperative complication incidence of group B was significantly lower than that of group A (χ2 =9.44,P<0.05).Conclusion Compared with D2 lymph-adenectomy by open operation,D2 lymphadenectomy by laparoscopy operation in treatment of patients with advanced gastric cancer can efficiently decrease the degree of surgical trauma,accelerate the process of recovering after opera-tion,and be helpful to reduce the risk of postoperative complications.

Objective To screen and identify the anomously expressed proteins at protein level in colon mucosa of diarrhea-predominant irritable bowel syndrome(D-IBS)patients and healthy individuals.Methods Four D-IBS patients and four healthy individuals were included in the study.Biopsies of mucosa at the ileocecal junction and sigmoid colon were performed via colonoscopy.The specimens were cleaned with ice cold saline which contained 0.1% PMSF,and were snap frozen in liquid nitrogen.The two-dimensional gel electrophoresis(2-DE)was used to screen the anomously expressed proteins,and the two proteins which presented the greatest changes in each group were identified by mass spectrometry method.Results Proteomics maps of human colon mucosa were obtained successfully with 2-DE.Average protein spots were 336 in normal control group,and the matching rate among them was 92%,while in D-IBS group,the average protein spots were 426,and the matching rate was 95%.The average matching rate between the test group and the control group was 74%.It was found that the volume value of 24 proteins spots changed more than two folds.The protein expression was found to decrease in 3 spots and increase in 21 spots.Four proteins were chosen for analysis with mass spectrometry analysis.The two up-regulated proteins were identified as Immunoglobulin J chain and heat shock protein 27,while the other two down-regulated proteins were identified as hemoglobin beta subunit and fructose-bisphosphate aldolase A.Conclusion With 2-DE,proteomics maps of human colon mucosa have been obtained successfully.The proteome expressions of colon mucosa in D-IBS patients are remarkably different from that of the healthy individuals.The four identified proteins may play a certain role in the pathogenesis of D-IBS.

Objective The patients with metastatic spinal tumors often suffered from severe back pain and spinal cord compression directly caused by tumor tissue or severe spine kyphosis.In order to treat or prevent spinal cord paralysis,decompression and stabilization should be performed on the patients with spinal pain and /or severe spinal cord compression.Methods From July1998through July2001,62patients(27women and35men)with metastatic spinal tumors had been treated at our department.Of 62patients,the thoracic vertebrae were involved in37cases,lumbar vertebrae in19and cervical vertebrae in6.Among43of 62patients who pre sented with neurological dysfunction,24patients were incompletely para plegic and the others were completely paraplegic.The fol low-up ranged from8to36months.Results Pain relief was ob-tained in58of 62patients(94%),and good neurological recovery was obtained in33of the43patients.Improved bowel and bladder function was obtained in12of 25patients who presented with bowel and blad der dysfunction.After decompression,neurological function,evaluated as Frankel grade E or D,was ob-tained in5patients whose neurological function had been evaluated as Frankel grade A or B,and other9pa-tients ex perienced a neurological recovery from Frankel grade A or B to C or D.Conclusion The time developing from neurological dysfunction to complete para plegia is the most important prognostic factor.Poor prognosis is often inevitable when complete paraplegia appeared less than48hours.Complete loss of bowel and bladder function is also a factor for poor prognosis.Decompression should be performed immedi -ately if the patient is presented with neurological dysfunction.Spinal metastasis of thyroid or breast cancer has a rela tive good prognosis.However,metastasis of lung or liver cancer is associated with a short-term survival.Neu rological function of patients with spinal metastasis at thoracic region is more difficult to recover.Com-mon motor and sensory functions are often improved earlier than bowel and bladder function.Thorough re-section of metastatic tumor and stable in ternal fixation should be performed when single vertebra is involved.Conservative tumor resection,decompression and posterior internal fixation should be performed when two or more seg ments are involved in order to alleviate paraplegia,improve spinal stability and the quality.[

Objective To explore the complications of the total elbow arthroplasty after the resection of the peri-elbow tumor. Methods Between June 1998 and June 2002, eight patients underwent total elbow arthroplasty after resection of tumors, which involved 7 males and 1 female (mean age, 42.6 years; range, 22-63 years). The patients included 1 metastasis, 1 GCT, 2 MFH, 1 osteosarcoma, 1 lymphoma, 1 desmoid fibroma, and 1 synovial sarcoma. The tumors located 3 in distal humerus, and 5 in proximal ulna. For those of the distal humerus, after the resection of the tumors, the origins and the insertions of the musculi flexors, extensor, pronators and supinators were repaired as far as possible. The application of the prothesis was relatively simple, the prosthetic stem of the distal humerus was cemented, the intercondylar notch was sawn off, but both the lateral and medial epicondyles were kept, the prothesis impacted in the notch; While for those tumors located on the proximal ulna, the stem was spiraled in the intramedullary cavity, Patients were evaluated according to the Mayo Elbow Performance Score. Results All the patients were followed up at least one year or to death (mean duration, 2.5 years). Pain scores decreased from a mean of 3.6 to 2.0. Mean elbow motion from extention to flexision arc improved from 29? to 73? (range, 55?-105?). Seven cases were excellent or good (87.5%), and only one was poor (12.5%). There were none of the complications, such as infection, incision non-union and nerve injury. All patients without local recurrence as well. The X-ray didn't reveal any sign of loosening or breakage for the artificial elbow joint. Conclusion Total elbow arthroplasty after resection of tumors can decrease the pain and improve the function substantially. For metastatic tumors, this technique can be also used to alleviate symptom if there is no other good option.

[Objective]To evaluate the preemptive analgesic effect and safety with celecoxib in patients undergone the hip joint replacement.[Method]Fifty patients scheduled for elective hip joint replacement were randomly divided into two groups,celecoxib group and control group.Those of celecoxib group were given celecoxib 200 mg 24,12 h before incision.The operation was performed under extradural anesthesia by the same surgeons. All patients were given celecoxib 200 mg 8,24,36,48,60,72 h after the operation.Before celecoxib administration and after the operation,pain intensity was measured using visual analog scale(VAS),and analgesic requirements,side effects,hip joint ranges of motion,sleep states,hemorheology and phlebothrombosises messured with the ultrasonic wave were compared.[Result]There were no marked differences in the VAS pain scores before celecoxib administration between two groups.Compared with control group,the patients of celecoxib group had significantly lower VAS pain scores after the operation(P

Adolescent ; Ammonia ; poisoning ; Female ; Humans

OBJECTIVEThis study aims to determine the effect of fluoride concentration on the corrosion behavior of cobalt-chromium alloy fabricated by two different technology processes in a simulated oral environment.

METHODSA total of 15 specimens were employed with selective laser melting (SLM) and another 15 for traditional casting (Cast) in cobalt-chromium alloy powders and blocks with the same material composition. The corrosion behavior of the specimens was studied by potentiodynamic polarization test under different oral environments with varying solubilities of fluorine (0, 0.05%, and 0.20% for each) in acid artificial saliva (pH = 5.0). The specimens were soaked in fluorine for 24 h, and the surface microstructure was observed under a field emission scanning electron microscope after immersing the specimens in the test solution at constant temperature.

RESULTSThe corrosion potential (Ecorr) value of the cobalt-chromium alloy cast decreased with increasing fluoride concentration in acidic artificial saliva. The Ecorr, Icorr, and Rp values of the cobalt-chromium alloy fabricated by two different technology processes changed significantly when the fluoride concentration was 0.20% (P < 0.05). The Ecorr, Icorr, and Rp values of the cobalt-chromium alloy fabricated by two different technology processes exhibited a statistically significant difference. The Icorr value of the cobalt-chromium alloy cast was higher than that in the SLM group cobalt-chromium alloy when the fluoride concentration was 0.20% (P < 0.05). The Ecorr, tRp alues of the cobalt-chromium alloy cast were lower htan those of the SLM group cobalt-chromium alloy when the fluoride concentration was 0.20% (P< 0 .05).

CONCLUSIONFluoride ions adversely affected the corrosion resistance of the cobalt-chromium alloy fabricated by two different technology processes. The corrosion resistance of the cobalt-chromium alloy cast was worse than that of the SLM group cobalt-chromium alloy when the fluoride concentration was 0.20%.