Objective To explore effective methods of diagnosis and treatment for delayed rupture of the spleen (DRS) through retrospective analysis of 32 cases. Methods A retrospective study was done in 32 cases with DRS. The effects of CT, ultrasound and diagnostic peritoneal lavage on diagnosis of DRS was observed and compared. Results Splenectomy was performed in 26 cases, among which one died four days after splenectomy because of complicated brain injury and six given conservative treatment under continuous monitoring discharged. The mean hospitalization duration was 18.5 days. Conclusions Diagnostic peritoneal lavage can improve the positive rate of peritoneal puncture. Ultrasound is an important method for diagnosing DRS and closely monitoring the patients receiving conservative treatment.

Objective To evaluate ‘Cool-tip nee dl e’ radiofrequency ablation (RFA) for the treatment of solid tumors. MethodsIn this study, 102 patients w ith 157 tumors underwent RFA. Tumor size varied from 1.0cm to 20.0cm in d iameter. Result The comple te ablation(CA) rate was 83.5%(91/109)in tumors less than 5cm in diameter , and 35.4%(17/48)when tumors were larger than 5cm. RFA significantl y ameliorates symptoms in most lung cancer patients, and in 40%(4/10)patient s of pancreatic tumors. In the group receiving percutaneous RFA , no patients we re shifted to celiotomy, nor skin burn, or pneumothorax occurred. RFA for hepa tic tumors was complicated with abdominal pain in 13.4%(11/82), nausea in 6 .1%(5/82), jaundice in 9.7%(8/82), fever in 23.2%(19/82), and biliary leak age in 1.2%(1/82). Post RFA complications for pulmonary tumors included pain in 14.3%(1/7)and hypodermal gas accumulation in 14.3%(1/7). For pancrea tic tumors, pancreatic leakage in developed 20%(2/10), elevated blood amylas e in 70%(7/10), GI bleeding in 20%(2/10). Con clusions Treating solid tumors with ‘Cool-tip needle ’ RFA is efficient, reliable and safe, but great care should be taken in case o f pancreatic tumors.

Objective To explore the management strategy for liver trauma combined with juxla-hepatic venous injury and discuss relating factors leading to postoperative deaths. Methods The clini-cal data of 11 patients with juxtahepatic venous injury were retrospectively analyzed in aspects of prefer-ence of irregular hepatectomy and vein repair.There were 8 males and 3 females,at age range of 22-65 years(mean 33.7 years).Injury causes included traffic injury in 7 patients,fall-from-height injury in 3 and crush injury in 1.Of all,9 patients were combined with other abdominal organ injury and 7 with over one part fractures.All patients showed symptom of shock on admission. Results No patient died dur-ing operation but 3 died after operation.The complications included bleeding in 6 patients,severe infec-tion in 2.liver function failure in 3, acute renaI function failure in 2.bile-1eakage in 4,abdominal ab-scess in 4 and incision infection in 6. Conclusion Low blood pressure in the operation is the main cause for death.It is safe and effective to treat liver trauma combined with juxtahepatic venous injury with irregular hepatectomy and vein repair.

Objective To investigate the minimum local analgesic concentration(MLAC)of epidural hydromorphone combined with bupivacaine for analgesia during the first stage of labor by establishing clinical model.Methods Sixty four labouring parturi-ents at 3-7 cm cervical dilation who requested epidural analgesia were allocated to one of two groups.After a lumbar epidural cath-eter was placed,study participants received 15 mL bupivacaine(n=30),bupivacaine with hydromorphone 200 μg(n=30).The con-centration of bupivacaine was determined by the response of the previous patient using 0 - 100 mm visual analog pain scores, with≤30 mm within 30 min defined as effective.Results Four women were excluded,leaving 30 patients in each of the two groups for analysis.The MLAC of bupivacaine alone was 0.103%(95% CI :0.094%-0.113%).The addition of hydromorphone at doses of 200 μg resulted in significant reduction(P <0.05)in the MLAC of bupivacaine to 0.044%(95% CI :0.034%-0.053%),the difference was significant (P <0.05).There was no significant difference in Bromage scores,HR,BP,FHR,UC and adverse reac-tion (P >0.05).Conclusion The study showed a significant reduction in the MLAC of bupivacaine by hydromorphone.Hydromor-phone could be safely used in epidural analgesia for labor.

Objective To investigate the effect of all-trans retinoic acid (ATRA) on expression of gap junction genes 26, 32 and 43 in two human hepatocellular carcinoma cell lines. Method Human hepatocellular carcinoma cell lines SMMC-7721 and BEL-7404 were cultured and inoculated in culture plate. Cells were divided into 2 groups and cultured respectively with normal medium and medium contains ATRA at a concentration of 10-mol/L. After 24, 48 and 72 hours, cells were collected and total mRNA were extracted. RT-PCR was used to detect the transcription of gap junction genes 26, 32 and 43. Result SMMC-7721 and BEL-7404 cultured under condition of normal medium do not express CX26 mRNA and CX32 mRNA. With the effect of ATRA for 48 and 72 hours, SMMC-7721 cell expressed CX26 mRNA and CX32 mRNA. BEL-7404 expressed CX26 mRNA and CX32 mRNA while cultured with ATRA for 72 hours. CX43 mRNA expression of the two cell lines was not altered by ATRA. Conclusion ATRA affects the expression of CX26 and CX32 in HCC cell lines SMMC-7721 and BEL-7404 at the transcription level.

AIM: To evaluate the blood compatibility of a new bioartificial reactor membranous material (propylene-acidamide grafted poly propylene membrane, PP-g-AAm) in vitro. METHODS: Contacted PP-g-AAm membrane and PP (polypropylene) memb rane with platelet-rich plasma in a swing bed, 37 ℃, to simulate the conditions in vivo, and another group of PRP without any membranes was set as control group. ELISA was used to study the expression of ?-thromboglobulin, and flow cy tometry was used to study CD62P and CD63 expressio n of the activated blood platelets after contacting the two kinds of membranes w ith PRP. Scanning electrical microscopy was used to study the configuration and numbers of platelet cells adhered on the membranes. RESULTS: After contacting with PRP 30 min, ?-TG expression show ed marked difference between the two kinds of material groups and the control gr oup (P

Objective To evaluate dual-source dual-energy CT(DSCT) for the differentiation of urinary stone composition in vitro. Methods Ninety-seven urinary stones were obtained by endoscopic lithotripsy and scanned using dual-source dual-energy CT. The stones were divided into six groups according to infrared spectroscopy stone analysis: uric acid ( UA ) stones ( n = 10 ), cystine stones ( n = 5 ), struvite stones( n = 6), calcium oxalate ( CaOx ) stones ( n = 22 ), mixed UA stones ( n=7 ) and mixed calcium stones(n=47). Hounsfield units (HU) of each stone were recorded for the 80 kV and the 140 kV datasets by hand-drawing method. HU difference, HU ratio and dual energy index ( DEI ) were calculated and compared among the stone groups with one-way ANOVA. Using dual energy software to determine the composition of all stones, results were compared to infrared spectroscopy analysis. Results There were statistical differences in HU difference [(-17±13), (229±34),(309 ±45), (512 ±97), (201±64)and (530±71) HU respectively], in HU ratio (0.96±0.03, 1.34 ±0.04, 1.41 ±0.03, 1.47 ±0.03,1.30±0.07, and 1.49 ±0.03 respectively), and DEI( -0.006 ±0.004, 0.064 ±0.007, 0.080 ±0. 007, 0. 108±0.011 ,0. 055 ±0.014 and 0. 112 ±0.008 respectively ) among different stone groups(F=124. 894,407.028, 322. 864 respectively, P ＜0. 01 ). There were statistical differences in HU difference,HU ratio and DE1 between UA stones and the other groups( P ＜ 0. 01 ). There were statistical differences in HU difference, HU ratio and DEI between CaOx or mixed calcium stones and the other four groups (P＜0. 01 ). There was statistical difference in HU ratio between cystine and struvite stones ( P ＜ 0. 01 ). There were statistical differences in HU difference, HU ratio and DEI between struvite and mixed UA stones (P＜0. 05 ). Dual energy software correctly characterized 10 UA stones, 4 cystine stones, 22 CaOx stones and 6 mixed UA stones. Two struvite stones were considered to contain cystine. One cystine stone, 1 mixed UA stone, 4 struvite stones and 47 mixed calcium stones were considered to contain oxalate. Conclusions DSCT has the ability to differentiate urinary stone composition in vitro. With dual energy software, the UA, cystine and mixed UA stones can be differentiated from other types of stones.

Objective To study the clinical features and postoperative complications for gastric carcinoma in the patients older than 65 years. Methods From January 2005 to January 2007, 65 elderly gastric carcinoma cases underwent surgical resection, the age related preoperative and postoperative complications were analyzed. Result The incidence of preoperative complications in elderly gastriccarc inoma patients is 83%, compared with younger group of 59%; Preoperatively, 52% elderly cases presented with two or more complications. The incidence of hypertension was the highest (40%), the radical curative rate for the elderly group was 86% as compared with younger group of 93%. The postoperative complications in elderly group was 37%. In elderly cases, postoperative complications were common in those suffering from preoperative complications such as hypertension, diabetes, respiratory diseases, anaemia, hypoalbuminemia. Conclusion The age itself is not a single influential factors indicating postoperative complications. There was no significant difference in the morbidity and mortality between elderly and younger gastric carcinoma cases undergoing a surgery.

AIM: To investigate the levels of mRNA, protein of glucosylceramide synthase (GCS) and caspase 3 in the drug resistance induced by doxorubicin in human gallbladder carcinoma cell line GBC-SD, the effect of ceramide metabolism in this process was examined. METHODS: Human gallbladder carcinoma cell line GBC-SD was treated by doxorubicin at concentration of 200 ?g/L for 12 weeks (named GBC-SD12). Cytotoxicity, mRNA and protein of GCS were measured on 1st week, 4th week and 12th week by MTT assays, RT-PCR or Western blotting. The levels of caspase 3 were measured by spectrofluorometry. RESULTS: A 3.8-fold increase in drug resistance to doxorubicin in GBC-SD12 was observed. Up-regulation of GCS mRNA and protein were also detected in GBC-SD12 (P

Background::As a non-invasive and effective diagnostic method for small intestinal bacterial overgrowth (SIBO), wild-use of breath test (BT) has demonstrated a high comorbidity rate in patients with diarrhea-predominant irritable bowel syndrome (IBS-D) and SIBO. Patients overlapping with SIBO respond better to rifaximin therapy than those with IBS-D only. Gut microbiota plays a critical role in both of these two diseases. We aimed to determine the microbial difference between IBS-D overlapping with/without SIBO, and to study the underlying mechanism of its sensitivity to rifaximin.Methods::Patients with IBS-D were categorized as BT-negative (IBSN) and BT-positive (IBSP). Healthy volunteers (BT-negative) were enrolled as healthy control. The patients were clinically evaluated before and after rifaximin treatment (0.4 g bid, 4 weeks). Blood, intestine, and stool samples were collected for cytokine assessment and gut microbial analyses.Results::Clinical complaints and microbial abundance were significantly higher in IBSP than in IBSN. In contrast, severe systemic inflammation and more active bacterial invasion function that were associated with enrichment of opportunistic pathogens were seen in IBSN. The symptoms of IBSP patients were relieved in different degrees after therapy, but the symptoms of IBSN rarely changed. We also found that the presence of IBSN-enriched genera ( Enterobacter and Enterococcus) are unaffected by rifaximin therapy. Conclusions::IBS-D patients overlapping with SIBO showed noticeably different fecal microbial composition and function compared with IBS-D only. The better response to rifaximin in those comorbid patients might associate with their different gut microbiota, which suggests that BT is necessary before IBS-D diagnosis and use of rifaximin.Registration::Chinese Clinical Trial Registry, ChiCTR1800017911.