Objective To explore the effects of p38 mitogen-activated protein kinase (MAPK) on apoptosis of small intestinal epithelial cells after transplantation in rats. Methods Small intestinal transplantation was performed in SD and Wistar rats. The recipients were divided into three groups: isograft group (Wistar→Wistar group), allograft group (SD→Wistar group) and allograft+cyclosporine A group (SD→Wistar+CsA group). The grafts were harvested on day 1, 3, 5 and 7 after operation. All graft samples were subjected to histological examination. The apoptosis of graft epithelial cells was detected by TUNEL method. p38 MAPK was measured by Western-blotting method and serum TNF-? was determined by ELISA. Results Mild, moderate and severe rejection reaction occurred in the SD→Wistar group, it was showed that the number of apoptotic cells increased with the severity of the rejection reaction by TUNEL. In SD→Wistar group, the numbers of apoptotic cells were significantly higher than those of the other two groups (P0.05). The expression of p38 MAPK and the level of serum TNF-? were positively correlated with apoptosis in small intestinal rejection after transplantation (r=0.875, P

0.05), but in Wistar→SD group and Wistar→SD+CsA group, the serum IL-1? (levels) (increased) as the number of apoptotic cells increased(P

Bone and Bones ; blood supply ; Tissue Engineering

The emulsifiers of the ferula oil was shown to suppress markedly the swelling of the hind paw induced by injection of carrageenin and to suppress the increase of vascular permeability induced by intrad-ermal HA or 5-HT in rats. It also showed significant suppressive effects on oedema of rats hind paw induced by CFA.Experimental results indicated that it has inhibiting effect on DTH by SRBC in mice and suppressing on lymphocytes transformation induced by PHA.

Reduced surgery for early gastric cancer has been actively performed because it can offer complete cure and a good postoperative quality of life.Pylorus-and vagus-preserving gastrectomy (PPG) is one form of function-preserving surgery.Laparoscopic surgery has been widely applied for the treatment of gastric cancer due to its advantages including low invasiveness,minimal bowel paralysis,earlier postoperative healing and nerve and gastric function preservation.Therefore,laparoscopic pylorus-and vagus-preserving gastrectomy (LAPPG) for the treatment of early gastric cancer is welcomed by surgeons.From May 2004 to April 2013,12 patients with early gastric cancer received LAPPG in the First Affiliated Hospital of Dalian Medical University.All the patients were followed up for 3-74 months.One patient died of gastric cancer liver metastasis at postoperative month 22.The 5-year cumulative survival rate was 86％.LAPPG preserves nerve function and limits surgical injury,it is one of the ideal surgical methods for the treatment of early gastric cancer.

Objective To investigate the surgical techniques and clinical efficacy of laparoscopic intersphincteric resection (ISR) in the treatment of low rectal cancer.Methods A retrospective descriptive study was performed.The clinical data of 12 patients who underwent laparoscopic low rectal anterior resection combined with ISR at the First Affiliated Hospital of Dalian Medical University from May 2014 to October 2014 were collected.The patients underwent abdominal operation including total mesorectal excision (TME) + sphincter mobilization,then transanal intersphincteric resection,finally colinic anal-anal anastomosis.The operation time,volume of intraoperative blood loss,number of lymph node dissected,postoperative complications,time to anal exsufflation,duration of hospital stay,duration of postoperative hospital stay,pathological stage and follow-up were observed.The patients were followed up by outpatient examination and telephone interview at month 1,3 and 6 after operation up to April 18,2015.The follow-up included the prognosis of patients and the recovery of anal function.The function of defecation was evaluated by Wexner scoring system and Kirwan grading.Measurement data with normal distribution were presented as (x) ± s.Results All the 12 patients were completed laparoscopic surgery without conversion to open surgery.Eight patients underwent partial internal anal sphincter resection,and 4 underwent subtotal resection.Four patients in T3 stage underwent lateral lymph node dissection preserving the left colonic artery,hypogastric nerve and pelvic nerve.The operation time was (290 ± 35) minutes.The volume of intraoperative blood loss was (124 ± 80) mL.The number of lymph nodes dissected was 17 ± 8,and the number of positive lymph nodes was 0-4.The distance of the distal margin was (2.0 ± 0.5) crm,and the margin was negative.All the 12 patients were not complicated with infection,bleeding,anastomotic leakage,anastomotic stenosis and other complications.The time to postoperative anal exsufflation was (3 ± 1)days,duration of hospital stay was (20 ± 3) days,and duration of postoperative hospital stay was (12 ± 3) days.The results of TNM stage showed 3 cases of pT1 stage,5 cases of pT2 stage,4 cases of pT3 stage,10 cases of pN0 stage,1 case of pN1 stage,1 case of pN2 stage,8 cases of Ⅰ stage,2 cases of Ⅱ stage and 2 cases of Ⅲ stage.All the 12 patients were followed up for 6-11 months.The defection frequency and the Wexner score at month 1,3 and 6 after operation were 12 ±7,15 ±3,9 ±5 and 13 ±4,5 ±3,10 ±3,respectively.Of the 12 patients,the number of patients with satisfactory Kirwan score,flatus incontinence and loose stool was 1,3,8 at month 1 after operation,3,3,6 at month 3 after operation,10,2,0 at month 6 alter operation,respectively.Conclusion Laparoscopic ISR is effective in the treatment of low rectal cancer.

This article reviewed the connotation,developing process and utilization theory of diagnosis related groups (DRGs).DRGs,which is one of ease mix systems,is now used widely in healthcare management.DRGs classify inpatient based on diagnose and procedure.Practices have shown that it has relative high capacity for the risk adjustment of acute care cases; therefore,it can improve the efficiency of expenditure and performance management of inpatient services.Currently,there are more than 30 countries and regions using DRGs,and the theories and methodologies of DRGs get mature.China's new round healthcare reform have developed in depth.The study and development of DRGs related health management tool will promote China' s healthcare system becoming more scientific,normalized and systematic.

Authors described characteristics of medical service performance evaluation,and strategy options for scientifically evaluating such performance,and systematically presented the conditions and methodology of DRGs-based evaluation of medical service performance.Six evaluation indicators were cited in terms of the capacity,efficiency and medical safety of medical service providers,with detailed introduction to the computation process of such indicators.Cases in hand indicate that the first-page data completeness and accuracy of medical records are preconditions for using DRGs in medical service performance evaluation.

Objective To discuss the significance of ventricular rate for patients with persistent atrial fibrillation and to provide theoretical evidence for how to prevent patients of atrial fibrillation from complications such as cerebral embolism and left ventricular dysfunction, and so on. Methods Patients with persistent atrial fibrillation for more than 1 year were divided into cerebral embolism group and non-cerebral embolism group,30 patients per group. The data of patients in both groups were collected and compared, including general clinical characteristics, prothrombin time international standard ratio (PT-INR), the highest, lowest and average ventricular rate detected by Holter monitor system, left atria diameter and left ventricular ejecting fraction measured by echocardiography. Results There was no significant difference between two groups about general clinical characteristics, left atria diameter and PT-INR. The highest,lowest and average ventricular rate were much higher in patients of cerebral embolism group than those in non-cerebral embolism group. However, left ventricular ejecting fraction was much lower in embolism group. Conclusions It is critical to control heart rate for patients of persistent atrial fibrillation to prevent cerebral embolism and left ventricular dysfunction.

Objective To discuss the diagnosis,differential diagnosis and treatment of obstructive jaundice in infants.Methods Infants with obstructive jaundice were examined by ECT to obtain dynamic images of the liver,biliary tract and intestine to find out the position and nature of the obstruction.Results Eight patients with delayed nuclide imagining were diagnosed as obstructive jaundice of cholestasis.Five of which with aggravated jaundice were cured by biliary irrigation and 3 by medication.For 16 patients with congenital biliary atresia,10 were exterior hepatic types and 6 interior hepatic types.They had the nuclide image of liver and biliary tract.Ten cases of the exterior hepatic types and four cases of the interior types received the Kasai operation.And bile was drained after the surgery.Seven patients survived and 4 of interior heaptic types died postoperatively.Due to bile fistula,3 patients died after the hepato-porto-jejunostomy for internal drainage.Two patients of interior hepatic types who had no operation died of the hepatic failure.Conclusion The nature and position of obstructive jaundice could be identified by nuclide imaging.Young patients with jaundice of cholestasis could be treated by antiinflamation,liver function protection,Hymecromone and Dexamethasone for two weeks.Once the serum bilirubin rises,operation would be indicated.In the case of congenital biliary atresia,operation should be done earlier on the basis of medication.