Objective To explore the clinical effect of surgical treatment of stricturing Crohn's disease (CD).Methods The retrospective cross-sectional study was conducted.The clinical data of 28 patients with stricturing CD who were admitted to the First Affiliated Hospital of Zhejiang University School of Medicine between June 2013 and April 2016 were collected.After improving the patients' nutritional status by preoperative corresponding treatment and optimizing the risk factors of complications,patients received individualized therapy according to their conditions.The intestinal one-stage resection and anastomosis or ostomy were performed at the stenotic locus causing sypmtoms,and no treatment or angioplasty for stenosis was performed at the gentle stenotic locus.Patients received regularly postoperative outpatient reexaminations.The medication was used to prevent recurrence according to the individual conditions.Observation indicators:surgical procedures (open or laparoscopic surgery),operation time,volume of intraoperative blood loss,number of patients with intraoperative blood transfusion,length of intestine resected,anastomosis methods,angioplasty for stenosis,duration of postoperative hospital stay,postoperative complications and follow-up.Follow-up using outpatient examination,telephone interview and wechat was performed to detect the abdominal pain,diarrhea,symptoms of clinical recurrence and endoscopic recurrence situations up to July 2016.Results All the 28 patients with stricturing CD underwent the selective operations,including 8 undergoing laparoscopic surgery (3 receiving conversion to open surgery) and 20 undergoing open surgery.Of 28 patients,2 underwent partial upper jejunum resection,10 underwent partial terminal ileum resection,15 underwent right hemicolectomy and 1 underwent colectomy.Operation time and volume of intraoperative blood loss were 33-288 minutes with an average time of 122 minutes and 50-650 mL with an average volume of 200 mL,respectively.One patient had intraoperative blood transfusion.Length of intestine resected of 28 patients was 10-150 cm,with an average of 54 cm and a total length of 1 510 cm.Of 28 patients,26 received the side-to-side anastomosis using linear closures (1 received the end-to-side anastomosis using pipe stapler,1 with multiple lesions and rectovaginal fistula received colectomy and ileostomy).Two patients with multiple stenosis of the small intestine underwent intestinal resection combined with angioplasty for stenosis in 3 loci.Duration of postoperative hospital stay was 7-45 days,with an average duration of 15 days.No patient died of surgery.Three patients had postoperative complications,including wound infection,incisional hernia and anastomotic leakage.Twenty-one patients were followed up for 3 months to 2 years,with a median time of 11 months,and there was no recurrence during the follow-up.Conclusions Surgical treatment should be performed to the patients with non-symptom,chronic and fibrous stricturing CD and anastomotic stenosis after ineffective medical treatment,with a satisfactory outcome.Meanwhile,it need follow the principle of minimally invasive.And optimizing high risk factors of complications before operation is a key point for preventing postoperative complications.

Here we reviewed the applications of laser scanning confocal microscope in biomedical field. The reformation and improvement based on this technique were also summarized. After analyzing the defects, we highlighted its potential applications in the future.

Objective To observe the impact of different culture conditions on the growth of the endothelial progenitor cells(EPCs) from rat peripheral blood. Methods Mononuclear cells obtained from rat peripheral blood were isolated by using density gradient centrifugation. According to the culture medium added with vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and the dishes were precoated with fibronectin or not, the mononuclear cells were divided into different groups and cultured under different conditions in vitro to compare the differences of the growth conditions. The different growth conditions were recorded and the result was calculated by statistics software. At last, the cells were identified by immunohistochemistry and immunofluorescence. Results The mononuclear cells from rat peripheral blood grew in the manner of keeping close to the wall in vitro. The cells and cell colonies cultured for 7 days hinted:under the same culture conditions, precoating FN was beneficial to the adherent proliferation of EPCs (t=4.43, P＜0.05; t=3.70, P＜0.05). Excluding the impact of fibronectin, growth factors could promote mononuclear cells differentiation to EPCs, indicating that growth factors enhanced proliferation of EPCs (t =-13.22, P＜0.01; t =-10.96, P＜0.01). Immunohistochemistry and immunofluorescence showed that, at day 4, 7, 10 of cells cultured, CD34 and CD133 expressions were increased gradually [(35.7±4.2)%, (60.1±3.8)%, (81.8±6.4)%; (3.2±0.9)%, (18.4±7.3)%,(32±3.8)%, respectively]; at day 14, both were decreased [(32.1±5.4)%, (1.9±2.7)%]; but Flk-1was increased at day 4, 7,10, 14 [(31.2±3.5)%, (40.6±5.3)%, (71.2±8.4)%, (81.5±4.1)%].Conclusions Fibronectin is conducive to adhesion and proliferation of EPCs. VEGF and bFGF play an important role in the differentiation of EPCs. The success culture of EPCs in vitro will provide a sufficient number of seed cells for its application in vascular tissue engineering, and offer new ideas for peripheral blood stem cell transplantation for the treatment of various diseases.

An in vitro detection method of the gastrointestinal absorption of Pilose Antler protein was established for mixed protein activity. Five bands of protein with molecular weight of 17.8-160 kD derived from the Pilose Antler were extracted and sufficiently labeled with FITC (FITC-PE). The stability and variation of FITC-PE in gastrointestinal circumstances were detected by native polyacrylamide gel electrophoresis and confocal laser scanning microscope. Results showed that the main component of FITC-PE kept invariant after being reacted with artificial gastric fluid and artificial intestinal fluid. The fluorescence signal was detected 20 min after administration in the valgus intestinal purse experiment, and three kinds of protein, with molecular weight of 45, 25, and 17.8 kD, were detected in the mixture of absorbent protein. The research laid the foundation for the further in vivo study of Pilose Antler protein. Meanwhile, it would be an in vitro screening method for the absorption, distribution and metabolism of mixed protein from traditional Chinese medicine.

Objective To explore the clinical characteristics of Henoch-Sch(o)nlein purpura complicated with acute necrotizing acute pancreatitis,in order to provide information for the diagnosis and differentiation of Henoch-Scht(o)nlein purpura complicated with acute abdominal disease.Methods There was a case present with purpura,abdominal pain,massive ascites and poor spirit in Department of Pediatrics,the First Affiliated Hospital of Zhengzhou University.The clinical manifestations and physical examination results were summarized and discussed,some pediatric specialists from nephrology department,surgery department,digestive system department were invited to discuss the case.The treatment was adjusted according to result of discussion,the final diagnosis was tracked.Results The case was firstly diagnosed with Henoch-Sch(o)nlein purpura,acute diffuse peritonitis with cause in dispute.After the discussion,the intestinal necrosis,perforation could not be excluded,acute pancreatitis required further identification.Exploratory laparotomy was received because of the changing condition after discussion.The intraoperative diagnosis was acute necrotizing pancreatitis.The patient recovered well with medical treatment.Conclusion When children with Henoch-Sch(o)nlein purpura had an acute abdominal disease,acute necrotizing pancreatitis should be considered in addition to intestinal necrosis,perforation.

Objective To evaluate the efficacy and safety of intrapleural fibrinolytic agents in the treatment of childhood empyema.Methods The data from China National Knowledge Infrastructure (CNKI),Chinese BioMedical (CBM),PubMed,VIP Database and Cochrane library were reviewed.Randomized control trials by using intrapleural fibrinolytic agents to treat childhood empyema were included.Two reviewers independently extracted the data from the eligible studies and evaluated the quality of the included studies.Meta-analysis was performed for the results of homogeneous studies using RevMan 5.2 software,while others analyzed descriptively.Results Five randomized control trials involving 248 children with empyema were included.Meta-analysis was not made in all of the indexes because of apparent heterogeneity and limited data.Two trials were compared which involved 98 patients receiving fibrinolytic agents or 9 g/L saline.The results suggested that fibrinolytic agents shortened the length of hospital stay and reduced complication(all P ＜ 0.05),but no significant differences were found between the 2 groups in the effective rate,duration of fever and pleural effusion amount(OR =3.61,95％ CI 0.84-15.49,P ＞ 0.05).Three trials involving 150 patients compared fibrinolytic agents and video-assisted thoracoscopic surgery (VATS).The data suggested that no significant differences were found between 2 groups in the effective rate (OR =0.70,95 ％ CI 0.30-0.61,P ＞ 0.05),but fibrinolytic agents cost less (P ＜ 0.05).The adverse drug reactions to intrapleural fibrinolytic agents were mild to moderate,and well tolerated.Conclusions The findings suggest that intrapleural fibrinolytic agents in the treatment of childhood empyema is safe and effective,especially in encapsulated effusion.Compared to 9 g/L saline,it can shorten the length of hospital stay and reduce complication.Compared with VATS,the curative effect is similar,while intrapleural fibrinolytic agents are economic.

OBJECTIVE:To discuss the role of clinical pharmacist participating in drug therapy for severe ulcerative colitis (UC)during late pregnancy. METHODS:Clinical pharmacists participated in the therapy for a UC patients during late pregnancy, assisted the doctors to optimize and improve drug therapy plan from antidiarrheal,anti-intestinal inflammation,regulating intestinal flora,recovering damaged mucosa;suggested regimen was as follows:montmorillonite powder 3 g,pr,qd,to avoid drug interac-tion;hydrocortisone 100 mg,ivgtt,bid to resist intestinal inflammation;prednisone 30 mg,po,qd+20 mg,po,qn,instead after symptom relieved;stopping taking Bifid triple viable capsules,supplementing Human serum albumin injection,Nutrients,Potassi-um chloride injection,Concentrated sodium chloride injection,etc. RESULTS:The suggestion provided by clinical pharmacists was adopted by doctors,and the patient was recovered. There was no significant difference in the intelligence development,body weight and height charge between born baby boy and infants with same month age. CONCLUSIONS:Clinical pharmacists assist physician to optimize and improve drug therapy plan to promote rational drug use in the clinic and guarantee the safety of drug use.

Objective To compare the efficacy and safety of icotinib therapy alone versus icotinib combined with thoracic radiotherapy for the treatment of advanced non-small cell lung cancer (NSCLC) patients with an activating epidermal growth factor receptor (EGFR) gene mutation.Methods A total of 83 patients with advanced NSCLC harboring an activating EGFR gene mutation was enrolled in this study.All the patients were randomly divided into 2 groups.Patients in group A (n =41) received thoracic radiotherapy (prescribed at 60-66 Gy) combined with icotinib (three times per day,125 mg once).Patients in group B (n =42) were given icotinib therapy alone (three times per day,125 mg once).Treatment was continued until disease progression or unacceptable toxicity or death.The primary end points were median progression-free survival (mPFS) and 12 month-PFS rate.The secondary end points included objective response rate (ORR),disease control rate (DCR) and adverse events.Results With a median follow-up of 18.2 months,mPFS was 15.2 months (95％ CI:12.2-17.4) in group A and 13.2 months (95％ CI:10.8-14.9) in group B (x2 =4.29,P=0.036).PFS rates of 12 months for group A and group B were 70.3％ and 61.2％,respectively.The ORR were 78.0％ vs.57.1％ (x2 =5.16,P =0.028),and the DCR were 95.1％ vs.92.9％ (P＞0.05) in groups A and group B,respectively.No grade 3-4 adverse events was observed in both groups except the rashes (4 cases in each group).Besides,10 patients had grade 1-2 radiation-related pneumonitis and 15 patients suffered grade 1-2 radiation-related oesophagitis in group A.Conclusions In advanced NSCLC patients with an activating EGFR gene mutation,the combination of thoracic radiotherapy and icotinib had achieved an improvement on ORR and PFS with good tolerance.Clinical trial registration Chinese clinical trial registry,ChiCTRINR-16010262.

Aim To establish a new,multi-parameter,real time and qualitative cell migration evaluation method.Methods Lung cancer cell line A549 was cultured on the glass bottom dish.After treated with different dosages of berberine or Rg3 for 24 hours,several scratching lines at the same dimension were made and observed by Living Cell Working Station.8 observation areas were selected randomly and imaged continuously for 24 hours.Transferred Area(TA),Transferred Distance(TD),Single Cell Transferred Speed(SCTS)and the Cell Division Number among defined area(CDN)were analyzed after getting sequence images.Results The focus stage and the incubation system were sufficient to keep cell proliferation and made it possible for long term observation.Berberine at 25 μmol·L~(-1) and 12.5 μmol·L~(-1) could inhibit the migration of A549(P<0.01).The analysis results of TA,TD,SCTS and CDN were basically coincident.Rg3 at 0.1 mmol·L~(-1) could inhibit SCTS and promote CDN in 6,12 and 24 h(P<0.01),while decrease both TA and TD in 24 hs.Conclusion The method is sensitive,rapid and simple to be applied in the research of tumor metastasis,wound healing and inflammatory response with real time,in-situ and multi-parameters.

Objective To study whether Helicobacter pylori CagA protein can control gastrin gene expression and the detailed mechanism. Methods First, pcDNA3. 1ZEO (-)/cagA7 was transfected into gastric cancer cell lines AGS and SGC-7901 cells. At the same time, culturing the Helicobacter pylori NCTC11637 and infecting AGS and SGC-7901 cells with it. Next, in the infected and transfecled AGS and SGC-7901 cells, respectively adding the JAK2 signaling pathway inhibitor AG490 and the ERK signaling pathway inhibitor U0126 to inhibit the two signaling pathway. Untreated gastric cancer cells and empty vector transfected cells as the control. Using real-time fluorescence quantitative PCR to detect the levels of gastrin mRNA in transfected and infected cells. Results After AGS and SGC-7901 cells were transfected with pcDNA3. lZE0(-)/cagA7 and infected with NCTC11637, the results showed that the expression of gastrin mRNA increased significantly (P ＜ 0. 05) in transfected and infected cells as compared with the control group, but after adding the inhibitor AG490 and U0126 respectively, the expression of gastrin mRNA decreased significantly(P＜0.05). Conclution These results suggest that CagA may up-regulate the expression of the gastrin gene, and CagA is one of the important proteins in regulating gastrin gene expression. The ERK/MAPK and JAK/STAT signaling pathways may be involved in controlling of gastrin gene expression by CagA.