Intestinal ischemia is a severe and life-threatening acute abdomen. Although its incidence is low,early diagnosis remains relatively difficult. The efficiencies of conventional laboratory biochemical tests are low. In recent years, many new markers for the early diagnosis of intestinal ischemia have been developed. In this article,we summarize their diagnostic efficiencies and relevant factors.

Objective To investigate the clinical values of serum histidine decarboxylase(HDC),intestinal fatty acid binding protein(I-FABP),and diamine oxidase(DAO)for diagnosing intestinal mucosal injury (IMI)in patients with intestinal obstruction.Methods The expression levels of serum HDC,I-FABP,and DAO in 28 patients with strangulated intestinal obstruction,19 patients with simple intestinal obstruction,17 patients with acute simple appendicitis,and 20 healthy control were determined by enzyme-linked immunosorbent assay (ELISA)before clinical treatment,and then the areaa under receiver operating characteristic curves(AUC)of these diagnostic indicators were compared.In addition,the incidences of systemic inflammatory response syndrome (SIRS)and infectious complications were closely observed.The difference of the expressions of HDC,I-FABP,and DAO and their relationship with SIRS and infectious complications were compared among these patients and controls.Results The expression levels of serum HDC, I-FABP, and DAO were the highest in patients with strangulated intestinal obstruction (all P < 0.001), and the expression levels of these three indicators were significantly higher in patients with simple intestinal obstruction than in those with acute simple appendicitis or healthy controls (all P<0.05).The AUC of HDC (0.913) was significantly larger than that of I-FABP (0.877, P =0.000) and DAO (0.873, P = 0.000).When the cut-off value of HDC ≥31.00 ng/ml, the sensitivity, specificity, false negative rate, and false positive rate of HDC were 74.5% , 94.6% , 25.5% , and 5.4% , respectively,which were all better than those of I-FABP and DAO.There were significant differences of the incidence of SIRS ( P = 0.046) and abdominal infection (P = 0.027) among patients with strangulated intestinal obstruction, patients with simple intestinal obstruction, and patients with acute simple appendicitis, while lung infection showed no such significant difference (P = 0.728).The expression level of serum HDC was significantly higher in patients with strangulated intestinal obstruction who were also suffered from SIRS ( P = 0.000) or abdominal infection ( P =0.002) than that of uninfected patients.Meanwhile, the expression levels of serum I-FABP and DAO were significantly higher in the SIRS patients with strangulated intestinal obstruction than that of uninfected patients ( P = 0.027, P=0.017, respectively).The expression levels of HDC, I-FABP, and DAO were significantly correlated with the incideces of SIRS and abdominal infection ( all P < 0.05 ) , among which the level of HDC and the incidence of SIRS had the highest correlation (R = 0.608, P = 0.001).Conclusion HDC can be an effective indicator for diagnosing IMI in patients with intestinal obstruction.

Intestinal immunologic barrier plays an important role in preventing the bacterium and endotoxin.Lymphocyte homing to the intestine is one of the normal intestinal immunologic functions,and has the theoretical significance and clinical value for the balance of intestinal immunologic barrier.The basic and clinical researches of lymphocyte homing to the intestine are reviewed.

Objective To evaluate and analyze the effect of treatment on fractures of the clavicle with reconstruction plate or with Kirschner wire.Methods Of 56 clavicular fracture cases for treatment with surgical procedures,22 cases were fixated with reconstruction plate.34 cases were fixated with Kirschner wire.Results All 56 cases were followed up for 10~48 months,on average 21 months.Reconstruction plate fixation group:2 cases concomitant with delayed fracture healing were multiple trauma patients.The mean union time in this group was 3.6 months(range from 3 to 5 months).Kirschner wire fixation group:3 cases with wires migration.The mean union time in this group was 2.3 months(range from 2 to 3 months).According to Kalarsson's shoulder function evaluating criteria,all cases were excellent.Conclusion Surgical technique with Kirschner wire is simple and credible treatment for clavicular uncomminuted fractures.,it complys with the conception of minimally invasive technique and is a recommendable way.

Objective To study the influence of fluorine on signaling pathway of osteoprotegerin(OPG)/ receptor activator of NF-κB ligand(RANKL) in cultured rat osteoblasts.Methods Osteoblasts were isolated from skull of neonatal rats(＜ 24 hours) by enzyme digestion,and fluorine of different concentrations [0 (control),1 × 10-3,1 × 10-4,1 × 10-5,1 × l0-6 and 1 × 10-7 mol/L] were added into the culture medium of second generation of osteoblasts.The expressions of OPG and RANKL mRNA were determined using real-time PCR 24 and 48 hours after culturing.The expressions of OPG and RANKL protein were measured by Western blotting.Results ① After exposed to fluorine for 24 hours,the differences of RANKL and OPG mRNA expression had statistical significance between groups(F =30.95,22.62,all P ＜ 0.01),the expression of RANKL mRNA(5.99 ± 0.39) in the 1 × 10-5 mol/L group and the expressions of OPG mRNA(3.52 ± 0.09,4.81 ± 0.15,3.68 ± 0.04) in the 1 × 10-4,1 × 10-5 and 1 × 10-6 mol/L groups were higher than those of the control group(3.20 ± 0.19,3.09 ± 0.58,all P ＜ 0.05),but in the 1 × 10-3 mol/L group,RANKL mRNA(2.29 ± 0.18) was lower than that of the control group(P ＜ 0.05).After exposed to fluorine for 48 hours,the differences of RANKL and OPG mRNA expression had statistical significance between groups(F =26.62,5.72,all P ＜ 0.01),the expressions of RANKL and OPG mRNA(6.67 ± 0.49 and 5.05 ± 0.51) in the 1 × 10-5 mol/L group were higher than those of the control group(4.29 ± 0.07 and 4.34 ± 0.12,all P ＜ 0.05),and in the 1 × 10-3 mol/L group the expression of OPG mRNA(3.63 ± 0.49) was lower than that of the control group(P ＜ 0.05).② The expression of RANKL protein was not statistically significant between 24 hours and 48 hours groups (F =0.07,0.49,all P ＞ 0.05) ; the differences of OPG protein expression had statistical significance between groups(F =3.26,P ＜ 0.05),the expression of OPG protein in the 1 × 10-5 mol/L group(1.45 ± 0.10) was higher than that of the control group(1.05 ± 0.06,P ＜ 0.05) at the 24 hours.After 48 hours,the expression of OPG protein was not statistically significant(F =0.44,P ＞ 0.05).Conclusions At lower fluorine concentrations,bone formation is the main activity.But when fluorine concentration increased and time prolonged,the osteoclast differentiation and maturation are promoted,and the bone resorption is the main thing.

Objective To investigate the effects and mechanism of hypoxia on the growth and invasion of human cervical cancer Hela cells. Methods Hypoxia microenvironment was mimicked by cobalt chloride (CoCl2), in which the growth of Hela cells were determined by MTT method, the migration ability was detected by scratch test, and the expressions of HIF-1αand Vimentin protein were measured by immunofluorescence. Results The growth of Hela cells treated with 150 μmol/L of CoCl2 for 6 h was promoted. The migration ability in hypoxia group at 48 h was significantly higher than that in ordinary oxygen group. The expressions of HIF-lαand Vimentin in Hela cells in hypoxia group were significantly higher than those in ordinary oxygen group. There was significantly positive correlation between the expressions of HIF-1α and Vimentin (P < 0.05). Conclusion Hypoxia could promote the expression of HIF-lα, which then could up-regulate the expression of Vimentin , and finally enhanced the ability of invasion and metastasis of Hela cells.

Objectives To investigate the clinical significance of CYP2C19 genotype detection for antiplatelet therapy of elder cardiovascular and cerebrovascular diseases(CCVD).Methods We enrolled all elderly patients with either cardiovascular or cerebrovascular disorders who received clopidogrel as mono drug or in combination with another antiplatelet drug aspirin as secondary prevention for more than 12 months in our hospital from January to August 2015.Somatotypes of CYP2C19 genotypes of all participants were assessed to analyze the relapse of cardiac-cerebral vascular diseases in these patients.Results A total of 250 patients were enrolled,including 179 male and 71 female,with average age of (85.2 ± 7.9) years.Among these patients,there were 97 (38.8％) cases with EM CYP2C19 genotypes,110 cases(44.0 ％) with IM CYP2C19 genotypes,43 cases(17.2 ％) with PM CYP2C19 genotypes.When treated with clopidogrel for antiplatelet in secondary prevention process,the rate of the relapse in cardiovascular event was 34.9％ and higher in PM CYP2C19 genotype than in EM and IM CYP2C19 genotype (19.6 ％ and 15.5 ％,respectively) (x2 =7.251,P =0.027).This phenomenon was similar to patients who received stent implantation(x2=6.393,P =0.041).However,no statistically significant difference was observed in the recurrence rate of cerebral vascular disease between three different genotypes(EM 29.9 ％,IM 20.0 ％,PM 27.9％,x2 =2.880,P =0.237).Conclusions Our results highlight that CYP2C19 genotype might be a potential guidance for secondary prevention of cardiovascular and cercbrovascular disorders among elderly patients.Clopidogrel may be less effective in patients with SM CYP2C19 genotype than those with EM or PM CYP2C19 genotype for secondary prevention of cardiovascular disease.

AIM: To investigate the protective effect of fluvastatin and its influence on ICAM-1 mRNA expression in ischemia/reperfusion myocardium of normocholesterolemic rabbits. METHODS: 24 rabbits were divided into three groups randomly and myocardial ischemia/reperfusion model in the rabbit was made. Rabbits were subjected to 45 min of regional myocardial ischemia and 2 h of reperfusion. 10 mg?kg~ -1 ?d~ -1 fluvastatin were administered for one week. Dynamic index of blood flow was recorded and analyzed. Serum activity of CK, CKMB, LDH and LDH-1 were measured. The expression of ICAM-1 mRNA in ischemic myocardium was detected with semi-quantitative RT-PCR. RESULTS: In comparison with control group, pretreatment with fluvastatin decreased LVEDP at the whole observed duration, and spontaneously increased ?dp/dt_ max . Serum activities of CK, CKMB and LDH-1 in control group were significantly higher than those in sham group, but heavily reduced in fluvastatin group. Increased expression of ICAM-1 mRNA due to ischemia reperfusion was reduced significantly in fluvastatin group compare to control group. CONCLUSION: Pretreatment of fluvastatin may reduce inflammation reaction in reperfused myocardium, and this may contribute to its protective effect against experimental myocardial ischemia reperfusion injury.

Objective To investigate the effects and mechanism of different dosage of fluvastatin on the prevention of heart muscle ischemia reperfusion injury in rabbits.Method Thirty-five rabbits were randomly divided into 5 groups with 7 rabbits in each: sham group,myocardial ischemia reperfusion control group,low dosage of fluvastatin pretreatment group (2 mg/kg,Group F1),middle dosage of fluvastatin pretreatment group(5 mg/kg,Group F2) and large dosage of fluvastatin pretreatment group(20 mg/kg,Group F3).The left ventricular systolic pressure(LVSP),the max rate of rise of left ventricular pressure(?dp/dt_(-max)) and left ventricular end-diastolic pressure(LVEDP) were detected during the experiment.At the end of reperfusion,the infarct size and area at risk were defined by Evans blue and TTC staining,and the levels of myocardial nitrogen monoxidum(NO) and nitricoxide synthase(NOS) were measured.Result Compared with the ischemia reperfusion group,the indexes of heart function improved significantly,the level of myocardial NO was increased significantly and the myocardial infarct size was decreased significantly in the groups F2 and F3.There was no significant difference between the group F1 and ischemia reperfusion group.Conclusion Fluvastatin exerts a cardioprotective effect against myocardial ischemia reperfusion injury in rabbits.NO is likely involved in this protective mechanism.