ObjectiveTo investigate the efficacy and safety of the self-expandable metal stent for treatment of gastric outlet and duodenal obstruction.MethodsData of 24 patients with symptomatic gastric outlet and duodenal obstruction diagnosed from January 2005 to February 2011 were retrospectively studied.All patients were measured by gastric outlet obstruction scoring system ( GOOSS ) before and one week after the placement of self-expandable metal stent.ResultsStent placement was succeeded in all patients with a mean operation time of 25.90 ± 11.03 min.Twenty patients (83.3％) were able to intake liquid food after the procedure.The GOOSS (P50 =0) before and after stent placement were 0.14 (P50 =0) and 1.42( P50 =2),respectively,with significant difference (P ＜0.01 ).Minor digestive bleeding occurred in 3 patients,but no severe complications including perforation or aspiration were observed.ConclusionPlacement of a self-expandable metal stent in patients with gastric outlet or duodenal obstruction is safe and effective for resolving obstructive symptoms.

Objective To investigate the epidemiologic characteristics of injuries of children aged 0 ~14 yrs. Methods Described analysis was used to analyze the epidemiologic characteristics about the age, gender, injury type and cause in children 0~14 years old who visited in emergency department of hospitals form 2006 to 2007. Results During the study period, 16 124 injured children were collected. the rank of injuries type were contused/abrased wound (44.41%), open injury (36.10%), sprain (12.81%), bone fracture (3.25%) and burn/scald injury (1.49%); the cause of injuries were fall down (55.24%), animal injury (21.49%) , blunt injury (8.47%) and traffic injury (6.96%); The common place of injury occurred were at home (53.66%), public and resident place (18.01%), road/street (11.73%) and school (10.70%). The gender ratio was 1.94, the median age was 6 years, the male injury was decrease with the age increase, but so wasn't the female. Conclusion Injury gradually becomes the key health problem and influences the children health. The effective measures should be taken in term of the epidemiology characteristics of the injuries among children at 0-14 to prevent and control injury occurring. The health education of preventing injury occurring and behavior drawback should be conducted as early as possible to raise awareness of injury issues among children in the kindergartens and promote them growing healthily.

Objective To investigate the expression of podoplanin,?-catenin and vascular endothelial growth factor receptor-3(VEGFR-3) in lymphatic vessels of human esophageal squamous cell carcinoma(ESCC) tissue and the normal tissues adjacent to the carcinoma,and explore the markers which can specifically show the lymphatics with metastasis.Methods 63 surgical specimens of esophageal squamous cell carcinoma and 20 normal tissue specimens were obtained and examined.Immunohisochemical measures were employed to detect the expressions of podoplanin,?-catenin and VEGFR-3.The difference in expression of VEGFR-3 between ESCC tissue with lymphatic metastasis and the tissue without metastasis was statistically assessed.The lymphatic microvessel density(LMVD) positively stained by podoplanin was observed and counted under microscope with ?200 magnification.Results Based on the morphological characters of lymphatic vessels and capillary vessels observed under microscope,it was confirmed that podoplanin(positively stained as yellow-brownish discontinuous lines) expressed only on the cellular membrane of endothelial cells of lymphatic and microlymphatic vessels.VEGFR-3 was positively expressed in the endothelial cells of lymphatic vessels as well as vessel wall and the cytoplasm of carcinoma cell.There existed a significant difference in VEGFR-3 expression between the ESCC tissue with lymphatic metastasis and the tissue without metastasis,and the positive rate was 68.57% and 28.00%,respectively(P

Bone growth factors play an important role in the process of bone metabolism and perform a variety of physio -logical functions such as regulating bone growth , differentiation and remodeling .Meanwhile , these cytokines are associated with orthopedic disorder and therapy .The curative effect of the overturned sartorius iliac flap in repair of acetabular defect in developmental dysplasia of the hip proves to be good , but mechanism between the overturned flap and the surrounding bone tissue is unclear .This review briefly summarizes the functions and applications of several major cytokines in bone for -mation and remodeling , which may provide new ideas and methods for illuminating the mechanism of these cytokines during the repair of the acetabular defect .

Objective To investigate the analysis of low calcium intravenous calcium supplementation agent and active vitamin D3 on total thyroidectomy on quality of life in patients with nodular goiter. Methods 40 cases of nodular goiter with total thyroidectomy were performed in our hospital from March 2014 to September 2016. It was randomly divided into control group and experimental group, 20 cases in each group. The patients in the control group were nodular thyroidectomy and the experimental group underwent total thyroidectomy. The quality of life of two groups of patients was evaluated by using the European five-dimensional health-related living quality scale (eq-5d). Results Two groups of patients, relevant questionnaire survey of the patient's ability to act, self-care ability, daily activity ability, pain or discomfort, anxiety, or depression, and the comparison of VAS score, according to the results of difference was not statistically significant. In comparison with ordinary people, the questionnaire survey results showed that the proportion of patients with moderate or above differences was higher and the difference was significant (P< 0.01). There was no statistical significance compared to the average person. Conclusion All patients with nodular goiter are treated with total thyroidism, and the effect is good, and the quality of life of patients is relatively small.

ObjectiveTo investigate the development of apoptosis during ischemia/reperfusion (IR) injury and acute rejection, and to explore the significance of apoptosis in the Graft Mesenteric Lymph Node (GALT) in a rat heterotopic small bowel transplant (SBT) model.MethodsSBT was performed in F344/N rats with either freshly harvested or preserved (4 h, in ringer lactate solution at 4 ℃) syngeneic and allogeneic (Wistar/A-F344/N) grafts. Bowel and GALT samples were collected 2 h after reperfusion and on small bowel transplant postoperative days (POD) 1, 4, and 7. Histopathology assessment of the graft and GALT were prepared for hematoxylin-eosin (H&E) staining. Apoptosis was detected by the TUNEL and the electron microscope. ResultsThe number of apoptotic cells 2 h after reperfusion increased profoundly in association with preservation. After a significant decrease on POD 1, the apoptotic cells rose again between POD 3 and 7 only in allogeneic grafts. On the other hand, the apoptotic cells in allogeneic GLAT markedly increased from POD 1 to day 3; at that time point, neither histological findings of rejection nor increase in apoptotic crypt cells were present in the graft jejunum. ConclusionIR injury and acute rejection may both induce extensive apoptosis. The graft jejunum distinct second increase in apoptosis may be an early and specific sign of acute rejection. Apoptosis of GLAT cells was well correlated with and ahead of progression of acute rejection.

Objective To explore the safety and efficacy of endoscopic retrograde cholangiopancreatography(ERCP)by using carbon dioxide for malignant biliary obstruction.Methods A total of 60 patients with malignant biliary obstruction, hospitalized from September 2008 to February 2010, were randomly divided into 3 groups to receive ERCP by using carbon dioxide, contrast agent or magnetic resonance cholangiopancreatography(MRCP)without any agent.The safety and efficacy of 3 contrast methods were compared.Results Successful stent or drainage tube insertion was achieved in all patients.Carbon dioxide was superior to contrast agent in terms of lowering postoperative infection rate(P ＜ 0.05), and it was also superior to MRCP for more effective drainage(P ＜ 0.05).There was no significant difference in occurrence of postoperative pancreatitis and hyperamylasemia between 3 groups.Conclusion Using carbon dioxide during ERCP, safe and effective, is superior to use of contrast agent in less leukocyte increase, and to MRCP in more adequate drainage in patients with malignant biliary obstruction.Furthermore, there is no more risk of pancreatitis and hyperamylasemia.

Objective To evaluate the clinical utility of SpyGlass single-operator ERCP-guided cholangiopancreatoscopy system for the diagnosis and treatment of bile duct disorders.Methods A total of 9 patients with biliary diseases were treated with SpyGlass single-operator ERCP-guided cholangiopancreatoscopy system.Four patients with large bile duct stones accepted laser lithotripsy,and stones were removed by ERCP.Five patients with indeterminate bile duct stricture accepted cholangioscopy-guided sampling.All patients underwent ENBD,routine blood test,blood amylase test,oral food and water restriction,acid suppression and prophylactic antibiotics.Results SpyGlass was successful in all patients with a manipulating time of 21.2min and total procedure time of 46.2min.Complete stone clearance was achieved in all 4 patients with large biliary stones.Sample quality was adequate in all patients with bile duct stricture with 2 patients diagnosed as having malignant biliary tumor and 3 as inflammatory bile duct stenosis.Post-ERCP complications including mild pancreatitis in 2 patients,and the patients recovered gradually after corresponding treatment.Conclusion ERCP-guided cholangiopancreatoscopy with the SpyGlass system is technically feasible and can be successfully and safely performed in patients with biliary disorders.

Objective To study the independent risk factors of early rebleeding after endoscopic variceal ligation (EVL) and/or endoscopic injection of fibrin tissue adhesive.Methods Data of 370 patients who had cirrhosis and accepted 396 procedures of EVL and/or endoscopic injection of fibrin tissue adhesive were retrospectively studied.Independent risk factors for early rebleeding were determined by Logistic regression analysis.Results Results of all the factors that were significantly different between the re-bleeding and non-rebleeding patients,the portal vein diameter,ascites volume,Child-Pugh score and serum albumin were independent ones of early rebleeding after EVL and/or endoscopic injection of fibrin tissue adhesive ( P ＜ 0.05).Larger volume of ascites,wider portal vein diameter,reduced albumin,Child-Pugh score greater than 10 were indicative factors of rebleeding.Conclusion The early rebleeding rate after EVL and/or endoscopic injection of fibrin tissue adhesive is determined by portal vein diameter,ascites volume,ChildPugh score,and serum albumin.

Objective To evaluate the accuracy of endoscopic ultrasonography (EUS) in preoperative TNM staging of gastric cancer.Methods EUS and abdominal helical computed tomography (HCT) were performed one week before the surgery in 126 gastric cancer patients who would receive surgery to determine the depth of tumor invasion (T),lymph node metastasis (N) and distant metastasis (M) stage and which were also compared with pathologic TNM stage after surgery to evaluate the accuracy of EUS in TNM staging.Pairing x2 test was performed for data analysis.Results Compared with pathologic TNM stage after surgery,the accuracy of EUS in T1,T2,T3 and T4 staging of gastric cancer were 84.6％,14/18,82.0 ％ and 85.7％ respectively.The accuracy of EUSin N0,N1,N2 and N3 staging of gastric cancer were 74.2％,75.0％,57.9％ and 5/17 respectively.The accuracy of HCT in N0,N1,N2 and N3 staging of gastric cancer were 80.6％,75.0％,73.7％ and 12/17 respectively.The accuracy of EUS was similar to HCT in N0 and N1 stage.For N2 and N3 stage,HCT was obviously better than EUS (x2 =4.89,P=0.027; x2 =13.88,P＜0.01).The accuracy of EUS and HCT in M1 stage of gastric cancer were 36.4％ and 95.5％respectively,HCT was better than EUS in M1 determination (x2 =7.90,P=0.001).Conclusions The clinical application value of EUS in the preoperative gastric cancer T staging was high,however the accuracy in determining lymph node metastasis N2 and N3 staging and distant metastasis M staging should be improved.In order to acquire more accurate preoperative TNM stage to guide the treatment selection,the combination with HCT examination is necessary.