Objective To explore clinical effect of arthroscopic circumpatellar denervation in anterior knee pain of patellofemoral osteoarthritis and its correlation with cartilage degeneration.Methods Totally 104 patients with anterior knee pain of patellofemoral osteoarthritis were randomly divided into two groups.Patients in control group(n =52) were treated with arthroscopic debridement,and those in combined group(n =52) were treated with arthroscopic debridement plus circumpatellar denervation.All the patients were followed-up for 6 months.The WOMAC scores,knee function recovery were compared between two groups,and the changes of WOMAC score among different degrees of cartilage degeneration were analyzed.Results The WOMAC score of pain,morning stiffness and joint function were significantly improved in combined group than those in control group at 6 months after surgery(P ＜ 0.05).At 6 months after surgery,the score of range of activity and walking distance in both groups were all increased,and combined group had more remarkable increase than that of control group(P ＜ 0.05).Compared with before surgery,the total WOMAC score in patients with grade Ⅰ-m at 6 months after surgery significantly decreased (P ＜ 0.05),while there was no significant difference in patients with grade Ⅳ level between before surgery and 6 months after surgery (P ＞ 0.05).Conclusion Arthroscopic debridement plus circumpatellar denervation for anterior knee pain of patellofemoral osteoarthritis can effectively relieve pain symptom,promote the recovery of knee joint function,especially suitable for patients with cartilage degeneration of Ⅰ ～ Ⅲ.

Objective To analyze the clinical features of acute hyperlipidemic panereatitis,and to investigate the therapeutic strategies.Methods In this retrospective study,44 patients with hyperlipidemic pancreatitis admitted to our hospital from January 2003 to December 2007 were enrolled,60 patients with acute pancreatitis of other etiologies were enrolled as the control group.Results The proportions of patients with overweight or obesity,hyperglycemia,fatty liver and hypertension were 81.8%,59.1%,54.5% and 68.2%,respectively;these were significantly higher than those in control group,which were 16.7%,16.7 %,13.3 % and 23.3 %,respectively (P＜0.05 or＜0.01).The proportion of patients with lithiasis was lower in HLP group than that in control group (13.6% vs 60.0%,P＜0.05).There was no difference in the proportions of patients with chronic alcoholism between two groups.The Ranson score,CTSI,complications in HLP group were 3.15±0.07,4.46±2.58 and 3.2±1.7,respectively;these parameters were significantly higher than those in control group,which were 1.62±0.22,2.62±1.90 and 0.9±1.2 (P＜0.05 or ＜ 0.01 ).The level of serum amylase in HLP group was 580±222 mmol/L,which was significantly lower than that of control group (1361±472 mmol/L,P ＜ 0.01 ).The triglyceride (TG) level was linearly correlated with Ranson score in HLP group ( r = 0.77,P ＜ 0.05 ),but there was no linear correlation between TG level and Ranson score in the control group.Conclusions There was a close relationship between HLP and metabolic syndrome.Serum TG was positively correlated with the severity of HLP.

Objective To investigate the clinical outcome before and immediately after implementation of fast track surgery protocol on patients with gastric cancer.Methods One hundred and thirty patients with gastric cancer in our hospital underwent an elective,uncomplicated,open gastric surgery before (Traditional care group,n =65) and immediately after implementing fast track surgery (Fast track surgery group,n =65).Postoperative food and fluid intake,mobilization,length of hospital stay,and clinical outcome were recorded and analysed,and a interview-based assessment was performed on days 14 and 30 postoperatively.Results Patients implemented fast track surgery were associated with a significantly earlier resumption of mobilization and oral fluids and normal diet,shorter duration of intravenous infusion compared with traditional care patients 0.3 (0-1) d vs 3.3 (2-4) d,0.2(0-1) d vs 3.5(3-4) d,3.3(3-4) d vs 5.6(5-6) d,3.4(3-4) d vs 5.2(5-6) d; P=0.000,respectively.Postoperative hospital stay was also shorter in fast track surgery group 6.6 (6-8) d vs 8.6 (8-9) d ; P =0.000.Instrumental activities of daily living decreased in both groups on day 14,but significantly more in the traditional care group,despite having a higher preoperative instrumental activities of daily living level compared with the fast track surgery group 5.0 (3-6) vs 3.0 (3-5),4.0 (3-6) vs 3.0 (3-5) ; P =0.000,respectively.Preoperative fatigue score was not different between two groups,but the fatigue score was significantly increased on day 14,and returned to normal value on day 30 in the traditional care group 2.0 (1-5) vs 3.0 (1-5),2.0(1-5) vs 2.0(1-6) ; P =0.005,P =0.065.Total length of sleep on day 14 was increased significantly in the traditional care group,but not changed in the fast track surgery group compared with preoperative value 9.0 (6-11) vs 8.0(5-10) h,8.0(5-11) vs 8.0(6-10) h; P=0.000,P=0.327.Conclusions A fast track surgery protocol can lessen postoperative stress reactions and enhance recovery for patients with gastric cancer undergoing an elective,uncomplicated,open resection.

Objective To investigate the effect of JNK signal pathway in acute necrotizing pancreatitis (ANP) associated lung injury.Methods A total of 24 SD rats were randomly divided into sham group and ANP group,ANP rats were induced by retrograde injection of 5％ sodium taurocholate into common bile duct.The rats were sacrificed 12 and 24h later,and the pancreas and lung tissue were resected and underwent routine pathologic examination,ELISA method was used to detect the level of TNF-α and IL-1β in lung tissue.Expression of JNK mRNA was detected by real time PCR,and the expression of JNK protein were evaluated by Western blotting.Results There was bleeding,necrosis,large amount of inflammatory cells infiltration in pancreatic tissue; and there was edema,pulmonary consolidation,interstitial edema,inflammatory cells infihration in lung tissue in ANP group.The levels of TNF-α and IL-1β,JNK mRNA,JNK protein,phosphorylation JNK were ( 374.3 ± 124.0) pg/ml,(649.0 ± 114.9) pg/ml,2.57 ± 0.76,1.40 ± 0.81,0.81 ± 0.20 in ANP group,which were significantly higher than those in with sham group[( 218.2 ± 68.4)pg/ml,(524.3±58.4)pg/ml,1.03±0.11,0.32±0.11,0.32±0.11,P＜0.05].Conclusions JNK signal pathway plays an important role in experimental ANP associated lung injury in rats.

Objective To evaluate the effect of neoadjuvant chemotherapy on lymph node micrometastasis and DC cell number in stage Ⅲ gastric cancer patients.Methods Lymph node micrometastases in pathologically negative lymph nodes from 76 stage Ⅲ gastric cancer patients [56 cases with neoadjavant chemotherapy (NCT) and 20 cases without],were assessed by cytokeratin-20 antibody.Dendritic cells (DC) in HE positive lymph nodes,HE negatives near tumor foci and HE negatives far foci were assessed by CD83 antibody respectively.Patients were divided into four groups:group 0 (20 cases without NCT),group 2 (two courses of NCT in 29 patients),group 3 (three courses of NCT in 16 patients),group 4 (four courses of NCT in 11 patients).Results In NCT group there were two patients with micrometastases (2/56).All the patients were with micrometastases in control group (20/20).Difference was statistically significant (P =0.000).In HE-positive lymph node group:the number of CD83-positive DC in 2 times group,3 times group,and 4 times group when compared with no chemotherapy group were statistically significant (P20 =0.001,P30 =0.000,P40 =0.000).In HE-negative lymph node near foci group:the number of CD83-positive DC in 3 times group,and 4 times group compared with 0 group were statistically significant increased (P30 =0.001,P40 =0.001).In HE-negative lymph node far foci group:the number of 4 times group was significantly higher than 0,2 and 3 group (P40 =0.000,P42 =0.000,P43 =0.001).Conclusions Neoadjuvant chemotherapy is effective in the prevention of lymph node micrometastases in stage Ⅲ gastric carcinoma and it increases the number of mature dendritic cells in lymph nodes.

Objective To investigate the clinical value of fetal echocardiography in prenatal diagnosis of complete vascular ring. Methods Ultrasound images of 6 cases with complete vascular ring were retrospectively analysed and summarized, all cases were confirmed by autopsy after termination of pregnancy. Results Right aortic arch and left ductus arteriosus formed U shaped comlete vascular ring coursing around the trachea in 5 cases, left aortic arch and right aortic arch formed O shaped complete vascular ring in 1 case on three-vessel trachea view. Color Dopple flow imaging aided in identifying various components of the vascular ring. Conclusions Fetal echocardiography is of great clinical value in prenatal diagnosis of complete vascular ring. Three-vessel trachea view is important for screening with particular attention to the relationship of the aortic and duct arches to the trachea.

In view of the deficiency of class hour and the limitations of classroom teaching in the course of ocular fundus disease, a network teaching platform, based on Browser/Server structure, was explored and constructed to assist classroom teaching. The network platform was constituted with teaching demonstration system, communication-test system, search system, and help system, mainly including 18 functional modules of learning-world et al. The students can be guided with the modules such as navigation, acting as a self-regulated learner through the modules such as learning-world, searching and downloading the related learning materials through the modules such as searching and discussing different learning topics with other students and their teachers through the modules such as forum. The network platform was used for classroom teaching of ocular fundus disease in auxiliary , and the result showed it was helpful to breaking the time and space constraints in conventional teach-ing, expanding the teaching content, solving the difficulties in teaching, improving the students' learning initiative, and realizing the interactive teaching.

Objective To investigate the diagnostic value of intraductal ultrasonography for the quality of biliary stricture.Methods Data of the patients who had received operation because of biliary stricture after IDUS examination from 2006 to 2010 were collected.IDUS results were compared with those of operation.Results There were 43 cases of malignant strictures and 6 benign strictures in total.The sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accuracy of intraductal uhrasonography for the quality of biliary stricture were 97.7％ ( 42/43 ),83.3％ ( 5/6 ),97.7％ ( 42/43 ),83.3％ (5/6) and 95.9％ (47/49),respectively,which were significantly higher than conventional imaging like ultrasound B,CT and MRCP.Twenty one cases in 32 were diagnosed as malignant biliary stricture with cytological brushing,with the diagnostic accuracy of 65.6％.All cases had been diagnosed by IDUS.Conclusion Intraductal ultrasonography is of high diagnostic value for biliary stricture.However,cytological brushing based on IDUS is of limited diagnostic value for malignant biliary stricture.

Objective To evaluate the safely and efficacy of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) and its related procedures in patients older than 85 years.Methods Data of patients older than 85 who underwent ERCP between 2004 and 2009 (group A, n =52) were reviewed and compared with those of patients aging 70-84 years (group B, n = 329).Results The rate of patients with underlying disorders of other systems in group A was significantly greater than that of group B (100.0% vs.77.5% , P < 0.05) , as well as the rate of multiple procedures to achieve stone clearance (42.3% vs.28.8% , P <0.05).There were no significant differences between 2 groups regarding the rates of complication (7.7% vs.4.9% ) and post-procedure mortality (1.9% vs.0.6% ).Conclusion Therapeutic ERCP and related procedures are safe and effective in patients aging over 85, and advanced age should not be regarded as the contraindication of the procedure.

ObjectiveTo investigate the diagnostic value of single balloon enteroscopy (SBE) for obscure gastrointestinal bleeding.MethodsA total of 78 SBE procedures was conducted on 72 patients with obscure gastrointestinal bleeding,with 40 via oral route and 38 via anal route.The procedure time,insertion depth and rate of positive finding were recorded.ResultsFor 40 SBE procedures performed via oral route,the mean procedure time was 60 minutes ( 15-110 minutes),and the mean insertion depth was 195 cm at the distal end of Trentz ligament (30-240 cm).For 38 SBE procedures performed via anus,the mean procedure time was 75 minuets (30-120 minutes),and the mean insertion depth was 160 cm at the proximal end of ileocecal valve (50-200 cm ).The whole diagnostic yield of obscure gastrointestinal bleeding was 62.5％.ConclusionSBE is a safe and useful tool for the diagnosis of obscure gastrointestinal bleeding.