Objective To explore the diagnostic values of bile cytology obtained in endoscopic retrograde cholangiopancreatography (ERCP) and blood tumor markers for malignant bile duct obstruction.Methods From August 2005 to April 2009, bile cytology and blood tumor markers measurement were performed in 47 cases with bile duct obstruction, in which 39 cases were confirmed to be malignant and 8 were benign. Results Malignant cells were found in bile from 26 of 39 malignant obstruction (66. 7% ), and serum CA19-9 was positive in 28 (71.8%). No malignant cells were detected in bile cytology from 8 cases with benign obstruction (with a specificity of 100% ) and serum CA19-9 was negative in 7 (87.5%). In 26 patients with cholangiocarcinoma, serum CA19-9 was positive in 18 (69. 2% ). For bile cytology and blood tumor markers test, sensitivity of parallel combination was 89. 7%, and the specificity of serial combination was 100. 0%. Conclusion Bile cytology testing during ERCP can provide the pathological evidence for malignant bile duct obstruction. The sensitivity is improved by combination tests of bile cytology and blood tumor markers.

Objective To explore the risk factors affected the timing of endoscopic examination in nonvariceal upper gastrointestinal bleeding (NVUGIB).Methods From January 2001 to December 2011 , 441 patients diagnosed as NVUGIB under endoscope were enrolled,and they were divided into the group receiving endoscopy within 24 hours (233 cases)and the group receiving endoscopy beyond 24 hours (208 cases).The demographic and clinical characteristics of the two groups were analyzed.Student′s t test was used for measurement data comparison and chi-square test for numerical data.Logistic regression analysis was used to analyze the multivariate factors which influenced the timing of endoscopy examination.Results The rates of complication in the group receiving endoscopy within 24 hours and the group receiving endoscopy beyond 24 hours were 9.0% (21/233)and 19.7% (41/208),and the difference was statistically significant (χ2 =10.411 ,P =0.001 ).The mean systolic blood pressure were (118 ±19 )and (122±19)mmHg (1 mmHg=0.133 kPa),respectively,and the difference was statistically significant (t=2.099,P = 0.036 ).On admission the mean hemoglobin were (98 ± 27 )and (93 ± 28 )g/L, respectively,and the difference was not statistically significant (t=1 .640,P =0.102).The mortality rate were 1 .3% (3/233 )and 5 .3% (11/208 ),respectively,and the difference was statistically significant (χ2 =5 .723,P =0.017).With multivariate Logistic regression,multivariate factors analysis indicated that complication was the main factor influenced the timing of endoscopy examination (OR =2.710,95 %CI :1 .502 to 4.899,P < 0.01).However,age,gender,systolic blood pressure,hemoglobin levels on admission,location of lesion and clinical symptoms were not related with timing of endoscopy examination (all P >0.05).Conclusion Complication is a risk factor in the timing delayed endoscopy.

To explore new agents of quinolone derivatives with high antibacterial activity, 7-(4-alkoxyimino-3-methyl-3-methylaminopiperidin-1-yl)quinolones were designed and synthesized, and their activity against gram-positive and gram-negative strains was tested in vitro. Sixteen target compounds were obtained. Their structures were established by 1H NMR, HRMS and X-ray crystallographic analysis. Compounds 14k and 14m-14o show good antibacterial activity against the tested five gram-positive strains and five gram-negative strains (MIC: 0.25-16 micromg x mL(-1)), of which the most active compound 14o is 8-fold more potent than levofloxacin against S. pneumoniae (MIC: 4 microg x mL(-1)), and comparable to levofloxacin against S. aureus, S. epidermidis, E. faecalis and E. coli (MIC: 0.25-1 microg x mL(-1)), but generally less potent than gemifloxacin.

Objective To evaluate the effectiveness and safety of a transanal drainage tube(TDT) for decompression of acute left-sided obstruction of colorectum.Methods Fifty-seven patients with acute left-sided colorectal obstruction were enrolled in this study from January 2010 to December 2014.The obstruction location, property, success rate of insertion, one-procedure rate and complication rate were analyzed.Results There were 53 cases of primary colorectal cancer,among which lesions were located in the transverse colon in 1 case, in descending colon in 10, in sigmoid colon in 24,and in rectum in 18.There were 4other cases, one sigmoid colonic metastases of pulmonary cancer, 1 adhesive colonic obstruction after ovary surgery, 1 cervical cancer involved with rectum with stricture and obstruction, and 1 descending colonic obstruction caused by Crohn's Disease.TDT was successfully inserted in 55 cases(96.5％) without complications,in which 43 cases of primary colorectal cancer finally underwent surgery.TDT indwelled from 0 to 22days, for an average of (8.7± 4.4)d.Hartmann operation was performed in 9 patients,6 of which underwent sufficient lymphnode dissection.Among the 43 patients, one-stage operation was performed in 34 (79.1％),of which 30 cases underwent sufficient lymph node dissection, without stoma leakage.And the rest of 13 cases refused surgery because of poor prognosis and financial problems.One patient with Crohn's Disease refused surgery after TDT insertion and was discharged after palliation of distention.Conclusion TDT is safe and effective in decompressing acute left-sided benign obstruction with high success rate and low expenditure, and can achieve preoperative colonic lavage in one-stage operation for acute left-sided colorectal malignant obstruction.

Objective:To study the effects of NS-398 on the expression of vascular endothelial growth factor (VEGF) in human tongue squamous cell carcinoma Tca8113 cells.Methods:Tca 8113 cells were exposed to the COX-2 inhibitor NS-398 at 150 ?mol/L for 48,72 and 96 h respectively,then cells were collected. VEGF expression was examined by RT-PCR and Western blot. Results:NS-398 inhibited VEGF mRNA and protein expression time-dependently in Tca8113 cells. Conclusion:NS-398 may inhibit VEGF expression in tongue squamous cell carcinoma.

Objective To observe the protection of human keratinocyte cell line, HaCaT cell, from UVA damage by resveratrol and its possible mechanism. Methods HaCaT cells were incubated with or without 0.01 mmol/L or 0.1 mmol/L resveratrol after exposure to 5 J/cm2 UVA irradiation. Unirradiated HaCaT cells-without the treatment with resveratrol served as the control. After another 24-hour culture, MTT assay was used to detect the proliferation of cells, RT-PCR and Western-blot to measure the iNOS mRNA and protein expression respectively, electron microscopic technique to observe the changes in cell ultrastructure. Results After irradiation with UVA of 5 J/cm2, the proliferation of HaCaT cells decreased with the absorbance at 490 nm descending from 0.889±0.083 to 0.542±0.004, while a significant increase was observed in the relative expression level of iNOS mRNA and protein in HaCaT cells (1.532±0.041 vs 0.009±0.003, 1.331 ±0.046 vs 0.003±0.001, both P < 0.05) with the presence of typical apoptotic cells. The treatment with 0.01 and 0.1 mmol/L resveratrol significantly promoted the proliferation of irradiated cells with the absorbance at 490 nm being 0.753±0.435 and 0.892±0.173 respectively, but inhibited the mRNA (0.853±0.038 vs 1.532±0.041, 0.392±0.033 vs 1.532±0.041, both P< 0.05) and protein expression level (0.809±0.018 vs 1.331±0.046, 0.412±0.026 vs 1.331±0.046, both P< 0.05) of iNOS in irradiated cells, and the resveratrol of 0.1 mmol/L was more effective than that ofO.01 mmol/L in all tested parameters (P< 0.05). Furthermore, no apoptofic cells or necrotic cells were observed in irradiated ceils incubated with resveratrol. Conclusion Resveratrol effectively protects HaCaT cells from UVA damage, which may be related to the inhibition of UVA-induced iNOS expression by resveratrol.

Incision of the spinal cord (myelotomy) after spinal cord injury (SCI) is a surgical treatment which is mainly performed within 24 hours after SCI. However, many patients are fi rst seen outside the established time window of 24 hours. Furthermore, little attention has been given to its effi cacy and mechanism after 24 hours. In this study, dorsal longitudinal incision of spinal cord on SCI rats was performed at 72 hours after SCI to remove the liquefi ed necrotic gray matter. The results indicated that after myelotomy, locomotor function of hindlimbs signifi cantly improved from 21st day after SCI. There was also increased residual white matter area at the rostral and caudal segments to the injury center when examined at day 42 after the injury. These results suggested that myelotomy at 72 hours after injury has protective effect on the spinal cord.

Objective To evaluate the left ventricular systolic dyssynchrony in patients with left ventricular apical ballooning syndrome (LVABS) quantitatively by real-time three-dimensional echocardiography(RT-3DE) and its correlation with left ventricular ejection fraction(LVEF).Methods 7patients with LVABS were enrolled in this study.The images of left ventricle in full volume mode were obtained by RT-3DE in the different time (just after admission,4 weeks and 8 weeks).Post-processing software of 4D LV Volume Tom-Tec was used for calculation of EF and 16-segmental time-volume curves was obtained.The time to the point with minimal systolic volume(Tmsv) of each segment was calculated and by which the following indexes of systolic dyssynchrony were derived:Tmsv16-SD/Dif,Tmsv-basalSD/Dif,Tmsv-mid-SD/Dif and Tmsv-apical-SD/Dif.The correlation between systolic dyssynchrony index (SDI) and LVEF was analysed.Results ① The Tmsv16-SD/Dif,Tmsv-basal-SD/Dif,Tmsv-mid-SD/Dif and Tmsv apical-SD/Dif of left ventricle in the patients of 4 weeks and 8 weeks were smaller than those of the patients just after admission.There were significant differences among them(all P ＜0.05).②The more SDI increased,the more LVEF decreased,and vice versa.SDI was negatively associated with LVEF in the different time of admission (just after admission:r =-0.758; 4 weeks:r =-0.831 ; 8 weeks:r =-0.889;all P ＜0.05).Conclusions Left ventricular systolic dyssynchrony of severe degree is observed in patients with LVABS just after admission.But the condition of dyssynchrony has been improved gradually after 4 weeks and 8 weeks.SDI is negatively correlated with LVEF.

Objective To evaluate narrow?band imaging(NBI)for early esophageal cancer and pre?cancerous lesions. Methods A total of 170 patients ( 192 lesions) diagnosed as having superficial esophageal carcinoma and precancerous lesions by endoscopy were retrospectively analyzed. Clinical data of endoscopy, narrow?band imaging (NBI) and iodine chromoscopy were analyzed.Results The detection rates of early esophageal cancer were both 100?? 0% in NBI(13/ 13) and iodine staining (13/ 13), with no statisti?cally significant difference (P>0?? 05).The detection rate of high grade intraepithelial neoplasia in NBI and i?odine staining was 94?? 9% (94/ 99) and 100?? 0% (99/ 99) respectively with no statistically significant differ?ence (P>0?? 05); The detection rate of low grade intraepithelial neoplasia in iodine staining was 100?? 0%(80/ 80), significantly higher than that of NBI 78?? 8% (63/ 80) (P<0?? 01).Conclusion NBI and iodine staining endoscopy show better diagnostic value for early esophageal cancer and similar diagnostic value for high grade intraepithelial neoplasia in precancerous lesions. But for the low grade intraepithelial neoplasia, the diagnostic value of iodine staining endoscopy is better than that of NBI.

Intracranial infection is a common and serious complication of acute severe traumatic brain injury, with high mortality and disability rates, which significantly affects the prognosis. In recent years, with the widespread use of antibiotics, antibiotic-resistance rates of pathogens have risen year by year, and the choice of sensitive antibiotics is less and less, sometimes even in difficulties of no drugs available. This paper reviewed the treatment process of 1 case with intracranial infection caused by multi drug-resistant Klebsiella pneumonia after severe traumatic brain injury . The aim is to summarize the clinical experience.