Objective To evaluate the effect of endoscopic variceal ligation(EVL) combined with splenectomy for the patients with portal hypertension. Methods Thirty two cases of portal hypertension underwent EVL plus splenectomy from May 1999 to May 2002 in our department. The patients were registered and followed up in the third, sixth and twelfth months after operation respectively. Re ligations were performed in case of relapsed varices. Results Thirty one patients were followed up for ≥2 years.Of them,esophageal varices recrrented in 6.4% of patients during following-up period,but no reblecding, and no death caused by hepatic encehpalopathy or other complications.Conclusions EVL combined with splenectomy has less trauma , less postoperative complications and high eradication rate of esophageal varices, so it can be used safely in the treatment of patients with ruptured esophageal varices.

Objective To Study the effect of splenectomy plus endoscopic varices ligation (SEVL) in the treatment of portal hypertension. Methods SEVL was carried out in 38 patients with portal hypertension from January 2000 to June 2002. The authors compared hemodynamic parameters and gastric emptying time before and after the operation. The incidence of upper gastrointestinal bleeding, the disappearance rate of esophageal varicosis, the outcomes of portal hypertensive gastropathy (PHG) and the incidence of complications were recorded at postoperative 3 weeks, 6 months, 12 and 18 months, respectively. Results Postoperatively, the free portal pressure, portal flow volume and velocity were significantly reduced in all the cases ( P 0.05). Portal thrombosis was seen in 6 cases (6/38, 15.8%). Conclusions SEVL has little influence on gastric emptying and PHG, offering a high disappearance rate of varicosis and a low incidence of complications.

Objective To explore the causes of an outbreak of 168 cases of incisional infection in one hospital.Methods The secretory substances of incisioral wound infection from 168 cases of operation patients were collected,cultured and identified in bacterium strain.We also did drug sensitivity test,pathological examination and investigation of environment.Results Above these experinental studies demostrated that the large-scale outbreak of incisiona infection was caused by mycobacterium chelonei in operation room.Used 0.137% glutaradehyde as disinfectant immersion surgical tools ,but the concentration too low to kill the mycobacterium chelonei,which polluted the hickeyes of surgical instrument.The pollution leading to outbreak of incisional infection.Conclusions By reason of the event lesson,authors suggest that the doctors and nurses should strengthen the detection of atypical mycobacterium,so as to reduce the iatrogenic infection,reducing,or stoping the outbreak of incisinal Infection.

Objective Inflammatory bowel disease is an important chronic gastrointestinal disease of childhood and adolescence.Intestinal mucosa barrier damage plays an important role in its pathogenesis.This study attempts to use IL-1β stimulating Caco-2 cell monolayer simulates inflammatory intestinal epithelial barrier in vitro,provides the basis for studying the pathogenesis and treatment of IBD.Methods Caco-2 cells were cultivated in vitro until the 21st day to simulate intestinal epithelial cell monolayer barrier.The cells of inflammation group one were disposed with IL-1β for 2 h since the 5th day and detected TEER every other day until the 21st day.The cells of inflammation group two were disposed with IL-1 β at the 18th day for 0,12,24,48,72h, and detected TEER respectively.Normal control group cells were cultured with common medium and detected TEER at the corresponding time point.Results The TEER of Caco-2 cells gradually increased from the 5th to 15th days,reached 600Ω·cm2 in the 15th day of a plateau until to the 21st day.Since the 5th day,the TEER of inflammation group one were all lower than normal group,and still to the 21st day ＜ 500Ω·cm2.Inflammation group two shows the time dependence TEER gradually reduce,peaked at 48 hours,then a slight increase in 72 hours.Conclusion The Caco-2 cells cultured for 2 ～ 3 weeks can form intestinal epithelial monolayer barrier with polarity,then treated with IL-1 β can manufacture inflammatory intestinal epithelial barrier model in vitro.

Objective Intestinal epithelial barrier damage is closely related to a variety of gastrointestinal disease,how to maintain its function effectively is the key to treat all these diseases.This research attempts to explore the protective effect and its mechanism of toll-like receptor 2 (Toll-like receptor,TLR2)on permeability of intestinal epithelial barrier by experiments in vitro,to lay a foundation for new treatment methods.Methods We cultured non-transfected Caco-2 cells,TLR2-deficiency Caco-2 cells,TLR2-overexpressed Caco-2 cells in normal control group until the 21 st d,then tested transepithelial electrical resistance(TEER) which reacts the permeability of epithelial barrier.We cultured 3 types of cells in inflammation group until the 19th d treated with 10 ng/ml IL-1 beta for 48 h,then tested TEER values at the 21st d.We treated 3 types of cells in inhibition group with PI3K/Akt pathway inhibitor for 1h befor IL-1 beta,then tested TEER values at the 21st d.Results TEER value of TLR2-deficiency Caco-2 cell monolayer significantly reduced (P ＜ 0.01),whereas TEER value of TLR2-overexpressed Caco-2 monolayer raised,but without statistically significant.TLR2 can prevent IL-1 beta caused TEER decreasing (P ＜ 0.01),but the effect disappeared after given PI3K/Akt pathway inhibitor.Conclusion TLR2 can regulate the permeability of intestinal epithelial barrier.In addition,TLR2 can protect permeability increasing caused by inflammation,this effect mediated by PI3 K/Akt pathway.

Objective To learn the degree of the asthmatic patients'understanding of the disease, and to provide references for formulating the plan of the asthma patient's education and management infuture.Methods One hundred and one outpatients were surveyed by questionnaire face to face.Results Among 101 patients,the percentages of mild intermittent,mild persistent,moderate persistent and severepersistent asthma assessed by current symptom were 23%,29%,30%,18%.Among these patients thosewho understanding the inflammatory nature of asthma account occupied 70.3%,those who realizing the importance of inhaled corticosteroids(ICS)and taking ICS as the first-line medicine for asthma occupied67.3%,those who knowing the indication about rational use of short-acting beta-2-agonists(SABA)occupied 88.1%,those who realizing the goal of asthmatic therapy occupied 71.3%.All these results were significantly better than both the reporter in the asthma insights and reality in Asia-Pacific and the realizing degree to asthma of the respiratory professionals in Beijing's urban district hospitals in 1997.Conclusion After long term systematic education and management,asthmatic patient's understanding of the disease has been improved greatly.

Objective To explore a new pathogenic gene mutationin in COL4A3 and COL4A4 genes of a family with thin-basement-membrane nephropathy (TBMN), and explain its mechanism.Methods Genomic DNA was extracted from blood samples.Mutation screening for all the exons in COL4A3 and COL4A4 of the proband was carried out by direct PCR sequencing.The sequences of the proband were compared with standard sequences in GenBank.After identifying the mutation in COL4A4, screening for the mutation site in 200 healthy controls and the rest of family members were conducted.RNA sequence of the proband was analyzed by reverse transcription PCR and TA cloning.The positive clones were sequenced for RNA screening.Results There was a G to A mutation in the 1459 site of COL4A4 (c.1459+G ＞ A) in the proband, her mother, and the elder sister, whereas the mutation was not found in other family members and healthy people.RNA screening showed that the COL4A4 (c.1459+G ＞ A) mutation was a heterozygous substitution in position + 1 of exon 21, in the splicing region.This mutation leaded to eliminating of exon 21 from the COL4A4 mRNA, causing the exon 21 deletion and frameshift mutation following the exon 20 in its amino acids sequence.Conclusions It is described that COL4A4 (c.1459+G ＞ A) is a new pathogenic mutation in TBMN, which further help understanding the pathogenesis and clinical diagnosis of TBMN.

Objective To establish a digital segmentational data set of larynx based on Chinese visible human (CVH). Methods Magnetic lasso and polygon tools of Photoshop were used to segment the small organs and structures of larynx of CVH to establish the segmentational data set of larynx. After conversion of the image format, the segmentational structures were extracted automatically with Thresholding Method and presented 3-D visualized, and then were checked up by its result of 3D reconstruction with Amira 4.1 software. Results Many small structures of larynx were segmentated, such as laryngeal cartilage, laryngeal muscles, vocal cords and so on. Then the segmentational data set of larynx based on CVH was established, which can be used to 3-D reconstruction accurately. Conclusion The segmentational data set of larynx is accurate and integrated, which is helpful to establish the elaborate model of larynx and can provide the method of color image segmentation.

Objective To investigate and analyze the status quo of the patients of extended stay at 11 clinical hospitals of a general university in Beijing, and explore the countermeasures and solutions.Methods Contact with the medical affairs departments of these hospitals to collect information about such patients of extended stay.Results A total of 43 cases of patients were identified as extended stay at these hospitals, accounting for 0.00% to 0.93% of total beds.Their stay ranged from 1 month to 15 years, including 17 cases with medical disputes (39.5%), and 26 cases without (60.5%).Conclusions The phenomenon of extended stay at hospitals deserve enough attention and appropriate actions accordingly.

AIM:To investigate morphologic and functional changes of small intestinal mucosa and proliferating cell nuclear antigen in postoperative portal hypertension patients with single or combined administration of Gln and rhGH.METHODS:Twenty-nine portal hypertension patients with surgical treatment were prospectively randomized to four groups as follows:① Gln group(n=6);② rhGH group(n=8);③ Gln+rhGH group(n=7)and ④ control group(n=8).A standard solution for TPN was given three days after operation for a week.The concentration ratio of urinary lactulose and mannitol(L/M),the villus height and crypt depth and PCNA index of small intestinal mucosa were compared.RESULTS:A week after TPN postoperation,the increased ratios of L/M in Gln+rhGH group were less than those in control group(P0.05).CONCLUSION:This study suggest that Gln together with rhGH reduce the intestinal permeability and protect the mucosa integrality in postoperative portal hypertension patients,but not in single treatment.