Objective To discuss the manifestations, diagnosis and management of acute superior mesenteric artery occlusion (ASMAO). Methods The clinical data of 15 cases of ASMAO admitted in our hospital between 2000 and 2007 were analyzed retrospectively. Results The causes of ASMAO were mesenteric artery embolism in 11 patients and mesenteric artery thrombosis in 4 patients. All cases underwent emergency laparotomy, in which 2 cases underwent removal of the embolus, 11 cases were subjected to resection of necrotic bowel after removal of the embolus, and 2 cases gave up definite surgery. Postoperative heparin anticoagutherapy was used in all patients. The overall mortality rate was 27% (4 cases). Conclusions Acute superior mesenterie artery occlusion should be suspected in a patient with sudden abdominal pain, especially in those who have organic cardiac disease. Early diagnosis and prompt embolectomy are the key to save the patients.

Objective: To observe the role of parenteral nutrition and laparoscopic therapy in chylous ascites.Methods: A patient with chylous ascites was therapied with parenteral nutrition(4 weeks) and laparoscopic therapy and parenteral nutrition(1 week) subsequently.Output of ascites was daily measured from the drainage catheter of abdominal cavity.The body weight and other nutritional indexes were determined.Results: During the course of parenteral nutrition,the production and output of ascites gradually decreased,the body weight increased,and the serum album in level kept unchanged.After laparoscopic therapy and parenteral nutrition(1 week),ascites decreased significantly and did not rebound after diet,the body weight and the serum album in level also obviously increased.Conclusion: Laparoscopic therapy and parenteral nutrition are very useful in the treatment of patients with chylous ascites.

Objective To investigate the effect of perioperative regional intra peritoneal chemotherapy on postoperative recurrence of advanced gastric cancer.Methods Eighty-six patients with advanced gastric cancer were divided into observation group (44 patients) and control group (42 patients) according to the aspiration of patients.All patients received 2-4 cycles of chemotherapy of PCF regimen before and after surgical treatment.Observation group was combined with perioperative regional intraperitoneal chemotherapy,and control group only received surgical treatment.The treatment effectiveness and the status of postoperative recurrence were compared between two groups.Results The response rate of control group and observation group were 76.2％ (34/42) and 93.2％ (41/44),respectively.There was significant difference (P ＜ 0.05).The adverse effect of the two groups were gastrointestinal adverse reaction and myelosuppression.There was no significant difference between two groups (P＞ 0.05).After followed up for 3-36 months,6 patients in observation group occurred recurrence,and 14 patients in control group occurred recurrence.The long-term recurrence rate (＞ 24 months) between two groups had significant difference (P ＜ 0.05).Conclusion Perioperative regional intraperitoneal chemotherapy has better effectiveness on inhibiting the postoperative recurrence of advanced gastric cancer.

Objective The investigation was to evaluate the efficiency of the frozen shoulder treated by hydraulic distention and manipulation under dynamic arthrography of shoulder joint ,and analyze the in-fluencing factors on the outcome.Methods One hundred patients with frozen shoulders were enrolled the prospective and controlled study,who were divided into two groups randomly.Fifty patients were treated by the hydraulic distention and manipulation under dynamic arthrography of shoulder joint (GroupⅠ),and fifty patients were treated by NSAIDs administration(GroupⅡ).The relationship of clinical results with the amounts of injected fluid during hydraulic distention and manipulation,the range of motion,the visualized rate of the vagina synovialis of long head of biceps brachii tendon and subacromial bursa,and releasing de-gree of joint adherence were observed.The patients consisting of forty-two males and58females aging from42to74years were assessed at two time-intervals.The short term follow-up period ranged from3to6months,and final follow-up from10to21months.Results The clinical results was significantly difference between GroupⅠand GroupⅡdepending on daily activity and range of motion(P

Objective To evaluate the clinical results of the anterior cruciate ligament (ACL) reconstruction by bone-patellar tendon-bone(BPB) transplantation and fixation with absorbable interface screws under arthroscopy. Methods From December 1999 to June 2003, 32 patients with ACL injuries underwent BPB transplantation. There were 22 males and 10 females, and the average age was 32.5 years (ranged from 20-45 years). The lesions were left knees in 18 and right knees in 14, including 8 acute and 24 chronic injuries. The BPB for reconstructing the ACL was harvested from the anterior approach mini-invasively; the implants were fixed with the absorbable interface screws under arthroscopy. The associated injuries were treated simultaneously. All the patients were encouraged to rehabilitate with the continuous passive motion (CPM) and other physical therapies earlier after operation. Results All the patients were available at follow-up; the average duration of follow-up was 32 months (ranged from 6-40 months). Before operation, anterior drawer test positive in 32, Lachman test positive in 20 and pivot shift test positive in 16, were changed into negative. The patients were evaluated according to Lysholm knee scoring scale and the modified Lysholm knee score, the functional results of knee joint were classified as excellent in 24, good in 7 and fair in 1, and the average knee score was 52.1?5.6 and 98.7?3.6 before and after operation respectively, the difference was of statistical significance(P

RORγt, an immune cell-specific isoform of RORγ( retinoic acid receptor-related orphan nuclear receptor gam-ma) , is a key transcription factor for the development of Th 17 cells both in human and mouse .RORγt is required for the induction of IL-17 transcription and for the manifestation of Th 17-dependent autoimmune diseases in mice .RORγt natural ligands are retinoic acid . RORγt is closely implicated in the pathology of numerous autoimmune diseases , infectious diseases and cancer .With the further re-searches about the role of RORγt, we will clarify the mechanism of RORγt in autoimmune diseases , which will provide new ideas to di-agnose and treat autoimmune diseases .

Objective To study the relationship between calcitonin gene related peptide(CGRP)and enhanced osteogencsis after brain injury by investigating the expression of CGRP in callas and the level of CGRP in serum of rats with brain injury and femoral fracture.Method The experiment was conducted in the Laboratory of Surgery,Affiliated Hospital of North Claim Coal Medical College.Totally 56 male Sprague-Dawley(SD)rats were divided randomly into 3 groups:fracture group(n=24),fracture with brain injury group(n=24)and normal control group(n=8).The parietal skull revealed,the bone windowwas opened,rats models of brain injury were established by falling freely,and rats models of fracture were established by cutting the right middle femur.The rats in normal control group were killed at the 21 days after operation,the rats in other two groups were killed at 7,14and 21 days after operation,respectively.The X-ray of femoral fracture was obtained,the CGRP concentration in serum was detected by mdioimmunoassay,and tissues at 5mm above and below the fracture were stained by HE and SP immtmohistochemistry to observe the expressions of CGRP and the fracture healing.The data were expressed as mean±SEM and ahalyzed with student't t test with SPSS,Results The serum levels of CGRP in fracture group were(91.58±28.67)ng/L,(102.46±27.95)ng/L,(86.54±24.13)ng/L at 7,14,21 days after operation,respectively,which were significantly higher than that in the control group.In fracture with brain injury group,the serum levels of CGRP(165.49±43.28)ng/L significantly increased at 7 days after operation,and compared with fracttwe group,there was significant difference.The serum levels of CGRP decreased at 14,21 days after operation,with 104.72±31.36)ng/L,(74.93±21.57)ng/L,respectively,and compared with fracture group,there was significant difference at 21 days.The mean optical density in callus of the fracture in brain injury group (0.496±0.108)were higher than that in the fracture group[(0.348±0.076)]at 7 days after operation(P＜0.01),but there were no significant difference on the 14 and 21 days.Conclusions CGRP may play a role in osteogenesis after brain injury.

By analysis on existing problems of the classification, the suggestions were put forward to provide a reference for improving the classification of medical devices.
Equipment and Supplies ; classification

Objective To analyze the correlations between acute respiratory distress syndrome ( ARDS) and extravascular lung water(EVLW),tumor necrosis factor alpha (TNF-α),E-selectin,vasostatin-2.To discuss the value of EVLW, TNF-α, E-selectin and vasostatin-2 in evaluating the severity of ARDS and prognosis of this disease . Methods There are thirty-six patients with ARDS were selected .According to the level of EVLWI shown by pulse indicator continuous cardiac output ( PiCCO) monitor,they were divided into the two groups:EVLWI≥14mL/kg group (n=18) and EVLWI<14mL/kg group(n=18).To monitor and record the levels of EVLWI ,PVPI,CI,ITBV,record oxygenation index ,calculate APACHEII score .The levels of TNF-α,E-selectin and vasostatin-2 in serum were meas-ured by ELISA.Results In EVLWI≥14mL/kg group,the APACHEⅡscore was (23.93 ±4.44),28-day mortality was 61.1%,the stay time in ICU was (19.05 ±4.0) d,which were higher than those in EVLWI <14mL/kg group [APACHEII score (18.58 ±3.66),28-day mortality(27.8%),the stay time in ICU(14.35 ±3.39) d](t=3.941,χ2 =4.050,t=3.797,all P<0.01).And the levels of TNF-α[(85.28 ±18.25)μg/L]and E-selectin[(74.07 ± 14.57)μg/L]in serum were higher than in EVLWI <14mL/kg group[TNF-α(63.27 ±20.28)μg/L,E-selectin (40.99 ±16.35)μg/L](t=3.422,5.847,all P<0.01).The oxygenation index of EVLWI≥14mL/kg group was (122.86 ±25.45),which was lower than that in EVLWI <14mL/kg group[(156.77 ±37.58)](t=-3.170,P<0.01).In the two groups of patients still alive within 28 days,after active treatment for 72 hours,the level of EVLWI was significantly lower than before in these 20 patients(Z=-0.392,P<0.01),oxygenation index was significantly higher than before(Z=-3.845,P<0.01),and the levels of TNF-αand E-selectin were significantly lower than before(t=7.194,4.025,all P<0.01).But 16 patients in the death group,after active treatment for 72 hours,the levels of EVLWI ,TNF-α,E-selectin and oxygenation index had no significant change ,there was no statistically signifi-cant difference(P>0.05).EVLWI had positive correlation with PVPI,TNF-αand E-selectin (r=0.605,0.649, 0.549,all P<0.01),and EVLWI had a negative correlation with oxygenation index (r=-0.715,P<0.01).Results showed no difference in vasostatin-2 between the two groups(P>0.05).Conclusion There were significant correla-tions between EVLWI and TNF-α,E-selectin in patients with ARDS.The levels of EVLWI,TNF-α,E-selectin were higher,and the mortality rate was higher,the the stay time in ICU was longer.The levels of EVLWI,TNF-αand E-selectin can provide a good reference value to the judgement of the severity of disease and prognosis in patients with ARDS.The level of vasostatin-2 had no correlation with EVLWI .

BACKGROUND: Cell apoptosis is one of the important pathological changes in ischemic-reperfusion (IR) injury. As the key factor involved in cell apoptosis regulation, interleukin (IL)-iβ converting enzyme, when activated, leads to cell apoptosis via protein degradation.OBJECTIVE: To investigate the relationship between the expression of IL-1β converting enzyme and cell apoptosis in cerebral IR injury and explore the role of this enzyme in post-ischemia cell apoptosis.DESIGN: Randomized controlled experiment.MATERIALS: The experiment was performed at the Center of Neuroscience of the Third Military Medical University between March 1996 and December 2000. Totally 64 adult healthy Wistar rats were randomized into two groups, namely IR group (n=56) and sham operation group (n=8). In IR group, the rats were subjected to four vessel occlusion to mimic whole brain IR injury, and reperfusion was carried out after 30 minutes of ischemia for 3, 6, 12, 24, 48, 72 hours and 7 days, respectively (8 rats at each time point). Only separation but not occlusion of the bilateral common carotid artery was performed in sham operation group.METHODS: Four rats were randomly selected from IR group at each time point and 4 from the sham operation group for immunohistochemical study and in situ hybridization, with the other 4 rats for in situ end-labeling assay.MAIN OUTCOME MEASURES: Protein and mRNA expression of ILlβ converting enzyme and neural cell apoptosis in the brain.RESULTS: Totally 64 rats were used in this study and all data were statistically analyzed. In the sham operation group, IL-1β converting enzyme protein and mRNA were expressed in small amount in most of the normal brain tissues, and their expressions were also detected in the neurons and small glial cells in IR group localized mainly in the cerebral cortex, cerebellum Purkinje's cells, hippocampal and subcortical white matters. The expression of IL-lβ converting enzyme began to increase at IR 12 hours, reaching the peak level at 48-72 hours followed by declination since 7 days after the operation. Cell apoptosis occurred 12 hours after IR (49.4±6.8) /section and peaked at 72 hours (228.6±29.8)/section, showing significant correlation with the temporal expression of IL-1β converting enzyme protein and mRNA (r=0.89, 0.68, P ＜ 0.05).CONCLUSIONS: Expressions of IL-1β converting enzyme protein and mRNA increased after IR in close correlation with post-ischemia cell apoptosis, and their temporal expression pattern supports the presumption that IL-1β converting enzyme is an important factor in cell apoptosis.Apoptosis is mostly likely to occur in the cerebral cortex, hippocampus and basal ganglion in IR injury, where IL-1β converting enzyme is highly expressed, further demonstrating that post-ischemia expression of IL-1β converting enzyme might be involved in cell apoptosis regulation.