Objective To investigate the gastroscopic manifestations and pathological diagnosis of large gastric folds.MethodsClinical data of 161 cases with large gastric folds,who were diagnosed by gastroscopy from January 2002 to April 2008,were analyzed.Endoscopic mucosal resection or strip-off biopsy by ultrasonic endoscopy was performed if diagnosis could not be identified using routine biopsy by the gastroscopy.ResultsOf the 161 cases,79 patients had chronic inflammation(49.1%),67 had gastric cancer(41.6%),11 showed malignant lymphoma(6.8%),2 suffered from Menetrier's disease(1.2%),1 had acute inflammation(0.6%),and 1 showed no obvious lesion(0.6%);the rate of Helicobacter pylori infection was 42.2%(68/161),and the positive rate for Helicobacter pylori in patients with gastric cancer was 34.3%(23/67).Endoscopic mucosal resection biopsy was performed on 15(9.3%) of the cases,5 of them had chronic inflammation,5 showed gastric cancer,4 were confirmed with malignant lymphoma,and 1 was diagnosed as having Menetrier disease.The lesion of large gastric folds involved the whole stomach in 10 patients,the gastric fundus in 10,gastric corpus in 86,gastric antrum in 5,both the gastric fundus and corpus in 31,and both the gastric corpus and antrum in 19.All of the 10 cases,who had the whole stomach being invaded,were diagnosed as having gastric cancer.Though both gastric cancer and chronic inflammation showed similar manifestations under gastroscope,the levels of the characteristics were significantly different(Dilatancy poor: ?2=10.093,P=0.001;peristalsis poor: ?2=19.116,P=0.000;gastric cavity narrowing: ?2=18.159,P=0.000;texture stiffness: ?2=54.302,P=0.000;texture brittle: ?2=6.132,P=0.013;erosion: ?2=5.619,P=0.018;and ulcer: ?2=22.743,P=0.000).ConclusionsMost of the patients with large gastric folds are diagnosed as having chronic inflammation,gastric cancer,or malignant lymphoma,while Menetrier disease and acute inflammation seldom occur.The lesion usually involves the gastric corpus.For those who have the whole stomach being invaded,gastric cancer can be revealed.Most of the malignant cases show ulcers,dilatancy poor,and peristalsis poor under a gastroscope.Endoscopic mucosal resection biopsy is effective for identifying the diagnosis of malignant lesions.

Objective To estimate the expressions of cyclin D1 and Ki67 in esophageal squamous cell carcinomas and their clinical significance. Methods The expressions of cyclin D1 and Ki67 were detected by immunohistochemistry in 28 specimens esophageal squamous cell carcinoma (ESCC) and 33 samples esophagitis tissue. Results The positive expression rate of cyclin D1 in ESCC and esophagitis tissues was 60.7% (17/28) and 33.3% (11/33) respectively (?2=4.573,P=0.032),while the mean Ki67 label index (Ki67 LI) was (49.21?25.15)% and (11.62?9.87)% respectively (t=7.908,P=0.000). The positive expression rate of cyclin D1 in TNM stage I tissues was 14.3% (1/7),which was significantly lower than that in stages Ⅲ and Ⅳ tissues[85.7% (6/7) and 100% (5/5),P=0.029 and 0.015,respectively]. In cases with lymph node metastasis,the positive rate of cyclin D1 expression was 90.9% (10/11) that was significantly higher than that in those without lymph node metastasis (P=0.016). The 28 patients with ESCC were followed up for 6 to 34 months [mean,(25.0?4.2) months],during which 19 patients survived,4 patients died of deterioration of the primary diseases (3 cases) or cerebrovascular affair (1 case),and the other 5 patients was lost to follow-up. Conclusions The expression of cyclin D1 is correlated with advanced tumor and lymph node metastasis. The Ki67 is highly expressed in ESCC tissues; no relationship exists between the level of the expression and the pathological differentiation type and TNM stage of ESCC.

Objective To investigate the relationship between the pathology of gastric polyp tissues and the precancerous and malignant transformations of its background mucosa by endoscopic biopsy. Methods From 2003 to 2008,1825 patients were diagnosed with gastric polyps in our hospital by gastroscopy and pathological examination. We classified the lesions and then analyzed the relationship between pathological changes of gastric polyp tissues and the precancerous and malignant transformations of its background mucosa by endoscopic biopsy. Results In this study,the detection rate of gastric polyps was 4.3% (1825/42 003). The lesions included fundic gland polyps (FGP,62.5%,1141/1825),hyperplasia polyps (HPP,32.2%,587/1825),adenoma (0.8%,14/1825),inflammatory polyps (IP,1.7%,31/1825),and coincident polyps (two types of polyps were found in one case,2.8%,52/1825). The rates of intestinal metaplasia (IM,5.3%,31/587) and dysplasia (6.8%,40/587) in HPP tissue were higher than those in FGP tissues (0.2%,2/1141 and 0.4%,4/1141,P

Objective To evaluate the clinical value of transnasal gastroscopy in diagnosis and treatment of upper gastrointestinal diseases and the endurance of patients to the operation,as well as to measure the distance between the external naris and pectinate line. Methods Between January 2007 and April 2008,totally 3481 patients underwent transnasal gastroscopy in our hospital,meanwhile 3705 patients received routine gastroscopy; 109 patients who received transnasal gastroscopy and 106 patients that underwent routine gastroscopy were surveyed by questionnaires on their tolerance to the procedures. In the transnasal gastroscopy group,210 patients were selected for measuring the distance between the external naris and pectinate line,while 210 patients from the routine gastroscopy group were examined to determine the length from the front teeth to the pectinate line. Results Among the patients underwent transnasal gastroscopy,89.9% (98/109)of them had no or mild nausea and 97.2% (106/109)had no or mild vomiting; 85.5%(53/62) of the patients who had suffered routine gastroscopy reported less pain after transnasal gastroscopy,and 93.6%(102/109)of the patients would like to underwent transnasal gastroscopy again if necessary. The average length from the external naris to pectinate line was (43.1?2.6) cm,which was statistically significantly different from that measured from the incisor teeth to pectinate line by routine gastroscopy [(39.7?1.9)cm,t=15.290,P=0.000]. The diagnostic and differential diagnostic value of transnasal gastroscopy is same to that of routine gastroscopy. Therapies under transnasal gastroscopy were conducted in 38 cases without complications occurred. Conclusions The feasibility,tolerance,and safety of transnasal gastroscopy are superior to routine transoral gastroscopy. It can provide a more comfortable process for examination. The ability of diagnosis and differential diagnosis of transnasal gastroscopy resembles those of routine transoral gastroscopy.

Objective To investigate the long -term angiography and clinical outcome of encephalo -duro-myo-synangiosis (EDMS) for the treatment of children w ith moyamoya disease. Methods The clinical and imaging data of before and after procedure in children w ith moyamoya disease treated w ith EDMS w ere analyzed retrospectively. Results A total of 21 children w ith moyamoya disease w ere enroled, including 13 females and 8 males, aged 4 to 16 years. The initial symptom: transient cerebral ischemic attack in 15 cases, ischemic stroke in 4 cases, and hemorrhagic stroke in 2 cases. Matsushima clinical classification: type Ⅰ in 8 cases, type Ⅱ in 7 cases, type Ⅳ in 3 cases, type Ⅴ in 1 case, and type Ⅵ in 2 cases. Suzuki stage: stageⅡ in 4 cases, stage Ⅲ in 11 cases, stage Ⅳ in 5 cases, and stage Ⅴ in 1 case. Ten children underw ent bilateral operation and 11 underw ent unilateral operation (a total of 31 sides). They w ere folow ed up for 13 to 91 months (mean 39.8 months). Three children had transient ischemic attack, 2 had cerebral infarction, 7 had facial edema, and none of them died during the perioperative period. The clinical symptoms w ere improved significantly in 14 sides (45.2%), good in 13 sides (41.9%), and general in 4 sides (12.9%) 1 year after operation. The proportion of children w ith modified Rankin Scale (mRS) score 0-2 after operation w as significantly higher than that before procedure (95 .2% vs.71.4%; χ2 = 4.29, P = 0.041). The middle meningeal artery and deep temporal artery participated in the blood supply of cerebral cortex in different degrees w ere observed by cerebral angiography again for 31 sides, excelent in 25 (80 .6%) and fair in 6 (19.4%). Conclusions The long-term angiography and clinical outcome in children w ith moyamoya disease treated w ith EDMS is good.

Objective:To establish a Mongolian gerbils model by long-term infection of Helicobacter py-lori (Hp) with highly-expressed thioredoxin-1 (Trx1 ) gene and to investigate the histopathological findings of gastric mucosa in Mongolian gerbils.Methods:In this study,75 healthy male Mongolian ger-bils were randomly divided into 3 groups:Hp with highly-expressed Trx1 gene group (n =30),Hp with lowly-expressed Trx1 gene group (n =30),and control group (n =15).The animals underwent gastric perfusion of Hp suspension once a week for 5 weeks.The animals were sacrificed at the end of 4,20, 34,48,70,and 90 weeks after inoculation for detecting Hp colonization by rapid urease test and War-thin-Starry silver staining and histological examination,respectively.Results:(1)The Mongolian gerbil model of long-term infection of Hp with highly-expressed Trx1 gene and lowly-expressed Trx1 gene were successfully established.(2)The macroscopic mucosal lesions,including erythema,uneven,erosion, nodules,etc.could be observed in experimental groups.The severity of lesions and the time when lesions occurred in Hp with highly-expressed Trx1 gene group were heavier/earlier than that in Hp with lowly-ex-pressed Trx1 gene group.(3)Histopathologically,the gastric mucosa of Hp with highly-expressed Trx1 gene group showed the mild dysplastic hyperplasia of epithelial cells 34 weeks after the Hp inoculation, and the time was in the 48th week in Hp with lowly-expressed Trx1 gene group.At the end of the 90th week after Hp inoculation,the gastric adenocarcinoma could be detected in the two experimental groups (71.4% vs.42.8%).The difference between the two experimental groups did not reach statistical sig-nificance (P =0.592),which might be due to the small sample capacity and /or short observation time. In addition,there were 2 cases with severe epithelial dysplastic hyperplasia in Hp with highly-expressed Trx1 gene group,and only 3 cases with moderate epithelial dysplastic hyperplasia in Hp with lowly-ex-pressed Trx1 gene group.The uninfected control animals showed no abnormal findings throughout the en-tire observation period.Conclusion:Hp with highly-expressed /lowly-expressed Trx1 gene colonizes stab-ly in the glandular gastric mucosa of Mongolian gerbils.The histological changes after infection are similar to those of the Hp infected human being,and Hp with highly-expressed Trx1 gene cause the injury of gas-tric mucosa and the occurrence of gastric adenocarcinoma.Trx1 maybe the virulence factor that partici-pates in the pathogenesis of gastric cancer and Hp expressing high levels of Trx1 should be highly toxic for gastric diseases in China.

Cation exchange (CX) reaction for the non-fluorescent ZnS nanocrystal clusters (NCCs) can be used to detect trace biomolecules . Nano clusters synthetized by hydrothermal synthesis are porous. So they can quickly release large amounts of Zn2+ from through cation exchange ( CX) reaction and nano cluster, generate fluorescent signal under the action of zinc reagent to detect fluorescence. The relationship between the release efficiency, target binding force of Zn2+ and its average diamete was investigated when the average diameter was 44 nm, 86 nm and 144 nm in this experiment. Results showed that the smallest nano cluster exhibited the highest cation exchange efficiency, and 71 percent of Zn2+ closed could be released by microwave radiation within 2 min. When the sandwich method of NCCs of 44-nm was used to detect immunoglobulin E (IgE) in a sandwich assay, the limit of detection (LOD) was 5 ng / L, which was 1000 times lower than that of ELISA. It turns out that CX for the ZnS NCCs is superior to the conventional signaling strategies in its high amplification efficiency, robustness, and biocompatibility.

Objective To investigate the relevant factors for fungal infection following pancreatoduodenectomy and offer the theoretical foundation for preventing the emergence of complications after operation. Methods Medical records from 562 consecutive patients who underwent pancreatoduodenectomy in this hospital from 1995 to 2005 were retrospectively reviewed by using single factor and non-condition Logistic regression analyse. Results ①Seventy-eight patients (13.9%) developed invasive fungal infection. The most frequently isolated fungal were Candida albicans accounted for 67.0%, and followed by Candida glabrata, Candida papasilosis and Candida tropicalis and gastrointestinal tract was the most common infection site, followed by respiratory tract, abdominal cavity. ②Fungal infection occurred significantly more often in patients with the length of time in parenteral nutrition, antibiotic use or abdominal cavity complications. Conclusion The most common infection site and isolated fungal associated with pancreatoduodenectomy were gastrointestinal tract and Candida albicans. Abdominal cavity complications such as pancreatic fistula, biliary fistula and abdominal infection and extended use parenteral nutrition and antibiotic are the most important factors leading to invasive fungal infection after pancreatoduodenctomy. Eliminating the various risk factors will decrease the incidence of fungal infection.

Objective To investigate the clinical guiding significance of lymphoscintigraphy with 99mTc-DX for radical lateral lymph node dissection with pelvic autonomic nerve preservation(PANP) in lower rectal cancer.Methods In 67 patients with pathologically proven lower rectal cancer,37MBq/0.8ml 99mTc-DX was injected into submucosa of the rectum through rectal endoscopy.At 0.5h,1h,2h,3h,4h,6h,12h,and 24h after the injection,the patients underwent pelvic and lower abdominal lymphoscintigraphy. The operative method was determined according to the imaging results,and the results of lymphoscintigrams were correlated with postoperative lateral node histologic examination.Results The scintigrams were postive in 37 cases,and all were unilateral.The positive patients underwent PANP.The image results were compared with histological lymph node examination in all patients operated upon for rectal cancer.Histologically,the cases in conformity were 26(70.3 %),false positive in 11 cases(29.7 %),and 2 of 30 false positive patients who demonstrated metastases to lateral node were operated by PANP,while the others underwent only PANP(type Ⅰ) without lateral lymph nodes dissection.The percentage of good sexual function of the two groups of cases after operation was 74.4 % and 71.4 % respentively.The percentages of mild dysuria and good function of urination were both 100 %.Conclusions Lymphoscintigraphy with 99mTC-DX has particular guiding significance in selection of PANP for lower rectal cancer.

Objective To evaluate the effects of sevoflurane postconditioning on mitophagy during myocardial ischemia-reperfusion (I/R) in rats.Methods Forty-two pathogen-free adult male SpragueDawley rats, weighing 250-300 g, were randomly divided into 3 groups (n=14 each) using a random number table: sham operation group (group S) , I/R group and sevoflurane postconditioning group (group SP).Myocardial I/R was induced by 30 min ligation of the left anterior descending branch of the coronary artery followed by 2 h of reperfusion.In group SP, 2.4％ sevoflurane was inhaled for 15 min starting from the onset of reperfusion, while 33％ oxygen was inhaled in group I/R.The rats were sacrificed at the end of reperfusion, and the hearts were removed for measurement of myocardial infarct size (by 1％ 2, 3, 5 triphenyltetrazolium chloride) , expression of LC3 Ⅱ/LC3 Ⅰ , Beclin-1, p62 and Parkin (by Western blot) ,and mitochondrial menbrane potential (by using JC-1 probe) , and for examination of the uhrastructure of cardiomyocytes (with transmission electron microscope).Results Compared with group S, the myocardial infarct size was significantly increased, mitochondrial membrane potential was decreased, the expression of LC3 Ⅱ/LC3 Ⅰ , Beclin-1 and Parkin was up-regulated, and the expression of p62 was down-regulated in group I/R.Compared with group I/R, the myocardial infarct size was significantly decreased, the mitochondrial membrane potential was increased, and the expression of LC3 Ⅱ/LC3 Ⅰ , Beclin-1, p62 and Parkin was down-regulated in group SP.Conclusion Sevoflurane postconditioning can mitigate I/R injury in rats, and inhibition of excessive activation of mitophagy may be involved in the nechanism.