Endoscopic treatment is the main therapy for controlling variceal bleeding and secondary prophylaxis of rebleeding of gastroesophageal varices of portal hypertension. Endoscopic treatment of gastroesophageal varices are developing towards individualization, precision and whole management in recent years. We can diagnose the etiology and characteristic of portal hypertension through medical history, physical examination, laboratory and radiological tests. It is important to identify the etiology of portal hypertension that can control the progress of varices. There is a complex classification of varices. Individualized stratification and treatment selection are based on the results of endoscopic finding, contrast computed tomography (CT), hepatic venous pressure gradient, etc. Modified precise endoscopic injection of cyanoacrylate is important part to improve the efficacy and reduce the complications of endoscopic treatment. We need to pay attention to the complications and comorbidities of portal hypertension, comprehensive management with the multidisciplinary teams, that is the most important thing to improve the efficacy of endoscopic treatment and the prognosis of patients with portal hypertension.

Objective Isosorbide-5-mononitrate(ISMN), a long-acting venous dilator,has been shown to decrease portal pressure and used in cirrhotic patients to prevent esophageal variceal bleeding(EVB). We performed a meta-analysis to evaluate ISMN in prevention of EVB. Methods Data from Medline(1968-2003), EMBASE(1986-2003), Cochrane Library(issue 3,2003),CJFD(1994-2003) were searched to retrieve randomized controlled trials comparing ISMN combined with or without other treatments to placebo or other treatments in prevention of EVB.Outcome measure was odds ratio( OR ) of bleeding rate. Mantel-Haeszel method was used in fixed model, while Der Simonian and Laird methods were used in random model. Results Seven trials were identified including prevention of first bleeding and rebleeding. The results of meta-analysis indicated that ISMN had no effect on prevention of EVB[study group vs control group: 88/463 vs 117/465, random model: OR (95% CI ): 0.63(0.37, 1.08 )]. Based on sensitivity analysis compared with control group, ISMN had no effect [43/314 vs 40/314, fixed model: OR :0.63(0.37, 1.08)]on prevention of first bleeding, but had therapeutic efficacy [45/149 vs 77/151, fixed model: OR :0.39 (0.24,0.65)]on prevention of rebleeding. Combination therapy of ISMN and ?-blocker revealed more effective than single therapy with ?-blocker[53/327 vs 74/329, fixed model: OR :0.64(0.42, 0.98)]in prevention of rebleeding [25/80 vs 41/81, fixed model: OR :0.44(0.23, 0.85 )], but had no significant difference in prevention of first bleeding[28/247 vs 33/248, fixed model: 0.84(0.48, 1.44)]. Conclusions ISMN is effective in prevention of esophageal variceal rebleeding. Furthermore , combination with ?-blockers has more therapeutic efficacy in prevention of esophageal variceal rebleeding.

Objective To explore the expression of survivin gene in gastric cancerous tissue and its relationship with gastric cancer prognosis. Methods All the samples were obtained from patients with gastric cancer who underwent surgery in Zhongshan Hospital from July 1995 to June 1996.“ Envision two steps”of immunochemistry was used to detect survivin expression in the resected gastric cancerous tissue.TNM stages were determined by pathological diagnosis and clinical status.All the cases were followed up at least 5 year or until death.The discrepancy of survivin expression was compared in different pathological types and TNM stages.Survivial curves were compared in the two groups with or without survivin expression. Results Totally 96 cases(male/female:59/37;age:29-84 years old,mean age 56) were recruited and survivin expression rate was 70.8%(68/96).Among pathological types,78 cases were adenocarcinoma,18 were non-adenocarcinoma.Survivin expression was similar in different pathological types (69.7% in adenocarcinoma vs.60.0% in non-adenocarcinoma,P=0.369).Among adenocarcinoma,survivin expression rate was higher in poorly differentiated group than that in well differentiated one(82.1% vs. 62.5%,P=0.053).As the infiltration denoted in adenocarcinoma,the expression rates of survivin were 33.3% in cases limited to mucosa and submucosa,81.3% in cases limited to muscularis layer and 75.9% in cases infiltrated to whole layers (P= 0.020).Expression rate of survivin was not related with lymph node metastasis(68.1% vs.70.8%,P= 0.771).Five-year survival rate in 68 survivin positive cases was 42.93%,lower than 52.93% of 28 survivin negative cases,but no statistical difference was observed. Conclusions Survivin is highly expressed in gastric cancer.Survivin expression is closely related with differentiation status of adenocarcinoma and degree of infiltration.Further studies are needed to evaluate its role in the prognosis of gastric cancer.

Objective To explore the protective effects of Acanthopanax senticousus saponins (ASS) on ischemia-hypoxia injury of cortical neuron. Methods The models of cortical neuron damage induced by hypoxia-ischemia (HI) and glutamate (Glu) were established on cultured embryonic cortical neurons. The neurons were randomly divided into HI group, Glu group, ASS group and control group. ASS (50 mg/L) was added into the ASS group before and during neuron damage. The rate of neuronal apoptosis was measured by flow cytometer, nitric oxide (NO) content was determined by Nitrate reductive assay and neuron survival was measured by MTT assay and the release of LDH. Morphologic change of neurons was observed under electron microscopy.Results (1) The cortical neuron survival decreased time-dependently in HI group and reached peak at 8h after hypoxia-ischemia. Glutamate leaded the cortical neuron survival decreasing time-dependently. (2) Compared with the control group, the cortical neuron survival decreased in HI group and Glu group, but the neuron apoptosis, the release of LDH and NO contents increased significantly (all P

Objective To study relationship of Helicobacter pylori (H.pylori) eradication and pathological development of gastric mucosa among H.pylori related diseases. Methods One hundred and ninty one H.pylori infected patients were randomly given anti H.pylori or non anti H.pylori medications, and endoscopic examination was repeated one year after the treatment. Pathological classification was followed the Sydney system. Results Among 191 patients, degree of chronic inflammation of gastric mucosa had ameliorated ( P

Background and purpose:Blood biochemistry and ascites test, imageology examination has low sensitivity in abdominal neoplasmas diagnosis. And also exploratory laparotomy is not suitable for final stage patients. Mini-laparoscopy has been a new diagnostic technology for abdominal disease recently. We aimed was to evaluate the value of Mini-laparoscopy in diagnosing Abdominal Neoplasms. Methods:By reviewing the clinical and operational data, a retrospective analysis of 20 cases with pathologically confirmed abdominal malignancies was performed. Among this group, 10 cases were diagnosed by mini-laparoscopy, and the other 10 cases by exploratory laparotomy. Between the two groups, the surgical expense, anesthesia cost, para-operation nursing, monitoring and treating charges, post- operative hospital days and complications were compared. Results:Comparing mini-laparoscopy to exploratory laparotomy, the surgical and anesthesia charges were statistically lowered (P

BACKGROUND:Atlantoaxial fusion is currently the main surgical treatment of atlantoaxial dislocation, but the premise is at the expense of atlantoaxial range of motion, especial y the rotation motion. Restricted non-fusion fixation is a method that can maintain the atlantoaxial stability, while retain the atlantoaxial range of motion. Further research should be performed to compare the biomechanical characteristics between the two methods. OBJECTIVE:To develop a three-dimensional finite element model of atlantoaxial instability, compare and determine the biomechanical properties of posterior atlantoaxial restricted non-fusion fixation system and posterior atlantoaxial screw-rod fixation system. METHODS:A verified intact finite element upper cervical (C0-C3) model was established and analyzed by Simpleware 3.0, Geomagic 8.0, Hypermesh 10.0, Abaqus 6.9, and Rhino 4.0 softwares based on the CT data col ected from a 31-year-old healthy male volunteer. The moment couple of 1.5 N?m was loaded, which made the model movement in flexion-extension, lateral bending, and rotating direction, respectively. The range of motion was recorded and compared with the in vitro biomechanical experimental data to verify the effectiveness of the model. The ranges of motion of the posterior atlantoaxial restricted non-fusion fixation system model and the posterior atlantoaxial screw-rod fixation system model were analyzed using the finite element method under flexion, extension, lateral bending, and axial rotation;meanwhile, stress nephograms of the posterior atlantoaxial restricted non-fusion fixation system model were observed. RESULTS AND CONCLUSION:(1) There were 206 747 elements and 72 500 nodes in the intact model of upper cervical spine (C0-C3) in this experiment, and the range of motion of intact model validated with the reported cadaveric experimental data. (2) The range of motion of the posterior atlantoaxial restricted non-fusion fixation system group was similar to which of the posterior atlantoaxial screw-rod fixation system group in flexion-extension direction. (3) In lateral bending direction, the range of motion of the posterior atlantoaxial restricted non-fusion fixation system model was obviously limited, respectively. The range of motion of the posterior atlantoaxial restricted non-fusion fixation system model was larger than that of the atlantoaxial dislocation model and basical y same as that of the normal atlantoaxial model. (4) As to the rotating direction, the range of motion of the posterior atlantoaxial restricted non-fusion fixation system mainly disappeared at the atlantoaxial segment;by contrast, a majority of rotating motion was stil retained in the posterior atlantoaxial restricted non-fusion fixation system group. (5) The stress concentration occurred in the contact part between the screw and the connecting rod in posterior atlantoaxial restricted non-fusion fixation system model. (6) Results suggest that posterior atlantoaxial restricted non-fusion fixation system is effective and useful for atlantoaxial fixation. It not only restricted atlantoaxial flexion-extension, but also preserved axial rotation and lateral bending at the atlantoaxial joint.

Objective To analyse the clinical characteristics,follow up their prognsis and evaluate the treatment of patients with Crohn' s disease (CD). Methods The data of patients with CD were collected at Zhongshan Hospital of Fudan University from 2002 to 2007. The diagnosis was made according to the consensus recommended by Chinese Society of Gastroenterology. The disease severity, follow-up and prognsis were evaluated according to the consensus. Results Sixty-six CD patients were enrolled in this study. The ratio of males to females was 2.47 : 1. Age at diagnosis ranged from 12 to 76 years old, and the mean age was (32 ± 17)years old. The main gastroenterological manifestations were abdominal pain (80.3 %), diarrhea (54.6 %), fistula formation (31.8%) ; and the main systemic manifestation was fever (80.3 %) and defective nutrition. A total of 60.6 % of patients with CD had complications and 34. 8% of these patients had more than one complications. Extraintestial manifastation were presented in 7.6% of patients with CD. A total of 86.4% of patients with CD were active state cases and 57. 6% were suffered from inflammation of ileum and colon. Abdominal pain (P = 0. 011), hematochezia (P = 0. 008), fever (P = 0. 001), anemia (P = 0. 020), underweight (P = 0. 010) and heightening of CRP (P = 0. 033) were more common in patients who were in active state than those who were in slient state. During their inducing alleviate treatment, 33.3% of patients with CD were treated with aminosalicylate alone, 36.4% were treated with both aminosalicylate and glucocorticoids, 7. 6% were treated with aminosalicylate, glucocorticoids and immunosuppressant. After medicine treatment, 6.8% of the patients relieved, 62.7% turned better, 28.8% were ineffective, 1.7% died, 55.9% recurd. And 21.2% were treated by surgical operation. A total of 42.4% of patients with CD had histroy of surgical operation and 9.1% were carried on more than one surgical operation.ConclusionsActive state patients with CD had high rate of complications, low extraintestial manifestatons, rare rate of dysplasia and canceration, and high rates of surgical operation and recurring.

Objective To observe the risk factors for portal vein thrombosis (PVT) in cirrhotic patients prior to receiving endoscopic treatment to prevent gastroesophageal varices rebleeding.Methods A retrospective analysis was conducted on cirrhotic patients admitted to Zhongshan Hospital,Fudan University from 2008 to 2013 for secondary prevention of gastroesophageal varices bleeding via endoscopic treatment.Relevant information and data were collected,followed by an univariate analysis and multiple Logistic regression analysis in attempt to identify potential factors affecting the formation of PVT.Results Totally 591 patients were enrolled in the present study and were classified as present-PVT group (n =122,20.64 ％) and absent-PVT group (n =469,79.36 ％).Univariate analysis showed that MELD score,hemoglobin,platelet count,total bilirubin,alanine aminotransferase,blood urea nitrogen,splenectomy ratio all achieved statistical significance between the two groups (P＜0.05).The multiple Logistic regression showed that MELD score,lowered blood urea nitrogen,elevated D-dimer and history of splenectomy were independent factors associated with the formation of PVT (P values were separately 0.016,0.026,0.014 and ＜0.001).Conclusions Cirrhotic patients should receive regular surveillance for MELD score,liver function,D-dimer and portal vein ultrasonography,especially in patients received with a previous history of splenectomy.

Objective To study the tumorigenetic characteristics of side population (SP) cells and their exsistence in gastric cancer cell lines and tissues.Methods Flow cytometry and the DNA-binding dye Hoechst 33342 staining were used to analyze sorted SP cells in 3 gastric cancer cell lines(SGC-7901,BCIC-823 and MKN28).SP cells and non-SP cells(main population cells)isolated from SGC-7901 cell line weresubcutaneously injected into 36 nude mice with 500,5000 or 50 000 cells per mouse,respectively.Thetumorigenity was observed 8 weeks after injection.The expression of ATP-binding cassette sub-family Gmember 2(ABcG2)mRNA in three gastric cell lines and its level in gastric cancer tissues were detected by real-time PCR and immunostaining.respectively.Results The proportion of SP cells was accounted for 1.0%in SGC-7901 cells and 1.3%in BGc-823 cells.No SP cell was found in MKN28 cells.As low as 500 SP cells or 50 000 non-SP cells could initiate tumors in mice.The expression of ABcG2 mRNA was higher in SGC-7901(O.162)and BGC-823(O.096)cell lines than that in MKN28 cell line(0.005).The value of AtCG2 mRNA/beta-aetin mRNA and protein in gastric cancer tissues was different from those in gastritis tissues.Condasimm SP cells have strong ability of tumorigenesis compared with non-SP cells.The expression of ABCG2 is found in gastric cancer tissues and part gastritis tissues.The more the SP cells in gastric cell lines,the higher the expression of ABCG2.