Objective To investigate the diagnosis and treatment of abdominal compartment syn-drome (ACS)aftergiantabdominal incisional hernia surgery.Methods The diagnosis and treatment of eight cases of ACS after giantabdominal incisional hernia surgery in our hospital from June 201 0 to June 201 4 were retrospectively analyzed.Results Seven cases of ACS were cured,with a cure rate of 87.5%. One case with chronic pulmonary heart diseasedied ofsevere lung infection caused by ARDS,with a mor-tality of 1 2.5%.The cured patients discharged and werefollowedup for threeto six months,without any signs of recurrence and organ dysfunction.Conclusion Abdominal compartment syndrome is a serious complication aftergiantabdominal incisional hernia surgery,with treatment difficult and high mortality.The keysinreducingmortalityare early diagnosis and comprehensive treatment.

Objective To learn the incidence of the inherited metabolic diseases in Beijing. Methods Urine samples were analyzed by gas chromatography-mass spectrometry(GC-MS)for inherited metabolic diseases in high risky infants in Beijing . Results Urine samples from 411 high risky infants were analyzed by gas chromatography-mass spectrometry. 269 cases (65.5%) were detected to have metabolic abnormalities, including 19 cases (4.6%) diagnosed of inherited metabolic diseases in which there were 15 cases of methylmalonic academia and 1 case each of propionic academia, hyperphenylalaninemia, urea cycle abnormality and pyroglutamic aciduria. There were 22 suspected cases (5.4%) of inherited metabolic diseases including 13 cases of lactic acidosis, 5 cases of primary glycerol aciduria, 4 cases of fatty acid metabolic disorders including 1 case each of Citrin defects, tyrosinemia, galactosemia 3-methylcrotonoyl coenzyme A carboxylase deifciency and maple syrup urine disease. There were also 228 cases (55.5%) of metabolic abnormalities, such as increasing urine levels of lactic acid, sucrose,lactose, galactose, N-acetyl tyrosine, succinic acid, dicarboxylic acid and abnormal serine/threonine ratio. Conclusions Methylmalonic academia might be the most common inherited metabolic diseases in high risky infants in Beijing. For infants with clinical manifestations but unclear etiology, GC-MS should be performed. MS-MS and gene analysis could be combined if necessary.

Acrylonitrile ; poisoning ; Adult ; Female ; Humans ; Male ; Middle Aged ; Young Adult

Objective To compare the effect of guide-wire assisted cannulation and traditional con-trast assisted cannulation on the occurrence post-endoscopic retrograde cholangiopancreatography(ERCP) pan-creatitis(PEP). Methods The effect of guide-wire assisted biliary cannulation on the incidence of PEP was systematically evaluated by searching for literatures on prospective randomized controlled trials(RCTs) on the Cochrane Controlled Trials Register (Issue 4, 2008), MEDLINE (1966-Oct, 2008), EMBASE (1966-Oct 2008), Science Citation Index(1966-Oct, 2008), CBMdisk(1970-Sep, 2008) and conference abstracts(2002 -2008). A meta-analysis of these clinical trials was performed. Results Seven RCTs, with a total of 2474 patients enrolled, were retrieved. Meta-analysis demonstrated a lower risk for PEP after guide-wire assisted bil-iary cannulation (RR=0.46, 95% CI 0.25-0.85, P=0.01). However, sub-category analysis showed that it was not statistically superior to contrast assisted cannulation in reduction of PEP (RR=0.66, 95% CI 0.28-1.54, P=0.33). Conclusion Guide-wire assisted biliary cannulation might be effective in preventing PEP, but further RCTs are warranted due to the limitations of trials included in this analysis.

Objective To explore imaging features of the lateral atlanto-dental interval (LADI) of atlanto-axial joint and its value in the diagnosis of atlanto-axial joint dislocation/subluxation. Methods Two hurdred and forty healthy volunteers without atlanto-axial joint dysfunction and 32 patients with torticollis and/or functional impairment at atlanto-axial joint were enrolled into this study. All subjects were examined with multi-slice CT in both neutral and max rotation positions to the left/right. Clinical endpoints including VBLADI, variance range of the VBLADI and asymmetric conditions were evaluated. x2 test is used to evaluate the variance of incidence of bilateral LADI asymmetry in different age groups, Pearson-test(2-tailed) is used to evaluate the correlation between VBLADI and rotary function of atlanto-axial joint,precise test of fourfold table is used to compare normal group with patient groups. Results ( 1 ) In the normal control group: asymmetry of bilateral LADI were observed in 204 among 240 (85.00%) healthy volunteers including 60 youngsters( ＜ 15 years) and 180 adults( ≥ 15 years). The median and P95% of |VBLADI| were 0.850 mm,2.450 mm in the young ( ＜ 15 years) and 0.700 mm,2.051 mm in the adult(≥15 years),there were 2 and 10 volunteers whose |VBLADI| ≥P95% in the young and in the adult respectively. There was no correlation between VBLADI( -2.146 to 2.114 mm,Median 0.000 mm) and LA(22.949° to 44.649°, Median 34.500°), RA (25.284° to 45.334°, Median 35.300° ), VLRA ( - 11.643°to 8.623 °, median 0.000 ° ) respectively in normal people ( r = - 0.030, - 0.005,0.026, P ＞ 0.05 ). ( 2 ) In the study with 32 patients including 25 youngsters( ＜ 15 years) and 7 adults( ≥ 15 years). Seventeen of 32 had atlanto-axial lateral subdislocation (AALSD),in 16 youngsters( ＜ 15 years), the median of the |VBLADI| was 3.350 mm and 14 cases |VBLADI| ≥2.450 mm;1 adult patient(≥ 15 years) had |VBLADI| ≥ 2.051 mm; 7 of 32 patients had atlanto-axial rotatory dislocation (AARD) including 4 youngsters |VBLADI| ＜2.450 mm,median 1.200 mm,3 adults |VBLADI| ＜2.051 mm,all of the 7 patients with AARD had unilateral parasol LADI in neutral position;8 of 32 patients had atlanto-axial complicated dislocation(AACD) including 5 youngsters |VBLADI| ≥2.450 mm,3 adults |VBLADI| ≥2.051 mm. There are more cases whose |VBLADI| ≥P95% in group AALSD and group AACD than in abnormal group( P<0.01 ), but there is no difference between group AARD and normal group( P = 0.738 ).Conclusion The imaging finding of "asymmetry of bilateral LADI" may be either a physiological variation or a pathological condition, clinical manifestations and other imaging findings should be evaluated to make a diagnosis.

OBJECTIVETo investigate the clinical experiment of cortical screw in the treatment of tibiofibular syndesmosis separation together with ankle fractures.

METHODSFrom March 2008 to May 2012,42 patients with tibiofibular syndesmosis separation were treated with cortical screw, including 20 cases in the left and 24 cases in the right. All the patients had closed injury. According to Lauge-Hansen classification, there were 18 cases of supination-external rotation, in which 4 patients with injuries belong to type II, 8 patients with injuries belong to type III, 6 patients with injuries belong to type IV; 14 cases of pronation-external rotation, in which 6 patients with injuries belong to type III, 8 patients with injuries belong to type IV; and 12 cases of pronation-abduction, in which 4 patients with injuries belong to type II, 8 patients with injuries belong to type III. According to injury of ankle, 4 patients had injuries in one ankle, 28 patients had injuries in 2 ankles, and 12 patients had injuries in 3 ankles. All the patients were diagnosised definitely in sight of medical history, checking-up, iconography. The clinical effects were evaluated based on Baird-Jackson score and activity degree of ankle.

RESULTSAll the patient were followed up, and the duration ranged from 11 to 23 months, with an average of 15.7 months. No postoperative wound infection, nonunion, and tibiofibular syndesmosis separation again and other complications occurred. Postoperative Baird-Jackson score exhibited 91.56 ± 6.26 (75 to 99), and 26 patients got an excellent result, 10 good, 6 poor and 2 bad. One patient had nail broken after operation,and got good function after removing broken nail without external fixation. Other 1 patient had osteoarthritis to 1 degree, and got better result with the treatment of physical therapy and intra-articular injection.

CONCLUSIONCortex screw is the effective treatment for tibiofibular syndesmosis separation. Clear diagnosis, delicate operation and postoperative reasonable functional exercise are primary factor of prognosis.

Adult ; Ankle Fractures ; surgery ; Ankle Joint ; surgery ; Bone Screws ; Female ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Treatment Outcome

Objective:To observe the effect of Gegen Qinlian decoction on serum high sensitive C-reactive protein(hs-CRP)expres-sion of rats with periodontitis and atherosclerosis(P-AS).Methods:40 male Wistar rats were randomly divided into 2 groups:control group(A,n=1 0),P-AS group(B,n=30).5 rats in group A and B were used for the identification of P-AS model.Then rats with P-AS in group B were randomly divided into 5 groups(n=5)and administered with saline(B1 ),atorvastatin(B2),metronidazole (B3),atorvastatin+metronidazole(B4)and Gegen Qinlian decoction(B5)respectively for 4 weeks.Serum hs-CRP level was assayed by ELISA.Periodontal attachment loss(AL)and artery change were examined by pathology.Results:Serum hs-CRP level in group B1-5 was higher than that of group A(P<0.01 ).Serum hs-CRP level of group B4 and B5 was lower than that of group B1-3(P<0.01 ),B4 vs B5,P>0.05.The inflammation of periodontal tissues in group B2-5 was improved more than that in group B1 .AL in group B4 and B5 were lower than that in other groups(P<0.01 ),B4 vs B5,P>0.05.Histopathological observation of arteries re-vealed that there was no foam cell in group B4 and B5 ,the artery wall in group B4 and B5 was more even and muscle fibers were ar-ranged more regular.Conclusion:Gegen Qinlian decoction may decreas serum hs-CRP expression and depress the development of pe-riodontitis and atherosclerosis.

Objective:To observe the effect of Gegen Qinlian decoction on high sensitive C-reactive protein(hs-CRP)and interleu-kin-6(IL-6)in serum of the rats with periodontitis and the IL-6 expression level in periodontal tissues.Methods:45 Wistar rats were randomly divided into 2 groups:control group N(n =1 0),periodontitis model group P(n =35).After periodontitis model was identi-fied by the examination of 5 rats,the rest rats were randomly divided into 3 groups(n =1 0)and treated by gavage of saline(group P0 ), metronidazole(group P1 )and Gegen Qinlian decoction(group P2 )respectively for 4 weeks.Then all the rats were sacrificed.Serum was immediately harvested for the test of serum hs-CRP and IL-6 levels by ELISA.Attachment loss level(AL)was examined by pa-thology.IL-6 expression in periodontal tissues was examined by S-P immunohistochemistry.Results:The inflammation of periodontal tissues in P1 ,P2 were improved more than that in P0 .AL in group P2 were lower than that in other groups(P <0.05).The IL-6 expres-sion in periodontal tissues and the levels of serum hs-CRP and IL-6 of group P2 were lower than those of other groups(P <0.05).Ser-um hs-CRP level was positively correlated with IL-6 level.Conclusion:Gegen Qinlian decoction may inhibit the development of peri-odontitis by depressing the expression of serum hs-CRP and IL-6.

Objective To investigate the effects of cold preservation on the expression of GATA in intrahepatic bile duct.Methods The intrahepatic bile duct tissues of SD rats were obtained by collagenase perfusion combined with mechanical separation.After being cut into fragments,the intrahepatic bile duct tissues were cultured in rat tail collagen gel for 48 hours before experiment.All the rats were divided into the control group,cold preservation 1 hour (CP1 h) group and cold preservation 12 hours (CP12 h) group.There were 5 rats in each group.The mRNA and protein expressions of GATA were detected by Real-Time polymerase chain reaction and Western blot.Measurement data with normal distribution were presented as (x) ± s.Comparison among 3 groups was done by ANOVA and pairwise comparisons were done by LSD test.Results The mRNA expressions of GATA3,GATA4,GATA6 were detected,while the mRNA expressions of GATA1,GATA2 and GATA5 were undetectable in intrahepatic bile duct tissue of the control group.The mRNA expressions of GATA4 in the CP1 h group,CP12 h group and the control group were 0.72 ± 0.08,0.56 ± 0.07 and 0.96 ± 0.06,with significant difference among the 3 groups (F =38.981,P ＜0.05).The mRNA expression of GATA4 in the CP12 h group was significantly lower than that in the CP1 h group and the control group,and the mRNA expression of GATA4 in the CP1 h group was significantly lower than that in the control group (P ＜ 0.05).The mRNA expression of GATA6 in the CP1 h group,CP12 h group and the control group were 0.83 ± 0.07,0.68 ± 0.12 and 0.98 ± 0.12,with significant difference among the 3 groups (F =10.175,P ＜ 0.05).The mRNA expression of GATA6 in the CP12 group was significantly lower than that in the CP1 h group and the control group,and the mRNA expression of GATA6 in the CP1 h group was significantly lower than that in the control group (P ＜ 0.05).The mRNA expressions of GATA3 in the CP1 h group,CP12 h group and the control group were 0.92 ± 0.06,0.89 ± 0.05 and 0.98 ± 0.11,with no significant difference among the 3 groups (F =1.674,P ＞ 0.05).The protein expressions of GATA4 in the CP1 h group,CP12 h group and the control group were 0.78 ± 0.07,0.64 ± 0.06 and 0.99 ± 0.10,with significant difference among the 3 groups (F =24.211,P ＜ 0.05).The protein expression of GATA4 in the CP12 h group was significantly lower than that in the CP1 h group and the control group,and the protein expression of GATA4 in the CP1 h group was significantly lower than that in the control group (P ＜ 0.05).The protein expressions of GATA6 in the CP1 h group,CP12 h group and the control group were 0.90 ± 0.04,0.75 ±0.06 and 0.98 ±0.11,with significant difference among the 3 groups (F=11.651,P＜0.05).The protein expression of GATA6 in the CP12 h group was significantly lower than that in the CP1 h group and the control group (P ＜ 0.05).Conclusion The expressions of GATA4 and GATA6 in the intrahepatic bile duct tissues are decreased significantly after cold preservation,which indicate that GATA4 and GATA6 might be involved in the pathophysiological process of the bile duct after cold preservation.

ObjectiveTo verify whether the three different framing effects distinguished by Levin still exist in imitatively medical situation.MethodsEstablished medical decision making problems concerning doctor evaluation,medical compliance and treatment options selection.All these problem were described in the gain and loss frames.300 volunteers were randomly assigned to six groups.Every volunteer completed 2 decision making problems and evaluated their degrees of certainty.ResultsIf doctors were described in valid number,people tended to make more positive evaluations than described in invalid number( x2 =32.09,P ＜ 0.01 ).If treatment options were described in survival rates,people tended to choose adventure option of long-term benefit,otherwise people tended to choose conservative option of short-term benefit( x2 =25.92 P ＜ 0.01 ).If doctors' advices were respectively described in damaging or beneficial frames,the former one has better compliance (x2 =11.07,P ＜0.01 ).Parts of the deferences between the decision making confidence of choosing the adventure or conservative options were significant ( t attribute,positive =3.84,P ＜ 0.01 ; t goal,negative =6.44,P ＜ 0.01 ; t risky,positive =6.57,P ＜0.01 ).People were likely to be more confident with these options conforming to the framing effect.Conclusion-Framing effect exists in imitatively medical situation.