Objective To explore the relationship between preoperative serum pro-adrenomedullin (pro-ADM) in the patients with closed rupture of small intestine,and postoperative secondary abdominal infection,and to study the value of postoperative serum pro-ADM in assessment of severity of postoperative secondary abdominal infection of this patients.Methods Eighty-five patients with closed rupture of small intestine treated in the emergency surgery from June 2014 to May 2015 were selected.According to the presence of postoperative abdominal infection or not,these patients were divided into infection group and non-infection group.The infection group was further divided into SIRS,sepsis,severe sepsis,septic shock subgroups as per the severity of infection.The levels of serum pro-ADM,interleukin-6 (IL-6),C-reactive protein (CRP) were determined and the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was calculated at admission and the first day、the second day and the third day after operation.Comparisons of these biomarkers were carried out to find out the factors associated with postoperative abdominal infection.In addition,ROC curve was used to verify the factors for predicting the abdominal infection of these patients after operation.The relationship between serum levels of pro-ADM and APACHE Ⅱ score after operation was analyzed.The severity of abdominal infection after operation was assessed with laboratory findings.Results Compared with non-infection group,preoperative and postoperative serum pro-ADM (P =0.03,P ＜ 0.01),IL-6 (P =0.02,P ＜0.01) levels and APACHE Ⅱ scores (P ＜ 0.01,P ＜ 0.01) were significantly higher in infection group (P ＜ 0.05).In the infection groups,the postoperative levels of serum pro-ADM and APACHE Ⅱ scores were increased with the severity of infection increased (r =0.924),and the difference between the groups was statistically significant (P ＜ 0.05),but there were no significant differences in IL-6 and CRP levels between two groups.Conclusion (1) The serum levels of pro-ADM before operation has value in predicting the genesis of abdominal infection in these patients after operation.(2) The serum levels of pro-ADM after operation has value in severity assessment of abdominal infection in these patients after operation.

Objective To study the relationship among Alzheimer-like neuropathologic changes and their relationship with age and sex. Methods From January 1,1986 to April 1,2000,all autopsy caus of non-demented individuals ≥40 years of age in the General Hospital of PLA were examined for Alzheimer-like neuropathologic changes in hippocampus.There were 41 female and 97 male. Senile plaques(SP),neurofibrillary tangles(NFT) were identified with modified Palmgren-stain method. Hirano bodies(HB) or granulovacuolar degeneration(GVD) were identified with HE stain methods. Results About 40% patients had Alzheimer-like neuropathological changes in hippocampus. There was a highly significant correlation was found between the incidence and severity of SP?NFT?Hirano or GVD and patients' age in the CA1 field of the hippocampus, but no significant difference between male and female. There was a strong correlation among the prevalence and numerical densities of these four types of Alzheimer-like changes. Conclusions Alzheimer-like neuropathologic changes were mainly distributed in CA1 of hippocampus. In CA1 they had relationship with age, but no relationship with sex and they had correlation each other.

Objective To discuss the diagnosis and inductive chemoradiotherapy of stage Ⅲ and stage Ⅳa invasive thymoma.Methods Clinical data of 13 cases with incomplete resected invasive thymoma were analyzed retrospectively,among which 8 cases were in stage Ⅲ and 5 cases in stage Ⅳa.All the 13 cases had invasion of major vessels,pericardial and lung tissues,or had metastasis of pleura and pericardium.Each patient got pathological diagnosis by fine needle aspiration,video-assisted thoracoscopic biopsy or anterior mediastinal biopsy.After 3 cycles of NP or CAP inductive chemotherapy and synchronous radiotherapy,tumors shrank and got palliative or complete surgical resection.The Follow up ranged from 2.8 to 9 years.Results All the 13 cases were malignant thymoma,including 4 cases of type B2,6 cases of type B3 and 5 cases of type C.7 patients got radical resection and 2 got palliative resection.9 patients survived more than 3 years after operation,7 patients survived more than 5 years,one patient even lived 8 years,and the other 4 patients without getting surgery died in 4 years.Conclusion Inductive chemoradiotherapy could shrink stage Ⅲ and stage Ⅳa invasive thymoma,reduce clinical stage,improve the resection rate,and prolong survival.

Objective To study the change of serum diamine oxidase (DAO) level in patients with severely acute pancreatitis (SAP) in order to explore the role of DAO in assessing the severity of SAP and the magnitude of gastrointestinal dysfunction.Methods From January 2012 through December 2013,56 SAP patients with 33 male and 23 female and average age (45-± 14) years admitted within 3 days after onset were enrolled for this study.At admission,serum diamine oxidase (DAO) was detected,and APACHE Ⅱ score,computed tomography severity index (CTSI) score and Balthazar grading and gastrointestinal dysfunction score were calculated.And at the corresponding time,serum procalcitonin (PCT) was detected.The correlations between serum DAO level and 4 other markers were analyzed.Results The high level of serum DAO was found at admission in SAP patients correlating positively with serum PCT concentrations (r =0.516,P＜ 0.01),APACHE Ⅱ score (r =0.631,P＜ 0.01),CTIS score (r=0.640,P ＜ 0.01),and the degree of gastrointestinal dysfunction (r =0.730,P ＜ 0.01).Conclusions The role of serum DAO in assessing the severity of SAP and magnitude of gastrointestinal dysfunction in SAP patients is really valid.

Objective To evaluate HSP90 levels in the diagnosis and staging of gastrointestinal tumors.Method Patients with gastrointestinal tumors hospitalized from 2014 January to 2015 April were enrolled in this study.Serum level of HSP90 was detected.Results The serum HSP90 level of cancer group(112 ± 74)was significantly higher than the control groups,the area under the ROC curve of HSP90's was 0.875 and the cut-off point was 63.63 with sensitivity of 76.1％ and specificity of 92.6％.The HSP90 level in gastric cancer group(135 ±73)ng/ml was the highest,in colon cancer group was (105 ± 60) ng/ml and in rectum cancer group was(79 ± 42)ng/ml (all P ＜ 0.05).Serum HSP90 levels in moderate and low differentiated adenocarcinoma were higher than well differentiated adenocarcinoma group (P ＜ 0.05).Serum HSP90 level was higher in tumors with submucosa and serosa infiltration (P ＜ 0.05).Those with lymphatic metastasis tend to have a higher serum HSP90 level than those without.Conclusion Serum HSP90 level has a good predictive value on gastrointestinal tumor diagnosis,and it is correlated with tumor staging and infiltration status.

Objective To investigate the interventional therapy and its value in the metal foreign matter in the stomach. Methods Eight patients with metal foreign matter in the stomach was studied. All patients were male, and their age ranged from 28 to 46 years with the mean age of 32.2 years. All patients had the medical history of swallowing metal foreign matter in compulsory detoxification or imprisonment. The catheter was inserted into the stomach lead by guide wire lubricated by paraffine. Then the guide wire was withdrawn and a 2.6 m long guide wire was folded in the middle and was inserted into the sromach through the catheter. A loop was made on the guide wire, and the loop was controlled to to hitch the forigen mater, then the guide wire was drawn out slowly . Results A total of 12 metal foreign matters in the stomach in all 8 patients were taken out safely, and no comqlications occurred. Conclusion The interventional therapy for the metal foreign matter in the stomach is simply, minimal invasive, cheap, effective, and with little complication. This therapy is a clinic treatment, the patient is glad to accept, and is the ideal therapy for foreign matter in the stomach.

Objective To study the effect of small interfering RNA targeted on Apollon for proliferation on pancreatic cancer cells and its possible acting mechanism.Methods The small interfering RNA targeted on apollon in our previous study was transfected to the cells using LipofectamineTM 2000,after 48 hours transtection.The inhibitory effects of small interfering RNA targeted on Apollon (Apollon siRNA)on cell proliferation were detected by WST-8.Their inhibition rate and IC50 were calculated.The percentage of apoptosis cells were determined by flow cytometry.The expression of Apollon mRNA was analyzed by real time fluorescent quantitative reverse transcription polymerase chain reaction.The Apollon protein ex-pression levels were detected by western blotting.Results Apollon siRNA could effectively inhibit the proliferation of pan-creatic cancer cell.The amount of apoptotic cells increased significantly.The early apoptotic rate was 37.1%,and the RT-PCR results showed that the relative expression levels of Apollon mRNA were down-regulate,and shows a dose-effective-ness relations.The protein expression levels were decreased by Apollon siRNA.Conclusion Apollon siRNA can effectively inhibit the proliferation of pancreatic cancer cell.The mechanism may be work together to promote pancreative cancer cell early apoptosis and decreased the expression levels of gene and protein,which provides a novel potential approach for treat-ment of target therapy of pancreatic cancer.

AIM: To explore the effects of glucocorticoids on fracture healing in a rat model of tibial fracture. METHODS: Sixty three months old female SD rats were divided into control and glucocorticoid-treated group. A glucocorticoid-induced osteoporosis model was established by intramuscular injection of prednisolone acetate (5 mg·kg~(-1)·d~(-1) for 3 weeks), in which the tibial was osteotomized by a wire saw as fracture healing model and internal fixed with a Kirschner pin. The rats were scarified at different time points after operation. The callus formation was monitored over a period of 6 weeks by histological method, bone mineral density (BMD) detection and biomechanical examination. Western blotting was used to measure the expression of type II collagen. RESULTS: A glucocorticoid-induced osteoporosis model was successfully established and conformed by BMD measurement. The formation of primary callus was observed in both groups 3 days after fracture. At 2 weeks after injury, the glucocorticoid-treated group had a lower BMD and less cartilage matrix as compared to control group. An increase in bone callus and chondrogenesis was observed at 4 to 6 weeks after fracture in glucocorticoid-treated group as compared to control group. The expression of type II collagen was delayed in glucocorticoid-treated group. Biomechanical measurement showed that the actual maximum load was increased by 35.8% in control group as compared to glucocorticoid-treated group at 6th week. CONCLUSION: These results indicate that chondrogenesis and transformation from cartilage callus to bony callus are delayed by glucocorticoids. The retardation of collagen Ⅱ production may be the reason for the inhibition of fracture healing.

Objective To evaluate the training quality of anaesthesiology residents in different hospitals. Methods The scores of 125 residents,attending Shanghai resident clinic skill examination from 2005 to 2007,were analyzed. ResultsThe scores of examinees from municipal hospitals were higher than those from district hospitals,municipal specialized hospitals and traditional Chinese medicine hospitals.The scores of practice part were higher than those of theory part in all groups. Conclusion The training quality is related to the comprehensive strength of the hospital in which examinees work,but the training of theory knowledge still need to be strengthened.

Objective To evaluate the methods of postoperative respiratory management and complications prevention of patients with myasthenia gravis who received thymectomy. Methods According to the accumulated scores of myasthenic crisis prediction, the patients with myasthenia gravis who underwent thymectomy in the past 5 years were divided into 2 groups: high risk group(12, n=11). The time of mechanical ventilation, restoration of muscle strength and spontaneously breathing during extubation, results of arterial blood gas analysis, body temperature, chest X-ray examination and sputum culture of each patient were analyzed. Results The time of mechanical ventilation in high risk group (18~30 h, 26 h in average) was longer than that in control group(4~28 h, 14 h in average)(P