Objective To investigate the changes of plasma adiponectin concentration in type 2 diabetic patients with macrovascular complications.Methods Forty-nine cases of type 2 diabetic patients with macrovascular complications,fifty-four cases of type 2 diabetic patients without macrovascular complications and thirty-five healthy people were investigated.Their plasma adiponectin levels was assayed.Meanwhile,the levels of blood pressure,plasma glucose,lipids and C-peptide were measured.The plasma adiponectin levels among three groups were compared,and the factors affecting the plasma adiponectin were analyzed.Results The plasma adiponectin levels in the group of type 2 diabetes without macrovascular complications were lower than in the control group and were the lowest in the group of type 2 diabetes with macrovascular complications.The plasma adiponectin levels of these three groups were (16.37?3.03)mg/L,(6.69?4.42)mg/L,(4.08?3.24)mg/L,respectively.The differences among the three groups were statistically significant (P

Objective To study the therapeutic value of a second ERCP for the patients with failure of pre-cut ERCP.Methods A total of 167 cases of pre-cut ERCP failure were recruited to the study,among which 109 cases were diagnosed as common bile duct stones and/or benign papillary stenosis,and 58 cases as biliopancreatic lesion.ERCP failed with standard intubation for more than 20 minutes,even with pre-cut or fenestration.A second ERCP was preformed after rest of 3-5 days.The position sequence of intubation for most patients was horizontal,the front and rear.Results The success rate was 79.6％ (133 cases) for the patients with a second ERCP,85 patients received the procedures via the horizontal intubation,36 via anterior,and 12 via posterior intubation.The treatments were performed after successful completion of the endoscopic cannulation.One patient had retroperitoneal infection with duodenal perforation,another patient had severe pancreatitis,who were cured by the intervention methods.Conclusion The success rate of a second ERCP is high with proficient intubation skills.

Comparative genomic hybridization is a techniqu e combining fluorescence in situ hybridization with subtractive hybridization in molecular-cytogenetics. The technical basic priciple, methods, quality control , advantages,disadvantages, applications and advances in the study of colorectal carcinoma are reviewed.

OBJECTIVE:To evaluate the content validity and interrater reliability of the modified medication discrepancy tool (MDT). METHODS:According to the structure of MDT(English edition),the terms of MDT were modified,and 5 invited ex-perts used content validity indicator to test the content validity of MDT. The interrater reliability method was adopted to test the reli-ability of MDT. The interrater reliability was performed by 2 evaluators to same 20 research objects with modified MDT. RE-SULTS:Average item-level content validity index was over 0.800,and scale-level content validity index was 0.970. The item-level interrater reliability was between 0.667 and 1.000(P<0.01). The scale-level interrater reliability was 0.840(P<0.01). CONCLU-SIONS:The modified MDT has good content validity and interrater reliability,and can be used to evaluate discharged medication discrepancies in China.

Background and purpose:The membrane cytoskeletal crosslinker—Ezrin may be involved in several functions including cell adhesion,motility and cell survival.There is increasing evidence that it regulates tumor progression.However,the role of Ezrin in the carcinogenesis,progression and metastasis of primary sporadic colorectal carcinoma is still under investigation.This research is to study the expression,the localization and the clinical significance of Ezrin in human sporadic colorectal carcinoma(SCRC).Methods:Immunohistological EnVision staining was used to detect the expression of Ezrin in 132 cases of human sporadic colorectal carcinoma and 43 adjacent normal colorectal mucosa,and the different expressions of Ezrin among metastatic and non-metastatic SCRC,including 74 metastatic cases and 58 non-metastatic cases were also under investigation.Results:① The expression rate of Ezrin in SCRC was significantly higher than that in adjacent normal colorectal mucosa(79.5% Vs 11.6%,P

Background and purpose: Anti-tumor chemotherapy compromises normal immune function of the patients. There were many reports that chemotherapy for advanced colorectal cancer often inhibit the cellular immune function. The effect of FOLFOX regimen chemotherapy on immunity of the patients with colorectal cancer before and after therapy was studied, and healthy people were used as a control. Methods: Eighty colorectal cancer patients were treated by FOLFOX regimen, which consisted of 2-hour infusion of oxaliplatin(85 mg/m~2) and 2-hour infusion of leucovorin (CF)(200 mg/m~2) on Day 1, followed by 5-fluorouracil(5-FU) bolus (400 mg/m~2) on Day 1 and 46-hour infusion (2 400 mg/m~2). FOLFOX regimen was repeated at 2-week intervals. Two treatments of the above regimen were defined as one cycle. Flow cytometry was used to detect T lymphocyte subsets and NK cells in blood samples from patients with colorectal cancer before and after therapy. Data obtained fi'om healthy people was used as control. Results: CD3~+, CD4~+ T cells, NK cells and CD4~+/CD8~+ ratio in blood samples were not significant before and after chemotherapy in first day, second week and fourth week(P0.05). Lower CD3~+, CD4~+ T cells, NK cells and CD4~+/CD8~+ ratio were detected in blood samples from cancer group than that from the healthy control(P<0.05). CD8~+ T lymphocyte were reverse. This change was related to the TNM pathological stage. Conclusion: FOLFOX regimen was effective for patients with coloreetal cancer, which can improve patients' life quality and did not impact on the immune function of the patients. The immune function of lymphocytes in peripheral blood of the patients with colorectal cancer was low, and even worse in the patients with late TNM stage. It is valuable for estimating the function of cell immune of the patients, patients prognosis and the role of immune therapy in the treatment of the patients by detecting T lymphocyte subset and NK cell.

1263 patients with choledocholithiasis were treated with endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) from January 2005 to December 2008, with 1235 (97.8%) cases successfully treated. One-time ERCP removal of the stones was successful in 982 patients, with two times in 129 patients and three times in 124. 1130 patients (89. 5% ) underwent endoscopic nasal biliary drainage (ENBD) after the procedure. 56 patients with refractory stone were treated with intrabiliary plastic stent, among whom 42 were cured through endoscopic retrograde biliary drainage (ERBD) of 1 -3 times. Complications occurred in 29 patients (2. 3% ) with hemorrhage in 8 patients,acute pancreatitis in 17 and perforations in 4. Mortality rate was 0. We concluded that the majority cases of choledocholithiasis can be successfully treated by ERCP, while intrahepatic cholelithiasis and refractory common bile duct stone remained therapeutic challenges. It is also mandatory to evaluate long-term efficacy and complications of ERCP.

Objective To explore the strategies for diagnosis and treatment of anomalous junction of pancreaticobiliary duct (AJPBD) complicated by acute pancreatitis. Methods The clinical dataof 22 patients with abnormal pancreaticobiliary junction were analyzed retrospectively. Results The incidence of acute pancreatitis in this series was 31.8 % (7/22), thereinto, 5 cases(71.4%) in C-Ptype (the common bile duct joining the pancreatic duct) and 2(28.6%) in P-C type (the pancreatic duct joining the common bile duct). Seven patients underwent ERCP+ EST+ ENBD. Two patients with common bile duct stones were treated with stone basket and cholecystectomy was performed in two cases with gallstone. All patients were successfully treated. The follow-up for l year showed that there was no recurrence of pancreatitis. Conclusion Acute pancreatitis usually occurs in patients with AJPBD, especially in C-P type or with gallbladder stone or common bile duct stone. ERCP+EST+ENBD and prophylactic cholecystectomy are effective to prevent and treat acute pancreatitis.

Objective To observe the effect and safety of endoscopic retrograde cholangiopancre-atography(ERCP)in pregnant patients with acute biliary pancreatitis(ABP). Methods Twenty-four ABP patients,14 mild and 10 severe cases combined with pregnancy,were hospitalized from Januaray 2002 to Januaray 2007. Besides conventional managements,emergency endoscopic nasobiliary drainage(ENBD) without monitor of X-ray was performed in all patients to decrease the pressure in bile duct. Once the condi- tion of the patients Was stabilized and the common bile duct stone was confirmed,secondary endoscopic retro- grade biliary drainage(ERBD)with stent was performed in patients at early and midtrimester pregnancy,while secondary ERCP was employed in late pregnant patients after pregnancy termination. Results All pa-tients safely went through emergency ENBD without complication,and 4 patients with ampulla incarceration accepted sphinectomy with needle knife and stones were removed successfully. Common bile duct stone was confirmed in 15 patients and 5 of them underwent ERBD,the other 10 accepted ERCP. No patient died or needed surgical intervention,and they were all discharged with complete remission. Fetus of two patient with severe ABP did not survive. Conclusion Emergency ENBD and secondary ERCP or ERBD are safe and ef-fective in management of pregnancy patient with ABP.

Objective To investigate the role of endoscopic sphincterotomy(EST)and endoscopic nasobiliary drainage(ENBD)in the treatment of non-biliary severe acute pancreatitis(SAP).Methods 73 patients were randomly divided into the endoscopic treatment group(35 cases)and control group(38 cases).The patients in control group received non-surgical treatment.EST plus ENBD were performed in patients in the endoscopic treatment group 72h within hospitalization.Serum levels of amylase before EST and 1d,3 d,7 d after EST were measured;the ease of pain and recovery of bowel function were documented;the mortality rate,complication rate,surgery rote and hospital stay were also observed.Results The successful cannulation rate in the EST group was 94.3%(33/35),and there was no procedure related complication.Serum levels of amylase before EST and 1d,3 d,7 d after EST were(1376±131)U/L,(675±49)U/L,(238±49)U/L,(75±13)U/L,the serum levels of amylase before EST and 1d after EST in the EST group were not significantly different from those in the control group,but the corresponding values at 3 d,7 d were significantly lower than those in the control group(P＜0.01).The apparent effective rate and total effective rate of pain relief was 37.1%and 48.6%.which was significantly higher than those in the control group (26.3%and 28.9%,P＜0.05).There was no mortality in both groups.The complication rate in the EST group within 30 d was 14.3%,which was signiilcanfly higher than that in the control group(44.7%,P＜0.01).The gurgery rate in EST group was 2.86%,which was significantly lower than that in the control group (21.1%,P＜0.05).The hospital stay in EST group was(27.6±4.0)d,which was significantly shorter than that in the control group[(41.7±5.9)d,P＜0.05].Conclusions EST and ENBD treatment for non-biliary SAP was superior to non-surgical treatment within 72 h of symptom onset with excellent safety and feasibility profile.