Gastrointestinal bleeding is common in children. The causes of hemorrhage is numer-ous and varies with age. Most of them can be identified by conventional endoscopy and imaging examina-tion. For unexplained bleeding,especially repeated bleeding which failed to conservative therapy,a one-stop hybrid procedure of gastrduodenoscopy,colonoscopy and laparoscopy showed great clinical application value. Endoscopic hematischesis is widely used for minimally invasiveness,effectiveness,and recognition of biopsied lesions. With the progress of laparoscopic technology,single-port transumbilical laparoscopy is increasingly applied in pediatric gastrointestinal bleeding. While surgical exploration is still mandatory for massive hemorrhage in emergency circumstances.

Objective To explore the relationship between plasma homocysteine(Hcy) levels and cerebral infarction.Methods 87 patients with acute cerebral infarction and 80 controls were enrolled in the study. Plasma Hcy levels were measured by high-performance liquid chromatography-fluorescence detection(HPLC-FD) technology using Baseling 810 type high-performance liquid chromatograph.Results Fast plasma Hcy levels were higher in the patient group[(15.28?4.33)?mol/L] compared with those in the control group[(11.32?3.86) ?mol/L]( P

Objective To study the relationship of plasma homocysteine (Hcy), polymorphism in 5,10-methylenetetrahydrofolate reductase (MTHFR) and cystathionine-?-synthase (CBS) genes, and cerebral infarction in the elderly. Methods 61 elderly patients with first-ever acute cerebral infarction and 57 controls were studied. The plasma Hcy levels were measured using high-performance liquid chromatography-fluorescence detection (HPLC-FD). The polymorphism in MTHFR was determined by a polymerase chain reaction (PCR) assay and subsequent restriction enzyme digestion.CBS was determined by amplification refractory mutation system (ARMS). Results The fast plasma Hcy levels were higher in the patient group compared with those in the control group [(13.07?3.96)?mol/L vs (11.51?3.90)?mol/L, P 0.05). There were no differences in the plasma Hcy levels among the different genotypes. Conclusions The MTHFR, CBS gene mutations cannot lead to hyperhomocysteinemia in the elderly patients with acute cerebral infarction. Hyperhomocysteinemia is associated with the independent risk of cerebral infarction, however, mutations only in MTHFR and CBS cannot be ascertained to be independent risk of cerebral infarction in the elderly.

Objective To investigate the changes in brain MRI scan in neuromyelitis optica (NMO).Methods MRI images in 27 cases with NMO were examined in a retrospective study.Results Twenty-two of 27 patients (81.5%) had abnormal brain MRI findings,which were classified as nonspecific (7 cases),atypical (1 case),multiple sclerosis-like (3 cases) and ventricle-aqueduct-syringocoele lesions (11 cases).The lust type is the most common (40.7%).Furthermore,the analysis showed that the number of brain lesions positively correlated with lag time from the onset to the last MRI scan (r=0.475,P=0.025).Conclusions Brain lesions in NMO are diverse,which might result from different pathogenesis.However,ventricle-aqueduct-syringocoele is the most common lesion.Early brain MRI examination of suspected cases is essential.

Objective To compare the activation of microglia in vitro induced by oligomeric and fibrillar Aβ,and research the effects of Piper Kadsura Ohwi extracts on the microglial activation.Methods Microglia were divided randomly into 4 test groups,intervened by fibrillar Aβ25-35,fibrillar Aβ25-35 + Piper Kadsura Ohwi extracts,oligomeric Aβ25-35 and oligomeric Aβ25-35 + Piper Kadsura Ohwi extracts respectively.Also a blank contrast group was set without any intervention.48 hours later,activation of microglia was tested by immunocytochemistry,using the CD68 molecule as a specific marker of microglial activation and the incidences of active microglia in different groups were compared.Results Each of the 4 test groups had a higher positive incidence of CD68 expression than that of the blank contrast (5.1％ ) (P ＜ 0.05 ) ; positive incidence of fibrillar Aβ + Piper Kadsura Ohwi extracts group (52.1％) was lower than that of the fibrillar Aβ group (60.8％) (P＜0.05) ; positive incidence of oligomeric Aβ + Piper Kadsura Ohwi extracts group (67.0％) was not significantly different with that of the oligomeric Aβ group (71.2％),P=0.101.Conclusion Both fibrillar and oligomeric Aβ has the ability to activate the silent microglia.Piper Kadsura Ohwi extracts could inhibit the activation of microglia induced by fibrillar Aβ25-35,but didn't show significant effects on the activation induced by oligomeric Aβ25-35.

Objective To investigate the influences of the genetic factors on the plasma homocysteine (Hcy) level, and the relationships between the plasma homocysteine levels and the polymorphisms in 5,10-methylenetetrahydrofolate reductase (MTHFR) and cystathionine ?-synthase (CBS) and the cerebral infarction. Methods All 87 patients with acute cerebral thrombosis and 80 controls were studied. Plasma Hcy levels were measured by high-performance liquid chromatography-fluorescence detection(HPLC-FD)from using baseline 810 high-performance liquid chromatograph. The presence of the MTHFR C677T mutation was determined by polymerase chain reaction (PCR) assay and subsequent restriction enzyme digestion, and the presence of the CBS G919A or CBS T833C was determined by amplification refractory mutation system. Results Fast plasma Hcy levels were shown higher in the patient group (15.3?4.3) ?mol/L as compared with those in the control group (11.3?3.9) ?mol/L (P

Objectives To explore the impact of Aβ oligomer(Aβo) and fibrillar Aβ( Aβf) on the ethology of model rat and to explore whether or not piper kadsura ohwi(PKO) can ameliorate the ethological changes.Methods AD animal model was made by continuous intracerebroventricular infusion of Aβ through mini-osmotic pump.After surgery,rats of Aβo + PKO group and Aβf + PKO group received intraperitoneal injection of 10％PKO everyday,rats from Aβo + DMSO group and Aβf + DMSO group received intraperitoneal injection of 2.5％ DMSO.The treatment lasted 5 weeks.Morris water maze experiment began on the 31st day after surgery.Results ( 1 ) Acquisition trials:the escape latency was longer in Aβo group ( ( 89.40 ± 7.20 ) s ) than that in Aβf group ( (65.00 ± 10.89 ) s ) ; escape latency was shorter in Aβf + PKO group ( ( 34.00 ± 11.26 ) s) than that in Aβf group and Aβf + DMSO group( (60.6 ± 6.95 ) s) ; escape latency was shorter in Aβ3o + PKO group ( ( 65.33 ±8.89) s) than that in Aβo group and Aβo + DMSO group ( ( 85.60 ± 6.02) s).( 2 ) Robe trial:the times ( 3.00 ±0.71 ) and the proportion of time (0.23 ± 0.02 ) and path(0.23 ± 0.04) spent in the target quadrant in Aβo group was less than that in Aβf group(6.00 ± 1.58,0.25 ± 0.01,0.26 ± 0.03 ) ; the three parameters in Aβf + PKOgroup were more than those in Aβ3f group and Aβf+ DMSO group; the three parameters in Aβo + PKO group were more than those in Aβo group and Aβo + DMSO group.Conclusions Aβ oligomer had a more severe impact on the ethology of AD model rats than fibrillar Aβ did; piper kadsura ohwi may ameliorate the ethological changes of AD model rats.

Objective To investigate the characteristic MRI appearance of neuromyelitis optics (NMO) and muhip]e sclerosis (MS) in the spinal cord.Methods Twenty cases of MS and 23 cases of NMO were examined by MRL All image appearances were analyzed.Results The characteristic MRI appearance of NMO patients in the spinal cord was linear medullary lesion (LML), linear medullospinal lesion (LMSL), linear spinal lesion (LSL) and longitudinally extensive transverse myelitis (LETM), and spinal cord MRI with contiguous T2-weighted signal abnormality extending over 3 or more vertebral segments (23 cases), while in MS, spinal cord MRI with contiguous T2-weighted signal abnormality often extended less than 3 vertebral segments (only 12 cases, χ2 = 19.142, P < 0.01), and the distribution of spinal lesion usually was eccentric (17 cases, compared with NMO group, χ2 = 25.256, P < 0.01).Conclusions NMO is distinct from MS.In MRI, spinal lesion in NMO usually conforms to the distribution of aquaporin 4, while spinal lesion in MS always conforms to the demyelination.NMO has neuroimaging features that move it ever closer to distinct disease status.

Objective To investigate the clinical features of pedistric Littre hernia.Methods Clinical data of 11 cases of Littre hermia admitted from January 2002 to December 2010 was studied retrospectively.Results The diagnosis of Littre hernia was all established by laparotomy.All of the 11 cases were boys,the median age was 1.2 years (22 days to 3 years and 7 months).The main clinical features were:painful,irregular and nonresetable mass in the groin area (11/11),vomiting in 6 cases (6/11 ),fever (＞38.5 ℃ ) in 4 cases (4/11 );X-ray showed intestinal obstruction in 9 cases (9/11 ),Ultrasound found mixed mass in the groin area in 11 cases ( 11/11 ),pouch-like structure were found in 6 cases (6/11).Eight cases (8/11) presented with elevated WBC ( ＞ 10000).Palpable lobulated structure were fell in 5 cases (5/11).All cases of Littre hernia were successfully operated on,Meckel diverticulum perforation was found in 2 cases ( 2/11 ),Meckel diverticulum adhered to the hernia sac in 8 eases (8/11).All patients were cured by surgery,and postoperative follow-up (10ms-8y) found no recurrence.Conclusions Pediatric Littre hernia is rare,preoperative diagnosis is difficult.Avoiding preoperative violent reduction and intraoperative injuring Meekel's diverticulum or the small bowel helps improve the cure rate of Littre hernia in children.

Objective To explore the etiology,clinical characteristics,diagnosis and treatment of the bile duct perforation in children.Methods The clinical data of 7 children with the bile duct perforation were retrospectively summarized in Wuhan Children's Hospital from April of 2009 to April of 2014.Results There were 7 cases of the children with perforation of the bile duct,1 male and 6 female,the average age was 2.05 years.The most common presenting symptoms were abdominal distension in 7 cases(100.0％),nausea and vomiting in 6 cases(85.7％),abdominal pain in 5 cases(71.4％),jaundice in 1 case(14.3％) and diarrhea in 1 case(14.3％).Six cases experienced preoperative abdominal paracentesis,which all gained bilious ascites.Both abdominal ultrasound and computed tomography(CT) showed ascites in 5 cases.On exploration,sites of perforation were seen in 3 cases(42.8％) at the junction of the common hepatic duct and cystic duct,1 case(14.3％) at common hepatic duct,and 1 case(14.3％) at common bile duct,while sites of perforation in other 2 cases(28.6％) were not localized.In the cases(case 1,2,5 and 7) whose site of perforation was large,the T-tube drainage and peritoneal drainage through laparotomy or laparoscopic surgery was performed.In case 4 whose site of perforation was very small,and case 3 and 6 whose site of perforation was not localized,the cholysystostomy and peritoneal drainage was performed through laparotomy or laparoscopic surgery.Simple closure of the perforation was performed in case 4.Case 4 and 5 showed recurrent abdominal pain after operation and abdominal CT revealed biliary tract dilatation,and then biliary reconstruction was performed.Both of the patients recovered well postoperatively.The other 5 children recovered well and had an uneventful postoperative period from the 7 months to 5 years follow-up.Conclusions Early diagnosis of perforation of the bile duct can be made based on clinical manifestations,abdominal ultrasound and CT and abdominal paracentesis.Active surgical treatment should be performed once diagnosis was made.Depending on the size of perforation of the bile duct,appropriate surgical drainage scheme is made.The children with recurrent abdominal pain and biliary tract dilatation should receive biliary reconstruction.