Objective To investigate the clinical features of acute mesenteric ischemia (AMI) in the elderly and provide evidence for early prevention,diagnosis and treatment of AMI for elderly patients.Methods A retrospective analysis was performed in 104 patients with AMI in our hospital,who were divided into two groups:the elderly group (aged≥60 years) and the non-elderly group (aged ＜ 60 years).Clinical manifestations,misdiagnosis rate,laboratory data,underlying diseases,treatment and prognosis were compared between the two groups.Results Acute superior mesenteric artery thromboembolus (ASMATE) was the main cause of AMI in the elderly group and acute mesenteric venous thrombosis (ASMVT) was the main cause of AMI in the non-elderly group.Elderly patients were more prone to misdiagnosis as compared with the non-elderly group (P =0.007).Abdominal pain (100.0％) was the most common clinical manifestation of AMI patients,followed by vomiting (58.7％).Nausea and vomiting were strongly associated with AMI in the elderly (P＜0.05).In laboratory data,serum creatinine,lactate dehydrogenase and uric acid were higher and the D-Dimer level was lower in elderly patients than in non-elderly patients (P＜0.05).Hypertension,atrial fibrillation,arteriosclerosis,ischemic heart disease,cerebral infarction and chronic renal insufficiency were more common in the elderly with AMI (all P＜0.05),while history of alcohol intake was higher in the non-elderly group (P=0.042).Hypertension,arteriosclerosis and cerebral infarction were independent relevant factors for elderly-onset AMI (P =0.000,OR =4.057;P =0.001,OR=4.585;P=0.007,OR=4.269).The number of patients with colon necrosis was higher in the elderly group than in the non-elderly group (P=0.038),and the prognosis was worse in the elderly group than in the non-elderly group (P=0.001).Conclusions ASMATE is the main cause of AMI in elderly patients.Nausea and vomiting are the main clinical manifestations,together with impaired renal function.Hypertension,arteriosclerosis and cerebral infarction are the independent relevant factors for elderly-onset AMI.Elderly patients are more prone to misdiagnosis,show more severity and have worse prognosis.

Objective To develop a protocol for ultrasound-guided percutaneous radiofrequency ablation (RFA) on hepatic tumors larger than 3.5 cm in diameter, and to evaluate its role in ablation treatment. Methods Mathematical analysis was performed to generate the preoperative protocol which included the least ablation (sphere) number and the optimal overlapping mode and procedure for adequately ablating a large and spherical target lesion. The target ablation volume consisted of a tumor plus a 0.5- 1.0 cm tumor-free margin. The operation method for electrode placement was also described. Based on this mathematical protocol, 113 patients with 124 hepatic tumors [( 4.75? 0.92)cm in diameter, ranging from 3.6- 7.0 cm] were enrolled and treated. Seventy-one patients had 76 primary and 42 had 48 metastatic hepatic tumors. Results Totally 554 ablations (electrode placements) were performed in 124 tumors. The tumor complete necrosis rate was 87.9% (109/124), the local recurrence rate 24.2% (30/124), the estimated mean time to local recurrence 17.3 months. Twenty-five patients had received 38 retreatments for the local recurrence (17 received one time, and 8 received two or three times). Major complications were found in 7 patients (6.2 %). Of them, only one patient who suffered from colon perforation one week after RFA treatment required surgical intervention. Conclusions A theoretic basis and clinical guidance in RFA of hepatic tumors larger than 3.5 cm might be provided. Treatment results indicated that the protocol might probably be used to improve complete necrosis rate and reduce local recurrence rate in ablation therapy. The protocol was firmed effective and feasible.

Humans ; Pancreatic Neoplasms ; surgery ; therapy

Objective To analyze the findings of recurrent/residual caner after thyroidectomy for thyroid cancer in both ultrasonography (US) and contrast-enhanced CT (CECT),and to assess the diagnostic value of combination of these two modalities.Methods Forty-six patients with recurrence/ residue of thyroid cancer underwent both high-frequency US and CECT examinations and were enrolled in this study.The imaging features on US and CECT were reviewed and diagnostic accuracies for local residual lesions and cervical lymph node metastasis were evaluated according to pathological results.Results In 46 patients,the average period between thyroidectomy and diagnosis of recurrent/residual cancer was (14.6 ± 12.1) months(range,7 days-10 years).Twenty patients had local recurrent tumors at the surgical bed and the average size of tumors was 2.1 cm(range,0.5-4.6 cm).On US finding,the recurrent/residual tumors were hypoechoic in 60 ％ of cases,had microcalcification in 40 ％.Cervical lymph node metastasis were found in 40 patients,and 75％ of them were located in zone V[.The smallest size of abnormal lymph node which can be detected by US was 3 mm.In cases of lymph node metastasis,12 cases (30％) became cystic,10 (25 ％) presented microcalcifications,and 5 (12.5 ％) showed microcalcifications and cystic change within a lymph node.Microcalcifications,cystic change and hyperechoic appearance within a lymph node suggested malignant.The detection rate of US and CECT in the local recurrent/residual cancer were 90％ and 90％,respectively.The detection rate of cervical lymph nodes metastasis were 80 ％ and 72.5 ％,respectively.The diagnostic accuracy of US and CECT in local recurrence,cervical lymph node metastasis and both were 65％,67.5％ and 65.2％ vs 75％,55％ and 65.2％,respectively (P ＞ 0.05 for all comparisons).the diagnostic accuracy of combination of US and CECT were increased to 86.4％,77.5％ and 91.3％,respectively.US combined with CECT significantly improved the diagnostic capability compared with US or CECT alone(P ＜0.05).Conclusions US should be used as the first choice of imaging examination for post-thyroidectomy of thyroid cancer.US combined with CECT could further increase the diagnostic accuracy in recurrent/residual thyroid cancer.

ObjectiveTo evaluate prognostic factors affecting local tumor progression after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC).MethodsA total of 246 HCC patients (343 lesions) underwent RFA treatment in our department and were enrolled into this study.The average tumor size was 3.7 cm ( range 0.9 ～ 3.7 cm).Regular follow-up with enhanced CT was performed to evalutate the treatment results.Kaplan-Meier model and log-rank test were used in univariate analysis and COX regression model was used in multivariate analysis to identify risk factors for local tumor progression.ResultsThe local tumor progression rate was 11.4％ (39/343 lesions),and the average time from initial RFA to local tumor progression was 12.0 months.Univariate analysis indicated tumor size ( P ＜0.001 ),close to intrahepatic vessels ( P ＜0.001),tumor boundary ( P =0.020),pathological grade( P =0.010) and CEUS before RFA ( P =0.001) as risk factors for local progression.The following factors were identified as independent prognostic factors for local tumor progression by multivariate model:tumor size (P ＜ 0.001),isolated or close to intrahepatic vessels( P ＜0.001) and CEUS before RFA(P =0.018).ConclusionsTumor size,CEUS before RFA and close to intrahepatic vessels are the most important factors for local progression after RFA.Being awaring of possible risk factors for local tumor progression may increase the treatment efficacy and help to promote the use of RFA technique.

Traditional Chinese Medicine (TCM) is the gem of Chinese culture,while TCM culture the root and driving force for its development.Higher learning institutes,one of whose main missions is innovating and inheriting culture,are playing the unique roles in promoting world-wide recognition of TCM culture through international cooperation due to the abundant resources in TCM academy,talent,clinical study and international education.Taking Jiangxi University of Traditional Chinese Medicine as an example,this paper has made constructive exploration and study on how to promote the international communication of TCM culture to allow the international community for better understanding and the application of TCM based on the analysis of current situation and experience summarization with literature investigation and case study.Effective measures that have been put forward include establishing TCM experiencing center,promoting the construction of Confucius Institute,proactively building TCM library,improving the standardization of TCM translation,optimizing approaches of TCM international communication,and speeding up the cultivation of TCM international communication talents.

Objective:To evaluate the physiological roles of bmp3,bmp4 and bmp7 during the formation of permanent tooth roots in dog. Methods:The expression of bmp3,bmp4 and bmp7 mRNA at different stages of the development of permanent tooth roots was examined by in situ hybridization in 3 dogs aged 12-18 weeks. Results:bmp3 was found in dental sac surrounding the germs at the early stage of tooth root development, and in cementoblasts and periodontal cells at the later stage. bmp4 was found in odontoblasts, dental papilla and osteoblasts. bmp7 positive signals was found only in epithelial cells of root sheath around cervical circulus at early stage, then located in cementoblasts and odontoblasts at later stage. Conclusion:The spatiotemporal expressions of bmp3,bmp4 and bmp7 are widely diverse, indicating that they participate in the regulation of tooth root development.

Objective To investigate the microsatellite instability(MSI) and monomorphism at microsatellite DNA BAT 26 locus in esophageal mucosa. Methods Genomic DNA extracted from tissues was amplified by PCR. PCR products were run on 9% denaturing polyacrylamidegel and stained with silver. Then MSI and monomorphism of microsatellite at BAT 26 locus in normal tissues at the incised edge and esophageal cancer tissues in 45 cases of esophageal caner were analyzed. Results All normal specimens showed no change in the length of MS DNA at BAT 26 locus. MSI was detected in 3 out of 45(6 7%) cases of esophageal cancer. Conclusion BAT 26 has complete monomorphism in genome of normal esophageal tissues, but is not sensitive to the identification of MSI.

Objective To detect the state of microsatellite instability (MSI) and investigate the relationship between MSI and clinical pathological parameters in esophageal cancer. Methods MSI was analyzed by PCR SSCP method. Results MSI was detected (22 22%) in 45 cases of esophageal cancer. Effects of MSI on clinical stage, pathological classification, lymph node metastasis, and invasion were not found. Conclusion MSI may be an early molecular pathway and play a certain role in the development of the esophageal cancer.

Objective To compare the contrast-enhanced ultrasonography (CEUS) manifestations of pNENs with the pathological changes and to explore the clinical value of CEUS in diagnosis of pNENs. Methods The CEUS of sixteen pathologically diagnosed pNENsfrom April,2012 to February,2014 were retrospectively observed.The CEUS of thirty pathologically diagnosed pancreatic carcinomas during the same period were taken as the control group.The enhancement extent and enhancement patterns of CEUS in pancreatic tumors were analyzed. The specimens of pNENs were stained with HE and CD34 immunochemistry.The grading of interstitial content and Ki-67 index were obtained on HE-stained slices and microvascular density(MVD) were obtained on CD34 immunochemistry stained slices.Spearman rank test analysis was employed to analyze the correlation.Results Among the 16 cases of pNENs,12 cases (75.0%) demonstrated hyper-or iso-enhancement,which included 6 cases (37.5%) showing homogeneous enhancement and 6 cases (37.5%) showing inhomogeneousen hancement,and the other 4 cases demonstrated hypo-enhancement. Among 30 cases of pancreatic carcinomas,25 cases (83.3%) demonstrated hypo-enhancement and 5 cases (16.7%) hyper- or iso-enhancement,and 21 cases (70.0%) demonstrated homogenous enhancement,and 9 cases(30.0%)inhomogeneous enhancement.Taking hyper-or iso-enhancement on CEUS as the diagnostic criteria,its diagnostic sensitivity,specificity,positive predictive value,negative predictive value,and accuracy were 75.0%,83.3%,70.6%,86.2%,80.4%respectively.Negative and positive correlation of the enhancement extent of pNENs with the interstitial content(r =-0.880,P < 0.001) and MVD (r =0.658,P =0.003) were observed,respectively.Six tumors with inhomogeneous enhancement contained cystic degradation or necrosis under microscope. Conclusions CEUS is an effective and non-invasive diagnostic approach for pNENs and can reflect the pathological changes.Hyper-or iso-enhancement of CEUS is typical appearance of pNENs.