10.3969/j.issn.1000-3606.2013.06.001

Objective To raise diagnostic rate of protruded lesion of gastrointestinal mucosa and to judge the precise differentiation to the depth of malignant lesion.Methods 12 cases of gastrointestinal diseases were examined by MPS combined with endoscopic examination.Results To the patients suffering protruded lesion of gastrointestinal mucosa with negative biopsy,the MPS provided a sound basis for diagnosis;To the cases of malignant lesion,findings of MPS with regard to the depth were in total concordance with that of surgical biopsy.Conclusion MPS is significanfly superior to conventional endoscopy with pathological biopsy in the differentation of protruded lesion of gastrointestinal mucosa.But in the case of malignant lesion,only the depth of infiltration of gastrointestinal wall can be correctly assessed by MPS.The value is limited in showing whole Picture for larger focus and in the identification of around lymphnodes and whether or no distal metastases in the near organs.

Objective To investigate the analgesic efficacy of intravenous administration of lidocaine in patients following laparoscopic cholecystectomy. Methods Twenty-five ASA Ⅰ or Ⅱ patients, aged 30-55 yr,weighing 50-70 kg, scheduled for laparoscopic cholecystectomy, were enrolled in this study. Lidocaine 1.5 mg/kg was injected intravenously immediately before anesthesia. Anesthesia was induced with intravenous fentanyl 2 μg/kg, propofol 2 mg/kg and rocuronium 1 mg/kg and maintained with inhalation of isoflurane (end-tidal concentration 1.5%-2.0%) and intermittent iv boluses of rocuronium after tracheal intubation. Lidocaine was infused abdominal intravenously at a rate of 1.5mg·kg-1·h-1 form the end of ofperation to 24 h after operation. The degree of abdominal pain and shoulder pain was assessed with VAS score at 1, 6, 12 and 24 h after operation. The effective analgesia was defined as VAS score of ≤ 3. The adverse reactions were recorded. Results The effective analgesia rate was 100% within 24 h after operation. No adverse reactions occurred. Conclusion Intravenous administration of lidocaine exerts satisfactory analgesia in patients after laparoscopic cholecystectomy.

The author analyzed how toelaborate narrative contents using structured standard with electronical -ly structured medical record information model and the relation of the two .Astructured medical record data entry way was worked outcompatible with standard terminology based on ways of expressing narrative contents using structured standard.It provided a theoretical basis for clinical use .

Objective To evaluate the similarities and differences between four-dimensional radiotherapy (4D-CT ) and active breathing control techniques(ABC) in respiratory management in lung radiotherapy ,and investigate the indications and feasibility of different breathing control techniques for different patients .Methods Twenty-one patients treated with lung radiotherapy received respiratory management .4D-CT technology was used in 11 patients ,while ABC technology was adopted in the rest 10 .The ratios of planning target volume(PGTV) to gross tumor volume(GTV)[(PGTV/GTV)] were calculated .The differences between these two respiratory management technologies were compared in terms of the PGTV ,positioning time ,planning time and treatment time to investigate the indications .Results 4D-CT technology had higher PGTV/GTV ratio ,and shorter positioning time and irradiation time than ABC technology(P<0 .05) ,but there was no significant difference in the planning time(P>0 .05) .In patients with ABC and 4D-CT technology ,objective response rates were 50 .0% ,45 .5% ,respectively ,and the radiation pneumonitis rates were 30 .0% ,27 .3% ,respectively .There was no significant difference in both groups (P>0 .05) .Conclusion In lung tumor radiothera-py ,ABC can reduce irradiation volume ,suitable for patients with good performance status .4D-CT is time-saving and well tolerated , suitable for patients with smaller tumors .

Objective EpCam and Wnt/ β-catenin pathway in colon carcinoma and its clinic-pathological significance of the distribution,studying the relationship between EpCam and Wnt / β-catenin.Methods Retrospective analysis detected by immunohistochemistry 60 cases of colon cancer,20 cases of adjacent atypical hyperplasia,60 normal colon tissue EpCam and Wnt / β-catenin protein expression.Results (1)normal colon tissue,cancer tissue and cancer tissue showed positive expression EpCam clear upward trend,were 23.5％,62.3％,96.5％ ; with normal colonic mucosa to cancer transformation,β-catenin in the membrane expression of the positive rate decreased,while the cytoplasm is followed by increased expression rate in poorly differentiated carcinoma or even nuclear expression,EpCam strong positive expression of Wnt / β-catenin cytoplasmic-positive rate of histological type,depth of invasion,lymph node metastasis; (2)the EpCam with the Wnt / β-catenin expression showed a positive correlation (r =0.653,P ＜0.05) ;(3)high expression EpCam and Wnt / β-catenin in patients with colon significant increase in cancer recurrence rate and 5-year survival rate was significantly reduced.Conclusion EpCam and Wnt / β-catenin pathway in colon cancer positively is correlated,EpCam and Wnt / β-catenin is connected with high expression and tumor invasion,metastasis and prognosis.

Objective To track superparamagnetic iron oxide (SPIO)-labeled pancreatic islet cells in rats using 3.0T magnetic resonance imaging (MRI), and to detect the survival and rejection of grafts after transplantation. Methods Twenty male Wistar rats and 5 male Lewis rats were included in the study. SPIO-labeled pancreatic islet cells were tracked using a GE 3.0T Signa Excite MRI scanner with an animal coil. The images of SPIO-labeled islet cells in rats after transplantation were compared with those of the unlabeled ones. FSE T2WI sequence and GRE T2*WI sequence were used for the detection. The sensitivity of images for detection of grafts was also compared. SPIO-labeled pancreatic islet cells isolated from Wistar and Lewis rats were transplanted into the liver of Wistar rats. Afterwards, the survival and rejection of islet cells were observed sequentially in these two growps. The rats in the syngeneic group were sacrificed 3 months post-transplantation, while the rats in the allogeneic group were sacrificed 3 weeks post-transplantation. MRI of the grafts were correlated with the pathological results. Results SPIO-labeled pancreatic islet cells were seen on MRI as distinct homogenous, hypointense spots in the liver. GRE T2*WI were more sensitive to the detection of SPIO-labeled islet cells than FSE T2WI. The relative count of hypointense spots in the syngeneic group were (90.03±9.52)%, (92.87±18.21)% and (86.25±24.81)%, respectively at 1 week, 2 weeks and 3 weeks after transplantation, while the relative count in the allogeneic group were (41.40±15.41)%, (33.41±14.01)% and (23.58±16.78)%, respectively. The difference between these counts was statistically significant (P<0.01). Iron particles were detected only in the SPIO-labeled cells. Three months post-transplantation, the grafts were found well-preserved in the liver of the rats of the syngeneic group, while only a few grafts were found in that of the allogeneic group. Conclusions MRI can be used to track SPIO-labeled islet cells in vivo, and has significant value in detecting the survival and rejection of grafts after transplantation in rats.

Objective To investigate the diagnosis and treatment of the blunt pancreatic injury.Methods The clinical data of 21 blunt pancreatic trauma patients admitted to our hospital in the past 5 years were analyzed retrospectively.Results 3 of 21 patients were simple blunt pancreatic injury, while the other 18 patients were complicated with other abdominal organs injuries.According to the grading criteria, the number of Ⅰ , Ⅱ, Ⅲ, Ⅳ, Ⅴ grade injury were 4, 7, 5, 3 and 2 cases, respectively, and only 9 patients were diagnosed by CT before operation, and the diagnosis was confirmed during the operation in 11 patients, and 1 was miediagnosed in the first operation.Single drainage or debridement and drainage were performed in 8 cases and distal pancreatectomy with and without spleen were performed in 5 and 3 cases, respectively, and 3patients received pancreaticojejunostomy, 1 received Whipple operation, the other 1 case underwent duodenorrhahy and diverticulation.The mortality rate was 9.5% (2/21), and the complications of pancreatic pseudocyst and fistula developed in 2 (9.5%, 2/21 ) and 5 (23.8%, 5/21 ) cases respectively, and they were cured by drainage, while the other 12 were cured completely.Conclusions The preoperative misdiagnosis rate of pancreatic trauma is high;CT scan should be used to confirm the diagnosis.Careful pancreatic exploration is mandatory and simple and effective surgical procedures with effective drainage is important for treatment success.

Objective To investigate the effect of different reference transducer positions measurement on intra-abdominal pressure (IAP) in ICU patients. Methods 31 cases of patients in ICU in need of measuring IAP were studied from January 2015 to July 2015 in this study. In each patient, transvesical and the direct methods were both used to measure IAP. Three sets of IAP measurements were obtained in the supine position, using the different reference levels and kept as IAPpubis, IAPmidax, IAPphlebostatic. The results were compared using Spearman rank correlation,paired t test and Bland–Altman statistics. Results When symphysis pubis was uesd, the result of direct method was (9.82±4.01) mmHg, the result of indirect method was (8.77 ± 4.48)mmHg (P<0.05), the correction between two methods was 0.967, P<0.05. When midaxillary level was uesd to measure, the result of direct method was (11.74 ± 4.71) mmHg, the result of indirect method was (11.65 ± 4.63)mmHg, the correction between two methods was 0.972, P=0.10. When phlebostatic was uesd, the result of direct method was (10.98 ± 4.65) mmHg, the result of indirect method was (10.38 ± 4.75)mmHg, the correction between two methods was 0.970, P<0.05. The calculated bias between IAPmidax and IAPpubis was 2.9 mmHg, 95%agreement of limits was (-0.8-6.5) mmHg, and the maximum difference value was 11 mmHg. The calculated bias between IAPmidax and IAPphlebostatic was1.3 mmHg, 95%agreement of limits was-1.4-4.0 mmHg, and the maximum difference value was 4.2 mmHg. Conclusion In supine position, the value obtained via the bladder can reflect the true IAP, and the symphysis pubis or phlebostatic axis reference lines are not interchangeable with the midaxillary level.

Aim To observe the effects of activation of aldehyde dehydrogenase 2 ( ALDH2 ) by ethanol on testis injury of type 2 diabetic rats. Methods Type 2 diabetic rats model were established by high-fat diet combined with low-dose streptozotocin ( STZ ) injec-tions. After the success of modeling, the rats were ran-domly divided into 3 groups ( n =6 ): normal control group (NC), type 2 diabetes group (T2DM) and eth-anol+type 2 diabetes group (EtOH+T2DM). Rats of EtOH + T2DM were treated with low-dose ethanol, then rats of NC and T2 DM were given normal diet for 8 weeks. After 8 weeks, the levels of the fasting blood glucose ( FBG ) , glycosylated hemoglobin ( HbA1 c ) and testosterone were tested, and the ratio of testis weight to body weight ( TW/BW ) was calculated. Morphological changes of testis tissue were observed by optical microscope. The levels of ALDH2 mRNA and transforming growth factorβ1 ( TGF-β1 ) mRNA in tes-tis tissue were measured. The expression of TGF-β1 in testis tissue was observed by immunohistochemical stai-ning, then the positive rate of TGF-β1 was calculated. Results Compared with NC, the levels of FBG, HbA1 c and TW/BW increased significantly and the level of testosterone decreased significantly in T2DM. The morphological observation showed that some semi-niferous tubules atrophied, spermatogenic cells de-creased and arrangemented loosely, Leydig cells de-creased in testicular interstitial. The level of ALDH2 mRNA in testis tissue decreased significantly, and the level of TGF-β1 mRNA and the positive rate of TGF-β1 in testis tissue increased significantly. However, compared with T2DM, the levels of FBG, HbA1c and TW/BW decreased, and the level of testosterone in-creased and the damage of testis tissue was attenuated in EtOH+T2DM. The level of ALDH2 mRNA in testis tissue increased significantly, and the level TGF-β1 mRNA and the positive rate of TGF-β1 in testis tissue decreased significantly. Conclusion Activating AL-DH2 can protect testis in type 2 diabetic rats, which may be related to the downregulation of TGF-β1 ex-pression.