Objective To investigate the incidence and the risk factors of the vascular disease in lower limbs of patients with type 2 diabetes(T2DM).Methods To retrospectively analyze 318 cases with T2DM patients.All the patients were checked on both lower limbs by color ultrasonic Doppler.The differences of ordinary and biochemical indicators between PVD group and non-PVD group were compared.Results There were 67.2％ (205/318) patients who had vascular disease in lower limbs with type 2 diabetes.Age,course of disease,HbAlC,TC,TG,SBP,DBP and BMI in PVD group were significantly higher than those in non-PVD group( P ＜ 0.01 ).Conclusion There was higher incidence of the vascular disease in lower limbs of patients with type 2 diabetes.And the independent risk factors were hypertension,hyperglycemia,hyperlipemia.It could help to prevent the development of lower limb blood vessel pathological changes in DM patients by controlling the levels of blood pressure,lipid and blood sugar strictly.

Purpose To screen and identify T cell lymphoma invasion and metastasis 1 (Tiam1) related genes and expression profile during distant metastasis of colorectal cancer. Methods Colorectal cancer( CRC) in a mice model was established by intraperitoneal injection of dimethylhydrazine ( DMH) . Five panels of fresh primary tumor tissues from Tiam1 transgenic mice were collected and com-pared with that from wild type mice. Differentially expressed genes were detected by Affymetrix human genome-wide expression profile chip and verified by real-time quantitative PCR ( qRT-PCR) analysis. Results The genechip result showed that 794 genes were differ-entially expressed by at least 3 folds in Tiam1 transgenic mice with distant metastasis of colorectal cancer tissue, including 400 up-regu-lated and 394 down-regulated ones. Bioinformatics analysis and gene co-expression network building identified 3 genes (PIK3R5, FIGF and RPS6KA6) with specific expression in colorectal cancer tissue with distant metastasis, and this result was confirmed by qRT-PCR. Conclusion A specific Tiam1 gene expression profile related to colorectal cancer distant metastasis has been established through screening and identifying the genes related to Tiam1 by gene chip technique. These findings provide a basis for exploring the molecular markers of colorectal cancer with distant metastasis.

Objective To observe the clinical effects of the children with svstemic inflammatorv re- active syndrome(SIRS)receiving micro-dose heparin at early stage of the diseases.Methods The 53 cas- es diagnosed as SIRS were included in the randomized control trial.They were divided into two groups,26 cases in control group and 27 cases in therapeutic group.The children in control group received therapy for their primary diseases and other routine managements for SIRS.The children in therapeutic group received both above therapy and micro-dose heparin(5-10 U/kg,1 fime/6hours)via subcutaneous injection at earlv stages of diseases for 3 days.Results There were improvements in both control and therapeutic group, platelets count increased,C-reactive protein decreased (P＜0.01),there were significant diffemnce in platelets and C-reactive protein between two groups,the time of platelets recovery in therapeutic group [(28±9)h]Was less than that in control group[(55±14)h](P＜0.01).In therapeutic group,the dumtion of SIRS was shortened (P＜0.05),mortality and the incidence of multiple organ dysfunction svndrome (MODS)and disseminated intravascular eoagultion(DIC)were decreased significantly(P＜0.05).Con- clusion Early micro-dose heparin in SIRS can shorten its duration and decrease the mortality and the inci- dence of MODS in the children with SIRS.

Objective To discuss pathological features of three cases of uterine primary NHL(non Hodgkin′s lymphoma).Methods The clinical and pathological data of 3 cases of NHL were collected.Immunohistochemical method was used to label the tumor cells.Their histological types were classified by the latest WHO Classification of Tumors of Haematopoietic and Lymphoid Tissues,and then differential diagnosis with other uterus diseases was offered.Results Three cases were presented with abnormal vaginal bleeding or ejecting as the first symptom,which was easily misdiagnosed as common diseases of the uterus in preliminary clinical and pathological diagnosis.Histopathology of general uterus specimens demonstrated that case one expressed CD3,CD56,TiA-1 and so on,and detected EBV virus cells expression,which supported the diagnosis of NK/T cell lymphoma.Another two cases expressed B cell-specific markers(CD20) and so on,and these tumor cells volume was 3 times larger than that of lymphocyte.These tumor cells had high proliferation index and supported diffuse large B-cell lymphoma diagnosis.Conclusion The tumor cells are like lymphocytes.We infiltrate endometria and myometrium,which is difficult to identify from endometria stromal sarcoma and other tumors,and need to use immunohistochemistry(IHC) for definitive diagnosis and differential diagnosis.

Objective To evaluate the efficacy of surgical procedure for tibia-fibula fracture using a combination of internal fixation and vacuum sealing drainage(VSD).Methods Totally 108 patients were enrolled in this study and these patients were from January 2012 to December 2015 divided into two groups(54 per group) according to the surgical method.Patients in the observation group were treated with locking plates or intramedullary naiis fixation combined with VSD covered the wound for the following 6 to 10 days,and then the transplantation was performed.Patients in control group received external fixation with kirschner wire and screw fixation.When granulation tissue filled the wound,flap transplantation was performed to repair tissue defect and cover the exposed bone.The average hospital stay,operation time,local infection rate,fracture healing time were recorded and analyzed.Results In the observation group,the average hospital stay was (24.8 ± 4.2) d,wound closure time was (9.4 ± 1.7) d,rate of local infection was 5.6％,rate of bone nonunion was 7.4％,rate of osteomyelitis was 1.9％,fracture healing time was (17 ±4.7)weeks;the corresponding data in the control group was (32.2 ±8.7)d,(14.1 ±3.8)d,22.2％,9.3％,0 and (16 ± 6.5) weeks.The average hospital stay,wound closure time and infection rate of the two groups were of significant difference(P ＜0.05).There was no significant difference in terms of bone nonunion rate,osteomyelitis rate and union time (P ＞ 0.05).Conclusion Tibia-fibula fracture patients can be effectively treated with a combination of internal fixation and vacuum sealing drainage (VSD).This treatment may shorten the length of hospital stay,reduce the wound-close time and lower the infection rate.

Objective To explore the effect of Tiam1 overexpression on the biological behaviors of human colorectal cancer cells ( CRC ) . Methods The human CRC lines under the established stable overexpression of Tiam1 were studied. Cell morphology was detected before and after transfection by commassie blue staining and scanning electron microscope. The proliferation in vitro of CRC was tested by cell cycle, MTT and plate colony formation assay, the migration and invasion ability of CRC was tested by Transwell assay. The proliferation ability in vivo was studied by induced subcutaneous tumors of nude mice. Results Compared with HT29/mock cells, HT29/Tiam1 cells formed as spindle, the pseudopodia increased and elongated. The proportion in S phase of HT29/Tiam1 was higher (t=19.546, P=0.000), the proliferation ability enhanced (F=177.125, P=0.000), colonies formation ratio increased ( t = 3 . 222 , P = 0 . 032 ) . The number of HT29/Tiam1 cells acrossing the microporous membrane (t = 4.832, P=0.001)and Matrigel(t=3.779, P = 0.005)all raised. On the fifteenth day, the growth deference between the HT29/Tiam1cells and HT29/mock cells in nude mice in vivo occurred. Till the thirtieth day, the size of the tumors in HT29/Tiam1 cell group were 2.3 times as large as that in HT29/mock cell group (F=53.040, P=0.002). Conclusions Tiam1 stable overexpression can promote the proliferation, migration and invasion ability of CRC which indicates its important role in carcinogenesis and evolution of colorectal cancer. Tiam1 may represent a new therapeutic target for colorectal cancer.

Objective To explore the morphological characteristics of Barrett's esophagus under confocal laser endomicroscopy (CLE).Methods A total of 112 patients with suspected Barrett's esophagus (BE) under endoscopy were enrolled in this study.The lower esophageal columnar mucosa was examined with CLE to real-time forecast the histological type and extent of intestinal metaplasia of BE,followed by mucosal biopsies and histopathological examination in inspected area.The relationship between the features under common endoscopy or CLE and histopathological diagnosis was analyzed.Results A total of 94 patients were diagnosed as BE.Island type is the most common type under common endoscopy (54.3％),and the incidence of short-segment BE was higher than that of longsegment BE (86.2 ％ vs 13.8 ％).Specialized intestinal metaplasia,cardiac and fundic epithelium can be distinguished under CLE,and the accuracy was 94.7％,89.4％ and 91.5％ respectively.The histopathological examination in targeted biopsy specimens indicated that the proportion of intestinal metaplasia was higher in long-segment BE (9/13) than that of short-segment BE (33.3 ％,x2 =4.684,P=0.039),and the proportion of intestinal metaplasia was higher in circumferential(11/17) and tongue-like BE (65.4％) than that of island type (15.7％,x2 =15.217 and 19.399 respectively,P＜0.01).There were no significant difference in the extent of intestinal metaplasia among island type,circumferential type and tongue-like type in short-segment and long-segment BE.Conclusions The histological type of BE can be accurately distinguished with CLE.The most common type of BE is island type.The incidence of intestinal metaplasia is higher in circumferential and tongue-like type.The incidence of intestinal metaplasia is higher in long-segment BE than that of short-segment BE.

Objective To explore the effectiveness and safety of endoscopic papillary balloon dilation( EPBD ) for the removal of common bile duct stones. Methods Three hundred and twenty consecutive patients with common bile duct stones on endoscopic retrograde cholangiopancreatography (ERCP) who met all eligibility criteria were randomly assigned endoscopic sphincterotomy (EST) or EPBD.Complications were classified by an expert panel unaware of treatment allocation and outcome. Results After a single ERCP, all stones were removed from 112 patients ( 70% ) assigned EST and 104 ( 65% )assigned EPBD. Mechanical lithotripsy was used to fragment stones in 36 (22. 5% ) EPBD procedures and 32 ( 20. 0% ) EST procedures. Early complications occurred in 5.6% EST patients and 8.1% EPBD patients. No patient died. Gallstone disease recurrence, which is a long-term complication, is 7. 5% ( 12/160) in EST patients and 2.5% (4/160) in EPBD patients, P ＜0. 05. Conclusions The success rate of EPBD was similar to that of EST. We found no evidence of previously suggested higher risk of pancreatitis with EPBD, and suggest that EPBD is preferred in patients who are not suitable for EST, such as those with high risk of bleeding. This procedure is a valuable alternative to EST in patients with bile duct stones.

Objective To observe the role of brain-derived neurotrophic factor (BDNF) in the plasticity of enteric nervous-smooth muscle system,and to investigate the effects of BDNF induced plasticity on gastrointestinal motility in mice.Methods Male hybrid BDNF knockout (BDNF+/) mice and wild type (BDNF+/+) mice were selected,eight in each group.Gastrointestinal motility of BDNF+/+ mice and BDNF+/ mice were tested and compared.Longitudinal muscle strips of mice colon smooth muscle were prepared.The effects of carbachol (1 × 10 5 mol/L) and BDNF (1 × 10 7 mol/L) on contractile function of muscle strips were observed.And the effects of tetrodotoxin (TTX,1 × 10-6 mol/L) on BDNF induced contractile function of muscle strips were also studied.The changes of the density of mice intestinal myenteric plexus and the expression of smooth muscle α-actin (α-SMA) in colon smooth muscle were detected by immunohistochemical techniqne.The ultrastruetural alterations of myenteric plexus,neuromuscular junction (NMJ) and smooth muscle cells were detected by transmission electron microscope (TEM).T-test or Rank sum test was performed for comparison between groups.Results Number of feces particles and water content in feces of BDNF+/-mice ((3.80±0.75) and (39.60±1.47)％) were both lower than those of BDNF+/+ mice ((6.30± 1.03) and (51.00± 1.61) ％),and the differences were statistically significant (t=4.792,12.827;both P＜0.05).Carbachol (1 × 10-5 mol/L) could significantly increase contraction activity of smooth muscle of BDNF+/+ mice (R =3.26 ± 0.43) and BDNF+/-mice (R=2.15 ± 0.36),and the difference was statistically significant (t=15.754,9.632;both P＜0.05).The effects on contraction exciting of smooth muscle strips of BDNF+/+ mice were more significant than BDNF+/ mice,and the difference was statistically significant (t =5.972,P＜0.05).BDNF could significantly increase contraction of muscle strips of BDNF+/+ mice and R value increased from 1 to 1.41±0.09,and the differences were statistically significant (t=13.674,P＜0.05).TTX could obviously inhibit the excitatory effects of BDNF,R value decreased from 1.41 ± 0.09 to 1.03 ± 0.04 (t=11.692,P＜0.05).The density of myenteric plexus of BDNF+/ mice (median 5.8％,interquartile range 4.2％-7.0％) was significantly lower than that of BDNF+/+ mice (median 9.0％,interquartile range 7.1％-10.8％),and the difference was statistically significant (Z =3.730,P＜ 0.05).The expression of α-SMA of BDNF+/-mice (median 33.4％,interquartile range 28.8％-38.5％) was significantly lower than that of BDNF+/+ mice (median 44.6％,interquartile range 39.2％-48.8％),and the difference was statistically significant (Z=4.565,P＜0.05).The results of TEM indicated ultrastructural alterations of myenteric plexus,NMJ and smooth muscle in BDNF+/-mice.Conelusionss BDNF could induce the plasticity of morphology and function in enteric nervous-smooth muscle system,which may play an important role in mice gastrointestinal motility.

Objective To analyse the suspected hereditary non-polyposis colorectal cancer (HNPCC) in mismatch repair protein (MMR) expression of hMLH1 and hMSH2. Methods Immunohistochemical staining method was used for the detection of hMLH1 and hMSH2 protein expression in 193 cases suspected HNPCC patients, the deletion of MMR proteins was identified as highly suspected HNPCC cases. Results Of the 193 patients with suspected HNPCC hMLH1/hMSH2 abnormal expression rate was 29.02%; ≤30 years old was 40%, 31 ~ 40 years old was 28.05%, 41 ~ 50 years old was 28.71%,3 suspected HNPCC showed the deletion of hMLH1/hMSH2 protein expression at the same time ,; In the right colon , the left half colon and rectal anomaly detection rates were 40.74%, 32.65%and 18.89%; hMLH1/hMSH2 deletion was 46.15%with family history. Conclusions The deletion of MMR protein is closely related to age,site and family history in suspected HNPCC, and the deletion of hMLH1 is an important factor to induce early-set colorectal cancer. The deletion of hMLH1/hMSH2 at the same time indicates that hMLH1/hMSH2 genes may play important role in the incidence of HNPCC.