Objective To evaluate the clinical efficacy and safety of metallic hemoclips in the treatment of gastric defects during endoscopic full-thickness resection. Methods Patients with submucosal tumors derived from the muscularis propria and adhesion of the gastric serosa diagnosed by EUS and CT were enrolled in the study.A total of 62 patients,22 males and 40 females,mean age 58.5 years,were recruited into the present study from June 2009 to December 2010,in which 37 patients were with tumors in gastric fundus,20 in gastric body and 5 in antrum.All patients were treated with endoscopic full-thickness resection.After the operation,metallic hemoclips were used to close the defects through endoscopic biopsy channel.The closure success rate with metallic hemoclips were assessed.The patients were followed up endoscopically for evaluation of efficacy and safety of the procedures.Results All patients underwent endoscopic full-thickness resection.Uncontrollable bleeding occurred in 1 patient,who subsequently underwent emergent laparoscopic surgery and was excluded from the study.Metallic hemoclips were applied to close defects in 57 patients,and metallic hemoclips combined with omentum obstruction in 4 patients.The overall success rate was 100％ in 61 patients.Endoscopic follow-up was completed in all patients in average of 4.4 months.The clinical wound healing rate was 100％.No complications such as fever,abdominal pain were found in 2months after the procedures.Conclusion Application of metallic hemoclips during endoscopic full-thickness resection for gastric defects is a safe and effective technique.

Objective To evaluate the risk factors of chronic liver failure(CLF) complicated invnsive fungal infections(IFI) and prevention and treatment. Methods The clinical data and risk factors of 52 patients with CLF complicated IFI were analyzed retrospectively and were compared with those not complicated IFI. Risk factors were analyzed by chi-square test and Logistic regression test and Ridit test. Results In 52 patients with CLF complicated IFI, there were 69 fungal infections in different tissue and organs, the most were in oral cavity, but other tissue and organs especially bellows infections were rising. Candida albieans infeefions were the most, but cryptococcus neoformans infections and aspergillus infections were rising. The risk factors included species of bacteria infections, serum total bilimbin, hospital days, times of antibiotics using, number of invasive operation,species of antibiotics and degrees of aseites. The mortality of patients with CLF complicated IFI were much higher than those not complicated IFI. Conclusion Patients with CLF complicated IFI have poor progress and prognosis. The effective prevent methods are treating primary disease actively, reducing hospital days, detecting patients' body fluids closely, identifying source of infection as early as possible, using antibiotics correctly, reducing or avoiding invasive operation, using immunoactivators and disinfecting air regularly.

Objective To assess the clinical significance of fetal pyelectasis and its changing in utero. Methods One hundred and ninty-seven isolated pyelectasis cases were retrospective reviewed from Jan 2012 to Jul 2014.Isolated pyelectasis was defined as a renal pelvis anteroposterior diameter (RPAPD)of ≥5 mm without other fetal anomaly in second trimester.Persistent or progressive pyelectasis was defined as a RPAPD of ≥10 mm before delivery.They were divided into two groups according to the size of renal pelvis in second trimester:group A (RPAPD 5 - 10 mm)and group B (RPAPD ≥ 10 mm).As the same,there were two groups after 32 weeks of gestation:group C (RPAPD < 10 mm)and group D (RPAPD ≥ 10 mm).Results Totally 1 54 cases were followed up.There were 1 88 cases (95.4%)in group A,with 41 cases lost,141 cases (95.9%)RPAPD <10 mm,6 cases (4.1 %)RPAPD ≥10 mm before delivery.There were 9 cases (4.6%)in group B,with 2 cases lost,remained 7 cases RPAPD ≥ 10 mm before delivery. Conclusions Although most of the fetuses with RPAPD 5 - 10 mm in second trimester will remain the same or resolved before delivery,those with RPAPD ≥ 10 mm may persistent or progress.Prenatal assessment of fetal renal pelvis may provide properly consultation.

Objective To explore the risk factors and clinicopathologic characteristics of severe hand,foot and mouth disease (HFMD),and to provide a scientific basis for clinical interventions.Methods The clinical data of 2606 hospitalized children with HFMD in Ningbo No.2 Hospital were analyzed retrospectively from January 2010 to December 2012.Clinical characteristics were compared between two groups (regular case group and severe case group),and risk factors of severe HFMD were analyzed by Logistic regression test.The clinicopathologic features were analyzed from an autopsy case.Results Among total 2606 cases,619 cases were severe HFMD (23.7％).Logistic regression test showed that EV71 infection,poor spirit,blood glucose ＞ 9 mmol/L,high fever (temperature ≥ 39.1 ℃) lasted more than three days,younger than 3 years and abnormal neural reflex were the independent risk factors of HFMD seriousness.The results of the autopsy showed that the central nervous system,lung and intestinal were most severely.Conclusion Attention should be paid to observe the condition changes in HFMD patients with EV71 infection,younger than 3 years,nervous system symptoms,blood glucose ＞ 9 mmol/L and high fever.Targeted clinical intervention is particularly important for improving cure rate,and the protection of intestinal function can't be ignored.

ObjectiveTo evaluate the efficacy and safety of submucosal tunneling endoscopic resection (STER) for upper gastrointestinal (GI) submucosal tumors (SMTs) originating from the muscularis propria (MP) layer.MethodsA total of 26 upper GI-SMTs originating from the MP layer were treated by STER after endoscopic ultrasonography (EUS) and CT examination.The lesions were localized endoscopically and a submucosal tunnel was created to expose the tumor.The lesion was then resected under direct endoscopic view and the mucosal incision site was closed with hemostatic clips.ResultsOf the 26 SMTs,14 were located at esophagus,7 at cardia and 5 at stomach,with 11 originated from superficial MP layer and 15 from deep MP layer ( including 2 gastric SMTs adherent with serosa).All lesions were successfully resected by STER with an en bloc resection rate of 100％.The average operation time was 68.5 min ( range 25-145min).Four to six (mean five) hemostatic clips were used to close the mucosal incision site.The average lesion size was 1.8 cm ( range 1.0-3.2 cm).The pathology results were 17 leiomyomas,7 stromal tumors (GISTs),1 glomus tumor and 1 Schwannoma.All resected lesions showed both lateral and vertical tumorfree margins.Subcutaneous emphysema occurred in 2 patients (7.7％ ).One patient (3.8％ ) developed left pneumothorax and subcutaneous emphysema,and 2 others (7.7％) pneumoperitoneum.All of them recovered uneventfully on conservative treatments.No delayed bleeding,GI tract leakage or secondary peritoneal/thoracial infection occurred.None of the 26 cases developed submucosal hematoma or infection.No tumor residual or recurrence was found during follow-up period (range 3-9 months).ConclusionSTER is a safe,efficacious and feasible new method for providing accurate histopathological evaluations,as well as radical treatments for upper GI-SMTs from the MP layer.It can regain the mucosal integrity of the GI tract,preventing leakage and secondary infection.

Objective To evaluate the efficacy and the feasibility of peroral endoscopic myotomy (POEM) for achalasia (AC). Methods The clinical data of 8 patients diagnosed as having AC and receiving POEM at our center from August 2010 to December 2010 were reviewed. The patients were 16-62 years old, mean 43yr, whose disease courses lasted for 2-20 years, mean 8.4 years. The key procedures of POEM were as the following, esophageal mucosal incision, submucosal tunneling by endoscopic submucosal dissection ( ESD), endoscopic myotomy of the circular muscle and closure of mucosal entry by hemostatic clips. Results All the 8 patients underwent POEM successfully. The mean operation time was 68.5 min ( ranging 45-115 min). The mean submucosal tunneling length was 9.5 cm ( ranging 8-13 cm). The average length of endoscopic myotomy of inner circular muscle was 8.5cm ( ranging 7-11 cm). No severe complications related to POEM occurred. Patients were followed up for 1-4 months ( mean 2. 5 months). Dysphagia was relieved significantly during the follow-up in 7 patients. But dysphagia and vomiting re-occurred in one patient 15 days after the operation. Endoscopy revealed a submucosal fistula, which was managed by incision. Conclusion As a new minimally invasive therapy for AC, POEM is very effective to relieve dysphagia in a short term. However, further observation is needed to evaluate long-term efficacy and complications.

OBJECTIVETo evaluate mesenteric vascular anatomy using 256 multi-slice computed tomography (MSCT) before laparoscopic colorectal surgery.

METHODSEleven patients with colorectal cancer underwent 256 MSCT from February 2010 to December 2010. The evaluation items were visualization of mesenteric artery and vein by 3-dimensional CT angiography, which was compared with findings on laparoscopic surgery.

RESULTSThree-dimensional CT angiography correctly demonstrated variations of the mesenteric artery and vein and were consistent with laparoscopic findings. Of the 3 patients undergoing right hemicolectomy, ileocolic artery (ICA) ran ventrally to the superior mesenteric vein(SMV) in 1 patient, whereas ICA ran dorsally to the SMV in 2 patients; the right colic artery (RCA) branched directly from superior mesenteric artery(SMA) in 2 patients; RCA was absent and the left branch of middle colic artery(MCA) fed the tumor in 1 patient. In the patients who had transverse colon resection, MCA branched from SMA. In 2 of 3 patients who underwent sigmoidectomy, sigmoid artery (SA) branched from left colic artery(LCA); in 1 of 3 patients of sigmoid resection, SA branched from inferior mesenteric artery(IMA). In 4 patients with rectal cancer, the superior rectal artery (SRA) fed the tumor.

CONCLUSIONThe 256 MSCT is effective for evaluating mesenteric vascular anatomy variation before laparoscopic surgery for colorectal cancer.

Aged ; Angiography ; methods ; Colorectal Neoplasms ; blood supply ; diagnostic imaging ; Female ; Humans ; Imaging, Three-Dimensional ; Laparoscopy ; Male ; Mesenteric Arteries ; diagnostic imaging ; Mesenteric Veins ; diagnostic imaging ; Mesentery ; blood supply ; Middle Aged ; Tomography, Spiral Computed

OBJECTIVETo explore whether bone marrow stem cells (MSCs) from adult mice can be induced to differentiate into hepatocytes by hepatocyte growth factor (HGF) alone and the time phase characteristics in the differentiation progress.

METHODSAdult mouse MSCs were treated with or without 100 ng/ml HGF, on days 0, 7, 14, 21, and 28. The morphologic characteristics of the cells were examined; the albumin (ALB), AFP mRNA was analyzed sub-quantively using reverse transcription polymerase chain reaction (RT-PCR) and immumohistochemistry techniques. The expression of ALB, AFP and CK19 were detected by using anti-ALB, AFP and CK19 antibodies.

RESULTSFreshly isolated adult mouse MSCs expressed ALB and AFP mRNA weakly; in the group without HGF, no ALB mRNA was detected on day 7. The expression of AFP mRNA was reduced significantly on day 7, and could not be detected anymore after day 14. In the HGF treated group, ALB mRNA was not detected on day 7, but the positive lane appeared again on day 14, and the expression of ALB mRNA was increased on day 21 but reduced in the following days. The AFP mRNA was positive at all times, however it tended to decrease after day 14 in the HGF treated groups. The result of immumohistochemistry was consistent with that of RT-PCR, and CK19 was always negative.

CONCLUSIONAdult mouse MSCs can be induced into hepatocyte differentiation in vitro. The optimal time for the induction was 2 to 3 weeks.

Animals ; Bone Marrow Cells ; cytology ; Cell Differentiation ; drug effects ; Cells, Cultured ; Hepatocyte Growth Factor ; pharmacology ; Hepatocytes ; cytology ; Male ; Mice ; Stem Cells ; cytology ; Time Factors

Information on co-adherence of different oral bacterial species is important for understanding interspecies interactions within oral microbial community. Current knowledge on this topic is heavily based on pariwise coaggregation of known, cultivable species. In this study, we employed a membrane binding assay coupled with polymerase chain reaction-denaturing gradient gel electrophoresis (PCR-DGGE) to systematically analyze the co-adherence profiles of oral bacterial species, and achieved a more profound knowledge beyond pairwise coaggregation. Two oral bacterial species were selected to serve as "bait": Fusobacterium nucleatum (F. nucleatum) whose ability to adhere to a multitude of oral bacterial species has been extensively studied for pairwise interactions and Streptococcus mutans (S. mutans) whose interacting partners are largely unknown. To enable screening of interacting partner species within bacterial mixtures, cells of the "bait" oral bacterium were immobilized on nitrocellulose membranes which were washed and blocked to prevent unspecific binding. The "prey" bacterial mixtures (including known species or natural saliva samples) were added, unbound cells were washed off after the incubation period and the remaining cells were eluted using 0.2 mol x L(-1) glycine. Genomic DNA was extracted, subjected to 16S rRNA PCR amplification and separation of the resulting PCR products by DGGE. Selected bands were recovered from the gel, sequenced and identified via Nucleotide BLAST searches against different databases. While few bacterial species bound to S. mutans, consistent with previous findings F. nucleatum adhered to a variety of bacterial species including uncultivable and uncharacterized ones. This new approach can more effectively analyze the co-adherence profiles of oral bacteria, and could facilitate the systematic study of interbacterial binding of oral microbial species.
Adult ; Animals ; Bacterial Adhesion ; DNA, Bacterial ; analysis ; Denaturing Gradient Gel Electrophoresis ; Fusobacterium nucleatum ; physiology ; Humans ; Membranes, Artificial ; Mice ; Microbial Interactions ; physiology ; Polymerase Chain Reaction ; Protein Binding ; Saliva ; microbiology ; Streptococcus mutans ; physiology

OBJECTIVESTo investigate CD3+CD56+ lymphocytes and their subsets in the peripheral blood of chronic hepatitis B patients and to explore the relationship between these cells and the pathogenesis of their diseases.

METHODSBlood samples from 53 chronic hepatitis B patients, 17 from HBV asymptomatic carriers (ASC) and 19 from healthy controls (HC) were collected. CD3+CD56+ lymphocytes were detected by flow cytometry (FCM), then the CD3+CD56+ lymphocytes were gathered to analyze their expressions of CD4, CD8, TCR Valpha24, TCRalpha/beta and TCRgamma/delta.

RESULTSThe number of CD3+CD56+ lymphocytes of chronic hepatitis B patients (7.4+/-4.6%) was more than those of ASC (4.5%+/-3.5%) and healthy controls (4.4%+/-3.7%). The expressions of TCR Valpha24 on CD3+CD56+ lymphocytes showed no significant differences among the three groups, but the expression of TCR Valpha24 on CD3-CD56+ lymphocytes of ASC ( 2.8%+/-1.4% ) was much more than that of the HC (1.7%+/-1.0%). For the subsets analysis, the CD8 and TCRalpha/beta subsets of CD3+CD56+ lymphocytes of chronic hepatitis B (61.9%+/-16.8% and 68.1%+/-16.9%) were significantly higher than those of the HC (49.2%+/-15.6% and 56.4%+/-17.9%), while the TCRgamma/delta subsets of chronic hepatitis B and ASC (29.6%+/-15.4% and 30.5%+/-14.8%) were decreased significantly than those of the HC (41.4%+/-19.4%). On the other hand, the CD8 and TCRalpha/beta subsets of CD3+CD56+ lymphocytes of severe chronic hepatitis B (69.0%+/-14.0% and 76.1%+/-12.9%) and CD8 subsets of moderate chronic hepatitis B patients (66.4%+/-14.9%) were significantly higher than those of the mild chronic hepatitis B patients (51.4%+/-16.2% and 62.1%+/-14.6%).

CONCLUSIONThe pathogenesis of chronic hepatitis B may positively relate to the high expression of CD8 on the CD3+CD56+ lymphocytes.

Adult ; CD3 Complex ; immunology ; CD56 Antigen ; immunology ; CD8-Positive T-Lymphocytes ; immunology ; Case-Control Studies ; Female ; Hepatitis B, Chronic ; immunology ; pathology ; Humans ; Male ; Middle Aged ; T-Lymphocyte Subsets ; immunology ; T-Lymphocytes, Regulatory ; immunology ; Young Adult