Early diagnosis is one of the difficulties in strangulated intestinal obstruction.Serological markers for the early diagnosis of intestinal obstruction has become a hot spot resently.Studies have shown that histidine decarboxylase had a high sensitivity and specificity in the diagnosis of gastric mucosal injury of intestinal obstruction,which would be expected to become an effective serological marker for the early diagnosis of strangulated intestinal obstruction.In this review,the author will describe the advance of serum histidine decarboxylase level for diagnosis of strangulated intestinal obstruction.

Objective To explore the applicative effect of the clinical cluster management during perioperative period on esophageal cancer in elderly patients aged 75 years and over.Methods A total of 36 cases with esophageal cancer aged 75 years and over admitted into Thoracic Surgery Department in our hospital from January 2010 to February 2015 were divided into experimental and control group.Patients in experimental group received clinical cluster management including preoperative therapy for improvement of heart and lung function, selective protection during operation, strengthening support after operation and early nasal tube nutrition.Patients in control group received routine treatment for esophageal carcinoma during perioperative period.The postoperative complications, intensive care unit (ICU) stay, the incidence of anastomotic leakage,postoperative feeding time, postoperative hospitalization time and other indicators were observed.Results Among 20 patients in the experimental group, postoperative cardiopulmonary complications were found in 6 cases, postoperative cardiovascular complications in 3 cases and anastomotic leakage in 2 cases.Among 16 patients in the control group, postoperative cardiopulmonary complications were found in 12 cases, postoperative cardiovascular complications in 10 cases and anastomotic leakage in 5 cases.The incidences of postoperative cardiopulmonary and cardiovascular complications were lower in experimental group than in control group (x2 =7.200 and 8.693, P =0.007 and 0.003).The incidence of anastomotic leakage showed no significant difference between the two groups (x2 =2.562,P=0.109).The mean duration of ICU stay and postoperative hospitalization time were shorter in experimental group than in control group[(5.6±2.7) d vs.(9.8±4.9) d, (15.4±4.5) d vs.(20.6±5.5) d, t=3.208 and 3.125, P=0.003 and 0.004].There was no significant difference in postoperative feeding time between the two groups [(8.4±1.5)d vs.(9.1±1.1)d, t=1.569, P=0.126].Conclusions A tightly clustered clinical managements during perioperative period can minimize the incidences of postoperative complications and mortality rate in elderly patients with esophageal carcinoma.

Objective To systematically compare the operative and non-operative treatments of acute injury to the lateral ankle ligaments in terms of efficacy and complications.Methods The databases of MEDLINE (From January 1966 to October 2011 ),EMBASE (From January 1988 to October 2011 ),CBMdisc (From January 1978 to October 2011) and CNKI (From January 1980 to October 2011 ) were researched for eligible randomized-controlled trials (RCTs),controlled clinical trials,quasi randomized controlled trials and cohort study which compared operative and non-operative treatments for acute injury to the lateral ankle ligaments.The methodological quality of the eligible studies collected was evaluated.The data of the studies included were extracted for a Meta analysis to compare the motional recovery,functional stability,re-injury,residual pain and post-treatment complications of the ankle between operative and non-operative treatments.RevMan 5.0 software was used for statistical analysis.Results In all the eligible 13 studies included,713 patients were treated operatively and 817 patients non-operatively.The functional stability of the ankle was significantly better in the operative treatment group than in the non-operative treatment group [ OR =0.72,95％ CI,(0.52,0.99),P ＜ 0.05].The incidence of ankle arthrocleisis in the operative treatment group was significantly higher than in the non-operative treatment group [ OR =3.41,95％ CI (1.56,7.44),P =0.002].There were no statistical differences in the motional recovery [ OR =1.14,95％ CI (0.58,2.21),P＞ 0.05],incidence ofre-injury [OR=0.68,95％ CI (0.35,1.31),P＞0.05],residual pain [ OR =0.81,95％ CI(0.56,1.16),P＞ 0.05],or ankle dyskinesia [ OR =2.38,95％ CI (0.91,6.25),P＞ 0.05]between the 2 groups.The incidences,scar tenderness [01R=7.46,95％CI(1.32,42.08),P ＜0.05]and sensory nerve loss [OR=12.16,95％ CI(2.24,66.02),P ＜0.05]were significantly higher in the operative treatment group than in the non-operative treatment group.The total rate of complications was significantly higher in the operative treatment group than in the non-operative treatment group [0R=6.20,95％ CI (2.67,14.41),P ＜0.05].Conclusions Compared with non-operative treatments,operative treatments for acute injury to the lateral ankle ligaments can significantly improve the functional stability of the ankle,but make no significant differences in the motional restoration,re-injury or the residual pain of the ankle.In addition,operative treatments may increase the risk of complications.

Objective To investigate the effect of nimodipine (ND) injecting into cisterna magna on the mitochondrial pathway in hippocampus in rabbit model of subarachnoid hemorrhage (SAH). Methods Eighteen New Zealand white rabbits were randomly allocated to Sham group, SAH group and ND group, six in each group. All the animals underwent operation under anaesthesia. One mL/kg autologous non-heparinized arterial blood was injected into cisterna magna in SAH group and ND group, and the same dosage of saline was injected into cisterna magna in Sham group. Thirty minutes after injection, 1 mg/kg nimodipine was injected into cisterna magna in ND group, and equal-volume of saline was injected into cisterna magna in Sham group and SAH group. All the animals were assessed for the grade of food intake and neurological impairment, and rats were killed 72 hours after SAH. Their hippocampus were processed for detecting the expressions of Bcl-2, Bax, Caspase-3 and Cyt-C mRNA by qRT-PCR. The protein expressions of Caspase-3 and Cyt-C were detected by Western blot assay. Results Compared with the Sham group, there were lower grade of food intake, varying degrees of neurological impairment and lower ratio of Bcl-2/Bax, while the mRNA levels of Bcl-2, Bax, Caspase-3 and Cyt-C and protein levels of Caspase-3 and Cyt-C showed elevated expressions in SAH group and ND group (P<0.05). Compared with SAH group, there were no significant differences in the score of food intake and neurological impairment in the ND group ( P>0.05). There were higher ratio of Bcl-2/Bax and expression levels of Bcl-2 mRNA and lower expression levels of Bax mRNA, Caspase-3 and Cyt-C mRNA and proteins in ND group than those in SAH group (P<0.05). Conclusion Nimodipine plays a protective role in inhibiting the activity of mitochondrial pathway in hippocampus after subarachnoid hemorrhage.

Objective To investigate the clinical application of anti-β2 glyeoprotein Ⅰ antibodies (IgG, IgM, IgA)in systemic lupus erythematosus(SLE). Methods The anti-β2-GP Ⅰ antibodies and anti-cardiolipin antibodies(ACL) level were measured by ELISA in 100 SLE patients, 39 other rheumatoid arthri-tis patients and 30 healthy control people. Their clinical application was analyzed in SLE diagnose and thera-py. Results The level of anti-β2-GP Ⅰ (IgG, IgM, IgA)were significantly higher in SLE than that in healthy (P < 0. 01 ). Sensitivity, specificity, positive predictive value and negative predictive value were 17.2%, 95.7%, 85.0% and 44. 6%, respectively. There was a significant and positive correlation be-tween anti-β2-GP Ⅰ antibodies and ACL antibodies ( IgG, IgM, IgA) (r = 0.418, 0. 624, 0.518, 0. 583, P <0.01). In multivariate analysis the factors(anti-β2-GP Ⅰ antibodies, ACL antibodies, dsDAN, u1-RNP, Sm, SSA, SSB, Jo-1, Scl-70, P-protein, PT, APTT) associated with SLE disease activity index(SLEDAI) were anti-β2-GP Ⅰ (IgG) and dsDNA. Conclusion anti-β2-GP Ⅰ antibody has high specificity and positive predict value, also is associated with SLE's thrombosis. It has some values in the clinical application.

Objective To evaluate the efficacy of percutaneous vertebroplasty(PVP) using instruments and drugs made in China, and to provide the data for the clinical application Methods Polymethylmethacrylate(PMMA) without adding contrast was classified into 3 groups according to the ratio of powder/liquid as 2∶1,3∶2,1∶1,PMMA with contrast was also classified into 3 groups according to the ratio of powder/liquid/contrast as 2∶1∶1,3∶2∶1,1∶1∶1 There were 6 groups totally The periods and temperature of polymerizing process were measured The PMMA specimens of different group were made,with the diameter of 1 0 cm, height of 3 0 cm The density was determined in X ray pictures and mechanical testing with universal testing machine was performed PVPwas performed in the spines of 3 human cadavers with transpedicular route under fluoroscopic control The PMMA was injected into vertebra at an interval of one vertebra from T4-L4, 7 vertebra were injected on each cadaver The injected volume was recorded The spines were dissected into 42 single vertebrae, with all soft tissues removed Overall,21 pairs of adjacent vertebrae were subjected to axial compression in an universal testing machine The cranial vertebra of each pair was injected with PMMA, the caudal one served as a control Results Lower temperature was observed in the PMMA groups with adding contrast than those without adding contrast during the polymerizing process, the average temperature in the PMMA group with the ratio of powder/liquid/contrast as 3∶2∶1 was 67 4℃ There was significant X ray density difference between the groups with contrast and corresponding groups without contrast ( t = 20 00, t = 20 00, t = 22 86, P 0 05) The group with ratio of power/liquid/contrast 3∶2∶1 was (127? 4 70) s in the period of the paste, and the ultimate compressive strength (mPa) was 47 23 The punctures were successfully reached in all vertebra The injected PMMA average volume was 5 ml in the thoracic vertebra and 7 5 ml in the lumbar vertebra PMMA leaking into adjacent paravertebral tissue was demonstrated in 3 of 21 vertebrae The ultimate compressive strength of the vertebrae without PMMA injection in the 3 groups was 3 28,3 63,and 3 69, respectively The ultimate compressive strength of the injected PMMA vertebrae in the 3 groups was 4 52,4 73,and 4 81, respectively The ultimate compressive strength was significantly higher in the injected PMMA vertebrae than that in the vertebrae without PMMA injection( t =3 17,3 55,3 99, P

Objective To investigate the clinical characteristics, diagnosis, treatment and prognosis of pancreatic gastrointestinal stromal tumor (GIST). Methods We reported a case and reviewed the medical literature on pancreatic malignant GIST. We searched the Pubmed and main domestic database. The clinical data of the reported cases were studied, and their predictive factors for postoperative recurrence and metastasis were analyzed. Results Between January 1980 and July 2010, 16 cases of pancreatic GIST were reported. There were 7 males and 9 females, with a median age pf 56.5 (31-72)years. The clinical symptoms were nonspecific. The main presentation was upper abdominal pain or discomfort. A preoperative diagnosis was suspected on radiological examination. The tumor mainly appeared as a well-defined solid-cystic mass. Irregular enhancement appeared in the circumferential and solid portion of the tumor on enhanced CT scan sequences. The pancreatic and biliary ducts were rarely dilated. Endoscopic ultrasound guided fine needle aspiration cytology (EUS-FNA) was helpful in preoperative diagnosis. Of the 15 surgical patients, 14 underwent complete resection, while the remaining received cyst-jejunostomy. A correct diagnosis was made on histopathology and immunohisto-chemistry. On a mean follow up of 21 months (range, 1-60) in 14 patients, all patients were alive.Recurrence or metastasis occurred in 4 patients with tumors of high malignant potential. On univariate analysis, the only significant predictor for adverse outcome was mitoses≥10/50 HPF. Conclusions Pancreatic GIST is a rare tumor of relatively low malignant potential. It has a better prognosis than ductal adenocarcinoma. It is important to arrive at a correct diagnosis and treat the tumor with radical resection. Aggressive surgical resection is potentially curative. Imatinib is recommended in the treatment of patients with tumors with high malignant potential.

Objective To investigate the regulatory effects of extracellular matrixes, including fi-bronectin(FN), and collagen Ⅰ (ColⅠ ) on the immunologic function of human airway smooth muscle cells (HASMCs) passively sensitized with asthmatic serum, and the role of phosphoinosifide 3-kinase (PI3K). Methods Primarily cultured HASMCs were inoculated on the blank plates or on the plates coated with difference matrix proteins, added 10% asthmatic serum to passively sensitized non-asthmatic HASMCs and 10% non-asthmatic serum treated HASMCs as control, cell pretreated with PI3K inhibitor LY294002 for 30 min. The expressions of RANTES, Eotaxin, TGF-β1 mRNA were observed by RT-PCR and RANTES, Eotaxin, TGF-β1 protein in the ceil culture supernatunts was detected by enzyme-linked immtmosorbent assay (ELISA). Results Compared with the control serum group, the expressions of RANTES, Eotaxin, TGF-β1 mRNA of HASMCs and those protein in HASMCs culture supematants were significantly increased in the asthmatic serum group and the control serum + FN group and the control serum + Col Ⅰ group ( P < 0.05 ). The expressions of RANTES, Eotaxin, TGF-β1 mRNA of HASMCs and protein in HASMCs culture superna-tants were significantly increased in the asthmatic serum + FN group and the asthmatic serum + Col Ⅰ group. 50 μmoL/L LY294002 could significantly inhibit the expressions of RANTES, Eotaxin, TGF-β1 mRNA of HASMCs and protein in HASMCs culture supematants(P < 0.05). Conclusion These results suggest ex-tracellular matrixe may regulate immunomodulatory function of HASMCs passively sensitized with asthmatic serum and PI3K signaling pathway may play an important role in the process.

Objective To identify the types of pulmonary complications after pancreaticoduodenectomy,and to discuss the prevention and management of these complications.Methods Clinical data of 165 cases of pancreaticoduodenectomy in our hospital were retrospectively analyzed.Pulmonary complications were identified,therapeutic effects were observed.Results The incidence rate of pulmonary complications was 19.4％ ( 32/165),case-fatality rate was 6.25％ (2/32),two patients died from pneumonia,respiratory failure and ARDS.Complications mainly included pneumonia 13.9％ (23/165),pleural effusion 4.2％ (7/165),atelectasis 3.6％ (6/165),pneumothorax 1.8％ ( 3/165 ),respiratory failure 2.4％ (4/165) and ARDS 1.2％ (2/165).Conclusion Pulmonary complications after pancreaticoduodenectomy are not rare,especially for pulmonary infection and most are hospital acquired pneumonia.To understand rules and particularity of respiratory physiopathological changes after pancreaticoduodenectomy is very important for patients to safely pass over the perioperative period.

Objective To study the clinical manifestation of intracranial anomalous venous return associated with the facial nevi and hydrocephalus. Methods Along with reviewing of the literatures, the clinical records of 3 patients suffered from the facial nevi and hydrocephalus were analyzed. Results All of 3 patients also have sinovenous occlusion, which affect cerebral venous return. Conclusions Intracranial anomalous venous return, which is induced by extensive sinovenous occlusion, has been considered to be the main cause of hydrocephalus in the facial nevi. The formation of sinovenous occlusion and anomalous venous return may be due to developmental defect in the embryonic stage.