0.05).From ≤40 years to 71～80 years, the proportion of proximal colon cancers remained stable, distal colon cancers increased from 14.7% to 26.9%, and rectal cancers decreasd from 58.6% to 47.8% (P

0.05),cyclin D1 was positively and P16 negatively associated with the differentiation and the lymph node metastasis of tongue cancer(P

Objective To study a new stuff-block therapy method to promote closure of external gastrointestinal fistula. Methods Twenty-eight patients with different type of external gastrointestinal fistulae in different sites were treated with fibrin glue stuff-blocking technique. The fibrin glue dispensary system designed by the authors has a double-lumen catheter in different size.When the catheter inserted via the fistula to about 1cm from the intestinal fistula,the glue was relased through the catheter to seal the whole fistula. Results The insertion of dispensary catheter into the fistulae was successful in all the cases. No side-effect was observed in all the patients. In 17 patients the fistulae healed about one week after one time treatment, 11 patients′ fistulae healed in about two weeks after 2-3 time treatment. Twenty-five patents were followed up for 3-6 months . The fistula sustained healing and normal deal was restored.Conclusions Stuff-blocking of the fistula with fibrin glue by means of the dispensary system designed by the authors has satisfy results. It provided a new method for the treatment of external gastrointestinal fistula .

Objectives:To investigate the model and effect of nutritional spport in patients with gastrointestinal fistulas and biliary or pancreatic fistulas. Methods:Step by step nutritional spport was studied in 23 patients with gastrointestinal fistulas and biliary or pancreatic fistulas.The calorie and days provided by different ways of nutritional support and routes of enteral nutrition were reviewed.The nutrition state was evaluated in all cases before TPN and after TEN.Liver functions were observed at the end of every phase of nutrition support. Results:The total hospitalization days of 23 patients were 1 498.TPN,PN+EN and TEN days were 901(60.1%),445(29.7%) and 152(10.2%) respectively,providing non protein calorie of 32.5?5.6,29.5?3.4 and 27.8?4.7 kJ/(kg?d).The routes of enteral nutrition were nasal jejunum tube (13 cases),jejunostomy (5 cases) and nasal gastric tube(2 cases).4 patients died and 19 patients recovered.The nutrition state were significantly improved after nutrition treatment. Conclusions:TPN→PN+EN→TEN→EN+oral feeding was a model of step by step nutritional support,which was effective in patients with gastrointestinal fistulas and biliary or pancreatic fistulas.PN remains the main way providing nutrition support,while EN should be used as soon as possible.

Objective To investigate the diagnosis measures and treatment methods of white line hernia. Methods Analyze the clinical data of 12 cases of white line hernia who were treated by surgery. We performed peritoneal adipose tissue before resection on hernia without hernial sac type. And for those with hernial sac type, apothesis of material in hernia were firstly made, then ligated the hernia sac neck and resection were made. Then according to the white line defect size, we used pure involution suture and Onlay without tension patch repair to repair defect in the white line. Results Surgery of all the 12 cases were successful. 2 cases of them merged postoperative renal dysfunction and infection, and after hemodialysis and anti-infection treatment, they both recoverd well without recurrence. Conclusion There is no spe-cific symptoms and signs in white line hernia, but incarceration and strangulation may cause life threaten, so we should pay more attention to it. For symptomatic, large, difficult, incarcerated or strangulated white line hernia,we should take timely surgical treatment.

Objective To explore the diagnosis, treatment and prognosis of acute perforation of gnstric cancer. Methods The clinical data of 24 patients with acute perforation of gastric cancer who had been admitted to Guangzhou General Hospital of PLA from July 1996 to December 2008 were retrospectively analyzed. Results Of all patients, 4 were treated by perforation repair, 2 by perforation repair combined with gastrojejunostomy, 11 by palliative subtotal gastrectomy, 2 by radical gastrectomy, and 5 by radical gastrectomy after perforation repair. The mean survival time of patients treated by perforation repair, perforation repair combined with gastro-jejunostomy, partial gastrectomy and radical gastrectomy were (4±5), (6±9), (12±7), and (25±9) months, respectively. Conclusions Early diagnosis and reasonable operation are the keys to decrease the morality and increase life quality for patients who suffered from acute perforation of gastric cancer. Different pathologic stages maybe an important factor in deciding the prognosis.

ObjectiveTo investigate the expression and clinical significance of CD40 in the spleen of cirrhotic portal hypertension. MethodsExpression of CD40 was determined with S-P immunohistochemistry in spleen specimens from 50 cases of cirrhotic portal hypertension and 15 healthy individuals. ResultsThe CD40 positive rates in normal spleen and cirrhotic spleen were 86.7% and 36.0%, respectively. There was a significant difference between the 2 groups (P＜0.05). There was a negative correlation between the expression of CD40 and Child grades of liver function and cirrhotic splenic types(P＜0. 05). Conclusion CD40 might reflect the changes of splenic immune function,which might be one of more exact clinical examination indexes of splenic immune function.

Objective To study the iodine nutritional status and the thyroid function of pregnant women during different periods,and provide scientific basis for iodine supplementation.Methods Totally 728 pregnant women who visited the obstetric outpatient of Nanjing Drum Tower Hospital for routine prenatal care from December 2014 to August 2016 were recruited in this study,and at the same time 182 non-pregnant women were recruited as control group.The thyroid stimulating hormone (TSH) and free thyroxine (FT4) were measured by Roche 601.The urinary iodine level was measured by SR-I-100 kit.Results The median urinary iodine of 728 pregnant women was 168.24 g/L,and the median urinary iodine of those women in the T1,T2 and T3 period were 186.31,162.65 and 148.76 g/L,respectively.The TSH at T1 period was lower than T2 and T3 period (t=3.429,3.135,P＜0.05).The FT4 at T1 period was higher than T2 and T3 period (t=5.251,5.965,P＜ 0.05).The prevalence rate of thyroid disease in normal urinary iodine group was lower than that in low urinary iodine group and high urinary iodine group (x2 =4.139,4.131,P＜0.05).Conclusion There was no iodine deficiency among those pregnant women groups,but only 34.75 ％ individuals reached the appropriate iodine nutritional level,and the ratio of iodine insufficient increased with the extension of pregnancy.The whole prevalence rate of thyroid disease in abnormal urinary iodine pregnant women was obviously higher than that in normal.It is necessary to improve the pregnant women's knowledge of iodine nutrition,moreover it is suggested that urinary iodine monitoring and thyroid function should be conducted in pregnant women.

Objective To identify a novel pathogenicity mutation of acid alpha‐glucosidase(GAA) gene in a Chinese family with two siblings affected with juvenile onset form glycogen storage disease Ⅱ(GSD Ⅱ) .Methods The clinical and family data of two siblings presenting recurrent respiratory tract infections ,respiratory failure associated with systemic muscle weakness ,were an‐alyzed and diagnosed with GSD Ⅱ by detecting alpha‐1 ,4‐glucosidase activity .DNA was extracted from peripheral blood of the proband ,younger brother and his parents .All 20 exons and the intron‐exon splice sites of GAA gene were amplified by polymerase chain reaction (PCR) .Mutations were detected by direct sequencing the PCR products .Results The younger brother was found to be compound heterozygous for two mutations in the GAA gene :c .1216G>A (p .Asp406Asn) missense mutation in the exon 8 from his father and c .1935C>A (p .Asp645Glu) missense mutation in the exon 14 from his mother .Conclusion The compound hetero‐zygous c .1216G>A and c .1935C>A mutations caused the juvenile onset form GSD Ⅱ characterized by dyspnea and cardiac hyper‐trophy .The novel c .1216G>A mutation may be related to the juvenile onset form GSD Ⅱ .

Objective To evaluate and screen out the specific characters of thyroid nodules on grayscale and color Doppler ultrasonography. Methods One hundred and four thyroid nodules in 95 patients were studied with gray-scale and color Doppler ultrasound before surgery.According to the probability of malignancy,the main independent characters were screened out by Logistic regression analysis and then got the formula which could calculate the probability of malignancy.Results Fifty three nodules,included 44 hyperplasia,7 adenomas,1 switch granuloma and 1 Hashimoto's disease,were benign.Fifty one nodules,included 47 papillary carcinomas,3 medullary carcinomas,1 metastatic carcinomas,were malignant pathologically.The significant characters to differentiate malignant from benign were the shape,margin,border,halo,echostucture,echogenecity,echo uniformity,calcicum,bolood vessel shape and partial abnormal rich blood of thyroid nodules.After two variables logistic regression analysis,a fomula were worked out.Probability of malignancy=1/1+e-z,which z=-7.44+1.30×halo+1.05×calcicum+1.5×vessel shape.If a thyroid nodule with no halo,microcalcicum and irregular vessel shape,the probability of malignancy was 0.99,while with complete halo,no calcicum and regular vessele shape,the probability of malignancy of the nodule was 0.02.Conclusions The halo,calcium and blood vessel shape of thyroid nodules were three independent characters of thyroid nodules to predict malignant thyroid nodules on gray scale and color Doppler ultrasound.