Acupuncture Therapy ; Acute Disease ; therapy ; Humans ; Male ; Middle Aged ; Spasm ; therapy ; Stomach Diseases ; therapy

Objective To study the feasibility and effect of implantation of the biliary stent for treatment of biliary obstruction.Methods A retrospective analysis of the diagnostic and therapeutic procedure was done in 131 cases of the inpatients from Apr.2006 to Feb.2007.The 131 patients with biliary obstruction underwent successfully 138 cases/times implantation of biliary stent.The results of recession of jaudince and the rate of complication were evaluated.Results All patients were implanted biliary stent successfully.The serum total bilirubin,direct bilirubin,alkaline phosphatase,?-glutamyl transpeptidase decreased obviously in three days,and the difference was remarkable.The main complication was infection of biliary tract and pancreatitis.Conclusion Implantation of biliary stent is an effective management for biliary obstruction,especially for patients who have lost the chance of operation.

Objective To evaluate the technique of transpancreatic septum precut for cannulation of inaccessible common bile duct in endoscopic retrograde cholangiopancreatography (ERCP). Methods Data of 109 patients with difficult biliary cannulation in ERCP, of whom 56 underwent transpancreatic septum precut and 53 had needle-knife sphincterotomy from January 2006 to July 2008, were analyzed retrospectively, and the success rate of cannulation and the occurrence of complications were compared between the two methods. Results Of 109 patients accepted precut papillotomy, common bile duct cannulation was successfully achieved in 97. The success rates of transpancreatic septum precut group and needle-knife sphincterotomy group were 96.4% (54/56) and 81.1% (43/53) respectively, which was significantly different (P<0.05). Complications occurred in 11 cases, including bleeding(n =4), acute pancreatitis(n=5), cholangitis(n=2). The tolal frequency of complications of the transpancreatic septum pre-cut papillotomy group was lower than that of needle-knife sphincterotomy group(3.6% vs. 17.0%, P<0.05). Conclusion In patients with inaccessible bile ducts, transpancreatic septum precut is a safe and effective procedure in cannulation, exhibiting a higher success rate and lower occurrence of complication when compared with needle-knife sphincterotomy.

Objective To investigate the changes of proteins expressions in intestinal mucosa of rats after is chemic postconditioning (IPo) against intestinal ischemic/reperfusion (Ⅱ/R) injury of intestine in order to elucidate its potential mechanisms of protective role. Methods Sixteen SD rats were randomly divided into Ⅱ/R group and IPo group ( n = 8). Rats of both groups received an episode of ischemic/reperfusion insult to intstine that was made by occlusion of the superior mesenteric artery (SMA) for 60 minutes. Rats of IPo group underwent three additional episodes of clamping SMA on for 30 seconds and off for 30 seconds successively after prolonged reperfusion/reperfusion of intestine. The intestinal mucosa was taken by scratching immediately after reperfusion in both groups, and total proteins were separated by immobilized pH gradient (IPG) based two-dimensional gel electrophoresis (2-DE). The differentially expressed proteins were analyzed using Image Master 2D Elite 5.0 image analysis software, and the proteins were cut out from the gel and then identified using MALDI-TOF-MS. The biological information of these proteins was looked for in the database of these peptide mass finger-printing (PMF) .Results Ten differentially expressed proteins were found, of which 6 were up-regulated and 4 were down-regulated in IPo group. Nine proteins were identified and characterized by their bioelements including aldose reductase and aldehyde dehydrogenase that were related to anti-oxidative stress and inhibition of cell apoptosis. Conclusions The well-reproducible 2-DE profiles of intestinal mucosa in II/R and IPo groups were established. The potentially protective effects of IPo may be attributed to up-regulating protein expressions of aldose reductase and aldehyde dehydrogenase, and thereby suppressing oxidative stress and cell apoptosis.

Objective To summarize and analyze the clinical characteristic of blue rubber bleb nevus syndrome (BRBNS).Methods The clinical data of four cases treated since 2001 and 30 BRBNS cases reported by domestic literature were retrospectively analyzed.The clinical manifestation,family history,endoscopy and imageology examination,site of lesions,treatment and follow up were analyzed.Results The male to female ratio was 1.8∶1 and median age was 19.5 years.A total of 33 cases (97.1％) presented with gastrointestinal bleeding,median age of gastrointestinal bleeding detected was 9.0 years.Among the 33 cases,anemiawas found as the primary symptom in nine cases (27.3％),and one case complicated with intussusception and intestinal necrosis accompanied with abdominal pain.Two cases have family history.Gastroscopy (85.3 ％) and colonoscopy(73.5 ％) were mainly examinations for detection.Lesions mainly involved skin (100.0％) and digestive tract (97.1％),and the locations of the lesion in digestive tract was stomach (64.7％),small intestine (64.7％),colon (58.8％),esophagus (29.4％).Treatment methods included symptomatic treatment,endoscopic therapy and surgery.Banding ligation and polypectomy resection were common endoscopic therapies.Gastrointestinal bleeding did not recur in six cases with endoscopic therapy and four cases receiving surgery during short-term follow up.Conclusions BRBNS lesions mainly involve skin and digestive tract,mostly complicated with gastrointestinal bleeding.For gastrointestinal bleeding,so far endoscopic therapy and surgery are the effective therapies.

ObjectiveTo investigate the role of 15-F2t-isoprostane in intestinal injury induced by intestinal ischemia/reperfusion (I/R) in rats.MethodsThirty-two pathogen free adult male SD rats weighing 230-255 g were randomly divided into 4 groups ( n =8 each):group sham operation (group S) ; group intestinal I/R; group SQ-29548 (TXA2 receptor antagonist) (group SQ) and group DMSO (the solvent).Intestinal I/R was induced by 60 min occlusion of superior mesenteric artery (SMA) followed by 120 main reperfusion in groups I/R,SQ and DMSO SQ-29548 2 μmol/kg and DMSO were injected subcutaneusly at abdominal wall at 30 min before SMS in groups SQ and DMSO respectively.Arterial blood samples were taken at 120 min of reperfusion for determination of serum diamine oxidase (DAO) activity and 15-F2t-isoprostane,endothelin-1 (ET-1) and thromboxane B2 (TXB2) concentrations.Intestinal tissues were removed for microscopic examination and determination of myeloperoxidase (MPO) and SOD activities,MDA and lactate contents.Intestinal damage was assessed and scored according to Chiu (0 =normal,5 =disruption of tunica propria,bleeding and ulceration).ResultsIntestinal I/R significantly increased Chiu's score,MDA and lactate contents and MPO activity and decreased SOD activity in intestine in group I/R as compared with group S.SQ-29548 pretreatment significantly decreased Chiu's score,lactate content and MPO activity in intestine and increased intestinal SOD activity and decreased serum DAO activity and ET-1 concentration in group SQ as compared with group I/R.Conclusion15-F2t-isoprostane is involved in the development of intestinal injury induced by intestinal I/R by activating TXA2 receptor,increasing ET-1 production and promoting neutrophil infiltration.

Objective To investigate the effects of intestinal ischemia-reperfusion (I/R) on the brain in rats. Methods Sixty-four healthy male SD rats weighing 250-300 g were randomly allocated to one of 2 groups (n = 32 each): sham operation group (S) and intestinal I/R group (I/R). Intestinal I/R was produced by occlusion of superior mesenteric artery (SMA) for 90 min followed by reperfusion. Eight animals were sacrificed at each of the following time points: 2, 6, 12 and 24 h of reperfusion (T1-4) in each group. After a median sternotomyblood samples were taken from left ventricle for measurement of plasma TNF-α and IL-6 (by ELISA). Intestine and brain tissue was harvested for microscopic examination and detection of apoptosis ( by TUNEL). The cognitive function was tested using Morris water maze at 24 h. Results No abnormality was found in intestine and brain tissue in group S. Intestinal damage and neurodegeneration were detected in group I/R. Intestinal I/R significantly increased cerebral apoptosis in group I/R compared with group S. Plasma TNF-a and IL-6 concentrations were significantly higher at T1-4 in group I/R than in group S. The escape latency and swimming distance were significantly increased, while the number of crossing the platform was decreased in group I/R compared with group S. There was no significant difference in the swimming speed between the 2 groups. Conclusion Intestinal I/R can induce brain injury and lead to cognitive dysfunction. I/R-induced release of inflammatory mediators and neuronal apoptosis are involved in the underlying mechanism.

Objective To investigate the effects of remote limb ischemic preconditioning (RLIP) on the lung injury in patients undergoing abdominal aortic aneurysm repair.Methods Sixty-two ASA Ⅱ or Ⅲ patients of both sexes,aged 54-72 yr,with body mass index 21-36 kg/m2,undergoing elective abdominal aortic aneurysm repair,were randomly divided to 2 groups ( n =31 each):control group (group C) and RLIP group.RLIP consisted of two 5-min cycles of left upper limb ischemia induced by a blood pressure cuff placed on the left upper arm and inflated to 200 mm Hg,with an intervening 5 min of reperfusion,during which time the cuff was deflated.RLIP was performed after anesthesia induction and before the start of surgery.Arterial and venous blood samples were taken at 10 min after intubation (T0),and 30 min and 4,8,12 and 24 h after aortic unclamping (T1-5) for blood gas analysis and determination of the concentrations of serum interleukin (IL)-6,tumor necrosis factor (TNF)-α,and plasma malondialdehyde (MDA) and superoxide dismutase (SOD) activity.The alveolar-arterial oxygen pressure difference (PA-aO2 ) and respiratory index (RI) were calculated.The peak airway pressure (Ppeak),plat airway pressure (Pplat) and positive end expiratory pressure (PEEP) were recorded at the same time points mentioned above to calculate dynamic lung compliance (Cd) and static lung compliance (Cs).The incidence of hypoxemia,extubation time and duration of stay in intensive care unit (IGU) were also recorded.Results Compared with group C,PA-aO2,RI and the concentration of IL-6 were significantly decreased at T3-5,Cs,Cd and SOD activity were significantly increased at T2-5,and the concentrations of TNF-α and MDA were significantly decreased at T2-5 in group RLIP ( P ＜ 0.05).Compared with group C,the incidence of hypoxemia was significantly decreased,and extubation time and duration of stay in ICU were significantly shortened in group RLIP ( P ＜ 0.05).Conclusion RLIP can reduce the lung injury through inhibition of the inflammatory response and lipid peroxidation in patients undergoing abdominal aortic aneurysm repair.

Objective To evaluate and analyse the efficacy and safety of endoscopic papillectomy for tumors of major duodenal papilla.Methods The clinical data of thirty-four patients with tumors of major duodenal papilla who were treated by endoscopic papillectomy were retrospectively reviewed,and the clinical outcome was summarized.Results The success rate of endoscopic papillectomy was 94.12％ (32/34),and the complete resection was 66.67％ (20/30).Short-term complications occurred in 10 cases,including postoperative gastrointestinal bleeding in 7cases and postoperative pancreatitis in 3 cases.Five cases need further surgical intervention for the reason that tumor was too deep in 2 cases,bile duct was invaded in 2 cases and conservational medication was unsuccessful in 1 case.Thirty-three cases were pathologically diagnosed as low grade intraepithelial neoplasia (LGIN),17 cases high grade intraepithelial neoplasia (HGIN),1 case carcinoid and 3 cases adenocarcinoma.The recurrence rate was 23.33 (7/33).tumor recurrence rate of HGIN was higher than that of LGIN(42.86％ VS10％,P =0.078).Conclusion Endoscopic papillectomy is an effective method for treating tumors of major duodenal papilla,however,hemorrhage is the main postoperative complication,the recurrence rate is higher in HGIN group.

Objective To report a Chinese pedigree with benign familial chronic pemphigus (BFCP),and to screen mutations of ATP2C 1 gene in this family.Methods A 39-year-old male patient with BFCP andhis family members underwent a clinical investigation.Blood samples were collected from all the members in this family and from 50 unrelated healthy controls.Genomic DNA was extracted from the blood samples,and PCR was performed to amplify all the 28 exons and flanking sequences of the ATP2C1 gene followed by DNA direct sequencing.The resulted DNA sequences were compared with the reported sequences of APT2C1 gene in Genbank (Number:NM_014382.2 and NC_000003.9).Results There were 24 family members in the four-generation pedigree,with 8 members affected by BFCP.A single-nucleotide substitution,c(1696C→T),in exon 17 of the ATP2C1 gene was identified in all of the members with BFCP,but not in unaffected third-or second-generation members or unrelated healthy controls.This substitution was also found in 1 out of 4 family members of fourth-generation.Conclusions The nonsense mutation c(1696C→T) in the ATP2C1 gene,is likely to be responsible for BFCP in this Chinese four-generation pedigree.The underage family member of fourth-generation who carried the mutation c(1696C→T) but had no clinical symptoms of BFCP,should be closely followed.