Objective To investigate the significance and possible mechanism of food intolerance in diarrhea-predominant irritable bowel syndrome (IBS-D).Methods Twenty-seven IBS-D patients matched the Rome Ⅲ criteria were selected as IBS-D group.Twenty-seven healthy individuals without gastrointestinal symptoms were assigned to control group.Food intolerance situation of two groups were analyzed with food intolerance status evaluation questionnaire,and detection of 14 food specific IgG antibody.The severity of IBS symptoms of IBS-D group were scored by IBS-symptom severity scale (SSS).Two pieces of mucosal tissues of both ileocecal junction and sigmoid colon were obtained under colonoscopy.The content of mucosal substance P (SP) was determined by immunohistochemistry.The quantity of mast cells were detected by Giemsa staining.Chi square test and Fisher exact probability method were performed for rate comparison between two groups.Measurement data were compared with t test and Mann-Whitney rank sum test.The correlation between IBS-SSS score and mast cells and the expression of SP positive cells were analyzed by Spearman rank correlation analysis.Results There was no statistically significant difference in positive rates of food specific IgG between two groups (x2 =3.085,P=0.389),however according to food intolerance status evaluation questionnaire,the incidence of food intolerance of IBS-D group was 44.4 ％ (12/27) which was higher than that of control group (14.8 ％,4/ 27),the difference was statistically (x2 =5.684,P=0.017).Food intolerance severity index of IBS-D group (median:0(0,60)) was higher than that of control group (median:0(0,0)),and the difference was statistically significant (U=239.50,P =0.007).In foods that may cause intolerance,the percentage of foods rich in fermentable oligosaccharides and monosaccharides,disaccharides and polyol (FODMAP) such as milk,noodles,soybeans was up to 71.4％ (30/42).The expression tates of SP positive cells in the mucosa of ileocecal junction and sigmoid colon of patients with IBS-D were higher than those of the control group (x2-20.735 and 22.071,both P＜0.01).The numbers of mast cell in the mucosa of ileocecal junction and sigmoid colonic of patients with IBS D (2.40 ± 1.04/high power field (HPF) and 2.35±1.11/HPF) were more than those of the control group (0.97 ± 0.70/HPF and 0.89 ± 0.72/HPF),and the difference was statistically significant (t=-5.850 and-5.629,both P＜0.01).The severity of bowel symptom of patients with IBS-D was moderately correlated with the number of mast cells in the mucosa of sigmoid colon (r=0.576,P=0.002),and was moderately correlated with the expression of SP positive cells (r=0.691,P＜0.01).Conclusions There may be relation ship among low-grade inflammation of intestinal mucosa,food intolerance and severity of intestinal symptoms in patients with IBS-D.

Objective To investigate the skills and effects of TriVex system and to discuss its indications and complications in the treatment of varicose vein in lower limbs.Methods The TriVex system operation was underwent in 106 lower limbs with varicose vein.Sixteen of them showed thrombophlebitis while 38 of them showed chronic ulcer and pigmentation.The lower limbs with perforating vein were treated with subfascial endoscopic perforator vein surgery(SEPS) and limbs with deep insufficient vein valve underwent endoscopic valve repair.Results The therapeutic effect of TriVex system was satisfactory and none of them had soft tissue infection.Hematoma occurred in 12 lower limbs(11.2%).Pigmentation and skin petechia disappeared in 3 weeks after operation.Chronic ulcer healed and ankle pigment reduced in 38 limbs.Hematoma,petechia and numbness were the common complications in the patients with varicose vein in lower limbs.Conclusion It was effective,cosmetic and micro invasive to use the TriVex system in the treatment of thrombophlebitis and varicose vein with chronic ulcer.Adept operation skill can minimize the postoperative complications but the long-term effects of this new technique still needed follow-up studies.

Traditional teaching mode of biochemistry experiment couldn’t satisfy the demand of cultivating creative medical talents in new era. Offering designing experiment is the developing direction of experiment teaching reforms. But in the practice,there are various of obstacles which prevent the reforming process.

Objective To analyze the clinical observation and incidences of complications of therapeutic post-endoscopic retrograde cholangiopancreatography (ERCP).Methods The clinical information of 1 482 cases of therapeutic ERCP was analyzed retrospectively.Results Among them,468 cases had nasal biliary drainage,532 cases had pancreatic or bile duct stent after endoscopic procedure and the other 482 case hadn't.For the drainage group, there were 396 cases of biliary stone,36 cases of simple dilatation of common bile duct,8 cases of biliary cyst,6 cases of strictured papilla,18 cases of inflammatory stricture of common bile duct,2 cases of sclerosing cholangitis and 2 cases of autoimmune pancreatitis.For the pancreatic or bile duct stent group,there were 483 cases of malignant bili-ary obstruction,13 cases of biliary stone,28 cases of pancreatic duct stone,3 cases of sclerosing cholangitis and 5 cases of inflammatory stricture of common bile duct.And there were 385 cases of biliary stone,36 cases of simple dilatation of common bile duct,38 cases of inflammatory stricture of common bile duct,11 cases of strictured papilla, 9 cases of pancreatic duct stone and 3 cases of biliary cyst for un -drainage group.The incidences of acute pancreati-tis and acute cholangitis (4.4%,2.6%)were higher in un -drainage group than the nasal biliary drainage group (1.5%,0.6%,P <0.05)or the stent group(1.7%,0.8%,P <0.05).The incidences of duodenum or biliary tract perforation and upper gastrointestinal hemorrhage(0.2%,1.2%)were not significantly different compared with the nasal biliary drainage group(0.2%,0.6%,P >0.05)and the stent group(0.4%,0.8%,P >0.05).The incidences of 4 kinds of complications were not significantly different between the nasal biliary drainage group and the stent group.Conclusion Endoscopic nasal biliary drainage or stent can prevent and treat some of therapeutic ERCP com-plications effectively.

Objective To observe the effect of prevention and treatment of gastrointestinal failure and coagu-lation function in severe acute pancreatitis(SAP)with single Rhubarb.Methods 68 caese with SAP were randomly divided into control group(n =34)and treatment group(n =34)by random number table.Both two groups were given routine western medicine,but in the treatment group the patients were additionally administered with single Rhubarb orally or nasal feeding.The time of first defecation,abdominal pain disappeared,bloating disappeared,upper abdomi-nal tenderness disappeared,serum amylase recovery,correction degree of coagulation function and average hospitaliza-tion days of the two groups were compared.Results The time of first defecation in the treatment group was (46.0 ± 18.0)h,which was (73.0 ±23.0)h in the control group,there was significant difference between the two groups(t =2.43,P <0.05).The time of abdominal pain disappeared[(4.3 ±1.2)d],bloating disappeared[(5.2 ±1.6)d], upper abdominal tenderness disappeared[(5.0 ±1.7)d],serum amylase recovery[(6.2 ±1.3)d]of the treatment group were significantly shorter than those of the control group[(5.6 ±1.7)d,(6.7 ±2.3)d,(6.4 ±2.1)d,(8.9 ± 1.6)d](t =2.36,2.17,2.60,2.48,all P <0.05).The average hospitalization days of the treatment group[(24.5 ± 12.3)d]was significantly shorter than the control group[(30.6 ±12.9)d](t =2.65,P <0.05).5 days after treat-ment,in the treatment group,the partially activated thromboplastin time(APTT)[(30.39 ±4.98)s]and prothrombin time(PT)[(12.65 ±1.32)s]were significantly shorter than the control group[(37.25 ±6.27)s,(14.87 ±1.68)s] (t =2.54,2.43,all P <0.05).The platelet count(PLT)and the fibrinogen(FIB)in treatment group were (186.30 ± 59.82)×109 /L and (3.89 ±1.17)g/L repectively,those in control group were (131.80 ±48.57)×109 /L and (5.29 ±1.33)g/L repectively,the differences were statistically significant between the two groups(t =2.16,2.83,all P <0.05).Conclusion The routine western medicine and additionally administered with single Rhubarb can effec-tively prevent and treat gastrointestinal failure,significantly improve coagulation function in SAP.

BACKGROUND:The mechanism of differentiation and proliferation of bone marrow-derived mesenchymal stem cells remains unclear. In addition, issues such as how signal pathways such as Ca2+and bone marrow-derived mesenchymal stem cellproliferation and differentiation signals form complex signal network remain poorly understood.
OBJECTIVE:To investigate the effect of Ca2+in the induced differentiation of bone marrow-derived mesenchymal stem cells into hepatocytes.
METHODS:Bone marrow-derived mesenchymal stem cells were isolated from rat bone marrow using whone bone marrow adherence method, purified, amplified, and induced with hepatocyte growth factor. [Ca2+]i in the directional differentiated bone marrow-derived mesenchymal stem cells and control bone marrow-derived mesenchymal stem cells were detected with flow cytometry. Bone marrow-derived mesenchymal stem cells induced with hepatocyte growth factor were mixed with nimodipine of different concentration, and cells were divided into three groups:hepatocyte growth factor+nimodipine 10 mg/L, 50 or 100 mg/L groups. cellgrowth was observed with inverted phase contrast microscope and alpha 1-antitrypsin expression of the cells was confirmed by immunocytochemistry. The calcineurin M and the activation of extracellular signal regulated kinase pathway was detected by reverse transcription-PCR and western blotting, respectively.
RESULTS AND CONCLUSION:[Ca2+]i in the directional differentiated bone marrow-derived mesenchymal stem cells was higher than in the control group (P<0.05). After addition of a larger dose of nimodipine, no differentiation of cells was obeserved and growth of bone marrow-derived mesenchymal stem cells was getting worse. There were few alpha 1-antitrypsin positive cells in the nimodipine groups. Calcineurin Mexpression was significantly increased in directional differentiated bone marrow-derived mesenchymal stem cells and smal dose of nimodipine than the controls (P<0.05). However, no significant difference was found among middle, high dose nimodipine and control groups (P>0.05). These findings indicate that Ca2+could participate in the differentiation of bone marrow-derived mesenchymal stem cells into hepatocytes incuded with cytokines, and also maintain the survival and proliferation of bone marrow-derived mesenchymal stem cells.

Objective To analyze the clinical features and prognosis of hyperlipidemic acute sancreatitis (HLAP) .Methods A retrospective study was conducted in a cohort of 72 hyperlipidemic acute pancreatitis patients admitted in hospital from June 2007 to June 2012 .83 patients with acute biliary pancreatitis (ABP) diagnosed were served as control group .The clinical data of both groups were compared between the two groups .The correlation between serum triglyceride(TG) levels and disease severity of HLAP was assessed .Results The age and serum amylase levels of the HLAP group were remarkably lower than those of the ABP group (both P<0 .05) .Patients with HLAP had a significantly increased prevalence of fatty liver and type 2 diabetes compared with those with ABP(P<0 .05) ,but no difference of incident hypertension was found (P>0 .05) .The Ranson score ,APACHE-Ⅱ score ,and Bal-thazar CT score were comparable between the two groups (all P>0 .05) .The recurrence risk of HLAP group was strikingly higher than that of ABP group(P<0 .05) ,whereas the surgical operation and mortality rates were not significantly different between the two groups(P>0 .05) .The serum TG levels of HLAP showed no significant correlation with Ronson score ,APACHE-Ⅱ score and Balthazar CT score values(all P>0 .05) .Conclusion HLAP mainly occurs in young to middle-aged people .The serum amylase val-ues of HLAP increased mildly .Patients with HLAP are often accompanied by fatty liver and type 2 diabetes ,and subjected to grea-ter complications and recurrence risk .The severity of HLAP doesn′t correlate with the serum TG levels .

Objective To investigate the clinical characteristics of alcoholic severe acute pancreatitis (SAP). Methods Clinical data of 166 cases of SAP in Fujian Provincial Hospital from January 2001 to December 2008 were collected and analyzed retrospectively. Cases were divided into alcoholic SAP group (43cases) and control group ( 123 cases) depending on deoholic intake volue whithin 12～48 hours. Age, gender,CT scores, APACHE Ⅱ score, serum glucose, serum triglyceride (TG), serum calcium, serum albumin,morbidity, later infection rate and mortality rate of the two groups were compared. Results There was no significant difference in terms of age, but the proportion of male in alcoholic SAP group (39/43) was higher than that in control group (58/123, P<0.01 ). CT score, serum glucose and calcium were not significantly different between the two groups. The APACHEⅡ score and serum TG in alcoholic SAP group [19.16±5.38,(5.06±4.03)mmol/L] were significantly higher than those in control group [16.02±5.09, (3.12±2.95)mmol/L]. The albumenjolevel in alcoholic SAP group (25.23±7.12)g/L) was lower than that in control group [(30.68±8.35 ) g/L, P<0.01]. The incidences of ARDS and upper gastroenterologic bleeding were not significantly different between the two groups. But the incidences of acute kidney failure (44.2%), liver failure (41.9%), heart failure (37.2%), shock (39.5%), infection (27.9%) and mortality (30.2%) in alcoholic SAP were significantly higher than those in control group (26.0%,30.9%, 20.3%, 16.3%,16.3%, 7.3%, P<0.05 or<0.01). Conclusions Males predominates alcoholic SAP patients with high mortality and morbidity. Alcohol abstinence is effective to prevent alcoholic SAP ocurrence.

objective To evaluate the therapeutic efficacy of endovenous radiofrequency ablation in combination with TriVex for the treatment of chronic venous insufficiency (CVI)of the lower extremity.Methods One hundred and fifty CVI cases(150 limbs)were randomly assigned to Group A(75 limbs)and Group B(75 limbs).Patients in Group A were treated with greater saphenous vein radiofrequency ablation procedures in combination with TriVex.Patients in Grpup B were treated with greater saphenous vein traditional stripping operation in combination with TriVex.The short-term results in hospital and patient self-assessment for the operation at postoperative 4 week were compared with each other:The changes of CEAP classification and venous clinical severity score(VCSS)were compared. Results Operation time was(67±11)min in Group A versus(69-4-9)min in Group B(P＞0.05).Postoperative pain,average hospital stay in Group A were significantly less and shorter than in Group B(P ＜0.05).The scores of selfassessment for the operation were(11.21±2.00)in Group A versus(10.52±2.08)in Group B(P＜0.05).The change of CEAP classification and VCSS were statistically significant after operation in both groups(P＜0.01).The VCSS decreased 4.6 ±2.5 in Group A versus 4.3±2.7 in Grpup B(P＞0.05).Conclusions Endovenous radiofrequency ablation in combination with TriVex for treatment of CVI are effective,less traumatic,of fast recovery.CEAP classification and VCSS are useful tools for assessing outcomes after the operation.

OBJECTIVE:To investigate the effects of target-controlled infusion of etomidate combined with remifentanil on in-dexes of immune and stress response in elderly surgery patients. METHODS:Totally 60 patients undergoing elective surgery were randomly divided into control group(n=30)and observation group(n=30). Control group was given Propofol injection 1.5-2 mg/kg intravenously. Observation group was given Remifentanil hydrochloride for injection with pump volume of 0.5 μg/(kg·min), and then target controlled infusion of Etomidate injection 0.1-0.3 mg/kg;the dose of etomidate increased by 0.05-0.1 mg/kg accord-ing to physical activity during surgery. Postoperative eye opening time,recovery time of orientation and extubation time were com-pared between 2 groups as well as the levels of immune indexes(CD4+,CD8+,CD4+/CD8+),stress response indexes [serum norepi-nephrine(NE),adrenaline(E)and cortisol(Cor)]. The occurrence of ADR was recorded during surgery. RESULTS:Postopera-tive eye opening time,recovery time of orientation and extubation time in observation group were significantly shorter than control group,with statistical significance(P<0.05). Before surgery,there was no statistical significance in CD4+,CD8+ and CD4+/CD8+between 2 groups(P>0.05). After surgery,CD4+ and CD8+ of 2 groups were significantly higher than before surgery,and the ob-servation group was significantly higher than the control group,CD4+/CD8+ of 2 groups was significantly lower than before,and the observation group was significantly lower than control group,with statistical significance(P<0.05). Before surgery,there was no statistical significance in the levels of NE,E and Cor between 2 groups(P>0.05);after surgery,the levels of NE,E and Cor in 2 groups were significantly higher than before surgery,but the observation group was significantly lower than the control group, with statistical significance(P<0.05). There were no obvious adverse reaction occurred in 2 groups during the surgery. CONCLU-SIONS:The target-controlled infusion of etomidate combined with remifentanil is ideal for perioperative anaesthesia in the elderly patients and effectively improves related immune indexes and stress response indexes with good safety.