Objective　To optimize the oral contrast media in three-dimensional display of gastric lesions. Methods　41 cases were randomly divided into 3 groups according to different oral contrast media administered: No. 1 air contrast group (n=17), No. 2 fat emulsion group (n=7) and No. 3 positive contrast group (n=25). The 3D CT images were reconstructed using MPR, SSD, RaySum display and virtual endoscopic techniques, and compared with gastric endoscopy and/or conventional barium study.Results　The detectability of gastric lesions using fat emulsion and air contrast was 42.8%(3/7) and 80.0%(20/25), respectively, both were significantly lower than that using positive contrast (100%, 30/30) (χ2=19.22,P＜0.01;χ2=6.60, P＜0.05). The capability of showing the details of stomach lesions was significantly affected by the oral contrast media administered（χ2=17.04，P＜0.01）. Conclusion　It is very important to choose the appropriate oral contrast media for 3D display of gastric lesions in spiral CT, the positive contrast agent is the optimal choice.

Objective To raise diagnostic rate of protruded lesion of gastrointestinal mucosa and to judge the precise differentiation to the depth of malignant lesion.Methods 12 cases of gastrointestinal diseases were examined by MPS combined with endoscopic examination.Results To the patients suffering protruded lesion of gastrointestinal mucosa with negative biopsy,the MPS provided a sound basis for diagnosis;To the cases of malignant lesion,findings of MPS with regard to the depth were in total concordance with that of surgical biopsy.Conclusion MPS is significanfly superior to conventional endoscopy with pathological biopsy in the differentation of protruded lesion of gastrointestinal mucosa.But in the case of malignant lesion,only the depth of infiltration of gastrointestinal wall can be correctly assessed by MPS.The value is limited in showing whole Picture for larger focus and in the identification of around lymphnodes and whether or no distal metastases in the near organs.

Objective Measuring the therapeutic effect of the isolated duodenal exclusion for type 2 diabetes mellitus rats by observing the post-surgery change of glycometabolism-related indicators which could be contributed to the isolation between food and the duodenal mucosa with an endoluminal sleeve placing into the duodenum intestine duodennal of type 2 diabetes mellitus Rats.Methods In this experiment,12 male type 2 diabetes mellitus Goto-Kakizaki (GK) rats were randomized to endoluminal exclution as the experimental group and 12 to sham surgery as the control group,The body mass,the average daily food intake and fasting plasma glucose were determined before (0 week) and 1,3,6,12 weeks after operation;For testing the hematoglobinA1c(HbA1c) level,blood samples were collected before and 6,12 weeks after operation.Results No statistical significant differences between two groups before operation index.In both groups,The body mass and average daily food intake decreased markedly at 1 week after surgery:the experimental group body mass preoperative(262.6 ± 5.6 g)vs postoperative(224.0 ± 6.3 g) ;the average daily food intake preoperative(25.5 ± 2.7 g) vs postoperative (16.5 ± 3.0 g),P ＜ 0.05.Changes in the experimental group with control group,P ＜0.05.The 3 week,6 week,12 week body weight was gradually increased in rats of two groups.The experimental group daily feed intake is always lower than the preoperative postoperative,P ＜ 0.05.In the 3 weeks,the control group's body weight and daily food intake were higher than those before operation,P ＜ 0.05.The experimental group post-FPG level (7.5 ± 1.1) mmol/L,(7.2 ± 1.2) mmol/L,(7.3 ± 0.9) mmol/L,(7.1 ± 1.0) mmol/L vs preoperation (12.2 ± 1.2) mmol/L were decreased significantly,P ＜ 0.05.Compared to the preoperation,the HbA1c concentration of the experimental group decreased significantly,6 w (7.8 ± 0.9) ％,12 w(8.2 ± 1.2) ％ vs the preoperation (10.3 ± 1.4) ％,P ＜0.05.These indicators of the control group showed no significant changes,P ＞ 0.05.Conclusion The isolated duodenal exclusion can achieve the therapeutic effect for type 2 diabetes mellitus on GK rats,and which might be attributed to the improvement of the glycometabolism.

Purpose To detect the expression of NKX2. 2 protein in gastrointestinal, pancreatic and esophageal neuroendocrine tumors and the correlation between the expression of NKX2. 2 and the clinicopathologic parameters. Methods 41 cases of gastrointestinal, pancreatic and esophageal neuroendocrine tumors were collected. The expression of NKX2. 2, Syn and CgA in neuroendocrine tumor samples were checked by using immunohistochemical staining. Results The positive expression of NKX2. 2 protein was localized in the nucleus. NKX2. 2 protein showed positive staining in neuroendocrine tumors of the seven original sites. In the four cases of normal pancreatic islet cells also showed strongly diffuse positive nuclear staining. The positive rates of NKX2. 2, Syn and CgA protein in the small intestine, rectum, pancreatic neuroendocrine tumors were 100%, 100% and 46. 7%, respectively. The positive rates of NKX2. 2 in foregut, midgut and hindgut were 30% and 87% (χ2 = 11. 09, P=0. 001). Positive NKX2. 2 protein expression was not associated with gender, age group, grade, tumor size and lymph node metastasis. Conclusion NKX2. 2, as a new type of neuroendo-crine markers, is obviously superior to CgA in the diagnosis of neuroendocrine tumors in the small bowel, rectum and pancreas. NKX2. 2, Syn and CgA, a panel approach may be beneficial to enhance diagnostic accuracy of the neuroendocrine tumors.

Objective Primitive neuroectodermal tumor (PNET) is a rare malignant small round cell tumor .This paper aimed to study the clinical and pathological features of primary pulmonary primitive neuroectodermal tumor . Methods We collected 2 cases of primary pulmonary PNET to review the clinical and pathological features .Immunohistochemical staining was used to detect immune mark-ers, and fluorescence in situ hybridization (FISH) was applied to detect EWS translocation. Results 2 patients were aged 33 years and 17 years.Microscopically, the tumor cell was composed of single small round cells in diffusion or in distribution of sheets or beams , with scant cytoplasm , oval or spindle-shaped nucleus , high mitotic count .Irregular tumor necrosis scattered in the tumor along with visi-ble rosette structure.Immunohistochemical study showed that the tumor cells were positive for CD 99, FLI-1 and Syn, while CKpan, EMA, Desmin, CgA, TTF1, CD34 were negative.EWS/FLI1 translocations were detected positive in both the cases .2 patients died 7 months and 32 months after operation , respectively . Conclusion Primary pulmonary PNET is rare , so the selection of appropriate im-mune markers (CD99, FLI-1, Syn) and FISH for the detection of EWS translocation helps to improve the accuracy of diagnosis .

Objective To retrospectively analyzed the current application of warfarin in hospitalized patients with non-valvular atrial fibrillationand ( NVAF), explore the key role of clinical pharmacists in warfarin medication. Methods A retrospective survey of anticoagulant therapy for 179 hospitalized patients with non-valvular atrial fibrillation in Renming Hospotal of Wuhan University from January to December 2013 was retrived,including the usage of warfarin for NVAF and new-onset atrial fibrillation,dosage,international normalized ratio(INR),hemorrhage event and so on.The simple factor like the age,complicated chronic diseases and previous cerebrovascular events on the use of warfarin was explored. Results The total response rate to anticoagulants was 85.6% for patients with high risk of stroke(27.3% with warfarin and 58.3% with antiplatelet therapy),who are recommended to use warfarin,patient were treated with anti-thrombotic therapy.The total of 19.1% of the patients with new-onset atrial fibrillation used warfarin as therapy.The whole monitoring rate of INR was 89.8%,and the good control rate was 11.9%. Univariate analysis showed that some high risk factors such as age and high blood pressure affected the usage of warfarin. Conclusion The anti-thrombotic therapy for NVAF patients in the hospital is good,but usage of warfarin for those with new-onset atrial fibrillation is low,which couldn't reach the INR standard. More attention should be taken by the clinic pharmacists in effective managing the use of anticoagulant to build a safe,economic and effective medication system for warfarin application.

Objective To investigate the influence of previous abdominopelvic surgery on gynecological laparoscopic operation.Methods A retrospective analysis of 3 283 cases of gynecological diseases by laparoscopic operation patients in Peking University First Hospital from 2007 January to 2012 December,among them,719(21.90％) patients with previous abdominopelvic surgery history (study Group),2 564 (78.10％) patients have no history of abdominopelvic surgery (control group).Study group 719 patients,previous operation times:one time in 525 cases,194 cases were multiple; previous operation:185 cases of gynecological surgery,305 cases of obstetric surgery,108 cases of general surgery,and 121 complex surgery (include at least two kinds of surgery) ;previous operative approach:650 cases laparotomy and 69 cases laparoscopy.Compared two groups of patients with abdominopelvic adhesion and the gynecologic laparoscopic operation situation,analyzed the influence of previous abdominopelvic surgery on abdominopelvic adhesionon and gynecological laparoscopic operation.Results The incidence of abdominopelvic adhesion in the patients with previous abdominopelvic surgery was 51.2％ (368/719),which was significantly higher than that of 8.2％ (211/2 564) in patients without previous abdominopelvic surgery (P＜0.01).But the study group score (median 3) and the degree of abdominopelvic adhesion [mild 49.7％ (183/368),moderate 36.1％ (133/368),severe 14.1％ (52/368)] compared with the control group score (median 2) and degree [mild 55.0％(116/211),moderate 25.6％(54/211),and severe 19.4％(41/211)] were no statistical difference (P=0.930,P=0.684).Super-umbilical primary trocar site were chosen more common in patients with previous abdominopelvic surgery (23.1％,166/719) was significantly higher than that in the control group (3.3％,85/2 564; P＜0.01).And the rate of conversion to laparotomy was 0.6％ (4/719)significantly more than the control groups(0.l％,2/2 564; P=0.023).Compared with other groups,patients with gynecological or complex surgery or multiple operation history presented more severe abdominopelvic adhesion both in the score and degree (P＜0.01).The rate of super-umbilical primary trocar site,hospitalization time,operation time and bleeding during operation in patients with multiple operation history were significantly higher than those with single operation history (P＜0.05) ; the rate of blood transfusion,postoperative complication and conversion to laparotomy showed no statistical difference between the two groups (P＞0.05).Conclusion The laparoscopic operation could be carried out successfully and safely in patients with a history of various abdominopelvic operations,but the conversion rate increases,for patients with a history of multiple operation because of pelvic adhesion increases the difficulty of the laparoscopic operatio

BACKGROUND:Transplantation of mesenchymal stem cells (MSCs) to multiple sclerosis (MS) is a new developed treatment to be given more and more attention.However,whether the MSCs function by cell replacement after going cross the blood-brain barricr or immune suppression needs further confirmation.OBJECTIVE:To establish a steady and effective method of Y chromosome in situ hybridization (ISH) and to detect the distribution of MSCs in a mouse model with MS.DESIGN,TIME AND SETTING:The observational study was performed at the Laboratory of Molecular Immunology,Institute of Healthy Science from September 2007 to February 2009.MATERIALS:A total of 30 C57BL/6 mice,aged 6-8 weeks and weighing 15-20 g,were selected.Female mice were used to establish experimental autoimmune encephalomyelitis (EAE).METHODS:Y chromosme specific DNA probe labled with digoxine (DIG) was designed and ISH was performed to confirm that the designed probe was Y chromosome specific and biologically sensitive.We transplanted the MSCs from male mice into the female EAE mice,and tracked the MSCs by Y chromosome ISH.MAIN OUTCOME MEASRUES:Distribution of MSCs in mice with EAE was observed under the optical and fluorescence microscope.RESULTS:The probe was confirmed to be Y chromosome specific and biologically sensitive.What's more,a steady and effective method of ISH was established.Some MSCs were detected in the periphery organs-spleen and lymph node of mice with EAE;seldom in spinal cord which indicated that MSCs might play its roles by immune suppression.CONCLUSION:Some MSCs were detected in the periphery organs-spleen and lymph node of mice with EAE,but seldom in spinal cord in the central nervous system.

Objective To study the skills of laparoscopy for hight difficulty eholecystectomy.Method Forty-eight cases of hight difficulty laparoscopic cholecystectomy from July 2005 to July 2007 were analyzed retrospectively. Result In 48 cases, 5 cases were converted to open surgery, 2 cases suffered in-cision infection, all the patients recovered. Conclusion According to the operating status and experience of the performer, Calot triangle dissection and judge good opportunity to change open surgery are the key faetora to the successful operation for difficult and complex laparoscopie cholecystectomy, which is safe and feasible.

Adult ; Altitude ; Case-Control Studies ; Humans ; Immunoglobulins ; blood ; Occupational Exposure ; T-Lymphocyte Subsets ; immunology