Type Ⅳ hiatal hernia with a high risk usually presents sudden or suddenly worsening epigas-tric pain,vomiting,and dysphagia.It is not conducive to early diagnosis and treatment when symptoms are atypi-cal.Type Ⅳ hiatal hernia with severe anemia is rare.This article reports an atypical case of typeⅣhiatal hernia with melena and severe anemia as the main manifestations,aiming to improve clinicians'identification of the atypical clinical presentations of type Ⅳ hiatal hernia.

Objective:To evaluate the effect of selective cerebral mild hypothermia on the expression of histone deacetylase 1-3 (HDAC1-3) during focal cerebral ischemia-reperfusion (I/R) in rats.Methods:Sixty clean-grade healthy male Sprague-Dawley rats, aged 6-8 weeks, weighing 240-260 g, were divided into 4 groups ( n=15 each) using a random number table method: sham operation group (S group), focal cerebral I/R group (I/R group), selective cerebral mild hypothermia group (SCH group), and normothermia group (N group). Only the cervical vessels were isolated in S group. In the other three groups, sutures were inserted into the internal carotid artery to block the middle cerebral artery for 2 h, and then the sutures were pulled out to restore perfusion for 24 h. A focal cerebral I/R model was prepared. Normal saline at 20 ℃ and 37 ℃ was infused into the internal carotid artery at a rate of 0.6 ml/min for 10 min starting from the time point immediately after removal of the sutures in SCH group and N group respectively. Cerebral temperature and rectal temperature were continuously monitored during the operation. The modified neurological severity score (mNSS) was assessed at 24 h of reperfusion. The rats were then sacrificed under deep anesthesia and brains were obtained for determination of cerebral infarct size (by TTC staining). The tissues of the cerebral ischemic penumbra were taken for determination of the apoptosis rate of neurons (by TUNEL method) and lactylation modification and expression of HDAC1-3 (by Western blot) and for observation of the morphology of neurons (by HE staining). Results:Compared with S group, the mNSS, cerebral infarct size and apoptosis rate of neurons were significantly increased, HDAC1-3 expression was down-regulated, and the lactylation modification was increased in the other three groups ( P<0.05). Compared with I/R and N groups, the mNSS, cerebral infarct size and apoptosis rate of neurons were significantly decreased, HDAC1-3 expression was up-regulated, and the lactylation modification was decreased in SCH group ( P<0.05). There was no statistically significant difference in the aforementioned parameters between I/R group and N group ( P>0.05). HE staining showed that the morphology of neurons was intact and well-defined in S group, a large number of cells with edema and irregularly solidified nuclei were found in I/R group and N group, and the nuclear shrinkage and morphological changes of neurons were alleviated in SCH group. Conclusions:The mechanism by which selective cerebral mild hypothermia alleviates cerebral I/R injury may be related to up-regulation of HDAC1-3 expression in rats.

Hepatic sclerosing hemangioma (HSH) is a rare benign tumor that is considered fibrosis and hyaline change caused by degenerative changes of cavernous angioma, and changes in pathological features cause the changes in imaging features, making this atypical hemangioma easily misdiagnosed as primary or metastatic malignant tumor. Although there are many studies on the imaging findings of this disease, it is still difficult to diagnose and most patients underwent resection since it is misdiagnosed as malignant tumor. There is still a low rate of confirmed diagnosis before surgery. This article elaborates on the etiology, clinical manifestations and pathological features, imaging findings, diagnosis, and treatment of HSH, in order to provide a reference for the diagnosis and treatment of this disease.

Protein–protein interactions (PPIs) are of great importance to understand genetic mech-anisms, delineate disease pathogenesis, and guide drug design. With the increase of PPI data and development of machine learning technologies, prediction and identification of PPIs have become a research hotspot in proteomics. In this study, we propose a new prediction pipeline for PPIs based on gradient tree boosting (GTB). First, the initial feature vector is extracted by fusing pseudo amino acid composition (PseAAC), pseudo position-specific scoring matrix (PsePSSM), reduced sequence and index-vectors (RSIV), and autocorrelation descriptor (AD). Second, to remove redundancy and noise, we employ L1-regularized logistic regression (L1-RLR) to select an optimal feature subset. Finally, GTB-PPI model is constructed. Five-fold cross-validation showed that GTB-PPI achieved the accuracies of 95.15％and 90.47％on Saccharomyces cerevisiae and Helicobacter pylori datasets, respectively. In addition, GTB-PPI could be applied to predict the independent test datasets for Caenorhabditis elegans, Escherichia coli, Homo sapiens, and Mus musculus, the one-core PPI net-work for CD9, and the crossover PPI network for the Wnt-related signaling pathways. The results show that GTB-PPI can significantly improve accuracy of PPI prediction. The code and datasets of GTB-PPI can be downloaded from https://github.com/QUST-AIBBDRC/GTB-PPI/.

Objective: To evaluate the effect of multidisciplinary cooperative pain management on the rapid recovery of patients with total hip and total knee arthroplasty. Methods: A total of 120 patients, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 20-64 yr, with body mass index of 18-25 kg/m², were divided into 2 groups using a random number table method: test group (group T, n=66) and control group (group C, n=54). Multidisciplinary cooperative pain management mode was adopted for pain management in the perioperative period in group T, while traditional pain management was used in group C. Numeric rating scale scores were recorded at 4 h and 1, 2, 3 and 7 days after surgery and on discharge from hospital.The postoperative joint recovery time, length of hospital stay and satisfaction were recorded in two groups. Results: Compared with group C, the numeric rating scale scores were significantly decreased at 4 h and 1, 2, 3 and 7 days after surgery and on discharge from hospital, the postoperative joint recovery time and length of hospitalization were shortened, and the degree of satisfaction was increased in group T (P<0.05). Conclusion Multidisciplinary cooperative pain management can effectively promote the rapid recovery of patients with total hip and total knee replacement.

Adenosine 5'-monophosphate-activated protein activated protein kinase (AMPK), a heterotrimeric complex, is an important kinase to regulate glycolipid metabolism and energy balance involved in a variety physiological processes in human body. Many research indicated that the function and activity of AMPK were closely related to inflammation, diabetes and cancers. Recent reports show that inhibition of metformin (a first-line drug) on hepatic glucose in patients with hyperglycemia is associated with AMPK pathway, suggesting that targeting AMPK may be one of the effective strategies for the prevention and treatment of a variety of chronic diseases. Here, we review research progress on the structure, activation and regulation of AMPK in glycolipid metabolism to provide an insight into the basic and clinical research of diabetes therapy.
AMP-Activated Protein Kinases ; Adenosine ; Adenosine Monophosphate ; Energy Metabolism ; Enzyme Activation ; Glycolipids ; Humans

Objective To compare the clinical value of early enteral nutrition and parenteral nutrition therapy in postoperative patients of cholangiocarcinoma.Methods 56 cases of cholangiocarcinoma patients were randomly divided into early enteral nutrition group (EPN group) and parenteral nutrition group (PN group).All patients received nutritional support on the basis of metabolic support.Leukocyte count and neutrophil percentage decrease rate,total bilirubin decrease rate and hepatase (valley-C conversion) were counted at 3 and 7 days after operation.The decrease rate of aminase and glutamic oxaloacetic transaminase,recovery time of intestinal function (anal exhaust and defecation),incidence rate of surgical site infection (abdominal cavity and wound),hospitalization time after operation,incidence rate of bile leakage and hospitalization cost were compared between the two groups.Results The recovery time of intestinal function [(51.2 ±4.4) h],the decrease rate of leukocyte count (0.438 7 ±0.191 5) and neutrophil ratio (0.179 5 ± 0.046 1),the decrease rate of bilirubin (0.502 5 ± 0.153 5),alanine aminotransferase (ALT) (0.688 1 ±0.113 3),aspartate aminotransferase (AST) (0.617 0 ± 0.178 8) and hospitalization expenses [(87 852.37 ±9 127.04)yuan] in EPN group were better than those in PN group [(72.0 ± 12.9)h,0.090 5 ±0.120 3,0.083 4 ±0.036 8,0.201 5 ±0.077 8,0.251 6 ±0.419 0,0.230 9 ± 0.437,(109 036.69 ± 7 949.71) yuan,P ＜ 0.05].However,the incidence of abdominal distension (42.31％) was higher than that of PN group (13.33％,P ＜ 0.05).The incidence of bile leakage (7.69％) was not significantly different from that of PN group (13.33％,P ＞0.05).Conclusions Early enteral nutrition has obvious advantages in postoperative recovery of patients with cholangiocarcinoma.

OBJECTIVETo demonstrate the feasibility of extralevator abdominoperineal excision (ELAPE) for locally advanced low cancer in China.

METHODSA prospective multicenter clinical trial was carried out by 7 general hospitals across China from August 2008 to October 2011. A total of 102 patients underwent ELAPE for primary locally advanced low rectal cancer. There were 60 male and 42 female patients. The patients' characteristics, complications and prognosis were recorded.

RESULTSAll patients underwent the ELAPE procedure successfully. The median operating time was 180 minutes (range 110-495 minutes) and median intraoperative blood loss was 200 ml (range 50-1000 ml). The rates of sexual dysfunction, perineal complications, urinary retention, and chronic perineal pain were 40.5%, 23.5%, 18.6% and 13.7%, respectively. Chronic perineal pain was associated with coccygectomy (12 months postoperatively, t = 8.06, P < 0.01), and the pain might gradually ease over time. Reconstruction of pelvic floor with biologic mesh was associated with lower rate of perineal dehiscence (χ(2) = 13.502, P = 0.006) and overall perineal wound complications (χ(2) = 5.836, P = 0.016) compared with primary closure. A positive circumferential margin (CRM) was demonstrated in 6 (5.9%) patients, and intraoperative perforations occurred in 4 (3.9%) patients. All CRM involvement and intraoperative perforation located at anteriorly and anterolaterally. The local recurrence was 4.9% at a median follow-up of 35 months (range, 18-58 months).

CONCLUSIONSELAPE performed in the prone position for low rectal cancer leads to a reduction in CRM involvement, intraoperative perforations, and local recurrence, but it might result in a little high rate of perineal wound related complications. Reconstruction of pelvic floor with biologic mesh might lower the rate of perineal wound complications.

Adult ; Aged ; Digestive System Surgical Procedures ; methods ; Female ; Humans ; Male ; Middle Aged ; Perineum ; surgery ; Postoperative Complications ; Prognosis ; Prospective Studies ; Rectal Neoplasms ; surgery ; Treatment Outcome

Objective To investigate the development and application of a simple one-time cricothyroid membrane fast trocar.Methods The cricothyroid membrane puncture ventilation device can be divided into two parts.Respectively was the casing column stabber parts,parts of the cutter head was an isosceles triangle,the column part slightly flat column arc,the rear end was provided with a cylindrical handle,it was also casing inner core.The second was casing parts.Corresponding for columnar needle knife,the rear end of the sleeve had a cylindrical breathing tube interface,can be connected with the breathing bag or ventilator breathing.Material thyrocricoid puncture sleeve was ABS engineering plastic,the first trial was made of three D printer technology.After technology finished the plastic injection machine or machine production were used to make it.Using this instrument 6 healthy dogs were in the cricothyroid membrane puncture.Respectively after operation with 2 days,4 days,7 days,drug treatment did not be taken during this period after they were observed after 6-12 months.Results 6 dogs were thyrocricocentesis cannulation success only once,with no infection.For 6-12 months after extubation,the dogs bark and systemic activity were normal,no abnormal shortness of breath,breathing difficulties and complications were taken placed.Conclusion The research and production of this instrument has been successful,through animal experiments illustrate the use of this device is safe and effective.It has the advantages of convenient operation and no complications.

Objective To study the laws of heating and thermal field of heating seed arrays in different magnetic field intensity during the magnetic induction hyperthermia.Methods 3.0 cm×3.0 cm ×2.6 cm and 5.0 cm ×5.0 cm×2.6 cm of magnetic heating seed was implanted respectively in 10.0 cm×10.0 cm ×10.0 cm pure agar phantom.The regions was divided into one file per 5 Gs in the range of 60-120 Gs magnetic induction.The temperature measurement experiments were implemented in each sub-file.Muscle-agar mixture model was used in the magnetic induction 60 Gs and 90 Gs to implement GTV-heating simulation experiments and thermal field analysis.Results The pure agar phantom heating experiments show that the heating is of basically the same rule when seeds with various diameters were implanted in the magnetic thermal array.Along with the increase of magnetic induction,the final temperature of the focal point heated for 40 min increased accordingly.and time required for heating to 50℃ was shortened correspondingly.The thermal field analysis of muscle-a mixture agar mixture model showed that the implantation density of magnetic heating seed is closely associated with the temperature of the target area and thermal field in difierent magnetic field intcnsity.Conclusions The magnetic induction has a significant impact on heating of the seeds,as the magnetic modium,and this impact is trending downwards when the magnetic field reaches a certain intensity.Within a certain size,adequate magnetic heating seed density is necessary to achieve the desired temperature required for the temperature value.The heating seeds should be put in a certain order to heat the venue evenly,not in a simply order,but in line with the principle of outer dense and inner sparse.