Characteristics of benign and malignant lesions of ampullary polyps and the accuracy of forceps biopsy / 北京大学学报(医学版)

OBJECTIVE@#To distinguish the endoscopic and clinical features of ampullary polyps, to investigate the endoscopic cancer risk factors of ampullary polyps based on the compared differences of benign lesions and adenocarcinoma, and to assess the accuracy of forceps biopsy.@*METHODS@#Authors retrospectively analyzed the data extracted from patients treated with endoscopic papillectomy (EP) from January 2009 to May 2019 in the Department of Gastroenterology, Peking University Third Hospital. Endoscopic pictures and pathology reports were reevaluated and analyzed. Differences between benign and cancer groups were conducted.@*RESULTS@#In the study, 42 cases were involved, 35 to 83 years old, containing 83.3% older than 50 years old patients. The histological types were as follows, 2 for inflammatory polyps (4.8%), 1 for neuroendocrine tumor (2.4%), 1 for hyperplastic polyp (2.4%), 5 for grade Ⅰ adenoma (11.9%), 10 for grade Ⅱ adenoma (23.8%), 4 for grade Ⅲ adenoma (9.5%) and 19 for adenocarcinoma (45.2%), and 90.5% were adenoma or adenocarcinoma. The average age of benign group (inflammatory polyps and adenomas) was (56.7±9.2), which was significantly younger than that of adenocarcinoma group [(66.0±9.8), P=0.004]. Tumor diameter in adenocarcinoma group[(2.3±0.8) cm] was significantly larger than that in benign group[(1.6±0.6) cm, P=0.002]. Benign lesions only showed Yamada type Ⅰ(57.1%)and type Ⅱ(42.9%). The percentage of Yamada type Ⅰ (36.8%)and type Ⅱ(31.6%) in adenocarcinoma group was lower than that in benign group. Moreover, Yamada type Ⅲ (31.5%) was only found in the adenocarcinoma group. Significant differences were observed between the two groups in Yamada types (P=0.046). Most of the benign lesions had clear boundary(18/21, 85.7%). The percentage of clear boundary in adenocarcinoma group (2/19, 10.5%) was significantly lower than that in the benign group (P < 0.001). No significant differences were investigated in color (P=0.353) and surface (P=0.324) between benign and adenocarcinoma lesions. Pooling age, lesion diameter, Yamada type and clear boundary into Logistic regression analysis, only age (OR=1.186, 95%CI 1.025-1.373, P=0.022) and clear boundary (OR=66.218, 95%CI 3.421-1 281.840, P=0.006) were the independent cancer risk factors. Only 2 (10.5%) in the 19 cancer patients had positive biopsy results before EP. As compared with post-EP, 55.3% (21/38) biopsies were under-estimated, including 17 (17/19, 89.5%) adenocarcinomas and 4 (4/10, 40%) grade Ⅱ adenomas.@*CONCLUSION@#adenoma and adenocarcinoma were the major histological type of ampullary po-lyps. Age and unclear boundary were the independent risk factors of ampullary adenocarcinoma. Forceps biopsy was not enough for ampullary polyp differentiation.

Comparison of the minimally invasive treatments of laparoscopic and endosopic for common bile duct stones after gastrojejunostomy / 北京大学学报(医学版)

OBJECTIVE@#To explore the feasibility and to compare the merits and demerits of laparoscopic and endoscopic approach in removing common bile duct stones in patients with gastrojejunostomy after gastrectomy.@*METHODS@#Between January 2012 and December 2016, 25 patients with common bile duct stones after gastrojejunostomy received laparoscopic or endoscopic treatment in our centers. They were divided into laparoscopic group and endoscopic group based on treatment approaches for common bile duct stones, including 15 patients in laparoscopic group and 10 in endoscopic group. The clinical characteristics and outcomes between the two groups were retrospectively analyzed.@*RESULTS@#Among the 25 patients with gastrojejunostomy, the method of reconstruction was Billroth II in 21 patients and Roux-en-Y in 4 patients. Six patients received laparoscopic or endoscopic treatment during the acute cholangitis state. Among the laparoscopic group, 5 patients with stones more than 1 cm, 7 patients with multiple stones, while in the endoscopic group, 3 patients with stones more than 1 cm and 4 patients with multiple stones. Fourteen patients in the laparoscopic group with coexisting gallbladder stones, and 6 of their common bile duct stones were successfully removed by transcystic approach without T tube drainage. Stone removals were successful in 4 patients of the endoscopic group by a single performance, including 3 patients with single small stone and one patient with multiple small stones. Two patients in the laparoscopic group were converted to open surgery for severe adhesion and one patient in the endoscopic group turned to laparoscopic operation for failing of finding papilla in the Roux-en-Y anastomotic status. The median hospital stays were 12 d and 10 d, respectively in the laparoscopic and endoscopic group. There were 3 patients with postoperative complications, including one patient with paralytic ileus in the laparoscopic group and 2 patients with biliary pancreatitis or bacteremia in the endoscopic group, and all of them recovered uneventfully with conservative treatment.@*CONCLUSION@#Both laparoscopic and endoscopic approaches are feasible for removing stones in the common bile duct in patients with gastrojejunostomy after gastrectomy, and they complement each other. In addition, both techniques are difficult to conduct, and a technical competence should be considered in selection of each method.

Comparative treatment analysis of upper gastroenterology submucosal tumors originating from muscularis propria layer: submucosal tunneling endoscopic resection versus endoscopic submucosal excavation / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the efficacy and safety of submucosal tunneling endoscopic resection (STER) and endoscopic submucosal excavation (ESE) for upper gastroenterology submucosal tumors (SMT) originating from the muscularis propria (MP) layer.@*METHODS@#Clinicopathological and endoscopic data of 42 cases with upper gastroenterology tumors originating from the MP layer who were treated with STER (n=28) or ESE (n=14) between April 2013 and December 2016 in Peking University Third Hospital were retrospectively analyzed. The treatment and complications of the two groups were compared.@*RESULTS@#In the study, 42 cases were all resected by therapeutic endoscopy successfully．There was no significant difference (STER vs. ESE) in gender, age, mean tumor size [1.5 (1.0-6.0) cm vs. 1.3 (0.5-2.0) cm, P=0.056]. STER was superior to ESE with reduced sutured time [3.5 (1.0-11.0) min vs. 8.0 (2.0-33.0) min, P=0.006], but more resection time [46.5 (11.0-163.0) min vs.19.5 (6.0-56.0) min, P=0.007]. There was statistical difference between the two groups in resection time or sutured time, but no significant difference (STER vs. ESE) in total operative time [52.0 (14.0-167.0) min vs. 31.5 (10.0-88.0) min, P=0.080]. En bloc resection rates (92.9% vs. 85.7%), hospital stay duration and complications (10.7 vs. 0.0) were similar in the STER and ESE groups. One case developed mediastinal emphysema and 2 pneumonia after operation in STER group, and all of them recovered uneventfully after conservative treatments; There were no complications in the ESE group. After operation, 28 cases of leiomyoma and 14 cases of stromal tumor were diagnosed by routine pathological and immunohistochemical staining. Among them, 6 cases of stromal tumors in group STER were all extremely low risk, 4 cases of stromal tumors in group ESE were extremely low risk, 4 cases of stromal tumors in group ESE were medium risk (the size of the lesion was about 1.0-2.0 cm, and mitotic figures counted (6-8)/50 high power field). The median follow-up time of all the patients was 46.5 (24-60) months, and the shortest follow-up time for medium risk stromal tumors was 32 months. No residual tumor, recurrence and implantation in the tunnel were observed.@*CONCLUSION@#STER or ESE can be used as an effective and safe option for treatment of submucosal tumors originating from the muscularis propria of the upper digestive tract. Compared with STER, ESE had shorter resection time but longer wound closure time. There was no significant difference in total operation time.

Short-Term Clinical Response of DEB-TACE Combined with Apatinib on Patient with Intermediate-advanced Hepatocellular Carcinoma / 中山大学学报(医学科学版)

@#【Objective】To evaluate the safety and effects of transcatheter arterial chemoembolization using Drug-eluted beads（DEB-TACE）plus apatinib in patients with hepatocellular carcinoma（HCC）.【Methods】A retrospective analysis was performed，which included 11 HCC patients treated with DEB- TACE and followed by a target therapy of apatinib（500 mg QD）in our clinical research center. Radiograph evaluation and tumor biomarker，alpha- fetoprotein（AFP）， were recorded before the procedure and during the follow-up of the first cycle after 4~8 weeks. Adverse events induced by apatinib were recorded. 【Results】 According to the response evaluation criteria in solid tumors （RECIST），modified response evaluation criteria in solid tumors （mRECIST） and European Association for the study of the liver （EASL） criteria，the objective response rate （ORR） was 36.4% ，63.6% ，72.7% respectively，and the disease control rate（DCR）was 90.7% ，72.7% ，81.8% respectively. AFP levels were 44 251.7 μg/L which significantly decreased after the procedure ，compared to 366 336 μ g/L ，the levels before the treatment. Four reversible grade III adverse events were recorded and no grade IV adverse events found in these cases. 【Conclusion】According to the short-term treatment response and safety，DEB- TACE combined with apatinib could be considered as a promising treatment for intermediate and advanced stage hepatoma.

Correlation Between Expression Levels of Copper Chaperone for Superoxide Dismutase and Malignancy Related Biomarkers in Hepatocellular Carcinoma / 中山大学学报(医学科学版)

@#【Objective】To explore the correlation between the expression levels of copper chaperone for superoxide dismutase（CCS）and the malignancy related biomarkers in hepatocellular carcinoma（HCC）.【Methods】From January to December 2018，we obtained fresh samples of surgically dissected HCC paired with para-carcinoma normal tissues from 10 HCC patients and collected their clinical and pathological data. Western blotting（WB）was performed to examine the expression of CCS in HCC tissues and adjacent noncancerous tissues. Immunohistochemical staining（IHC）was employed to detect the expression of Ki67，CD34，vimentin and glypican-3（GPC3）. The correlation between the expression levels of CCS and biomarkers was analyzed by using Wilcoxon rank sum test. The association between CCS expression and clinical pathological characteristics of HCC patients was investigated by using Fisher′s exact probability test.【Results】In 7 of the 10 HCC cases，the expression level of CCS in HCC tissue samples was lower than that in adjacent noncancerous tissues，and in other 3 HCC cases，CCS expression higher. In the group with low CCS expression，compared with those in the group with high CCS expression，the expression levels of Ki67，vimentin and GPC3 were higher （Z=- 2.400，P=0.016；Z=- 2.423，P=0.015；Z=- 2.400，P=0.016），while the expression level of CD34 lower（Z=- 2.423，P=0.015）. There was no statistically significant difference in clinical and pathological variables including gender ，age ，hepatitis B virus infection，liver cirrhosis，preoperative serum AFP level，tumor size，Edmondson-Steiner grade and microvascular invasion between two groups with high and low CCS expression.【Conclusions】The results revealed that in most of HCC patients，the expression level of CCS in HCC tissues was lower than that in adjacent noncancerous tissues. Additionally ， higher expression levels of Ki67，vimentin and GPC3 in HCC tissues with low CCS expression indicated that low expression level of CCS correlated with malignant biological behaviors such as HCC proliferation ，invasion and metastasis. The mechanism that the expression level of CD34 appeared lower in HCC tissues with low CCS expression，however，needs further study. These findings suggest that compared with that in normal liver tissues，CCS expression is decreased in a majority of the cases，and it may serve as a promising therapeutic and prognostic biomarker for HCC.

Preliminary Research on Doxorubicin Loaded Hydrophobic Linear Alkyl Modified Graphene Oxide in Transcatheter Arterial Chemoembolization / 中山大学学报(医学科学版)

@#【Objective】 To investigate the safety and benefit of doxorubicin loaded hydrophobic linear alkyl modified graphene oxide （DOX@GO- C18） served as vectors in transcatheter arterial chemoembolization （TACE）. 【Methods】 Doxorubicin loaded hydrophobic linear alkyl modified graphene oxide was manufactured and characterized. VX2 liver carcinoma was established in rabbits and the hepatic lesions were treated with TACE using DOX@GO- C18 which was dissolved in lipiodol. Pre- and post- CT scans were performed to evaluate the treatment response. Liver function was assessed via blood samples drawn on day 0（preoperative），1，3，7，and day 14. The animals were sacrificed on day 14 and tissue samples collected to stain for pathology（hematoxylin-eosin staining），lipiodol（oil red O staining）and DOX（fluorescent）.【Results】The dispersion of DOX@GO-C18 in lipiodol was highly stable. Pre-and post-CT scan revealed that the diameter of the VX2 lesions barely varied and enhancements were decreased after the treatment. Target lesions gained stable disease（SD）as the treatment response based on Response Evaluation Criteria in Solid Tumors 1.1（RECIST 1.1）. Histological examination revealed that DOX@GO-C18 was located within the tumor tissue along with the lipiodol. The release of DOX may contribute to the necrosis in tumor.【Conclusions】DOX@GO-C18［CC2］may proved to be a safe and effective vectors in TACE treatment for liver carcinoma.

Establishment of a quantitative real-time PCR for rapid detection of Panax quinquefolius / 中国中药杂志

In this study, the specific primers and probes of Panax quinquefolius were designed for a quantitative real-time PCR, and the rapid identification method of P. quinquefolius was established by optimizing conditions. The method was used to validate 43 samples of the traditional Chinese medicine,and the results showed that 22 samples of P. quinquefolius were identified accurately. The limit of detection of the method can be reach to 1×10⁻⁴ ng. The method is accurate, fast, sensitive and specifically.

Research status on finite element analysis of bone drilling / 上海交通大学学报（医学版）

In recent years,the virtual surgery training system with force feedback has provided a new way for young doctors to improve their surgical skills in a safe,efficient and flexible training method.Precise drilling force and realistic hand feeling of manipulation are the cruxes in the virtual surgery training,and the accurate simulation of bone drilling depends on the accurate establishment of drilling force prediction model.The establishment of force prediction model with finite element analysis is the key part in the development of virtual training system.In this paper,the current research status of finite element analysis of bone drilling presented in four aspects:bone model reconstruction,material model,mesh model and prediction of drilling force,especially the construction of bone tissue material model is discussed in detail and several important models are analyzed.This paper presented a relatively complete overview of the approaches commonly used in this research field to promote the establishment of more accurate force prediction models of bone drilling.

Phosphorylcholine Oligomer-Grafted Graphene Oxide for the Transcatheter Arterial Chemoembolization of Liver Cancer / 中山大学学报(医学科学版)

[Objective]To investigate the safety and efficacy of phosphorylcholine oligomer grafted graphene oxide as a drug carrier for transcatheter arterial chemoembolization in the treatment of liver cancer.[Methods]Doxorubicin loaded folic acid labeled phosphorylcholine oligomer grafted graphene oxide(DOX@GO-PCn-FA)was prepared. Graphene ox-ide(GO)and DOX@GO-PCn-FA were injected intravenously via marginal ear vein in New Zealand white rabbits respec-tively to assess their safety and biodistribution for intravenous administration.Ten male New Zealand rabbits were used to establishe the VX2 liver cancer model and the tumor characteristics were confirmed by dynamic contrast enhanced CT scan.Catheter was inserted via femoral artery and advanced into hepatic lobar or segmental artery.Digital subtraction angi-ography(DSA)was performed to validate the tumor feeding vessels.DOX@GO-PCn-FA was injected through the cathe-ter to carry out selective transcatheter arterial chemoembolization(TACE). Dynamic enhanced CT scan and pathological examinations of major tissues and organs were implemented 7 days post TACE to evaluate the efficacy of embolization effect of DOX@GO-PCn-FA against liver tumor as well as the biodistribution and safety.[Results]Intravenous injection of GO resulted in significant thrombosis and pulmonary embolism whereas DOX@GO-PCn-FA of same dosage did not. DOX@GO-PCn-FA was capable of effectively diminishing the blood supply of liver tumors when applied in TACE. Pathologic exploration revealed that DOX@ GO-PCn-FA mainly deposited in the tumor,and no obvious complications were observed.[Conclusions]GO-PCn presented superior biocompatibility and exerted effective chemoembolization against liver cancer.

Effect of Calcium-sensing Receptor on the Apoptosis of Rat Spinal Cord Neurons in Anoxia/Reoxygenation Injury and Its Significance / 中国医学科学院学报

Objective To investigate the effect and significance of calcium-sensing receptor (CaSR) on the apoptosis of rat spinal cord neurons in anoxia/reoxygenation(A/R) injury. Methods The spinal cells were in ischemia and hypoxia environment for 1 h and in normal environment for 24 h to establish a model of A/R. After spinal A/R model was established,the spinal cells were divided into four groups randomly:the control group,A/R group,A/R+GdCl3 group,and A/R+NPS-2390 group. The expression of CaSR in each group was detected by immunofluorescence and Western blotting. The concentration of intracellular calcium was measured by laser confocal scanning microscopy. The expressions of Caspase-3,Bax,and Bcl-2 were detected by using Western blotting. The apoptotic rate of spinal cells was detected by Tunel assay. Results Compared to the control group, there was a significant increase in the level of CaSR (t=5.462, P=0.006), the concentration of intracellular calcium (t=8.573, P=0.001), the apoptotic rate (t=4.899, P=0.008), Caspase-3 (t=5.118, P=0.007), and Bax (t=10.930,P=0.001) in A/R group. Compared to the A/R group, there was a significant increase in the level of CaSR (t=4.975, P=0.008),the concentration of intracellular calcium (t=4.899, P=0.008), the apoptotic rate (t=7.746, P=0.002), Caspase-3 (t=4.776, P=0.009), and Bax (t=5.281, P=0.006) in A/R+GdCl3 group. Compared to the A/R group, there was a significant decrease in the level of CaSR (t=3.674,P=0.021), the concentration of intracellular calcium (t=3.846, P=0.018), the apoptotic rate (t=4.281,P=0.013), Caspase-3 (t=3.521, P=0.024), and Bax(t=3.473, P=0.026) in A/R+NPS-2390 group. However, compared to the control group, there was a significant decrease in the level of Bcl-2 (t=6.242,P=0.003) in A/R group. Compared to the A/R group, there was a significant decrease in the level of Bcl-2(t=3.028, P=0.004) in A/R+GdCl3 group. Compared to the A/R group, there was a significant increase in the level of Bcl-2 (t=2.840, P=0.047) in A/R+NPS-2390 group.Conclusion During the process of A/R injury in rat spinal cord neurons,the expression of calcium sensing receptor increases,along with increase in intracellular calcium and spinal neuron apoptosis.

Effect of Basic Fibroblast Growth Factor and Transforming Growth Factor-Β1 Combined with Bone Marrow Mesenchymal Stem Cells on the Repair of Degenerated Intervertebral Discs in Rat Models / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the effects of the combination of basic fibroblast growth factor (bFGF), transforming growth factor-Β1 (TGF-Β1), bone marrow mesenchymal stem cells (BMSCs), and temperature-responsive chitosan hydrogel (TCH) gel on the repair of degenerative intervertebral disc in rat models.</p><p><b>METHODS</b>Rat models of intervertebral disc degeneration were established by acupuncture. The degenerative effects were observed under magnetic resonance imaging (MRI). The BMSCs was cultured in vitro and then transfected by adenovirus with enhanced green fluorescent protein to make it carry the gene of enhanced green fluorescent protein,which functioned as fluorescence labeling. The SD rat models of intervertebral disc degeneration were divided into four groups: group A, treated with the combination of bFGF, TGF-Β1,BMSCs,and TCH gel; group B, treated with the combination of BMSCs and TCH gel;group C, treated with the combination of bFGF,TGF-Β1, and TCH gel;and group D, treated with PBS buffer solution. After the corresponding reagents were injected into the degenerative intervertebral discs of each group, the rats were cultivated for another four weeks and then the repair effects of the intervertebral discs were observed under MRI. Furthermore,the intervertebral discs of each group were taken out and observed by HE and Masson staining. The nucleus pulposus was aspirated and the expressions of aggrecan,collagen 2,Sox-9,and collagen I of nucleus pulposus of each group were tested by reverse transcription polymerase chain reaction and Western blot.</p><p><b>RESULTS</b>The transplanted BMSCs survived in the intervertebral disc and differentiated into nucleus pulposus-like cells. MRI showed that:the signal intensity of the nucleus pulposus of group A was much higher than that of the rest groups, the signal intensity of group B was higher than that of group C, and the signal intensity of group D was the lowest,in which the dura mater spinalis was in compression and the spinal cord changed in beaded shape. The differences of the Pfirrmann grading among the four groups had statistical significance (P<0.05). The results of the HE and Masson stains showed:the intervertebral disc of group A was well-structured,the quantity of nucleus pulposus cells was larger than that of the other three groups,and the boundary between the nucleus pulposus and the annulus fibrosus was clearly defined;the quantity of the nucleus pulposus cells of group B was larger than that of group C, and the broken annulus fibrosus was not observed in group B, while the broken annulus fibrosus could be observed in group C; and, the nucleus pulposus cells of group D were replaced by fibrous tissue. The results of the reverse transcription polymerase chain reaction and Western blot tests showed that,in terms of the expressions of aggrecan,collagen 2 and Sox-9,group A was the highest, followed by group B,group C,and group D (P<0.05); in terms of the expression of collagen 1,there was no obvious difference among these four groups (P>0.05).</p><p><b>CONCLUSIONS</b>The transplanted BMSCs can survive in the degenerative intervertebral disc and differentiate into nucleus pulposus-like cells. The combination of bFGF, TGF-Β1, BMSCs,and TCH gel has obvious repair effect on the degenerative intervertebral discs. The effect of the combination of BMSCs and TCH gel on transplantation therapy of the degenerative intervertebral discs is better than that of the combination of bFGF, TGF-Β1 and TCH gel but worse than that of the combination of bFGF, TGF-Β1, BMSCs, and TCH gel.</p>

Role of bone marrow mesenchymal stem cells in restoring the functions of degenerative nucleus pulposus cells / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the effects of bone mesenchymal stem cells (BMSCs) in restoring the functions of degenerative nucleus pulposus cells (dNPCs).</p><p><b>METHODS</b>The animal models of degenerative nucleus pulposus were established by means of acupuncture and aspiration. The BMSCs as well as the normal and degeneratived nucleus pulposus cells of SD rats were isolated and cultured. The BMSCs/alginate gel complex and dNPCs/alginate gel complex were used for indirect co-culture in vitro, which was set as experiment group. The NPCs and dNPCs cultured alone as positive and negative controls. The cell growth conditions were observed by light microscopy, and suitable cells were selected to combine alginate gel stents and cultured in transwell plate. Seven days later, nucleus pulposus cells of each group were recycled, and the mRNA expressions of Collagen2, SOX 9, and Aggrecan were detected by RT-PCR, and the Collagen1, 2, and Aggrecan were detected by Western blotting and immunofluorescence.</p><p><b>RESULTS</b>After non-contact co-culture for 7 days, the mRNA levels of Collagen2, SOX 9, and Aggrecan increased apparently in BMSCs+dNPCs group, while it was significantly lower in dNPCs sample (all P<0.05). The content of Collagen2 and Aggrecan detected by Western blotting in BMSCs+dNPCs group got close to NPCs sample, but it was significantly higher than dNPCs samples (all P<0.05), while the content of Collagen1in BMSCs+dNPCs group got close to NPCs samples, but it was significantly lower than dNPCs sample (P<0.05). Immunofluorescence results showed that cytoplasm was dyed red and the color near the caryon became dark in BMSCs+dNPCs group and dNPCs group;however, the colored scope of cytoplasm and the dark colored scope surrounding the caryon in BMSCs+dNPCs group was obviously larger than dNPCs group.</p><p><b>CONCLUSION</b>Under a 3D non-contact co-culture system, BMSCs can promote the expression of epimatrix of the dNPCs, which shows that BMSCs can restore the functions of dNPCs of intervertebral disc to certain extent.</p>

Design and clinical application of new type two-head automatic pressure external fixation (TAPEF) / 中国骨伤

<p><b>OBJECTIVE</b>To design a new type two-head automatic pressure external fixator and explore its clinical effects in treating intertrochanteric fracture of the femur.</p><p><b>METHODS</b>Base on unilateral angulated external fixator and Ilizarov techiques, a new type two-head automatic pressure external fixator were designed and made. From October 2006 to December 2010, 120 patients with intertrochanteric fracture of the femur were treated with the new type two-head automatic pressure external fixator. There were 67 males and 53 females with an average age of 76.7 years (ranged, 60 to 93 years). According to Evans classification, type I was in 65 cases, type II in 41, type III a in 10, type III b in 2 and type IV in 2. Operative time was from 0 to 11 days after injury with an average 5 days. Postoperative functional recovery was evaluated according to criteria of Sanders.</p><p><b>RESULTS</b>Among 120 patients, 116 cases were followed up with an average of 12 months (ranged, 2 to 24 months). All fractures obtained healing with average healing time of 12 weeks (ranged, 10 to 13 weeks). Five cases occurred with superficial infection of pin site and no deep infection,non-union, coxa adducta were found. Joint function of hip recovered well. According to Sanders scoring, pain, walking, function, muscle strength, daily activities and X-ray estimate were respectively (9.07 +/- 0.41), (9.23 +/- 1.00), (9.42 +/- 1.10), (9.31 +/- 1.06), (9.22 +/- 1.03), (10.00 +/- 0.00) with total amount of (56.27 +/- 4.16). A hundred and six cases got an excellent results, 6 good, 4 poor.</p><p><b>CONCLUSION</b>The new type two-head automatic pressure external fixator is easy and convenient to apply in operation. It has duplicate functions of load and minimal invasive. It is an ideal method for treatment of the intertrochanteric fracture of the femur in high-risk and senile patients.</p>

A clinical study on multi-disciplinary team and surgery for resectable colorectal cancer with liver metastases / 中华外科杂志

<p><b>OBJECTIVES</b>To analyze the survival outcomes of the surgery for colorectal cancer with liver metastases (CRCLM), and study the mode of multi-disciplinary team (MDT) for CRCLM.</p><p><b>METHODS</b>The retrospective analysis was conducted for 38 patients with CRCLM received MDT management and surgical treatment from January 2009 to August 2011. The peri-operative and survival outcomes of MDT and surgery were evaluated.</p><p><b>RESULTS</b>All the cases met the present criteria of resetability for CRCLM, but only 4 cases (10.5%) met the previous one. Coloproctectomy and hepatectomy were performed in all cases, with 39 colorectal neoplasms and 155 liver lesions removed. One case died of postoperative septic shock. Colorectal and hepatic specific complications were absent in the others patients except one case of biliary leak which was treated with conservative management. Neoadjuvant chemotherapy was arranged in 13 cases. Adjuvant chemotherapy was administered for every patient. After a mean follow-up of (22 ± 10) months according to the finding time of liver metastases, recurrence and metastases were observed in 16 cases and 6 cases died of late-stage cachexia. The 1-, 2- and 3-overall survival rate were 94.4%, 85.3% and 75.8% respectively, and the 1-, 2- and 3-disease-free survival rate were 70.1%, 54.2% and 54.2% respectively.</p><p><b>CONCLUSIONS</b>MDT mode for resectable CRCLM is recommendable. Surgical resection of CRCLM is feasible and safe, which seems to achieve favourable short-middle oncologic outcomes. And long-term survival is expected.</p>

Application of digital subtraction angiography and interventional treatment in gastrointestinal arterial hemorrhage / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical value of digital subtraction angiography (DSA) and interventional treatment in gastrointestinal arterial hemorrhage.</p><p><b>METHODS</b>DSA data and experiences of interventional treatment of 78 cases with gastrointestinal arterial hemorrhage were retrospectively analyzed.</p><p><b>RESULTS</b>The positive rate of DSA diagnosis was 74%(58/78). Contrast media overflow direct sign was found in 33%(26/78) patients. Contrast media overflow direct sign of postoperative anastomotic stoma was found in 83%(15/18) patients. Hemorrhage causes of 15 cases were duodenal ulcer, 5 stomach ulcer, 2 gastric cancer, 1 Dieulafoy disease, 9 vascular malformation and dysplasia, 8 in anastomotic stoma bleeding after gastrointestinal operation, 10 hepatic artery blow out and bleeding after operation of liver disease, 5 Crohn disease, 6 intestinal tract diverticulum hemorrhage, 6 enteritis or ulcer and 3 polyp of small intestine, 1 midrange malignant small intestinal interstitial tumor, 2 well differentiated small intestine leiomyosarcoma, 5 colon and rectal cancer. Fifteen cases received arterial drug infusion and 36 received arterial embolization. Twenty-seven cases underwent operation after DSA and interventional treatment, whose coincidence with pathology was 78%(21/27). Technical success rate of arterial embolization was 86%(31/36) and clinical success rate was 72%(26/36). Technical success rate of arterial drug perfusion was 60%(9/15) and clinical success rate was 40%(6/15). Rebleeding rate was 16%(8/51) after intervention treatment. During follow-up for 2-36 months, 1 rebleeding patient received gastroscope treatment after embolization, but failed and died later. There were no severe complications,such as ischemic necrosis,in all the cases.</p><p><b>CONCLUSION</b>DSA is very important for the location and qualitation of gastrointestinal arterial hemorrhage. Transarterial drug infusion and embolization are safe and effective, and available to selective operation and complication handling.</p>

Recent changes in the prevalence of Helicobacter pylori infection among children and adults in high- or low-incidence regions of gastric cancer in China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The prevalence of Helicobacter pylori (H. pylori) infection varies by geographic locations. Studies indicate that the infection rate of H. pylori was previously high in China but that rates had been declining worldwide over recent decades.</p><p><b>THE AIMS OF OUR STUDY WERE</b>(1) to determine the current prevalence of H. pylori infection among children and adults residing in areas with high (Muping County, Shandong) and low (Yanqing County, Beijing) incidences of gastric cancer in China, and (2) to compare the prevalence for 2006 with the prevalence for the early 1990s.</p><p><b>METHODS</b>Using Warthin-Starry silver staining of gastric mucosal biopsy specimens and H. pylori stool antigen tests (HpSA), we tested a total of 2065 asymptomatic children aged 8 - 15 years and adults aged 40 - 79 years in the above two regions from May to July 2006. We evaluated 520 children and 526 adults from Muping, and 516 children and 503 adults from Yanqing. Subjects were selected randomly and H. pylori status was determined by HpSA in children and either HpSA or histology of gastric biopsies in adults. Data obtained in the early 1990s in the same two areas of China were also collected and studied.</p><p><b>RESULTS</b>For children, the prevalence of H. pylori infection was significantly higher in Muping (37.69%) than it was in Yanqing (25.58%, P < 0.001). In both regions, the prevalence of H. pylori increased with age but was not related to gender. A significant difference was observed between 8 - 9-years old and 10 - 11-years old (P < 0.05), but not between other adjoining age groups (P > 0.05). From 1991 to 2006 H. pylori prevalence among 8 - 10-year-old children decreased in Muping (60.00% vs 32.07%, P < 0.001), but not Yanqing (24.06% vs 19.10%, P > 0.05). In the adult group, H. pylori prevalence was 50.95% in Muping, which was significantly higher than the 41.35% positive rate in Yanqing (P < 0.01). But there were no statistically significant differences between different age groups of 40 - 49, 50 - 59, and 60 - 79 years, or between males and females. A significant decrease in H. pylori prevalence in both regions was observed when the results of 2006 were compared with the data obtained in 1990 in Muping (50.95% vs 73.78%, P < 0.001) and in 1992 in Yanqing (41.35% vs 55.35%, P < 0.01).</p><p><b>CONCLUSIONS</b>After fifteen years, the prevalence of H. pylori infection among both children and adults remained significantly higher in areas with a high incidence of gastric cancer in China compared with that in areas with a low incidence of gastric cancer. H. pylori infection rates have decreased in the general Chinese population during recent years.</p>

Hepatic perfusion changes after interventional disconnection evaluated by CT perfusion imaging / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the changes in hepatic perfusion after interventional obliteration in patients with cirrhosis and portal hypertension by means of spiral CT perfusion imaging.</p><p><b>METHODS</b>Twenty-three patients who suffered from cirrhosis and portal hypertension were selected to undergo interventional disconnection. Partial spleen embolization (PSE) was performed in 15 patients and PSE combined with percutaneous transhepatic obliteration (PTO) was carried out in 8 patients. Hepatic perfusion was carried out pre- and post-operation. The density-time curve was obtained from the interest region of liver, abdominal artery, portal vein. The parameters of perfusion were calculated by the means of deconvolution simultaneously.</p><p><b>RESULTS</b>The portal vein perfusion (PVP) decreased in patients with PSE, but total hepatic blood perfusion was not statistically different from that of pre-operation. After treatment, the hepatic artery perfusion increased obviously. PVP decreased from 0.862 to 0.722 ml x min(-1) x ml(-1) but was not statistically different from that of pre-operation. Hepatic arterial perfusion and total hepatic blood perfusion increased from 0.128, 0.990 ml x min(-1)x ml(-1) pre-operatively to 0.290, 1.021 ml x min(-1) x ml(-1) postoperatively in patients with PSE combined with PTO.</p><p><b>CONCLUSIONS</b>Spiral CT perfusion could objectively reflect the hemodynamic change in hepatic parenchyma after the interventional vascular obliteration.</p>

The veracity and reproducibility of hepatic CT perfusion imaging:an animal experiment and clinical study / 中华放射学杂志

0.9). Conclusions CT perfusion imaging could quantify the hepatic blood flow.The accuracy is similar to electromagnetic flowmeter,and it could effectively reflect physiological or pathological hemodynamies of liver.CT perfusion is noninvasive,high reproducible and convenient,which could be widely used in clinical practice.

Hemodynamic changes in liver measured by multi-imaging methods before and after transjugular intrahepatic portosystemic stent-shunt / 中华放射学杂志

Objective To evaluate hemodynamic changes in liver treated by transjugular intrahepatic portosystemic stent-shunt(TIPSS)with hepatic computed tomography(CT)perfusion,Doppler ultrasound and portal vein pressure measurement,as well as the correlation among these methods.Methods Hepatic CT perfusion was performed in 9 cirrhotic patients one week before TIPSS and 72 hours after TIPSS. Intraoperative portal vein pressure was measured before and after portosystemic shunt establish.The follow- up hepatic CT perfusion were carried out in 3 cases at 3 months and 6 months postoperatively.The hemodynamic surveillance by Doppler ultrasound were performed in 48 hours and 3 months after TIPSS for 9 cases,and in 6 months after TIPSS for 6 cases.Two cases underwent venography and portal vein pressure measurement in 6 months after TIPSS treatment.Results The mean of portal vein perfusion(PVP),total hepatic blood flow(THBF),hepatic perfusion index(HPI)and portal vein free pressure(PVFP)before TIPSSwere(0.92?0.18)ml?min~(-1)?ml~(-1),(1.28?0.17)ml?min~(-1)?ml~(-1),(28?8)%,and (23.92?0.86)mmHg,respectively.In 72 hours after TIPSS,the mean of PVP,THBF,HPI and PVFP were(0.21?0.15)ml?min~(-1)?ml~(-1),(0.74?0.18)ml?min~(-1)?ml~(-1),(74 +13)%,and (12.62?1.54)mm Hg,respectively.After treatment,the mean of PVP was(0.49?0.05)ml?min~(-1)? ml~(-1)at 3 months and(0.57?0.03)ml?min~(-1)?ml~(-1)at 6 months,respectively.There was negative correlation between PVP and PVFP before TIPSS(r=0.678,P0.05).Moreover,a signifieant correlation was found between the degree of portal vein pressure decrease and portal vein perfusion decrease(r=0.867,P