Balthazar computed tomography severity index is superior to Ranson criteria and APACHE Ⅱ scoring system in predicting acute pancreatitis outcome

AIM： Acute pancreatitis （AP） is a process with variable involvement of regional tissues or organ systems. Multifactorial scales included the Ranson, Acute Physiology and Chronic Health Evaluation （APACHE Ⅱ） systems and Balthazar computed tomography severity index （CTSI）. The purpose of this review study was to assess the accuracy of CTSI, Ranson score, and APACHE II score in course and outcome prediction of AP. METHODS： We reviewed 121 patients who underwent helical CT within 48 h after onset of symptoms of a first episode of AP between 1999 and 2003. Fourteen inappropriate subjects were excluded; we reviewed the 107 contrastenhanced CT images to calculate the CTSI. We also reviewed their Ranson and APACHE Ⅱ score. In addition, complications, duration of hospitalization, mortality rate, and other pathology history also were our comparison parameters. RESULTS： We classified 85 patients （79%） as having mild AP （CTSI 〈5） and 22 patients （21%） as having severe AP （CTSI ≥5）. In mild group, the mean APACHE II score and Ranson score was 8.6±1.9 and 2.4±1.2, and those of severe group was 10.2±2.1 and 3.1±0.8, respectively. The most common complication was pseudocyst and abscess and it presented in 21 （20%） patients and their CTSI was 5.9±1.4. A CTSI ≥5 significantly correlated with death, complication present, and prolonged length of stay. Patients with a CTSI ≥5 were 15 times to die than those CTSI 〈5, and the prolonged length of stay and complications present were 17 times and 8 times than that in CTSI 〈5, respectively. CONCLUSION： CTSI is a useful tool in assessing the severity and outcome of AP and the CTSI ≥5 is an index in our study. Although Ranson score and APACHE II score also are choices to be the predictors for complications, mortality and the length of stay of AP, the sensitivity of them are lower than CTSI.

Parallel Image Processing Technology of Surface Detection System

To improve image processing speed and detection precision of a surface detection system on a strip surface,based on the analysis of the characteristics of image data and image processing in detection system on the strip surface,the design of parallel image processing system and the methods of algorithm implementation have been studied. By using field programmable gate array(FPGA) as hardware platform of implementation and considering the characteristic of detection system on the strip surface,a parallel image processing system implemented by using multi IP kernel is designed. According to different computing tasks and the load balancing capability of parallel processing system,the system could set different calculating numbers of nodes to meet the system's demand and save the hardware cost.

Risk factors of acute cholecystitis after endoscopic common bile duct stone removal

AIM： To evaluate the risk factors of acute cholecystitis after endoscopic common bile duct （CBD） stone removal. METHODS： A total 100 of patients who underwent endoscopic CBD stone removal with gallbladder （GB） in situ without subsequent cholecystectomy from January 2000 to July 2004 were evaluated retrospectively. The following factors were considered while evaluating risk factors for the development of acute cholecystitis： age, gender, serum bUirubin level, GB wall thickening, cystic duct patency, presence of a GB stone, CBD diameter, residual stone, lithotripsy, juxtapapillary diverticulum, presence of liver cirrhosis or diabetes mellitus, a presenting illness of cholangitis or pancreatitis, and procedure-related complications. RESULTS： During a mean 18-mo follow-up, 28 （28%） patients developed biliary symptoms; 17 （17%） acute cholecystitis and 13 （13%） CBD stone recurrence. Of patients with acute cholecystitis, 15 （88.2%） received laparoscopic cholecystectomy and 2 （11.8%） open cholecystectomy. All recurrent CBD stones were successfully removed endoscopically. The mean time elapse to acute cholecystitis was 10.2 mo （1-37 mo） and that to recurrent CBD stone was 18.4 mo. Of the 17 patients who received cholecystectomy, 2 （11.8%） developed recurrent CBD stones after cholecystectomy. By multivariate analysis, a serum total bUirubin level of 〈1.3 mg/dL and a CBD diameter of 〈11 mm at the time of stone removal were found to predict the development of acute cholecystitis. CONCLUSION： After CBD stone removal, there is no need for routine prophylactic cholecystectomy. However, patients without a dilated bile duct （〈11 mm） and jaundice （〈1.3 mg/dL） at the time of CBD stone removal have a higher risk of acute cholecystitis and are possible candidates for prophylactic cholecystectomy.

Tissue microarray for high-throughput analysis of gene expression profiles in hepatocellular carcinoma

AIM: To study the expression profiles of HBsAg, HBcAg,p21WAF1/CIP1 (p21), Rb genes in hepatocellular carcinoma (HCC) and to investigate their roles in the hepatocarcinogenesis.METHODS: HCC tissue microarray containing 120-min tissues of 40 HCC cases was constructed. HBsAg, HBc Ag,p21 and Rb proteins were immunohistochemically stained by streptavidin-peroxidase conjugated method (S-P). The expression loss of these genes in cancerous, paracancerous tissues and adjacent normal liver tissues of 40HCCs were comparatively examined.RESULTS: The positive rate of HBsAg expression in cancerous tissues of 40 HCCs was 7.5%, which was lower than that in para-cancerous and adjacent normal liver tissues (x2 =12.774, P＜0.01; x2= 18.442, P＜0.01). The positive rate of HBcAg expression in cancerous tissues of 40 HCCs was 20.0%, which was also lower than that in para-cancerous and adjacent normal liver tissues(x2= 9.482, P＜0.01; x2= 14.645, P＜0.01). p21 protein deletion rate in cancerous tissues of 40 HCCs was 27.5%,which was higher than that in para-cancerous and adjacent normal liver tissues (x2 = 7.439, P＜0.01; x2 = 11.174,P＜0.01). p21 protein deletion correlated remarkably with the pathological grade of HCC (x2 = 0.072, P＜0.05). Rb protein deletion rate in cancerous tissues of 40 HCCs was42.5%, which was also higher than that in para-cancerous and adjacent normal liver tissues (x2 = 10.551, P＜0.01;x2= 18.353, P＜0.01). Rb protein deletion rate did not correlate remarkably with tumor size or pathological grade of HCC (x2 = 0.014, P＞0.05; x2 = 0.017, P＞0.05).CONCLUSION: Expression deletion of HBsAg, HBcAg, p21and Rb proteins in HCCs may play important roles in the carcinogenesis of HCC. Tissue microarray is an effective high-throughput technique platform for cancer research.

Metastatic tumors to the stomach: Clinical and endoscopicfeatures

AIM: To evaluate the clinical and endoscopic patterns in a large series of patients with metastatic tumors in the stomach. METHODS: A total of 64 patients with gastric meta- stases from solid malignant tumors were retros- pectively examined between 1990 and 2005. The clinicopathological findings were reviewed along with tumor characteristics such as endoscopic pattern, location, size and origin of the primary sites. RESULTS: Common indications for endoscopy were anemia, bleeding and epigastric pain. Metastases presented as solitary (62.5%) or multiple (37.5%) tumors were mainly located in the middle or upper third of stomach. The main primary metastatic tumors were from breast and lung cancer and malignant melanoma. CONCLUSION: As the prognosis of cancer patients has been improving gradually, gastrointestinal (GI) metastases will be encountered more often. Endoscopic examinations should be conducted carefully in patients with malignancies, and endoscopic biopsies and information on the patient’s clinical history are useful for correct diagnosis of gastric metastases.

Laser ultrasonic technique for surface defects detection of 6061 aluminum alloy

In order to estimate and detect the surface defect depth of metals, the transmission method of laser ultrasonic surface waves is used in this work. The laser ultrasonic detection platform taking use of thermoelastic mechanism as acoustic signal excitation method and interference receiver as acoustic signal receiver method was built, by which B-scan images of detected specimens with surface defects were collected to establish the relationship between the transmission coefficient and depth of the surface defect. Experimental results show that the amplitude of transmitted acoustic signal is related to the depth of surface defect. At last, a fitted curve of transmission coefficient using measured experimental data is obtained to estimate depth of surface defect on the 6061 aluminum alloy. Furthermore, a surface defect depth of 0.3 mm is estimated by the fitting curve with an estimated error of 16%. Therefore, a experimental method using the transmission method by laser ultrasonic is presented in this paper.

B Cell Epitopes within VP1 of Type O Foot-and-mouth Disease Virus for Detection of Viral Antibodies

In this study, the coding region of type O FMDV capsid protein VP1 and a series of codon optimized DNA sequences coding for VP1 amino acid residues 141-160 （epitopel）, tandem repeat 200-213 （epitope2 （＋2）） and the combination of two epitopes （epitopel-2） was genetically cloned into the prokaryotic expression vector PPRoExHTb and pGEX4T-1, respectively. VP1 and the fused epitopes GST-E1, GST-E2 （＋2） and GST-E1-2 were successfully solubly expressed in the cytoplasm of Escherichia coli and Western blot analysis demonstrated they retained antigenicity. Indirect VP1-ELISA and epitope ELISAs were subsequently developed to screen a panel of 80 field pig sera using LPB-ELISA as a standard test. For VP1-ELISA and all the epitope ELISAs, there were clear distinctions between the FMDV-positive and the FMDV-negative samples. Cross-reactions with pig sera positive to the viruses of swine vesicular disease virus that produce clinically indistinguishable syndromes in pigs or guinea pig antisera to FMDV strains of type A, C and Asia1 did not occur. The relative sensitivity and specificity for the GST-E1 ELISA, GST-E2 （＋2）, GST-E1-2 ELISA and VP1-ELISA in comparison with LPB-ELISA were 93.3% and 85.0%, 95.0% and 90%, 100% and 81.8%, 96.6% and 80.9% respectively. This study shows the potential use of the aforementioned epitopes as alternatives to the complex antigens used in current detection for antibody to FMDV structural proteins.

A case of bowel schitosomiasis not adhering to endoscopic findings

Schistosomiasis is a chronic worm infection caused by a species of trematodes, the Schistosomes. We may distinguish a urinary form from Schistosomes haematobium and an intestinal-hepatosplenic form mainly from Schistosomes mansonicharacterized by nausea, meteorism, abdominal pain, bloody diarrhea,rectal tenesmus, and hepatosplenomegaly. These infections represent a major health issue in Africa,Asia, and South America, but recently S mansoni has increased its prevalence in other countries, such as Europe countries and USA, due to international travelers and immigrants, with several diagnostic and prevention problems. We report a case of a 24-yearold patient without HIV infection, originated from Ghana, admitted for an afebrile dysenteric syndrome.All microbiologic studies were negative and colonoscopy revealed macroscopic lesions suggestive of a bowel inflammatory chronic disease. Since symptoms became worse, a therapy with mesalazine (2 g/d) was started,depending on the results of a bowel biopsy, but without any resolution. The therapy was stopped after 2 wk when the following result was available: a diagnosis of"intestinal schistosomiasis" was done (two Schistosoma eggs were detected in the colonic mucosa) and this was confirmed by the detection of Schistosoma eggs in the feces. Therapy was therefore changed to praziquantel(40 mg/kg, single dose), a specific anti-parasitic agent,with complete recovery. Schistosomiasis shows some peculiar difficulties in terms of differential diagnosis from the bowel inflammatory chronic disease, as the two disorders may show similar colonoscopic patterns.Since this infection has recently increased its prevalence worldwide, it was considered in the differential diagnosis of our patient with gastrointestinal symptoms.

An rpoB gene-based PCR-DGGE method for simultaneous detection of multiple Vibrio species

Using PCR-denaturing gradient gel electrophoresis （DGGE） targeting the RNA polymerase beta subunit （rpoB） gene, a simultaneous detection method for Vibrio species was established, rpoB gene-based PCR-DGGE was carried out with eight Vibrio reference strains （each from different species）, mixed sample （including these Vibrio reference strains）, two non Vibrio strains, four environmental Vibrio strains, and three unidentified environmental strains. For comparison, 16S rRNA gene-based PCR-DGGE of the eight Vibrio reference strains was performed with universal primers. In addition, three unidentified strains were identified by 16S rRNA and gyrB gene sequencing and API20E system in order to confirm the accuracy of rpoB gene-based PCR-DGGE detection. Results revealed that rpoB-based PCR-DGGE could well discriminate eight Vibrio reference strains and could not discriminate different strains within the same species. The bands derived from two non Vibrio strains could not match with any bands in reference marker. Meanwhile, 16S rRNA gene-based DGGE failed to distinguish these reference strains. Further-more, four out of eight Vibrio species exhibited heterogenous bands in 16S rRNA gene-based DGGE. Sequencing and API 20E identification of unidentified strains coincided with the detection by rpoB gene-based PCR-DGGE. The results demonstrated that rpoB-based PCR-DGGE provided a rapid and efficient method for simultaneous detection of muhiple Vibrio species, which can avoid the limitations inherent in 16S rRNA gene-based PCR-DGGE.

How to improve patient satisfaction during midazolam sedation for gastrointestinal endoscopy?

To determine the procedure-related factors that affect sedation satisfaction and to make a suggestion to improve it.METHODSWe prospectively enrolled a total of 456 patients who underwent outpatient endoscopy procedures with midazolam sedation between March 2014 and August 2014. All patients completed both pre- and post-endoscopy questionnaires about sedation expectations and satisfaction.RESULTSThe study cohort included 167 (36.6%) patients who underwent esophagogastroduodenoscopy (EGD), 167 (36.6%) who underwent colonoscopy, and 122 (26.8%) who underwent a combined procedure (EGD and colonoscopy). Over 80% of all patients were satisfied with sedation using midazolam. In univariate and multivariate analyses, total procedure time in the EGD group, younger age (≤ 50 years), and longer colonoscopy withdrawal time in the colonoscopy group were related to decreased satisfaction with sedation. However, in active monitoring and intervention group, there was no decrease in grade of satisfaction despite longer procedure time due to more procedures during colonoscopy. Younger age (≤ 50 years), longer inter-procedure time gap, and colonoscopy withdrawal time were related to decreased satisfaction in the combined EGD and colonoscopy group.CONCLUSIONMidazolam is still a safe and effective sedative for gastrointestinal endoscopy. Satisfaction with sedation depends on several factors including age (≤ 50 years) and procedure time duration. To improve patient satisfaction with sedation, active monitoring of sedation status by the endoscopist should be considered for patients who require long procedure time.

Function of chloride intracellular channel 1 in gastric cancer cells

AIM:To investigate the effect of chloride intracellular channel 1(CLIC1) on the cell proliferation,apoptosis,migration and invasion of gastric cancer cells.METHODS:CLIC1 expression was evaluated in human gastric cancer cell lines SGC-7901 and MGC-803 by real time polymerase chain reaction(RT-PCR).Four segments of small interference RNA(siRNA) targeting CLIC1 mRNA and a no-sense control segment were designed by bioinformatics technology.CLIC1 siRNA was selected using Lipofectamine 2000 and transfected transiently into human gastric cancer SGC-7901 and MGC-803 cells.The transfected efficiency was observed under fluorescence microscope.After transfection,mRNA expression of CLIC1 was detected with RT-PCR and Western blotting was used to detect the protein expression.Proliferation was examined by methyl thiazolyl tetrazolium and apoptosis was detected with flow cytometry.Polycarbonate membrane transwell chamber and Matrigel were used for the detection of the changes of invasion and migration of the two cell lines.RESULTS:In gastric cancer cell lines SGC-7901 and MGC-803,CLIC1 was obviously expressed and CLIC1 siRNA could effectively suppress the expression of CLIC1 protein and mRNA.Proliferation of cells transfected with CLIC1 siRNA3 was enhanced notably,and the highest proliferation rate was 23.3%(P = 0.002) in SGC-7901 and 35.55%(P = 0.001) in MGC-803 cells at 48 h.The G2/M phase proportion increased,while G0/G1 and S phase proportions decreased.The apoptotic rate of the CLIC1 siRNA3 group obviously decreased in both SGC-7901 cells(62.24%,P = 0.000) and MGC-803 cells(52.67%,P = 0.004).Down-regulation of CLIC1 led to the inhibition of invasion and migration by 54.31%(P = 0.000) and 33.62%(P = 0.001) in SGC-7901 and 40.74%(P = 0.000) and 29.26%(P = 0.002) in MGC-803.However,there was no significant difference between the mock group cells and the negative control group cells.

Quantitative Surface Chirality Detection with Sum Frequency Generation Vibrational Spectroscopy： Twin Polarization Angle Approach

Here we report a novel twin polarization angle （TPA） approach in the quantitative chirality detection with the surface sum-frequency generation vibrational spectroscopy （SFG-VS）. Generally, the achiral contribution dominates the surface SFG-VS signal, and the pure chiral signal is usually two or three orders of magnitude smaller. Therefore, it has been difficult to make quantitative detection and analysis of the chiral contributions to the surface SFG- VS signal. In the TPA method, by varying together the polarization angles of the incoming visible light and the sum frequency signal at fixed s or p polarization of the incoming infrared beam, the polarization dependent SFG signal can give not only direct signature of the chiral contribution in the total SFG-VS signal, but also the accurate measurement of the chiral and achiral components in the surface SFG signal. The general description of the TPA method is presented and the experiment test of the TPA approach is also presented for the SFG-VS from the S- and R-limonene chiral liquid surfaces. The most accurate degree of chiral excess values thus obtained for the 2878 cm^-1 spectral peak of the S- and R-limonene liquid surfaces are （23.7±0.4）% and （-25.4±1.3）%, respectively.

A Case Report of One-Point Gastric Cancer

Carcinoma of the stomach is the most common malignant tumor in China. Due to advanced endoscopic techniques and equipment, the detection of early gastric carcinoma （EGC） has increased worldwide. Yet gastric one-point cancer is rarely detected.

Poorly differentiated carcinoma of the rectum with aberrant immunophenotype: A case report

We report a case of a poorly differentiated epithelial tumour of the rectum with a highly pleomorphic morphology and an aberrant immunophenotype, including the expression of epithelial markers, the focal parameter of neuroendocrine differentiation, and the unexpected detection of CD-117 overexpression. A 69-year-old man was admitted to our clinic complaining of rectal bleeding and weight loss. Colonoscopy showed an ulcerative bleeding mass located about 8 cm from the anal verge. Abdominal and pelvis CT scans demonstrated a large low-density lesion with extracanalicular growth from the middle rectum, with local lymph-node spread, and without tumour infiltration of other pelvic organs, or evidence of distant intra-abdominal spread. The patient underwent a low anterior resection for rectal cancer together with wide resection of lymph nodes. In immunohistochemical analysis, pankeratin and Epithelial Membrane Antigen (EMA) immunolabeling proved the epithelial nature of the tumor cells. Chromogranin A and Leukocyte Common Antigen (LCA) were negative, whereas CD-56 expression was scanty and Neuron Specific Enolase (NSA) was heavily and diffusely expressed. Ki67 immunoexpression was particularly increased. Interestingly, the intense c-kit immunoreactivity (100%) was a common feature. The above phenotypic and immunohistochemical profile was consistent with an anaplastic carcinoma of the large intestine, with focal neuroendocrine differentiation and diffuse immunoreactivity to c-kit protein. Given the resistance of this tumor to conventional chemotherapy and radiation, the incidence of the c-kit alteration may represent a novel approach to a gene-directed treatment using a c-kit inhibitor (STI571) similar to that which has been proposed in GISTs.

Physical statistical algorithm for precipitable water vapor inversion on land surface based on multi-source remotely sensed data

Water vapor plays a crucial role in atmospheric processes that act over a wide range of temporal and spatial scales, from global climate to micrometeorology. The determination of water vapor distribution in the atmosphere and its changing pattern is very important. Although atmospheric scientists have developed a variety of means to measure precipitable water vapor(PWV) using remote sensing data that have been widely used, there are some limitations in using one kind satellite measurements for PWV retrieval over land. In this paper, a new algorithm is proposed for retrieving PWV over land by combining different kinds of remote sensing data and it would work well under the cloud weather conditions. The PWV retrieval algorithm based on near infrared data is more suitable to clear sky conditions with high precision. The 23.5 GHz microwave remote sensing data is sensitive to water vapor and powerful in cloud-covered areas because of its longer wavelengths that permit viewing into and through the atmosphere. Therefore, the PWV retrieval results from near infrared data and the indices combined by microwave bands remote sensing data which are sensitive to water vapor will be regressed to generate the equation for PWV retrieval under cloud covered areas. The algorithm developed in this paper has the potential to detect PWV under all weather conditions and makes an excellent complement to PWV retrieved by near infrared data. Different types of surface exert different depolarization effects on surface emissions, which would increase the complexity of the algorithm. In this paper, MODIS surface classification data was used to consider this influence. Compared with the GPS results, the root mean square error of our algorithm is 8 mm for cloud covered area. Regional consistency was found between the results from MODIS and our algorithm. Our algorithm can yield reasonable results on the surfaces covered by cloud where MODIS cannot be used to retrieve PWV.

Coating of microbially produced calcium carbonate onto stone materials

The coatings of microorganism-induced calcium carbonate onto the stone surface carried out by using both of the immersion method and coating method were investigated. Various analysis and testing techniques such as scanning electron micrograph （SEM） and X-ray diffraction （XRD） were used to characterize the deposited mineral layer. The adhesive property, acid re- sistance, frost resistance, light and aging resistance, water adsorption and permeability were investigated in detail. The results showed that both immersion method and coating method could produce calcium carbonate granules with sizes ranging from 1 to 10 pm and form a layer of dense mineralization membrane which is about 50 to 100 pm thick. Immersion method was more efficient than coating method. The large cohesive force between calcium carbonate layer and stone materials could improve the acid rain resistance as well as excellent heat tolerance, frost resistance and light aging resistance. The coating process could not only help the stone materials maintain its original permeability with the aid of calcium carbonate layers but also improve the penetration resistance significantly. Therefore, this type of technology shows a great potential in the protection of stone relics.

Equality detection for linear arithmetic constraints

Satisfiability modulo theories (SMT) play a key role in verification applications. A crucial SMT problem is to combine separate theory solvers for the union of theories. In previous work, the simplex method is used to determine the solvability of constraint systems and the equalities implied by constraint systems are detected by a multitude of applications of the dual simplex method. We present an effective simplex tableau-based method to identify all implicit equalities such that the simplex method is harnessed to an irreducible minimum. Experimental results show that the method is feasible and effective.

Retrieval algorithm for microwave surface emissivities based on multi-source, remote-sensing data: An assessment on the Qinghai-Tibet Plateau

The Qinghai-Tibet Plateau plays a very important role in studying severe weather in China and around the globe because of its unique characteristics. Moreover, the surface emissivities of the Qinghai-Tibet Plateau are also important for retrieving surface and atmospheric parameters. In the current study, a retrieval algorithm was developed to retrieve the surface emissivities of the Qinghai-Tibet Plateau. The developed algorithm was derived from the radiative transfer model and was first validated using simulated data from a one-dimensional microwave simulator. The simulated results show good precision. Then, the surface emissivities of the Qinghai-Tibet Plateau were retrieved using brightness temperatures from the advanced microwave-scanning radiometer and atmospheric profile data from the moderate resolution imaging spectroradiometer. Finally, the features of the time and space distribution of the retrieved results were analyzed. In terms of spatial characteristics, a spatial distribution con- sistency was found between the retrieved results and surface coverage types of the Qinghai-Tibet Plateau. In terms of time characteristics, the changes in emissivity, which were within 0.01 for every day, were not evident within a one-month time scale. In addition, surface emissivities are sensitive to rainfall. The reasonability of the retrieved results indicates that the algorithm is feasible. A time-series surface emissivity database on the Qinghai-Tibet Plateau can be built using the developed algorithm, and then other surface or atmospheric parameters would have high retrieval precision to support related geological re- search on the Qinghai-Tibet Plateau.