Significant factors associated with fatal outcome in emergency open surgery for perforated peptic ulcer

AIM:To evaluate the main factors associated with mortality in patients undergoing surgery for perforated peptic ulcer referred to an academic department of general surgery in a large southern Italian city. METHODS:One hundred and forty-nine consecutive patients (M:F ratio=110:39,mean age 52 yrs,range 16-95) with peptic ulcer disease were investigated for clinical history (including age,sex,previous history of peptic ulcer,associated diseases,delayed abdominal surgery,ulcer site,operation type,shock on admission,postoperative general complications, and intra-abdominal and/or wound infections),serum analyses and radiological findings. RESULTS:The overall mortality rate was 4.0%.Among all factors,an age above 65 years,one or more associated diseases,delayed abdominal surgery,shock on admission, postoperative abdominal complications and/or wound infections,were significantly associated (x^2) with increased mortality in patients undergoing surgery (0.0001<P<0.03). CONCLUSION:Factors such as concomitant diseases,shock on admission,delayed surgery,and postoperative abdominal and wound infections are significantly associated with fatal outcomes and need careful evaluation within the general workup of patients admitted for perforated peptic ulcer.

Computer Programs for Prediction of Mining Area Deformation with Time Factor Taken into Consideration

This paper discussed the current of works on computerisation of all problems related to mining subsidence, including the time factor,carried out in the Division of Mining Geodesy of Technical University of Silesia, Poland. First, the formulas implemented in the programs were presented. These formulas considerably increase the description accuracy of final deformations by taking into uncaved strip along extraction rib (extraction margin). They also improve the deformation description of areas located far from the extraction place. Then, the research results aiming to improving the description of deformation with time were introduced. Finally, the Windows based version of the program for the creation of mining geological opinions were presented in the form accepted by Mining Offices of Poland.

Spatial-temporal Characteristics and Factors Influencing Commuting Activities of Middle-class Residents in Guangzhou City, China

The middle class in metropolitan Chinese cities has become an important social group. With the rapid development of urbanization and constant advancement of suburbanization, the middle class has increasingly come to influence city traffic. Research into middle-class commuting activities thus has practical significance for improving traffic congestion and reducing the commuting burden in metropolitan cities. Based on a dataset formed by 816 completed surveys, this paper analyzes the commuting mode, time and distance of middle-class residents in Guangzhou City using the descriptive statistical method. The results indicate that private cars are the main commuting mode, followed by public transport. Meanwhile, middle-class residents mainly undertake medium-short time and medium-short distance commuting. The study subsequently uses multilevel logistic regression and multiple linear regression models to analyze the factors that influence commuting mode choice, time and distance. The gender, age, number of family cars, housing source and jobs-housing balance are the most important factors influencing commuting mode choice; housing, population density, jobs-housing balance and commuting mode significantly affect commuting time; and transport accessibility, jobs-housing balance and commuting mode are the notable factors affecting commuting distance. Finally, this paper analyzes what is affecting the commuting activities of middle-class residents and determines the differences in commuting activity characteristics and influence factors between middle-class and ordinary residents. Policy suggestions to improve urban planning and urban management are also proposed.

The Time-Frequency Energy Attenuation Factor and Its Application on the Basis of Gauss Linear Frequency-Modulated Continuous Wavelet Transform

Based on the Gauss linear frequency modulated wavelet transform, a new characteristic index is presented, namely time frequency energy attenuation factor which can reflect the difference features of waveform in earthquake focus mechanism, wave traveling path and its attenuation characteristics in focal area or near field. In order to test its validity, we select the natural earthquakes and explosion or collapse events whose focus mechanisms vary obviously,and some natural earthquakes located at the same site or in a very small area. The study indicates that the time frequency energy attenuation factors of the natural earthquakes are obviously different with that of explosion or collapse events, and the change of the time frequency energy attenuation factors is relatively stable for the earthquakes under the normal seismicity background. Using the above mentioned method, it is expected to offer a useful criterion for strong earthquake prediction by continuous earthquake observation.

Bouveret's syndrome complicated by a distal gallstone ileus

AIM:Gastric outlet obstruction caused by duodenal impaction of a large gallstone migrated through a cholecystoduodenal fistula has been referred as Bouveret's syndrome.Endoscopic lithotomy is the first-step treatment, however,surgery is indicated in case of failure or complication during this procedure. METHODS:We report herein an 84-year-old woman presenting with features of gastric outlet obstruction due to impacted gallstone.She underwent an endoscopic retrieval which was unsuccessful and was further complicated by distal gallstone ileus.Physical examination was irrelevant. RESULTS:Endoscopy revealed multiple erosions around the cardia,a large stone in the second part of the duodenum causing complete obstruction,and wide ulceration in the duodenal wall where the stone was impacted.Several attempts of endoscopic extraction by using foreign body forceps failed and surgical intervention was mandatory.Preoperative ultrasound evidenced pneumobilia whilst computerized tomography showed a large stone,5 cm×4 cm×3 cm,logging at the proximal jejunum and another one,2.5 cm×2 cm×2 cm, in the duodenal bulb causing a closed-loop syndrome.She underwent laparotomy and the jejunal stone was removed by enterotomy.Another stone reported as located in the duodenum preoperatively was found to be present in the gallbladder by intraoperative ultrasound.Therefore, cholecystoduodenal fistula was broken down,the stone was retrieved and cholecystectomy with duodenal repair was carried out.She was discharged after an uneventful postoperative course.CONCLUSION: As the simplest and the least morbid procedure, endoscopic stone retrieval should be attempted in the treatment of patients with Bouveret's syndrome.When it fails, surgical lithotomy consisting of simple enterotomy may solve the problem. Although cholecystectomy and cholecystoduodenal fistula breakdown is unnecessary

Clinical course of subepithelial lesions detected on upper gastrointestinal endoscopy

AIM:To evaluate the natural history of subepithelial lesions.METHODS:We reviewed the medical records of 104 159 patients who underwent upper gastrointestinal endoscopy at the Center for Health Promotion of Samsung Medical Center between 1996 and 2003.Subepithelial lesions were detected in 795 patients(0.76%);252 patients were followed using upper gastrointestinal endoscopy for 82.5 ± 29.2 mo(range,12-160 mo;median,84 mo;1st quartile,60 mo;3rd quartile,105 mo).The median interval of follow-up endoscopy was 12 mo(range,6-105 mo;1st quartile,12 mo;3rd quartile,24 mo).RESULTS:The mean patient age was 53 years(range,22-80 years),and the male-to-female ratio was 2.36:1(177/75).The lesion size at initial measurement averaged 8.9 mm(range,2-25 mm;median,8 mm;1st quartile,5 mm;3rd quartile,10 mm).Of the 252 lesions,244(96.8%) were unchanged and 8(3.2%) were significantly increased in size(from 12.9 ± 6.0 to 21.2 ± 12.2 mm) after a mean interval of 59.1 ± 27.5 mo(range,12-86 mo).Surgical resection of lesions was performed when the lesions were ≥ 3 cm in diameter.Two lesions were diagnosed as gastrointestinal stromal tumors with an intermediate or high risk of malignancy and one lesion was classified as a schwannoma.CONCLUSION:Most small subepithelial lesions do not change as shown by endoscopic examination,and regular follow-up with endoscopy may be considered in small,subepithelial lesions,especially lesions < 1 cm in size.

Deformation response of roof in solid backfilling coal mining based on viscoelastic properties of waste gangue

Solid backfill mining(SBM)is a form of green mining,the core of which is to control and minimize the deformation and movement of strata above longwall coal mines.Establishing a mechanical model that can reliably describe roof deformation by considering the viscoelastic properties of waste gangue is important as it assists in improving mine designs and reducing the environmental impact on the surface.In this paper,the time-dependent deformation characteristics of gangue under different stress levels were obtained by using lateral confinement compression,that reliably represents the compaction of goaf.The viscoelastic foundation model for gangue mechanical response is different from the traditionally used elastic foundation model,as it considers the time factor and viscoelasticity.A mechanical model using a thin plate on a fractional viscoelastic foundation was established,and the roof deflection,bending moment,time-dependent,viscous and other characteristics of SBM were included and analyzed.Compared with the existing elastic foundation model,the proposed fractional order viscoelastic foundation model has higher accuracy with laboratory data.The plate deflection increases by 50.9%and the bending moment increases by 37.9%after 100 days,which the elastic model would not have been able to predict.

The intracellular mechanism of alpha-fetoprotein promoting the proliferation of NIH 3T3 cells

AIM: The existence and properties of alpha-fetoprotein (AFP) receptor on the surface of NIH 3T3 cells and the effects of AFP on cellular signal transduction pathway were investigated. METHODS: The effect of AFP on the proliferation of NIH 3T3 cells was measured by incorporation of 3H-TdR. Receptor-binding assay of 125I-AFP was performed to detect the properties of AFP receptor in NIH 3T3 cells. The influences of AFP on the [cAMP]i and the activities of protein kinase A (PKA) were determined. Western blot was used to detect the change of K-ras P21 protein expression. RESULTS: The proliferation of NIH 3T3 cells treated with 0-80 mg/L of AFP was significantly enhanced. The Scatchard analysis indicated that there were two classes of binding sites with KD of 2.722 x 10(-9)M (Bmax=12810 sites per cell) and 8.931 x 10(-8)M (Bmax=119700 sites per cell) respectively. In the presence of AFP (20 mg/L), the content of cAMP and activities of PKA were significantly elevated . The level of K-ras P21 protein was upregulated by AFP at the concentration of 20 mg/L. The monoclonal antibody against AFP could reverse the effects of AFP on the cAMP content, PKA activity and the expression of K-ras p21 gene. CONCLUSION: The effect of AFP on the cell proliferation was achieved by binding its receptor to trigger the signal transduction pathway of cAMP-PKA and alter the expression of K- ras p21 gene.

Get effective polyclonal antisera in one month

According to the traditional immunization procedure, after the first injection of the sample A (emulsion of aimed antigen and Freund's complete adjuvant) to immunize rabbit, successive injections of the sample B (emulsion of aimed antigen and Freund's incomplete adjuvant) were followed every 2-4 weeks. In general,high titer of the corresponding polyclonal antisera will be observed after 4-5 injections of sample B in 3-4months. This report presents a simply modified procedure that was able to stimulate the antisera formation in one month and achieve enough avidity to satisfy either Western blot or immunohistochemistry analysis.It just applied an additional injection of the sample A to the rabbit at the 3rd day after the primary immunization injection. You could gain the high titer of the antisera right after the first sample B injection in one month. This method has produced the desired results in three different recombinant antigens with different molecular weight (5.9 KD-55 KD) expressed from prokaryotic or eukaryotic cells.

Stability and water control of nitrogen foam in bulk phase and porous media

Foam is widely used in the petroleum industry thanks to its unique properties and performance. Its application to water control in oil wells has received more and more attention. The stability of nitrogen foam was investigated in pressurized equipment and sand pack. The result indicated that with increasing pressure （0-2 MPa） the stability of foam in the pressurized equipment increased linearly. Increased nitrogen injection pressure caused better dispersion of nitrogen-foaming solution in porous media. The initial residual resistance factor to gas was an exponential function of injection pressure, but the residual resistance factor （to gas and liquid） decreased exponentially with time. The halflife of foam in porous media （expressed in residual resistance factor） was much longer than that in bulk phase （expressed in foam height）. Pore model analysis indicated that good dispersion in porous media and the presence of thick liquid film during dispersion were the main reasons for high stability. Field test indicated that effective residence of foam in the formation not only resulted in much better heat insulation, but also improved steam stimulation by enhancing steam heating.

Histomorphological and Histochemical Alterations Following Short-term Inhalation Exposure to Sulfur Mustard on Visceral Organs of Mice

Toxic effects of inhaled sulfur mustard (SM) on the histology of visceral organs was investigaed by exposing mice to 84. 6mg/m3 for 1h duration, using controlled single exposure conditions. A progressive fall in body weight from third day onwards was noticed. Light microscopic examination of the pulmonary tissue of these animals at 6 h post exposure revealed that the tracheobronchial epithelium remained intact, but was infiltrated by inflammatory cells. By 24 h post exposure, the mucosecretory cells were destroyed. The indanunatory reaction was maximum at 48 h. By 7th day post exposure there was swelling and vacuolation of lung parenchymal cells and thrombi formation. In addition SM caused congestion and hemorrhage at alveolar level. SM also caused granulovacuolar degeneration with perinuclear clumping of the cytopasm of hepatocytes and renal parenchymal cells. Renallesions were chazacterized by congestion and hemorrhage. Among visceral tissues, maximum atrophywas observed in spleen. Distribution of lesions increased with post exposure period. The maximum lesions were observed at 7th day post-exposure.

Pseudoaneurysm of gastroduodenal artery following radical gastrectomy for gastric carcinoma patients

We report a rare case of postoperative pseudoaneurysm of the gastroduodenal artery following radical gastrectomy.Surgical trauma to the gastroduodenal artery during regional lymphadenectomy was considered as the cause of the postoperative pseudoaneurysm. The pseudoaneurysm was successfully managed by ligating the bleeding vessel. We should consider the possibility of pseudoaneurysm formation in a patient with gastrointestinal bleeding in the postoperative period following radical gastrectomy with regional lymph node and perivascular lymphatic dissection.

Interleukin-1 beta up-regulates tissue inhibitor of matrix metalloproteinase-1 mRNA and phosphorylation of c-jun N-terminal kinase and p38 in hepatic stellate cells

AIM： To study the relationship between interleukin-lbeta （IL-1β） up-regulating tissue inhibitor of matrix metalloproteinase-1 （TIMMP-1） mRNA expression and phosphorylation of both c-jun N-terminal kinase （INK） and p38 in rat heffatic stellate cells （HSC）. METHODS： RT-PCR was performed to measure the expression of TIMMP-1 mRNA in rat HSC. Western blot was performed to measure IL-1β-induced JNK and p38 activities in rat HSC. RESULTS： TIMMP-1 mRNA expression （1.191± 0.079） was much higher after treatment with IL-1β （10 ng/mL） for 24 h than in control group （0.545±0.091） （P〈0.01）. IL-1β activated INK and p38 in a time-dependent manner. After stimulation with IL-1β for 0, 5, 15, 30, 60 and 120 min, the INK activity was 0.982±0.299, 1.501±0.720, 2.133±0.882, 3.360±0.452, 2.181±0.789, and 1.385 ± 0.368, respectively. There was a significant difference in JNK activity at 15 min （P〈 0.01）, 30 min （P〈 0.01） and 60 min （P〈0.01） in comparison to that at 0 min. The p38 activity was 1.061±0.310, 2.050±0.863, 2.380±0.573, 2.973±0.953, 2.421±0.793, and 1.755 ± 0.433 at the 6 time points （0, 5, 15, 30, 60 and 120 min） respectively. There was a significant difference in p38 activity at 5 min （P〈0.05）, 15 min （P〈0.01）, 30 min （P〈0.01） and 60 min （P〈0.01） compared to that at 0 min. TIMMP-1 mRNA expression trended to decrease in 3 groups pretreated with different concentrations of SP600125 （10 μmol/L, 1.022±0.113; 20 μmol/L, 0.869±0.070; 40 μmol/L, 0.666±0.123）. Their decreases were all significant （P〈0.05, P〈0.01, P〈0.01） in comparison to control group （without SP600125 treatment, 1.163±0.107）. In the other 3 groups pretreated with different concentrations of SB203580 （10 μmol/L, 1.507±0.099; 20 μmol/L, 1.698±0.107; 40 μmol/L, 1.857±0.054）, the expression of TIMMP-1 mRNA increased. Their levels were higher than those in the control group （without SB203580 treatment, 1.027 ± 0.061） with a significant statistical significance （P〈 0.01）. CONCLUSION： IL-1β has a direct action on hepatic fibrosis by up-regulating TIMMP-1 mRNA expression in ratessionin in rate HSC.JNK and p38 mitogen-activated protein kinases （MAPKs） are involved in IL-1β-induced TIMMP-1 gene expression, and play a distinct role in this process, indicating that p38 and .INK pathways cooperatively mediate TIMP-1 mRNA expression in rat HSC.

Safe upper limit of intermittent hepatic inflow occlusion for liver resection in cirrhotic rats

AIM: To evaluate the effects of varying ischemic durations on cirrhotic liver and to determine the safe upper limit of repeated intermittent hepatic inflow occlusion. METHODS: Hepatic ischemia in cirrhotic rats was induced by clamping the common pedicle of left and median lobes after non-ischemic lobes resection. The cirrhotic rats were divided into six groups according to the duration and form of vascular clamping: sham occlusion (SO), intermittent occlusion for 10 (IO-10), 15(IO-15), 20(IO-20) and 30(IO-30) minutes with 5 minutes of reflow and continuous occlusion for 60 minutes (CO-60). All animals received a total duration of 60 minutes of hepatic inflow occlusion. Liver viability was investigated in relation of hepatic adenylate energy charge (EC). Triphenyltetrazollum chloride (TTC) reduction activities were assayed to qualitatively evaluate the degree of irreversible hepatocellular injury. The biochemical and morphological changes were also assessed and a 7-day mortality was observed. RESULTS: At 60 minutes after reperfusion following a total of 60 minutes of hepatic inflow occlusion, EC values in IO-10 (0.749 +/- 0.012) and IO-15 (0.699 +/- 0.002) groups were rapidly restored to that in SO group (0.748 +/- 0.016), TTC reduction activities remained in high levels (0.144 +/- 0.002 mg/mg protein, 0.139 +/- 0.003 mg/mg protein and 0.121 +/- 0.003 mg/mg protein in SO, IO-10 and IO-15 groups, respectively). But in IO-20 and IO-30 groups, EC levels were partly restored (0.457 +/- 0.023 and 0.534 +/- 0.027) accompanying with a significantly decreased TTC reduction activities (0.070 +/- 0.005 mg/mg protein and 0.061 +/- 0.003 mg/mg protein). No recovery in EC values (0.228 +/- 0.004) and a progressive decrease in TTC reduction activities (0.033 +/- 0.002 mg/mg protein) were shown in CO-60 group. Although not significantly different, the activities of the serum aspartate aminotransferase (AST) on the third postoperative day (POD(3)) and POD(7) and of the serum alanine aminotransferase (ALT) on POD(3) in CO-60 group remained higher than that in intermittent occlusion groups. Moreover, a 60% animal mortality rate and more severe morphological alterations were also shown in CO-60 group. CONCLUSION: Hepatic inflow occlusion during 60 minutes for liver resection in cirrhotic rats resulted in less hepatocellular injury when occlusion was intermittent rather than continuous. Each period of 15 minutes was the safe upper limit of repeated intermittent vascular occlusion that the cirrhotic liver could tolerate without undergoing irreversible hepatocellular injury.

Acupuncture Treatment of Chronic Superficial Gastritis by the Eight Methods of Intelligent Turtle

With the clinical manifestations and the point electric conduction volume as the indexes, the authors observed the immediate effects of the acupuncture treatment on chronic superficial gastritis with the points selected according to the date and time set by Ling Gui Ba Fa (灵龟八法 Eight Methods of Intelligent Turtle), which was compared with the effects in the control group treated with the points selected according to syndrome-differentiation. A higher symptom improvement rate (P<0.01) and a higher channel's balance-inverting rate were noticed in the former (P<0.01), indicating that Ling Gui Ba Fa can give a better therapeutic results.

Helicobacter pyloriin gastric corpus of patients 20 years after partial gastric resection

AIM:To determine the long-term prevalence of Helicobacter pylori(H pylori)gastritis in patients after partial gastric resection due to peptic ulcer,and to compare the severity of Hpylori-positive gastritis in the corpus mucosa between partial gastrectomy patients and matched controls. METHODS:Endoscopic biopsies were obtained from 57 patients after partial gastric resection for histological examination using hematoxylin/eosin and Warthin-Starry staining.Gastritis was graded according to the updated Sydney system.Severity of corpus gastritis was compared between Hpylori-positive partial gastrectomy patients and Hpylori-positive duodenal ulcer patients matched for age and gender. RESULTS:In partial gastrectomy patients,surgery was performed 20 years(median)prior to evaluation.In 25 patients(43.8%)Hpyloriwas detected histologically in the gastric remnant.Gastric atrophy was more common in H pylori-positive compared to H pylori-negative partial gastrectomy patients(P<0.05).The severity of corpus gastritis was significantly lower in Hpylori-positive partial gastrectomy patients compared to duodenal ulcer patients (P<0.01).There were no significant differences in the activity of gastritis,atrophy and intestinal metaplasia between the two groups. CONCLUSION:The long-term prevalence of Hpylorigastritis in the gastric corpus of patients who underwent partial gastric resection due to peptic ulcer disease is comparable to the general population.The expression of Hpylorigastritis in the gastric remnant does not resemble the gastric cancer phenotype.

Hypertrophied anal papillae and fibrous anal polyps,should they be removed during anal fissure surgery?

AIM:Hypertrophied anal papillae and fibrous anal polyps are not given due importance in the proctology practice. They are mostly ignored being considered as normal structures.The present study was aimed to demonstrate that hypertrophied anal papillae and fibrous anal polyps could cause symptoms to the patients and that they should be removed in treatment of patients with chronic fissure in anus. METHODS:Two groups of patients were studied.A hundred patients were studied in group A in which the associated fibrous polyp or papillae were removed by radio frequency surgical device after a lateral subcutaneous sphincterotomy for relieving the sphincter spasm.Another group of a hundred patients who also had papillae or fibrous polyps,were treated by lateral sphincterotomy alone.They were followed up for one year. RESULTS:Eighty-nine percent patients from group A expressed their satisfaction with the treatment in comparison to only 64% from group B who underwent sphincterotomy alone with the papillae or anal polyps left untreated.Group A patients showed a marked reduction with regard to pain and irritation during defecation (P=0.0011), pricking or foreign body sensation in the anus (P=0.0006) and pruritus or wetness around the anal verge (P=0.0008). CONCLUSION:Hypertrophied anal papillae and fibrous anal polyps should be removed during treatment of chronic anal fissure.This would add to effectiveness and completeness of the procedure.

The Missing Time Calculation of the Hiatus Surface:A Case Study of the Upper Permian Reef Section the Platform Margin, Ziyun, Guizhou

Taken as an example the Upper Permian reef section on the carbonate platformmargin at Ziyun, Guizhou, the paper discusses the missing time of a hiatus surface, an impor-tant problem in chemical sequence stratigraphy, with the concept of cosmic chemistry. Then thepaper proposes a series of new concepts for chemical sequence stratigraphy, including the con-densation surface, relative compaction factor and time missing factor. Finally a quantitativecurve of Late Permian relative sea-level change in the Ziyun area is presented with timecoordinates.

Adenovirus-mediated expression of pig α(1,3) galactosyltransferase reconstructs Gal α(1,3) Gal epitope on the surface of human tumor cells

Gal alpha(1, 3) Gal (gal epitope) is a carbohydrate epitope and synthesized in large amount by alpha(1, 3) galactosyltransferase [alpha(1, 3) GT] enzyme on the cells of lower mammalian animals such as pigs and mice. Human has no gal epitope due to the inactivation of alpha(1, 3) GT gene but produces a large amount of antibodies (anti-Gal) which recognize Gal alpha(1, 3) Gal structures specifically. In this study, a replication-deficient recombinant adenoviral vector Ad5sGT containing pig alpha(1, 3) GT cDNA was constructed and characterized. Adenoviral vector-mediated transfer of pig alpha(1, 3) GT gene into human tumor cells such as malignant melanoma A375, stomach cancer SGC-7901, and lung cancer SPC-A-1 was reported for the first time. Results showed that Gal epitope did not increase the sensitivity of human tumor cells to human complement-mediated lysis, although human complement activation and the binding of human IgG and IgM natural antibodies to human tumor cells were enhanced significantly after Ad5sGT transduction. Appearance of gal epitope on the human tumor cells changed the expression of cell surface carbohydrates reacting with Ulex europaeus I (UEA I) lectins, Vicia villosa agglutinin (VVA), Arachis hypogaea agglutinin (PNA), and Glycine max agglutinin (SBA) to different degrees. In addition, no effect of gal epitope on the growth in vitro of human tumor cells was observed in MTT assay.