Search

In order to improve the efficiency of artificial breeding and aquaculture efficiency of Chinese horseshoe crab, the breeding equipment used in the process of artificial breeding and larval cultivation of Chinese horseshoe crab was optimized and improved, and the breeding effects of the old and new equipments were compared. The results showed that the average egg-production amount per female Chinese horseshoe crab in the new temporarily rearing system of Chinese horseshoe crab was 3530, which was significantly higher than that in the conventional temporarily rearing system (2320) (P<0.05), and the cleaning frequency of the filter vat was significantly lower than that in the conventional system (P<0.05). The ratios of 2nd instar larvae (93.33%) and 3rd instar larvae (35.33%) obtained by the new larval rearing device were significantly higher than those obtained by the conventional larval rearing device (being 83.33% at 2nd instar and 10.33% at 3rd instar) (P<0.05). The average mortality rates of 1st instar larvae (6.67%) and 2nd instar larvae (6.33%) in the new larval rearing device were significantly lower than those in the conventional larval rearing device (16.67% and 30.67%) (P<0.05). The 2nd instar molting began from the 11th to 12th day and the 3rd instar molting began from the 21st to 30th day in the new larval rearing device, while the 2nd and 3rd instar molting began from the 31st to 40th day in the conventional larval rearing device. It could be seen that the molting time required for the new larval rearing device was significantly reduced (P<0.05). The above results showed that the new temporarily rearing system of horseshoe crab could enhance the purification capacity of waters, increase the egg laying amount of horseshoe crab, significantly accelerate the molting speed of the 2nd instar and 3rd instar juvenile Chinese horseshoe crab, and reduce the mortality rate of the 2nd instar juvenile Chinese horseshoe crab. The research results could provide important technical reference for the subsequent large-scale artificial breeding and larval cultivation of horseshoe crab. [ABSTRACT FROM AUTHOR]

Carbon fiber is composed of crystallite and amorphous carbon. The X-ray diffraction (XRD) and Raman spectroscopy were used to investigate the influencing mechanism of the microstructure of crystallites of polyacrylonitrile (PAN)-based carbon fibers on tensile strength. The results show that the crystallinity, the degree of graphitization, the degree of crystallites structural disorder and the crystallite size have obvious effects on tensile strength. The larger the crystallinity and the degree of graphitization,the larger the tensile strength; the smaller the degree of crystallites structural disorder, the larger the tensile strength; the larger the crystallite size, the smaller the tensile strength. Comparing T300 with T700, the increment of tensile strength, which is caused by the increase of the crystallinity and the degree of graphitization, and the decrease of the degree of crystallites structural disorder, is larger than the decrement of tensile strength, which is caused by the increase of the crystallite size. Therefore, the tensile strength of T700 is larger than that of T300, and the same with that the tensile strength of T800 is larger than that of T700. When M35J is compared with M40J, the increment of tensile strength, which is caused by the increase of the crystallinity and the degree of graphitization, and the decrease of the degree of crystallites structural disorder, is smaller than the decrement of tensile strength, which is caused by the increase of the crystallite size. Therefore, the tensile strength of M40J is smaller than that of M35J, and the same with that the tensile strength of M46J is smaller than that of M40J. In M35J, M40J and M46J, the bigger crystallite size is a crucial factor that affects the tensile strength.

Good water and fertilizer regulation mode is conducive to the exchange of nutrients elements between soil and crops, which is one of the important factors for high yield of rice. In order to explore the mechanism of the effect of slow-release fertilizer on paddy soil, fertility root dry weight and yield under alternate wetting and drying irrigation conditions, pit test of rice planting was carried out in Hubei Irrigation Experiment Center Station from May to September 2019. Plant height, chlorophyll SPAD value, tiller number and soil samples were collected under the interaction of flooding irrigation (W1, CF), alternate wetting and drying irrigation (W2, AWD) coupled with traditional fertilizer (N1) and slow-release fertilizer (N2) to analyze the nitrogen and phosphorus content, yield and root dry weight at yellow ripe stage. The results show that the total nitrogen of upper layer (0~20 cm) and lower layer (20~40 cm) of AWD is 2.2%~78.63% higher than that of CF, the total phosphorus of upper layer is 64.27%--162.86% higher than that of CF, and the total phosphorus of lower layer is 30.80%~43.52% lower than that of CF. The total nitrogen in the upper and lower layers of slow-release fertilizer is 5.06%~79.95% lower than that of traditional fertilizer. Total nitrogen in lower soil is significantly different under different fertilizer types, and total phosphorus in upper soil is highly significant under different fertilizer types. Slow-release fertilizer significantly improves the dry weight of roots. AWD and slow-release fertilizer (W2N2) has the highest yield of 10 505 kg/hm², AWD and slow-release fertilizer (W2N2) is 8.53% higher than that of lowest control treatment CF and traditional fertilizer (W1N1). Conclusion: AWD can better maintain soil total nitrogen in the upper layer and lower layer than CF, and its effect on maintaining soil total phosphorus in the upper layer is stronger than CF. Slow-release fertilizer can promote the dry matter accumulation of rice roots, improve the uptake and utilization efficiency of nitrogen and phosphorus in soil, and have a positive effect on the formation of effective panicle number, thus increasing rice yields. AWD coupled with slow-release fertilizer can improve rice yields. [ABSTRACT FROM AUTHOR]

Clubroot has recently become one of the main diseases of oilseed rape and cruciferous crops in China, which seriously affected the yield of cruciferous crops. Therefore, an efficient method with a high efficiency for molecular detection of P. brassicae was developed for accurate diagnosis in various samples using a pair of specific primers (PbITS1) designed on ITS (internal transcribed spacer) sequence, and the molecular detection of P. brassicae and disease assessment were carried out by PCR procedure. The results indicated that PCR system could specifically detect P. brassicae without any amplification product from representative soil - borne pathogenic fungi, bacteria, nematodes and endophytes. Sensitivity assay showed that the minimum concentration of template DNA was 1 x 10-3 ng/µL, the minimum number of spores in the contaminated soil was 1 x 10 spores/g soil, and the minimum level of spore with seeds was 1 x 10 spores/g seeds. Moreover, rape and other cruciferous plants (e. g., tissues and seeds) and soils could be applied in this detection system, meanwhile roots and surrounding soils collected from the different growth stages could be used for disease assessment. The benefit of this detection system was convenient, sensitive and specific with a wide range of detectable samples, which provided insights on detection of P. brassicae as well as the diagnosis, monitoring epidemic pattern, and integrated management of clubroot. [ABSTRACT FROM AUTHOR]

The study on floral syndrome and breeding system of Atractylodes japonica was carried out with the method of fixed-point observation, pollen-ovule ratio (P/ O), out-crossing index, bagging pollination, in order to provide the theoretical basis for its resource protection and artificial cultivation. The results showed that flowering period of populations was from late July to early September, the life span of individual inflorescence was 12-17 d, and the peak period of daily flowering for floret was at 7: 00 8: 00 a. m. Pollen vitality was the highest ( above 90%) within 2 h, while stigma was no receptivity and its receptivity was the highest after flowering 48-72 h. The P/ 0 ratio was 6 690, hybrid index was 5, breeding system was xenogamy, and the main floral visitors were bees and flies. There was no apomixes based on bagging and pollination studies, inbred and geitonogamous seed setting rate was low. So, the outcrossing was the major breeding system of A. japonica. [ABSTRACT FROM AUTHOR]

A blind space spectrum subtraction( BSSS) method based on hyper beam forming for interference cancellation is proposed for two typical near-field strong interference sources (towed-ship self noise and friendly neighbor ship noise) which affect the target detection performance of towed array sonar. The hyper beam technology is used to form multi-beams to cover a strong interference area. The amplitude spectrum of interfering beams is computed, and the multi-beam amplitude spectrum is subtracted from the basic element field amplitude spectrum by using an appropriate spectrum subtraction strategy. The frequency signal of basic element field is get from the cancelled amplitude spectrum signal, and the target azimuth is estimated using the frequency field block adaptive filtering algorithm. The simulation and sea test results show that BSSS method can improve the array gain by about 10 dB compared to the minimal variance distortionless response (MVDR) method under the conditions of high interference-to-noise ratio and low signal-to-noise ratio. BSSS method can be used simultaneously to cancel the towed-ship self noise and the friendly neighbor ship noise, and effectively reduce the fluctuation of detected background. [ABSTRACT FROM AUTHOR]

Structured grids are hard to be generated on high lift configuration of transport airplanes due to geometry irregularity, unstructured grids have the chance of optimizing local mesh quality and timesaving with strong adaptability and automatism in grid generation. With tetrahedron grids and cell centered finite volume discretization, solutions on a trapezoidal three-element high-lift wing obtained with an 3D compressible Reynolds averaged Navier-Stokes code are presented. High aspect ratio meshes are formed by advancing layer methods to simulate viscous effect in boundary layer, surrounding high aspect ratio difficulties, methods of solution gradients reconstruction and slope limiters are discussed, and accurate and affordable schemes for current grids are summarized. In the simulation, flows are assumed to be fully turbulent, Spalart-Allmaras turbulence model coupled with N-S equations are solved on parallel computers, flux conservation are enforced at partition boundary. Integrated and distributed aerodynamics loads are compared with experimental data, lift, drag and pitching moment are shown to be in good agreement, pressure distributions are mostly identical except that on wing tip location, where excessive numerical dissipations are exposed because of wing tip vortex. Three different grids ranging from 466M to 2674M are computed comparatively to study grid convergence at α=11.02°, the close up to test data are shown through grid refinement, but the curve slope is not a linear, which can be attributed to complexity of flows. [ABSTRACT FROM AUTHOR]

Rear fuselage mounted engine is applied on ARJ21-700 aerocraft. Under some special conditions, the ice shedding from the surface may do harm to the engine. In order to research the relationship between the ice shape, shedding pose or shedding position and the probability of entering engine, MBNS3D is employed to calculate the flowfield of ARJ21-700 and variable ice shapes, and the trajectories of ice shedding from head and upper wing of craft are calculated by solvering six-degree equations. It is found that this method can calculate large amount of trajectories quickly and precisely. Finally, the rule of ice blocks being pulled into the engine is concluded, to provide surpport to the airworthy certification of ARJ21-700. [ABSTRACT FROM AUTHOR]

In this paper, the γReoθ transition model is presented briefly and implemented in the "In house" CFD code mbns3d. The zero pressure gradient flat plate test data are adopted for calibrating the transition model. A series of the correlation function are obtained. The test case of A-aerofoil at 13.1 and 13.3 angles of attack are calculated, the results indicate that the transition model is capable of simulating the transition effect accurately. And the accuracy of lift and drag are increased. Subsequently, the two element airfoil of NLR7301 is studied. The transition model and vortex correction are applied to increase the drag prediction accuracy, and the max drag coefficient deviation is controlled fewer than 4 percent in comparison with experiments. [ABSTRACT FROM AUTHOR]

Separation trajectories of a missile are influenced by many factors including eject force, separation altitude and separation velocity etc. It is a challenge for CTS experiments or CFD computation if all influence factors are considered. However, a missile's separation boundary can't be achieved if the factors are ignored. In this paper Monte Carlo method is introduced to simulate the errors of the factors. Grid survey approach is employed to establish aerodynamic force database. Then 6DOF equations are solved to obtain the missile's every separation trajectory while the missile's separation boundary is obtained finally when all errors are considered. [ABSTRACT FROM AUTHOR]

In order to solve the problem of high cost and low efficiency by using the traditional soil geochemical survey methods, this paper studied the simple detection method of soil heavy metal content with visible and near-infrared reflectance spectroscopy. The study collected visible and near-infrared reflectance spectroscopy of soil samples in Xifanping mining area; then treated the reflectance spectroscopy with six mathematic changes such as differentials and continuum removal in advance; the next step was to select characteristic wavelengths that were sensitive to soil copper content by using stepwise regression method and Pearson correlation coefficient as set of comprehensive characteristic variables; finally, utilized different methods and parameters of characteristic variable selection to build the soil total copper content models and tested them. Results showed that: to extract the information of copper content in soil, the performance of different spectral transform methods varied, and each spectrum transform method corresponded to its certain sensitive spectral ranges; the inversion models based on the integrated spectrum transform information were better than that based on only one kind of spectrum transform information; as for establishing the prediction model of soil copper content by using the integrated spectrum transform information, backward elimination was better than forward selection and stepwise selection, and when the Removal is 0.20, the optimum model was obtained, its coefficients of determination(R(2))and determination coefficients of prediction(R(2)(pre))reached 0.851 and 0.830, root mean square error of calibration(RMSEC)and root mean square error of prediction(RMSEP)were 0.349 and 0.468 mg·kg(-1). The model has a good precision, and it provides a train of thought for the detection of other soil heavy metal elements with visible and near-infrared reflectance spectroscopy.

Objective: To investigate the situation and the influential factors of child neglect between left-behind children and living-with-parents children aged 6-17 years in the rural areas in western China., Methods: Students were randomly selected according to the principle of multi-stage stratified cluster sampling and they were from three cities in Shanxi and four districts in Chongqing. Among the 4,131 children, there were 1,874 students in the 6-11 years group and the left-behind children accounted for 50.21% (941/1,874) in this group. There were 2,257 students in the 12-17 years old group and the left-behind children accounted for 53.35% (1,204/2,257) in this group. The questionnaire named "Evaluation on Neglect for Elementary and Secondary School Students Aged 6-17 Years in Rural Areas in China" was used in the field investigation. The students' neglect frequency was described by neglect rate and the factors affecting students' neglect were analyzed by means of binary logistic regression., Results: In the 6-11 years old group, the neglect rates of left-behind children and living-with-parents children were 63.03% (474/752) and 43.87% (347/791), respectively (χ2=58.86, P<0.001). In the 12-17 years old group, the neglect rates of left-behind children and living-with-parents children were 60.64% (627/1 034) and 53.57% (495/924), respectively (χ2=9.96, P<0.001). For factors influencing left-behind children, compared to the factors about boys, younger mother (≤40 years old), presence of parents' income reduction within the last year and nuclear family, the factors about girls, elder mother (41-49 years), absence of parents' income reduction within the last year and three-generation family or single-parent family were associated with lower neglect risk, and OR values were 0.67, 0.68, 0.70, 0.73, and 0.43 (P<0.05); compared to the factors about Han nationality, only child, with separate room at home, and resident children, the factors about other nationalities, non-only child, no separate room at home, and non-resident children were associated with high neglect risk, and OR values were 1.85, 1.34, 1.46, and 1.32 (P<0.05); compared to the lower father's education background (primary school or uneducated), the higher father's education background (junior middle school, senior middle school, technical secondary school, college and above) was associated with lower neglect risk, and OR values were 0.66, 0.50, and 0.25 (P<0.05); compared to good relationship between children and parents as well as good relationship between parents, fair or poor relationship was associated with high neglect risk, and OR values were 1.57-3.79 (P<0.05). For factors influencing non-left-behind children, compared to the factors about younger mother (≤40 years old), changes of patient's work in the last year, presence of parents' income reduction within the last year and nuclear family, the factors about elder mother (41-49 years), no changes of patients' work in the last year, absence of parents' income reduction within the last year and three-generation family or single-parent family were associated with lower neglect risk, and OR values were 0.69, 0.71, 0.75, 0.82, and 0.56 (P<0.05); compared to the factors about Han nationality, only child and younger father (≤40 years old), other nationalities, the factors about non-only child, and elder father (41-49 years) were associated with high neglect risk, and OR values were 1.45, 1.56, and 1.57 (P<0.05); compared to lower father's education background (primary school or uneducated), higher father's education background (junior middle school, senior middle school, technical secondary school, college and above) was associated with lower neglect risk, and OR values were 0.65 and 0.49 (P<0.05); compared to good relationship between children and parents as well as good relationship between parents, fair or poor relationship was associated with high neglect risk, and OR values were 1.56-7.69 (P<0.05)., Conclusion: The situation of child neglect among left-behind children aged 6-17 years in rural areas of the two provinces in western China was serious, their neglect rates were higher than those of living-with-parents children, and there were many risk factors affecting the neglect rates of the two group children.

Objective: 10 learn about the neglected conditions and intuence factors of middle school students aged 12 to 17 years old in rural areas of Shaanxi Province and Chongqing City., Methods: The scale and evaluation method formulated in "The Normal Value of Evaluation on the Neglect of Middle School Students from 12 to 17 Years Old in Rural China" was adopted. 2257 respondents among which there were 1157 male students and 1,100 female students in the rural areas of Shaanxi Province and Chongqing City were selected according to the principle of multi-stage stratified cluster sampling. The severe degree of neglect was reflected through the indicator of neglect degree. The method of binary Logistic regression analysis was adopted to analyze the influence factors of neglect. Results The total neglect degree of respondents was (51. 80 ± 9. 06). The neglect degree of middle school students in the rural areas of Chongqing was (53. 21 ± 9. 03). The neglect degree of middle school students in the rural areas of Shaanxi was 50. 50 8. 90. The statistical significance was found in the difference between the two groups (U =6. 17, P <0. 01). The neglect degree of male students was (51. 93 ± 8. 67) while the neglect degree of female students was (51. 66 ± 9. 46). The statistical significance was not found in the difference between the two groups of total neglect degree of different sexes (U = 0. 60, P > 0. 05). The statistical significance was noticed in the differences of neglect degrees of middle school students in different grades at all levels (P <0. 05). The neglect degrees of junior three and senior three students were relatively high. Their total neglect degrees were (53. 54 ± 9. 70) and (53. 36 ± 8. 69) respectively. Except social neglect and safety neglect, there was statistical significance in the differences of neglect degrees of students with different family backgrounds at all levels (P <0. 01). The neglect degree of middle school students in a remarried family was the highest. The total neglect degree was (56. 92 ± 8. 83). The factors influencing the neglect of middle school students were shown in the result of Logistic regression analysis, including the educational level of their fathers, whether they had a separate room, family types, whether the working places of their parents changed in one year, whether the incomes of their parents decreased in one year, their relationship with their parents and the relationship between their parents., Conclusion: The neglected conditions of middle school students in the rural areas of Shaanxi Province and Chongqing City are relatively severe and the factors influencing the neglect of children include the educational level of their fathers, whether they have a separate room, family types, whether the working places of their parents changed in one year, whether the incomes of their parents decrease in one year, their relationship with their parents and the relationship between their parents.

Objective: To screen optimal Inonotus obliquus strains that is suitable to cultivation, extracting effective components on industrialized production, genetics and breeding., Methods: Inonotus obliquus mycelia from different countries were used. High quality strain was screened by comparing the antagonism between Inonotus obliquus and penicillium. The contents of crude fat, crude ash, crude protein and crude fiber were analyzed., Results: It was showed that antagonism ability of Finnish birch was the strongest, its mycelia diameter was up to 53. 27 mm. It was also showed that nutritional ingredient was abundant in artificial cultured Inonotus obliquus strains. The contents of crude fat and crude protein in Finnish birch were higher, which was 1. 93% and 20. 23%, respectively. The contents of crude fat and crude protein in NBRC8681 strains were lower, which was 1. 55% and 19. 85%, respectively. The content of crude ash of JL04 strains was higher(8. 76%). The content of crude ash of NBRC8681 strains was lower(6. 8%). Crude fiber content was higher in HLJ01 strains, its content reached to 45. 09%. The least content appeared in MAFF420101 strains, whose crude fiber content was only 38. 27%., Conclusion: The strains of Finnish birch, HLJ01 and JL04 are suitable to exploitation.

Objective: To understand the neglect situation of elementary and high school students aged 6-17 years in western rural areas of China., Methods: Using multi-stage stratified cluster sampling method, 4 131 students were recruited from 26 rural elementary and high schools of 7 districts in Shanxi province and Chongqing from September 2012 to April 2013. The investigation was conducted based on 'The Development of Neglect Evaluation Norms and Influence Factors for Primary and Middle School Students' in rural areas of China. SAS 9.21 software was used for analyzing neglect rate and neglect degree for groups of age, sex and neglect types (including neglect of physical, emotional, medical, educational, safety and social)., Results: The total neglect rate and degree were 55.50% (1 943/3 501) and 49.96 ± 9.67; the neglect rates for males and females were 56.78% (1 018/1 793) and 54.16% (925/1 708) (P = 0.119); the neglect degrees were 50.08 ± 9.31 and 49.83 ± 10.02 (P = 0.479), respectively. The girls' medical neglect rate (18.25%, 348/1 907) was significantly higher than that in boys (14.72%, 294/1 997) (P < 0.01); the boys' neglect degrees of physical, educational and social neglect (50.05 ± 10.46, 49.99 ± 10.81, 57.63 ± 14.63) were significantly higher than that in girls (49.34 ± 10.70, 49.07 ± 11.30, 56.37 ± 14.80) (P < 0.05). The total neglect rates of 6-8, 9-11, 12-14 and 15-17 groups were 44.48% (310/697), 60.40% (511/846), 60.89% (601/987) and 53.66% (521/971) (P < 0.01), and the total neglect degrees among these groups were 46.89 ± 8.57, 51.88 ± 9.25, 51.88 ± 9.25 and 51.72 ± 8.89 (P < 0.01), respectively. Except the neglect rates of medical and social neglect, significant differences were found in other three neglect rates and neglect degrees. The rates of social, emotional and safety neglect in 9-11 group were higher than that in other groups (28.39% (264/930), 26.41% (239/905), 20.35% (187/919)). The 12-14 group has the highest educational neglect rate(29.41%, 317/1 078). While the physical and emotional neglect degrees in 12-14 and 15-17 group were higher than that in other groups(12-14 group: 51.59 ± 10.02, 53.43 ± 12.02, 15-17 group: 51.96 ± 9.80, 52.61 ± 11.59). The social, safety, educational and medical neglect degrees were the highest in 6-8, 9-11, 12-14 and 15-17 group (60.91 ± 13.13, 48.29 ± 11.34, 52.43 ± 10.55, 51.15 ± 17.25), respectively. The neglect rates and neglect degrees were significantly higher in minorities(68.88% (374/543) and 52.91 ± 9.14) than those in Han population (53.04% (1 569/2 958), 49.44 ± 9.67)(P < 0.01 in both indexes); and the neglect rates and neglect degrees were significantly higher in children with siblings group (58.20% (1 504/2 584), 50.58 ± 9.54) than those the in one-child group (47.87% (439/917), 48.27 ± 9.80) (P < 0.01 in both indexes); and the neglect rates and neglect degrees were significantly higher in left-hand students (61.65% (1 101/1 786), 51.41 ± 9.51) than those in living-with-parents students(49.10% (842/1 715), 48.56 ± 9.61) (P < 0.01 in both indexes)., Conclusion: The children neglect situation is serious in western rural areas, close attention from families, schools and the society is in urgent need.

Objective: To investigate the expression of DAB2IP in bladder transitional cell carcinoma (BTCC) and its correlation with clinical characteristics and prognosis of BTCC patients., Methods: Immunohistochemical staining was applied to detect DAB2IP protein level in 79 cases of TCCB tissues and 11 cases of normal bladder tissues, and the relationships of the staining results with pathological grade, stage, lymph node metastasis, gender, age and the 3-year survival rate of the patients were analyzed., Results: The expression of DAB2IP in BTCC tissues was significantly lower than that in normal bladder epithelium, and the expression score and rate of DAB2IP in the high-grade, invasive and metastatic BTCC were significantly lower than those in low-grade, superficial and non-metastatic BTCC (P < 0.05). The 3-year survival rate of the patients with high DAB2IP expression was significantly higher than that of the patients with low DAB2IP expression., Conclusion: DAB2IP may be one of the important inhibitory factors during the occurrence and progression of BTCC.

Objective: To compare the clinical value of narrow band imaging (NBI) and iodine staining for margin determination of early esophageal cancer during endoscopic submucosal dissection (ESD)., Methods: Clinical data of 87 patients with early esophageal cancers undergoing endoscopic submucosal dissection (ESD) were analyzed retrospectively. Patients were assigned to NBI group and iodine staining group according to the staining method before ESD operation. Clinicopathological features, esophageal spasm ratio, operation time, en bloc resection rate, complications, local recurrence, and distant metastases were compared between the two groups., Results: There were 37 patients in NBI group while 50 patients in iodine staining group. Location and size of the lesions between two groups were not significantly different. The ratio of moderate-severe esophageal spasm in NBI group was significantly lower as compared to iodine staining group [10.8%(4/37) vs. 32.0%(16/50), P<0.05]. The average operation time in NBI group was significantly shorter than that in iodine staining group [(42.2±19.5) min vs. (53.3±30.9) min, P<0.05). All the tumors were resected in an en bloc fashion and the R0 resection rate was 100%. Perforations in 2 patients and delayed bleeding in 1 patient were successfully treated by endoscopic methods. Esophageal strictures occurred in 3 patients of NBI group and 4 patients of iodine staining group, who were treated by endoscopic dilation and retrievable stents. During mean 13.2 months (range 4 to 20 months) follow-up periods, local recurrence occurred in 2 patients of NBI group and 2 patients of iodine staining group. These patients received ESD or other surgery., Conclusion: Compared with iodine staining, using NBI for margin determination of early esophageal cancer during ESD is more convenient and fast because of distinctly lower degree of esophageal spasm.

Objective: To investigate the prevention and treatment of complications during and after endoscopic mucosal band ligation (EMBL) for precancerous lesions and early cancer in the esophagus., Methods: Clinical data of 47 patients with esophageal precancerous lesions and early cancer undergoing EMBL in our center from June 2011 to August 2013 were reviewed retrospectively. Complications and associated treatment during operation, after operation and during follow-up were analyzed., Results: Complications during operation included 7 cases of bleeding (14.9%) and 1 case of perforation (2.1%), who received hot biopsy forceps and argon plasma coagulation to stop bleeding successfully, and titanium clamp to suture wound surface. No cutaneous emphysema and pneumothorax occurred. Complications after operation included 1 case of delayed bleeding (2.1%) who received blood stopping under gastroscope, 2 cases of mediastinal and subcutaneous emphysema (4.3%), 6 cases of pleural effusion (12.8%), and 5 cases of minor inflammation or segmental atelectasis of pulmonary (10.6%), who all received successful conservative treatment. Seven cases of esophageal stricture occurred during follow-up, who were improved by balloon dilatation and metal-film stent placement. No deaths associated with EMBL occurred. All the complications were cured through conservative treatment. No additional surgery associated with the complications was needed. Post-operative pathology revealed 1 case was chronic inflammatory hyperplasia, 11 were low-grade intraepithelial tumor, 15 were high-grade intraepithelial tumor, 8 were carcinoma in situ, 12 were squamous cancer (8 with invasion into mucous muscular layer, 4 into submucous layer). Only 1 case of submucous cancer needed transthorax esophageal cancer radical operation because of dangerous margin. No relapse case was found during followed-up., Conclusion: EMBL can treat the esophageal precancerous lesions and early esophageal cancer effectively and its complications can be managed with conservative therapy usually.

Objective: To evaluate the clinical value of submucosal tunneling endoscopic resection (STER) for rectal submucosal tumors (SMT) originating from muscularis propria., Methods: Clinicopathological data of 8 cases with rectal SMT originating from muscularis propria undergoing STER in our center from March 2011 to March 2013 were analyzed retrospectively., Results: En bloc STER was performed successfully in all the 8 cases. The tumors location was 5-15 cm from the edge of anus. The resected specimen size ranged from 1.0 to 3.5 cm (average 1.8 cm). The mean procedure time was 51 min (range, 40-70 min). One patient developed mucosa perforation and was repaired with metal clips. One patient developed subcutaneous emphysema in one leg, which was disappeared after two weeks. Postoperative pathological examination revealed schwannoma in 3 cases, leiomyoma in 2 cases, stromal tumor in 1 case, and proliferation of collagen fibers nodular degeneration in 2 cases. Postoperative follow-up ranged from 6 to 30 months and no residual lesion or recurrence was found., Conclusion: STER is a safe and effective method for rectal SMT originating from muscularis propria in our initial experience.

Objective: To investigate the efficacy and safety of membrane-covered self-expanding metal stent in the treatment of high-positioned esophageal diseases, including esophageal stenosis, esophagotracheal fistula and anastomotic stricture., Methods: Clinical data of 84 patients who underwent stenting in our center from May 2005 to July 2013 were retrospectively analyzed. Of 84 patients, 31 were diagnosed as esophageal malignant stenosis, 2 compression stenosis, 10 radiation stenosis, 4 recurrent malignant stenosis, 27 anastomotic stricture, 1 esophageal stenosis after endoscopic submucosal dissection (ESD), 7 esophageal-tracheal fistula, 1 esophageal-mediastinal fistula, and 1 remnant stomach fistula. Distance from stenosis or fistula to central incisor was 15-20 cm in 48 cases, and more than 20 cm in 36 cases. All the patients were treated by 16 mm membrane-covered self-expanding metal stents. Main clinical manifestations and complications were evaluated., Results: A total of 100 stents were placed in 84 patients,with a success rate of 100%. There were no complications such as perforation and bleeding during operation. Dysphagia and cough were improved quickly with a success rate of 100%. After the placement of stents, the incidence of complication was 6.0% (5/84), of which 2 cases were severe retrosternal pain, 1 was tracheal collapse, and 2 were stent displacement. Seventy-six patients (90.5%) received complete follow-up of 1 to 36 months (mean 15 months). Re-stenosis occurred in 4 cases, new esophageal-tracheal fistula in 2 cases. Among these 6 cases, 5 cases underwent successfully stent placement once again, and another one case received Savary bougie and Argon-ion coagulation with good efficacy., Conclusion: Endoscopic membrane-covered self-expanding metal stent placement is effective and safe for the relieve of dysphagia symptoms and the sealing of esophagotracheal fistula.

Objective: To study the effects of nitrogen (N), phosphorus (P2O5) and potassium (K2O) fertilizers on the growth, yield total saponins content and nutrient absorption of Pulsatilla cernua and provide a theoretical basis for good agriculture practice., Methods: Field plot experiments was conducted, based on the D-saturation optimal design with three factors of nitrogen, phosphorus and potassium. Samples collected periodically were used for determination the contents of nutrient and total saponins, and for measurement of yield and agronomic characters., Results: Nutrient contents in Pulsatilla cernua varied with growth stage and part under the same growth stage. Nutrient contents in aerial part were higher than that in root, while the proportion of nutritional absorption from seedling stage to the middle growth stage was larger than that at the late growth stage. Yield and total saponins content of Pulsatilla cernua were significantly influenced by the N1P2O5 and K2O applications, among three factors, N had the greatest effects, the next was K2O and P5O2., Conclusion: Pulsatilla cerntua under field cultivation should be fertilized properly, top-dressing with these fertilizers during the early growth stage and increasing the proportion of potassium. According to total saponin production of Pulsatilla cernua, the optimum fertilization model for high yield and good quality is 180 kg/hm2 of N, 79.74 kg/hm2 of P2O5, and 225 kg/hm2 of K20, with a N : P2O : K2O ratio of approximately 2.3 : 1 : 2.8.

Drug metabolism studies, including in vivo and in vitro metabolism studies, are significant in the design of candidate compounds and screening of lead compounds at drug discovery/development stages. Compared with in vivo metabolism studies, in vitro metabolism studies have the advantages of rapidity, simplicity, without consumption of large amounts of samples and animals. Moreover, it is convenient for researchers to observe the selective interaction between compound and target. Therefore, in vitro metabolism studies are appropriate for high throughput screening of compounds which are lack of metabolism information and have been widely used during drug discovery stages. This article briefly introduced the application of in vitro drug metabolism studies based on the metabolic stability, reaction phenotyping and metabolic drug-drug interactions, aiming to raise valuable evaluation strategies for innovative drug discovery in China.

Objective: To evaluate the short-term efficacy and safety of endoscopic mucosal band ligation(EMBL) in the treatment of esophageal precancerous lesions and esophageal early cancer., Methods: Clinicopathological data of 21 cases with esophageal precancerous lesions and esophageal early cancer undergoing EMBL at the Endoscopic Center in Zhongshan Hospital of Fudan University from January 2012 to November 2012 were analyzed retrospectively. Short-term efficacy and complications after operation were summarized., Results: All the 21 cases underwent EMBL operation successfully. The mean operative time was(21.0±8.3) minutes. No subcutaneous emphysema, mediastinal emphysema, pneumothorax or delayed bleeding occurred. Esophageal stricture occurred in 2 cases and the symptoms were alleviated after balloon dilation. Pathological examination showed moderate dysplasia(n=1), moderate-severe dysplasia(n=2), severe dysplasia(n=10), carcinoma in situ(n=2) and early stage of squamous cell carcinoma(n=6). All the resection margins were negative except for 1 case of early stage squamous cell carcinoma, whose margin was only 1 mm and so underwent additional open surgery for esophageal cancer. No relapse of cancer was found during follow-up., Conclusion: EMBL can cure esophageal precancerous lesions and esophageal early cancer effectively and is safe, minimally invasive and simple to perform.

Procedure for prolapse and hemorrhoids( PPH) is one of the important techniques developed for the treatment of hemorrhoids with severe degree in the last decade. Its principle is based on the "anal cushion" theory.Compared with traditional hemorrhoidectomy , PPH has advantages of shorter operation time , minor degree of postoperative pain , shorter hospital stay and quicker recovery.However, the occurrence of relapse and re-prolapse of hemorrhoids is high. Besides, the short-term efficacy of PPH for the constipation outlet obstruction caused by anterior rectocele is also favorable.

Objective: To investigate PIK3CA, PTEN status in the primary lesion of colorectal cancer (CRC): relationship with occurrences of liver metastasis and its prognosis., Methods: Patients with CRC who had the primary tumor resected between 2003 and 2008 were selected and enrolled into three groups according to the occurrence of liver metastasis. The mutations of PIK3CA exon 9 and 20, PTEN exon 5, 7, 8 in primary cancer cells in formalin-fixed, paraffin-embedded specimens were detected by Pyrosequencing, then a statistical analysis was deduced to find out the relationship between PIK3CA, PTEN status and occurrences of liver metastasis as well as the prognosis., Results: Of all the 300 CRC cases, the mutation rates of PIK3CA and PTEN was 18.2% (51/300) and 16.3% (49/300). The multivariate Logistic analysis revealed that exon 5 mutation of PTEN was one of the independent risk factors of occurrence of metachronous liver metastasis in CRC patients (HR = 1.634, 95%CI: 1.796 - 3.355, P = 0.041). Patients with PTEN mutation had a poorer overall survival in group with synchronous liver metastasis (median survival time 62.0 months vs 71.0 months, χ(2) = 12.942, P = 0.048) while CRC patients who had the liver metastasis resected in group of synchronous and metachronous liver metastasis had a poorer disease free survival rates with PIK3CA mutation (median survival time 16.0 months vs 25.0 months, χ(2) = 9.679, P = 0.037)., Conclusions: The exon 5 mutation of PTEN of CRC is potentially correlated with the occurrence of synchronous liver metastasis. CRC patients who had the liver metatasis resected but with PIK3CA mutation could have a poorer prognosis.

Objective: To analyze the relationship of K-ras mutation with the development of liver metastasis in colorectal cancer patients and the survival outcomes., Methods: From 2003 to 2008, 300 patients who underwent colorectal cancer surgery in the Department of General Surgery of Zhongshan Hospital, Fudan University were assigned to different groups, according to the diagnosis and follow-up results. The mutation of exon 2 of K-ras was detected in primary paraffin-embedded lesions by PCR and Pyrosequencing. The association of gene mutation with the development of liver metastasis and its prognosis was studied., Results: Among 300 cases, the mutations of exon 2 were present in 120 cases(40%). The G13D mutation was more common in metachronous metastasis group than that in synchronous group(17.0% vs. 8.0%, P=0.041). Multivariable regression analysis showed that G13D mutation was an independent risk factor(HR=1.108, 95%CI:1.032-5.062, P=0.048) for metachronous metastasis. Patients with mutated K-ras had a poorer overall survival compared to those without mutated K-ras for patients without liver metastasis(median overall, 65 vs. 72 months, P=0.039), and for patients who received metastasis resection(median disease-free survival 18 vs. 24 months, P=0.048). Multivariable analysis showed that K-ras mutation was an independent risk factors of overall survival(HR=1.561, 95%CI:1.022-6.422, P=0.045) in patients without liver metastasis., Conclusion: Detection of K-ras mutation may predict the development of liver metastasis and prognosis.

Objective: To investigate the value of serum cystatin C (Cys-C), urinary Cys-C, urinary retinol binding protein (RBP) and urinary neutrophil gelatinase-associated lipocalin (NGAL) in the early assessment of multiple myeloma (MM) and their characteristic changes in different pathological types of renal impairment., Methods: According to glomerular filtration rate (eGFR), the patients were divided into two groups, of which marked group A with normal renal function, the other marked group B with abnormal renal function. Sixty healthy subjects were chosen as control. Detection of the serum Cys-C, urinary RBP, urinary Cys-C, urinary NGAL, serum creatinine (Scr), urinary microalbumin (MAU) and urinary α1-microglobulin (α1-MG) were performed. Renal biopsy was carried out for patients who had abnormal serum Cys-C, urinary Cys-C, urinary RBP, urinary NGAL and were willing to accept further test., Results: Compared with healthy controls, the serum Cys-C, urinary RBP, urinary Cys-C, urinary NGAL of group A were significantly higher than that of healthy controls. Six group A patients received renal biopsy, and varying degrees of renal damage were discovered. The serum Cys-C, urinary RBP, urinary Cys-C and urinary NGAL positive rate were 66.7%, 66.7%, 66.7% and 83.3%, respectively. Of twenty-four cases received biopsy after abnormal examination results were shown, six turned out to be amyloidosis, twelve cast nephropathy (CN) and 6 monoclonal immunoglobulin deposition disease (MIDD). Compared with MIDD and amyloidosis, the urinary Cys-C and NGAL of the CN group are significantly higher (P < 0.05). Compared with CN and amyloidosis, urinary RBP of MIDD is significantly higher (P = 0.043). Compared with MIDD and CN, the MAU of amyloidosis is significantly higher (P = 0.006)., Conclusion: Compared with the conventional indicators, serum Cys-C, urinary Cys-C, RBP and NGAL are more sensitive in early assessment of MM patients with renal damage. The MAU is higher in amyloid, the urinary Cys-C and urinary NGAL are significantly elevated in CN, the urinary RBP is significantly elevated in MIDD.

Objective: To investigate the clinical application and indication of endoscopic dissection technique for submucosal tumors (SMTs) of the esophagogastric junction (EGJ) originating from the muscularis propria., Methods: A total of 143 SMTs of the EGJ were treated by endoscopic resection in the Endoscopy Center of Zhongshan Hospital Affiliated to Fudan University between March 2007 and June 2011. The clinical and histopathologic feature, surgical approach, en bloc resection rate, complications, and postoperative follow up were evaluated., Results: There were 74 males and 69 females with a mean age of 49.1 years old. The en bloc resection rate was 94.4%(135/143). There were 126 patients who underwent endoscopic submucosal excavation in an en bloc fashion. Six patients underwent endoscopic full-thickness resection without laparoscopic assistance. Three patients underwent submucosal tunneling endoscopic resection. The other 8 SMTs were partially resected for histological evaluation and the residual tumors were further treated with nylon snare ligation. The mean lesion size was 17.6 mm. The mean procedure time was 45.1 minutes and the mean intraoperative bleeding was 50.0 ml. Perforations occurred in 6 patients and metal clips were used to close the defect. One patient with Mallory-Weiss syndrome was successfully treated with conservative treatment. Pathological examination showed that the lesions were leiomyoma (n=121), gastrointestinal stromal tumor (n=20), granulosa cell tumor (n=1), and intermuscular lipoma (n=1). No local recurrence and distant metastasis were noted during the follow-up (range, 3-48 months)., Conclusion: Endoscopic resection technique is safe and effective, and should be selected for each patient individually.

Objective: To assess the clinical value of endoscopic submucosal dissection(ESD) for duodenal lesion., Methods: A total of 78 patients with duodenal lesion were treated with ESD from November 2006 to August 2010. The clinical data were retrospectively analyzed., Results: There were 46 male and 14 female patients. The mean age was(54±9) years. The lesion location included the duodenal bulb(n=39, 50%), the junction of bulb and descending part(n=19, 24.4%), and the descending part(n=20, 25.8%). The mean diameter of the lesions was(2.1±1.7) cm. Fifty-one(65.4%) lesions originated from the mucosa, including inflammatory/ hyperplastic polyps(n=22, 28.2%), villous/tubular adenoma(n=26, 33.3%), and hamartomas polyps(n=3, 3.8%). Twenty-five(32.1%) lesions originated from the submucosa, including Brunner's glands adenoma(n=15, 19.2%), ectopic pancreas(n=3, 3.8%), carcinoid tumor(n=3, 3.8%), lipoma(n=2, 2.6%), myxoinoma(n=1, 1.3%), and angio-lymphangioma(n=1, 1.3%). There were two lesions originated from the muscularis propria(n=2, 2.5%), and both were ectopic pancreas. All cases received ESD successfully. The mean operative time was(37±41) min and the mean blood loss was(23±15) ml. The perioperative complication rate was 35.9%(28/78), including intraoperative perforation(n=6), delayed perforation(n=3), intraoperative hemorrhage(n=10), delayed bleeding(n=7), and transient elevation of serum amylase(n=2). Postoperative pathological examination showed vascular invasion with tumor cells in one patient, who received extended resection later. The remaining 77 patients showed no recurrence during the followed up(rang, 3-23 months) using endoscopy., Conclusion: ESD is an effective, safe, minimally invasive method for the management of duodenal lesions.

Objective: To prospectively evaluate the clinical value of different magnifying chromoendoscopy(MCE) methods in screening gastric precancerous lesions and early cancers., Methods: Between March 2010 and October 2011, among all the patients aged over 40 who received esophagogastroduodenoscopy at Zhongshan hospital, Fudan University, suspicious lesion was detected in 699 patients, who were randomly assigned to three groups: epinephrine dye(n=240), indigo carmine dye(n=246), and acetic acid-indigo carmine mixture dye(n=213). Diagnosis was made according to surface patterns and microvessels of the lesion. Pathological diagnosis was used as the gold standard. The concordance between endoscopic diagnosis and pathological diagnosis was evaluated through the agreement(Kappa) test. McNemar Paired chi-square test was used to compare the concordance of three MCE methods, regular white light, magnification alone, and NBI magnifier before and after MCE., Results: Pathological examination showed inflammatory lesions in 415 patients, intestinal metaplasia in 190, low grade intra-epithelial neoplasia in 17, and high grade intra-epithelial neoplasia or early cancer in 77. The percentage of patients with consistent endoscopic and pathological diagnosis was 77.1%(185/240) for epinephrine dye, 80.5%(198/246) for indigo carmine dye, and 81.2%(173/213) for acetic acid-indigo carmine mixture dye. Kappa values were 0.579, 0.502, and 0.667 respectively(all P<0.01). For the screening of high grade intra-epithelial neoplasia or early cancer, the diagnostic sensitivities were 84.0%, 83.3%, and 92.9%, respectively, and the specificities were 98.6%, 97.3%, and 98.4%. All the three chromoendoscopy methods improved the diagnostic accuracy for precancerous lesions compared with conventional gastroscopic observation with white light(all P<0.01). Indigo carmine and acid-indigo carmine mixture dye improved the diagnostic accuracy of magnification alone(both P<0.05). There was no significant difference in diagnostic accuracy between each MCE method and magnifying NBI observation(all P>0.05)., Conclusion: NBI magnification and all the three MCE methods may improve the diagnostic accuracy of early gastric cancer and precancerous lesions.

Objective: To investigate the effects of peroral endoscopic myotomy(POEM) on esophageal dynamics in patients with esophageal achalasia., Methods: From September 2011 to November 2011, 20 cases with esophageal achalasia received POEM at the Endoscopic Center in the Zhongshan Hospital of Fudan University. Pre-operation esophageal dynamics of all the patients were evaluated by high resolution manometry(HRM) system and 3 days after operation the test was repeated. Lower esophagus sphincter resting pressure(LESP), 4-second integrated relaxation pressure(4sIRP), lower esophagus sphincter relax rate(LESRR), lower esophagus sphincter length(LESL), and esophageal manometry were analyzed., Results: After POEM, LESP decreased from(29.1±17.0) mm Hg to(14.6±4.9) mm Hg, and decrease rate was 49.8%(P<0.01). However, the decreases in LESRR and LESL were not statistically significant(P>0.05). Esophageal peristaltic contraction was absent in all the 20 patients preoperatively. After POEM, changes in the esophageal contraction were seen in 7 patients, and peristalsis was noticed but was below normal level. There were no significant changes in peristalsis in the remaining 13 patients., Conclusion: POEM can significantly reduce LESP and 4sIRP in patients with achalasia, but can not affect the contraction of the esophagus.

Objective: To evaluate the clinical value of submucosal tunneling endoscopic resection(STER) for gastric submucosal tumor(SMT) originating from the muscularis propria (MP) layer., Methods: Clinicopathological data of 23 cases with gastric SMT originating from the MP layer treated with STER from September 2010 to December 2011 were analyzed retrospectively., Results: There were 13 males and 10 females. The age ranged from 28 to 73(mean, 52.4) years old. Of the 23 SMTs, 11 were located in the cardia adjacent to the gastric body, 4 in the cardia adjacent to the fundus, 5 in the lesser curvature of gastric body and 3 in the gastric antrum of greater curvature. All the SMTs originating from the MP layer, 14 were located in the superficial MP layer and 9 in the deep MP layer(including 5 gastric SMTs close to serosa). En bloc STER was performed successfully in all the patients. The mean lesion size was 2.1 cm(range 1.5-3.2 cm). The mean procedure time was 54.8 min(range 30-125 min). Pathological examination showed that the lesions were leiomyomas(n=10), stromal tumors(n=8), glomus tumor(n=2), Schwannoma(n=2), and calcifying fibrous tumor(n=1). Both lateral and vertical margins were negative in all the cases. Three patients developed pneumothorax and subcutaneous emphysema and 5 pneumoperitoneum. One patient developed effusion under the left half of the diaphragm and secondary infection. All of them recovered uneventfully after conservative treatments. No delayed bleeding or GI tract leakage was noticed. None of the 23 cases encountered submucosal hematoma or infection. No tumor residual or recurrence was found during the follow up(range, 3-18 months)., Conclusions: STER is a safe, effective for appropriate lesions in the MP layer of the stomach. En bloc resection and accurate histopathological evaluations can be achieved.

Objective: To investigate the feasibility and safety of endoscopic full-thickness resection(EFTR) in the treatment of colorectal submucosal tumor(SMT)., Methods: From September 2009 to March 2012, 4 cases with colorectal SMT received EFTR at the Endoscopic Center in the Zhongshan Hospital of Fudan University. The operative time, complications, and follow-up data were analyzed., Results: There were 3 females and 1 male. The age ranged from 33 to 78 years. The tumor location included the upper rectum(n=2), the ascending colon(n=1), and the descending colon(n=1). The mean operative time was 48.0(24-80) min. The mean diameter was 1.45(0.8-2.0) cm. Postoperative pathological examination revealed schwannoma, pneumatosis cystoides intestinalis, endometriosis, and mild hyperplasia of smooth muscle in the muscularis mucosa. There was no bleeding or perforation intraoperatively and postoperatively. Two patients developed abdominal pain and fever, one of whom had regional peritonitis and was managed by fasting and intravenous antibiotics. No surgical intervention was required. Postoperative follow up ranged from 1 to 30 months and no residual cancer or recurrence was found., Conclusion: EFTR is a safe and effective method for colorectal SMT.

Objective: To compare the enhanced recovery program after surgery (ERAS) with conventional perioperative management in patients undergoing radical resection for colorectal cancer., Methods: The ERAS protocol included a combination of evidence-based and consensus methodology. A total of 597 consecutive patients undergoing elective colorectal resection were randomized to either the ERAS(n=299) or the control group(n=298). Outcomes related to nutrition and metabolism index, stress index, and recovery index were measured and recorded., Results: Demographics and operative parameters were similar between the two groups(P>0.05). The nutritional status of patients in the ERAS group was improved after surgery compared with that of the control group. On postoperative day (POD) 1, the HOMA-IR in the ERAS group was significantly lower than that in the control group(P<0.01). The cortisol level in the control group was elevated on both POD 1(P<0.01) and POD 5(P<0.01) compared to the preoperative level. However, the cortisol level was not increased until POD 5(P<0.01) in the ERAS group. The levels of TNF-α, IL-1β, IL-6, and IFN-γ were reduced in the ERAS group, indicating less postoperative stress responses compared with the control group. In addition, ERAS group was associated with accelerated recovery of gastrointestinal function. The postoperative length of stay [(5.7±1.6) d vs. (6.6±2.4) d, P<0.01] and expense[(15 998±2655) RMB vs. (17 763±3059) RMB, P<0.01] were reduced in the ERAS group. Twenty-eight patients(9.4%) in the control group and 29(9.7%) in the ERAS group developed complications, while the difference was not statistically significant(P>0.05)., Conclusion: ERAS protocol alleviates surgical stress response and accelerates postoperative recovery without compromising patient safety.

Objective: To explore the risk factors of fungal infection so as to provide rationales for the prevention of fungal infection after liver transplantation., Methods: The clinical data of 94 cases of fungal infections after liver transplantation from January 1, 2003 to November 30, 2010 at our hospital were collected as the infective group. A total of 603 liver transplant patients without fungal infections during the same period were selected as the control group. χ(2) test and t test were utilized for the analysis of possible risk factors for fungal infection., Results: Fungal infection rate was 13.5% (94/697) after liver transplantation and mortality rate of fungal infection 86.2% (81/94). Candida albicans was the majority infective fungi. And the main site of infection was the lungs. The postoperative acute physiology and chronic health evaluation III (APACHE III) score of the infective group was significantly higher than that of the control group (26.0 ± 5.4 vs 21.5 ± 4.7, P < 0.01). The number of patients with primary liver cancer was lower than that of the control group (26.6% vs 45.8%, P < 0.01). The number of decompensated HBV cirrhosis and diabetics in the infective group was higher than that of the control group at pre-operation (23.4% vs 11.6%, 9.6% vs 2.8%, both P < 0.01). The number of patients with postoperative mechanical ventilation over 10 days, postoperative antibiotics over 14 days, postoperative cardiopulmonary dysfunction and liver function recovery time over 7 days, parenteral nutrition over 12 days and hyperglycemia over 7 days in the infective group were significantly higher than that in the control group (all P < 0.01)., Conclusion: Preoperative primary disease, postoperative disease severity, postoperative organ dysfunction, long-term mechanical ventilation, antibiotics and hyperglycemia, etc. may be the important risk factors of fungal infection after liver transplantation.

Objective: To study the value of the metal clips and endoloop snare for gastric wall defect after endoscopic full-thick resection(EFR)., Methods: All the patients who underwent complete closure of gastric wall defect after endoscopic full-thick resection with metal clips and endoloop snare in the Endoscopy Center of Zhongshan hospital from March 2011 to October 2011 were retrospectively studied. The feasibility, safety, and efficacy were evaluated., Results: Fourteen patients were included in this study. The median age was 49(32-63) years. Lesions located in the gastric body in 5 cases, the gastric fundus in 8 cases, and the gastric antrum and body junction in 1 case. The were diameter was 0.6-3.0 cm. Complete closure rate was 100% using this technique. The median repair time was 12(8-20) min. No patients were converted to surgery or laparoscopic surgery. Four patients complained of abdomen pain with elevated body temperature, and ultrasonography showed minor peritoneal fluid in 2 cases, which were drained. These four cases were asked to maintain semi-reclining position and were put on fasting, continuous gastrointestinal decompression, and received antibiotics. They were discharged after 1-3 days. All the patients were followed up with a median time of 3(1-8) months. Nylon and clips residual were removed endoscopically and the wound healing was satisfactory., Conclusion: Metal clips and endoloop snare is safe and effective for the closure of gastric wall defect after EFR.

In recent years, with the development of digestive endoscopy, endoscopic submucosal dissection(ESD) and its derived techniques including endoscopic submucosal excavation(ESE), submucosal tunnelling endoscopic resection(STER) and laparoscopic endoscopic combined surgery(LECS), can cure most of the gastric gastrointestinal stromal tumor(GIST). This article reviews the indication, method and evaluation of endoscopic resection for gastric GIST.

Objective: To evaluate the safety and efficacy of endoscopic submucosal dissection (ESD) for gastrointestinal stromal tumor(GIST) in the esophagogastric junction(EGJ)., Methods: Twenty patients with pathologically confirmed GIST in the EGJ were screened from all the patients undergoing ESD between November 2007 and June 2011. The clinicopathological and postoperative follow up data were analyzed., Results: There were 11 males and 9 females with the age ranging from 29 to 67 years(mean, 54.1 years). The maximum diameter of the lesions ranged from 8 to 20 mm(mean,14.8 mm). Fifteen patients underwent endoscopic submucosal excavation, 4 patients underwent endoscopic full-thickness resection, and 1 patient underwent submucosal tunneling endoscopic resection. The operative time ranged from 15 to 90 min(mean, 47.8 minutes). The estimated blood loss was 5 to 200 ml. The en bloc resection rate was 100%. Perforations occurred in 4 patients, pneumoperitoneum in 3 patients, cardia mucosal tear in 1 patient. All the complications were successfully managed with endoscopic intervention and conservative therapy. The post-operative follow up ranged from 3 to 36 months(mean, 13.2 months). No local recurrence or distant metastasis occurred., Conclusion: ESD is a safe and effective procedure for GIST in the EGJ.

Objective: To evaluate the feasibility, efficacy, and safety of metallic clips for closure of full-thickness defects in the stomach wall., Methods: Forty-eight rabbits were randomly divided into 4 groups with 12 in each group using random digits table. A 2 cm×2 cm full-thickness defect was created in the gastric body. No closure was performed in the first group; in the second group, mucosa closure with metallic clips; the third group, closure of full-thickness gastric tissue with metallic clip; the fourth group closure with 3-0 silk suture. After operation the animals were sacrificed at the third day and the seventh day. Wound healing was evaluated. Bursting pressure was recorded. HE and Masson staining was performed to inspect wound inflammation and tissue fibrosis situation., Results: After operation all the animals in the first group died within 34 hours, while those in other groups survived. No intraperitoneal bleeding or infection were seen in the survived animals. General observation showed that the metallic closure group caused less intraperitoneal adhesions. Operative time was shorter in the second and third group compared to the fourth group [(45.8 ± 1.6) min and (42.5 ± 1.5) min vs. (48.0 ± 1.4) min, P<0.05]. The bursting pressure on the third day was lower [(36.9 ± 4.6) mm Hg and (39.8 ± 4.1) mm Hg vs. (50.5 ± 4.2) mm Hg, P<0.05]. There was no significant difference in bursting pressure on the 7th day among the three groups [(95.0 ± 7.9) mm Hg and (97.8 ± 6.8) mm Hg vs. (98.5 ± 7.0) mm Hg, P>0.05]. HE staining revealed that metal closure had a better healing and Masson staining reflected no significant difference in healing at the same time point., Conclusions: Metal clips closure full-thickness defects in the stomach, regardless in full thickness or mucosa closure, is as safe and effective as suture closure.

Objective: To evaluate the value of endoscopic treatment for duodenal Brunner adenoma., Methods: Twenty-nine cases of duodenal Brunner adenoma were diagnosed by pathology between November 2006 and May 2010 in the Endoscopy Center of Zhongshan Hospital. The clinical data were retrospectively analyzed., Results: In 29 cases, there were 13 males and 16 females. The median age was 55(29-72) years. The mean adenoma diameter was (1.7 ± 0.1) cm, among which 17 adenomas ranged from 0.5 to 1.0 cm, 6 ranged from 1.0 to 2.0 cm, and 6 greater than 2.0 cm. Nine cases were treated by polypectomy, 12 by endoscopic mucosal resection (EMR), and 8 by endoscopic submucosal dissection(ESD). En-bloc resection rate was 100%. Intraoperative bleeding was seen in one case (200 ml), managed by nonsurgical method, including electrocoagulation, metal clips and nylon rope. Perforation occurred in 1 case during the procedure and was managed by metal clips. Delayed bleeding occurred in 1 case in the second day and was managed endoscopically. During a median follow-up of 13 (range, 2-39) months, the quality of life was satisfactory in this cohort, and no patients developed long-term complications. There was one recurrence within 1 year after the procedure and a second ESD was performed., Conclusion: Endoscopic treatment is technically feasible and may be considered as the procedure of choice for duodenal Brunner adenoma.

Objective: To evaluate the efficacy and the feasibility of peroral endoscopic myotomy (POEM) for esophageal achalasia (AC)., Methods: The clinical data of 42 patients diagnosed as AC and received POEM in the Zhongshan Hospital of Fudan University between August 2010 and March 2011 were reviewed retrospectively. The key procedures of POEM included esophageal mucosal incision, submucosal "tunneling" by endoscopic submucosal dissection(ESD) technique, endoscopic myotomy of the circular muscle, and closure of mucosal incision by hemostatic clips., Results: The mean age of 42 cases was 43.9(range 10-70) years. The mean duration of disease was 8.7 years (range, 3 months to 50 years). The mean operative time was (68.5 ± 25.5) (range 23-180) minutes with a mean submucosal tunneling length of(10.5 ± 1.5)(range 8-15) cm. The average length of endoscopic myotomy of inner circular muscle was(9.5 ± 2.5)(range 7-13) cm. No serious complications related to POEM were encountered. The median follow-up period was 2.5(range 1-6) months. Dysphagia symptom was relieved significantly during the follow-up period in 41 patients; one patient had dysphagia and vomiting 15 days after the operation. Endoscopic observation showed a submucosal fistula which was managed by endoscopic incision., Conclusions: As a novel minimally invasive therapy for AC, POEM appears to have definite short-term outcomes and can rapidly alleviate dysphagia symptom. Further observations and long follow-up are needed to evaluate long-term outcome and complications.

Objective: This study explored the subjective quality of life in children with Tourette syndrome (TS) in order to provide a basis for more effective interference of TS., Methods: A total of 174 children with TS (≥ 8 years old) and 186 aged-matched healthy children as controls were enrolled. The subjective quality of life was investigated by a case-control study., Results: The total score of subjective quality of life in the TS group (156.6 ± 21.1) was lower than that in the control group (164.2 ± 21.2; P<0.01). The scores of family life, school life, cognitive component, anxiety experience and depression experience (19.1 ± 3.5 vs 20.7 ± 3.0, 24.1 ± 4.4 vs 26.6 ± 3.2, 90.6 ± 13.3 vs 97.9 ± 15.3, 24.0 ± 4.6 vs 25.1 ± 3.1 and 23.8 ± 4.4 vs 24.7 ± 3.5) in the TS group were lower than those in the control group (P<0.05). The correlation analysis showed that the total score of subjective quality of life in children with TS was negatively related to the age, the course of disease, the severity of symptoms, the total score of child behavior problem and family conflict (r=-0.432, -0.213, -0.869, -0.137, -0.257; P<0.01), while it was positively related to family active-cultural orientation (r=0.084, P<0.01). The multiple step regression analysis indicated that the factors influencing the subjective quality of life in children with TS included the severity of symptoms, age, family conflict and family active-cultural orientation (β'=-0.787, -0.171, -0.109, 0.106; P<0.01)., Conclusions: The subjective quality of life is not well in children with TS. It is important to control clinical symptoms and improve family environment for the improvement of the subjective quality of life in children with TS.

Objective: To assess the application value of emergency colonoscopy in the diagnosis and treatment of acute colorectal obstruction., Methods: A total of 459 patients with acute colorectal obstruction received emergent colonoscopy from July 2002 to July 2010. The safety and effective rates were analyzed., Results: The diagnostic rate of successful emergency colonoscopy was 100% (459/459) without any complication. Colorectal cancer were found in 71.3% cases (327/459), volvulus of sigmoid in 11.3% (52/459), diaphragmatocele in 0.4% (2/459), megacolon congenitum in 0.6% (3/459), fecal obstruction in 2.7% (12/459) and none in 13.7% (63/459). The therapeutic rate of colonoscopy was 83.2% (385/459). There were colorectal cancer (n = 327), volvulus of sigmoid (n = 52) and megacolon congenitum (n = 3). The successful treatment rate was 95.8% (369/385) and the complication rate 1.4% (5/385). Among all colorectal cancers, 93.9% (307/327) received endoscopic drainage (mental stents or drainage tube) so as to avoid emergency operations and stoma. And 232 cases underwent phase I operation and another 75 cases received chemotherapy or supportive treatment., Conclusion: Emergency colonoscopy is an effective, safe, minimal invasive approach for diagnosing and managing acute colorectal obstruction.