Objective To observe the expression levels of p27 and PCNA protein in patients with chronic gastric diseases and in patients with gastric cancer,and to explore the correlation between the expressions of p27,PCNA protein and pathogenesis of gastric cancer.Methods A total of 155 biopsy specimens of gastric mucous membrane by gastroscopy were collected including 32 cases of chronic non-atrophic gastritis,25 cases of chronic atrophic gastritis, 30 cases of intestinal metaplasia,32 cases of atypical hyperplasia and 36 cases of gastric carcinoma. The expression levels of p27 and PCNA protein in gastric mucosa were detected by immunohistochemistry (SP) and statistically analyzed. Results The colouring of P27 protein in gastric cancer tissue superficial parts was relatively strong,however,which in deep part was relatively weak. The expression levels of p27 were gradually decreased in the order of chronic non-atrophic gastritis, chronic atrophic gastritis, intestinal memplasia,atypical hyperplasia and gastric carcinoma,however, the expression levels of PCNA were gradually increased with the order,there were significant differences between two groups each other(P<0.05).Moreover the expression levels of P27 were negatively correlated with chronic non-atrophic gastritis, chronic atrophic gastritis,intestinal memplasia, atypical hyperplasia and gastric carcinoma,(r= -0.976,P<0.01),however,the expression levels of PCNA were positively correlated with the disease types mentioned above (r=0.979,P<0.05).In addition the the expression levels of P27 were negatively correlated with those of PCNA among the 5 groups(r= -0.920,P<0.01).Moreover the expressio nlevels of P27 and PCNA protein were not correlated with patient's age and sex,location and size of tumor (P>0.05).Conclusion The expression levels of P27 and PCNA protein in gastric mucosa are correlated with the pathogenesis and development of chronic gastric diseases,gastric precancerous lesion and gastric cancer,which play an important role during the development process of gastric cancer.

Objective To investigate the effects of metformin on hepatic inflammation, liver fibrosis and insulin resistance in patients with type 2 diabetes mellitus ( T2DM) complicated by nonalcoholic fatty liver disease ( NAFLD). Methods A total of 70 patients with T2DM complicated by NAFLG who were admitted and treated in our hospital from June 2011 to May 2016 were divided into observation group ( n =35 ) and control group ( n =35 ) according to random number table. The patients in control group were treated by diet and exercise only,however,the patients in observation group,on the basis of control group,were treated by oral metformin. After 12-week treatment, the levels of tumor necrosis factor-α( TNF-α), interleukin 6 (IL-6), high sensitivity C reactive protein (hs-CRP), triglyceride (TG), total cholesterol (TC), high density lipoprotein ( HDL-C ) , low density lipoprotein ( LDL-C ) , alanine transferase ( ALT ) , aspartate aminotransferase (AST), type Ⅲ procollagen (PCⅢ), type Ⅳ collagen (Ⅳ-C), hyaluronic acid (HA), laminin (LN), fasting plasma glucose (FPG), 2h postprandial blood sugar glucose (2 hPG), glycosylated hemoglobin (HbA1c), fasting insulin (Fins), insulin resistance index ( HOMA-IR ) and incidence of adverse reactions before and after treatment were observed and compared between the two groups. Results After treatment, the indexes of serum inflammatory factors ( TNF-α, IL-6, hs-CRP) , indexes of blood lipid and liver function ( TC, TG, LDL-C, ALT, AST) , indexes of liver fibrosis ( PCⅢ,Ⅳ-C, LN, HA) and indexes of blood glucose and insulin (FPG, 2 hPG, Fins, HbA1c and HOMA-IR) were significantly decreased in both groups, as compared with those before treatment (P<0. 05). Moreover these indexes mentioned above in observation group were significantly lower than those in control group (P<0. 05), however the levels of HDL C in observation group were significantly higher than those in control group (P<0. 05). In addition there was no significant difference in incidence rate of adverse reactions during treatment between two groups (P>0. 05). Conclusion Metformin can significantly improve hepatic inflammatory reactions of patients with T2DM complicated by NAFLD, relieve liver fibrosis, reduce insulin resistance of body, which is conducive to control blood glucose smoothly, without increasing adverse reactions of patients.

Objective To study the expression of p27 protein and apoptosis index in gastric mucosa of patients with chronic gastric diseases and patients with gastric cancer, and to explore the relationship between the expression of p27 protein in gastric cancer and the evolution of AI. Methods A total of 155 mucosal biopsy specimens including 32 cases of chronic nonatrophic gastritis, 25 cases of chronic atrophic gastritis, 30 cases of intestinal metaplasia, 32 cases of atypical hyperplasia and 36 cases of gastric cancer from outpatients were enrolled in the study. The expression levels of p27 protein and apoptosis index ( AI) were detected by immunohistochemical SP method. Results Yellow or brown granules were located in the nucleus in gastric cancer tissues, with relatively weak staining in superficial layer and relatively strong staining in deeper layer. The expression levels of P27 protein were gradually decreased with the progression of disease. There were significant differences between the groups each other (P<0. 05). The positive staining of apoptotic cells were located in the nucleus, with condensed cytoplasm against the nuclear membrane or stained evenly, without inflammatory reaction around. With the progression of disease ( chronic nonatrophic gastritis, chronic atrophic gastritis, intestinal memplasia, atypical hyperplasia, gastric cancer) , AI was increased gradually in the first three stages, then decreased gradually in the last stages, and there were no significant differences between the first three groups each other (P > 0. 05),however, there were significant differences between the last three groups each other (P<0. 05). In addition, the expression of p27 protein in gastric mucosa of the patients was negatively related to the type of disease (r=0. 976,P<0. 01). However there was no correlation between the expression levels of AI and the type of disease (r=0. 060,P>0. 05),moreover, the expressions levels of p27 protein and AI were not correlated with patient's age, gender, the location and size of the tumor (P>0. 05). Conclusion The expression levels of P27 protein and cell apoptosis are related with the pathogenesis and development of chronic gastric diseases, gastric precancerous lesions and gastric cancer, which play an important role in the evolution of gastric cancer.

Objective To study the expression of p27 proteins and cyclin B1 in gastric mucosa in patients with chronic gastritis and gastric carcinoma,and their correlations with pathogenesis of gastric carcinoma. Methods Immunohistochemical SP method was used to investigate the expression levels of p27 and cyclin B1 in chronic non-atrophic gastritis,chronic atrophic gastri-tis,intestinal metaplasia,atypical hyperplasia and gastric carcinoma. Results From chronic non-atrophic gastritis to chronic a-trophic gastritis,intestinal metaplasia,atypical hyperplasia and the final gastric carcinoma,the expression levels of p27 proteins decreased while cyclin B1 increased,showed a negative correlation. Conclusion The expression levels of p27 proteins and cyclin B1 are related to chronic gastritis,gastric lesion and gastric carcinoma,both take significant roles in the development of gastric carcinoma.

Objective To explore and analyze the effect of crystal and colloid fluid resuscitation on hemodynamics in patients with severe acute pancreatitis. Methods 100 cases of severe acute pancreatitis were randomly divided into observation group and control group,50 cases in each group according to the random number table method,cases of severe acute pancreatitis in our hospital from June 2015 to January 2012. The observation group give 6% hydroxyethyl starch 130 / 0. 4 0. 9% sodium chloride solution resuscitation,the control group were given 0. 9% sodium chloride solution resuscitation,the venous blood gas analysis results to adjust the amount of fluid,observe and record two groups of patients with map(mean arterial pressure),HR(heart rate),PaO2 / FiO2(oxygen index)and PVpi(pulmonary vascular permeability index),EVLWI(extra-vascular lung water index),CVP( central venous pressure)and volume of liquid. Results After repeated analysis of variance,MAP,HR, PaO2 / FiO2 ,two groups were significantly improved,with statistical significance( P ﹤ 0. 05). There was no significant difference in HR,MAP and PaO2 / FiO2 between the two groups( P ﹥ 0. 05). CVP,PVPI,EVLWI,CVP were significantly improved,with statistical significance. There were no significant differences in EVLWI,CVP and PVPI between the two groups( P ﹥ 0. 05). In the two groups,the amount of liquid used was significantly different( P ﹤ 0. 05). The total amount of liquid used in the observation group was significantly lower than that of the control group ( P ﹤ 0. 05). Conclusion For the patients with severe acute pancreatitis,the recovery of the liquid and the recovery of colloid solution can ef-fectively improve the hemodynamics and the effect is not obvious. But after adding colloid can effectively reduce the total volume of patients,re-duce the patient capacity load.

目的 探讨定量与定性便隐血检测在下消化道疾病诊疗中的应用价值.方法 选择我院2015年1月至2015年7月经肠镜检查和病理诊断确诊的下消化道疾病患者392例,共分3组:结直肠癌组(40例)、慢性结肠炎组(247例)、结直肠息肉组(105例).分别取大便标本,用定量法和定性法检测便隐血,比较两种方法的检测效果.结果 两种检测方法在各组阳性检出率上无统计学差异(P＞0.05),结直肠癌组、结肠息肉组、慢性结肠炎组便隐血阳性测定值中位数分别为1208.00、305.00、179.50 ng/mL.结直肠癌组阳性测定值较结肠息肉组(x2=36.339,P=0.00)和慢性结肠炎组(x2=57.080,P=0.00)对比,差异有统计学意义(P＜0.01).结直肠息肉组阳性测定值与慢性结肠炎组(x2=24.020,P=0.00)比较,差异有统计学意义(P＜0.01).结论 与定性法检测相比,定量法检测便隐血对下消化道良恶性疾病的鉴别更有应用价值.

目的:探讨乌司他丁对急性胰腺炎患者的临床疗效及可能机制.方法:收集我院收治的重症急性胰腺炎患者66例,随机分为实验组和对照组.所有患者均给予禁食水、充分补液、纠正电解质紊乱等常规支持对症治疗.对照组予奥曲肽,实验组予乌司他丁,共治疗7天.测定两组患者治疗前、后各血清白介素-6(IL-6)、白介素-8(IL-8)及肿瘤坏死因子-α(TNF-α)水平;治疗前、治疗第1、3天及治疗后进行血常规检测,观察白细胞计数(WBC),并进行血淀粉酶(AMS)、尿淀粉酶(UAMY)测定;分别记录两组患者临床症状及体征恢复时间,判定临床疗效.结果:①治疗后,两组患者血清IL-6、IL-8及TNF-α水平均较治疗前显著下降,且实验组较对照组下降更明显(P＜0.05);②治疗后,两组患者白细胞计数及血、尿淀粉酶水平均较治疗前明显下降,且实验组较对照组下降更明显(P＜0.05);③治疗后,实验组各项临床症状及体征消失时间均明显短于对照组(P＜0.05).结论:乌司他丁可有效改善急性胰腺胰腺炎患者的各项临床症状,这可能与其显著降低其血清IL-6、IL-8、TNF-α、淀粉酶水平、白细胞计数及尿淀粉酶水平有关.

Objective To investigate the clinical value of blood gas analysis in the early stage of severe acute pan-creatitis (SAP). Methods A total of 64 patients with SAP, who admitted to ICU of our hospital from September 2012 to Sep-tember 2014, were enrolled in the study. With ICU stay of 10 d as the primary endpoint, the patients were divided into survival group (36 cases, with remission or with no deterioration) and death group (28 cases, death). All patients were treated by routine treatment in ICU. Blood gas analysis and electrolyte examination were carried out within 48 h, which were compared with the results of APACHEⅡ. Results Blood gas test results within 48 h showed that there were sig-nificant differences in arterial-venous blood pH (A-VpH) [(0.022±0.09) vs (0.031±0.015)] and arterial-venous blood CO2 levels (A-VPCO2) [(8.68 ± 1.35) vs (11.48 ± 4.56)] between survival group and death group (P<0.05), with no significant differences in blood pH [(7.35±0.06) vs (7.36±0.05)] and blood PO2 levels [(95.3±8.9) mmHg vs (95.9±9.1) mmHg], P>0.05. The two groups showed statistically significant differences in PCO2 [arterial:(35.3 ± 3.0) mmHg vs (29.9 ± 3.0) mmHg;venous:(35.3 ± 3.0) mmHg vs (29.9 ± 3.0) mmHg], blood HCO3-[arterial:(23.8 ± 1.2) mmol/L vs (20.2 ± 1.9) mmol/L;venous: (17.5±1.0) mmol/L vs (19.3±1.2) mmol/L], blood Lac [arterial: (2.7±0.9) mmol/L vs (4.1±1.7) mmol/L;venous:(1.7±0.6) mmol/L vs (1.8±0.4) mmol/L mmol/L], blood BE [arterial:(-1.7±1.2) mmol/L vs (-4.3±1.6) mmol/L;arterial:(1.9±1.2) mmol/L vs (2.1±0.9) mmol/L mmol/L] (P<0.05). There were no significant differences between the surviv-al group and the death group in the levels of K+[(3.71 ± 0.69) mmol/L vs (3.79 ± 0.70) mmol/L], Na+[(135.60 ± 7.88) mmol/L vs (134.32±7.94) mmol/L], Cl-[(100.85±20.73) mmol/L vs (98.49±24.3) mmol/L] within 48 h (P>0.05). The Ca2+levels in the two groups were both decreased, and the level in the survival group was significantly lower than that in death group [(1.47 ± 0.50) mmol/L vs (1.22 ± 0.38) mmol/L,P<0.05]. In order to determine the value of PCO2, HCO3-and BE in the prognosis of patients with SAP, the ROC curves were used to calculate the accuracy rate of prognosis of patients with SAP. The area under the ROC curve of BE and APACHEⅡscore was the largest, which indicated the highest diagnostic accuracy. Conclusion The early detection of blood gas analysis in patients with SAP is more conducive to the judg-ment of prognosis. The prognosis of patients with bigger negative BE score and older age may be poor.

目的：探讨运用早期腹腔置管灌洗透析治疗急性重症胰腺炎的治疗效果。方法选取2010年3月～2013年1月收治的急性重症胰腺炎患者60例，分成观察组和对照组，各30例。对照组进行常规治疗，对患者施以生长抑素、抑酸、抗感染、保持水电平衡的治疗。观察组患者则在对照组患者基础上实施腹腔置管灌洗透析治疗。分析对比两组的临床疗效情况、住院时间以及腹水淀粉酶的改善情况。结果对照组总的有效率为63.3%，低于观察组总的有效率为93.3%，组间差异具有统计学意义（P＜0.05）；两组患者在住院时间、腹水淀粉酶水平上差异也均具有统计学意义（P＜0.05）。结论联合运用早期腹腔置管灌洗透析治疗急性重症胰腺炎，与一般的治疗方法比较，能显著改善患者的临床症状，降低腹水淀粉酶的水平，缩短住院时间，具有更好的效果。

目的：探讨慢性萎缩性胃炎内镜下诊断与病理诊断的相关性。方法对在内镜下诊断慢性萎缩性胃炎倾向的338个病例进行分析。结果338例内镜下诊断为慢性萎缩性胃炎倾向的患者中199例与病理结果相符合，均位于胃窦部，符合率为58．88％（199/338），其中伴肠化生133例，伴轻度异形增生43例；伴重度异形增生2例。338例中幽门螺旋杆菌感染（H．pylori）阳性率为48．22％（163/338）；病理确诊为慢性萎缩性胃炎的H．pylori阳性率为63．82％（127/199）。结论慢性萎缩性胃炎内镜下和病理诊断及H．pylori感染有一定相关性，掌握镜下表现，采取H．pylori检测、胃镜检查与病理诊断相结合的方法有利于慢性萎缩性胃炎的正确诊断。

目的：高频彩色多普勒超声对甲状腺疾病的诊断价值。方法回顾性分析2009至2013年收治的甲状腺疾病患者398例，采用高频彩色多普勒超声进行检测，全部进行术后病理诊断对照，观察病变区的血流分布[收缩期血流速度（Vs）、舒张期血流速度（Vd）、阻力指数（RI）]。结果甲状腺疾病的诊断符合率为90构．7％（361/398），其中良性病变符合率为91．6％（327/357），恶性病变符合率为83．0％（34/41）。多发性结节311例（78．1％），单发结节87例（21．9％）。甲状腺内结节共有431个，结节呈囊性或混合性回声247个（57．3％）；结节完全为实性回声184个（42．7％）。结节性甲状腺肿与水平与甲状腺腺瘤比较，差异有统计学意义（ P ＜0．01）。甲状腺腺瘤和甲状腺癌的Vd、RI水平与结节性甲状腺肿比较，差异有统计学意义（ P ＜0．01），甲状腺癌Vd、RI水平与甲状腺腺瘤比较，差异有统计学意义（ P ＜0．01）。结论应用二维声像图特征，结合彩色多普勒及脉冲多普勒血流参数测值，对甲状腺结节可做出较准确的诊断。

<正>患者,女性,67岁,农民,主因胸骨后疼痛2d入院。患者2d前无明显诱因出现胸骨后疼痛,呈持续性压榨样疼痛,伴有双侧胸部及背部疼痛、烧心反酸,于当地医院予扩张冠状动脉、改善微循环治疗,症状无好转,后查心电图、心肌酶、肌钙蛋白及上消化道造影未见异常,予"奥美拉唑",效果欠佳。遂来我院消化科就诊。患者发病以来无发热、胸闷、心悸、气短、喘憋、腹痛、腹胀、呕吐、吞咽困难、吞咽疼痛等不适,二便正常,纳差,睡眠欠佳。10年前诊断"高血压病",血压最高达180/90mm Hg,日常口服"脉通",血压控制在正常范围。1周前患"上呼吸道感染",自行抗感染治疗(具体用药不详),入院时鼻塞、

AIM:To observe the characteristics of autonomic nervous activity before and after meals in individuals with obesity,and to discuss the relationship between autonomic nervous activity and gastric motility. METHODS:One hundred and two subjects with obesity and 49 controls were studied with 24-hours dynamic electrocardiography,and the electrocardiograms were recorded 1 hour be- fore and after meals.Heart rate variability was analyzed. RESULTS:Before a meal,SDNN index,RMSSD, high frequency power(HF)and ultra-low fre- quency power(ULF)in subjects with obesity were higher than those in control subjects(87.31±15.64 ms,82.50±67.19 ms,31 168.60±6361.00 ms~2,22 814.17±4083.90 ms~2 vs 79.38±12.28 ms,56.04±10.15 ms,12 999.4±5995.00 ms~2, 16 595.75±5615.09 ms~2,P<0.05,P<0.01),and L/H was lower in subjects with obesity than in the controls(0.65±0.43 vs 0.99±0.42,P<0.01). After a meal,RMSSD and HF were higher in subjects with obesity than in the controls(87.90±57.21 ms,36 158.56±6361.00 ms~2 vs 39.25±11.15 ms,6570.50±5995.80 ms~2,P<0.01).SDN- Nindex,ULF and low-frequency power(LF)/HF were lower in the subjects with obesity than in the controls(79.59±32.54 ms,14 135.7±8083.90 ms~2,0.63±0.34 vs 141.67±10.28 ms,22 785.63±9615.20 ms~2,1.11±0.32,P<0.01).Compared with before meals,SDNNindex,ULF and LF/ HF after meals increased significantly in the con- trols(P<0.01),and RMSSD and HF decreased markedly(P<0.01).In subjects with obesity,af- ter meals,SDNNindex and ULF decreased,and RMSSD and HF increased significantly(P<0.01); LF/HF did not differ between before and after meals(P>0.05). CONCLUSION:In fasting and post-prandial states,people with obesity have abnormal auto- nomic nervous activity.This may be one mecha- nism of hypermotility in obesity.