Comparison of the clinical effects among single-incision laparoscopic appendectomy, laparoscopic appendectomy and open appendectomy in elderly patients with acute appendicitis / 中华老年医学杂志

Objective To compare the clinical effects among single-incision laparoscopic appendectomy (SILA),laparoscopic appendectomy(LA)and open appendectomy(OA)in the treatment of elderly patients with acute appendicitis.Methods A total of 98 consecutive elderly patients undergoing appendectomy in our hospital from November 2014 to December 2016 were retrospectively selected.Among them,31 patients underwent SILA,35 underwent LA and 32 underwent OA.The operation time,the first exhaust time after operation,length of hospital stay,Numerical Rating Scale(NRS)pain score,wound infection rate and incidence of postoperative complications were compared between the three groups.Results The postoperative venting time and length of hospital stay were shorter,NRS was less,wound infection rate and incidence of postoperative complications were lower in the SILA and LA groups than in the OA group[(21.5±5.2) h,(22.1±5.4) h vs.(24.8±5.8) h,(4.5±1.3) d,(4.8±1.4) d vs.(9.4±1.5) d,(3.7±0.5),(4.1±0.7) vs.(6.3±0.9),0％,0％ vs.12.5％,9.7％ or 3/31,14.3％ or 5/35 vs.43.8％ or 14/32,respectively,P ＜ 0.05),while the operative time was less in the LA and OA groups than in the SILA group(45.4±10.5) min,(48.6±1.4) min vs.(73.2±12.3)min,P＜0.05).The incision NRS pain score was lower in the SILA group than in the LA and OA groups(3.7±0.5 in SILA vs.4.1±0.7 in LA vs.6.3±0.9 in OA,P＜0.05).Conclusions LA has advantages of less trauma,less pain,quicker recovery,fewer complications and beautiful incisions.SILA has less pain than LA,but needs longer operative time.SILA is worthy of promotion in the treatment of acute appendicitis especially in the elderly,but still needs further improvement.

Comparison of the clinical effects among single-incision laparoscopic appendectomy, laparoscopic appendectomy and open appendectomy in elderly patients with acute appendicitis / 中华老年医学杂志

Objective@#To compare the clinical effects among single-incision laparoscopic appendectomy(SILA), laparoscopic appendectomy(LA)and open appendectomy(OA)in the treatment of elderly patients with acute appendicitis.@*Methods@#A total of 98 consecutive elderly patients undergoing appendectomy in our hospital from November 2014 to December 2016 were retrospectively selected.Among them, 31 patients underwent SILA, 35 underwent LA and 32 underwent OA.The operation time, the first exhaust time after operation, length of hospital stay, Numerical Rating Scale(NRS)pain score, wound infection rate and incidence of postoperative complications were compared between the three groups.@*Results@#The postoperative venting time and length of hospital stay were shorter, NRS was less, wound infection rate and incidence of postoperative complications were lower in the SILA and LA groups than in the OA group[(21.5±5.2) h, (22.1±5.4) h vs.(24.8±5.8) h, (4.5±1.3) d, (4.8±1.4) d vs.(9.4±1.5) d, (3.7±0.5), (4.1±0.7) vs. (6.3±0.9), 0%, 0% vs. 12.5%, 9.7% or 3/31, 14.3% or 5/35 vs. 43.8% or 14/32, respectively, P<0.05), while the operative time was less in the LA and OA groups than in the SILA group(45.4±10.5) min, (48.6±1.4) min vs.(73.2±12.3)min, P<0.05). The incision NRS pain score was lower in the SILA group than in the LA and OA groups(3.7±0.5 in SILA vs.4.1±0.7 in LA vs. 6.3±0.9 in OA, P<0.05).@*Conclusions@#LA has advantages of less trauma, less pain, quicker recovery, fewer complications and beautiful incisions.SILA has less pain than LA, but needs longer operative time.SILA is worthy of promotion in the treatment of acute appendicitis especially in the elderly, but still needs further improvement.

Current status and perspectives of integrated traditional Chinese and Western medicine therapy for pancreatitis / 临床肝胆病杂志

Integrated traditional Chinese and Western medicine therapy for pancreatitis has been used since the 1960s.According to the clinical manifestations and traditional Chinese medicine (TCM) syndrome differentiation of pancreatitis,pancreatitis was named true heart pain with cold limbs caused by spleen disease.Syndrome differentiation of acute pancreatitis and treatment with modified Dachaihu decoction achieved good clinical effects.After the 1990s,the research focus of pancreatitis research was shifted to severe acute pancreatitis (SAP).The clinical course of SAP was divided into three phases,and different therapeutic regimens were given.Clinical studies achieved good therapeutic effects in terms of cure rate and fatality rate.After 2000,integrated traditional Chinese and Western medicine therapy for chronic pancreatitis has been promoted systemically,and the cooperation between traditional Chinese medicine,endoscopic techniques,and operative treatment helps to significantly improve pain control,nutritional status,and incidence of complications.

A study on alleviation of acute lung injury in rats with bowel repletion pattern by mesenteric lymph drainage and its mechanism / 中国中西医结合急救杂志

Objective To observe the effects of mesenteric lymph drainage on acute lung injury and expression of p38 mitogen activated protein kinase (p38MAPK) signal pathway in rats with bowel repletion pattern. Methods Thirty male Wistar rats were randomly divided into three groups according to random number table method, namely sham operation group (sham group), bowel repletion model group (model group) and mesenteric lymph drainage group (drainage group), 10 rats in each group. The rat model of bowel repletion was established by ischemia/reperfusion (I/R) method, firstly 1 hour occlusion of superior mesenteric artery (SMA) to induce ischemia followed by reperfusion for 2 hours. In the rats of drainage group, the drainage of mesenteric lymph duct began at the end of model establishment and persisted for 3 hours. In the rats of sham group, the SMA and mesenteric lymph ducts were exposed with blunt dissection, and then they were immediately placed back into the abdominal cavity. After 3 hours of mesenteric lymph drainage, the lung and ileum tissues of rats in each group were harvested for evaluation of pathohistological changes and for the determination and comparison of myeloperoxidase (MPO) activity changes; the levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in bronchoalveolar lavage fluid (BALF) were detected by enzyme linked immunosorbent assay (ELISA), and the expressions of Toll-like receptor 4 (TLR4) mRNA and p38MAPK mRNA in the lung tissues were measured by fluorescence quantitative polymerase chain reaction (PCR).Results Under the light microscope, the pulmonary capillaries markedly dilated and congested, the interstitium width of lung increased with a large amount of inflammatory cells infiltration, the intestinal mucosal layer becoming thinner with detachment of intestinal villi and a large amount of inflammatory cells infiltration were detected in rats of model group. Compared with those in sham group, the levels of TNF-α and IL-6 in BALF, the MPO activity of lung and ileum tissues, and the expressions of TLR4 mRNA and p38MAPK mRNA in the lung tissues were significantly increased in model group.Compared with those in model group, the pathohistological damages in lung and ileum tissues were ameliorated, the levels of TNF-α and IL-6 in BALF, the MPO activity of lung and intestinal tissues and the expressions of TLR4 mRNA and p38MAPK mRNA in the lung tissues were lower in the rats of drainage group [TNF-α in BALF (ng/L): 858.55±27.16 vs. 1 680.58±105.62; IL-6 in BALF (ng/L): 0 vs. 484.71±5.43; MPO activity of lung (U/g): 0.95±0.13 vs. 1.36±0.11; MPO activity of ileum tissues (U/g): 0.75±0.13 vs. 1.30±0.16; TLR4 mRNA: 0.21±0.11 vs. 0.69±0.13, p38MAPK mRNA: 0.21±0.13 vs. 0.47±0.09; allP < 0.05].Conclusion Mesenteric lymph drainage can alleviate acute lung injury in rats with bowel repletion, and its mechanism may be related to the reduction of the expressions of TLR4 mRNA and p38MAPK mRNA and the release of TNF-α and IL-6 in lung tissues.

Effect of different dose of persicae semen extract to barrier function of intestinal mucous membrane and immunologic function in acute pancreatitis rats / 中国免疫学杂志

Objective:To study the effect of different dose of persicae semen extract extract(PSE) to barrier function of the intestinal mucous membrane and immunologic function in acute pancreatitis rats.Methods:A total of 48 rats were divided into model control group,low dose,medial dose and high dose PSE groups,and there were 12 rats in each group.Another 12 rats were Sham-operation group.After anesthesia recovery,rats in low dose,medial dose and high dose PSE groups respectively received PSE 0.12 g/kg,0.248 g/kg and 0.36 g/kg,and rats in Sham-operation group and model control group receive isovolumetric distilled water,once per 6 h,4 times in 24 hours.All rats were anesthetized by 10%chloral hydrate after in 24th hour after dosing.Thorax and enterocoelia were opened; 5 ml of blood were respectively drawed to EDTA-anticoagulation tube and un-anticoagulation tube from aorta abdominalis.CD4+, CD8+and Treg cells were determined by direct fluorescent-labelded flow cytometry.IgA, IgG and IgM were determined by immunoturbidimetry.Serum amylase was determined by EPS-G7 substrate,D-lactic acid was determined by enzymology, and serum diamine oxidase was determined by active ration of colorimetry method.Pathological examination of small intestine mucous membrane tissue was taken after HE staining.sIgA in small intestine was determined by radioimmunoassay.mRNA of TLR4 and NF-κBp65 in small intestine tissue was determined by RT-PCR.Results:(1) Serum amylase,D-lactic acid and diamine oxidase in medial dose and high dose PSE groups were significantly decreased ( P<0.01 ) , and sIgA in small intestine was significantly increased ( P<0.01).These indicators were significantly different in medial dose and high dose PSE groups(P<0.01).(2) CD4+and CD4+/CD8+in medial dose and high dose PSE groups were significantly increased(P<0.01),and CD8+,Treg cells were significantly decreased(P<0.01) compared with those in low dose PSE group.These indicators were significantly different in medial dose and high dose PSE groups(P<0.01).(3) IgA,IgG and IgM in medial dose and high dose PSE groups were significantly decreased(P<0.01) compared with those in low dose PSE group.These indicators were significantly different in medial dose and high dose PSE groups(P<0.01).(4) Small intestine mucous membrane tissue in Sham-operation group was not damaged significantly,but that in model control group was damaged significantly.Small intestine mucous membrane tissue in low dose PSE group was similar to that in model control group,and damage in medial dose and high dose PSE groups was decreased significantly.( 5 ) mRNA of TLR4 and NF-κBp65 in small intestine tissue in medial dose and high dose PSE groups were significantly increased ( P<0.01 ) compared with those in low dose PSE group.These indicators were significantly different in medial dose and high dose PSE groups ( P<0.01 ).Conclusion: PSE has protective effect to barrier function of the intestinal mucous membrane,and significantly improve the immunologic function.

Analysis of components of mesenteric lymph in rats with severe intraperitoneal infection / 中华危重病急救医学

Objective To investigate the components of mesenteric lymph of the rats with severe intraperitoneal infection,and inquire into the effect of intestinal lymphatic pathway in severe intraperitoneal infection.Methods Twenty-four male Wistar rats were randomly divided into two groups according to random number table method,namely model group and sham group with 12 rats in each group.The rat model of severe intraperitoneal infection was reproduced by injecting artificial gastric juice and E.coli intraperitoneally.Mesenteric lymph in both groups was collected 4 hours after the reproduction of the model,and white blood cells were counted and classified.The levels of endotoxin,alkaline phosphatase (AKP),lactate dehydrogenase (LDH),creatine kinase (CK),glutamine transferase (GST),protein and cytokines of mesenteric lymph were determined.Results Compared with the sham group,there was an increase in the neutrophil ratio in mesenteric lymph (0.167 ± 0.004 vs.0.610 ± 0.006,t=33.520,P＜0.001),however the percentage of both macrophages (0.009 ± 0.001 vs.0.020 ± 0.004,t=-6.677,P＜0.001) and lymphocytes (0.824 ± 0.005 vs.0.921 ± 0.004,t=-31.471,P＜0.001) was decreased in model group.Compared with sham group,the levels ofendotoxin (kEU/L:0.346 ±0.022 vs.0.186 ±0.001,t=18.103,P＜0.001),AKP [U (king unit):13.97 ± 5.55 vs.3.76 ± 0.18,t=4.503,P=0.006],LDH (U/L:2 827.45 ± 1 940.32 vs.712.68 ± 14.09,t=2.670,P=0.044),CK (kU/L:2.19 ± 1.21 vs.0.70 ± 0.01,t=3.035,P=0.029),GST (kU/L:12.33 ± 6.53 vs.1.36 ± 0.39,t=4.105,P=0.009) were all significantly elevated.The concentration of protein (g/L:4.40 ± 0.48 vs.2.84 ± 0.16,t=6.882,P=0.001),tumor necrosis factor-α [TNF-α (ng/L):499.39 ±76.36 vs.180.90 ± 70.98,t=7.483,P＜0.001],interleukin-6 [IL-6 (μg/L):13.74 ± 0.78 vs.-0.07 ± 0.07,t=52.972,P＜0.001],intercellular adhesion molecule-1 [ICAM-1 (ng/L):2 754.19 ±221.48 vs.1 362.85 ±393.43,t=6.891,P＜0.001] and monocyte chemo-attractant protein-1 [MCP-1 (μg/L):28.23 ± 1.77 vs.24.87 ± 1.15,t=3.561,P=0.007] and high mobility group protein-1 [HMGB-1 (ng/L):1 392.78 ± 572.42 vs.564.17 ± 21.32,t=3.543,P=0.016] in mesenteric lymph in model group were significantly higher than those in sham group.Conclusion Intestinal lymphatic pathway maybe the early pathway for the production of remote organ injury caused by severe intraperitoneal infection.

The effect of Qingfei Chengqi decoction on lung tissue cell apoptosis in rats with severe intraperitoneal infection / 中国中西医结合急救杂志

Objective To observe the effects of Qingfei Chengqi decoction on lung tissue cell apoptosis and its associated protein,tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)of lung tissues in rats with severe intra-peritoneal infection(SII). Methods Thirty male Wistar rats were randomly divided into three groups:sham operation group,model group and traditional Chinese medicine(TCM)group(each n=10). Simulating clinical pathophysiological process of digestive tract perforation,the rat model of SII was reproduced by injecting E. coli intraperitoneally. The TCM group was treated by gavage with Qingfei Chengqi decoction one day in advance of the study,3 times per day,once 2 mL. The same amount of nutrient broth which contained 10%barium sulfate(BaSO4) to replace the bacteria solution was injected into the sham operation group. Six hours after model establishment,all rats were killed and lung tissues were harvested for pathohistological evaluation and for the determination of apoptosis rate with TdT-mediated dUTP nick-end labeling(TUNEL)method,of Bax,Bcl-2 protein expression with Western Blot method,and of the level of TNF-α,IL-6 with enzyme-linked immunosorbent assay(ELISA)method,and the pathological changes of lung tissues were observed under the light and electron microscopes. Results Compared with sham operation group,the apoptosis rate〔(12.7±5.4)%vs. 0〕,the expression of Bax protein〔absorbance(A)value:8 416.89±875.16 vs. 6 654.09±1 130.18〕,the level of TNF-α(ng/L:3 132.56±457.96 vs. 1 948.55±269.32), the level of IL-6(ng/L:75.14±1.63 vs. 31.17±0.81)of lung tissues were significantly increased(all P<0.05), meanwhile Bcl-2 protein expression decreased observably(A value:7 490.59±200.34 vs. 12 289.02±535.93,P<0.05)in model group induced by SII. After treatment with TCM,apoptosis rate〔(7.9±0.3)%〕,the expression of Bax protein(A value:7 619.50±999.30),the level of TNF-α(ng/L:3 114.34±454.32)and IL-6(ng/L:52.46±0.96) of lung tissues were decreased and Bcl-2 protein expression(A value:11 155.07±1 018.87)increased(all P<0.05) compared with model group. General observation:the color of lung tissues was uniform in sham operation group;the lung tissues of model group swelled obviously,and parts of lung tissues had patches of ecchymosis and hemorrhage. The light microscope showed:the pulmonary vessels,the alveolar interstitium,alveolar epithelium and lobular interstitium of sham operation group were all normal,while in the model group,the pulmonary interstitium was edematous and hemorrhagic,and in the alveolar cavities there was infiltration of inflammatory cells. Under the electron microscope, the lung tissue type Ⅱ alveolar epithelial cells of model group were increased,and they had morphological changes in various degrees,such as cell shrinkage and change becoming round,and cell nucleus presenting irregular in shape. After treatment with TCM,the above pathological changes were all alleviated compared with those in the model group. Conclusions Qingfei Chengqi decoction can ameliorate the SII leading to acute lung injury,and reduce the cell apoptosis rate of lung tissues in SII rats. Its mechanism may be related to the intervention of above TCM which can lower the levels of inflammatory media and elevate the protein expression of Bcl-2.

Effect of mesenteric lymph drainage on intestinal barrier function in rats with severe intraperitoneal infection / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of mesenteric lymph drainage on intestinal barrier function in severe intraperitoneal infection (SII).</p><p><b>METHODS</b>Thirty healthy male Wistar rats were randomly divided into 3 groups(model group, drainage group and control group). SII model rats were prepared by injecting E.coli intraperitoneally. Rats in drainage group rats underwent mesentery lymphatic duct ligation and drainage 2 hours after model induction, and those in control group received equal amount of 10% BaSO4 nutrient broth injection intraperitonerally. Six hours after model induction, rats were sacrificed. The intestinal samples were collected for pathology analysis and content of DAO and concentration of TNF-α, IL-6. Content of D-lactate in blood plasma was detected.</p><p><b>RESULTS</b>Under light microscopy, ileum mucosa tissue structure of model group was disordered. Under transmission electron microscopy, intestinal mucosal epithelial cells of model group swelled obviously, close connection was destructed, and early apoptosis cells occurred. After mesentery lymph drainage, intestinal mucosa tissue structure was improved obviously, endoplasmic reticulum and mitochondria of epithelium swelled mildly. The contents of intestinal tissue DAO in drainage group, model group and control group were (5.9±0.4) U/L, (3.0±0.1) U/L and (18.3±2.1) U/L respectively. There was significant difference among groups (P<0.05). Compared with control group [(45.4±37.9) μg/L], the plasma content of D-lactate in model group [(256.0±177.2) μg/L] increased significantly (P<0.05). The plasma content of D-lactate in drainage group [(136.9±21.5) μg/L] was not significantly different compared with model group (P>0.05), but was significantly higher compared to control group (P<0.05). Compared with control group, model group had significantly higher levels of TNF-α [(3431.3±23.9) ng/L vs. (2730.0±408.7) ng/L] and IL-6 [(86.3±1.6) ng/L vs. (30.2±0.9) ng/L] (P<0.05), while the TNF-α was (2653.2±324.1) ng/L, and the IL-6 was (50.9±0.7) ng/L in drainage group, which were significantly lower compared with model group (P<0.05).</p><p><b>CONCLUSION</b>Mesenteric lymph drainage can obviously improve intestinal barrier function in severe intraperitoneal infection and may play a protective role in intestinal mucosa.</p>

The effects of Rheum emodin on LPS-induced HIF-1α and COX-2 expression in intestinal epithelial cells / 中华急诊医学杂志

Objective To observe the level of hypoxia-inducible factor-1 alpha (HIF-1α) and its downstream target gene cyclooxygenase-2 (COX-2) in LPS-treated intestinal epithelial cells,and to explore the possible intervention targets of Rheum emodin.Methods Human intestinal epithelial cells were cultured in vitro treated with LPS to establish the experimental model.The protein level trends of HIF-1α and COX-2 were measured by Western blot in LPS dose-dependent and time-dependent manners.The protein level trends of HIF-1α,COX-2,Phospho-IκB-α and Phospho-NF-κB p65 were measured in LPS plus various concentrations of Rheum emodin treated groups.The expression of HIF-1α mRNA were detected by PCR after cells treated with LPS or LPS plus Rheum emodin,respectively.The effect of Rheum emodin on the proliferation of intestinal epithelial cells was measured by MTT assay in each group.Data were analyzed with ANOVA,and P ＜0.05 was considered significant.Results LPS induced the protein level of HIF-1α in a dose-dependent and a time-dependent manners.With increasing concentrations of LPS,the protein level of HIF-1α increased to the peak when cells were treated with LPS at 10-30mg/mL,and then gradually decreased (P ＜0.05).Firstly the protein level of HIF-1α reached the peak at 0.5 h after treatment,and then decreased to the lowest level at 4 h,and finally returned to a high level (P＜0.05).The protein level trend of COX-2 went a similar way to that of HIF-1α (P ＜0.05).Rheum emodin inhibited the protein levels of LPS-induced HIF-1α,COX-2,Phospho-IκB-α and Phospho-NF-κB p65 with a significant dose-effect relationship (P ＜ 0.05).The PCR showed Rheum emodin inhibited LPS-induced increasing expression of HIF-1α mRNA.MTT assay showed different concentrations of Rheum emodin (0 μmol/L,20 μmol/L,40 μmol/L,60 μmol/L,80 μmol/L) had no significant effect on cell proliferation (0.95 ± 0.02,0.89 ± 0.03,0.88 ± 0.04,0.91 ± 0.03,0.83 ± 0.03,P ＞ 0.05).Although Rheum emodin produced biological effect at this concentration range,and it had no toxicity to intestinal cells.Conclusions LPS induces HIF-1α/COX-2 signaling pathway in a time-dependent and a dose-dependent manners in intestinal epithelial cells.Rheum emodin blocks the hypoxia pathway of LPS/HIF-1α/COX-2 and the inflammatory pathway of LPS/IκB-α/NF-κB/COX-2,which may play a protective effect on intestinal epithelial cells.

Clinicopathological features of polypoid lesions of the gallbladder: report of 1396 cases / 中华普通外科杂志

Objective To probe the differences in clinicopathological features between benign and malignant polypoid lesions of the gallbladder.Methods In this study,1396 PLG cases diagnosed by postoperative pathology between 2007.1 to 2009.12 were enrolled.Cases were divided into three groups according to the pathological classification:1339 cases of benign proliferative diseases ;42 cases of adenoma,15 cases of malignant disease.Comparing the clinical characteristics of the three groups,we screened out the risk factors for malignant transitions.Results Age (F =8.090,P =0.000),size of polyp (F =102.61,P =0.000),single vs multiple lesions (x2 =214.25,P =0.000),concurrent inflammation (x2 =9.362,P =0.009),and stones (x2 =34.022,P =0.000) were significantly different between the three groups.Conclusions Size of polyps over 0.8 cm,age over 60 years,single polyp,accompanied by stones and inflammation were the risk factors for malignancy in gallbladder polypoid lesions.

Risk factors in patients with hereditary gallstones in chinese pedigrees

We aimed to define the risk factors and to evaluate the impact of family background on the prevalence of gallstones in China. Thirty-eight gallstone pedigrees were collected and a case-control study was conducted. This study consisted of 272 first-degree relatives and 201 non-first-degree relatives of index patients. The participants completed a questionnaire and underwent physical and ultrasonographic examinations.The riskfactors examined included age, sex, body mass index [BMI], smoking status, alcohol consumption, pregnancy, fat content in dietary meat, history of gastrointestinal surgery, hypertension, hyperlipidemia, fatty liver, coronary heart disease and diabetes. The prevalence of gallstones in first-degree and non-first-degree relatives of index patients was 38.2 and 10.9%, respectively. Age, pregnancy and BMI significantly differed between cases and controls [p < 0.05]. The relative risks were: consumption of meat with a high fat content 1.4 [95% Cl 1.1-1.8]; hyperlipidemia 2.4 [95% Cl 1.3-4.6]; diabetes 1.9 [95% Cl 1.1-3.2]; fatty liver 4.9 [95% Cl 1.0-24]; coronary heart disease 2.5 [95% Cl 1.7-3.9]. Data showed that age, overweight, more consumption of high-fat food, high frequency of pregnancy, fatty liver, hyperlipidemia, coronary heart disease and diabetes could increase the risk of gallstones in the first-degree relatives of index patients

Construction and identification of the replication defective adenoviral vectors carrying mouse SCp2shRNA / 中华肝胆外科杂志

Objectives It was constructed that the replication defective adenoviral vectors carried the short hairpin sequences of mouse SCP2.And we will make a further study of mechanism between SCP2 gene and cholesterol stone in gallbladder.Methods The short hairpin sequences of mouse SCP2 were cloned by two-step PCR,and connected together with the plasmid pDC312.The Admax Adenoviral Vector System was used to generate the replication defective adenoviral vectors,which were purified by CsCl method.The processes of TCID50 were applied to detect the titers of the adenoviral vectors.Furthermore,Protein levels of SCP2 were determined by Western blot analysis,and the levels of SCP2、CYP7A1、HMGCR mRNA from the hepa1-6 cell of mouse were measured by the usage of RT-PCR.Results SCP2mRNA and SCP2 protein were down-regulated by the replication defective adenoviral vectors carried the SCP2-shRNA.With the decreasing SCP2mRNA,the levels of HMGCRmRNA were down-regulated at same the time,while CYP7A1mRNA were up-regulated.Conclusions The replication defective adenoviral vectors carried SCP2-shRNA were constructed successfully.The lower levels of SCP2 could affect the activities of HMG-CoA reductase and CYP7-a enzyme,which caused the variations of cholesterol metabolism and then decreased the formation of cholesterol stone.

Appendiceal mucoceles:a report of 50 cases / 中华普通外科杂志

Objective To evaluate the diagnosis and surgical management of appandiceal mucoceles.Method The clinical data of 50 patients with appendiceal mucoceles surgically treated from January 2004 to January 2008 were reviewed retrospectively. Result The correct preoperative diagnosis rate was 8%.Eight patients were complicated with pseudomyxoma peritonei.The canceration rate was 4%.All the 50 patients recovered uneventfully after the surgery.There was no complications,no recurrence during the follow-up period,including the 2 patients with canceration. Conclusion It was difficult to make correct diagnosis of appendiceal mucoceles preoperatively.The diagnosis should always be in mind if the B-type ultrasonography indicated a cystoadenoma.Abdominal CT coupled with necessary digestive image examinations may improve the correct diagnosis rate.Some patients may be complicated with pseudomyxoma peritonei.Occasionally this abdominal mass was also associated with malignancy.Surgery is the management of choice,and the prognosis is good.

Nosocomial mortality and early assessment of patients with severe acute pancreatitis / 中华急诊医学杂志

Objective To analyze risk factors in order to predict the in-hospital mortality of patients with se-vere acute pancreatitis (SAP), especially the factor of total cholesterol. Method Factors for predicting in-hospi-tal mortality were evaluated retrospectively from the clinical data collected from 338 SAP patients of Tianjin Nankai Hospital between January 1999 and December 2008 according to the Guidelines for for clinical diagnosis and classi-fication of Acute Panereatitis set by the Society of Chinese Medical Association in 2003. The patients were treated with intensive care, blood routine examination, blood biochemical test and even computed tomography within 24 hours after admission. The patients were divided as per outcome into deceased and survivor group. All patients were admitted within 72 hours after the onset of symptoms. The Off-square test was used for univariate analysis and multivariate test was performed by logistic regression. Results Compared with TC≤3.67 mmol/L, when the TC was between 3.67 -4.37 mmol/L, OR was 0.664 (P = 0.412), while TC was between 4.37 mmol/L and 5.23 mmol/L, OR was 0.144 (P =0.021).The OR was 1.013 (P =0.018) when TC was ≥5.23 mmol/L. The variation of serum TC levels was accompanied with the changes of C-reactive protein (CRP). When the CRP was ≥170 mg/L, OR was 7.074 (P =0.031). When the serum ALB≤30 g/L, OR was 7.224 (P =0.029).Conclusions The CRP, ALB, TC can be used for early predicting the in-hospital mortality of SAP patients. TC is a protective factor when it was between 4.37 mmol/L and 5.23 mmol/L, while it is a risk factor when ≥5.23 mmol/L or≤3.67 mmol/L. CRP> 170 mg/L or ALB < 30 g/L increases the probability of fatal outcome. Low level of albumin is a stronger predictor than the high level of CRP. Moderate elevation of TC level seems to in-crease the resistance to inflammation and hence improving the survival rate of patients with SAP and reducing the in-hospital mortality.

Clinical analysis of 212 patients suffering from benign biliary strictures / 中国综合临床

Objective To analyze the etiology,diagnosis and therapy of benign biliary strictures and im-prove curative and preventive effects. Methods 212 patients suffering from benign biliary strictures in Nankai Hos-pital from January 2004 to December 2006 were retrospectively analyzed. Results Inflammatory strictures (65.12%,140/215) and strictures caused by operations (20.46%,44/215) were the most two causes. Strictures parts were mainly located in the latter segment of common bile duct 52.09% (112/215). In our group,the stent of strictures parts took 31.37% (64/204), bilioendodraignage 18.13% (37/204), and the modification of strictures parts 43.63% (89/204) as well as resection of stricture parts 1.96% (4/204). Conclusions Inflammatory stricture is the main cause in benign biliary strictures and the main locus is the hinder segment of common bile duct. The di-agnesis of benign biliary strictures before operation is important because it can help to decide the approach way and prognosis. The strategies of curing benign biliary strictures could include operations and endoscopy. The stent of stric-tures parts, bilioendodraignage and the modification of strictures parts are the main treaments for benign biliary stric-tures.

Analysis on the relative factors of recurrence of severe pancreatitis / 中华胰腺病杂志

Infection rate and in-hospital treatment were two prognostic factors for SAP recurrence.

Risk factors of the onset of multiple organ dysfunction syndrome in patients with severe acute pancreatitis / 中华消化外科杂志

Objective To analyze the value of early evaluation in predicting the onset of multiple organ dysfunction syndrome (MODS) in patients with severe acute pancreatitis (SAP). Methods The clinical data of 338 patients with SAP who had been admitted to Tianjin Nankai Hospital from January 1998 to September 2008 were retrospectively analyzed. The patients were divided into MODS group (n = 163) and control group (n = 175) according to whether they did or did not have MODS. Risk factors causing MODS were analyzed by t test and Logistic regression analysis. Results The factors leading to the MODS included white blood cells count≥ 16 ×109/L, serum creatinine≥ 180 μmol/L, serum calcium≥2.5 mmol/L, c-reactive protein≥ 120 mg/L and pH value of blood≥7.35 (χ2 = 51.720, 21.421, 12.393, P < 0.05). The total cholesterol was a protective factor when it was 3.67-5.23 mmol/L. Conclusions Infection, renal insufficiency and hypercalcinemia are early predictive factors for MODS, and infection is the strongest predictive factor. Appropriate elevated total cholesterol can reduce the incidence of MODS.

Effects of long time sedation with propofol on immune balance in severe sepsis / 中华急诊医学杂志

Objective To clarify the effects of sedation with propofol on pro/anti-inflammatory cytokines balance in severe sepsis patients resulted from intra-abdominal infection.Methods Fifteen patients with severe sepsis were randomly divided into two groups,propofol group received intravenous propofol sedation more than 48 hours,and no sedation drug were used in control group,3 volunteers as healthy group.Plasma TNF-?,IL-10 concentrations were measured at admission and 48 hours later,the ratio of TNF-?/IL-10 (T/I) were also calculated.Results Levels of both TNF-?,IL- 10 were significantly elevated in patients compared with healthy group,but no difference between prepofol and control group.The mean load doses of propofol was 0.063 mg/kg and maintained at 0.054 mg/(kg?h).After 48 hours infusion of prepofol,TNF-?,IL-10 decreased significantly compared with admission in propofol group,while no changed in control group.Compared with control group,IL-10 was lower and ratio of T/I was higher in propofol group.Conclusion Sedation with prepofol in severe sepsis patients attenuated the pro-and anti-inflammatory cytokine responses.Moreover, propofol accelerate the shift to Th1.These findings suggest that the influence of sedation drug on immune function must be considered in sepsis patients.

Effects of gadolinium chloride on acute hemorrhagic necrotizing pancreatitis associated lung injury in rats / 中国普通外科杂志

Objective To investigate the role of hepatic Kupffer cells in acute hemorrhagic necrotizing pancreatitis associated lung injury(AHNP LI) and the therapeutic effects of gadolinium chloride(GdcI_3). Methods Forty-two Wistar rats were randomly divided into four groups:(I) sham operation group;(II) AHNP group;(III) Gdcl_3 (protection) group(Gdcl3 10mg/kg);(IV) Gdcl_3control group(Gdcl_3 10mg/kg).In the sham operation group, the (abdominal) vescera were shifted around for several times and the abdomen was closed.The AHNP model was induced by retrograde intraductal administration of 5% sodium taurcholate(1ml/kg,0.1ml/min).In the Gdcl_3 protection group,Gdcl_3 solution was admmistered by caudal vein injection one day before the AHNP model was made.In these 3 group of animals,specimens were obtained in order at 3h and 6h postoperatively:(1)Blood was withdrawn from the abdominal aorta to determine serum amylase,TNF?,IL-1(in addition,in the sham operation group,blood AST and ALT were determined);(2)A portion of liguefied right lung was obtained to determine MPO;another portion was fixed with 10% formalin for tissue pathological examination;(3)Bronchoalveolar lavage fluid of excised left lung was obtained ,and then alveolar macrophages were isolated,collected and purified.After removal of their nuclear (proteins),the alveolar macrophages were tested to determine NF-?B activation with the use of chemical illumination ELISA method;and (4)pancreatic tissue was reserved for pathological examination.In the Gdcl_3 control group, Gdcl_3 was administered by caudal vein injection,the animals were sacrificed 24h later,and blood was obtained to determine blood AST and ALT. Results In the Gdcl_3 prevention group,the level of MPO in lung tissue,serum (levels) of TNP? and IL-1,and NF-?B activation of alveolar (macrophages) were all significanfly reduced as compared with the AHNP model group(in all,P