Application of the ultrasonic lithotripsy system in assisting nephroscopic retroperitoneal debridement in pancreatic necrosectomy / 中华肝胆外科杂志

Objective:To study the safety and efficacy of using the ultrasonic lithotripsy system (ULS) in assisting percutaneous nephroscopic retroperitoneal pancreatic necrosectomy in patients with acute necrotizing pancreatitis (ANP) extending to both sides of the retroperitoneal regions.Methods:The clinical data of 47 patients with extensive ANP who underwent video-assisted retroperitoneal debridement (VARD) from January 2017 to October 2022 at the Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, were analyzed retrospectively. There were 32 males and 15 females, aged [ M( Q1, Q3)] 60(43, 75) years old. The patients were divided into two groups based on the debridement methods: patients treated by nephroscopic pancreatic necrosectomy (NPN) were included in the NPN group ( n=22), while patients treated by the ULS-assisted treatment were included in the ULS group ( n=25). The surgical debridement time, operation time and complications of the two groups were compared. Follow up on recurrence and death of patients was done by telephone, outpatient and/or re-hospitalization records. Results:All patients underwent the VARD operation successfully, without any need for conversion to laparotomy, transfer to intensive care unit and death related to the operations. The pancreatic exocrine function was not damaged in both groups. When compared with the ULS group, the NPN group required significantly more debridement time [3(2, 4) times/person vs. 2(1, 2) times/person], longer operation time [65(40, 85) min vs. 35(30, 50) min] and longer hospitalization time [91(76, 130) d vs. 72(62, 102) d, all P<0.05]. No complications occurred in the ULS group. In the NPN group, postoperative hemorrhage occurred in 3 patients, colon fistula in 1 patient, and delayed viral encephalitis in 1 patient. The incidence of postoperative complications in the NPN group was significantly higher than that in the ULS group [22.7%(5/22) vs. 0(0/25), P=0.032]. All the 47 patients with extensive ANP were followed up for a median of 28 months (range 3 to 60 months), and there were no patients who developed residual recurrence and death. Conclusion:For patients with extensive ANP, ULS-assisted nephroscopic pancreatic necrosectomy was safe and feasible. When compared with NPN, the ULS-assisted procedure showed more advantages in debridement efficiency, operation time and hospital stay.

Effect and regulatory mechanism of PPAR-γ agonists rosiglitazone on hepatocytes of Sprague Dawley rats with severe acute pancreatitis / 中华肝胆外科杂志

Objective:To study the effect of peroxisome proliferator activated receptor- γ (PPAR-γ) agonists rosiglitazone on the hepatocytes of Sprague Dawley (SD) rats with severe acute pancreatitis (SAP) and the regulatory mechanism.Methods:Seventy two healthy male SD rats, weighing 255-315 g, aged 49-56 days, were randomly divided into SAP model group ( n=24, SAP model preparation), rosiglitazone group ( n=24, rosiglitazone intravenous injection after SAP model preparation) and sham operation group ( n=24, normal saline injection only). After 6 h, 12h and 24 hours of injection, 8 rats were treated at each time point. HE staining was used to study the liver tissue structure and detect the levels of serum tumor necrosis factor-α(TNF-α), interleukin (IL) -1β, IL-6, AST, ALT and lactate dehydrogenase (LDH) in the rats. Western blot was used to detect the expression of high mobility group box-1 protein (HMGB1), Janus activated kinase (JAK)2 and signal transducer and activator of transcription (STAT)3. Results:The levels of serum TNF-α , IL-1β, IL-6, AST, ALT, LDH in SAP model group and rosiglitazone group were significantly higher than those in the sham operation group (all P<0.05). IL-1β at 6, 12h and 24 h in rosiglitazone group was (226.5±52.1)ng/L, (458.2±82.3)ng/L, (556.4±83.4) ng/L, ALT was (158. 3±39.2) U/L, (235.0±44.6)U/L, (298.4±56.6) U/L, which was lower than that in SAP model group (443. 5±62.3) ng/L, (622.6±78.3) ng/L, (789.1±105.7) ng/L and (198.4±42.5)U/L, (253.8±47.0)U/L, (337.2±60.1) U/L, the differences were statistically significant (all P<0.05). AST and LDH in rosiglitazone group were also lower than those in SAP model group at each time point, and the differences were statistically significant (all P<0.05). HE staining showed that there were less inflammation, hemorrhage and necrosis in rosiglitazone group than those in SAP model group. Expression of STAT3 in liver of rosiglitazone group at 6 h, 12 h and 24 h was (0.22±0.03), (0.30±0.04), (0.31±0.06), lower than SAP model group (0. 28±0.04), (0.38±0.05), (0.40±0.06), the differences were statistically significant (all P<0.05). Expression of JAK2 and HMGB1 in rosiglitazone group at 12 h and 24 h was also lower than that in SAP model group (all P<0.05). Conclusion:PPAR-γ agonists rosiglitazone can protect the SAP rats suffering from hepatocyte injury and inflammation, through JAK2/STAT3 pathway.

Nephroscopic pancreatic necrosectomy through sinus tracts of drains using a dual-scope necrosectomy approach without the need for anesthesia: a report on 17 patients / 中华肝胆外科杂志

Objective:To analyse the use of nephroscopic peripancreatic necrotic tissue removal through drainage tube sinus tracts without the use of anesthesia.Methods:The data of 17 patients with severe acute pancreatitis (SAP) were treated from August 2016 to December 2019 at the Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine were studied. There were 5 males and 12 females, age ranged from 24 to 80 years (mean 49.3 years). These 17 patients underwent nephroscopic pancreatic necrosis tissue removal through drainage tube sinus tracts of drains using a dual-scope necrosectomy approach without the use of any anesthesia. The surgical related and follow-up data were analysed.Results:Of 17 patients who underwent pancreatic necrosis removal as the first operation, one underwent a further postoperative nephroscopic resection without anesthesia, while 10 patients underwent three nephroscopic resections without anesthesia, and 6 patients underwent four nephroscopic resections without anesthesia. The operative durations of nephroscopic resection without anesthesia was 26 to 37 min. All patients had smooth surgical procedures and they were fed on the same day after surgery. There were no postoperative complications on follow-up after discharge from hospital for 1 to 40 months.Conclusion:Transcatheter sinusoidal nephroscopic pancreatic necrotic tissue removal without anesthesia was safe. There was no need for fasting. The procedure is minimally invasive and it can be repeated, especially for those patients who cannot tolerate any form of anesthesia. This is the least invasive procedure for treatment of SAP.

Treatment of Chilomastix mesnili infection with traditional Chinese medicine: a case report / 中国血吸虫病防治杂志

This paper reports a case with Chilomastix mesnili infections, and summarizes the diagnosis and treatment with traditional Chinese medicine.

Risk factors predicting conservative treatment failure of acute calculous cholecystitis in pregnant women / 中华普通外科杂志

Objective To explore the predictor of invalid conservative treatment of acute calculous cholecystitis (ACC) in pregnant women.Methods A total of 107 pregnant patients with ACC in a tertiary hospital from Jan.2010 to Jun.2017 were studied retrospectively.Results Univariate analysis revealed that body temperature ＞ 37.3 ℃ (x2 =4.721,P ＜ 0.05),gallbladder dilation (x2 =4.764,P ＜ 0.05),TBiL (t=-2.518,P＜0.05),ALT (t=-2.860,P＜0.05),AST (t=-3.014,P＜0.05),hospital stay (x2 =9.769,P ＜ 0.05),rate of pregnancy termination (x2 =7.349,P ＜ 0.05) were all significantly higher in conservative therapy failure group than those in the conservative therapy success group.Multivariate analysis showed that gallbladder dilation,TBiL,body temperature ＞ 37.3 ℃,AST were the independent risk factors predicting invalid conservative management.Conclusion Gallbladder dilation,body temperature ＞ 37.3 ℃,high level of TBiL and AST are the early predictors for the invalid conservative management for ACC in pregnant women.

Laparoscopic combined with percutaneous nephroscopic necrosectomy for peripancreatic abscesses: a report of 8 cases / 中华肝胆外科杂志

Objective To study the effect of combined laparoscopic and percutaneous nephroscopic necrosectomy in the treatment of peripancreatic abscesses.Methods The clinical data of 8 patients with peripancreatic abscesses treated by combined laparoscopic and percutaneous nephroscopic necrosectomy in our hospital from June 2015 to June 2017 were retrospectively analyzed.Results 8 patients were treated with percutaneous puncture and drainage under Ultrasonic / Computed Tomography guidance.Combined laparoscopic and percutaneous nephroscopic necrosectomy was then carried out.Two patients underwent percutaneous nephroscopic surgery twice and laparoscopic surgery once,and 3 patients underwent percutaneous nephroscopic surgery thrice,and 3 patients underwent percutaneous nephroscopic surgery 4 times and laparoscopic surgery once.One patient after percutaneous nephroscopic necrosectomy was complicated with sinus tract hemorrhage,which was treated by haemostasis through a small incision.Two patients who developed postoperative colonic fistula were treated successfully by conservative treatment.The average length of hospital stay was 80 d (60 ～ 153 d),and there was no death.Conclusion Combined laparoscopic and percutaneous nephroscopic necrosectomy was a minimally invasive and efficacious method to treat peripancreatic abscesses.

Curative effect of different surgical approaches for orbital tumors / 国际眼科杂志(Guoji Yanke Zazhi)

· AIM:To analyze the clinical effect of different surgical approaches for orbital tumors.· METHODS:A total of 52 patients (56 eyes) with orbital tumors who were admitted to the hospital from January 2012 to June 2017 were examined by brain MRI and orbital sectional CT scan to identify the relationship between tumors and surrounding anatomical structures.They were treated by orbitotomy,and the approaches included anterior conjunctival approach,lateral approach and combined medial and lateral approach.The removal of tumors,recovery of visual acuity,postoperative early complications and follow-up recurrence were statistically analyzed.· RESULTS:Among the 52 patients,there were 7 cases 8 eyes (14％) with residual tumors.The rate of residual tumors after anterior conjunctival orbitotomy (23％) was higher than that after lateral orbitotomy or combined medial and lateral orbitotomy (6％,7％;P＜ 0.05).The visual acuity was improved in 28 cases 30 eyes (54％),no change in 18 cases 19 eyes (34％) and decreased in 6 cases 7 eyes (13％).The incidence of early complications was 23％,including 2 cases 2 eyes with accidental loss of vision,2 cases 2 eyes with pupil changes,3 cases 3 eyes with ptosis and 5 cases 6 eyes with eye movement disorders,which mainly occurred in the elderly.The recovery of visual acuity and the incidence rates of complications (23％,19％,29％) of the three kinds of surgical approaches were close (P＞ 0.05).During the follow-up period,there were 3 cases 3 eyes (5％) with recurrence in the 52 patients,and the recurrence rate after combined medial and lateral orbitotomy (14％) was significantly higher than that after anterior conjunctival or lateral orbitotomy (4％,0;P＜0.05).· CONCLUSION:The appropriate surgical approach can successfully remove the orbital tumors,improve or stabilize the visual function,and reduce complications and recurrence.

Analysis on postoperative infection after pocket tape scleral reinforcement / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the postoperative infection of pathological myopia with pocket scleral reinforcement. ·METHODS:The clinical data of 167 cases of pathological myopia treated with pocket scleral reinforcement in June to December 2014 were analyzed. The postoperative infection rate, the resistance of pathogenic bacteria were analyzed, and the related factors of infection were analyzed. ·RESULTS: A total of 286 eyes were obtained in 167 patients. The infection rate was 6. 3% in 10 patients ( 18 eyes) . There were 30 pathogenic bacteria isolated from the 18 infected eyes, in which were 10 Staphylococcus aureus, 10 Staphylococcus epidermidis, 6 Klebsiella pneumoniae, 4 Pseudomonas aeruginosa infection. Gram positive bacteria showed higher resistance to penicillin, ampicillin and ciprofloxacin, and were sensitive to vancomycin. The resistance rates of gram negative bacteria to cefotaxime were higher, but to imipenem was low. The two groups of patients age, culture level, operation time, the number of operation, intraoperative nursing staff seniority, postoperative medication compliance rate was statistically significant (P<0. 05), which related to the infection after pocket scleral reinforcement. ·CONCLUSION:The infection caused by Staphylococcus aureus is the most common after pocket scleral reinforcement, and it is sensitive to vancomycin, and gram negative bacteria is sensitive to imipenem. Shortening the operation time, using the experienced nursing staff to cooperate, reducing the number of operation and improving the compliance of the patients can reduce the postoperative infection.

Pharmacology research on PXR as a potential target in screening bioactive components of Chinese material medica / 中国中药杂志

Pregnane X receptor (PXR) is key transcription factors which mainly regulate the expression of CYP3A genes. At the molecular level, PXR has been revealed the protection mechanism of the body against xenochemicals and a major mode of the drug-drug interactions. Besides playing an important role in drug metabolism and interactions, PXR and its target genes also play an important role in maintaining normal physiological function and homeostasis. Therefore, it is necessary to study the regulation of PXR and its related pharmacological effects of TCM and natural products, and to provide new clues for the new pharmacological pathway.

Screening active components in compound danshen based on PXR-CYP3A4: an experimental study / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To screen active components in Compound Danshen (CD) based on pregnane X receptor-cytochrome P450 3A4 (PXR-CYP3A4).</p><p><b>METHODS</b>By using PXR-CYP3A stable transfection human hepatoblastoma G2 (HepG2) cell lines engineering cell strain combined reporter genes technology, active components that induce or inhibit PXR-CYP3A4 paths in CD were screened, and confirmed at the level of enzymic activities. The experiment was divided into the positive control group (RIF 10 micro mol/L), the DMSO group (DMSO 0.1%), each dose of treatment groups (ginsenoside Rc, Rf, Rb2, Rg2, F2, F1, tanshinone I , isoborneol 5, 10, 25, 50, 100, and 200 micro mol/L; each with six duplicates). Cells medium was removed 36, 48, and 60 h after treatment. The activity of CYP3A4 was then determined in the supernant and the fold induction was calculated.</p><p><b>RESULTS</b>Compared with the DMSO group, the fold induction increased when ginsenoside Rc, Rf, Rb2, Rg2, F2, F1, tanshinone I , and isoborneol 50 and 100 micro mol/L was respectively intervened for 36, 48, and 60 h (P <0.05). When cells were treated with isoborneol 200 micro mol/L for 48 and 60 h,the fold induction of ginsenoside Rb2, Rg2, and F1 was significantly higher than that of the RIF group (P <0.05). Enzymic activity results showed that ginsenoside Rc, Rf, Rb2, F2, and F1 could increase the enzyme activity of CYP3A4 at 48 h (P <0.05).</p><p><b>CONCLUSION</b>Ginsenoside Rc, Rf, Rb2, F2, F1, tanshinone I, and isoborneol in DC could induce CYP3A4 enzymes.</p>

Simultaneous determination of bisphenols and alkylphenols in water by solid phase extraction and ultra performance liquid chromatography-tandem mass spectrometry / 生物医学与环境科学（英文）

To establish an analytical method for determination of four bisphenols (BPA, BPB, BPF, and BPS) and two alkylphenols (4-n-OP, 4-n-NP) in water by ultra performance liquid chromatography- tandem mass spectrometry (UPLC/MS/MS). The water samples were extracted and condensed with solid-phase extraction (SPE) using C18 cartridges and eluted by acetonitrile. Separation was carried out with Acquity BEH C8 column and detection were performed by UPLC/MS/MS. Quantification was calculated by using the internal standard BPA-d16 and 4-n-NP-d8. The linear correlation coefficients of these compounds in the range of 1.0-100.0 μg/L were all over 0.999. The minimum detectable concentrations were 0.75-1.0 ng/L, and the recoveries ranged from 87.0% to 106.9%. Relative standard deviations (RSDs) were between 1.26% and 3.67%. Applying this method to detect the source water of Chaohu Lake and drinking water of Hefei, six target compounds were detected in different levels. This method is simple with high sensitivity and selectivity, could be suitable for the determination of these compounds in source and drinking water.

Screening of pregnane X receptor activation from ginsenosides / 药学学报

In order to study effects of ginseng on the metabolism of drug belong to CYP3A4 substrate, screening of pregnane X receptor activation from ginsenosides was performed by reporter assay. Based on PXR-CYP3A stable translation cell lines, 13 ginsenosides were screened for pregnane X receptor activation by reporter assays, and RIF as the positive control. The effect of ginsenosides Rg1 onCYP3A4 mRNA expression was also investigated by RT-PCR. The PXR-CYP3A stable translation cell lines had good response to RIF, and the EC50 is 2.51 micro mol x L(-1). When the condition of final concentration was 10 micromol x L(-1), ginsenoside F2 and protopanaxatriol had moderate inductive effects on PXR. Panaxotriol, Rg2, pseudoginsenoside F11, Rg1, ginsenoside and Rb3 had inhibitory effects on PXR. Ginsenoside Rf1, Rg3, Rh2 and protopanaxdiol had no obvious effects on PXR. Rg1 down-regulated CYP3A4 mRNA expression in a concentration-dependent manner. Activation of pregnane X receptor by ginsenosides may influence the metabolism of drug belong to CYP3A4 substrate, and cause ginseng-drug interactions.

Research on the incompatibility of Radix adenophora, Radix glehniae combined with Veratrum nigrum L. by uniform designed toxicity assay / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To study the toxicity changes of different proportions of Radix Adenophora, Radix Glehniae combined with Veratrum nigrum L., thus providing acute toxicity data and investigating whether decoction factors were correlated with toxicity.</p><p><b>METHODS</b>The uniform design method was used by two factors and seven levels to investigate the toxicity changes in different proportions of Radix Adenophora, Radix Glehniae combined with Veratrum nigrum L. The decoction factors were also investigated.</p><p><b>RESULTS</b>The compatibility toxicity was affected mainly by Veratrum nigrum L. and the toxicity increased along with increased doses of Veratrum nigrum L. The toxicity of co-decoction was higher than mixed decoction in the same dosage of Radix Glehniae and Veratrum nigrum L. The promotion of the dissolution of the toxic component of Veratrum nigrum L. in co-decoction may be the cause of the higher toxicity.</p><p><b>CONCLUSION</b>Radix Adenophora and Radix Glehniae combined with Veratrum nigrum L. resulted in higher toxicity, which indicated that the incompatibility between Radix Adenophora, Radix Glehniae, and Veratrum nigrum L. In clinic practice, a prescription contained these drugs should be avoided.</p>

Value of transesophageal echocardiography in case selection of transthoracic minimally invasive device closure of ventricular septal defect / 中华医学超声杂志（电子版）

Objective To evaluate the value of transesophageal echocardiography (TEE) in transthoracic minimally invasive device closure of ventricular septal defect(VSD).Methods A total of 164 cases of VSD were recruited as candidates to receive transthoracic minimally invasive device closure between January 2007 and October 2010,including 138 perimembranous VSDs,3 muscular VSDs and 23 supracristal VSDs.Among these groups,85 male patients were included.Four-champer view,five-champer view,left ventricular long-axis view,short-axis view and right ventricular inflow view were detected to evaluate the availability of device closure.Results A total of 152 cases(92.7%)were successfully closed with a device.All the patients were followed up more than 3 months arranged with a standard protocol.No complete atrioventricular block (CAVB) or associated valvular complications were observed.Three of the five cases with traced residual shunt after device closure closed spontaneously.Conclusion TEE plays an important role in transthoracic minimally invasive device closure of ventricular septal defect,which has been proved by the good follow-up results without CAVB and associated valvular complications.

Protective effects of bone marrow mesenchymal stem cells transplantation and mobilization for severe acute pancreatitis with acute renal injury / 中华消化外科杂志

Objective To investigate the protective effects of bone marrow mesenchymal stem cells transplantation (MSCT) and mobilization on severe acute pancreatitis (SAP) with acute renal injury.Methods A total of 240 SD rats were randomly divided into sham operation group ( n =48 ),model control group ( n =48 ),MSCT group ( n =48),bone marrow mesenchymal stem cells mobilization (MSCM) group ( n =48) and MSCT +MSCM group ( n =48 ) according to the random number table.Rat models of SAP were made by peritoneal injection of L-arginine.Rats in the MSCT group were injected with 1.2 ml of bone marrow mesenchymai stem cells via femoral vein at 6 hours after SAP model establishment; rats in the MSCM group were subcutaneously injected with 40 μg/kg of granulocyte-colony stimulating factor (G-CSF) at 3 days before SAP model establishment; rats in the MSCT + MSCM group were injected with 1.2 ml of MSC and 40 μg/kg of G-CSF simultaneously; rats in the sham operation group were injected with equal volume of normal saline.According to different time points after operation,rats in each group were subdivided into 12 h,24 h,48 h and 72 h groups (n =12).At each time points after operation,the mortality rate,pathological changes of renal tissue,expression of Bax protein,Bcl-2 protein and apoptosis indexes of renal tubular epithelium cells were observed.The contents of tumor necrotic factor-α (TNF-α),interleukin-6 (IL-6),blood urea nitrogen (BUN),creatinine (Cr),lactate dehydrogenase (LDH) and C-reactive protein (CRP) were determined.All data were analyzed by using SNK-q test,Fisher exact probability and analysis of variance.Results All rats in the sham operation group were survived.The numbers of rats in the model control group survived at postoperative 48 hours and 72 hours were 11 and 8,respectively.No rat died at postoperative 48 hours in the MSCT group,MSCM group and MSCT + MSCM group.The numbers of rats survived at postoperative 72 hours in the MSCT group,MSCM group and MSCT + MSCM group were 11,10 and 11,which were not significantly different from the number of survived rats in the model control group (P ＞0.05).The pathological injuries of renal tissues were relieved in the MSCT group,MSCM group and MSCT + MSCM group when compared with model control group.The expression of Bax protein,Bc1-2 protein,renal tubular epithelium cell apoptosis indexes at 12-72 hours were 12.80 + 1.78-20.30 + 2.40,4.34 + 1.20-3.03 ± 1.06,12.65％ ±2.31％-35.10％ ± 5.54％ in the model control group,9.68 ± 2.11-17.01 ± 2.54,5.57 ± 1.35-4.13 + 1.05,6.20％ ± 1.53％- 17.50％ ± 2.80％ in the MSCT group,10.05 ± 2.17-16.81 ± 2.55,5.49 ± 1.48-4.19 ±1.05,6.41％± 1.64％-17.14％±2.27％ in the MSCM group,8.33 ±2.06-14.03 ±2.27,6.60 ±2.11-5.63 ±1.52,5.80％ ± 1.52％-12.30％ ±2.43％ in the MSCT + MSCT group.There were significant differences in the expressions of Bax protein at 24 and 72 hours,Bcl-2 protein at 48 and 72 hours,renal tubular epithelium cell apoptosis index at 24,48 and 72 hours between the MSCT group,MSCM group and MSCT + MSCM group ( P ＜0.05 ),but no significant difference was found between the MSCT group and the MSCM group ( P ＞ 0.05 ).The contents of TNF-α,IL-6,BUN,Cr,LDH,CRP in the MSCT group,MSCM group and MSCT + MSCM group were decreased when compared with those in the model control group,and a significant decrease of the 6 factors was observed in the MSCT + MSCM group.There were significant difference in the content of TNF-α at 72 hours,IL-6,BUN and Cr at 48 and 72 hours,LDH at 24,48 and 72 hours and CRP at 72 hours between the MSCT group,MSCM group and MSCT + MSCM group (P ＜0.05),while no significant difference was observed between the MSCT group and the MSCM group (P ＞ 0.05).Conclusion MSCT and MSCM can significantly protect acute renal injury in the progress of SAP,the probable mechanisms are pathological regeneration,anti-inflammatory effect and apoptosis inhibition of mesenchymal stem cells.

Clinicopathologic features of systemic EBV-positive T/NK-cell lymphoproliferative disease in adults / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinicopathologic features, immunophenotype, clonality and Epstein-Barr virus (EBV) status of systemic EBV-positive T/NK-cell lymphoproliferative disease in adults (ASEBV(+)T/NK-LPD).</p><p><b>METHODS</b>Twenty cases of ASEBV(+)T/NK-LPD were analyzed retrospectively with histopathologic review, immunohistochemistry and in-situ hybridization for EBV-encoded RNA (EBER). The follow-up data were collected.</p><p><b>RESULTS</b>There were altogether 15 males and 5 females. The median age of the patients was 34 years. The average duration from onset of symptoms to diagnosis was 8.7 months. Fever (18/20), hepatosplenomegaly (18/20) and lymphadenopathy (17/20) were the main clinical manifestations. Eleven of the 17 patients died during follow-up, with a mean survival of 2.9 months. Histologically, there was obvious expansion of T zone of the involved lymph nodes, associated with diminished lymphoid follicles. The interfollicular areas were widened and infiltrated by small to median-sized lymphoid cells which showed only mild atypia. Scattered large lymphoid cells were not uncommon. The nodal capsule was thickened in 6 cases. Focal necrosis was seen in 9 cases. Sinus histiocytic proliferation with erythrophagocytosis was observed in 3 cases. In addition, there were mild atypical lymphoid cells infiltrate into the liver, spleen, intestinal mucosa and bone marrow. Immunohistochemical study and in-situ hybridization showed that the EBER-positive cells were of T-cell lineage, with CD3 expression. They were also positive for cytotoxic molecules (granzyme B or TIA-1). Only 1 case was CD56 positive. A predominance of CD8-positive cells was demonstrated in 8 of the 14 cases studied, while CD4-positive cells predominated in the remaining 5 cases. One case showed similar proportion of CD8 and CD4-positive cells. The number of EBER-positive cells ranged from 30 to more than 300 per high-power fields. These EBER-positive cells were of small to large size and located mainly in the expanded T zone and occasionally in the germinal centers. Three of the 7 cases exhibited clonal rearrangement of T-cell receptor gamma gene, while the other 4 cases exhibited polyclonal rearrangement of T-cell receptor gamma gene.</p><p><b>CONCLUSIONS</b>ASEBV(+)T/NK-LPD is a systemic disease with a subacute or chronic clinical course. Most patients suffer from relapsing fever, lymphadenopathy and hepatosplenomegaly. The disease is characterized by proliferation of EBV-infected cytotoxic T cells. The T zone of the involved lymph nodes shows expansion by mildly atypical lymphoid cells. The disease is associated with poor clinical outcome and can be life-threatening. The patients often die of multiorgan failure and bleeding.</p>

Molecular genetic features of sporadic Burkitt's lymphoma in children / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate the molecular genetic features and diagnostic aspects of sporadic Burkitt's lymphoma (BL) in children.</p><p><b>METHODS</b>Tissue microarray was constructed to include 64 cases of pediatric BL and 6 cases of pediatric diffuse large B-cell lymphoma (DLBCL). Immunohistochemistry and fluorescence in-situ hybridization for c-myc, bcl-2, bcl-6, IgH, myc/IgH and bcl-2/IgH gene were performed. Cases of pediatric Burkitt's lymphomas were subclassified into three groups based on their cellular orgins: the germinal center (GC) group, the late-germinal center (late-GC) group and the post-germinal center (post-GC) group.</p><p><b>RESULTS</b>Among 64 Burkitt's lymphomas studied, expression of CD20, CD10, bcl-6, bcl-2 and MUM1 by immunohistochemistry were 100% (64 cases), 98.4% (63 cases), 96.9% (62 cases), 0 (0 cases) and 23.4% (15 cases), respectively. Various gene rearrangements were found involving the c-myc 93.1% (54/58 cases) and IgH 82.8% (48/58 cases). Detailed rearrangements are as follows: 46 cases (85.2%) myc/IgH gene translocation along with c-myc and IgH gene rearrangement; 4 cases (7.4%) c-myc gene rearrangement without IgH and myc/IgH abnormality; 4 cases (7.4%) without c-myc, IgH or myc/IgH gene rearrangement. No case showed bcl-2 gene abnormality (100%). Fifty nine cases showed normal bcl-6 gene status. One case had bcl-6 gene rearrangement and amplification with the pathologic and immunophenotypic characteristics of BL, leading to a revised pathological diagnosis of B-cell lymphoma, unclassifiable with features intermediate between diffuse large B-cell lymphoma and Burkitt's lymphoma (DLBCL/BL). Two cases showed c-myc gene rearrangement. Two cases showed bcl-6 gene amplification and 6 DLBCL cases had a normal status of bcl-2/IgH.</p><p><b>CONCLUSIONS</b>A majority of pediatric sporadic BL arise from the germinal center B cells, most of which have c-myc gene rearrangement. It is useful to distinguish BL and DLBCL by multiple genes detection.</p>

Influence of baicalin on TNF-a mRNA, caspase-3 and P-selectin expression in pancreatic tissue of rats with severe acute pancreatitis.

Objective Baicalin reduces the severity of severe acute pancreatitis (SAP) in a rat model. This study was carried out to examine the effect of baicalin on TNF-α mRNA, caspase-3 and P-selectin protein expression in the pancreas of rats with SAP. Methods Rats with SAP were randomly assigned to untreated, baicalin-treated, octreotide-treated and sham-operated group. The TNF-α mRNA expression level, caspase-3 and P-selectin protein expression levels of pancreatic tissue were measured 3, 6 and 12 hours after operation. Results The caspase-3 protein expression level was significantly higher in the treated groups than that in the untreated group at 3 hours (p <0.01). P-selectin protein expression level in pancreas of the treated groups was significantly lower than that of the untreated group (p <0.05 or <0.01). TNF-α mRNA expression level in pancreas decreased in baicalintreated group while untreated group increased at different time points (p <0.05). Conclusion Baicalin increases caspase-3 expression and inhibits TNF-α mRNA and P-selectin protein expression in pancreatic tissue of SAP rats.

Acute gangrenous cholecystitis after endoscopic sphincterotomy:a report of 16 cases / 中华消化内镜杂志

Objective To explore the causes and surgical management of acute gangrenous cholecvstitis(AGC)after endoscopic sphincterotomy(EST).Methods Clinical and pathological data of 1066 patients who underwent EST from June 2003 to January 2007 were analyzed retrospectively.ResultsAGC was complicated in 16 patients(16/1066,1.5%),who underwent emergency operations and no death occurred.During the follow-up period of 4 to 36 months,no infection or obstruction was found.Conclusion Difficuitv in EST manipulation and biliary obstrucion might play a leading role in AGC after EST,and early surgical intervention is effective.

Protective effects of bone marrow mesenchymal stem cells transplantation Combined with bone marrow stem cells mobilization on liver cells in rats with severe acute pancreatitis / 中华急诊医学杂志

Objective To observe the protective effects of autologous bone marrow mesenchymal stem cells transplantation alone with bone marrow stem cells mobilization on liver cells in rats with severe acute paucreatitis in order to explore their mechanism. Method After the establishment of severe acute pancreatitis in rats made by intraperitoneal injection of L-arginine, 240 SD rats were randomly divided into sham-operated group (n = 48), model control group (n = 48), bone marrow mesenchymal stem cell transplanted (MSC) group (n = 48), granu-lacyte-colony stimulating factor treated (G-CSF) group (n = 48) and MSC + G-CSF (n = 48). The rats of MSC group were prepared by injection of 1.2 mL MSC into femoral vein 6 hours after SAP. The rats of G-CSF group were prepared by subcutaneous injection of G-CSF 40 μg/kg for 3 days before SAP. The rats of MSC + G-CSF group received MSC and G-CSF together. The rats of sham-operated group were injected with equal volume of nor-real saline. The rats in each group were sabdivided into 12 h, 24 h, 48 h and 72 h sub-groups (n = 12) according to the examinations in different intervals after operation. Of different subgroups, the morality rate, pathological changes, expression levels of Bax, Bcl-2 proteins and apoptosis indexes of livers were observed respectively. The contents of serum TNF-α,IL-6,ALT,AST,LDH and CRP were simultaneously determined to compare the difference among subgroups by variance analysis. Results Compared to the respective model group, the mortality rates of all treated 72 h subgroups showed no difference (P > 0.05), and no rats died before 48 h. The pathological injuries of liver cells were rather attenuated in rats of treated group than in rats of control group. The liver cell apoptosis in-dexes of 48 h and 72 h MSC + G-CSF subgroups were 107.1 ± 7.0, 110.3 ± 8.6, respectively; the expression of Bax in livers of 24 h,48 h and 72 h subgroups was 5.60±0.Z5, 5.69±0.22, 5.73±0.27, respectively;Bcl-2 protein of 48 h,72 h subgroups was 4.61±0.28, 4.43±0.28, respectively; compared with MSC and G-CSF subgroups the differences were significant (P < 0.05). The serum TNF-α, IL-6, ALT, AST, LDH and CRP de-creased obviously in 24 h/48 h treated subgroups in comparison with control group (P < 0.05). The MSC + G-CSF group showed more significant effects on those biomarkers than MSC or G-CSF alone after 48 hours (P < 0.05). Conclusions Autologous bone marrow mesenchymal stem cells transplantation alonewith bone marrow stem cells mobilization can significantly protect livers from severe damage during the course of severe acute panere-atitis, and the probable mechanisms are likely associated with the pathological regeneration, anti-inflammatory ef-fect and apoptosis inhibition of MSC.