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Objective To investigate the role of early enteral nutrition on TLR 4 signaling pathway in rats with acute necrotizing pancreatitis (ANP).Methods Sixty SD rats were randomly divided into three groups:sham operation group ( SO group ) , total parenteral nutrition group ( TPN ) , early enteral nutrition group ( EEN ) .One day after ANP model induction , the serum level of amylase was measured .Nutrient solution was given for five days , then the rats were sacrificed , and the blood , pancreas and colon tissue were collected.The serum levels of IL-6, TNF-αwere detected by ELISA .Pathologic changes of pancreas were observed by HE staining.The intestinal TLR4, NF-κB expression was measured by Western blot .Results Mortality rates of SO group, TPN group, EEN group were 0, 50%, 25%, respectively; the serum levels of amylase were (744 ±41), (3 278 ±219), (2 227 ±169) U/L, respectively;the serum levels of TNF-αwere (81.57 ±18.25), (465.72 ±42.47), (223.21 ±29.94)ng/L, respectively; the serum levels of IL-6 were (362.83 ±41.32), (932.46 ±57.21), (628.62 ±142.24) ng/L, respectively; the pancreatic pathologic scores were (0.91 ±0.15), (11.1 ±0.61), (6.9 ±0.62);the intestinal TLR4 expressions were 0.7506 ± 0.003, 1.3404 ±0.004, 0.9544 ±0.004;the intestinal NF-κB expressions were 1.33 ±0.50, 6.92 ±1.06,2.93 ±0.89.The values of TPN and EEN group were significantly higher than those of SO group (P<0.05). The values of EEN group were significantly lower than those of TPN group (P<0.05).Conclusions EEN can inhibit TLR4 and NF-κB signal pathway in gut , then reduce IL-6 and TNF-αexpression and relieve inflammatory reaction of ANP , finally decrease the mortality of ANP .
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Objective To study the value of endoscopic management of thyroid disease through periareola approach. Methods From Nov. 2008 to Feb. 2010, 20 cases were treated by endoscopic throidectomy using bilateral areola three-hole method. The chest skin and platysma were separated and CO2 (6 - 8mmHg pressure)was inflowed to establish the operative space. Thyroid tissues were cut and separated by harmonic scaple. Recurrent laryngeal nerve, superior laryngeal nerve and parathyroid gland were preserved. Results Operations were successfully completed using endoscope, among which there were 1 case of thyroid cyst resection, 5 cases of thyroid adenoma resection, 8 cases of thyroid unilateral partial resection, 3 cases of thyroid bilateral partial resection and 3 cases of thyroid sub-total resection. The average operation time was (100. 0 ± 30. 5) min. Blood loss was (70. 0 ± 15. 0) ml. 1 case of neck skin burns and 3 cases of subcutaneous hydrops appeared. No convertion occured. Conclusion Endoscopic thyroidectomy through periareolar approach is a safe minimal invasive surgical procedure with excellent cosmetic results.
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Objective To evaluate the CT features and the role of CT in the diagnosis of Crohn′s disease. Methods CT manifestations of 18 patients with pathology confirmed Crohn′s disease were retrospectively analyzed. The majority of the patients were scanned with spiral CT or multidetector row CT.Results All 18 patients, segmental thickening of the bowel wall was detected. There were two different appearances in contrast-enhanced CT scans: (1) mural thickening without enhancement or mural stratification, and homogeneous attenuation in the thickened wall were observed in 7 patients; (2) mural thickening and stratification, resulting in the target or double-halo appearance, were detected in 11 patients, and the bowel wall thickening ranged from 5 to 10 mm. Nine patients had perienteric abnormalities including fibrofatty proliferation, phlegmon and mesenteric hypervascularity. According to the CT manifestations, 5 patients were initially diagnosed as other diseases including intestinal obstruction (1 case), tuberculosis (1 case), cancer (2 cases), and abscess (1 case), respectively. Conclusion CT has the unparalleled ability to depict the abnormalities in the bowel wall, mesentery, abdominal and pelvic viscera, and contrast-enhanced CT can distinguish active Crohn′s disease from quiescent Crohn′s disease. These features make CT particularly valuable in the management of Crohn′s disease.
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Objective To compare the postoperative complications rate of total mesorectal excision(TME) performed by laparoscopic and conventional laparotomy method in treatment of rectal cancer.Methods The clinical data of patients with rectal cancer treated by laparoscopic surgery(n=42) or traditional laparotomy(n=50) were retrospectively analysed to analysis of the cause and occurrence rate of complications.(Results) The laparoscopic group had an advantage over the conventional laparotomy group in bowel movement recovery,earlier mobility and short hospital stay time.There was no difference in intraoperative injury,(anastomotic) leakage,sexual function preservation,long-term urinary dysfunction,and local recurrence or(incision) metastasis rates.Conclusions Laparoscopic TME treatment of rectal cancer had the same therapeutic effect as the conventional laparotomy procedure did,and has a better subjective outcome.