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Objective To systematically evaluate the surgical effect in duct-to-mucosa and invagination groups of pancreaticojejunostomy after pancreaticoduodenectomy.Methods The Cochrane Library,PubMed,EMbase and CBM data bases were searched to identify randomized controlled trials that compared the postoperative pancreatic fistula,mortality,incidence of complications,delayed gastric emptying,postoperative haemorrhage,infection,reoperate rate,postoperative hospital stay of duct-to-mucosa and invagination for pancreaticcoduodenectomy.Meta-analysis was performed using the software RevMan 5.3.Results Nine trials with 1 163 patients comparing the duct-to-mucosa group with invagination group were included,the duct-to-mucosa group with 579 patients and the invagination group with 584 patients.The meta-analysis revealed that,compared the duct-to-mucosa group with the invagination group,the rate of postoperative pancreatic fistula was not significantly reduced (RR =1.13,95 ％ CI:0.88-1.45,P =0.34),there was no significa nt difference between the two group.To systematically evaluate the total mortality (RR =0.80,95 ％ CI:0.42-1.52,P =0.49),incidence of complications (RR =1.04,95 ％ CI:0.88-1.24,P =0.63),delayed gastric emptying (RR =1.26,95 ％ CI:0.90-1.76,P =0.18),postoperative haemorrhage (RR =0.86,95 ％ CI:0.51-1.44,P =0.57),postoperative infection (RR =1.20,95％ CI:0.86-1.69,P =0.29),reoperate rate (RR =1.05,95％ CI:0.62-1.78,P =0.84),postoperative hospital stay (WMD =-1.36,95％ CI:-2.91-0.20,P =0.09) in duct-to-mucosa and invagination groups.There was no significant difference between the two group.Conclusions There was no significant difference of postoperative pancreatic fistul and mortality,incidence of complications,delayed gastric emptying,postoperative haemorrhage,postoperative infection,reoperate rate,postoperative hospital stay in duct-to-mucosa and invagination groups of pancreaticojejunostomy after pancreaticoduodenectomy.
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Objective@#To systematically evaluate the surgical effect in duct-to-mucosa and invagination groups of pancreaticojejunostomy after pancreaticoduodenectomy.@*Methods@#The Cochrane Library, PubMed, EMbase and CBM data bases were searched to identify randomized controlled trials that compared the postoperative pancreatic fistula, mortality, incidence of complications, delayed gastric emptying, postoperative haemorrhage, infection, reoperate rate, postoperative hospital stay of duct-to-mucosa and invagination for pancreaticcoduodenectomy. Meta-analysis was performed using the software RevMan 5.3.@*Results@#Nine trials with 1 163 patients comparing the duct-to-mucosa group with invagination group were included, the duct-to-mucosa group with 579 patients and the invagination group with 584 patients. The meta-analysis revealed that, compared the duct-to-mucosa group with the invagination group, the rate of postoperative pancreatic fistula was not significantly reduced (RR=1.13, 95%CI: 0.88-1.45, P=0.34), there was no significant difference between the two group. To systematically evaluate the total mortality (RR=0.80, 95%CI: 0.42-1.52, P=0.49), incidence of complications (RR=1.04, 95%CI: 0.88-1.24, P=0.63), delayed gastric emptying (RR=1.26, 95%CI: 0.90-1.76, P=0.18), postoperative haemorrhage (RR=0.86, 95%CI: 0.51-1.44, P=0.57), postoperative infection (RR=1.20, 95%CI: 0.86-1.69, P=0.29), reoperate rate (RR=1.05, 95%CI: 0.62-1.78, P=0.84), postoperative hospital stay (WMD=-1.36, 95%CI: -2.91-0.20, P=0.09) in duct-to-mucosa and invagination groups. There was no significant difference between the two group.@*Conclusions@#There was no significant difference of postoperative pancreatic fistul and mortality, incidence of complications, delayed gastric emptying, postoperative haemorrhage, postoperative infection, reoperate rate, postoperative hospital stay in duct-to-mucosa and invagination groups of pancreaticojejunostomy after pancreaticoduodenectomy.
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Pancreatic cancer is a common malignancy of the digestive system,which is difficult for early diagnosis and surgical resection.Currently,the main clinical treatment strategies are not effective.High-intensity focused ultrasound (HIFU),for its non-invasive characteristic,with combination therapy,such as chemotherapy,radiotherapy and traditional Chinese medicine,has made great progress in the clinical treatment of advanced pancreatic cancer.This literature will review the clinical status of HIFU in in the treatment of advanced pancreatic cancer,in order to provide references for the study of pancreatic cancer.
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Hepatic ischemia-reperfusion injury has always been a difficult problem in liver transplantation and liver tumor resection. The involvement of multiple mechanisms makes it particularly complex, among which energy expenditure during ischemia and oxidative stress induced by reperfusion are the main mechanisms leading to hepatic ischemia-reperfusion injury and may cause cell death and even liver failure. Silent information regulators are a class of nicotinamide adenine dinucleotide-dependent deacetylases which can lead to deacetylation of transcription factors including histones and nonhistones, and they are playing an important regulatory role in cell apoptosis, inflammatory response, energy balance, and oxidative stress. There are 7 types of silent information regulators in mammals, i.e., Sirt1-Sirt7, among which Sirt1 can reduce hepatocyte stress, regulate cell metabolic pathways, and thus alleviate the degree of hepatic ischemia-reperfusion injury through various signaling pathways. This article reviews the role of Sirt1-related signaling pathways in hepatic ischemia-reperfusion injury.
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At present, radical resection remains the best treatment strategy for liver metastasis of colorectal cancer, and patients with large or multiple tumors often face the problem of insufficient residual liver volume after hepatectomy, which may lead to serious complications including liver failure after surgery. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel two-step hepatectomy that allows rapid proliferation of the residual liver after primary surgery and can improve the resectability of liver tumors and reduce the risk of postoperative liver failure. Although ALPPS can achieve R0 resection or tumors and prolong patients’ survival time, there are still controversies over its application due to high incidence rates of complications and mortality rate. With reference to related studies in China and foreign countries, this article reviews the current application status and clinical value of ALPPS in liver metastasis of colorectal cancer.
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Objective To evaluate the efficacy and safety of early endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) in patients of acute biliary pancreatitis (ABP).Methods Databases including PubMed,EMBASE,Cochrane library,CBM,CNKI,WanFang data and VIP data were searched with " Endoscopic retrograde cholangiopancreatography" "Endoscopic sphincterotomy" "ERCP" "Pancreatitis" "Biliary pancreatitis" resection up to September 2017.Randomized controlled trails (RCTs) conternming the comparison of ERCP with EST versus conservative management in ABP patients were enrolled in the study.Two reviewers independently screened literature,extracted data,and assess the risk of bias of the included studies.The Meta-analysis was conducted by RevMan 5.3 software.Results A total of 10 RCTs involving 1 752 cases were included in the Metaanalysis.The results of Meta-analysis showed that compared with the control group,early ERCP with EST reduced the systemic complication rate of ABP (RR =0.66;95％ CI:0.47-0.93;P ＜ 0.05).However,there were no significant differences in overall mortality,local complication rate,and ERCP related complication rate in ABP between early and selected ERCP with EST treat (P ＞ 0.05).Subgroup analyses indicated that early ERCP with EST therapy reduced the mortality of severe acute biliary pancreatitis (SABP),ABP with biliary obstruction and within 24 hours of admission (RR =0.48,0.35,0.25;95％ CI:0.24-0.96,0.17-0.74,0.09-0.73;P ＜ 0.05);decreased the local and systemic complication rate of SABP,ABP with biliary obstruction (RR =0.56,0.54,0.51,0.51;95％ CI:0.37-0.86,0.33-0.91,0.32-0.81,0.32-0.80;P ＜ 0.05);reduced the local and systemic complication rate of SABP (RR =0.42,0.47;95％ CI:0.25-0.70,0.25-0.87;P ＜0.05) and shortened the hospital stay of SABP (MD =-11.22 d;95％ CI:-16.09--6.36;P ＜ 0.01).However,there were no significant differences of overall complication rate in ABP without biliary obstruction and hospital stay in MABP.Conclusion Early ERCP with EST therapy appears to be safe and effective for ABP patients.
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Chylous fistula after abdominal operation is a rare complication which easily lead to malnutrition or immunosuppression and even cause death due to constant loss protein and lymphocytes.The therapeutics of the chylous fistula after abdominal operation includes conservative treatment,surgery and special management modalities at present.The most of the patient can be cured by non-surgical treatment,which should be considered as the first treatment regimen,surgery should be choosen if it failed.Only the obove methads have failed can we take the special treatments cound be taken into consideration.In this paper,new progress in diagnosis and therapeutics of the chylous fistula after abdominal operation will be reviewed.
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BACKGROUND@#Epidemiological studies have suggested that noise exposure may increase the risk of type 2 diabetes mellitus (T2DM), and experimental studies have demonstrated that noise exposure can induce insulin resistance in rodents. The aim of the present study was to explore noise-induced processes underlying impaired insulin sensitivity in mice.@*METHODS@#Male ICR mice were randomly divided into four groups: a control group without noise exposure and three noise groups exposed to white noise at a 95-dB sound pressure level for 4 h/day for 1, 10, or 20 days (N1D, N10D, and N20D, respectively). Systemic insulin sensitivity was evaluated at 1 day, 1 week, and 1 month post-noise exposure (1DPN, 1WPN, and 1MPN) via insulin tolerance tests (ITTs). Several insulin-related processes, including the phosphorylation of Akt, IRS1, and JNK in the animals' skeletal muscles, were examined using standard immunoblots. Biomarkers of inflammation (circulating levels of TNF-α and IL-6) and oxidative stress (SOD and CAT activities and MDA levels in skeletal muscles) were measured via chemical analyses.@*RESULTS@#The data obtained in this study showed the following: (1) The impairment of systemic insulin sensitivity was transient in the N1D group but prolonged in the N10D and N20D groups. (2) Noise exposure led to enhanced JNK phosphorylation and IRS1 serine phosphorylation as well as reduced Akt phosphorylation in skeletal muscles in response to exogenous insulin stimulation. (3) Plasma levels of TNF-α and IL-6, CAT activity, and MDA concentrations in skeletal muscles were elevated after 20 days of noise exposure.@*CONCLUSIONS@#Impaired insulin sensitivity in noise-exposed mice might be mediated by an enhancement of the JNK/IRS1 pathway. Inflammation and oxidative stress might contribute to insulin resistance after chronic noise exposure.
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Animals , Male , Mice , Biomarkers , Metabolism , Inflammation , Insulin Receptor Substrate Proteins , Genetics , Metabolism , Insulin Resistance , Genetics , Allergy and Immunology , MAP Kinase Signaling System , Physiology , Mice, Inbred ICR , Mitogen-Activated Protein Kinase 8 , Genetics , Metabolism , Noise , Oxidative Stress , Physiology , Proto-Oncogene Proteins c-akt , Genetics , Metabolism , Random Allocation , Time FactorsABSTRACT
<p><b>OBJECTIVE</b>To investigate the dynamic features of angiogenesis in residual tumors after high intensity focused ultrasound (HIFU),and to determine the temporal effect and mechanism of hypoxia inducible factor-2 alpha (HIF-2a) in the angiogenic process of residual tumors.</p><p><b>METHODS</b>Xenograft tumors of HepG2 cells were generated by subcutaneously inoculating athymic BALB/c nu/nu mice with the hepatoma cells.About 30 days after inoculation,all mice (except in the control group) were treated by HIFU and assigned randomly to the following 7 groups according to various time intervals post-treatment:1st,3rd,5th day and 1st,2nd,3rd,4th week when the residual tumor tissues were obtained from the experimental groups.Protein levels of HIF-2a and vascular growth factor A (VEGF-A) were quantified by immunohistochemistry and western blotting,and mRNA levels were measured by (real-time quantitative) qPCR. Microvascular density (MVD) was calculated by counting the CD31-positive vascular endothelial cells identified by means of an immunohistochemical staining method.</p><p><b>RESULTS</b>Compared with results from the control group,the protein and mRNA levels of HIF-2a expression reached the highest level in the experimental mice at the 2nd week (P=0.000 and P < 0.01 respectively),and were decreased thereafter(3rd week and 4th week, P=0.000 and P < 0.05).VEGF-A expression in the residual tumor tissues group that received HIFU was significantly decreased,compared with the control group,at all time points uPto 1 week (all P=0.000 and P < 0.01),but the levels increased compared to controls in the 2nd through 4th week (all P=0.000, P < 0.05). Similar results were obtained for MVD.</p><p><b>CONCLUSION</b>HIFU treatment can inhibit angiogenesis in residual hepatoma tissues in the short-term (1 to 2 weeks post-treatment) in mice with hepatocellular carcinoma,but can promote angiogenesis overtime (2 to 4 weeks post-treatment); the angiogenic process may involve the HIF-2α/VEGFA pathway.</p>
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Animals , Humans , Mice , Blotting, Western , Carcinoma, Hepatocellular , Pathology , Hep G2 Cells , High-Intensity Focused Ultrasound Ablation , Hypoxia-Inducible Factor 1, alpha Subunit , Metabolism , Immunohistochemistry , Liver Neoplasms , Pathology , Mice, Inbred BALB C , Mice, Nude , Neoplasm Transplantation , Neovascularization, Pathologic , Vascular Endothelial Growth Factor A , MetabolismABSTRACT
Objective To study the effects of apoptosis of the tumor cells in rabbit liver VX2 carcinoma after treatment by radiofrequency ablation(RFA) combined with trans arterial chemoembolization(TACE) and high‐frequency hyperthermia(HFH) . Methods Rabbit liver VX2 carcinoma model was established .Rabbit liver VX2 tumor models were divided into the following group:group A ,RFA+ TACE;group B ,RFA + TACE + HFH ;group C ,RFA + HFH ;group D ,TACE+ HFH .The changes of serum ALT was detected to realize the safety of the treatment .Cell apoptosis were detected by DNA agarose gel electrophoresis and terminal deoxynucleotidyltransferase‐mediated Dutp nick end‐labeling(TUNEL) assay ;SP immunohistochemistry ,Western blot and Real‐time quantitative PCR(RT‐PCR) were used to detect Caspase‐3 protein and mRNA expression levels .Results The changes of serum ALT in group B was significantly higher .Compared with other groups ,the apoptosis index in group B was increased marked‐ly(P<0 .05) .Western blot and RT‐PCR Caspase‐3 protein and mRNA levels in group B were higher than the other groups(P<0 .05) .Conclusion RFA+ TACE+ HFH can effectively kill tumor cells and promote apoptosis of tumor cells ,but ,at the same time ,can damage liver function .
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Objective To systematically evaluate the postoperative pancreatic fistula rate,overall postoperative morbidity rate,overall postoperative mortality rate and length of stay in external stent group versus no stent group for pancreaticcoduodenectomy.Methods The Cochrane Library,PubMed,Embase and CBM data bases were searched to identify randomized controlled trials that compared the effectiveness of external stent versus no stent for pancreaticcoduodenectany.Meta-analysis was performed using the software RevMan 5.2.Results Four trials with 416 patients comparing external stent with no stent were included,the external stent group with 207 patients and the no stent group with 209 patients.The Meta-analysis revealed that,compared the external stent group with the no stent group,the rate of postoperative pancreatic fistula was significantly reduced in the external stent group [RR =0.57,95％ CI(0.41,0.80),P =0.001],especially for the patinets of pancreatic diameter ≤ 3.0 mm[RR =0.55,95 ％ CI(0.37,0.82),P =0.003] and soft pancreatic [RR =0.67,95 ％ CI(0.45,0.99),P =0.040],the overall postoperative morbidity rate of external stent group versus.no stent group was reduced[RR =0.79,95 ％ CI (0.64,0.98),P =0.030],and length of stay was shortened [WMD =-3.98,95％ CI(-6.42,-1.54),P =0.001].There was no difference between the two groups regarding the postoperative pancreatic fistula rate of diameter ＞ 3.0 mm [RR =0.37,95 ％ CI(0.08,1.83),P =0.220],and the overall postoperative mortality rate [RR =0.86,95 ％ CI(0.28,2.65),P =0.800].Conclusions Exental stent significantly reduced the postoperative pancreatic fistula rate and overall postoperative morbidity rate 、shortened the length of stay,and thus it can be identified as a preferable option for Pancreaticcoduodenectomy.
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<p><b>OBJECTIVE</b>To study the changes in hypoxia-inducible factor (HIF1α, HIF2α) in the residual tumor cells in nude mice bearing hepatocellular carcinoma (HCC) following treatment with high-intensity focused ultrasound (HIFU).</p><p><b>METHODS</b>Thirty nude mice bearing human HCC received treatment with HIFU. At 1, 3, and 5 days and 1 and 2 weeks after the treatment, the mice were examined for pathological changes of the residual tumor with HE staining; SP immunohistochemistry, Western blotting and real-time quantitative PCR were used to detect the protein and mRNA expressions of HIF1α and HIF2α in the tumor.</p><p><b>RESULTS</b>HE staining revealed the presence of residual tumor cells and large necrotic areas after the treatment. Immunohistochemistry showed a gradual increment of HIF1α protein and mRNA expressions after the treatment, reaching the peak level at 3 days (P<0.05) followed by progressive reduction at 5 days and 1 and 2 weeks. HIF2α expressions at either the protein or mRNA levels exhibited no significant changes within 3 days after the treatment (P>0.05) but increased significantly at 5 days and 1 and 2 weeks (P<0.05).</p><p><b>CONCLUSION</b>The changes of HIF1α and HIF2α in the residual tumor after HIFU treatment in nude mice bearing HCC can be associated with tumor cell apoptosis and angiogenesis after the treatment.</p>
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Animals , Humans , Mice , Carcinoma, Hepatocellular , Metabolism , Pathology , Therapeutics , Hep G2 Cells , Hypoxia-Inducible Factor 1, alpha Subunit , Metabolism , Liver Neoplasms , Metabolism , Pathology , Therapeutics , Neoplasm, Residual , Metabolism , Pathology , Ultrasonic Therapy , MethodsABSTRACT
Objective To explore the regulation mechanism of X box binding protein 1 (XBP1)signal transduction pathway for TNF-α and effective approach in ischemia/reperfusion (I/R) injury of liver transplantation for short hairpin RNA (shRNA) interference used to gene therapy in liver graft.Methods Male Sprague-Dawley rats were divided into three groups: the cold ischemia transfection group (CIT), the in vivo transfection group (IVT) and the control group. Experiments of orthotopic liver transplantation were performed by two cuff method. The rats in CIT were perfused with XBP1-shRNA plasmid (pSIXBP1) during cold ischemia phase, those in IVT received the equivalent volume (2 ml) of pSIIRAK 4 after portal vein inoculation, and those in the control group were not subjected to any treatment. Rats were killed at 60 or 180 min after restoring reperfusion of hepatic portal vein.Histopathological damage degree of graft liver was observed by light microscope. The expression levels of XBP1 gene and protein were detected by RT-PCR and Western blotting. The activities of NF-κB and the serum TNF-α level were detected by ELISA. Results All the indexes including the degree of histopathological damage, the expression levels of XBP1 mRNA and protein and the TNF-α level were significantly decreased in CIT as compared with IVT and control group (P＜0. 05). However,there was no significant difference in NF-κB activity among the three groups (P＞0. 05). Conclusion The role of XBP1 pathway in TNF-α gene regulation and that of NF-κB pathway in rat liver I/R injury are two relatively independent aspects, and the depression of XBP1 expression with XBP1 shRNA through portal vein perfusion during cold ischemia phase could effectively alleviate graft hepatic I/R
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Nowadays, tumor is one of the most challenging human health diseases, which oblige human tirelessly to studied for the tumor.Gene therapy is a promising treatment in oncotherapies. Suicide gene therapy is the most widely researched among gene therapies. At the same time, bystander effect take important role in the mechanism of suicide gene therapy. Therefore, more researchers devote themselves to studyinghow enhance the bystander effect in order to improve the effect of suicide gene therapy. This article reviewed in short how to augment bystander effect of suicide gene therapy against cancer.
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Hepatocellular carcinoma(HCC) is one of the most common malignant tumors in the world.According to the statistic data of Ministry of Public Health of China in 1995, the annual mortality of HCC was 20.4 per 0.1 million, and had the rise tendency. Surgery is commonly the main modality of HCC combined therapy. The high intensity focused ultrasound (HIFU), as a noninvasive therapy, with the mechanism of transient high temperatures, cavitation and mechanical effects, has been recognized. This review aimes to elucidate the immune changes in HCC after HIFU exposures and the mechanism.
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Hepatocellular carcinoma(HCC)is a common world wide disease.Transcatheter arterial chemoembolization(TACE)has been the first choice for the unresectable midadvanced ones.However, TACE has its own limitation such as high recurrence rate and many complications, what's more, recurrence induced by neovascularization which is stimulated by activation of vascular endothelial growth factors promoted by ischemia and hypoxia in local tissues after the embolization always reduce the effect of treatment.And combination of TACE and anti-angiogenesis therapy is capable to make up the shortage of each other and reduce the recurrence rate, which has been a hot issue for non-surgical treatment of HCC.
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The purpose of this study was to investigate the effect on the expression of NF-kappaBp65 of osteoblast-like cell under stretch load with the same amplitude but different daily loading times. The osteoblast-like cells MG-63 were passage cultured and stretched by the four-point-bend loading device; based on the daily loading times, the osteoblast-like cells were randomly divided into four groups. The first was the control, the others were stretched with mechanical tension with the same amplitude of 2,000 mu strain and at the same frequency of 0.5 Hz., but the daily loading times were 1 time/d, 2 times/d, 4 times/d differently for each group, the periods of mechanical tension applied to the cells of the three groups were all 60 min/d and lasted for 2d total. After the cells being streteched, the expression levels of NF-kappaBp65 of the osteoblast-like cells of the three groups and control group were investigated by using the techniques of immunohistochemistry, and were compared with each other. The results showed that the positive expression ratios of the four groups were different significantly; the positive expression ratio of the control was lower than those of the other three groups; the positive expression ratio of the 4 times/d group was higher than those of the other two stretched groups; the positive expression ratio of the 2 times/d group was higher than that of the 1 time/d group. The results suggested that when the osteoblast-like cell was under the stretch load with different daily loading times but the same amplitude, the expression ratio of NF-kappaBp65 in the cell increased with the rising of the stimulating times. It means that the mechanical strain with high daily loading times could promote the transcriptional level of osteoblast-like cell more effectively.
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Humans , Cell Line , Mechanotransduction, Cellular , Osteoblasts , Cell Biology , Metabolism , Stress, Mechanical , Time Factors , Transcription Factor RelAABSTRACT
Bile leak is a commonly complication after biliary tract surgery.In the past,operation was considered priorly to deal with bile leak besides putting a drainage tube in advance.Minimally invasive surgery has gradually become a primary management of bile leak,with the development of minimally invasive surgery such as abdominoscope in the 20th century.
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OBJECTIVE:To summarize the materials, design, fit-shape and fixation techniques and clinical application of temporomandibular joint (TMJ) prosthesis.DATA SOURCES: An online search was undertaken to identify English articles about TMJ prosthesis published in Pubmed database from January 1998 to December 2006 using the key words of "temporomandibular joint, joint prosthesis".STUDY SELECTION: The collected literatures about TMJ prosthesis were sorted, and those with good pertinence were selected. For the literatures of the same field, those published recently or in authorized journals were selected.DATA EXTRACTION: Totally 69 literatures were collected, 28 were enrolled, and the other 41 were excluded, including 23 were irrelative with the aim of this study, and 18 were repetitive studies.DATA SYNTHESIS: Joint prosthesis is one of the fields that develop the fastest in orthopedic surgery in recent 30 years.TMJ replacement aims to enhance the function of TMJ, alleviate pain, and prevent serious complication. With the rapid developments of material science, tissue engineering, joint biomechanics and other related subjects, TMJ prosthesis has been significantly improved in the materials, design, fit-shape and fixation techniques. People have developed from simply imitating the outline form and mechanical motor of TMJ to pay more attention to its pathological function. It is very significant to trace the new progress in hip prosthesis and knee joint, and apply the good outcomes in the design and manufacture of TMJ prosthesis.CONCLUSION: Prosthetic material plays leading and promoting roles in the development of joint prosthesis, good design,fit-shape and fixation are the necessary conditions for prosthesis to act its role, and it is also necessary to investigate joint biomechanics. TMJ prosthesis should be further investigated, and it has good prospect.
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This study sought to elucidate the function of NO during the signal transduction wherein fluid shear stress regulates the proliferation and differentiation of osteoblast cells. The isolated rat osteoblast-like cells were exposed to fluid shear stress 12 dyn/cm2 for 5, 10, 15, 30, 60 and 120 min respectively with the use of a flow chamber. The NO release was examined. After the exposure to fluid shear stress, the NO synthesis of rat primary osteoblast-like cells increased significantly (P<0.05) when compared with the control. After 60 minutes of exposure, the release of NO began to increase significantly (P<0.05), but no significant increase as such was seen in the control (P>0.05). NO synthesis may be one of the signal transduction pathways which transduce the fluid shear stress into osteoblast cells. In early stage, it may be induced by cNOS and in late stage by iNOS.