Expression of Toll like receptor in pancreatic cancer cells / 中华肝胆外科杂志

Objective:To compare the expression difference of Toll like receptor (TLR) and inflammatory factors between pancreatic cancer and normal pancreatic epithelial cells, and explore the correlation between TLR and inflammatory microenvironment.Methods:Normal pancreatic duct epithelium cells (HPNE) and pancreatic cancer cells (Panc-1 and Mia-PACA-2) were cultured and proteins were obtained. The expression of TLR family protein, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and myeloid differentiation factor 88 (MyD88) were examined by western blot in HPNE, Panc-1 and Mia-PACA-2. The correlations between TLR and inflammation cytokines of pancreatic cancer were analyzed by Pearson correlation analysis.Results:Compared with HPNE, the TLR2, TLR3, TLR4, TLR7, TLR8 and TLR9 were highly expressed in Panc-1 and Mia-PACA-2 (all P<0.05). Compared with Panc-1, the expression of TLR2 and TLR4 in Mia-PACA-2 were increased obviously, while the TLR9 expression was mildly decreased (all P<0.05). The expression of IL-6 in HPNE was found less than that in Panc-1 (0.52±0.03 vs. 0.76±0.04) and Mia-PACA-2 (0.52±0.03 vs. 1.12±0.09) with statistical differences ( P<0.05). Similarly, the expression of TNF-α was found significantly less than that of Panc-1 cells (0.63±0.04 vs. 0.87±0.06) and Mia-PACA-2 cells (0.63±0.04 vs. 0.95±0.10) with statistical differences (all P<0.05). The expression of IL-6 was found positively correlated with expressions of TLR2 ( r=0.964), TLR4 ( r=0.968), TLR7 ( r=0.844), TLR8 ( r=0.668) (all P<0.05), and the expression of TNF-α was found positively correlated with expressions of TLR2 ( r=0.805), TLR4 ( r=0.893), TLR7 ( r=0.847), TLR8 ( r=0.780) (all P<0.05). In contrast with HPNE, the expression of MyD88 was found highly expressed in Panc-1 (0.91±0.10 vs. 0.33±0.03) and Mia-PACA-2 (1.14±0.10 vs. 0.33±0.03) (all P<0.001). Compared with Panc-1, the expression of MyD88 in Mia-PACA-2 was obviously increased (1.14±0.10 vs. 0.91±0.10) with statistical difference ( P=0.048). Conclusion:The TLR family may play a critical role in development of pancreatic cancer by regulating the immune microenvironment, and its mechanism may be through upregulating MyD88 which functions as key signal transduction.

Synergistic effect of β-thujaplicin and tigecycline against tet(X4)-positive Escherichia coli in vitro / 生物工程学报

The widespread of tigecycline resistance gene tet(X4) has a serious impact on the clinical efficacy of tigecycline. The development of effective antibiotic adjuvants to combat the looming tigecycline resistance is needed. The synergistic activity between the natural compound β-thujaplicin and tigecycline in vitro was determined by the checkerboard broth microdilution assay and time-dependent killing curve. The mechanism underlining the synergistic effect between β-thujaplicin and tigecycline against tet(X4)-positive Escherichia coli was investigated by determining cell membrane permeability, bacterial intracellular reactive oxygen species (ROS) content, iron content, and tigecycline content. β-thujaplicin exhibited potentiation effect on tigecycline against tet(X4)-positive E. coli in vitro, and presented no significant hemolysis and cytotoxicity within the range of antibacterial concentrations. Mechanistic studies demonstrated that β-thujaplicin significantly increased the permeability of bacterial cell membranes, chelated bacterial intracellular iron, disrupted the iron homeostasis and significantly increased intracellular ROS level. The synergistic effect of β-thujaplicin and tigecycline was identified to be related to interfere with bacterial iron metabolism and facilitate bacterial cell membrane permeability. Our studies provided theoretical and practical data for the application of combined β-thujaplicin with tigecycline in the treatment of tet(X4)-positive E. coli infection.

Prospective study on the effect of prophylactic octreotide administration in preventing pancreatic fistula after pancreatoduodenectomy / 中华胰腺病杂志

Objective:To evaluate the effect of prophylactic octreotide administration on pancreaticoduodenectomy (PD)associated postoperative pancreatic fistula (POPF), total complications, peri-operative death and postoperative in-hospital days.Methods:From January 2020 to August 2021, 148 patients who underwent PD in the Department of Biliary-Pancreatic Surgery in Ren Ji Hospital affiliated with School of Medicine of Shanghai Jiao Tong University were recruited into this single-center randomized control double-blinded clinical trial. Patients were randomly assigned into octreotide group ( n=74) and control group ( n=74). Octreotide group was subcutaneously injected with 0.1 mg (1 ml) octreotide after preoperative anesthesia, and was subcutaneously injected with the same dose every 8 hours for 5 days, with a total of 16 doses. Control group was injected with 1 ml normal saline in the same way, and relevant clinical data and indicators of the two groups were recorded. The primary endpoint was clinically relevant pancreatic fistula, and the secondary endpoints were total complications, perioperative death and postoperative in-hospital days. Univariate and multivariate logistic regression analysis were used to screen the risk factors of clinically related POPF after PD. Results:120 patients were finally enrolled, including 61 in octreotide group and 59 in control group. There were no significant differences on age, gender ratio, body mass index, preoperative surgery rate of jaundice reduction, preoperative major biochemical indicators, operation time, intraoperative blood loss, pancreatic duct diameter, pancreatic texture and pathological type composition ratio. The total incidence of clinical relevant POPF was 8.3%, and there were no significant differences on biochemical leakage (4.9% vs 8.5%, P=0.435), grade B fistula (4.9% vs 8.5%, P=0.435) and grade C fistula (1.6% vs 1.7%, P=0.981). The total complication incidence (24.5% vs 28.8%, P=0.601), perioperative mortality (0 vs 3.3%, P=0.147) and postoperative in-hospital days (20.6±11.1 d vs 19.5±12.2 d, P=0.633) were not significantly different between two groups. Univariate analysis showed that preoperative serum albumin level <30 g/L( P<0.001) and pathological type of pancreatic ductal adenocarcinoma ( P=0.036) were independent risk factors for POPF after PD, while multivariate analysis found no statistically significant risk factors. Conclusions:Octreotide can neither reduce the incidences of POPF, total complications and postoperative mortality, nor shorten postoperative in-hospital days. However, for patients with preoperative hypoproteinemia and (or) the pathological type of pancreatic duct adenocarcinoma, the prophylactic use of octreotide during PD and after PD may reduce the occurrence of POPF.

Efficacy of 90Sr- 90Y low dose applicator, topical timolol maleate, and the combination in the treatment of superficial infantile hemangioma: a prospective cohort study / 中华核医学与分子影像杂志

Objective:To investigate the clinical efficacy and safety of 90Sr- 90Y β-ray low dose applicator, topical timolol maleate, and their combination in the treatment of superficial infantile hemangioma (IH). Methods:From May 14, 2013 to April 11, 2017, 400 children (126 males, 274 females, age 5.3(3.9, 7.1) months) with superficial IH in Department of Nuclear Medicine, the First People′s Hospital of Foshan were prospectively enrolled. All patients were randomly divided into 4 treatment groups according to the proportion of 1∶1∶1∶1 by the method of random number table: topical timolol maleate (group A, control group), 90Sr- 90Y β-ray low dose applicator (group B), single course applicator combined with timolol (group C), and multi-course applicator combined with timolol (group D). Lesions were followed up to the 104 th week (W104). Cure rate of W104 was considered as primary end point. Efficacy and safety of different treatment were compared. Kruskal-Wallis rank sum test, Mann-Whitney U test, and logistic regression analysis were used for statistical analysis. Results:Totally, 438 lesions in 400 cases were included in this prospective study. There was no significant difference in baseline characteristics among 4 groups ( χ2 values: 1.709-11.616, H values: 3.681-7.653, all P>0.05). As of W104, 11 lesions (2.51%, 11/438) were lost follow-up, 32 lesions (7.31%, 32/438) were with early withdrawal, 357 lesions (81.51%, 357/438) were cured, 15 lesions (3.42%, 15/438) were with residual, 23 lesions (5.25%, 23/438) were with rebound growth, and no serious adverse events occurred in the 4 groups. Multivariate analysis showed that lesions thickness (<3 mm vs ≥ 3 mm, odd ratio ( OR)=16.689, 95% CI: 7.908-35.223; χ2=54.555, P<0.001) and treatment (considering group A as reference category, OR (95% CI) of group B, C and D were 16.842(6.179-45.901), 4.801(2.167-10.638) and 39.127(10.468-146.243), respectively; χ2=47.663, P<0.001) were independent factors affecting the cure rate of W104. 90Sr- 90Y low-dose fractionation radiotherapy was significantly better than topical timolol maleate ( OR=16.842, 95% CI: 6.179-45.901), and the combination with timolol could significantly reduce the cumulative absorbed dose of radiotherapy (group D vs B: 16(8, 16) vs 16(16, 24) Gy; z=-4.947, P<0.001). Conclusion:90Sr- 90Y low dose applicator therapy is superior to topical timolol maleate for superficial IH, and the combination with timolol could significantly reduce the cumulative absorbed dose of applicator.

Simultaneous Determination of 11 Active Components in Yuhuai Tablets by HPLC-QAMS / 中国药房

OBJECTIVE：To establish the method for simultaneous determination of 11 active components in Yuhuai tablets ， such as gardoside ，shanzhiside，gardenoside，genipin 1-gentiobioside，geniposide，ziyuglycoside Ⅰ ，ziyuglycoside Ⅱ ，narirutin， naringin，hesperidin and neohesperidin. METHODS ：HPLC-QAMS method was adopted. The determination was performed on Agilent TC-C 18column（250 mm×4.6 mm，5 μm）with mobile phase consisted of acetonitrile （A）-0.1％ phosphoric acid solution （B） （gradient elution ）at the flow rate of 1.0 mL/min. The column temperature was set at 30 ℃. The detection wavelengths were set at 238 nm for gardoside ，shanzhiside，gardenoside，genipin 1-gentiobioside and geniposide ，203 nm for ziyuglycoside Ⅰ and ziyuglycoside Ⅱ，and 283 nm for narirutin ，naringin，hesperidin and neohesperidin. Using geniposide as an internal reference ，the relative correction factors of other 10 components relative to this component were calculated ，and the contents of each component in 10 batches of samples were calculated. The results obtained by HPLC-QAMS method were compared with those obtained by external standard method. RESULTS ：The linear ranges of gardoside ，shanzhiside，gardenoside，genipin 1-gentiobioside，geniposide， ziyuglycoside Ⅰ，ziyuglycoside Ⅱ，narirutin，naringin，hesperidin and neohesperidin were 0.87-43.50，1.99-99.50，4.06-203.00， 7.35-367.50，12.97-648.50，28.98-1 449.00，3.79-189.50，1.57-78.50，18.05-902.50，0.66-33.00 and 14.38-719.00 μg/mL（all r＞0.999 0）. RSDs of precision ，repeatability and stability （24 h）tests were all less than 2％（n＝6）. The average recoveries were 96.90％-100.10％，and RSDs were 0.67％-1.74％（n＝9）. E-mail：289931673@qq.com There was no significant difference in the contents of 10 active components as gardoside between HPLC -QAMS method and external standard method in 10 batches of Yuhuai tablets （P＞0.05）. CONCLUSIONS ：The HPLC-QMAS method established in this study is convenient and accurate. It can be used for the simultaneous determination of gardoside ，shanzhiside，gardenoside，genipin 1-gentiobioside，geniposide，ziyuglycoside Ⅰ，ziyuglycoside Ⅱ，narirutin，naringin，hesperidin and neohesperidin in Yuhuai tablets.

Prognostic factors of survival for patients with duodenal papilla carcinoma after pancreaticoduodenectomy / 中华普通外科杂志

Objective To investigate the prognostic factors of survival for patients with duodenal papilla carcinoma (DPC) after pancreaticoduodenectomy.Methods 98 DPC patients undergoing pancreaticoduodenectomy with follow-up from Jan 2010 to Dec 2017 at Renji Hospital,School of Medicine,Shanghai Jiao Tong University were analyzed retrospectively.Results 80 Cases were followed up.The 1,3,and 5 year survival rates of 80 patients were 89.9％,72.4％,and 66.6％,respectively.Univariate analysis showed tumor size,T stage,N stage,TNM stage,tissue differentiation degree were related to postoperative survival(all P ＜0.05).Multivariate analysis showed that tumor size,N stage,TNM stage,and tissue differentiation degree were independent factors influencing postoperative prognosis(all P ＜ 0.05).Conclusions Tumor size,N stage,TNM stage and tumor tissue differentiation degree were independent factors influencing the prognosis of DPC after pancreaticoduodenectomy,suggesting that early diagnosis,early treatment and radical resection were the key to improve the postoperative prognosis of DPC.

Diagnostic efficacy of 99Tcm-sestamibi SPECT/CT for parathyroid lesions in patients with secondary hyperparathyroidism caused by chronic kidney disease / 中国医学影像技术

Objective To investigate the efficacy of SPECT/CT in detecting parathyroid lesions in chronic kidney disease (CKD) with secondary hyperparathyroidism (sHPT) patients.Methods Within 2 weeks before parathyroidectomy (PTX),52 patients of CKD with sHPT underwent 99Tcm-sestamibi (99Tcm-MIBI) dual-phase planar and delayed SPECT/CT scintigraphy.Taking surgical pathology as the golden standards,the sensitivity,specificity and accuracy of dual-phase planar,SPECT,CT and SPECT/CT were calculated and compared.Results Totally 172 lesions were detected in surgical operation,including 13 parathyroidomas (PM),26 adenomatoid hyperplasias (AH) and 133 diffuse parathyroid hyperplasias (PH).The sensitivity of 99Tcm-MIBI dual-phase planar,SPECT,CT and SPECT/CT was 55.81％ (96/172),70.35％ (121/172),79.65％ (137/172) and 81.40％ (140/172),respectively,while the specificity was 92.05％(81/88),90.91％ (80/88),76.14％ (67/88),93.18％ (82/88),the accuracy was 68.08％ (177/260),77.31％ (201/260),78.46％ (204/260) and 85.38％ (222/260),respectively.The sensitivity of SPECT/CT was superior to that of SPECT (x9 =17.053,P＜0.001) and 99Tcm-MIBI dual-phase planar (x2 =44.000,P＜0.001).SPECT/CT was superior to CT (x2 =10.316,P =0.001) for specificity,and superior to CT (x2 =13.136,P＜0.001),SPECT (x2 =14.815,P＜0.001) or 99Tcm-MIBI dual-phase planar (x2=39.706,P＜0.001) for accuracy.Conclusion SPECT/CT fusion imaging is better in localization of parathyroid lesions of CKD with sHPT patients than 99Tcm-MIBI dual-phase planar,SPECT or CT imaging alone.

Analysis of human papillomavirus infection in male patients with condyloma acuminatum / 中华传染病杂志

Objective@#To explore human papillomavirus (HPV) infection and genotype distribution in male patients with condyloma acuminatum (CA).@*Methods@#Totally 332 male patients with CA were enrolled from March 2015 to September 2017 at Henan Provincial People′s Hospital. By means of flow-through hybridization after polymerase chain reaction (PCR), the wart tissue HPV DNA genotypes were detected by gene chip. χ2test was used to perform statistical analysis.@*Results@#Among 332 male CA patients, 239 was positive for HPV with the positive rate of 71.99% (95%CI: 67.16%-76.82%). A total of 37 kinds of genotypes, except for genotypes 26, 45, 69, 70, the others were all detected. The positive rate of genotype 6 was the highest in all detected genotypes (39.46%, 95%CI: 34.20%-44.72%) and the second one was genotype 11 (22.59%, 95%CI: 18.09%-27.09%), and the difference was significant (χ2=22.070, P<0.05). Among 239 HPV-positive CA patients, 158 were single infection and 139 were low-risk genotype (low-risk vs hight risk genotype: χ2=182.3, P<0.05), and 81 were multiple infection and 55 were mixed genotype (mixed vs low-risk genotype: χ2=32.241, P<0.05; mixed vs high-risk genotype: χ2=60.201, P<0.05). The CA patients mainly distributed in those aged 20 to 29 years, followed by those aged 30 to 39 years.@*Conclusions@#The genotypes of HPV infection in male patients with CA are mainly low-risk genotypes 6 and 11. Single infection is common, and the age of patients mainly distributes among 20 to 29 years old.

Propofol Inhibiting the Expression of VEGF through MAPK/ERK Signal Pathways in Oesophageal Carcinoma Cells EC9706 / 医学研究杂志

Objective To investigate the effect of propofol on the expression of VEGF in Oesophageal carcinoma cells EC9706 and its related molecular mechanism.Methods The expression of VEGF in human Oesophageal carcinoma cells EC9706 and normal esophageal epithelium cells HEEC were compared by immunoblotting.EC9706 was treated with different concentrations of propofol (0,2,6,10μg/L).After incubation,the EC9706 cell lines were detected with MTT,flow cytometry,cell invasion and cell scratch tests.The expression of VEGF,and the phosphorylation of p38 (MAPK) and p44/42 (ERK1/2) were detected by qRT-PCR and immunoblotting in each group.Results The expression of VEGF in EC9706 cells was significantly higher than that in HEEC cells.After propofol intervention,the proliferation,migration and invasion of propofol groups were significantly lower than that of Ctrl group,while the apoptotic rate of propofol groups were significantly higher than that of Ctrl group.The expression of VEGF mRNA and protein in propofol groups were significantly lower than that in Ctrl group.The expression and phosphorylation of p38 (MAPK) and p44 / 42 (ERK1 / 2) were inhibited by propofol.Both of these effects were dose-dependent.Conclusion Propofol inhibits the proliferation,invasion and migration of OC cells EC9706 and promotes apoptosis.Its potential mechanism may work by inhibiting the MAPK/ERK signaling pathway,thereby inhibiting VEGF expression.

Urine albumin excretion and related factors in patients with essential hypertension / 心血管康复医学杂志

Objective:To study urine albumin excretion (UAE) and its related factors in patients with essential hyper‐tension (EH) .Methods :A total of 113 EH patients without significant target organ damage were enrolled as EH group ,while another 92 healthy subjects were regarded as healthy control group .Ratio of morning urinary albumin to creatinine was measured and regarded as UAE index .Plasma homocysteine (Hcy) ,serum uric acid ,creatinine , blood urea nitrogen ,blood glucose ,blood lipids etc .levels were measured ,and compared between two groups Re‐sults:Compared with healthy control group ,there were significant rise in UAE ,body mass index (BMI) ,waist hip ratio ,blood pressure ,pulse pressure ,heart rate ,plasma levels of triglyceride (TG) ,low density lipoprotein choles‐terol (LDL‐C) ,serum uric acid and Hcy (P<0.05 or <0.01) ,and significant reduction in level of high density lip‐oprotein cholesterol (HDL‐C) in EH group ( P=0.001) .Pearson correlation analysis indicated that lgUAE was pos‐itively correlated with lgTG (r=0.257 ,P=0.015) and estimated glomerular filtration rate (eGFR ,r=0.284 ,P=0.007) ,and inversely correlated with lg creatinine (r= -0.277 ,P=0.008) in healthy control group ,while in EH group ,lgUAE was positively correlated BMI (r=0.231 ,P=0.014) ,lgTG (r=0.200 ,P=0.034) and lgHcy (r=0.244 , P=0.009) .Muti-factor gradual regression analysis indicated that lg TG (β=0.265 ,P=0.001) and lg Hcy (β=0.170 , P=0.012) were independently positively correlated with lg UAE , R2 =0.112.Conclusion:UAE level significantly rises in EH patients ,and it′s significantly positively correlated with plasma levels of TG and Hcy .

Impact of lymph node metastasis on survival of patients with pancreatic cancer / 中华肝胆外科杂志

Objective To study the impact of lymph node metastasis on prognosis of patients with pancreatic cancer and to evaluate predictors of postoperative survival of these patients.Methods The clinical data on patients with pancreatic cancer who underwent pancreatic cancer radical surgery in our hospital from January 2002 to December 2013 were reviewed and analyzed.Data on lymph node metastasis,number of lymph node dissection,number of positive lymph nodes and positive lymph ratio were analyzed.Results Of 101 patients,the 6-month,1-year and 2-year survival rates were 84.2％,56.6％ and 28.5％,respectively.The median survival was 13.8 months.Univariate and multivariate analyses showed lymph node metastasis,a positive lymph node ratio,number of lymph node dissection and positive lymph nodes were independent influential factors of prognosis.Results of subgroup analysis showed the number of lymph node dissection was a prognostic factor for pNO patients,while a positive lymph ratio had no impact on survival of pN1 patients.In the subgroup of patients with pancreatic head cancer,lymph node metastasis was associated with prognosis but not in the subgroup of patients with pancreatic body and tail carcinoma.Conclusions For patients with pancreatic head cancer,lymph node metastasis was closely correlated with prognosis.In addition,factors including lymph node metastasis,number of lymph node dissection,a positive lymph node ratio and number of positive lymph nodes were independent influential factors of prognosis for patients with pancreatic head cancer.However,for pN1 patients,a positive lymph node ratio has no influence on prognosis.

Application of pancreaticojejunostomy procedures selection strategy in pancreaticoduodenectomy and risk factors analysis of pancreatic fistula after operation / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the pancreaticojejunostomy procedures selection strategy in pancreaticoduodenectomy and to analyze risk factors of pancreatic fistula.</p><p><b>METHODS</b>Clinical data of 352 patients who received pancreaticoduodenectomy from September 2009 to September 2012 were retrospectively analyzed. For patients with soft pancreas, binding pancreaticojejunostomy was applied to 153 patients. For patients with hard pancreas, duct-to-mucosa pancreaticojejunostomy (DMPJ) was applied (199 cases). The clinical efficacy and incidence of postoperative complications were compared among 2 groups. Risk factors of pancreatic fistula were screened out from many factors by univariate and multivariate analysis.</p><p><b>RESULTS</b>The overall incidence of pancreatic leakage was 13.9% (49/352). There were no significant difference in incidences of pancreatic leakage (χ(2) = 0.512), peritoneal bleeding (χ(2) = 0.784), abdominal infection (χ(2) = 1.161), digestive dysfunction rate (χ(2) = 4.753) and mean duration of hospital stay (t = 2.13) among 2 groups (all P > 0.05). The results of multivariate analysis showed pancreatic tube diameter < 3 mm (OR = 5.748), preoperative total bilirubin level > 171 µmol/L (OR = 5.112), duration of preoperative jaundice > 8 weeks (OR = 5.090), preoperative albumin level < 30 g/L (OR = 4.464) were independent risk factors of pancreatic fistula (all P < 0.05).</p><p><b>CONCLUSIONS</b>Bunding pancreatojejunostomy was as good as soft pancreatic; for duct diameter ≥ 3 mm suggested using duct-to-mucosa pancreaticojejunostomy. For the risk factors for pancreatic leakage actively cooperate with preoperative nutritional support and timely treatment of jaundice, the incidence of postoperative pancreatic leakage will be further reduced.</p>

Association between arterial stiffness and risk of coronary artery disease in a community-based population / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Arterial stiffness is well known as an important risk factor for coronary artery disease. In this study, we aimed to investigate the association between carotid-ankle pulse wave velocity (caPWV) and risk of coronary artery disease (CAD), and the interaction between pulse wave velocity (PWV) and other potential risk factors of CAD.</p><p><b>METHODS</b>A community-based cross-sectional study was conducted for subjects living in Beijing, China. We collected 213 subjects with coronary artery disease and 1 266 subjects without CAD between September 2007 and January 2009 in a community center of Beijing. A multivariate Logistic regression analysis was carried out to assess the odds ratios of factors related to CAD.</p><p><b>RESULTS</b>We found CAD subjects were more likely to have a higher body massindex (BMI), fasting glucose, uric acid, low-density lipoprotein (LDL) cholesterol, high-sensitivity Creactive protein (hs-CRP), carotic-femoral pulse wave velocity (cfPWV) and caPWV (P < 0.05), and CAD subjects had a significantly lower HDL cholesterol levels (P < 0.05). Moreover, the proportion of hypertension in CAD subjects was significantly higher than non-CAD subjects. The multiple Logistic regression analysis showed that hypertension, higher uric acid, hs-CRP, cfPWV and caPWV levels significantly increased the risk of CAD, with ORs (CI) of 1.47 (1.25-1.74), 1.17 (1.01-1.26), 1.35 (1.10-1.67), 1.15 (1.09-1.19) and 1.07 (1.01-1.15), respectively. Higher HDL cholesterol was significantly associated with reduced risk of CAD, with ORs (CI) of 0.58 (0.40-0.83). In addition, cfPWV had significant association with age, hypertension, LDL cholesterol, with Pearson's coefficients of 0.166, 0.074, and 0.030, respectively.</p><p><b>CONCLUSIONS</b>cfPWV and caPWV are independently associated with significant CAD, and cfPWV has significant correlation with age and hypertension. cfPWV and caPWV may be used as a practical tool for predicting the risk of CAD.</p>

Risk factors of pancreatic fistula after pancreaticoduodenectomy / 中华胰腺病杂志

Objective To analyze the risk factors of pancreatic fistula after pancreaticoduodenectomy,in order to provide evidence to reduce post-operative complication in clinical practice.Methods The clinical data of 352 patients with malignancy who received pancreaticoduodenectomy at the Shanghai Renji Hospital from September 2009 to September 2012 were retrospectively analyzed.The patients were divided into pancreatic fistula group and non-pancreatic fistula group.Peri-operative risk factors of pancreatic fistula after pancreaticoduodenectomy were analyzed by univariate and multivariate logistic regression analysis.Results Forty-nine cases of pancreatic fistula occurred,and the incidence rate of pancreatic fistula was 13.9％ (49/352).Univariate and multivariate logistic regression analysis showed sex,age,history of diabetes,operation time,intra-operative blood loss,vessel reconstruction,pancreatic tube placement,anastomosis time,type of digestive tract reconstruction were not risk factors of pancreatic fistula; however,brittle pancreatic tissue,diameter of pancreatic duct ＜3 mm,pre-operative total bilirubin level ＞ 171 μmol/l,duration of preoperative jaundice ＞ 8 weeks,pre-operative albumin level ＜30 g/L were the independent risk factors of pancreatic fistula (P ＜ 0.05).Conclusions Brittle pancreatic tissue,small pancreatic duct,high level of serum bilirubin,long duration of preoperative jaundice,low level of serum albumin are the independent risk factors of pancreatic fistula after pancreaticoduodenectomy.

The role of hydrogen peroxide on mesenteric artery RhoA/ROCK signal pathway in cirrhotic rats with portal hypertension / 中华肝胆外科杂志

Objective To explore the role of hydrogen peroxide in mesenteric artery contraction of cirrhotic rats with portal hypertension,which was induced by bile duct ligation.Possible mechanism in RhoA/ROCK signal pathway was also part of the focus.Methods The bile duct ligation-induced cirrhotic rats and normal rats (control group) were treated equally with PEG-catalase(10 000 U/kg-1 · d-1,ip.) or by its vehicle for 8 days.Then the level of H2O2 in mesenteric arteries was detected.The contractile response to norepinephrine of arterioles was analyzed by vascular perfusion system.The protein expressions of the α1 adrenergic receptor,β-arrestin-2 and Rho kinase-1 (ROCK-1),and the activity of ROCK-1 were measured by western blot.In addition,the interaction of α1-adrenergic receptor with β-arrestin-2 was assessed by co-immunoprecipitation.Results Compared to normal rats,the dose-response curve of the mesenteric arterioles in response to norepinephrine shifted to the right,and the EC 50 increased in the rats with portal hypertension.PEG-catalase treatment can decrease the hydrogen peroxide level in arteries,thus significantly lowered EC50 and improved the reactivity to norepinephrine of the mesenteric arterioles in portal hypertension rats.No significant difference in the α1-adrenergic receptor amounts was observed among groups.There was remarkable decreases in the protein expressions of β-arrestin-2 and its interaction with the α1-adrenergic receptor in cirrhotic rats with PEG-catalase treatment.PEG-catalase also increased the amount and activity of ROCK-1 in cirrhotic rats.Conclusions The level of hydrogen peroxide increases in the mesenteric arteries in bile duct ligation-induced cirrhotic rats.And it enhances the β-arrestin-2 expression and its interaction with the α1-adrenergic receptor,which subsequently decreases the amount and activity of ROCK as well as the contractility of mesenteric arteries in response to vasoconstrictors.

Analysis and treatment of intra-abdominal infectious after pancreatic surgery / 中华肝胆外科杂志

Objective To study the bacterial types and their drug resistance in intra-abdominal infections after pancreatic surgery,and to evaluate the appropriate treatment measures.Methods 113 patients who underwent pancreatic surgery from Jan 2012 to Dec 2012 in our hospital were included into this study.The drainage liquid from the surgical sites were collected for bacterial culture and drug susceptibility tests.Results The incidence of intra-abdominal infections was 39.8％ (45/113).There were 54 pathogenic strains of bacteria isolated,including 49 strains of gram-negative bacteria (90.7％),4 strains of gram-positive bacteria (7.4％),and 1 strain of fungus (1.9％).The top three pathogens were Pseudomonas aeruginosa (50.0％),Acinetobacter baumannii (14.8％) and Singular deformation bacteria (1 1.1％).Most gram-negative bacteria were sensitive to Polymyxin B and Aminoglycoside antibiotics (＞ 70％),but they were resistant to Imipenem and Cephalosporin which were commonly administered.Pancreatic fistula was closely related to intra-abdominal infections.Concluusions A gram-negative bacteria,Pseudomonas aeruginosa,was the predominant organism in intra-abdominal infections after pancreatic surgery in our hospital.The situation of drug-resistance was still severe.More effective measures should be taken to prevent growth of resistant strains such as using antibiotics according to drug sensitivity and avoiding empirical single use of broad-spectrum antibiotics.Pancreatic fistula commonly led to intra-abdominal infections.

The value of right lateral decubitus position to decrease artificial defect of cardiac anterior wall in 99Tcm-MIBI SPECT myocardial perfusion imaging for women / 中华核医学与分子影像杂志

Objective To explore the value of right lateral decubitus position MPI for differentiating myocardial perfusion defect from cardiac anterior wall attenuation artificial defect,caused by breast of woman.Methods Forty-nine patients(average age (61.5±8.4) years) who had low likelihood of coronary artery disease and had perfusion defect in the anterior wall after exercise stress 99Tcm-MIBI MPI were included.All underwent supine and right lateral decubitus position during resting SPECT images.The myocardial perfusion SPECT images at left ventricle were reconstructed and were measured by Bull's-eye,based on the counts.Results from both supine position imaging and right lateral decubitus position imaging were compared.Paired t test was used to statistically analyse the data by SPSS 13.0.Results Compared with supine position,the counts of the anterior,inferior,apex and lateral wall in right lateral decubitus position were significantly higher:(71.30±3.53) ％ vs (66.50±3.85) ％,(70.06±4.45) ％ vs (65.44±4.16) ％,(77.90±3.00)％ vs (75.81±4.08)％,(79.30±2.26)％ vs (72.60±3.87)％ (t=6.731,5.286,3.555,10.885,all P＜0.01).The counts of septal wall were significantly lower ((66.60±3.98)％ vs (70.06±4.51)％,t=-4.625,P＜0.01) in right lateral decubitus position than that in supine position.Among the different regions of anterior wall,the counts of the anterior-middle ((76.40 ± 3.80) ％ vs (68.60 ± 4.76) ％) and anterior-apex region ((77.10±3.24) ％ vs (69.00±3.54) ％) were significantly higher (t =9.916,8.870,both P＜0.01) in right lateral decubitus position than those in supine position,but there was insignificance ((56.94±6.06)％ vs (58.50±4.98) ％,t =-1.493,P＞0.05) at anterior-basal region.The artificial defect of different degrees in anterior wall was observed in all patients in supine position,23 cases (46.9％,23/49) showed artificial defect in the anterior-middle region and 16 cases (32.7％,16/49) in the anterior-apex region.All artificial defect showed radioactive filling in right lateral position imaging,12 cases(24.5％,12/49) filled markedly and 32 cases(65.3％,32/49) filled completely.Conclusions The artificial defects caused by breast of woman mainly present in anterior-middle region and in anterior-apex region of the anterior wall in supine position imaging.The right lateral decubitus position imaging can markedly improve these artificial defects.

The effects and mechanisms of vitamin C on intestional mesenteric arterioles responsiveness to vasoconstrictors in patients with cirrhosis and portal hypertension / 中华普通外科杂志

Objective To study the changes of mesenteric arterioles on the contractile response to norepinephrine in patients with cirrhosis and portal hypertension (PHT) caused by hepatitis B after treatment by high-dose vitamin C.Methods Eleven PHT patients and 6 non-PHT volunteer were those undergoing their respective surgeriesat in our hospital from January 2010 to June 2011.The PHT patients were randomly assigned to vitamin C treatment group and placebo treatment group.After admission and before induction of anesthesia,blood taken to mesure plasma concentration of malonaldehyde (MDA).Intraoperative portal pressure was measured.We took the third level intestinal mesentery vessels with their mesentery next to the jejunum and studied the contractile response to norepinephrine of the intestinal mesenteric arterioles.We also measured RhoA/ROCK pathway associated proteins' expression and activity changes by Western-blot method.Results The average value of the plasma MDA of PHT patients with cirrhosis was much higher than that of non-PHT patients.After treatment by vitamin C,the value decreased.The dose-response curve of isolated mesenteric arterioles to norepinephrine from PHT patients with cirrhosis shifted to the right,and the EC50 value was higher than that of non-PHT patients.But this phenomenon was reversed after the patients treated with vitamin C.The protein expression of RhoA in mesenteric arteries did not change significantly among the three groups.But the protein expression and activity of ROCK-1 was significantly reduced in PHT patients with cirrhosis.After treatment with vitamin C,the expression and activity of ROCK-1 in mesenteric arteries of cirrhosis was significantly increased.Conclusion The PHT patients with cirrhosis are in the situation of oxidative stress.The high-dose vitamin C treatment can reduce oxidative stress level and improve contractile hyporeactivity of mesenteric arterioles of PHT patients with cirrhosis to norepinephrine.The protein expression and activity increasement of ROCK in RhoA/ ROCK pathway is involved in thisphenomenon.

Experimental study of nitric oxide in decreasing intestinal mesenteric arterial hypocontractility in rats with hepatic cirrhosis and portal hypertension / 中华消化外科杂志

Objective To investigate the mechanisms of nitric oxide (NO) in decreasing intestinal mesenteric arterial hypocontractility in rats with hepatic cirrhosis and portal hypertension,and to analyze the interaction of NO and RhoA/ROCK pathway.Methods The levels of NO in the peripheral blood and mesenteric artery of normal rats (normal control group,5 rats),rats with portal hypertension (experimental control group,6 rats)and rats with portal hypertension treated by L-NAME (L-NAME group,6 rats) were detected.Mesenteric arteriole contractility to norepinephrine in the 3 groups was determined using a vessel perfusion system.The expressions of proteins of NO-cGMP-PKG pathway and RhoA/ROCK pathway in the 3 groups were detected by Western blot.All data were analyzed using the analysis of variance or LSD-t test.The changes of mesenteric arteriole contractility to norepinephrine was expressed in dose-response curve,and was analyzed using the nonlinear regression method,and the EC50 value was calculated.Results (1) The pressures of portal veins of the normal control group,experimental control group and L-NAME group were (6.2 ± 0.9)mm Hg (1 mm Hg =0.133 kPa),(13.9 ± 1.7)mm Hg and (16.6 ± 1.3) mm Hg,respectively,with a significant difference among the 3 groups (F =94.4,P ＜ 0.05).(2) The levels of NO in the normal control group,experimental control group and L-NAME group were (43 ± 5) μmol/L,(82 ± 16) μmol/L and (45 ± 9) μmol/L,respectively,with a significant difference among the 3 groups (F =24.77,P ＜ 0.05).The level of NO of the L-NAME group was significantly lower than that of the experimental control group (P ＜ 0.05).(3) The levels of NO in the mesenteric artery of the normal control group,experimental control group and L-NAME group were (236 ±41) μmol/g,(407 ± 82) μmol/g and (216 ± 42) μmol/g,respectively,with a significant difference among the 3 groups (F =20.29,P ＜ 0.05).The NO level of the L-NAME group was significantly lower than that of the experimental control group (P ＜ 0.05).(4) Compared with the experimental control group,the dose-response curve of mesenteric arterioles to norepinephrine shifted to the left,while it did not reach the level of the normal control group.The levels of EC50 of the normal control group,experimental control group and the L-NAME group were 6.458 × 10-7 mol,9.546 × 10-7 mol and 7.494 × 10-7 mol,respectively.There was a significant difference in the EC50 level between the L-NAME group and the other two group (t =2.726,3.112,P ＜ 0.05).(5) Compared with the normal control group,the protein expression levels of eNOS and p-VASP of mesenteric artery of the experimental control group were significantly increased (P ＜ 0.05),while they were decreased in the L-NAME group (P ＜ 0.05).The protein expression levels of eNOS and p-VASP of mesenteric artery of the L-NAME group were significantly higher than those of the normal control group (P ＜0.05).There were no obvious changes of protein expression levels of PKG-1,ROCK-1 and p-moesin in the 3 groups (P ＞ 0.05).(6) The activity of ROCK-1 was significantly increased with norepinephrine stimulation in the normal control group and the L-NAME group,while no obvious changes were detected in the experimental control group.Conclusions The NO expression is upregulated in mesenteric arteries in rats with hepatic cirrhosis and portal hypertension.Such changes induce ROCK activation via influencing the expression of vasoconstrictors.L-NAME can reduce the NO levels in the mesenteric arteries,which may improve RhoA/ROCK signal pathway transduction.This can help vasoconstrictors induce ROCK activation without affecting the protein expression of ROCK.

Research on geometric feature of femoral medullary cavity and it's matching with intramedullary nail / 中华骨科杂志

Objective To investigate the geometric feature of femoral medullary cavity through CT scanning and it's matching with femoral intramedullary nail,and to analysis the reason for difficulties in implanting distal lock pin.Methods Thirty dried femur specimens were measured through CT scanning,and twenty images were taken evenly according to the total length of shaft of femur from each femur.In each image,the data of the central axis point and eight points around medullary cavity wall in X and Y axes were obtained,which were used to reconstruct the three-dimensional models of medullary cavity,central axis,intramedullary nail by computer software.And the models were overlapped for comparison.Then the coronal and sagittal fold line charts for central axis of medullary cavity were drawn.The inserting process of intramedullary nail was simulated to observe whether the nail would punch out of the medullary cavity wall.Results The central axis of femoral medullary cavity and intramedullary nail were overlapped and compared.They matched well in the coronal plane,but the curves of femoral medullary cavity were larger than those of intramedullary nails in sagittal plane.While simulating the inserting process of intramedullary nail,6 nails punched out of the medullary cavity wall in coronal plane (20％,6/30),so did 13 nails in sagittal plane (43％,13/30).Conclusion Intramedullary nails match well with most of the femoral medullary cavities.However,the anatomic structure of the femoral medullary cavity differs individually.Curves of some femoral medullary cavity are large,which can cause deformation of intramedullary nail,and this is the main reason for the failure of distal locking.