Parenteral nutrition (PN) was given to 40 patients with upper gastric carcinoma after proximal gastrectomies; and full enteral nutrition (EN) was subsequently given when bowels function recovered.The nutritional indicators including serum albumin ( Alb),prealbumin .(PA) and transferring,and immunological indicators including IgA,IgG,IgM,C3,C4 were measured before and 1st,8th day after operation.The data were processed by software SPSS 13.0.The average length of hospital stay was 14 d and the aerofluxus time was (58 ±6)hours.There were no changes in blood biochemistry,hepatic function and renal function pre- and post-operation( P ＞0.05 ).The nutritional and immune indicators except the IgM in 1 st day after operation were decreased significantly ( P ＜ 0.05 ).The immune indicators except the IgG in 8th day after operation were significantly improved in comparison of those before and 1st day after operation ( P ＜ 0.05 ).Post-operative complications occurred in 3 patients including 1 case of subphrenic infection and 2 cases of anastomotic leakage.After proper treatment,all patients recovered well.Combined application of EN and PN may improve nutrition and immune status of patients after proximal gastrectomy.

Factor VII Deficiency ; complications ; Humans ; Liver Cirrhosis ; complications ; Male ; Middle Aged

Objective To study the effect of nutrition support with somatostatin in patients with gastro- esophagus leakage after proximal gastrectomy. Methods 6 patients with gastro-esophagus leakage after proximal gastrectomy for gastric cancer from July 2004 to September 2009 were enrolled. Then, the patients were treated with improved drainage, parenteral & enteral nutrition and somatostatin. Furthermore, nutrition index and duration of recovery were investigated respectively. All data were analyzed between preoperative and postoperative by student's T-Test.Results 6 patients were cured after non-operation. The average period of in-hospital was 32 days. Compared with the post-leakage day 1 ,the nutrition states were significantly improved when patients recovered( P ＜0. 01 ). Non-complication happened. Conclusion It was an effective way to improve the nutrition state and to promote the gastro-esophagus leakage healing.

Objective To study the expressions of survivin and PTEN in ampullary carcinoma and their clinical significance.Methods The expressions of Survivin and PTEN proteins were tested by EnVision immunohistochemistry in 40 cases of ampullary carcinomas and 8 cases of normal ampulla of vater as control.Results The positive rate of Survivin in ampullary carcinomas was significantly higher than normal human controls (82.5％ vs 0％,P ＜ 0.01 ).The differences of the expression of Survivin in ampullaty carcinoma of duodenal invasion,pancreatic invasion,and lymph node metastasis were significant ( P ＜0.05 ).Significant differences were also observed in the expression rate of PTEN hetween the patients with ampullary carcinoma and the normal controls (50％ vs 100％,P ＜ 0.01 ).The differences of the expression of PTEN in ampullary carcinoma of duodenal invasion,pancreatic invasion,and lymph node metastasis were significant ( P ＜ 0.05 ).Significantly negative correlation was found between the expression of Survivin and PTEN by using spearman correlation analysis ( r =-0.57,P ＜ 0.01 ).Conclusions The abnormal expression of Survivin and PTEN gene may promote tumor genesis and progression of ampullary carcinomas and it may be used as the marker for prognosis.

Objective To study the expression of Survivin and COX-2 in ampullary carcinoma and their clinical significance.MethodsThe expression of Survivin and COX-2 proteins were tested by EnVision immunohistochemistry in 40 cases of ampullary carcinomas,and 8 cases of normal ampulla of vater as the controls.ResultsThe positive rate of Survivin in ampullary carcinonas was significantly higher than that of the controls(82.5％ vs 0,P ＜ 0.01 ). The expression of Survivin in ampullary carcinoma was correlated with duodenal invasion,pancreatic invasion and lymph node metastasis ( P ＜ 0.05 ).Significant difference was also observed in the expression rate of COX-2 between the patients with ampullary carcinoma and the normal controls (67.5％ vs 0,P ＜ 0.01 ).The expression of COX-2 in ampullary carcinoma was correlated with duodenal invasion,pancreatic invasion and lymph node metastasis (P ＜ 0.05). Significantly positive correlation was found between the expression of Survivin and COX-2 by using spearman correlation analysis ( r =0.383,P =0.015).ConclusionThe specific up-regulation of COX-2 gene and Survivin gene may play an important role in the genesis and development of ampullary carcinoma.COX-2 and Survivin may be used as early diagnosis markers and potential therapeutic targets in ampullary carcinoma.

Objective To investigate the diagnosis and treatment of ectopic opening of the common bile duct in the duodenal bulb.Methods The clinical data of 3 patients who were admitted to the Binzhou People's Hospital and 9 patients who were admitted to the Tianjin People's Hospital from January 2006 to December 2013 with ectopic opening of the common bile duct in the duodenal bulb were retrospectively analyzed.Seven patients had choledocholithiasis and 5 had stenosis at the end of common bile duct.The medical histories and clinical features in patients were analyzed and routine blood test and serum liver function test were done.All the patients received the endoscopic retrograde cholangiopancreatography (ERCP) examination and were cured.All the patients were followed up via outpatient examination and telephone interview up to August 2014.Results Six patients had histories of cholangitis recurrence and 2 had histories of duodenal ulcer recurrence.All the patients had pain in the right hypochondriac region of the abdomen.Seven patients had fever,chills,skin yellowing sclera and tenderness in the right hypochondriac region of the abdomen.The levels of alkaline phosphatase (ALP) and glutamyltranspeptidase (GGT) in 11 patients,the levels of TBil and DBil in 8 patients and the count of WBC in 7 patients were increased.(1) The results of ERCP showed as follows:there was no papillar opening at the second and third segment of duodenum.The crack-like opening located at the duodenal post-bulb with rough and erosive mucosal surfaces and intermittent outflow of bile.Duodenal ulcer was detected in 5 patients and duodenal bulb metamorphosis in 3 patients.All the 12 patients received successfully intubations.(2)The results of retrograde cholangiography showed as follows:the end of common bile duct of 12 patients was taper and sickle-shaped.Intra-and extrahepatic bile duct dilation was detected in 10 patients,choledocholithiasis in 7 patients and clear findings for the pancreatic duct in 5 patients.Among the 12 patients,8 received balloon dilation (5 with stenosis at the end of common bile duct,3 with choledocholithiasis),3 received laparoscopic common bile duct exploration (LCBDE) combined with cholangioenterostomy due to diameter of stone more than 1.5 cm and ectopic opening stenosis of the common bile duct in the duodenal bulb.One patient was treated by percutaneous transhepatic cholangiography (PTC) lithotomy of common bile duct after unsuccessful ERCP without bleeding and pancreatitis-related complications.The symptoms of cholangitis in 3 patients were alleviated after balloon dilation,2 patients had recurrence of cholangitis and were cured by Roux-en-Y cholangioenterostomy.The mean open surgery time and mean duration of postoperative hospital stay in 5 patients were 85 minutes (range,60-150 minutes) and 10 days (range,8-14 days),respectively.All the 12 patients were followed up with a median time of 38 months (range,8-90 months).During the follow-up,10 patients survived well without recurrence of cholangitis and cholelithiasis.Two patients had recurrence of cholangitis at postoperative month 2 and month 14,including 1 patient with the recurrence of common bile duct sand-like stones,and they were readmitted to hospital and treated by Roux-en-Y cholangioenterostomy without recurrence by follow-up.Conclusions The clinical symptoms of ectopic opening of the common bile duct in the duodenal bulb included recurrence of cholangitis,duodenal ulcer history,pain in the right hypochondriac region of the abdomen,skin yellowing sclera,abnormal liver function,crack-like openings in the duodenal bulb by ERCP examination with outflow of bile,cholangiography-guided taper and sickle-shaped end of common bile duct.The treatment should be aimed at the concomitant diseases.

To study the chemical constituents of K. oblongifolia, silica gel column chromatography, MCI and Sephadex LH-20 were used to separate the 70% acetone extract of the stems of K. oblongifolia. The structures of the isolated compounds have been established on the basis of physicochemical and NMR spectroscopic evidence as well as ESI-MS in some cases. Twenty compounds were obtained and identified as heteroclitalignan A (1), kadsulignan F (2), kadoblongifolin C (3), schizanrin F (4), heteroclitalignan C (5), kadsurarin (6), kadsulignan O (7), eburicol (8), meso-dihydroguaiaretic acid (9), kadsufolin A (10), tiegusanin M (11), heteroclitin B (12), (7'S)-parabenzlactone (13), angeloylbinankadsurin B (14), propinquain H (15), quercetin (16), kadsulignan P (17), schizanrin G (18), micrandilactone C (19) and (-)-shikimic acid (20). Compouds 1, 5, 8, 11-15, 18 and 20 were isolated from this plant for the first time. Toxicity of compounds 1-10 were evaluated with zebrafish model to observe the effect on its embryonic development and heart function. The results showed that compounds 7, 9 and 10 caused edema of zebrafish embryo and decreased the heart rate of zebrafish, which exhibited interference effect on heart development of zebrafish.

Objective To investigate the expressions of cancerous inhibitor of protein phosphatase2A (CIP2A),phosphatidylinositol 3-kinase(PI3K),and survivin in pancreatic carcinomas and their clinical significance.Methods The expressions of CIP2A,PI3K,and survivin proteins were tested by immunohistochemistry in 64 cases of pancreatic carcinomas and adjacent paracancerous tissues.Results The positive rate of CIP2A in pancreatic carcinomas was significantly higher than adjacent paracancerous tissues (70.3％ vs 5.6％,P ＜0.05).Significant difference was observed in the expression rate of PI3K between the patients with pancreatic carcinomas and paracancerous tissues (73.4％ vs 8.3％,P ＜0.05).Significant difference was also observed in the expression rate of survivin between the patients with pancreatic carcinomas and paracancerous tissues (75.0％ vs 2.8％,P ＜0.05).CIP2A,PI3K,and survivin were significantly differentially expressed in pancreatic carcinoma among different tumor differentiation,tumor node metastasis (TNM) stage,and neural invasion and lymph node metastasis (all P ＜ 0.05).Spearman correlation analysis showed significantly positive correlation between the expressions of CIP2A and the others (PI3K and survivin) (both P ＜0.05),and between the expressions of PI3K and surviving (P ＜0.05).Conclusions CIP2A was involved in the development of pancreatic carcinomas and might activate the PI3K/Akt/survivin pathway.Our data identified CIP2A as a critical oncoprotein involved in cell proliferation,invasion,and metastasis.It could serve as a therapeutic target for pancreatic carcinomas.

Objective To investigate the relationship of Twist induced epithelial mesenchymal transitions (EMT) during pancreatic carcinoma progression.Methods The expressions of Twist,N-cadherin and Vimentin proteins were tested by immunohistochemistry in 42 cases of pancreatic carcinomas and 26 cases of adjacent paracancerous tissues.Results The positive rates of Twist,N-cadherin and Vimentin in 42 cases of pancreatic carcinomas were 76.2％,59.5％ and 57.1％,respectively.The positive rate of Twist,N-cadherin and Vimentin were all significant between pancreatic carcinomas and paired tumor-adjacent paracancerous tissues (all P ＜0.001).The differences of the expression of Twist,N-cadherin and Vimentin in pancreatic carcinoma of tumor differentiation,TNM stage,neural invasion and lymph node metastasis were significant (all P ＜ 0.05).Significantly positive correlation was found between the expression of Twist and the others (N-cadherin and Vimentin) by using spearman correlation analysis (r =0.506,P =0.001 ; r =0.417,P =0.006).Significantly positive correlation was found between the expression of N-cadherin and Vimentin by using spearman correlation analysis(r =0.462,P =0.002).Conclusions Twist signaling pathway activation might mediate pancreatic epithelial cells to EMT and then promote pancreatic carcinoma invasion and metastasis.