Objective To explore the effects of continuous renal replacement thempy ( CRRT) on efficacy in severe acute pancreatitis ( SAP) patients based on different time .Methods A total of 38 SAP patients were divided into two groups randomly:early group(CRRT within 48h) for 21 patients and late group(CRRT after 48h)for 17 pa-tients.the APACHE II score,the length of stay ICU and the mortality of 28d were compared between the two groups . Results The APACHE Ⅱscore was significantly higher in late group than that in early group in day 1 and 2 ( t=2.231,2.304,both P<0.05);there is no significant differences between late group than that early group in APACHEⅡscore before treatment(P>0.05);the hospitalizing days and mortality were significantly higher in late group than that in early group(t=2.156,χ2 =4.293,both P<0.05);there was no significant differences between late group and early group in gender,age,APACHEⅡscore(all P>0.05).Conclusion Early CRRT can decrease both the hospi-talizing days and mortality in SAP patients .CRRT may provide more clinical benefits in the early phase (within 48h) of SAP.

Objective To explore the influencing factors of gastrointestinal bleeding(GB) in secondary prevention patients with cerebral ischemic stroke(CIS).Methods A total of 616 patients were divided into bleeding group and control group according to the status (yes,no) of suffering GB during the 2years follow-up.Single factor analysis and Logistic regression analysis was used to explore the influencing factors of GB in CIS patients.Results The proportion of age≥65,a history of GB,gastric disease,renal insufficiency,sudden onset,NIHSS ≥12 and CIS ≥2 in the bleeding group was significantly higher than that in the control group (P ＜ 0.05) ; The proportion of combined with statins,proton pump inhibitors and gastric mucosal protective agent in the bleeding group was significantly lower than that in the control group (P ＜0.05) ; The Logistic regression analysis showed that age≥65,a history of GB,gastric disease,renal insufficiency,sudden onset,NIHSS≥12 and the times of CIS≥2 were risk factors of GB; however,combined with statins,proton pump inhibitors were protective factors.Conclusions Aging,a history of GB,gastric disease,sudden onset,higher NIHSS score and the times of CIS ≥ 2 were the risk factors of GB,combined with statins and proton pump inhibitors could reduce the risk of GB.

Objective To explore the effect of phenol oxidase antigen on liver pathologic change in mice infected with Schistosoma japonicum. Methods 42d-aged adult worms were incubated in RPMI 1640 containing 0.05% sodium phenobarbital for 8 h. The worms were washed three times with PBS (pH 6.8) and homogenized with a Teflon pestle. The homogenate was then centrifuged at 3000 g for 20 min at 4 ℃. Supernatant fractions containing phenol oxidase (PO) were analyzed by means of polyacrylamide gel electrophoresis (PAGE). The rude antigen of PO was obtained by cutting the corresponding gel of PO activities. Three groups were set up to observe whether PO could induce protective immunity: experiment group, adjuvant control group and water control group. On day 42 post infection with (40?1) cercariae of Schistosoma japonicum, the mice were sacrificed to observe liver pathologic changes. Results The liver surface of PO immunized group was rather smooth and the liver color was slightly gray. A few pale nods were seen indistinctly but not clearly. Necrosis and inflammatory cell infiltration were not clear. There were many immature eggs without granuloma reaction. The mean diameter and area of the granuloma in the experiment group were less than those in the control group. There were significant differences among the 3 groups (P

Objective To evaluate laparoscopic resection of gastric stromal tumors. Methods Clinical data of 20 patients undergoing laparoscopic resection of gastric stromal tumors from June 2003 to October 2007 were retrospectively analyzed. Result Laparoscopic wedge resection was completed successfully in all 20 patients with a mean operating time of(60±34) min, and without major complications. The mean hospital stay was (6.0±2.6) days. During a follow-up period from 10 to 22 months there was no recurrence. Conclusions Laparoscopic wedge resection is safe, effective, and minimally invasive for treating gastric stromal tumors.

Objective To investigate the feasibility and effectiveness of laparoscopic splenoctomy (LS)in patients with idiopathic thrombocytopenic purpura(ITP). Methods Clinical data of 17 ITP cases undergoing LS between Augest 2003 and December 2006 were analyzed retrospectively. Remits LS was Successfully conducted in all 17 cases without converting to open surgery with an average intraoperative blood loss of 120 ml in each case.There was no postoperative bleeding,fistula and infection.The platelet count increased rapidly in one week.After stopping glucocorticoid treatment for one month.15 cases achieved complete response(88.2%)and 2 caSes had partial response(11.8%).Fbllow-up of 3～43 months found no recurrence. Conclusions Use of LS for ITP is safe,feasible and effective.

Objective To evaluate the clinical results of total laparoscopic hepatectomy for hepatolithiasis. Methods The clinical data of 72 patients with intrahepatic lithiasis receiving total laparoscopic hepatectomy in our hospital from July 2005 to April 2009 were retrospectively analyzed. Results The mean age of the 72 patients was (43. 8±21.7) yrs (16-65 yrs). For laparoscopic hepatectomy, it was anatomical left liver resection in 34 patients, anatomical resection of left lateral liver in 19 and resection of S6 in 16. The operative duration was (262.5± 115.5)min (125-320 min). The median intraoperative blood loss was 150 ml (50-400 ml). The occurring rate of postoperative complications was 12.50 %. Complications included bile duct infection in 8 patients, bile leakage in 6, gastroparesis in 1,postoperative early inflammatory ileus in 1 and subcapsular fluid collection of liver in 1. All the complications were cured by non-surgical means. Conclusion In the era of minimally invasive surgery, total laparoscopic hepatectomy has gradually become the prominent treatment for hepatolithiasis.

We studied the regulatory effects of the estragen receptorbeta (ERbeta) gene on the downstream estrogen signal transfection pathway in colon cancer cells and the possible mechanisms involved. A human ERbeta gene recombinant expression plasmid, pEGFP-C1-ERbeta, was constructed and transfected into the Caco-2 colon cancer cell line, a line with low ERbeta gene expression. The expression of ERbeta mRNA and protein was detected 72 h after transfection. RT-PCR was used to examine the expression levels of the progesterone recepror (PR) gene containing the classic estrogen response element (ERE), the C-fos oncogene containing the AP-1 site (a non-classical ER binding site), the epigenetic modifying genes, such as Dnmt1, Dnmt3a, Dnmt3b, and histone methyltransferase (HMT), and the human mismatch repair gene hMLH1. Methylation-specific PCR was used to detect the changes in the methylated sites of the CpG islands in the promoters of the ERbeta, PR, and C-fos genes. The results indicated that the human ERbeta gene recombinant expression plasmid pEGFP-C1-ERbeta was successfully constructed and transfected into Caco-2 cells. As compared with the control group, the mRNA and protein expression of ERbeta gene was increased significantly 72 h after the transfection of pEGFP-C1-ERbeta into the Caco-2 cells. As compared with the control group, the mRNA expression of the PR, C-fos, Dnmt3a and Dnmt3b genes was increased significantly 72 h after the transfection of pEGFP-C1-ERbeta into the Caco-2 cells, but the mRNA expression of the Dnmt1, HMT, and hMLH1 genes decreased significantly (P<0.05). As compared with the control group, different degrees of demethylation occurred in the promoters of the ERbeta, progesterone receptor (PR), and C-fos oncogene 72 h after the transfection of pEGFP-C1-ERbeta into the Caco-2 cells. The methylation index of the estrogen signal transfection pathway in Caco-2 cells was decreased significantly following the expression restoration of ERbeta gene (P<0.05). It is concluded that the restoration or up-regulation of the ERbeta gene in Caco-2 cells may significantly activate the expression of the related target genes in the downstream estrogen signal transfection pathway and may result in the demethylation changes of the pathway. During the process, the expression level and activity of the epigenetic modifying genes and the human mismatch repair gene have changed simultaneously. The regulatory effect of the ERbeta gene on the estrogen signal transfection pathway to a certain extent partly involves demethylation.

ObjectiveTo evaluate the safety and efficacy of a modified hand-assited laparoscopic splenectomy (HALS) plus pericardial devascularization for the treatment of cirrhotic portal hypertension.MethodsFrom March 2009 to Dec 2011,modified hand-assited laparoscopic splenectomy plus pericardial devascularization was performed on 47 patients with portal hypertension and liver cirrhosis.We performed HALS first, thenconvertedtototallylarparocopicpericardialdevascularizationduring operation.ResultsAll patients received modified HALS plus pericardial devascularization without convertion to open surgery,the mean operative time was ( 154 ± 32) min,the mean intraoperative blood loss was ( 115 ±73) ml,and the mean postoperative hospitalization was (9.2 ± 1.6) days.The perioperative complications included plural effusion in 3 cases,ascites in 4 cases,pancreatic leakage in 1 case and wound dehiscence in 1case. Therewasnoperioperativemortality.ConclusionsModifiedHALSpluspericardial devascularization is a relatively safe and effective procedure in the treatment of portal hypertension due to liver cirrhosis,it has the advantage of hand-assisted and totally laparoscopic procedures.

Objective To summarize the experiences of repeated expansion surgery,to evaluate the changes of skin histological and biomeehanical properties,and to afford rationale for its application and popularization.Methotis Skin soft tissues were repeatedly expanded to repair the massive skin defection.All the 31 cases were divided into children group and adult group according to their ages.In each group the treatment experiences were summarized.The biomechanical and pathological properties were investigated and compared after samples had been made.Resuits A total of 31 cases were treated by serial tissue expansion.Complication incidences of every expanded procedure were 10%and 17%respectively.After 6-12months postoperative follow-up,most of the curative effects were satisfactory.The repeated expanded skin had lower enlarged rate,depressed stress-relaxation and stress-strength character,so was the deceased proliferation of the epidermal cells.The changes were significant in the adult group.Conclusions Repeated expansion is a feasible method of repairing the massive skin defection.Its curative effect is more satisfactory in children than adult.Due to the increase of the risk and skin quality decline,enough attention must be paid in clinical application.

Objective To compare clinical outcomes of modified hand-assisted versus total laparoscopic splenectomy and esophagogastric devacularization for treatment of portal hypertension due to cirrhosis.Methods From Jan 2007 to Dec 2011,modified hand-assisted laparoscopic splenectomy plus esophagogastric devascularization (MHLSED) and total laparoscopic splenectomy and esophagogastric devascularization (LSED) were performed on 47 and 38 patients with portal hypertension due to cirrhosis,respectively.For the MHLESD group,we performed hand-assisted laparoscopic splenectomy first,then converted during operation to totally laparoscopic esophagogastric devascularization.The operating time,intra-operative blood loss,postoperative complications and postoperative hospitalization time were analyzed.Results MHLSED were performed on 47 patients successfully without any need to convert to open surgery,and LSED were performed on 36 patients with 2 patients having to convert to open surgery.The mean operative time [(154 ±32)min] and mean intra-operative blood loss [(115± 73)ml] in the HLSED group were significantly lower than the LSED group [(212±45)min and (172±57)ml,respectively].There was no mortality.There were no significant differences in the time period for gastrointestinal function to recover,postoperative hospital stay and overall complication rate between the two groups.Conclusions MHALSD is a relatively safe and efficacious treatment for portal hypertension due to cirrhosis.It combines the advantages of hand-assisted and totally laparoscopic operations.