Objective To observe the change of endothelium-dependent vasodilatation function and to explore its mechanism in insulin-resistant (IR) rats induced by high fat feed. Methods (1) IR rat model was established by high fat feed for 4 weeks and IR was evaluated by glucose infusion rate (GIR) of euglycemic hyperinsulinemic clamp technique. (2) Acetylcholine (Ach)-dependent vasodilation response and nitric oxide synthase (NOS)-nitric oxide (NO)-cGMP function status were observed in isolated aorta of rats. Results (1) GIR was obviously lower in high fat feed group than that in routine feed group (P

AIM: To explore the effects of high glucose a t fluctuant concentrations on glucose transport activity and expression of phosp hoinositide 3-kinase (p85) in primary cultured skeletal muscle cells. ME T HODS: Rat skeletal muscle cells were cultured at fluctuant glucose conce ntrations (5, 25mmol/L) for 48h. Then the glucose uptake and the expression of p hosphoinositude 3-kinase were measured. RESULTS: The skeletal mu s cle cells treated with fluctuant high concentration glucose showed the impairmen t of the basal and insulin-induced increase in glucose uptake and significant de crease in p85 protein expression as well as p85 mRNA. Particularly, there was a significant decrease in p85 protein and mRNA expression in the high fluctuate l evel of glucose concentration. CONCLUSION: The exposure to fluct uant high concentration of glucose inhibits glucose uptake and induces insulin r esistance in skeletal muscle cells.

Objective To report our initial experience on the complications of retroperitoneoscopic live donor nephrectomy(RPLDN)and their managements in 117 cases.Methods From December 2003 to January 2009,117 cases of RPLDNs were carried out in our hospital.The operation was performed through 3 lumbar ports,after the kidney was liberated fully and the ureter was severed 7-8 cm under the lower pole of the kidney,the renal artery and vein were blocked with Endo-cut or Hem-o-lok and then cut off.Endo-cut was used in 3 patients and Hem-o-lok in 114 donors.Afterwards,the kidney was taken out quickly from the donor and infused with 4℃ kidney preserving fluid(HCA)immediately.We reviewed the intraoperative and postoperative complications in the donors and the grafts and the managements of the cases.Results All the 117 operations were successfully completed.No patients died during the operation or had delayed graft function recovery postoperation.No one was converted to an open surgery or needed blood transfusion during the procedure.Surgery-related complications occurred in 5 donors(4.3%)including intraoperative bleeding in 2(cured by hemostasis during the operation)and retroperitoneal hematoma in 3(cured by conservative management).Graft-related complications occurred in 8(6.8%)cases;among which extra arteries in the graft owning to endovascular stapler was found in 1 patient(who had a short common stem of the main renal artery,the three branches were anastomosed with the external iliac artery and 2 branches of internal iliac artery respectively);two graft kidneys were lacerated by laparoscopic instruments superficially and were repaired using absorbable sutures;renal subcapsular hematoma was noted in 2 grafts,capsulotomy was performed in one of them while the other received no treatment,both the cases had normal function of the transplanted kidneys;ureteral complications occurred in 3 grafts,in which vesico-urethral anastomotic leakage was developed in 10 days after withdrawal of the double J stents,they were cured by ureteral re-implantation.All the donors and recipients with complications were followed up for an average of 50 months(range 15-62 months).No other complications were found in the cases.During the follow-up,blood and urine routine,liver and renal functions,and blood glucose level are all in a normal range,abdominal B-ultrasonography revealed no abnormalities.B-ultrasonography of the implanted kidneys showed normal morphology and renal functions.Conclusions RPLDN is a safe and reliable method.Most of its complications complications may be attributed to the learning curve.Refinements in surgical techniques may decrease the rates of both donor and graft complications.

With the development of molecular biology,the study of biological markers will probably help to predict the prognosis and to improve the method of treatment and the survival. Advances in biological markers of esophageal cancer prognosis were reviewed. [

Objective To explore the surgical treatment for acute ulceration of gastric carcinoma.Methods The clinical data of 68 patients with ulceration of gastric carcinoma were analyzed retrospectively.All the cases,60 male patients and 8 females with average age of 58 years,were admitted from Jan.1990 to Jan.2007,and divided into three groups randomly,i.e.repair gastrectomy group(control,n=27),partial gastrectomy group(n=21) and radical cure group(n=20).Of the 68 patients,30 cases were diagnosed as ulceration of gastric carcinoma before surgical operation,25 cases were diagnosed as suspected ulceration of gastric carcinoma and 13 cases were misdiagnosed as gastric ulcer.All the cases were undergone operation.The ulcerations located at the superior part(6 cases),middle part(12 cases) or inferior part(50 cases) of stomach.38 cases were on Borrmann Ⅱ,and the other 30 cases were on Borrmann Ⅲ.The postoperative survival time of the patients in partial and radical gastrectomy groups was compared with that of the patients in repair group.Results Twenty-seven patients underwent repair of ulceration;21 patients received partial gastrectomy and 20 received radical gastrectomy(R2 distal subtotal gastrectomy 8 cases,R3 distal subtotal gastrectomy 12 cases).Postoperative complication occurred in 7.4% of the total cases and the mortality was 5.9%.One-,3-and 5-year survival rates were 3.7%,0 and 0 in repair gastrectomy group;52.4%,23.8% and 0 in partial gastrectomy group;and 75.0%,55.0% and 10% in radical cure group.Their Survival time were 5.93?4.95 months in repair gastrectomy groups,28.33?16.44 months in partial gastrectomy groups and 35.25?20.36 months in radical cure groups,respectively(P

Objective:To observe expression and diversity of glycogen synthase (GSK)-3 and ribosome S6 protein kinase (P70S6K) in skeletal muscle of insulin resistance (IR) rat induced by high fat food and to approach the effect and significance of GSK-3 and P70S6K in IR occurrence.Methods:Forty Wistar rats aged four-week were randomly divided into normal control, high-glucose, high-fat and high-fat high-glucose groups. 8 weeks after feeding, insulin sensitivity of the rats was evaluated by hyperinsulinism euglycaemic clamps technique (ring clamp experiment), GSK-3 and P70S6K in rat skeletal muscle were measured by Western blot and epididymis fat pad weight, blood glucose, insulin, triglyceride (TG), cholesterin (TC), free fatty acids (FFAs) and hsCRP levels were also determined.Results:IR was induced, body weight (P

Background and purpose:It may improve local control to increase radiation dose for esophageal cancer.The purpose of the study is to obtain the maximum tolerance dose(MTD)and assess toxicity of 3-D conformal radiation therapy(3-DCRT)for esophageal cancer.Methods:The scheduled dose escalation ranged from 70 Gy to 76 Gy.All patients received conventional fractionation irradiation to a dose of 46 Gy/23 Fx/4.5 weeks,followed by accelerated hyperfractionation irradiation using reduced fields,1.5 Gy twice a day,to a dose of 24 Gy/16 Fx.The criteria for stopping dose escalation was grade ≥3 radiation-induced toxicity in ≥15% patients.Results:From July,2000 to July,2001,18 patients were enrolled.Five patients completed a total dose of 70 Gy and an additional 5 patients received 73 Gy.Eight patients completed a total dose of 76 Gy.No patient occurred grade ≥3 radiation-induced toxicity at the level of 70 Gy.Four patients(80%)experienced grade ≥3 radiation-induced late toxicity(2 patients died of late radiation-induced pneumonitis)at the level of 73 Gy.Five patients(62.5%)experienced grade ≥3 radiation-induced acute toxicity and 6 patients(75%)had grade≥3 late toxicity(1 patients died of late radiation-induced esophagitis,and 2 patients died of late radiation-induced pneumonitis)at the level of 76 Gy.Conclusions:Based on the clinical trial,there were more severe radiation-induced toxicities when the patients with esophageal cancer received more than 70 Gy.

Objective To investigate the main technical points of detachable balloon in management of traumatic carotid-cavernous fistulas (TCCF) and evaluate objectively the clinical outcome.Methods A total of 59 patients with TCCF were treated with detachable balloons,which involved 64 embolization procedures.Follow-up ranged from 3 months to 2 years. Results Forty-eight patients with TCCF (81％) were successfully occluded with patency of internal carotid artery.The rest 11 patients were obstructed in both the fistula and the internal carotid artery.Recurrent TCCF was found within three days after embolization in five patients (with a recurrence rate of 8％ ) who underwent further embolization,of whom one patient went blind after the procedtre and the eyesight showed no recovery even after another embolization with balloon for successful occlusion of the fistula; one patient presented with intracerebral hematoma at day 3 postoperatively and underwent emergency embolization again to occlude the internal carotid artery and fistula,with slight paralysis of the left limb. Conclusions Embolization of TCCF with detachable balloon is a reliable treatment,which is characterized by slight injury and high safety.However,the disease' s development should be strictly observed after the treatment.In the case of recurrence of symptoms,brain angiography and CT scanning should be rechecked timely and emergency treatment should be performed.

Aim To investigate the effect of irbesartan and spironolactone on expressions of connective tissue growth factor(CTGF),P-p38MAPK proteins during vascular remodeling in renovascular hypertensive rats(RHR).Methods Renovascular hypertension was induced by two kidney one clip(2K1C)operation.8 weeks later,RHRs were given irbesartan or(and)spironolactone for 8 weeks.After 8 weekstreatment,the morphometric measurements were performed in the mesenteric arterioles.Concertration of carboxyterminal propeptide of typeⅠprocollagen(PⅠCP)and N-terminal propeptide of type Ⅲ procollagen(PⅢNP)in blood serum was measured by enzyme linked immunosorbent assay method,and the media collagen area was assessed by collagne-specific Picro-sirius red staining with computerized video processing.Expressions of collagen type I,CTGF,P-p38MAPK proteins were detected using immunohistochemistry respectively.Results The arterial systolic pressure was attenuated significantly after the treatment of irbesartan,and this effect could not be enhanced by spironolactone.The media thickness over lumen ratio,media cross-sectional area over luminal area ratio of mesenteric arterioles,concertration of PⅠCP and PⅢNP,media collagen area,and expression of collagen typeⅠwere significantly increased in RHRs but ameliorated by irbesartan and spironolactone.Meanwhile,the expressions of CTGF,P-p38MAPK proteins were up-regulated in RHRs but blunted significantly after the treatment of irbesartan and spironolactone.The combined treatment had the synergic effects.Conclusions There is a synergistic effect of attenuating extracellular matrix(ECM)producing and amelioration of vascular remodeling(VR)by combined use of irbesartan and spironolactone.It maybe related to the expressions of CTGF and P-p38MAPK proteins down regulated by these two drugs.