Objective To investigate the effect of TLCK(N-alpha-tosyl-L-lysyl-chloromethylketone) on acute hemorrhagic necrotizing pancreatitis(AHNP) associated with lung injury.Methods Seventy SD rats were randomized into seven groups(n=10 in each group): group1,normal control group(rats were treated with 0.9% sodium chloride i.v.);group 2,AHNP control group(AHNP rats were treated with 0.9% sodium chloride i.v.);group 3,AHNP rats were treated with 5?g/kg TLCK;group 4,AHNP rats were treated with 10?g/kg TLCK;group5,AHNP rats were treated with 20 ?g/kg TLCK;Group3,4,5were treated with TLCK i.v.immediately after the establishment of SAP rat model;group 6,AHNP rats were treated with TLCK i.v.30 minutes before the establishment of AHNP model;group 7,AHNP rats were treated with TLCK i.v.30 minutes after the establishment of AHNP rat model;Group 6,7 were treated with 10 ?g/kg TLCK.Group 1-7 were used to select the best dosage and administration time of TLCK by observing the survival rate for seven days.Then,according to the result of selecting,the SD rats were divided into three groups(n=6 in each group): group N,Sham operated control group(0.9% sodium chloride was reversely injected into SD rat′s pancreas and rats were treated with 0.9% sodium chloride i.v.);group P: AHNP group;group T: TLCK treatment group(AHNP rats were treated with 10 ?g/kg TLCK immediately after the establishment of AHNP rat model).The rats of the last three groups were killed 6 hours after operation.Alveolar macrophages(AMs) were harvested by bronchoalveolar lavage.The protein content of bronchoalveolar lavage fluids(BALF),the myeloperoxidase(MPO) of lung tissue,and tumor necrosis factor ?(TNF?) secreted by AMs were determined.The expression of NF-?B in AM was checked as well as lung histology.Results The survival rate of group 1-7 was100%,0%,70%,100%,80%,0%,and 90% respectively.The level of MPO of lung tissue and protein content of BALF ingroup N were lower than that,in groups P and T(P

Objective To explore risk factors relating to occurrence of spontaneous rupture (SR)of hepatocellular carcinoma (HCC). Methods We retrospectively reviewed medical records of 409 HCC patients treated in our department from Jan. 1st 2005 to Aug. 31st 2009. Clinicopathologic factors were explored for their possible association with occurrence of SR by univariate and multivariate analysis using Logistic regression model. Results Among 409 patients, SR occurred in 40 patients (9. 8% , 40/409).Type of SR was defined according to presentation of acute abdominal emergency, especially unstable hemodynamic status. Nineteen cases (4. 7%, 19/409) were grouped as type of HCC-SR Ⅰ and 21 cases (5. 1% ,21/409) as HCC-SR Ⅱ. Patients in the two groups possessed similar hepatitis infection status,severity of background liver disease and tumoral factors except for tumoral location, while HCC-SR Ⅰ group often needed emergency treatment demonstrating elevated values of aspartate aminotransferase (AST) and WBC, decreased PLT counts and worse Child-Pugh classification. Patients in the HCC-SR Ⅱ group had more opportunities of receiving curative hepatectomy and had longer overall survival. The 1,2 and 3 year survival rates were 26. 3 % (5/19), 5. 3% ( 1/19 ) and 0% (0/19)in the HCC-SR Ⅰ group and 66. 7% ( 14/21 ),42.9% (9/21)and 19. 5% (5/21) in the HCC-SR Ⅱ group, respectively. Differences reached statistical significance( P = 0. 011,0. 009,0. 049). Multivariate analysis identified that severity of concomitant liver cirrhosis , WBC ＞ 10 × 109/L and AST level more than twice normal (2N) as independent risk factors associating with occurrence of HCC-SR Ⅰ , while elevated values of AFP and presence of tumor thrombi in portal vein branch related to HCC-SR Ⅱ. Conclusions HCC-SR includes two different types, since different risk factors predict occurrence of each HCC-SR type.

Extended liver resection may provide longterm survival in selected patients with hilar cholangiocarcinoma.In May 2013,a patient with hilar cholangiocarcinoma received right hemihepatectomy combined with caudate lobectomy under the guidance of precision hepatectomy technique.The porta hepatis was clamped in the operation for 3 times intermittently.The operation time was 8 hours,and the volume of intraoperative blood loss was 600 mL.The patient was discharged at postoperative day 14.The results of pathological examination confirmed that the patient had moderately-highly differentiated adenocarcinoma with full-thickness infiltration of the bile duct and tumorfree margins.No tumor recurrence was detected during the followup which was lasted for 6 months.The operation was carried out based on the three dimensional reconstruction,liver reserve function evaluation,intraoperative controlled low central venous pressure and precision hepatectomy technique,and the results were satisfactory.

Objective To evaluate factors affecting early recurrence and overall survival after curative hepatectomy for hepatocellular carcinoma (HCC) in cirrhotic patients. Methods Sixty two HCC cases with concomitant liver cirrhosis were retrospectively reviewed after curative hepatectomy in our department during the period between Jan. 2002 and Jan. 2009. Clinicopathologic data were evaluated for their possible association with postoperative early recurrence (ER) and overall survival (OS) in univariate analysis followed by multivariate analysis using COX proportional hazard model. Receiver operating characteristics (ROC) analysis with calculation of the area under the curve (AUC), sensitivity, and specificity was applied to assess predictive ability of independent risk factors. Results During follow-up period, 47 patients developed postoperative ER. The 1-, 2-, 3-and 5-year cumulative recurrence rate was 62.9% (39/62) ,75.8% (47/62), 80.7% (50/62), 83.9% (53/62) ,respectively. The 1-, 3- and 5-year OS rates were 59. 7% (37/62), 21.0% (13/62) and 1.6% (1/62), respectively. Multivariate analysis revealed that increased BCLC staging, severity of liver cirrhosis and tumoral residue resectional edge as independent risk factors influencing ER. Cutoff point value ( PI ≥2.171 ) predicted ER with AUC of 0.874(95%CI, 0.757～0.990), sensitivity was 85. 1% and specificity was 77. 8% calculated from ROC.Difference of median recurrence time according to risk stratification reached statistical significance ( 18.7mons, 7.7 mons vs. 2.9 mons, Log-rank test,λ2 =25. 288, P =0.000. While ER, post-recurrence treatment and severity of liver cirrhosis affected OS, cutoff point value ( PI ≥ 2. 893 ) predicted OS with sensitivity 86. 8%, and specificity 88.9%, with AUC 0.894(95% CI,0.798 ～ 0.990). Median OS time according to risk stratification demonstrated significant difference (27.8 mons, 21.5 mons vs. 8.5 mons,Log-rank test, λ2 = 30. 869, P = 0. 000). Conclusion Severity of liver cirrhosis and surgical tumor margin determines postoperative ER and OS for HCC after curative hepatectomy. Effective management of ER also contributes to good prognosis. Risk stratification can be used for evaluation of ER and OS of HCC.

Objective Basing on overall survival(OS)of HBsAg-positive hepatocellular carcinoma(HCC)patients we evaluate several currently used HCC staging systems for OS predictivity.Methods This retrospective study included 775 patients with HBsAg-positive HCC treated in our department during 11-year period from Jan.2000 to Feb.2010.Clinicopathologic factors were evaluated for their possible association with OS in univariate and multivariate analysis using Cox proportional hazard model.Receiver operating characteristics(ROC)analysis with calculation of the area under the curve (AUC),sensitivity,and specificity was applied to define cutoff point values where appropriated and to assess HCC staging systems for their predictive ability of OS.Results The 1-,2-,3-and 5-year OS rates were 21.3％(165/775),9.4％(73/775),4.9％(38/775)and 1.7％(13/775),respectively.Multivariate analysis identified that severity of concomitant liver cirrhosis(B =4.519),treatment modality (B =4.888),ALT≥2N(B =4.068),portal vein tumor thrombi(B =0.537),spontaneous rupture(B =5.033)and inferior vena cava tumor thrombi(B =7.049)as independent risk factors influencing OS.NSMCS(North Sichuan Medical College Score)exhibited best performance predicting OS with AUC 0.801 (95％ CI 0.761-0.840),sensitivity of 78.8％,specificity of 69.3％ at NSMCS ≥-2.Median survival time reached statistically significant difference(13.6 mons,3.4 mons vs.1.3 mons,x2 =467.636,P =0.000).Conclusions Multiple factors determine OS in patients with HBsAg-positive HCC.NSMCS staging system demonstrates better predictability for the survival of HBsAg positive HCC patients.

ObjectiveTo evaluate the impact of anatomic and non-anatomic liver resection on prognosisofpatientswithsmallhepatocellularcarcinoma( HCC ) usingaMeta-analysis.MethodsLiterature on anatomic versus non-anatomic liver resection for the treatment of small HCC ( ≤5 cm) was retrieved. ResultsFour nonrandomized controlled trials were included consisting of 776 patients:484 undergoing anatomic liver resection and 292 non-anatomic resection.The age ranged from 53.4 to 63.0 years.Male ∶ female ratio was 3.56 ∶ 1.87.1％ patients were Child-Pugh class A.Most patients (94.5％ ) had a single tumor.No significant differences were found conceming the 1,3,and 5 year disease-free survival rate between the two groups.There was no significant difference in overall survival and disease-free survival between the two groups at 1,3,and 5 years.Sensitivity analysis found anatomic resection was superior to non-anatomic resection in 3 year disease free survival rate (OR =0.72,95％ CI:0.52 - 0.99,P =0.04). ConclusionsAnatomic liver resection elevated the 3 year disease free survival rate of patients with small hepatocellular carcinoma when compared with non-anatomic hepatectomy but failed to further elevate long-term disease free survival and overall survival.

Objective To explore the risk factors for upper gastrointestinal haemorrhage (UGH) in hepatocellular carcinoma (HCC) with portal hypertension (PH). Methods We retrospectively reviewed the medical records of 231 patients with HCC-PH treated in our Department from 1st January 2005 to 1st August 2009. The clinicopathologic factors were evaluated for their possible association with UGH in univariate analysis followed by multivariate analysis using Logistic regression model. The overall survival (OS) was calculated by the Kaplan-Meier method. Receiver operating characteristics (ROC) analysis with calculation of the area under the curve (AUC), sensitivity, and specificity were carried out to assess the predictive ability of the independent risk factors. Results Among 247 patients diagnosed with HCC-PH, 231 patients met the inclusion criteria and were entered into this study. UGH occurred in 28 patients (12.12 %, 28/231). Patients suffering from UGH had a higher 30-and 60-d mortality when compared with the non UGH group (53.57% vs. 4.43%, 96.43%vs. 10.34%, P＜0. 001, 0. 001). The 1-,2-and 3-year overall survival (OS) rates in the non-UGH and the UGH groups were 3. 57% (1/28), 0% (0/28), 0% (0/28) and 21.18% (43/203), 14.29% (29/203), 4.43% (9/203), respectively. There was a trend towards a non-significantly statistical difference in long-term (≥3 yr) survival (P=0. 605). UGH had a dismal prognosis with a median OS of 0. 8 months (0. 10-2. 40 months). Multivariate analysis of the risk factors showed elevated alpha-fetoprotein (AFP) (P = 0. 026) and aspartate aminotransferase (AST) more than twice normal (2N)(P=0. 004) were predictive factors, in particular, AST≥2N. A cutoff value (PI≥7. 242) predicted UGH with an AUC of 0.828 (95%CI, 0.698-0.957), sensitivity of 81.0% and a specificity of 81.0%, as calculated from the ROC. Risk score stratification predicted UGH to show a statistically significant difference (P＜0. 001). Conclusions UGH, as one of the end-stage incidents of HCC-PH,had a dismal prognosis. Patients with elevated AFP levels and AST levels above 2N were associated with high risks for UGH and should be monitored carefully or offered prophylactic treatments. Risk score stratification was useful for prediction of UGH.

ObjectiveTo investigate the immunological improvement effects of different doses of ursodeoxycholic acid (UDCA) on patients with different stages of primary biliary cirrhosis (PBC) and enhance the understanding of the roles of the immune system in the disease, and to provide evidence for the standardized clinical treatment of PBC. MethodsOne hundred and eighty patients with PBC who were admitted to our hospital from March 2012 to Janurary 2014 were enrolled and equally divided into three classes according to the stage of PBC: early stage, cirrhotic stage, and poor biochemical response stage. Patients in each class were equally divided into three groups according to the dose of UDCA: 8-10, 13-15, and 20-25 mg·kg-1·d-1. The general information, clinical symptoms, biochemical indices, and changes in T lymphocyte subsets and cytokines in peripheral blood after the treatment with different doses of UDCA were analyzed. Comparison of continuous data was performed by t test, and comparison of categorical data was performed by χ2 test. ResultsIn patients with early-stage PBC who were treated with 13-15 mg·kg-1·d-1 UDCA, the percentage of CD3+CD4+ T cells, CD4+/CD8+ ratio, and expression of interferon-gamma were significantly reduced after treatment (54.8%±11.6% vs 34.7%±7.7 %, t=6.5, P＜0.05; 2.3±1.0 vs 1.6±0.6, t=2.7, P＜0.05; 33.0±12.3 vs 23.7±7.2 ng/L, t=2.9, P＜0.05), while the secretion of interleukin-4 was significantly increased after treatment (29.0±4.6 vs 38.5±7.1 ng/L, t=5.0, P＜0.05). ConclusionThe UDCA with a dose of 13-15 mg·kg-1·d-1 can substantially improve the immune status in patients with early-stage PBC. The application of UDCA should be standardized in order to achieve the desired response.

Objective To evaluate the effect of Eucommia on hyperlipidemia and related indexes in rats, and provide animal data useful for the clinical experimental studies on hyperlipidemia.Methods Seventy-two healthy male SD rats were used in this study.One group of 12 rats fed with normal diet was chosen as normal control group, and other 60 rats were fed with high fat diet for two weeks to generate rat models of hyperlipidemia.48 of the hyperlipidemic model rats were taken and divided randomly into 4 groups, including model group, high dose Eucommia, moderate dose Eucommia, and low dose Eucommia groups.The last three groups were gavaged different dose of Eucommia, respectively.Druing this period, the other groups except the normal control group were fed with high fat diet continuously.The levels of serum TC, TG, LDL-C, and HDL-C of rats were measured on day 30 and 45.Results The serum levels of TC and LDL-C of the rats in the model group were obviously higher than those in the normal control group.The rat models of hyperlipidemia were established successfully.The three dose groups had a tendency of lowing blood lipid after 30 days.At 45 days, the levels of serum TC and LDL-C in the low and high dose groups were lower than those in the model group (P<0.01, P<0.05), (P<0.01, P<0.01).TG in the high, moderate and low dose groups were lower than that in the model group (P<0.01, P<0.01, P<0.01), but the level of the serum HDL-C was not significantly lower than that in the model group (P>0.05, P>0.05, P>0.05).Conclusions Eucommia in a dose of 0.43 g/kg, 0.86 g/kg and 1.71 g/kg administered for 30 days have a tendency to reduce the level of serum TC, TG, and LDL-C.When Eucommia is administered in a dose of 0.43 g/kg, 1.71g/kg and 3.42 g/kg for 45 days, it shows an adjuvant hypolipidemic effect.

OBJECTIVES: The long-term trends of cognitive function and its associations with physical performance remain unclear, particularly in Asian populations. The study objectives were to determine cognitive trajectories in middle-aged and elderly Chinese individuals, as well as to examine differences in physical performance across cognitive trajectory groups. METHODS: Data were extracted from the China Health and Retirement Longitudinal Study. A total of 5,701 participants (47.7% male) with a mean age of 57.8 (standard deviation, 8.4) years at enrollment were included. A group-based trajectory model was used to identify cognitive trajectory groups for each sex. Grip strength, repeated chair stand, and standing balance tests were used to evaluate physical performance. An ordered logistic regression model was employed to analyze differences in physical performance across cognitive trajectory groups. RESULTS: Three cognitive trajectory groups were identified for each sex: low, middle, and high. For both sexes, higher cognitive trajectory groups exhibited smaller declines with age. In the fully adjusted model, relative to the low trajectory group, the odds ratios (ORs) of better physical performance in the middle cognitive group were 1.37 (95% confidence interval [CI], 1.17 to 1.59; p<0.001) during follow-up and 1.40 (95% CI, 1.20 to 1.64; p<0.001) at the endpoint. The ORs in the high trajectory group were 1.94 (95% CI, 1.61 to 2.32; p<0.001) during follow-up and 2.04 (95% CI, 1.69 to 2.45; p<0.001) at the endpoint. CONCLUSIONS Cognitive function was better preserved in male participants and individuals with higher baseline cognitive function. A higher cognitive trajectory was associated with better physical performance over time.