Malnutrition is common in the abdominal surgery and affects the recovery of patients.Reasonable nutritional support therapy can improve the prognosis of patients.The nutritional risk screening should be apphed to patients within 24 hours of admission.Patients with the nutritional risk and malnutrition should receive the nutritional support by selecting a good timing and way based on the nutritional support planning.Preoperative fasting all night for the majority of patients is not necessary,patients should be allowed to intake low-concentration liquid diet at hour 2 before anesthesia.Patients with preoperative severe malnutrition should be given 7-10 days of nutritional support therapy.The enteral nutritional therapy was preferred to patients needing postoperative nutritional support therapy,while parenteral nutrition therapy should be supplied to patients with infeasible enteral nutrition or expected target of 60％ for enteral nutrition.Individual nutritional support therapy is not necessary for patients without severe concomitant disease.Pharmacological nutrients such as ω-3 polyunsaturated fatty acids and glutamine are beneficial for abdominal surgery and critical patients,which should be used reasonably.

Autoimmune pancreatitis (AIP), which is always associated with autoimmune manifestations, was introduced in 1995 and has been recognized as a type of chronic pancreatitis. Despite numerous studies in Japan, Europe and the United States in recent years, no consensus has been reached about the diagnostic criteria for AIP that may be difficult to distinguish from pancreatic cancer(PC). Nevertheless, the results find it dramatically responds to steroid therapy.

Serum glucose control is an important aspect of perioperative management. For major hepatobilipancreatic surgery, specific pathophysiologic changes can lead to specific problems. This article reviews recent advances in the perioperative serum glucose control for major hepatobilipancreatic surgery.

Objective To determine the key points in surgical treatment of Mirizzi syndrome in the olderlys. Methods Clinical data of 12 cases of Mirizzi syndrome treated in our hospital from 1995 to 2004 were retrospectively analyzed. Results Only 6 cases were definitely diagnosed by ERCP and ultrasounography before operations. Three cases were treated with cholecystectomy, 7 cases with cholecystectomy and T-tube drainage of common bile duct, 2 cases with cholecystectomy and Roux-Y hepaticojejunostomy. Conclusions It is still difficult to diagnose Mirizzi syndrome preoperatively. Appropriate operative patterns should be selected according to different types of Mirizzi syndrome.No patient death during operations.The patients were followed 1-10 years, average was 3.2 years. No bile duct stricture was found.

Objective A retrospective analysis was carried out in 3 cases of hepatocellular carcinoma (HCC) and liver cirrhosis associated with haemochromatosis in our hospital, to investigate the effect of surgery, radio frequency ablation (RFA) and erythroapheresis in such patients. Methods 8 operations including partial liver resection and ultrasound-guided percutaneous transhepatic RFA were performed in 3 male patients with HCC and liver cirrhosis arising from haemochromatosis.Capecitabine was used in 2 patients. Erythroapheresis was performed in all 3 patients. Result Pathological examination showed hepatocellular carcinoma and liver cirrhosis. Positive Prussian blue staining confirmed the diagnosis of haemochromatosis. The mean survival time of 3 patients was 86 months (from 39 to 154 months). Conclusion It is important to discover HCC in patients with haemochromatosis as early as possible. The curative therapy is liver transplantation and hepatic resection. For patients with recurrent HCC, the combined therapy including RFA, chemotherapy and erythroapheresis could prolong their survival.

Objective To study the role and mechanism of phosphatidylinositide 3-kinase gamma (P13Kγ) in mediating acinar cell necrosis in rat models with acute pancreatitis.Methods Twelve male C57BL/6 wild-type and twelve male P13Ky knockout mice were randomly divided into saline group and pancreatitis group.The pancreatitis group received an intraperitoneal injection of cerulean (50 μg/kg) to induce acute panreatitis.Pathologic changes in the two groups were observed by measuring the trypsin,cathepsin B,and cathepsin L activity.The protein expressions of cathepsin B and cathepsin L were detected by the Western blot assay.Results Compared with the wild-type mice,the P13Kγγknockout mice had fewer acinar cell necrosis [(2.25± 0.54)/HP vs (5.14±0.85)/HP] and vacuoles [(1.24±0.21)/HP vs (2.36± 0.34)/HP]according to histology.The cathepsin B activity [(1232± 21)pmolAMC/min/mg vs (1891 ±35)pmolAMC/min/mg] and trypsin activity [(0.358± 0.098)pmol/mg vs (0.827± 0.126)pmol/mg] were significantly decreased in the pancreatitis group (P＜0.05) compared to the saline group.However,the cathepsin L activity [ (415 ±11 ) pmolAMC/ min/mg vs (346 ± 6)pmolAMC/min/mg] was significantly higher in P13Kγγ knockout mice than in wild-type mice(P＜0.01).Conclusions P13Kγmay promote cell necrosis in acute pancreatitis by possibly changing the balance between eathepsin B and cathepsin L levels to promote the activation of trypsinogen.

Hedgehog (HH) signaling pathway is a classic signaling pathway which controls embryonic development.Recent studies show that HH signaling pathway plays an important role in the tumorigenesis and development of cancer.Breast cancer stem cells (BCSCs) is closely associated with malignant tumor metastasis,relapse and treatment resistance.HH pathway plays crucial roles in maintaining the characters of BCSCs,and will probably become a novel therapeutic target of breast cancers.

ObjectiveTo investigate the influence of phosphoinositide 3-Kinase-C2-gamma (PI3Kγ)on pancreas acinar cells autophagy in experimental acute pancreatitis in mice and explore its significance.MethodsEighteen C57BL/6 wild type (WT) and eighteen PI3Kγ knockout (KO) mice were randomly divided into control group (n =6) and acute panereatitis (AP) group (n =12),respectively.AP models were induced by intraperitoneal injection of 50 μg cerulein/kg body weight,once the other hour for seven times.The mice were sacrificed 7 hours after model induction.The pathological changes of the pancreas were observed through microscope,LC3 dots were determined by immunofluorescence,the trypsin activity was measured by fluorescence spectrophotometer,and the expression of autophagy related protein beclin1,p62 and LC3- Ⅱ were measured by Western blot.ResultsThe autophagy vacuoles counts in pancreatic tissue of WT mice and KO mice were (5.14 ±0.85),(2.25 ±0.54)/HPF,the LC3 immunofluorescence dots counts were (78.6 ±9.38),( 26.4 ± 4.21 )/HPF,the trypsin activities were ( 0.827 ± 0.126 ),( 0.358 ± 0.098 ) pmol/mg protein,the difference between the two groups was statistically significant ( P ＜ 0.05 ).The p62 protein expression was greatly decreased in WT mice compared with their KO counterpart (0.11 vs 0.92,P ＜ 0.05 ),while the expressions of LC3 Ⅱ,beclin1 were greatly increased in WT mice compared with their KO counterpart ( 1.82 vs 0.93,1.43 vs 1.05,P ＜ 0.05 ).Conclusions PI 3 Kγmay up- regulate autophagy of pancreatic acinar cells during acute pancreatitis in mice,then promote trypsinogen activation and necrosis of acinar cells.

Rational clinical nutrition support may slow down the progress from heart insufficiency to heart failure and improve the quality of life.This article summarizes advances in nutrition support in patients with heart insufficiency in terms of nutrition and metabolic characteristics, nutritional risk screening and nutrition status evaluation, nutrient recommendations, and clinical application of nutrition support.Moreover, nutrition and metabolic support in acute heart failure is also discussed.

Objective To investigate the diagnosis and treatment of injury in choledocho-pancreatico-duodenal junction. Methods The clinical data of 6 patients with injury in choledocho-pancreatico-duodenal junction who had been admitted to Beijing Hospital from January 2000 to January 2008 were retrospectively analyzed. Results Of the 6 patients, 4 were diagnosed according to the intraoperative findings, cholangiography and fiber cholangioscopy. The 4 patients were cured after suture of the perforation in the choledocho-pancreatico-duodenal junction, T-tube drainage and abdominal drainage. Two patients developed severe abdominal and retroperitoneal infection and other complications after operation, and were diagnosed by cholangiography and fiber cholangioscopy. Of the 2 patients, 1 was cured and 1 died after multiple drainage procedures and debridement. Conclusions Diagnosis and treatment in the early stage are crucial for the curative purpose. Cholangingraphy and fiber cholangioscopy are effective in the diagnosis of injury in choledocho-pancreatico-duodenal junction. The suture of the perforation in the choledocho-pancreatico-duodenal junction, T-tube drainage and abdominal drainage should be chosen for patients who are diagnosed during primary operation. For patients with abdominal and retroperitoneal abscess and cellulitis, drainage and debridement should be performed, and biliopancreatic diversion and duodenal diverticularizatian are applied to patients when necessary.