Objective To probe the differences in clinicopathological features between benign and malignant polypoid lesions of the gallbladder.Methods In this study,1396 PLG cases diagnosed by postoperative pathology between 2007.1 to 2009.12 were enrolled.Cases were divided into three groups according to the pathological classification:1339 cases of benign proliferative diseases ;42 cases of adenoma,15 cases of malignant disease.Comparing the clinical characteristics of the three groups,we screened out the risk factors for malignant transitions.Results Age (F =8.090,P =0.000),size of polyp (F =102.61,P =0.000),single vs multiple lesions (x2 =214.25,P =0.000),concurrent inflammation (x2 =9.362,P =0.009),and stones (x2 =34.022,P =0.000) were significantly different between the three groups.Conclusions Size of polyps over 0.8 cm,age over 60 years,single polyp,accompanied by stones and inflammation were the risk factors for malignancy in gallbladder polypoid lesions.

Objective To evaluate the diagnosis and surgical management of appandiceal mucoceles.Method The clinical data of 50 patients with appendiceal mucoceles surgically treated from January 2004 to January 2008 were reviewed retrospectively. Result The correct preoperative diagnosis rate was 8%.Eight patients were complicated with pseudomyxoma peritonei.The canceration rate was 4%.All the 50 patients recovered uneventfully after the surgery.There was no complications,no recurrence during the follow-up period,including the 2 patients with canceration. Conclusion It was difficult to make correct diagnosis of appendiceal mucoceles preoperatively.The diagnosis should always be in mind if the B-type ultrasonography indicated a cystoadenoma.Abdominal CT coupled with necessary digestive image examinations may improve the correct diagnosis rate.Some patients may be complicated with pseudomyxoma peritonei.Occasionally this abdominal mass was also associated with malignancy.Surgery is the management of choice,and the prognosis is good.

Integrated traditional Chinese and Western medicine therapy for pancreatitis has been used since the 1960s.According to the clinical manifestations and traditional Chinese medicine (TCM) syndrome differentiation of pancreatitis,pancreatitis was named true heart pain with cold limbs caused by spleen disease.Syndrome differentiation of acute pancreatitis and treatment with modified Dachaihu decoction achieved good clinical effects.After the 1990s,the research focus of pancreatitis research was shifted to severe acute pancreatitis (SAP).The clinical course of SAP was divided into three phases,and different therapeutic regimens were given.Clinical studies achieved good therapeutic effects in terms of cure rate and fatality rate.After 2000,integrated traditional Chinese and Western medicine therapy for chronic pancreatitis has been promoted systemically,and the cooperation between traditional Chinese medicine,endoscopic techniques,and operative treatment helps to significantly improve pain control,nutritional status,and incidence of complications.

Objective To observe the effects of Qingfei Chengqi decoction on lung tissue cell apoptosis and its associated protein,tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)of lung tissues in rats with severe intra-peritoneal infection(SII). Methods Thirty male Wistar rats were randomly divided into three groups:sham operation group,model group and traditional Chinese medicine(TCM)group(each n=10). Simulating clinical pathophysiological process of digestive tract perforation,the rat model of SII was reproduced by injecting E. coli intraperitoneally. The TCM group was treated by gavage with Qingfei Chengqi decoction one day in advance of the study,3 times per day,once 2 mL. The same amount of nutrient broth which contained 10%barium sulfate(BaSO4) to replace the bacteria solution was injected into the sham operation group. Six hours after model establishment,all rats were killed and lung tissues were harvested for pathohistological evaluation and for the determination of apoptosis rate with TdT-mediated dUTP nick-end labeling(TUNEL)method,of Bax,Bcl-2 protein expression with Western Blot method,and of the level of TNF-α,IL-6 with enzyme-linked immunosorbent assay(ELISA)method,and the pathological changes of lung tissues were observed under the light and electron microscopes. Results Compared with sham operation group,the apoptosis rate〔(12.7±5.4)%vs. 0〕,the expression of Bax protein〔absorbance(A)value:8 416.89±875.16 vs. 6 654.09±1 130.18〕,the level of TNF-α(ng/L:3 132.56±457.96 vs. 1 948.55±269.32), the level of IL-6(ng/L:75.14±1.63 vs. 31.17±0.81)of lung tissues were significantly increased(all P<0.05), meanwhile Bcl-2 protein expression decreased observably(A value:7 490.59±200.34 vs. 12 289.02±535.93,P<0.05)in model group induced by SII. After treatment with TCM,apoptosis rate〔(7.9±0.3)%〕,the expression of Bax protein(A value:7 619.50±999.30),the level of TNF-α(ng/L:3 114.34±454.32)and IL-6(ng/L:52.46±0.96) of lung tissues were decreased and Bcl-2 protein expression(A value:11 155.07±1 018.87)increased(all P<0.05) compared with model group. General observation:the color of lung tissues was uniform in sham operation group;the lung tissues of model group swelled obviously,and parts of lung tissues had patches of ecchymosis and hemorrhage. The light microscope showed:the pulmonary vessels,the alveolar interstitium,alveolar epithelium and lobular interstitium of sham operation group were all normal,while in the model group,the pulmonary interstitium was edematous and hemorrhagic,and in the alveolar cavities there was infiltration of inflammatory cells. Under the electron microscope, the lung tissue type Ⅱ alveolar epithelial cells of model group were increased,and they had morphological changes in various degrees,such as cell shrinkage and change becoming round,and cell nucleus presenting irregular in shape. After treatment with TCM,the above pathological changes were all alleviated compared with those in the model group. Conclusions Qingfei Chengqi decoction can ameliorate the SII leading to acute lung injury,and reduce the cell apoptosis rate of lung tissues in SII rats. Its mechanism may be related to the intervention of above TCM which can lower the levels of inflammatory media and elevate the protein expression of Bcl-2.

Objective To investigate the role of hepatic Kupffer cells in acute hemorrhagic necrotizing pancreatitis associated lung injury(AHNP LI) and the therapeutic effects of gadolinium chloride(GdcI_3). Methods Forty-two Wistar rats were randomly divided into four groups:(I) sham operation group;(II) AHNP group;(III) Gdcl_3 (protection) group(Gdcl3 10mg/kg);(IV) Gdcl_3control group(Gdcl_3 10mg/kg).In the sham operation group, the (abdominal) vescera were shifted around for several times and the abdomen was closed.The AHNP model was induced by retrograde intraductal administration of 5% sodium taurcholate(1ml/kg,0.1ml/min).In the Gdcl_3 protection group,Gdcl_3 solution was admmistered by caudal vein injection one day before the AHNP model was made.In these 3 group of animals,specimens were obtained in order at 3h and 6h postoperatively:(1)Blood was withdrawn from the abdominal aorta to determine serum amylase,TNF?,IL-1(in addition,in the sham operation group,blood AST and ALT were determined);(2)A portion of liguefied right lung was obtained to determine MPO;another portion was fixed with 10% formalin for tissue pathological examination;(3)Bronchoalveolar lavage fluid of excised left lung was obtained ,and then alveolar macrophages were isolated,collected and purified.After removal of their nuclear (proteins),the alveolar macrophages were tested to determine NF-?B activation with the use of chemical illumination ELISA method;and (4)pancreatic tissue was reserved for pathological examination.In the Gdcl_3 control group, Gdcl_3 was administered by caudal vein injection,the animals were sacrificed 24h later,and blood was obtained to determine blood AST and ALT. Results In the Gdcl_3 prevention group,the level of MPO in lung tissue,serum (levels) of TNP? and IL-1,and NF-?B activation of alveolar (macrophages) were all significanfly reduced as compared with the AHNP model group(in all,P

Objective To evaluate the effect of surgical treatment for cholecystolithiasis with billiary-cardiac syndrome(BCS). Methods The clinical data of 149 cholecystolithiasis patients with BCS were retrospectively analysed. Results The incidence of BCS in cholecystolithiasis was 39.4%(149/378).All the 149 patients underwent cholecystectomy.No severe complications or death occurred in this series. Three months after operation, 123(82.6%) cases of BCS were followed up. Of them, ECG returned to normal and the symptoms disappeared in 102 cases(82.9%);ECG had no obvious change,but the symptoms improved in 15 cases(12.2%). Conclusions Cholecystectomy is the only effective method for treating cholecystolithiasis with BCS. For patients with asymtomatic cholecystolithiasis,if the patients cardiac function can tolerate operation,a cholecystectomy should also be done.

Objective To investigate the components of mesenteric lymph of the rats with severe intraperitoneal infection,and inquire into the effect of intestinal lymphatic pathway in severe intraperitoneal infection.Methods Twenty-four male Wistar rats were randomly divided into two groups according to random number table method,namely model group and sham group with 12 rats in each group.The rat model of severe intraperitoneal infection was reproduced by injecting artificial gastric juice and E.coli intraperitoneally.Mesenteric lymph in both groups was collected 4 hours after the reproduction of the model,and white blood cells were counted and classified.The levels of endotoxin,alkaline phosphatase (AKP),lactate dehydrogenase (LDH),creatine kinase (CK),glutamine transferase (GST),protein and cytokines of mesenteric lymph were determined.Results Compared with the sham group,there was an increase in the neutrophil ratio in mesenteric lymph (0.167 ± 0.004 vs.0.610 ± 0.006,t=33.520,P＜0.001),however the percentage of both macrophages (0.009 ± 0.001 vs.0.020 ± 0.004,t=-6.677,P＜0.001) and lymphocytes (0.824 ± 0.005 vs.0.921 ± 0.004,t=-31.471,P＜0.001) was decreased in model group.Compared with sham group,the levels ofendotoxin (kEU/L:0.346 ±0.022 vs.0.186 ±0.001,t=18.103,P＜0.001),AKP [U (king unit):13.97 ± 5.55 vs.3.76 ± 0.18,t=4.503,P=0.006],LDH (U/L:2 827.45 ± 1 940.32 vs.712.68 ± 14.09,t=2.670,P=0.044),CK (kU/L:2.19 ± 1.21 vs.0.70 ± 0.01,t=3.035,P=0.029),GST (kU/L:12.33 ± 6.53 vs.1.36 ± 0.39,t=4.105,P=0.009) were all significantly elevated.The concentration of protein (g/L:4.40 ± 0.48 vs.2.84 ± 0.16,t=6.882,P=0.001),tumor necrosis factor-α [TNF-α (ng/L):499.39 ±76.36 vs.180.90 ± 70.98,t=7.483,P＜0.001],interleukin-6 [IL-6 (μg/L):13.74 ± 0.78 vs.-0.07 ± 0.07,t=52.972,P＜0.001],intercellular adhesion molecule-1 [ICAM-1 (ng/L):2 754.19 ±221.48 vs.1 362.85 ±393.43,t=6.891,P＜0.001] and monocyte chemo-attractant protein-1 [MCP-1 (μg/L):28.23 ± 1.77 vs.24.87 ± 1.15,t=3.561,P=0.007] and high mobility group protein-1 [HMGB-1 (ng/L):1 392.78 ± 572.42 vs.564.17 ± 21.32,t=3.543,P=0.016] in mesenteric lymph in model group were significantly higher than those in sham group.Conclusion Intestinal lymphatic pathway maybe the early pathway for the production of remote organ injury caused by severe intraperitoneal infection.

Objective To analyze the etiology,diagnosis and therapy of benign biliary strictures and im-prove curative and preventive effects. Methods 212 patients suffering from benign biliary strictures in Nankai Hos-pital from January 2004 to December 2006 were retrospectively analyzed. Results Inflammatory strictures (65.12%,140/215) and strictures caused by operations (20.46%,44/215) were the most two causes. Strictures parts were mainly located in the latter segment of common bile duct 52.09% (112/215). In our group,the stent of strictures parts took 31.37% (64/204), bilioendodraignage 18.13% (37/204), and the modification of strictures parts 43.63% (89/204) as well as resection of stricture parts 1.96% (4/204). Conclusions Inflammatory stricture is the main cause in benign biliary strictures and the main locus is the hinder segment of common bile duct. The di-agnesis of benign biliary strictures before operation is important because it can help to decide the approach way and prognosis. The strategies of curing benign biliary strictures could include operations and endoscopy. The stent of stric-tures parts, bilioendodraignage and the modification of strictures parts are the main treaments for benign biliary stric-tures.

Objective To observe the level of hypoxia-inducible factor-1 alpha (HIF-1α) and its downstream target gene cyclooxygenase-2 (COX-2) in LPS-treated intestinal epithelial cells,and to explore the possible intervention targets of Rheum emodin.Methods Human intestinal epithelial cells were cultured in vitro treated with LPS to establish the experimental model.The protein level trends of HIF-1α and COX-2 were measured by Western blot in LPS dose-dependent and time-dependent manners.The protein level trends of HIF-1α,COX-2,Phospho-IκB-α and Phospho-NF-κB p65 were measured in LPS plus various concentrations of Rheum emodin treated groups.The expression of HIF-1α mRNA were detected by PCR after cells treated with LPS or LPS plus Rheum emodin,respectively.The effect of Rheum emodin on the proliferation of intestinal epithelial cells was measured by MTT assay in each group.Data were analyzed with ANOVA,and P ＜0.05 was considered significant.Results LPS induced the protein level of HIF-1α in a dose-dependent and a time-dependent manners.With increasing concentrations of LPS,the protein level of HIF-1α increased to the peak when cells were treated with LPS at 10-30mg/mL,and then gradually decreased (P ＜0.05).Firstly the protein level of HIF-1α reached the peak at 0.5 h after treatment,and then decreased to the lowest level at 4 h,and finally returned to a high level (P＜0.05).The protein level trend of COX-2 went a similar way to that of HIF-1α (P ＜0.05).Rheum emodin inhibited the protein levels of LPS-induced HIF-1α,COX-2,Phospho-IκB-α and Phospho-NF-κB p65 with a significant dose-effect relationship (P ＜ 0.05).The PCR showed Rheum emodin inhibited LPS-induced increasing expression of HIF-1α mRNA.MTT assay showed different concentrations of Rheum emodin (0 μmol/L,20 μmol/L,40 μmol/L,60 μmol/L,80 μmol/L) had no significant effect on cell proliferation (0.95 ± 0.02,0.89 ± 0.03,0.88 ± 0.04,0.91 ± 0.03,0.83 ± 0.03,P ＞ 0.05).Although Rheum emodin produced biological effect at this concentration range,and it had no toxicity to intestinal cells.Conclusions LPS induces HIF-1α/COX-2 signaling pathway in a time-dependent and a dose-dependent manners in intestinal epithelial cells.Rheum emodin blocks the hypoxia pathway of LPS/HIF-1α/COX-2 and the inflammatory pathway of LPS/IκB-α/NF-κB/COX-2,which may play a protective effect on intestinal epithelial cells.

Objective To clarify the effects of sedation with propofol on pro/anti-inflammatory cytokines balance in severe sepsis patients resulted from intra-abdominal infection.Methods Fifteen patients with severe sepsis were randomly divided into two groups,propofol group received intravenous propofol sedation more than 48 hours,and no sedation drug were used in control group,3 volunteers as healthy group.Plasma TNF-?,IL-10 concentrations were measured at admission and 48 hours later,the ratio of TNF-?/IL-10 (T/I) were also calculated.Results Levels of both TNF-?,IL- 10 were significantly elevated in patients compared with healthy group,but no difference between prepofol and control group.The mean load doses of propofol was 0.063 mg/kg and maintained at 0.054 mg/(kg?h).After 48 hours infusion of prepofol,TNF-?,IL-10 decreased significantly compared with admission in propofol group,while no changed in control group.Compared with control group,IL-10 was lower and ratio of T/I was higher in propofol group.Conclusion Sedation with prepofol in severe sepsis patients attenuated the pro-and anti-inflammatory cytokine responses.Moreover, propofol accelerate the shift to Th1.These findings suggest that the influence of sedation drug on immune function must be considered in sepsis patients.