Objective To explore the surgical intervention outcomes of necrotizing enterocolitis (NEC)pa-tients with different extent of the disease.Methods The data of 25 pediatric patients with NEC who were treated with surgical intervention in Shanghai Children′s Hospital from December 201 1 to December 201 5 were retrospectively ana-lyzed.According to the extent of the disease,the patients were divided into 3 groups:focal disease(F),multisegmental disease(M),and pan -involvement(P).The information including operation style,survival rate and time for close osto-my was analyzed.Results There were 1 1 cases with F,8 cases with M,and 6 cases with P.All patients received lapa-rotomy surgery,colostomy,or peritoneal drainage.There were 1 2 patients with very low birth weight,7 patients with low birth weight,6 patients with normal birth weight in this study.There were 1 7 cases with gastrointestinal perforation (9 cases with pneumoperitoneum,8 cases without pneumoperitoneum),8 cases without digestive tract perforation (4 cases without pneumoperitoneum,4 cases with enterostenosis after conservative treatment).In this study,close ostomy was commonly conducted 3 -6 months after the operation,except for 3 cases who received 2 or more times of operation.The survival rate in F group was 1 00.0%(1 1 /1 1 cases),higher than those in the Mgroup with 62.5%(5 /8 cases)and P group with 1 6.7%(1 /6 cases)(χ2 =4.898,1 0.31 2,all P <0.05).However,there was no difference between Mgroup and P group (χ2 =1 .367,P >0.05).Conclusions The extent of disease is correlated to the outcomes of surgical in-tervention,as F had a better outcome than Mand P.Low birth weight is a risk factor for NEC.Protecting the edge of the bowel is a key factor to ensure the survival and improve the quality of life of NEC patients.Close ostomy should be con-sidered when the patients are in a stable condition (liver function and intestinal function recovery,good nutrition condi-tion,etc),and under special circumstances to conduct early or delayed closure of fistula.

Objective To enhance awareness of the dangerous of multiple magnets ingestion in children and to explore the optimal treatment of it.Methods The clinical data of 3 cases with multiple magnet ingestion were retrospectively studied based on literature review.Results Ingestion of multiple magnets (range:2-5 magnets) magnets occurred in 3 cases.Age ranged from 1 to 8 years old.Magnet sources included:2 from children's family,1 from their kindergarten.All patients had several bowel perforations(range:2-4).One case was completed by laparoscopic,1 case was converted to open suegery after laparoscopy,1 case was done by open surgery.All cases got complete recovery after surgical treatment,and no complications occurred by follow-up.Conclusions Ingestion of multiple magnets may show minimal initial physical manifestations at beginning but may result in significant complications later.Two or more magnets separated from each other along the gastrointestinal tract can attract each other across bowel walls,with may result in pressure necrosis,bowel perforation,and fistulas formation and even death.Early surgical consultation with an aggressive surgical approach is recommended.Family and society should be aware of the dangers of magnet ingestion.

AIM:To study the effects of methylene blue (MB) on myocardial ischemia/reperfusion (I/R)-induced mitochondrial injury in isolated rat hearts.METHODS:Spragure-Dawley (SD) rats were divided into 3 groups randomly (n=6): control group, I/R model group and MB treatment group (IR+MB group).The isolated rat hearts were prepared and set up to Langendorff perfusion.The rats in I/R+MB group received MB (2 mg/kg) by intraperitoneal injection 2 h before operation.The hearts in control group were perfused with K-H solution for 110 min consecutively.The hearts in I/R group and I/R+MB group were in equilibrium for 20 min, following by 45 min of global ischemia, and then reperfused for 60 min.The heart rate (HR), left ventricular developed pressure (LVDP), left ventricular pressure maximum change rate (±dp/dtmax) and left ventricular end-diastolic pressure (LVEDP) were recorded.The perfusate was collected to determine the activity of creatine kinase-MB (CK-MB) and lactate dehydrogenase (LDH).The contents of reactive oxygen species (ROS), malondialdehyde (MDA) and adenosine triphosphate (ATP), and the activity of superoxide dismutase (SOD) in the myocardial tissues were all determined.Histopathological examination of left ventricle was performed.The mitochondria from the heart tissues was isolated and the mitochondrial swelling and mitochondrial membrane potential (MMP) were analyzed.RESULTS:Compared with control group, the hearts in I/R group showed poorer function, higher CK-MB and LDH levels in the perfusate, increased ROS and MDA contents, higher SOD activity and less ATP content in the heart tissues (P<0.05).Furthermore, the mitochondrial swelling level increased and MMP reduced in I/R group (P<0.05).Compared to I/R group, MB improved heart function and reduced the release of CK-MB and LDH (P<0.05).MB also decreased ROS and MDA contents, and increased the activity of SOD and the content of ATP (P<0.05).In addition, MB alleviated mitochondrial swelling and restored the reduced MMP (P<0.05).CONCLUSION: MB protects the isolated rat hearts from I/R-induced injury by attenuating the damage of mitochondria.

Aim To explore the role of PI3 K/Akt/Sirt1 pathway in cardioprotection of hydrogen sulfide ( H2 S ) postconditioning against ischemia/reperfusion ( I/R) injury. Methods Langendorff perfusion appa-ratus was used to build an isolated rat myocardial I/R model. Isolated rat hearts were subjected to 30 min global ischemia followed by 60 min reperfusion after 20 min of equilibrium. 60 male SD rats were randomly di-vided into 5 groups(n=12):control group(Control), ischemia/reperfusion group( I/R) , H2 S postcondition-ing group( H2 S) , inhibitor LY294002 group( LY) and H2 S with inhibitor group( H2 S+LY) . The left ventric-ular diastolic pressure ( LVEDP ) , the left ventricular developed pressure(LVDP), the maximum rate of in-crease or decrease of left ventricular pressure ( ± dp/dtmax ) were registered at the end of 20 min equilibri-um, 30 and 60 min of reperfusion separately. Triphe-nyl tetrazolium chloride( TTC) staining was used to de-termine the myocardial infarct size. The levels of Sirt1 and PGC-1 mRNA were tested using real-time PCR. The expressions of Sirt1 and PGC-1αwere detected with Western blot analysis. Immunohistochemical method was used to determine the location of Sirt1 . Results There were no differences in equilibrium hemodynamics observed between the experimental groups(P>0. 05). At the end of reperfusion, compared with I/R group, H2 S group had obviously ameliorated functional recov-ery and significantly decreased the myocardial infarct size(26. 9 ± 4. 9)% vs(48. 9 ± 5. 6)%(P <0. 05). Meanwhile, the expression of Sirt1 and PGC-1α in-creased significantly. However,LY294002 reversed the cardioprotective effects provided by hydrogen sulfide postconditioning and reduced the level of Sirt1 and PGC-1α, the percentage of Sirt1-positive nuclei. Con-clusion PI3 K/Akt/Sirt1 signaling pathway mediates the hydrogen sulfide postconditioning-induced protec-tion against I/R injury.

OBJECTIVETo study the relationship and clinicopathological significance of Numb,MDM2 and p53 expression in human pancreatic cancer.

METHODSThe expression of Numb,MDM2 and p53 proteins in 65 cases of paired paraffin embedded pancreatic ductal adenocarcinoma (PDAC) specimens and adjacent non-cancerous pancreas was detected by immunohistochemistry (IHC). The relationship among their expression and clinicopathological characters was analyzed.Westem blot was used to examine their expression in 16 paired fresh PDAC specimens and adjacent non-cancerous pancreatic tissues. Meanwhile,Numb expression in Capan-2, PANC-1 and AsPC-1 pancreatic cancer cells with different differentiation were detected by immunofluorescence (IF) , Westem blot and quantitative real-time (qRT) -PCR, respectively. Paired sample t-test, χ(2) test, Kaplan-Meier and Cox regression were used to analyze the results of our experiments, respectively.

RESULTSIHC showed that there was no differential expression of Numb in PDAC and adjacent pancreas (t = 1.746, P = 0.086) , while the expression of MDM2 and p53 was significantly increased in PDAC, compared to that in paired normal pancreas (t = 3.294, P = 0.002; t = 3.152, P = 0.002, respectively) .Numb expression was negatively associated with tumor size (χ² = 5.206, P = 0.023), differentiation (χ² = 7.802, P = 0.005) and UICC stage (χ² = 4.770, P = 0.029), while expression of MDM2 and p53 was positively associated with tumor T and TNM stage, respectively (χ² = 5.182, P = 0.023; χ² = 6.448, P = 0.011) . Correlation analysis showed a negative association between Numb and MDM2 (r = -0.283, P = 0.023) , but there was no relationship of them with p53 (P > 0.05) .Univariate and multivariate analysis revealed that Numb was a protective prognostic indicator for patients with PDAC (χ² = 5.408, P = 0.020). Moreover, patients with Numb positive and MDM2 negative expression had a significantly better overall survival (χ² = 5.868, P = 0.015). Western blot showed that Numb expression was much higher in well differentiated PDAC than that in paired normal pancreas (t = 1.092, P = 0.020) , while the expression of MDM2 and p53 was significantly increased in 16 cases of PDAC (t = 3.263, P = 0.005; t = 3.607, P = 0.003, respectively). Numb expression was gradually increased in pancreatic cancer cells with the increasing degree of cell differentiation detected by IF, Westem blot and qRT-PCR.

CONCLUSIONSNumb acts as a tumor suppressor gene in the development of PDAC. Numb, MDM2 and p53 might coordinately participate in the development of PDAC.

Carcinoma, Pancreatic Ductal ; genetics ; Humans ; Immunohistochemistry ; Kaplan-Meier Estimate ; Membrane Proteins ; metabolism ; Neoplasm Staging ; Nerve Tissue Proteins ; metabolism ; Pancreas ; metabolism ; Pancreatic Neoplasms ; genetics ; Prognosis ; Proto-Oncogene Proteins c-mdm2 ; metabolism ; Tumor Suppressor Protein p53 ; metabolism

OBJECTIVETo evaluate the pancreatic fistula affected by different type of pancreaticojejunostomy after pancreaticoduodenectomy.

METHODSElectronic databases PubMed, EMBase, COCHRANE Library, Wanfang, and VIP etc were used to search for randomized controlled trials or non randomized prospective controlled trials reported before September 2013 on clinical effects of pancreaticojejunostomy after pancreaticoduodenectomy. The statistical analysis was done by Review Manager 5.0.

RESULTSA total of 8 trials were included in this meta-analysis. The effects of duct-to-mucosa pancreaticojejunostomy (dmPJ) and invaginating pancreaticojejunostomy (iPJ) on postoperative complication in five studies were compared, and no statistical significance were found in postoperative pancreatic fistula (POPF) (M-H:OR = 0.77, 95% CI:0.35-1.69, P = 0.52), reoperation (M-H:OR = 1.38, 95% CI:0.64-2.95, P = 0.41) and mortality (M-H:OR = 1.15, 95% CI:0.42-3.13, P = 0.79) between dmPJ and iPJ. The effects of binding pancreaticojejunostomy (bPJ) and conventional pancreaticojejunostomy (cPJ) (including duct-to-mucosa pancreaticojejunostomy and invaginating pancreaticojejunostomy) on postoperative complication were compared, and no statistical significance were found in postoperative pancreatic fistula (POPF) (M-H:OR = 0.57, 95% CI = 0.28-1.17, P = 0.13) , reoperation (M-H:OR = 1.18, 95% CI = 0.48-2.92, P = 0.72) and mortality (M-H:OR = 0.74, 95% CI = 0.27-1.99, P = 0.55) between bPJ and cPJ.

CONCLUSIONThere are no significant differences between dmPJ and iPJ in pancreatic fistula reoperation and mortality, and there are also no significant differences between bPJ and cPJ.

Anastomosis, Surgical ; adverse effects ; Humans ; Pancreas ; surgery ; Pancreatectomy ; adverse effects ; Pancreatic Fistula ; etiology ; surgery ; Pancreaticoduodenectomy ; adverse effects ; Pancreaticojejunostomy ; Postoperative Complications ; surgery ; Postoperative Period ; Prospective Studies ; Randomized Controlled Trials as Topic ; Reoperation

OBJECTIVETo study the role and possible mechanism of glioma-associated oncogene-1 (Gli1) in regulating the cell invasion and migration of pancreatic cancer cells.

METHODSQuantitative real-time (qRT) -PCR was used to detect the effect of siRNA interference on Gli1, murine double minute 2 (MDM2) and p53 genes. Cell invasion and migration assays were used to observe the effect of Gli1, MDM2 and p53 silence on cell invasion and migration in p53 wild-type Capan-2 pancreatic cancer cells, respectively. Meanwhile, immunoblotting (IB) was used to detect the protein level of matrix metalloproteinase (MMP) -9, phospho-excelluar signal-regulated kinase (pERK) and phosphorylation protein kinase B (pAKT) in Gli1-silencing Capan-2 cells. The data were analyzed by paired t-test.

RESULTSqRT-PCR showed that the expression of Gli1, MDM2 and p53 is down-regulated 70.5% and 74.5%, 61.8% and 65.3%, and 73.8% and 78.2% after siRNA interference, compared with the mock and siRNA control groups, respectively. Cell invasion (94 ± 8) and migration (143 ± 8) in p53 wild-type Capan-2 cells transfected with Gli1siRNA were significantly decreased, compared with the siRNA control group (150 ± 7, 190 ± 10) (t = 6.584, P = 0.022; t = 8.266, P = 0.014) , while MDM2 silence inhibited cell invasion (experiment group:85 ± 12, control group: 138 ± 6) and migration (experiment group: 127 ± 9, control group:180 ± 10) in the same cells, respectively (t = 5.097, P = 0.036;t = 4.860, P = 0.040). However, cell invasion (experiment group: 153 ± 11, control group: 106 ± 7) and migration (experiment group: 209 ± 13, control group: 164 ± 8) in p53-silencing Capan-2 cells were significantly enhanced (t = 4.669, P = 0.043; t = 4.990, P = 0.038). IB showed that Gli1 silence down-regulated MMP-9 but not pERK and pAKT protein expression.

CONCLUSIONGli1 might contribute to the cell invasion and migration in pancreatic cancer via the regulation of MDM2, p53 and MMP-9 expression.

Animals ; Cell Line, Tumor ; Cell Movement ; Cell Proliferation ; Matrix Metalloproteinase 9 ; metabolism ; Mice ; Neoplasm Invasiveness ; Oncogene Proteins ; genetics ; metabolism ; Pancreas ; metabolism ; Pancreatic Neoplasms ; metabolism ; pathology ; Proto-Oncogene Proteins c-akt ; metabolism ; Proto-Oncogene Proteins c-mdm2 ; metabolism ; RNA, Small Interfering ; genetics ; Trans-Activators ; genetics ; metabolism ; Transfection ; Tumor Suppressor Protein p53 ; metabolism ; Zinc Finger Protein GLI1

Objective To evaluate the effect of methylene blue (MB) on hydrogen peroxide (H2O2)-induced apoptosis in macrophages through mitochondria-dependent pathway in mice.Methods Mouse peritoneal macrophage line RAW264.7 cells were cultured in DMEM culture medium containing 10％ fetal bovine serum.Cells were divided into 6 groups (n =24 each) using a random number table method:control group (group C),H2O2 group,prophylactic different concentrations of MB groups (MB1,2 groups) and therapeutic different concentrations of MB groups (MB3.4 groups).H2O2 50 μmol/L was added to the culture medium in group H2O2.MB was added to the culture medium with the final concentrations of 0.1 μmol/L (in MB1 and MB3 groups) and 1.0 μmol/L (in MB2 and MB4 groups) at 30 min before adding H2O2 in MB1.2 groups and 30 min after adding H2O2 in MB3.4 groups.At 24 h of culture or incubation in each group,the cell survival rate was measured by methyl thiazolyl tetrazolium assay,the activity of reactive oxygen species (ROS) in cells was determined with the fluorescent probe,the lactate dehydrogenase (LDH) activity in supernatant was detected by spectrophotometry,the activity of superoxide dismutase (SOD) in cells was detected by colorimetric method,mitochondrial membrane potential (MMP) was measured using rhodamine 123 staining,the content of ATP was determined by an ATP bioluminescent method,the expression of pro-caspase-3 and spliceosomes P20 protein and P 18 protein was detected by Western blot,and cell apoptosis was detected using flow cytometry.Results Compared with group C,the cell survival rate,SOD activity and contents of MMP and ATP were significantly decreased,the ROS activity and activity of LDH in supernatant were increased,the expression of pro-caspase-3 and spliceosomes P20 protein and P18 protein was up-regulated,and early and late apoptosis rates were increased in the other five groups (P＜0.05).Compared with group H2O2,the cell survival rate,SOD activity and contents of MMP and ATP were significantly increased,the ROS activity and activity of LDH in supernatant were decreased,the expression of pro-caspase-3 and spliceosomes P20 protein and P18 protein was down-regulated,and early and late apoptosis rates were decreased in MB1-4 groups (P＜0.05).Compared with group MB1,the cell survival rate was significantly decreased,and the expression of caspase-3 spliceosome P 18 was down-regulated in group MB2,and the cell survival rate and SOD activity were significantly decreased,and the activity of ROS was increased in group MB3 (P＜0.05).Compared with group MB4,the expression of caspase-3 spliceosome P 18 was significantly down-regulated,early and late apoptosis rates were decreased,and the activity of ROS was increased in group MB2,and the activity of ROS was significantly increased in group MB3 (P＜0.05).Conclusion The mechanism by which MB attenuates H2O2-induced oxidative damage to macrophages is related to inhibiting cell apoptosis in macrophages through mitochondria-dependent pathway in mice.

Malignant tumors of the digestive system , with high morbidity and mortality rate , are insidious at the onset and lack of effective treatments so far .Interleukin-22 (IL-22) is one of the members of the IL-10 cytokine family discovered in recent years and was originally called IL-10-associated T cell differentiation inducing factor (IL-TIF).IL-22 expression is elevated in various digestive system malignant tumors, and increased IL-22 expression is associated with tumor progression and poor prognosis .Studies on the molecular mechanism revealed that IL-22 initiates a series of downstream signaling pathways such as JAK/STAT and MAPK, by acting on the IL-22 receptor, inducing tumorigenesis.IL-22 is expected to be a novel diagnostic biomarker and therapeutic target of digestive system malignant tumor .