Objective To explore the diagnosis,treatment,risk factors and prognosis factors of postpancreaticoduodenectomy hemorrhage (PPH).Methods The retrospective case-control study was adopted.The clinical data of 703 patients who underwent pancreatoduodenectomy at Hospital 401 of the People's Liberation Army from January 2008 to July 2013 were collected.Standard pancreatoduodenectomy was carried out for the malignant tumors of the head of pancreas or ampulla,pylorus-preserving pancreatoduodenectomy was operated for the benign tumor or the duodenal papilla tumor.The corresponding treatment was adopted for PPH.The observation indicators included:(1) the surgical situation (surgical method,operation time and the volume of intraoperative blood loss),(2) diagnosis of PPH,(3) treatment of PPH,(4) univariate and multivariate analyses for the risk factors affecting the occurrence of PPH,(5) univariate and multivariate analyses for the risk factors affecting prognosis of PPH patients.The measurement data with normal distribution were represented as x ± s.The measurement data with skewed distribution were represented as M (range).The chi-square test or Fisher exact probability was used for univariate analysis.Logistic regression model was used for multivariate analysis.Results (1) The surgical situation:among 703 patients,409 patients underwent standard pancreatoduodenectomy and 294 underwent pylorus-preserving pancreatoduodenectomy,including 1 combined with right hemihepatectomy,27 with portal vein reconstruction and 2 with hepatic artery reconstruction.Pancreaticojejunostomy was applied to 658 patients using mucosa anastomosis of the pancreatic duct to jejunum and 45 patients using invagination anastomosis.Supporting tube was routinely deposed in the pancreatic duct,598 patients had internal drainage and 105 patients had external drainage.The end-to-side anastomosis between common bile duct and jejunum was used for choledochojejunostomy.The 409 patients received the gastrojejunostomy using side-to-side anastomosis of gastric part and jejunum and 294 patients using end-to-side anastomosis of duodenum and jejunum.Operation time and volume of intraoperative blood loss were (324 ± 54) minutes and (428 ± 118) mL.(2) The diagnosis of PPH:among 703 patients after pancreatoduodenectomy,62 patients had PPH,the hemorrhage reasons of 38 patients had been identified,and the hemorrhage reasons of 24 patients had not been identified (A level in 5 patients,B level in 17 patients,C level in 2 patients).① The site of hemorrhage:the hemorrhage outside the cavity were detect in 27 patients,the hemorrhage inside the cavity in 28 patients,and the hemorrhage from both outside and inside part of the cavity in 7 patients.② The time of hemorrhage:early-stage hemorrhage were detected in 5 patients and the delayed hemorrhage in 57 patients.③The volume of postoperative blood loss was (885 ± 253)mL,30 patients had mild hemorrhage and 32 patients had severe hemorrhage.④ The clinical classification of PPH:5,32 and 25 patients were detected in level A,B,C,and 19 patients combined with sentinel hemorrhage.(3) The treatment of PPH:①5 patients with PPH in A level were given clinical observation,blood volume supplement and other treatment,then the symptoms gradually turned better.② Among 32 patients with PPH in B level,15 patients became better after symptomatic and supportive treatments,6 patients received successful hemostasis after guglielmi detachable colis embolization,4 patients received successful hemostasis under gastroscopic hemostasis,7 patients received emergency exploratory laparotomy.Thirty-two patients were improved and then out of hospital after treatment,without occurrence of death.③ Among 25 patients with PPH in C level,4 patients received successful hemostasis after guglielmi detachable colis embolization,17 patients received hemostasis by emergency exploratory laparotomy,4 patients with undiscovered bleeding points received the treatment of fluid infusion,blood volume supplement and antacid.Among 25 patients after corresponding treatment,10 patients were improved and 15 patients were dead.(4) The result of univariate analysis showed that the combined hypertension,vascular resection and reconstruction,postoperative pancreatic leakage and postoperative intraabdominal infection were risk factors affecting the occurrence of PPH (x2 =4.950,5.300,7.568,5.505,P ＜ 0.05).The results of multivariate analysis showed that the combined pancreatic leakage and postoperative intraabdominal infection were independent risk factors affecting the occurrence of PPH [OR =2.761,2.216,95％ confidence interval (CI):1.389-5.489,1.198-4.101,P ＜ 0.05].(5) The risk factors affecting the prognosis of PPH patients:the results of univariate analysis showed that postoperative sentinel hemorrhage,postoperative pancreatic leakage,site,degree and level of hemorrhage were risk factors affecting the prognosis of PPH patients (x2 =8.022,4.448,11.853,18.551,28.285,P ＜ 0.05).The results of multivariate analysis showed that postoperative sentinel hemorrhage and site of hemorrhage (outside and inside part of the cavity) were independent risk factors affecting the prognosis of PPH patients (OR =5.550,0.233,95％ CI:1.595-19.314,0.086-0.635,P ＜ 0.05).Conclusions Pancreatic leakage and intraabdominal infection are independent risk factors after pancreatoduodenectomy.The treatment effect of the early-stage hemorrhage is better than that of the delayed hemorrhage,and angiographic embolization is the first choice of diagnosis and treatment for the delayed hemorrhage.Sentinel hemorrhage could result from aneurysm or continuous arterial hemorrhage of vascular erosion,it is the independent risk factor affecting the death of hemorrhage after pancreatoduodenectomy.

[ABSTRACT]AIM:Toinvestigatetheroleofcysteine-rich61(Cyr61/CNN1)inproliferationandmigrationof bone marrow mesenchymal stem cells ( BMSCs ) .METHODS: The lentiviral vector carrying CCN 1 ( Lenti-GFP-CCN1 ) was constructed and then transfected into the rat BMSCs .The cells were divided into non-transfection group , transfection group ( transfected with Lenti-GFP-CCN1 ) and negative control group ( Lenti-GFP ) .The fluorescence intensity of the transfected BMSCs was observed under inverted fluorescence microscope .The effects of CCN1 on the proliferation and mi-gration of BMSCs were detected by MTT assay and scratch wound healing assay .RESULTS:The proliferation of BMSCs transfected with Lenti-GFP CCN1 had no significant difference compared with negative control group and control group .The width/thickness ratio of migrated BMSCs in wound healing was significantly higher in Lenti-GFP-CCN1 group than that in negative control group and control group (P<0.05).CONCLUSION:Exogenous CCN1 promotes the migration of BMSCs.

Objective Present study aimed to characterize the alteration of cortical thickness in first-episode, never-medicated, adult patients with major depressive disorder (MDD), and explore whether such deficits were related with their disease duration and clinical symptom severity. Methods Thirty-seven adult MDD patients were recruited from March 2013 to August 2015 as patient group, and 41 healthy volunteers were as control group. All the patients underwent three-dimensional spoiled gradient recalled (3D-SPGR) sequences, and the images were acquired. Constructions of the cortical surface were developed from 3D-SPGR images using FreeSurfer software, and the thickness of the entire cortex was measured according to the automated surface reconstruction, transformation, and high-resolution inter-subject alignment procedures. Finally, cortical thickness was compared between the two groups, and the relativity between clinical symptom severity, disease progression and clinical scores were analyzed using the General Linear Model (GLM). Results Our results revealed a significant increase in cortical thickness(P<0.05, false discovery rate corrected) in the left anterior and middle cingulate cortex, bilateral precentral cortex, left paracentral cortex, bilateral superior parietal cortex, left temporal pole, and right lateral occipital cortex (cortical thickness 1.89-2.87 mm, cortical volume 34-384 mm2, P<0.05) in MDD patients compared to healthy controls, while no reversed alternation was found. In addition, clinical symptom severity and disease progression showed no correlation with the cortical thickness abnormalities in MDD group(P>0.05). Conclusion Excluding the impact of treatment, our study showed that the cortical thickness change was mainly located in the prefrontal-limbic system in the in early course of MDD.

Objective To investigate the effects of N-acetylcysteine (NAC) pretreatment on the liver function and mRNA and protein expressions of nuclear factor-KB (NF-KB) in brain-dead BA-Ma mini pigs. Methods The brain-dead model was established by increasing intracranial pressure by a modi-fied, slow and intermittent way. A total of 15 BA-Ma mini pigs were randomly and equally divided into three groups (five in each group), ie, control group (Group C) : treated only with opening and closing abdomen after anesthesia; group without NAC treatment (group B): brain-dead models without use of NAC; NAC treatment group (Group N): 1 and 12 hours after establishment of brain-dead models, 200 mg/kg NAC was added into 100 ml normal saline and intravenously transfused. Levels of ALT and AST in serum as well as TNF-α, IL-1β and IL-6 were determined at 3,6,12, 18,24 hours after brain death. The changes of liver tissues were observed by HE staining under a light microscope, the uhrastruc-rural changes of liver tissues observed under electron microscope, the expression of NF-KB detected by immnohistochemistry and change of NF-KB mRNA by RT-PCR. Results (1) Compared with Group C, serum ALT and AST began to increase at 12 hours after brain death, but IL-1β, IL-6 and TNF-α be-gan to increase three hours after brain death in Groups B and N. mRNA and protein expressions of NF-KB in Groups B and N began to increase six hours after brain death, when Group B increased more sharply than Group N, with statistical difference (P<0.05). (2) At 12 hours after brain death, injury of liver cells in Group B was severer than that in Group N. Conclusion NAC can inhibit the mRNA and pro-tein expressions of NF-KB, decrease the release of inflammatory factors and hence protect the hepatic structure and function during brain death.

Objective:To study the expressione of autophagy-related protein Beclin-1 and LC3 in cortex and hippocampus of rats after cerebral ischemia reperfusion injury and the efficacy of Edaravone.Methods:Sprague Dawley rats were randomly divided into sham group,model group and Edaravone group.The cerebral ischemia reperfusion model was induced via Zea Longa with blocking the middle cerebral artery of 2 h and reperfusing of 24 h.Animals assigned to sham group were only separated left common carotid artery.Edaravone was injected intraperitoneally at a dose of 1 0 mg/kg at 15 min before reperfusion.The condition of nerve injury of rats was conducted by Neurobehavioral score.The degree of brain injury and success of model were determined based on 2,3,5-triphenyltetrazolium chloride(TTC)staining.The changes of neuron stained by hematoxylin and eosin (HE) in cortex and hippocampus were observed.The expression of Beclin-1 and LC3 was measured by immunohistochemistry.Results:After cerebral ischemia reperfusion the neurobehavioral score of edaravone group was(2.00± 0.67),which was obcviously less than(2.50± 0.53) of model group(P＜0.05).The infraction focus and the neuron injury in cortex and hippocampus neurons were also observed in model group,and the edaravone group reduced above expression.The positive rate of Beclin-1 of each group in cortex were (1 1.08± 0.85)％,(33.42± 1.57)％ and (25.61± 1.39)％,there was significant difference between model group with sham group and edaravone group (P＜0.05).The positive rate of Beclin-1 of each group in hippocampus were (10.34± 0.21)％,(31.82± 1.73)％ and (22.74± 1.26)％,there was significant difference between model group with sham group and edaravone group(P ＜ 0.05).The positive rate of LC3 of each group in cortex were (15.33± 0.47)％,(39.72± 1.73)％ and (28.53± 1.61)％,there was significant difference between model group with sham group and edaravone group(P＜0.05).The positive rate of LC3 of each group in hippocampus were (13.74± 0.37)％,(32.53± 1.43)％ and(25.38± 1.23)％,there was significant difference between model group with sham group and edaravone group (P＜0.05).Conclusion:The expression of Beclin-1 and LC3 was increased after cerebral ischemia reperfusion.Edaravone may reduce autophagy and brain injury through downregulation the expression of Beclin-1 and LC3.

Objective To study the relationships of alcohol consumption to the prevalence of metabolic syndrome and its re‐lated components in Yichang professional population and provide decision making basis for lifestyle intervention to MS crowd in the city .Methods We examined baseline data from 3 640 participants (2 285 men and 1 355 women) aged 20 to 70 years who under‐went a careful drinking habits survey ,then physical examination and blood chemical examination .They were divided into three groups by average ethanol intake [non ,occasional (<10 g/day) ,moderate (≥10 and <30 g/day) ,and heavy (≥30 g/day) drink‐ers] .Results Compared with no drinking and occasional drinking group ,the prevalence of MS and abnormal rate of BMI ,DBP ,TG , UA increased significantly (P< 0 .05) while SBP decreased significantly in moderate drinking group;compared with moderate drinking group ,the prevalence of MS and abnormal rate of BMI ,DBP and SBP ,GLU ,TCH ,TG ,LDL C ,UA increased significantly (P<0 .05) in heavy alcohol consumption group;whether moderate or heavy drinking ,abnormal rate of CRP and HDL C did not change significantly(P>0 .05) .Conclusion Even moderate drinking has a significant effect to BMI ,DBP ,TG ,LDL C ,UA ,but not obvious to CRP ,GLU ,TCH ,HDL C .Excessive alcohol consumption has a very bad effect on BMI ,DBP ,SBP ,GLU ,TCH ,TG , HDL C ,LDL C ,UA .Both the prevalence of MS and the abnormal rate of its related components are proportional to the alcohol in‐take .Although moderate drinking could lower SBP and GLU ,but can not reduce the incidence of MS .

PARP1 is an important part of DNA repair machinery. In recent years, PARP1 as novel anti-cancer therapeutic target has been broadly explored. In this study, we expressed hPARP1 enzyme in the baculovirus system and tested its activity. We inserted hPARP1 gene into the pFastBac1, a baculovirus transfer vector and then transformed it into DH10Bac containing a shuttle vector of Bacmid. After co-transfecting the recombinant plasmid into Sf9 insect cells, the expressed hPARP1 was purified by 3-aminobezamide affinity chromatography. The expression of hPARPI was visualized by SDS-PAGE and Western blotting; the activity of expressed and purified hPARP1 was confirmed by the reaction of consumption of NAD+ by hPARP1 in vitro. After the purification by 3-aminobezamide affinity column, 3.2 mg protein was obtained and its specific activity was 1.988 nmol/(min x microg).
Animals ; Baculoviridae ; genetics ; Blotting, Western ; Electrophoresis, Polyacrylamide Gel ; Genetic Vectors ; Humans ; Insecta ; Poly (ADP-Ribose) Polymerase-1 ; Poly(ADP-ribose) Polymerases ; biosynthesis ; Recombinant Proteins ; Sf9 Cells ; Transfection

This study sought to reveal the difference in resting-state brain functions between subjects with major depressive disorder and normal controls. Fifty-three depressed patients diagnosed with DSM-IV and 38 normal controls underwent resting-state functional magnetic resonance imaging (fMRI), and the data were analyzed using a new method called Regional Homogeneity (ReHo). Then voxel wised comparison was made to derive the resting-state brain function differences between groups. Compared with normal controls, depressed subjects showed decreased ReHo in bilateral anterior cingulate cortex (ACC), left medial frontal gyrus, and left middle temporal gyrus. Significant decreased ReHo in ACC might suggest less spontaneous neuronal activities or lower baseline brain activities of ACC in depressed subjects in comparison with normal controls.
Adult ; Brain ; physiopathology ; Case-Control Studies ; Depressive Disorder, Major ; physiopathology ; Female ; Gyrus Cinguli ; physiopathology ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Young Adult

Objective To investigate the brain perfusion changes in patients with refractory depressive disorder (RDD) and non-refractory depressive disorder (NDD) using arterial spin labeling (ASL).Methods Present study included 12 patients with RDD, 37 patients with NDD and 42 controls,and their age, sex and handedness were matched among the three groups.FAIR sequences were performed using a 3 T MR imaging system with an 8 channel phase array head coiL The labelled and controled images were subtracted and then averaged to obtain perfusion-weighted images.The first 2 images were excluded to avoid T, equilibrium effects and then voxel based analysis was performed using SPM2. One way ANOVA analysis using age as covariance ( thresholded at P ＜ 0.01 uncorrected) was performed.Results Patients with NDD showed regional alteration of the brain perfusion, mainly involved in two frontal subcortical circuits, i.e. significantly decreased perfusion in the left frontal and thalamus (the limbic thalamo-cortical circuit) whereas significantly increased perfusion in bilateral hippocampi, fight lentiform and left anterior cingulated gyros (the limbic-striatal-pallidal-thalamic circuit).In contrast, patients with RDD presented significantly decreased perfusion involving bilateral frontal areas (the limbic-thalamo-cortieal circuit) whereby no significantly increased perfusion areas were observed.Conclusion In addition to the reported experimental evidences, our results suggest that the RDD is associated with inactivity of bilateral frontal areas, while the NDD is associated with inactivity of left frontal areas and overactivity of bilateral limbic system.

Objective To investigate the surgical nursing coordination methods in the modified outflow tract trans-sternal approach for left ventricular assist device implantation.Methods A retro-spective analysis was conducted on the clinical data of 3 patients who underwent modified outflow tract trans-sternal LVAD implantation at our hospital.Results All 3 surgeries were successfully comple-ted.The mean operative time was(311.7±34.1)minutes,and the mean blood loss was(383.3±28.9)mL.Patients were discharged after(48.3±16.8)days postoperatively in average.No signifi-cant complications occurred,and the postoperative condition of patients was stable.Conclusion The modified outflow tract for left ventricular assist device implantation provides more stable hemodynamics for patients.Compared with the traditional median sternotomy,the trans-sternal approach not only fa-cilitates the dissection of chest wall tissues and better access to the surgical field but also offers the ad-vantages of smaller incisions and faster recovery.Proficient surgical operation techniques and skilled surgical coordination are crucial for the success of this procedure.