Objective To evaluate the surgical management of pancreatic fistula caused by pan-creatic trauma and pancreatitis through surgical drainage. Methods A series of 45 patients with pancreat-ic fistula undergoing Roux-en-Y surgery with or without fistulectomy from 2004 to 2014 was analyzed. Pa-tients were divided into two groups:patients in group A(n=21)underwent external drainage of pancreatic secretion by Roux-en-Y surgery,and patients in group B(n= 24)underwent Roux-en-Y surgery with fistu-lectomy. The surgery was performed at 4~6 months after formation of the fistula,and somatostatin was used postoperatively. Results Patients in group A developed more severe side effects than patients in group B, including chronic abdominal pain(6/21 vs. 1/24),pancreatic leakage(8/21 vs. 2/24),digestive bleeding (5/21 vs. 5/24)and incision infection(9/21 vs. 3/24). Conclusion Resection of the fistula plus Roux-en-Y surgery can significantly reduce the incidence of surgical complications,which is a safe and efficient management for pancreatic fistula.

Objective To investigate the factors and the preventive methods of gastrointestinal leakage.Method 32 cases of gastrointestinal leakage from 1996 to 2001 were analyzed retrospectively.Results In 32 patients,19 cases were benign diseases and 13 cases were malignant diseases.25 cases were selectively operation and 7 were emergency operation, 11 cases treated by re-operation and 21 cases by other methods.24 cases were cured and 8 cases were died.Conclusions Main cause of leakage was operative method unsuitable.Anastomostic skill was deficiency,local condition was bad and ignored postoperative treatment and so on.Preventive methods should be selected to decreasingintestinal leakage.

Purpose:Our experiments are dealing with the affect of docosahexaenic acid(DHA) in doxorubicin to cytoxicity effect of MDA-MB-435s, which is of the anti-human breast cancer and whether it is one of the effect mechanisms that it via the lipid peroxidation of DHA.Methods:Add different match such as anti-cancer drugs?PUFAs?oxidan system of sodium ascorbate and ?-methy-1.4-naphoqui-none?antioxidant of Dl-?-tocopherol and so on to the culture cell line of MDA-MB-435s each 24 hours for 6 days, estimate MDA by TBA with cell extracts and estimate the contents of NO via nitrite salt spectrophotography, then draw out a dosage-effect correlation straight line among contents of MDA,NO and cytoxicity. Mitox is used as contraposition to the peroxidation of ADM which is enhanced by DHA for peroxidation of mitox is low.Results:There have been obvious changes on the contents of MDA of the lipid peroxidation has paralled increased while NO has decreased. There is recitilinear correlation relationship among the contents of MDA and NO from cell extracts and the cytoxicity.Conclusions:It is obvious that DHA can add the cytoxicity of cell line of MDA-MB-435s with ADM, particularly after add non-cytoxicity oxidant. It is lipid peroxidation of oncocyte that one of the mechanisms of DHA can enhance anti-breast cancer effect of ADM.

ObjectiveTo investigate the relationship between the oxidative injury induced by low glucose and mitochondrial membrane potential in HUVEC-12 cells. Methods Human umbilicalvein endothelial cells HUVEC-12 were cultured in low concentration glucose for 4 h.Cell viability of HUVEC-12 cell was assessed with MTT assay.Dihydroethidium (DHE) was used as a reactive oxygen species (ROS)capture, which was detected the mean fluorescence intensity of samples and Rhodamine 123 as a fluorescence detector was to measure the level of mitochondrial membrane potential (MMP) in cells.Results Comparing to HUVEC-12 cells viability in 5.5 mmol/L glucose group (96.80 ±3.20)％, cells exposed to 2.8 mmol/L glucose group (66.40 ± 1.60) ％ and 0 mmol/L glucose group (58.93 ± 1.67) ％ were decreased by 32％ and 40％ respectively (P ＜ 0.01).ROS level of 5.5 mmoL/L glucose group, 2.8 mmol/L glucose group and 0 mmol/L glucose group were 0.59 ± 0.02, 0.74 ± 0.04 and 0.88 ± 0.05,respectivdy, increased by 25％ in cells exposed to 2.8 mmol/L glucose and by 48％ in cells without glucose exposure comparing to 5.5 mmol/L glucose group (P ＜0.01) ; MMP levels of 5.5 mmol/L glucose group,2.8 mmoL/L glucose group and 0 mmoL/L glucose group were 148.83 ± 3.51, 271.07 ± 19.54 and357.74 ±51.32 respectively, increased to 1.8 times in cells exposed to 2.8 mmol/L glucose and to 2.4times in cells without glucose exposure comparing to 5.5 mmoL/L glucose group (P ＜ 0.01).Conclusion Low glucose leads to injury in HUVEC-12 cells, which is probably induced by the oxidative stress via the increasing MMP.

Objective To investigate the etiology of iatrogenic bile duct injury and experience in its diagnosis and treatment. Methods A retrospective study was conducted on the clinical data of 86 patients with iatrogenic trauma in the bile duct. Results These 86 cases have received a total of 156 sessions of surgical procedures, including 2 explorations in 66 cases,3 explorations in 6 cases. Lateral bile duct injury in 22 cases was treated by suture repair and T tube stent. Eight cases suffering from iatrogenic transection of the common bile duct were retrieved by cholangiojejunostomy and T tube stent. Nine cases with inadvertent CBD ligature were managed by a lysis and T tube stent. Roux en Y cholangiojejunostomy was adopted in 77 cases. Sixty cases were followed up for 1～10 years, with good result in 90% of the cases. Conclusions Most CBD iatrogenic injury cases were encountered as a result of cholecystectomy.Roux en Y cholangiojejunostomy is the choice of therapy.

OBJECTIVE: To investigate the effects of Liuwei Dihuang Pills (LWDHP) on expressions of apoptosis-related genes bcl-2 and Bax in pancreas of OLETF rats. METHODS: Forty male OLETF rats were randomly divided into LWDHP-treated group and untreated group. Another ten male LETO rats were included in normal control group. OLETF rats in the LWDHP-treated group were given LWDHP (2.4 g.kg(-1).d(-1)) orally since the age of 8 weeks and the rats in the other two groups were given distilled water orally. Body weights of rats were recorded weekly and blood glucose concentration was determined by oral glucose tolerance test (OGTT). Pancreas weights were recorded after rats were killed and the expression levels of bcl-2 mRNA and Bax mRNA were detected by reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS: In the LWDHP-treated group, the expression of bcl-2 mRNA in the pancreas of rats at the age of 40 weeks (1.25+/-0.07) was much higher than that in the untreated group (1.01+/-0.16), P<0.01. Bax mRNA level in the LWDHP-treated group (0.57+/-0.11) was obviously lower than that in the untreated group (1.18+/-0.28), P<0.01. There was no significant difference of pancreas-to-body weight ratios between the LWDHP-treated group and the untreated group. The ability of glucose tolerance was improved in the LWDHP-treated group. CONCLUSION: LWDHP can up-regulate the expression of bcl-2 and down-regulate the expression of Bax at transcription level, which maybe contribute to the anti-apoptosis effects of LWDHP.

OBJECTIVETo investigate the mechanism through which Liuweidihuangwan improves hepatic insulin resistance in type 2 diabetic rats.

METHODSWith LETO rats as the normal control group, OLETF rats were treated daily with or without Liuweidihuangwan. At 8, 32, and 40 weeks of the treatment, 3 rats were randomly selected from each group for histological examination of the liver tissues and for detection of phosphoenolpyruvate carboxylase kinase (PEPCK) mRNA expression using RT-PCR and insulin receptor substrate-1 (IRS-1) and IRS-2 protein expressions using Western blotting.

RESULTSCompared with LETO rats, OLETF rats showed progressive destruction of the lobular structures and hepatic steatosis in the liver over time. OLETF rats with Liuweidihuangwan treatment had basically normal lobular structure with only mild fatty degeneration in the liver. RT-PCR detection demonstrated a significantly higher PEPCK mRNA expression in untreated OLETF rats than in LETO rats (P<0.01), but a significantly lowered PEPCK expression in OLETF rats after Liuweidihuangwan dosing (P<0.01). Western blotting showed that significantly lower p-IRS-1 and p-IRS-2 protein expressions in untreated OLETF rats than those in LETO rats and treated OLTEF rats (P<0.05).

CONCLUSIONLiuweidihuangwan improves hepatic insulin resistance in OLETF rats by inhibiting the activity of gluconeogenic key enzyme (PEPCK) in the liver and enhancing IRS-1 and IRS-2 expressions in the insulin signaling pathway.

Animals ; Diabetes Mellitus, Experimental ; drug therapy ; metabolism ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Insulin Receptor Substrate Proteins ; metabolism ; Insulin Resistance ; Intracellular Signaling Peptides and Proteins ; metabolism ; Liver ; drug effects ; metabolism ; pathology ; Male ; Phosphoenolpyruvate Carboxykinase (GTP) ; metabolism ; Rats ; Rats, Inbred OLETF ; Signal Transduction

OBJECTIVETo investigate the protective effects of exendin-4 on vascular endothelial cells and explore the possible mechanism.

METHODSHuman umbilical vascular endothelial cells (HUVECs) were cultured in the presence of high glucose and tumor necrosis factor-α (TNF-α, 10 ng/ml) with or without exendin-4. The level of nitric oxide (NO) in the cell culture supernatant was measured using a nitrate reductase method. The expression of intercellular adhesion molecule-1 (ICAM-1) mRNA was measured by real-time PCR, and nuclear factor-κB (NF-κB) p65 translocation was detected using immunofluorescence assay. Western blotting was employed to measure the expression of p38 MAPK protein in the treated cells.

RESULTSIn the presence of high glucose and TNF-α, treatment of cells with exendin-4 did not obviously affect the cellular synthesis of NO, but significantly down-regulated the expression of ICAM-1 mRNA (P<0.01). The nuclear fluorescence intensity of NF-κB p65 and the expression level of p38 MAPK protein in the cells were significantly lowered by exendin-4 treatment (P<0.01).

CONCLUSIONExendin-4 ameliorates high glucose- and TNF-α-induced HUVEC-12 cell damage by inhibiting the expression of p38 MAPK protein and translocation of NF-κB p65.

Cell Line ; Culture Media ; chemistry ; Glucose ; adverse effects ; Human Umbilical Vein Endothelial Cells ; drug effects ; metabolism ; Humans ; Peptides ; pharmacology ; Transcription Factor RelA ; metabolism ; Tumor Necrosis Factor-alpha ; adverse effects ; Venoms ; pharmacology ; p38 Mitogen-Activated Protein Kinases ; metabolism

Objective To evaluate the feasibility of wholeGtumor texture analysis of contrastGenhanced T1 WI (T1 Ce)in differentiating cystic glioma (CG)from brain abscess (BA).Methods MRI data of 25 cases of ringGenhanced CG and 24 cases of BA proven pathologically were retrospectively studied.All the patients underwent preGsurgery MRI plain and contrastGenhanced scans.FireVoxel software was used to outline the ROI of the wholeGtumor.The signal intensity histogram and related texture parameters of the 3D ROI were obtained,including mean, median,standard deviation,inhomogeneity,skewness,kurtosis and entropy.The data were first tested for normality and the differences in wholeG tumor texture analysis parameters of T1 Ce between CGs and BAs were compared using the independentGsample t test(normal distribution)and MannGWhitney rank sum test (skewed distribution).ROC curve was used to evaluate the efficacy of the parameter in differentiating CG from BA.Results There were statistical significances in the parameters of mean,median,standard deviation,inhomogeneity and skewness between CGs and BAs(P＜0.05),and there were no any statistical significances in kurtosis and entropy between CGs and BAs(P＞0.05).In all the texture parameters,the AUC of inhomogeneity was the largest(0.988),and when the threshold was 0.314, the sensitivity and the specificity were 92.60% and 9 7.1 0%,respectively.Conclusion Some of the quantitative parameters of the wholeGtumor texture analysis of T1 Ce(mean,median,standard deviation,inhomogeneity and skewness)could provide reliable and objective evidences for imaging differential diagnosis of CG and BA preGsurgery.

Impaired eady phase insulin secretion is an important reason for leading to postprandial hyperglycemia.Nateglinide is a rapid-acting insulin secretagogue,which reduces postprandial blood glucose of type 2diabetic patient by restoring early phase insulin secretion.The efficacy and safety have been fully verified by clinical administration and it is more widely used to treat type 2 diabetic patients.Both sulfonylureas and glinides were named insulin secretagogue agents and regarded as alternative first-line drugs in the 2010 Chinese Guideline for treatment of type 2 diabetes.AACE/ACE Consensus statement claimed that glinides would be one of the important choices after metformin.In order to further guide the clinical application of nateglinide,16 national specialists in the field of endocrinology and metabolism of China discussed,drafted,and edited this consensus.The current consensus combined clinical evidences at home and abroad.systematically reviewed and summarized tlle results of these studies about nateglinide.It will provide guiding recommendations and reference concerning how to reasonably and effectively use nateglinide in the clinical practice.