OBJECTIVETo investigate the role of autophagy in acute lung injury (ALI) caused by multiple trauma in rats via pretreat with 3-methyladenine (3-MA).

METHODSForty-five Sprague-Dawley male rats, with age of 4 months and body weight of 250-300 g,were randomly divided into three groups. In the sham group, the rats received sphenotresia only;in the control group, the rats were made model of femur shaft fracture combined with brain injury, and treated with physiological saline by abdominal cavity at 1 hour before making model; in the 3-MA group, the rats were made model of femur shaft fracture combined with brain injury,and treated with 3-MA of 10 mg/kg by abdominal cavity at 1 hour before making model. Histologic changes and the concentration of related inflammatory factors in the damaged lung tissue were examined at 48 h after opteration, at the same time, the effect of 3-MA on the expression of LC-3 II and Beclin-1 was examined through reverse transcriptase polymerase chain reaction technique (RT-PCR).

RESULTSCompared with sham group, LC-3 II and Beclin-1 level in control group at 48 h after operation were obviously increased (P < 0.01). Compared with control group, LC-3 II and Beclin-1 level in 3-MA group at 48 h after operation were obviously decreased (P < 0.01). Compared with sham group, the level of proinflammatory cytokines (TNF-α and IL-6) in control group obviously enhanced (P < 0.01). Compared with control group, above items in 3-MA group was obviously lower (P < 0.01). Compared with control group,the histopathological damage of lung in 3-MA group obviously reduced (P < 0.01).

CONCLUSIONAutophagy can aggravate the acute lung injury caused by fracture of shaft of femur combined with brain injuries,but 3-MA can reduce tissue damage by inhibiting the autophagy and inflammatory response.

Acute Lung Injury ; prevention & control ; Adenine ; analogs & derivatives ; therapeutic use ; Animals ; Apoptosis Regulatory Proteins ; analysis ; Beclin-1 ; Interleukin-6 ; analysis ; Lung ; chemistry ; immunology ; pathology ; Male ; Multiple Trauma ; complications ; Rats ; Rats, Sprague-Dawley ; Tumor Necrosis Factor-alpha ; analysis

Objective: To describe the differences of plasma folate concentration and prevalence of folate deficiency in genders and ages in Chinese adults aged 35 to 64 years. Methods: By cross-sectional analysis, plasma folate concentration was measured in 2 545 adults including men and women by microbiological assay. Results: (1) Men tended to have lower plasma folate concentration and higher prevalence of folate deficiency(9.70 nmol/L, 31.0%) than did women(14.2 nmol/L, 12.5%, P=0.001). (2) Men in South have significantly higher plasma folate concentration and lower prevalence of folate deficiency than in North. The difference of plasma folate concentration was not evident between urban and rural area, but evident in North between in winter and spring. There were no significant differences of prevalence of folate deficiency for men between urban and rural areas in both regions. For women, the differences of plasma folate concentration in areas were significant, which were higher in South and urban, and lower in North and rural areas. (3) Plasma folate concentration increased with age in Southern men. A similar trend for others was not significant. Conclusion: Men have lower plasma folate concentration and higher prevalence of plasma folate deficiency than do women. The distribution of plasma folate concentrations in urban and rural areas seems different between men and women.

Objective: To describe the distribution of plasma vitamin B12 concentration in Chinese adults aged 35 to 64 years.Methods:Cross-sectional analysis was empolyed.Plasma vitamin B12 concentration was measured in 2 459 adults sampled from the representative urban and rural areas in the South and North of China.Results:Adjusted plasma vitamin B12 concentration was significantly higher (260 pmol/L) in the Southerners than in the Northerners (189 pmol/L).There were different patterns of seasonal changes of plasma vitamin B12 concentration between South and North.Plasma vitamin B12 concenration was higher during the summer and autumn (269 pmol/L)than during the winter and spring (252 pmol/L) in the South.However,the concentration was lower during the summer and autumn (177 pmol/L) than during the winter and spring (200 pmol/L) in the North.Women tended to have higher plasma vitamin B12 concentration than men.There were 5.5 percent of the participants whose plasma vitamin B12 concentration was lower than 110 mol/L.Conclusion:Significant regional and gender differences in plasma vitamin B12 concentration were observed in Chinese adults.The seasonal changes between the South and North were different.

Objective To study the effect and mechanism of Xinkai Kujiang method(TCM treatment with the pungent and bitter herbs to regulate the gastrofunctions)on the functional dyspepsia(FD)rats.Methods Twenty-four rats were randomized into control group,model group,and Weikangning(herbal medicine for dyspepsia)group,with 8 in each.After a 7-day adaptive feed,the FD models were made with the clipping tail stimulation.Seven days after modeling,the Weikangning group was given Weikangning Capsule 0.625g/kg by gavage,twice a day,and the other two groups were given normal saline in the same dosage.The medication was appliey in succession for 12 days,and on the thirteenth day,the serum and gastric tissues were collected for detecting the lab indications:plasma motilin(MTL),plasma nitric oxide(NO),gastric tissue MTL,nitric oxide synthase(NOS),and the expression of Cajal interstitial cells(ICC)and gastrointesinal smooth muscle cells(SMC).Results Compared with the control group,the level of plasma MTL in the model group was significantly decreased,the level of NO significantly increased,and the expression of MTL,ICC and SMC positive neurons in the stomach myenteric nerve plexus was significantly weakened,but the expression of NOS positive neurons was significantly strengthened(P

Objective:To discuss the type, treatment and results of different therapies of biliary fistula after orthotopic liver tansplantation(OLT).Methods:Data of 24 patients who developed biliary fistula after OLT in the First Affiliated Hospital of Xi′an Jiaotong University from January 2000 to March 2019 were retrospectively analyzed. Patients with biliary fistula were classified into 4 types according to presence or absence of stricture. All patients were treated by endoscopic retrograde cholangiopancreatography (ERCP) or interventional therapy, including endoscopic nasobiliary drainage (ENBD), endoscopic retrograde biliary drainage (ERBD) or percuteneous transhepatic cholangial drainage (PTCD). Main outcome measurements were the onset time of biliary fistula, the site of biliary fistula, the complications of ERCP or PTCD, the time of removing abdominal or biliary drainage tube, and the onset of new biliary stricture.Results:Biliary fistula was found in (46.5±36.6) days (6-122 days) after OLT. The numbers of patients in four types of biliary fistula were 6, 14, 2 and 2, respectively. Biliary fistula was cured in 22 patients, with clinical cure rate of 91.7%. All patients underwent ERCP first, and the technical success rate and clinical cure rate were 87.5% (21/24) and 85.7% (18/21), respectively. The clinical cure rates of ERCP forⅠ-Ⅳ biliary fistula were 6/6, 84.6%(11/13), 1/2, and 0, respectively. The clinical cure rates of ENBD and ERBD were 8/10 and 6/8, respectively. Five cases in whom ERCP failed, underwent PTCD, with technical success and clinical cure rates of 4/5 and 3/4 respectively. Eight patients(33.3%)developed cholangitis after treatment, and the incidence rate seemed higher in type Ⅱ biliary fistula than that in type Ⅰ [35.7% (5/14) VS 16.7% (1/6)]. Incidence of cholangitis was higher in patients with non-anastomotic stricture than those with anastomotic stricture [83.3%(5/6) VS 16.7%(3/18)].Conclusion:The first line treatment for biliary fistula after OLT is ERCP, followed by PTCD. The best procedures of biliary fistula typeⅠ-Ⅳ were ENBD, ENBD combined with ERBD, ENBD and PTCD, respectively.

ObjectiveTo compare the clinical characteristics of ischemic colitis (IC) and ulcerative colitis (UC).MethodsThe data of 43 IC patients and 36 UC patients diagnosed from January 2008 to June 2011 were compared on the clinical and endoscopic characteristics.ResultsThere were statistical differences in terms of gender,age,course of disease and underlying diseases between the two groups( P ＜0.05 ).IC was more frequently seen in aged women with cardiovascular diseases,and with short course of disease (29/43,67.0％).IC group showed higher CRP and lower PLT level than did UC group (P ＜ 0.05 ).IC mostly involved sigmoid colon,with localized lesions of vertical or irregular ulcer which cured more quick and characterized with mucosal inflammation,while UC mainly originated from rectum and involved the whole intestinal wall,manifested with scattered spot ulcer,cryptitis and abscess.Conclusion Age,disease course,underlying diseases,serum CRP level,endoscopic and pathological characteristics are all factors to consider for differential diagnosis of IC and UC.

Objective To prospectively evaluate the value of US,MSCT,EUS and MRI in the quantitative evaluation of the extent of pancreaticobiliary duct obstruction in pancreatic cancer.Methods Consecutive 68 patients with pancreatic carcinoma underwent US,MSCT,EUS and MRI before surgery.The diameter of extrahepatic bile duct and pancreatic duet were measured,and correlation analysis was performed with surgical specimens.Results Diameters of extrahepatic bile duct scaled by US.MSCT,EUS and MRI were(16.60±6.33)mm,(18.90±6.74)mm,(18.80±5.88)nun and(17.26±4.83)mm,and diameter measured from surgical specimens was(18.39±6.05)mm;the correlation among the four imaging examinations and the surgical evaluation were r=0.3839,P=0.1055;r=0.7113,P=0.0011; r=0.3759,P=0.0465;r=0.3376,P=0.2872,respectively. Kappa Values were 0.6285,0.7115,0.6661 and 0.7490,respectively.The diameter of pancreatic duct was(15.90±3.41)mm,(6.83 4-3.70)mm,(6.77±3.22)mm and(5.58±2.65)mm,and diameter measured from surgical specimens was(5.97±2.60)mm,the correlation among the four imaging examinations and the surgical evaluation were r=0.3584,P=0.2895;r=0.6148,P＜0.0001; r=0.7373,P＜0.0001;r=1.0746,P＜0.0001.Kappa values were 4.159,9.094,9.001 and 4.050.All of these parameters were in coherence with surgical findings.Condusions US could be used as the initial method in the assessment of extrahepatic and pancreatic duct obstruction.MRI and MSCT,combined with EUS if necessary,could be used to quantitatively evaluate the extent of pancreaticobiliary obstruction.

Objective To measure and assess CT perfusion value for peri-pancreatic metastatic lymph node by using multiple spiral CT (MSCT) with body perfusion software package. Methods The MSCT perfusion imaging was performed for peri-pancreatic metastatic lymph nodes and muscle on a multi-section CT scanner (SOMATOM Sensation Cardiac 64). 4 x 5 mm collimation, 120 kV, 60mA. Contrast injection was done with 40 ml nonionic contrast agent (300 mg l/ml), at a flow rate of 4.0 ml/s, and 5 seconds delay, and data acquisition lasted for 40 seconds. The mean blood flow (BF) were measured and analyzed in patients with pathologically proven peri-pancreatic metastatic lymph nodes(n=29)and hyperplastic lymph nodes(n=15) on work station using body perfusion software (Siemens) with deconvolution method. Results The mean BF in peri-pancreatic metastatic lymph nodes were (53.63±18.82) ml·min-1·100 ml-1, in hyperplastic lymph nodes were 29.78±7.52 ml·min-1·100 ml-1, the difference was significant (P<0.001). Conclusions Perfusion imaging of MSCT was useful in differentiation between peri-pancreatic metastatic lymph nodes and hyperplastic lymph nodes.

Objective To evaluate the efficacy and adverse reactions of CT-guided 125I radioactive seed implantation in treatment of locally recurrent rectal cancer (LRRC).Methods Thirty patients with LRRC who refused operation or were unable to endure pelvic radiotherapy received 125I seed implantation under CT guidance.Three-dimensional treatment planning system was used to calculate the number,activity,and dose of the seeds needed.The activity of seeds ranged from 14.8 to 29.6 MBq with a median of 25.9 MBq,the seed numbers ranged from 33 to 137 with a median of 74.5,the prescription doses ranged from120-160 Gy,and the actual verification dose D90 ranged from 75.91 to 159.32 Gy with a median of 119.77 Gy.Dosimetric verification by CT scanning was conducted immediately after the treatment.Follow-up was conducted for 15.2 months(4.2-35.0 months).Results The follow-up rate was 93.3％.The pain relief rate was 95.2％.The overall response rate was 50.0％,including a complete response rate of 13.3％ and a partial response rate of 36.7％.The 1-and 2-year local control rates were 30.0％ and 8.0％ respectively.The median local control survival time was 7.8 month.The 1-and 2-year survival rates were 66.5％ and 32.9％ respectively.The median overall survival time was 21.5 months.Complications,mainly adverse effects of skin and urinary system (frequent urination,urgent urination,and dysuria) occurred in 6 patients with a rate of 20.0％.Conclusions Minimally invasive and with satisfying efficacy and tolerable complications,CT-guided 125I radioactive seed implantation is a favorable option for treatment of LRRC,especially for the patients who have undergone previous pelvic radiation.

Objective:To search for a method for radical resection of pancreatic and duodenal malignancy involving the mesentery root and for the long post-operation survival of patients.Methods:From Jan.2004 to Aug.2006,a total of 26(16 male and 10 female. aged 27-70)patients with pancreatic and duodenal malignancy involving the mesentery root were treated in our department.The patients included 3 with duodenal malignancy and 23 with pancreatic malignancy.Curative resection was performed by the extended pancreaticoduodenetomy(Whipple procedure)combined with mesentery root resection(MRR)for all patients.The outcomes,safety and the post-operation survival rate were analyzed retrospectively.Results:Thirteen patients were treated with Whipple procedures combined with MRR,9 were treated with partial portal vein/superior mesenteric vein(PV/SMV)and reconstruction of the vessel,and 4 patients received pre-shunt between PV and SMV with artificial vessel graft before the extended Whipple and MRR procedures.The operation time was 2.5 to 7(4.4?1.1)hour,and blood loss was 300 to 5 000(1892?1414)ml with the blood transfusion of 0 to 5 600(2 100?1 586)ml.There was no death in our group and 7(27%)had post-operation complication.The post-operation hospital stay was 10 to 30 days.The pathologic examination showed negative surgical margins for all specimens.The tumor size was 4 to 10 (6.17?2.03)cm.After a follow-up of 9 to 38 months,the pain was relieved in all patients.One of the 3 patients with duodenal adenocarcinoma had liver metastasis at 10 months after operation,and the other 2 survived 10 months and 27 months without evidence of tumor reccurence.The patient with pancreatic micro-adenocarcinoma died of local reccurence 9 months after operation.The patient with neuroendocrine carcinoma died of organ failure 24 months after operation.The patient with lymphoma have survived for 24 months after operation.The 1-year and 2-year accumulated survival rates in the 20 cases with pancreatic ductal cancer were 86.6% and 45.6%. respectively.Conclusion:The extended Whipple procedure with MRR is safe and effective.It can obtain R0 resection in patients with malignant tumors(over 5 cm in diameter)in the head,neck and uncinate process of the pancreas and duodenal.