Objectives:To evaluate if the administration of an enteral diet supplemented with glutamine,arginine and ? 3 fatty acids modulate the inflammatory and immune responses and the outcome after surgery. Methods:A prospective,randomized,double blind and clinical trial was performed.Eighty eight patients with gastrointestinal cancer were randomly divided itnto two groups.One group was given an isocaloric and isonitrogenous standard diet and the other was fed with the supplemented diet with glutamine, arginine and ? 3 fatty acids.Feedings were started within 48 hour after operation, and continued until day 8.All variables were measured before operation and on postoperative day 1,4 and 8.Blood was drawn at different time points to assess albumin, prealbumin and transferring.Immune responses was determined by phagocytosis ability,respiratory burst of polymorphonuclear cells, total lymphocytes, lymphocyte subsets, nitric oxide,cytokine concentration,immunoglobins,and inflammatory responses by plasma levels of C reactive protein and prostaglandin E 2. Results:Tolerance of both formula diets was excellent.There were significant differences in the immunological and inflammatory responses between the two groups.In supplemented group,the serum concentrations of IgA,IgG,IgM,phagocytosis and respiratory burst after surgery were higher and C reactive protein level was lower( P

Objectives: To investigate the role of glutamine on splanchnic blood flow in SAP rats and underling mechanism. Methods: 32 rats were randomized divided into 2 groups:glutamine group(Gln group, n =16) and SAP group ( n =16).Jejunotomy was performed. Gln group received glutamine.SAP group received saline.All groups were subdivided into 2 groups.8 normal rats were used as the controls.At 12,24hours after the induction of SAP,8 rats in each group were sacrificed.Plasma glutamine concentrations were measured by HPLC.The regional pancreatic microvascular blood flow was measured by Dopplar ultrasound,the blood flow of portal vein,spleen artery and superior mesenteric artery was also measured. Results: Enterally administered Gln was well tolerated by the rats.There was an increase in plasma Gln levels after Gln supplementation on Gln group.The regional pancreatic microvascular blood flow decreased significantly in SAP group( P

Objective To explore the expression change of intestinal epithelial tight junction (IJ)protein claudin-1 in mice with fulminant hepatic failure (FHF).Methods FHF was induced with a method that combined intraperitoneal injection of lipopolysaccharide (LPS,10 mg/kg) and D-galactosamine (GalN,800 mg/kg).Control saline (2 ml/kg,ip),LPS (10 mg/kg,ip) and GaIN (800 mg/kg,ip) were also detected.The effect of administration of anti-tumor necrosis factor alpha (TNF-α) IgG antibody (anti-TNF-α IgG,100 μg/per) on the level of TNF-α was assessed before administration of D-galactosamine/lipopolysaccharide.At the 2nd h,6th h,9th h,12th h,24th h after injection in FHF group,the 9th h after injection in control groups and 9th h after injection in anti-TNF-α IgG group,the mice were killed for the collection of large intestine specimens.Claudin-1 was analyzed with immunohistochemistry,Western blotting,and real-time quantitative PCR.Results Tight junction protein claudin-1 was localized along the apical region of the lateral plasma membrane representing the region of tight junctions in surface and crypt epithelial cells.Weakly distributed density of claudin-1 in intestinal mucosa was found in mice with FHF from the 9th h after injection.Compared to saline group,Western blotting analysis demonstrated markedly reduced claudin-1 expression in mice with FHF at the 6th h and 9th h after injection (6th h:0.8600±0.0208 vs 1.0,P ＜0.05; 9th h:0.6633 ±0.0328 vs 1.0,P ＜0.01).Furthermore,the expression of claudin-1 mRNA was markedly reduced at the 6th h,9th h,and 12th h after injection in mice with FHF (6th h:0.3067 ±0.1291 vs 1.0,P ＜0.05; 9th h:0.2233 ±0.1155 vs 1.0,P ＜0.01 ; 12th h:0.5275 ±0.1222 vs 1.0,P ＜0.05).Compared to saline group,no significant difference in claudin-1 expression was found with prophylactic treatment with anti-TNF-α-IgG antibody in mice with FHF at the 9th h after injection (protein:0.9533 ±0.0186 vs 1.0,P ＞0.05; mRNA:0.85 ±0.1437 vs 1.0,P ＞0.05).Conclusions The expression of tight junction protein claudin-1 was reduced at both protein and mRNA levels in intestinal epithelial cells that were induced by TNF-α in mice model of FHF.

Objective To construct MUC1-VNTR DNA vaccine pancreatic cancer. Methods The recombinant gene of VNTR was synthesized and cloned into MCS in the pcDNA3. 1/Myc-his ( + ) A vector. pcDNA3. 1-VNTR/Myc-his( + ) A was injected twice into C57BL/6( H-2b)female mice (V group, n = 15). Mice inoculated with either the empty plasmid vector ( D group, n = 15 ) or 0. 9% NaCl ( NS group, n, = 15) were used as control. Two weeks later, both humoral and cellular immunity of the mice were studied. Results The recombinant plasmid pcDNA3. 1 -VNTR/Myc-his ( + ) A encoded the whole exact translation frame region of the pcDNA3. 1/Myc-his ( + ) A vector and the recombinant gene of human VNTR. The transfected COS7 cells expressed transgene products at 48 hours after transfection. Intramuscular delivery of the recombinant plasmid into C57BL/6 mice resulted in more efficient induction of CTL lysis specific against VNTR polypeptide than the D group and the NS group (P

Objective To report the clinical features,management and prognosis of local recurrence with inferior vena cava tumor thrombus for renal cell carcinoma after laparoscopic partial nephrectomy.Methods A case of 37-year-old man was admitted to hospital for recurrent renal tumor in May 2013.The patient undervent laparoscopic partial nephrectomy for right kidney mass in June 2011,and renal cell carcinoma was diagnosed by pathological examination.The patient complained about pain of right flank in May 2013.Imaging examination (including CT,MRI and PET-CT) showed a 5 cm tumor on the upper-middle right kidney associated with inferior vena cava tumor thrombus,bulky retroperitoneal lymph nodes and extensive local invasion including psoas,ureter,perirenal fascia.Surgical excision of local recurrence,nephrectomy plus inferior vena eava thrombectomy was performed.Results Right nephrectomy and local recurrence incision plus inferior vena eava thrombectomy was performed successfully.The operation time was 360 min,blood loss was 4 000 ml.The patient was discharged on the 14th day after surgery.The pathological characteristics were as follows:the tumor was limited to the upper-middle right kidney,psoas,ureter,and inferior vena cava tumor thrombus,but carcinoma was not found in the lymph nodes,pelvis and others.The final pathological diagnosis was papillary renal cell carcinoma,type Ⅱ.Local recurrence and other distant metastasis were not demonstrated with CT in 12 months' follow-up.Conclusion Excision of locally recurrent renal cell carcinoma is possible,and complete surgical resection could lead to prolonged disease-free survival.

Objective: To discuss the imagingcharacteristics of S₂AI screw trajectory in ADS patients. Methods: Forty patients with degenerative scoliosis were scanned with Simens Sliding 40-slice spiral CT scanner. Three-dimensional scanning and reconstruction were performed in these patients with the scanning range including thoracolumbar spine, lumbar spine, lumbosacral region, pelvis and bilateral hip joints. The base of the lateral sacral crest on the midline between the lower edge of S₁ dorsal foramina and the upper edge of S₂ dorsal foramina was the starting point. The placement plane of S2AI screw trajectory was determined from the starting point to the lower margin of anterior inferior iliac spine. A 10mm diameter screw was the design template. A circle with a diameter of 5 mm as the center of the lowest point of the ilium inner cortex was made, and a tangent line from the starting point to the outer diameter of the circle (the inner part of the ilium) was selected as the axis of the screw trajectory. The lateral angle and the length of the axis of the screw trajectory and iliac width were measured in transverse plane. The caudal angle, the distance from the axis of the screw trajectory to iliosciatic notch, and the caudal angle, the distance from the axis of the screw trajectory to the upper edge of the acetabulum were measured in sagittal plane. These parameters were recorded and analyzed. Results: The trajectory length of S₂AI screw in ADS patients was 12.00±0.99 cm, the lateral angle was 41.24°±3.92°, the caudal angle was 27.73°±6.45°, and the distance from the axis of the screw trajectory to iliosciatic notch was 1.05±0.81 cm, the distance from the axis of the screw trajectory to the upper edge of the acetabulum was 1.85 ± 0.33 cm, and the iliac width was 2.12±1.65 cm. The trajectory length, lateral angle, caudal angle, distance from the axis of the screw trajectory to iliosciatic notch, distance from the axis of the screw trajectory to the upper edge of the acetabulum and iliac width of S2AI screw was respectively 12.40±0.83 cm, 39.47°±1.76°, 28.00°±6.39°, 1.08±0.32 cm, 1.76±0.34 cm, 2.26±0.25 cm in male patients, and was respectively 11.75±1.01 cm, 42.30°±4.48°, 27.56°±6.61°, 1.21±1.00 cm, 1.90±0.32 cm, 2.04±0.18 cm in female patients. The screw length and lateral angle had statistically difference between male and female patients(P<0.05). Compared with non-ADS patients in previous studies, female patients with ADS had significant differences in increased lateral angle and decreased caudal angle of S₂AI screw. Conclusion There is ideal trajectory of S₂AI screws in ADS patients. There was no significant difference of the length of S₂AI screws between ADS patients and non-ADS population. Different direction was noticed in the placement of S₂AI screws, especially in female patients. Increased lateral angle and decreased caudal angle would be obtained in the procedure of placing S₂AI screws in female ADS patients during operation.

Objective Based on social cognitive theory,to explore the main factors influencing the behavioral inten-tion of medical staff in merged medical community and the differences among county-township-village three levels medical staff.Methods The stratified random sampling was used to investigate the county-township-village three levels medical staff in merged county medical community,and multiple linear regression method and seemingly unrelated model(SUEST)were used to quantitatively analyze the influencing factors and differences among coun-ty-township-village three level medical staff's behavioral intention.Results The environmental factors including or-ganizational support(0.098),team integration(0.227),incentive mechanism(0.126)and individual factors including cognitive degree(0.118)and participation ability(0.053)can impact the behavioral intention of medical staff,and team integration has the greatest impact on the behavioral intention of medical staff at all levels.The incentive mecha-nism has more influence on the behavioral intention of medical staff at township(0.190)and county(0.165)level than village(0.083)level.Participation ability had more influence on the of village(0.187)level than township(0.129)and county(0.126)level.Cognition had a moderate effect,and organizational support had a smaller effect.Conclusion There are both similarities and differences in the influencing factors of medical staff's behavioral inten-tion,and targeted reforms should be carried out according to different characteristics.