The cytokines have close relationship with the rejection and infection in organ transplantation.The cytokine gene polymorphism influences the secretion of cytokines.The relationship between the rejection and infection in organ transplantation and some cytokines gene polymorphism is reviewed in this article.

OBJECTIVETo analyze the influence of pancreatic fistula in middle segmental pancreatic resection and summarize the experience in dealing with the stump.

METHODSThe data of 40 cases undergoing middle pancreatectomy were reviewed retrospectively to analyze the curative effect and pancreatic fistula between April 2003 and December 2009. Of these, 36 patients with benign cases outcomes were compared with 2 separate control groups, 44 pancreaticoduodenectomy (PD) and 26 extended distal pancreatectomy (EDP).

RESULTSThe mean operating time of group MSP was 222 min, which was significantly shorter than that of group PD. The mean blood loss of group MSP was 316 ml, which was less than that of others. Otherwise, the postoperative nutritional status and blood sugar control in group MSP was superior to the other 2 groups. Through long-term follow-up, the patients in group MSP retained endocrine and exocrine function better. Only 1 patient developed new-onset diabetes mellitus after operation, and no patient required enzyme substitution. No lesion recurred. The rate of pancreatic fistula was highest (42%), but didn't result in the significant deference of overall discharge time with group PD and EDP. The pancreatic fistula level and the mean postoperative time in hospital didn't differ significantly from the other 2 groups.

CONCLUSIONSMiddle segmental pancreatectomy is a safe and feasible technique that is indicated for selected patients with benign or low malignant lesion in the neck and body of the pancreas. Though the rate of pancreatic fistula is higher, the risk of which is reduced by the marked curative effect. It is very important to deal with the stump reasonably.

Adult ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pancreatectomy ; adverse effects ; methods ; Pancreatic Fistula ; etiology ; prevention & control ; Pancreatic Neoplasms ; surgery ; Postoperative Complications ; etiology ; prevention & control ; Retrospective Studies ; Treatment Outcome

BACKGROUNDThe optimal surgical management of nonfunctional pancreatic neuroendocrine tumors (NF-PNETs) is still controversial. Here, we evaluated the impact of lymph node status on postoperative recurrence in patients with NF-PNET and the potential of preoperative variables for predicting lymph node metastasis (LNM).

METHODSIn this mono-institutional retrospective cohort study conducted in 100 consecutive patients who underwent NF-PNET resection between January 2004 and December 2014, we evaluated risk factors for survival using the Kaplan-Meier method and the Cox regression model. Predictors of LNM were evaluated using the logistic regression model, and the power of predictive models was evaluated using receiver operating characteristic curve analysis.

RESULTSFive-year disease-free survival of resected NF-PNET was 64.1%. LNM was independently associated with postoperative recurrence (hazard ratio = 3.995, P = 0.003). Multivariate analysis revealed tumor grade as an independent factor associated with LNM (G2 vs. G1: odds ratio [OR] =6.287, P = 0.008; G3 vs. G1: OR = 12.407, P = 0.001). When tumor grade was excluded, radiological tumor diameter >2.5 cm (OR = 5.430, P = 0.013) and presence of symptoms (OR = 3.366, P = 0.039) were significantly associated with LNM. Compared to neoplasms with radiological diameter >2.5 cm (32.1%), tumors ≤2.5 cm had an obviously lower risk of LNM (7.7%), indicating the reliability of this parameter in predicting LNM (area under the curve, 0.693). Incidentally discovered NF-PNETs ≤2.5 cm were associated with a low-risk of LNM and excellent survival.

CONCLUSIONSLNM is significantly associated with postoperative recurrence. Radiological tumor diameter is a reliable predictor of LNM in NF-PNETs. Our results indicate that lymphadenectomy in small (≤2.5 cm) NF-PNETs is not routinely necessary.

Disease-Free Survival ; Female ; Humans ; Kaplan-Meier Estimate ; Logistic Models ; Lymph Node Excision ; Lymphatic Metastasis ; pathology ; Male ; Middle Aged ; Multivariate Analysis ; Pancreatic Neoplasms ; complications ; pathology ; surgery ; Proportional Hazards Models ; Retrospective Studies

A 9-year-old boy was admitted to Xiangya Hospital due to pain after trauma in the left lower limb for 5 days and fever with generalized pain for 2 days. The results of X-ray of the left lower limb were normal. Pulmonary computed tomography (CT) showed multiple pulmonary nodules in both lungs. Adrenal CT showed marked enlargement of the left adrenal gland. The patient also experienced generalized herpes and intermittent delirium and had a blood pressure up to 155/93 mm Hg. He was transferred to our hospital with a suspected diagnosis of pheochromocytoma. On admission, the patient had a blood pressure of 86/44 mm Hg, sporadic maculopapule and herpes, touch-evoked pain, exposure of superficial veins, white pus coating on the right side of the tongue, and tension in the abdominal muscle. No skin damage was observed in the left lower limb, and the patient was forced to be in the extending position and experienced significant swelling below the knees. Laboratory examination showed a reduction in platelet count, hypoproteinemia, a significant increase in creatase, a C-reactive protein level of 348 mg/L, and a procalcitonin level of >100 ng/mL. Thoracoabdominal and pelvic CT showed multiple patchy and nodular lesions in both lungs, which had an undetermined nature, as well as an enlarged spleen. The tests of puncture fluid from the left knee joint and the periosteum of the left tibia, blood culture, and bone marrow culture all showed methicillin-resistant Staphylococcus aureus. The patient was given anti-shock treatment, anti-infective therapy with vancomycin, debridement and continuous irrigation/drainage of osteomyelitis lesions in the left tibia, but the patient still experienced recurrent shivering and severe fever and increased subcutaneous and pulmonary nodules. Linezolid was added on day 8 after admission, and the patient's body temperature returned to normal on day 24 after admission. Subcutaneous and pulmonary nodules were gradually reduced and disappeared. The patient was treated for 2 months and then evaluated as cured.
Child ; Fever ; etiology ; Humans ; Male ; Methicillin-Resistant Staphylococcus aureus ; Multiple Pulmonary Nodules ; etiology ; Pain ; etiology ; Staphylococcal Infections ; complications ; drug therapy ; Tomography, X-Ray Computed

OBJECTIVETo investigate the effects of glutamine enriched enteral feeding on immunoregulation in burn patients.

METHODSTwenty burn patients were randomly divided into enteral nutrition (EN) group and enteral immune nutrition (EIN) group, with 12 patients in each group. Patients in EN group received a standard enteral formula, while those in EIN group received an enteral formula enriched with glutamine after hospital admission. Nutritional support was continued for 10 days. Blood samples were obtained to determine plasma level of total protein (TP), albumin (ALB), prealbumin (PAB) and transferrin (TF) at 1, 4, 7, 10 post-burn days (PBD). At the same time the concentration of immunoglobulin (IgA, IgG and IgM) were determined, the percentage of CD3+, CD4+, CD8+ subpopulations of T lymphocytes, and the ratio of CD4+/CD8+ were determined by FCM.

RESULTS(1) There were no obvious difference of the plasma level of TP, ALB, TF, CD3+, IgM between the two groups at each time-point (P > 0.05). (2) The plasma PAB contents in EIN group were significant higher than that in EN group on 4 PBD [(90 +/- 14 vs 60 +/- 15) mg/L, P < 0.05], 7 PBD [(92 +/- 16 vs 64 +/- 13) mg/L, P < 0.05] and 10 PBD [(106 +/- 21 vs 72 +/-16) mg/L, P < 0.05]. (3) The percentage of CD4+ subpopulation and ratio of CD4+/CD8+ in EIN group were obviously higher than those in EN group on 7 PBD [CD4+ (55 +/- 5 vs 45 +/- 5)%, CD4+/CD8+ (1.92 +/- 0.31 vs 1.53 +/- 0.27)%, P < 0.05] and 10 PBD [CD4+ (56 +/- 5 vs 49 +/- 5)%, CD4+/CD8+ (2.36 +/- 0.36 vs 1.72 +/- 0.42), P < 0.05]. (4) The concentration of IgA and IgG in EIN group were markedly higher than that in EN group on 7 PBD [IgA (2.8 +/- 0.6 vs 2.2 +/- 0.5) g/L, IgG (12.1 +/- 1.3 vs 9.8 +/- 1.2) g/L, P < 0.05] and 10 PBD [IgA (3.1 +/- 0.6 vs 2.5 +/- 0.5) g/L, IgG (14.2 +/- 1.3 vs 10.4 +/- 1.3) g/L, P < 0.05].

CONCLUSIONThese findings suggest that glutamine enriched enteral feeding can improve nutritional status by promoting the synthesis of IgA, IgG, and increasing the PAB concentration, and corrected immunologic dysfunction in burn patients.

Adolescent ; Adult ; Burns ; blood ; immunology ; therapy ; Enteral Nutrition ; Female ; Glutamine ; therapeutic use ; Humans ; Immunoglobulin A ; biosynthesis ; Immunoglobulin G ; biosynthesis ; Male ; Middle Aged ; Prealbumin ; metabolism ; T-Lymphocyte Subsets ; immunology ; Young Adult

Objective To observe the effects of enhanced exercise and combined vitamin D and calcium supplementation on muscular strength and fracture occurrence in postmenopausal women with a high risk of osteoporosis.Methods Totally 614 postmenopausal women at high risk factors of osteoporosis were enrolled in Dongcheng district of Beijing and randomized into four groups:group A(control group,n=173),group B(regular Tai Chi exercise,n=171),group C(calcium 600 mg/d+VitD800 U/d,n=139),and group D[calcium 600 mg/d+25 hydroxyl vitamin D(25OHD) 0.25 μg/d,n=131].Muscular strength was measured at baseline and one and two years after intervention.Bone turnover markers were measured at baseline and during the two-year follow-up.Falls and fractures were recorded.Results The incidence of 25OHD<50 nmol/L was approximately 92.6%.During the follow-up,the left grip strength decreased significantly two years after intervention(t=-3.252,P=0.001)in group A.Right grip strength decreased significantly in group B(t=2.460,P=0.015)while left grip strength improved significantly in group C(t=-2.051,P=0.043)one year after intervention.In group D,muscular strength in both 12-month and 24-month did not change compared with baseline(both P>0.05).Furthermore,serum procollagen type I N-terminal propeptide elevated significantly in group A(t=-2.962,P=0.004),group B(t=-2.888,P=0.005),and group C(t=-2.441,P=0.016),whereas β-C-terminal telopeptide of type I collagen decreased significantly in group B(t=2.285,P=0.024)and group D(t=2.596,P=0.011)two years after intervention.Conclusion Enhanced exercise and combined calcium vitamin D supplementation may help sustain muscle strength in postmenopausal women,while calcium and vitamin D supplementation may improve muscular strength within a short period of time.

Objective To explore the potential risk factors to Ymman endemic sudden cardiac death (YESCD) and provide evidence for prevention. Methods Twenty-two cases and 24 controls were randomly selected from YESCD areas and non-YESCD areas, respectively. Both cases and controls were interviewed with unified questionnaires. Univatiate X2 test and multivariate conditional logistic stepwise regression was conducted with SPSS 13.0. The optimal regression model was established and evaluated. Results The univariate X2 teat revealed that presence or absence of 5 potential factors might possibly be associated to YESCD: appropriate places for storing dining utensils, pens for livestock, consumption of mushrooms, exposure to any pesticides, and sudden climate changes before onset(X2=12.206,4.779,5.741,6.120,10.754, P<0.05). Multivariate conditional logistic stepwise regression demonstrated that consumption of mushrooms was a protective factor(OR=0.115, P<0.05) and sudden climate change was a risk factor(OR=36.592, P<0.01). Conclusions Sudden climate change might be a risk factor contributing to YESCD, and eating mushrooms before the prevalence seasons may provide some protection.

Objective To explore the iodine level in the environment and the iodine status among the general population as well as the prevalence of thyroid nodules in Hangzhou city.Relationship between the prevalence of thyroid nodules and the policy of universal salt iodization in Hangzhou was also analyzed.Methods Questionnaire,a 3- day weighed dietary record method,and 3 days' 24- hour dietary recall method were used to understand the iodine nutrition status and dietary intake of iodine among the general population in the city.Drinking water,edible salt and morning urine were collected to determine iodine content.All objects under survey underwent the thyroid B ultrasonic examination.Statistical analysis was done by SPSS 13.0 and SAS 9.1.Results (1)In total,12 620 effective questionnaires were available,with 221 water samples,12 730 urine samples,and 3593 salt samples collected.12 515 objects underwent B ultrasonic examination,and 1848received dietary investigation.(2)Water iodine level of Hangzhou was in the range of 0.20-5.99 μg/L,with the median level as 2.58 μg/L.(3) Average daily dietary intake of iodine for adult males in Hangzhou was 289.2 lμg/d.The contribution of iodine intake from iodized salt was 74.4％.(4) The median of Hangzhou residents' urinary iodine was 178.80 μg/L,with the urinary iodine levels at 100 μg/L-,200 μg/L-,＜100 μg/L,and ≥300 μg/L groups were 37.14％,23.11％,21.05％,and 18.69％ respectively.Urinary iodine of pregnant women was 141.0 tg/L.(5) Incidence of thyroid nodules in females(28.6％ ) was higher than that of males(20.1％ ).The detection rate increased with age (6.4％ at group 6-,10.9％ at 12-,12.0％ at 18-,24.4％ at 40-,and 38.8％ at 65-) ; with the highest in urban area (29.8％),followed by suburbs (23.3％) and in rural area it showed the least (20.3％).Urinary iodine level was found lower among the population who had been detected with thyroid nodules (160.36 μ g/L) than those among the undetected population (182.00 μg/L).Conclusion Hangzhou appeared to be an area where the environmental was iodine deficient.Iodized salt was the major source of iodine intake.The iodine status among the general population seemed to be safe and suitable,but the iodine level for pregnant women was not sufficient.There was still no evidence indicating that the universal salt iodization policy in Hangzhou was associated with the prevalence of thyroid nodules.

Objective To understand the acceptability and relevant impact factors of provider initiated testing counseling (abbreviated as PITC) in Liangshan Yi autonomous prefecture,so as to promote strategies for the sustainable development of PITC in AIDS epidemic areas.Methods Four medical institutions were selected with rates of acceptance counted.Multi-factors logistic regression was used to analyze the impact factors from the completed questionnaires.Results Among the 413respondents,197 patients accepted the PITC,with an acceptance rate as 47.7％ (95％ CI:42.9％-52.3％).Factors as being female (OR=7.283,95％CI:3.933-13.465),acceptance of publicity (OR=1.855,95％ CI:1.013-3.395),worried about being infected of HIV/AIDS (OR=2.699,95％ CI:1.616-4.506) etc.were protect factors of PITC,while those who previously received HIV testing (OR=0.226,95％CI:0.124-0.409),afraid of taking blood test (OR=0.052,95％CI:0.024-0.106),knowing more AIDS related knowledge (OR=0.446,95％ CI:0.258-0.773) would significantly reduce the rate of acceptance.Conclusion Nearly half of the outpatients from medical institutions were willing to accept PITC in Liangshan Yi prefecture,thus provided important chance for HIV screening.Ways as strengthening related counseling before and after HIV test,launching effective HIV/AIDS-related publicity and advocating correct knowledge on blood testing,etc.need to be promoted,in order to improve the acceptability of PITC.

OBJECTIVETo investigate the expression of perforin and granzyme B in rejection response following liver transplantation, and evaluate their roles to be used as predictive markers of rejection.

METHODSThe expression of perforin and granzyme B in liver biopsies obtained from liver allograft recipients was determined by immunohistochemistry. Biopsies were classified into two groups-no evidence of rejection and rejection-according to Histopathologic criteria. The relationship between the perforin/granzume B expression and acute rejection was analyzed.

RESULTSFrom 19 patients, thirty-five liver biopsies were obtained after liver transplantation. Among them, nineteen samples were diagnosed as rejection response. The frequencies of perforin and granzyme B expression in rejection group were 100% (19/19) and 94.7% (18/19), respectively. While those in no rejection group were 25.0% (4/16) and 12.5 (2/16), respectively. In most rejected samples, perforin and granzyme B were expressed simultaneously. Only three samples showed perforin expression alone, while no samples demonstrated granzyme B expression alone. There was a close relationship between perforin/granzyme B expression and liver allograft rejection.

CONCLUSIONPerforin and granzyme B expression seemed to be related to the development of acute rejection following liver transplantation, and might be served as sensitive and reliable markers in diagnosing acute rejection in early stage.

Adult ; Biomarkers ; Female ; Graft Rejection ; diagnosis ; metabolism ; Granzymes ; Humans ; Liver Cirrhosis ; surgery ; Liver Neoplasms ; surgery ; Liver Transplantation ; immunology ; Male ; Membrane Glycoproteins ; biosynthesis ; genetics ; Middle Aged ; Perforin ; Pore Forming Cytotoxic Proteins ; Serine Endopeptidases ; biosynthesis ; genetics ; T-Lymphocytes, Cytotoxic ; enzymology