Glutamine(Gln) is the most abundant free amino acid in the circulation. However, Gln depletion is obviously increased in critically ill patients. The liver plays a key role in glutamine metabolism since it can either generate or consume Gln. A number of studies have demonstrated that administration of Gln can protect from liver damage during sepsis or chemotherapy. The mechanism may be that glutamine can be more efficiently transported across cell membranes for glutathione synthesis. Supplement of Gln to PN has been proven to maintain intestinal integrity and reduce bacterial translocation. As a gluconeogenic amino acid, Gln can decrease the portal insulin/glucagon ratio and prevent hepatic steatosis through stimulating glucagon secretion.

ObjectiveTo study the diagnosis and trea tm ent of bilateral renal angiomyolipomas.MethodsThe clin ic data of 13 cases of bilateral renal angiomyolipoms were reviewed.There were 2 male and 11 female patients with an average age of 42.Preoperative ultrasonogra phy and CT scanning have been undertaken in all.Renal angiomyolipoma was diagnos ed in 11 and cancer nodules could not be ruled out in the other 2.Unilateral and bilateral renal sparing surgerys were carried out in 5 and 8 cases respectively .ResultsAll cases were examined with rapid frozen sect ion analysis at operations.The renal function of all the patients except 1 was n ormal after operation except 1 with a temporary rise in Scr (350 ?mol/L).The pa tients have been followed up 1 to 4 years after discharging from hospital and th e renal function became normal in all.No recurrence was found.Conc lusionsUltrasonography and CT are important methods to diagnose ang iomyolipoma with specific manifestations.Rapid frozen section analysis at operat ions is helpful to diagnose and to choose the correct surgical technique.Attenti on should be paid to reserve the renal tissues as much as possible and renal fun ction should be protected properly.

Objective To investigate the salty, efficacy and feasiblify on eholedochotomy with endobiliary drainage and prumary closure of the common bile duct. Methods There were 20 partients without introhepatic or re-tained stones and biliary stricture underwent common bile duet exploration. 20 of them with endobiliary tube drainage and primary CBD closure and the other 20 patients with T tube drainage. Results The average of the time to return routine home was (9. 2 ±1. 3)d, (15. 2 ± 3.6) d(P < 0. 01). The hospital expense of postoperation was (3 252± 312)Yuan,(4 116±388)Yuan(P<0.01). Conclusion Choledochotomy with endobiliary catheter and primary closure of CBD is a safe, effective and feasible procedure for the management of choledochohthiasis.

Guided by aim of improving the survival rate of the injuries, damage control surgery (DCS) have undergone developments from simple gauze packing to planned resuscitation and reoperation for nearly a century, which leads to a great improvement in the treatments. In recent years, the concept of DCS has been more and more widely accepted and applied in many fields other than abdominal trauma. Besides, the technologies have been constantly standardized and the procedures have been more scientific. At the same time, some remarkable progress has been made in the research of DCS, such as new concepts of damage control resuscitation, permissive hypotension, and new technologies such as resuscitative balloon aortic occlusion and hybrid emergency surgery system.

Objective To assess the efficacy of mycophenolate mofetil (MMF) combined with low dose of hormone and lamivudine in the treatment of hepatitis B virus associated glomerulonephritis (HBV-GN).Methods The clinical data of 49 HBV-GN patients diagnosed by renal pathology was reviewed.They were treated with MMF( ≥ 12 years old,0.75 g,two times a day; ＜ 12 years old,0.4 g/m2,two times a day),low dose of hormone [0.5 mg/(kg·d) ],lamivudine( ≥ 12 years old,100 mg/d; ＜ 12 years old,3 mg/kg,two times a day).Results Among of 49 HBV-GN patients,clinical cure rate was 71.4％(35/49),the total effective rate was 81.6％(40/49),85.7％(42/49) patients' HBV DNA level decreased from 5.43 ×104 copies/ml to ＜ 1000 copies/ml.The complete remission rate was 88.0％ (22/25),the partial remission rate was 8.0％ (2/25),the inefficiency was 4.0％ (1/25) in membranous nephropathy (MN);the complete remission rate was 44.4％ (4/9),the inefficiency was 55.6％ (5/9) in mesangial proliferative glomerulone phritis (MsPGN) ; the complete remission rate was 70.0％(7/10); the partial remission rate was 30.0％(3/10)in membrane proliferative glomerulone phritis (MPGN) ;the complete remission rate was 40.0％ (2/5),the inefficiency was 60.0％(3/5) in focal segmental glomerulosclerosts (FSGS).There was significant difference among the different pathological type (P＜0.05).There were less adverse reactions.Conclusions MMF combined with low dose hormone and lamivudine is safe and effective in treating HBV-GN.The efficacy and pathological type has some relationship,MN has the best response,MPGN and MsPGN are second,FSGS is poor.

Objective To investigate the effect of recombinant human growth hormone on the PingPang Racket flap survival.Methods Every two PingPang Racket flaps were designed on the both sides of 40 adult SD rats's back.The pedicle size was 1.0 cm × 1.0 cm,while the flap size was 3.0 cm in diameter circular.Longitudinal axis of flap was perpendicular to the center line of the rats back,to which the distance from proximal pedicle was about 1 cm.The flaps on the left side served as Ⅰ group,and the other side served as Ⅱ group,which were subdivided into Ⅰa and Ⅰb,Ⅱa and Ⅱb,respectively.And there were 20 rats in each subgroup.On the flap surfaces in group Ⅰ,it was 6 uniform injection poinsts,subcutaneously injecting with rhGF (the dose was 0.1IU · Kg-1 · d-1) for 7 days from the beginning of operation,that were designed.It goes the same way to the group Ⅱ,while normal saline was instead of rhGF.In subgroup Ⅰa and Ⅱa,the flaps were generally observed every day.The percentage of the flap survival area was determinated 7 days after operation.In subgroup Ⅰb and Ⅱb,specimens were collected at the distal end of flap at intraoperative(before injecting rhGF)and 1 st,3rd,5th,7th day after operation.Immunohistochemistry and enzyme-linked immunosorbent were applied to examine the expression of TGF-β1 and CD34,and the microvessel density of the flaps was calculated.Results According to the 7 days' observation after the surgery,the flap survival area percentage of subgroup Ⅰa was (97.00 + 2.12) ％,which was significantly higher (P ＜ 0.05) than that of subgroup Ⅱ a,whose was (81.00 +3.43)％.On 1st,3rd,5th and 7th day postoperatively,the expression of TGF-β1,CD34 in both subgroup Ⅰb and Ⅱb were elevated and reached peak on the 5th day.Content of GF-β1 and CD34 in Ⅰb were 1571.40 ± 13.32 pg/ml and 60.40 ±0.32 pg/ml,respectively,and in Ⅱb were 691.43 ± 11.06 pg/ml and 20.43 ± 0.06 pg/ml.At the same point of time,the expression of TGF-β1,CD34 were significant higher in Ⅰb subgroup than that in Ⅱb (P ＜ 0.05).In subgroup Ⅰb and Ⅱb,the number of microvessels increased on postoperative 1 st,3rd,5th and 7th day,especially on 3rd,5th and tended to be stable at 7th day.At the same point of time,the number of microvessels in Ⅰb was always higher than that in Ⅱb (P ＜ 0.05).Conclusion Subcutaneous injection of rhGH on flaps can enhance the expression of TGF-β1,CD34,promote microvascular generation of the flap tissue directly or indirectly,and also improve the survival of PingPang Racket flaps.

Objective: To investigate the effects of NO on cholestasis caused by TPN. Methods: 24 newborn rabbits were divided into 3 groups: control group, TPN for 1week group and TPN for 2weeks group. After 7 or 14 days, serum liver function test was determined using automatic biochemical analyzer, NO levels in serum and liver, liver NOS activity and iNOSmRNA expression were determined respectively by the Griess method, spectrophotometric analysis and in situ hybridization. Results: After having received TPN administration for 7 or 14 days, the NO levels of serum and liver, liver NOS activity and iNOSmRNA expression increased significantly than those in control group(P

Objective To study the therapeutic effect of the hip surface replacement on osteoarthrithis of hip.Methods The clinical data of 5 cases with osteoarthrithis of hip treated by hip surface replacement were retrospectively reviewed.Results Patients were followed up for an average period of 2.1 years(6～28 months).There were no femoral neck fracture,no dislocation,no infection in all patients.The average Harris score was 85.4(48.3 scores before surgery).Postoperatively quality of life improved obviously.Conclusion The therapeutic effect on osteoarthrithis of hip treated by the hip surface replacement is satisfactory,and the quality of patient's life can be improved,espcially for the youth.

Objective: To construct eukaryotic expression vector of tumor-associated gene SNC90 and transfect it into human colorectal cancer cell lines. Methods: A 1.5 kb tumor-associate gene SNC90 full length cDNA was inserted into a mammalian expression vector pREP9 to make recombinant vector pREP9-SNC90, which was then introduced into three kinds of colorectal cancer cell lines, SW1116, COL0205 and SW620, by lipofection or electroporation. The cells resistant to G418 drug were selected. Results: Cells transfected with pREP9-SNC90 showed fewer G418-resistant colonies than those transfected with void vector, the inhibitory rates are 72.2%, 74.2% and 59.7%, respectively. Conclusion : SNC90 may play a negative role in regulating growth of colorectal cancer cell.

Objective To investigate the relations of the expression of bcl-xL in superficial bladder tumor and prognosis. Method The expression of bcl-xL was detected by envision system in 80 cases of superficial bladder tumor. Results In patients with high expression of bcl-xL, the recurrence rate was higher than that of normal expression [71.4%(30/42) vs 50.0%(19/38) ,P < 0.05], and the recurrence of time as early as normal expression [(16.0 ± 1.2) months vs (36.0 ± 4.5) months](P < 0.05). Conclusion The expression of bcl-xL could effectively predict the prognosis of patients with bladder tumor, those who with high expression of-bcl-xL have bad prognosis.