Objective To observe the effect of diabetes on the activation of kinin-system and the role of the system in development of diabetic nephropathy. Methods The TKA activation was measured and the function of kinin-system was changed by the antagonist of bradykinin B2 receptor-HOE 140 and kallikrein. Results The activation of TKA decreased sharply at 18 week in diabetic acts and was much lower than the levels of TKA at & week or in control rats (P

AIM　To observe the preventive action of leflunomide (Lef) on CCl4-induced liver fibrosis and explore its mechanism. METHODS Model of liver fibrosis in mice was induced by subcutaneous injection of CCl4(20%). The levels of ALT、AST、NO in plasma and Hyp in liver tissue were determined by spectroscopy. The content of HA in plasma was determined by radioimmunoassay. RESULTS Pretreatment of Lef (4,12,36 mg·kg-1) significantly reduced the elevated levels of ALT、AST、NO in plasma and Hyp in liver tissue, Pathological examination suggested Lef has preventive action on experimental liver fibrosis with significance. CONCLUSION Lef has significantly preventive action on CCl4-induced liver fibrosis possibly mediated by reduction of NO.

AIM To observe the preventive action of leflunomide (Lef) on CCl4-induced liver fibrosis and explore its mechanism. METHODS Model of liver fibrosis in mice was induced by subcutaneous injection of CCl4(20% ). The levels of ALT\AST.NO in plasma and Hyp in liver tissue were determined by spectroscopy. The content of HA in plasma was determined by radioimmunoassay. RESULTS Pretreatment of Lef (4, 12, 36 mg. kg- 1 ) significantly reduced the elevated levels of ALT.AST.NO in plas- ma and Hyp in liver tissue, Pathological examination suggested Lef has preventive action on experimental liver fibrosis with significance. CONCLUSION Lef has significantly preventive action on CCl4-induced liver fibrosis possibly mediated by reduction of NO.

The right hepatic artery (RHA) is the terminal artery supplying the right hepatic lobe. There are many anatomic variations of RHA, including low RHA and left hepatic artery bifurcation, aberrant course, tortuosity, abnormal branches of cystic artery and origin variation. The origin variation of RHA is divided into replaced RHA and accessory RHA. The replaced artery origins include superior mesenteric artery, celiac trunk, aorta, common hepatic artery, gastroduodenal artery, left gastric artery, splenic artery and right renal artery. The variations of RHA are important causes of intraoperative adverse events and postoperative complications in hepatobiliary-pancreatic-splenic surgery. It is an important guarantee for the safety of operation to know and master these RHA variations well before operation, to separate it carefully and to protect it properly during operation.

Early postoperative hemorrhage (EPOH) is a common complication of pancreaticoduodenectomy (PD) and a main cause of death. The cause of EPOH is related to inappropriate vascular treatment during the operation, which may be recognized as a technical failure and avoided theoretically. PD is characterized by varieties of tissues that need to be separated and resected, large wound surface, many operations such as vascular separation, dissection, resection and reconstruction, and complex anastomoses. Therefore, the causes of EPOH are complex and varied. The most effective measure to prevent EPOH is to handle the vessels carefully and properly during the operation. In this paper, we systematically summarized the blood vessels involved in PD procedure, and the treatment strategies of these potential bleeding sites, and the clinical thinking and treatment principles of EPOH, so as to improve the quality of vascular treatment in PD procedure and to prevent EPOH.

Objective:To Investigate the application strategy and effect of cuffed tracheostomy tube with inner cannula in the treatment of postoperative complications of laryngeal and hypopharyngeal cancer.Methods:A total of 60 patients with laryngeal and hypopharyngeal cancer occurred serious postoperative complications, including 31 cases of severe postoperative neck infection, 8 cases of dyspnea, 5 cases of massive hemorrhage and 16 cases of seriously intractable aspiration. The tracheal cannula with inner cannula and outer cuff was immediately worn on these patients and the cuff was inflated. Different treatments were carried out according to different complications. The outer cuffs were inflated for patients with severe neck infections to prevent a large amount of neck secretions inhaled to the trachea. Patients with dyspnea immediately received ventilator-assisted ventilation. For those with massive hemorrhage on the wound, doctors should prevent bleeding and stop bleeding under general anesthesia. Patients with severely coughing should perform eating training to prevent food aspiration. The inner cannula was regularly replaced once a month for all of these patients.Results:Through targeted treatment, the complications of 60 patients with cuffed tracheostomy tube with inner cannula were effectively controlled. After dressing change, the neck wounds of 31 patients with neck infection were shrunk or healed. Finally, all of the patients were replaced with metal tracheal tubes. Eight cases with dyspnea were rescued with the symptomatic and related special treatment, and finally replace by metal tracheal tube. Five cases with massive bleeding in the neck wound were successfully rescued and replaced with metal tracheal cannula. Thirteen patients among 16 cases with intractable aspiration were removed the tracheal cannula and other 3 cases of old and severely ill were replaced with metal tracheal cannula.Conclusions:The cuffed tracheostomy tube with inner cannula is of great value in the treatment of severe postoperative complications of laryngeal or hypopharyngeal cancer. It is strongly recommended that the operators should fully understand and use it reasonably after the operation of laryngeal or hypopharyngeal cancer.

Objective:To investigate the significance of MLH1 protein expression and MLH1 gene methylation rate between metastatic solid pseudopapillary tumor of pancreas (SPT) and non-metastatic SPT, and to explore the correlation between MLH1 gene methylation and SPT metastasis.Methods:Twelve metastatic SPT patients admitted to Peking University People's Hospital, Rizhao Central Hospital and Chaoyang Central Hospital of Liaoning Province from January 2009 to May 2022 were studied retrospectively, including 3 males and 9 females, with a median age of 47 years old, ranging from 21 to 73 years old. Thirty non-metastatic SPT patients with clear diagnosis, clear medical history and complete follow-up data from pathological database of Peking University People's Hospital from January 2009 to May 2017 were selected as the control group, including 12 males and 18 females, with a median age of 42 years old, ranging from 34 to 69 years old. Clinical data such as gender, age and pathological data were collected. Immunohistochemical expression of MLH1 protein and methylation of MLH1 gene were detected by pathological paraffins.Results:There was no significant difference in general data between the two groups (all P>0.05). Among the 12 metastatic SPT patients, 4 cases metastasized to liver, 2 to spleen, 2 to lung, 2 to lymph nodes, 1 to mediastinum, and 1 to sacrum. Compared with the non-metastatic tissue, the MLH1 protein deletion in metastatic pancreatic lesions (metastatic SPT-P) and metastatic lesions (metastatic SPT-M) were increased [both 33.3%(4/12)], and the difference was statistically significant (both Chi square=5.00, both P=0.041). Compared with 0 (0/30) MLH1 gene methylation rate in non-metastatic SPT tissues, the methylation rate of MLH1 gene in metastatic SPT-M and metastatic SPT-P tissues [both 30% (3/10)] were higher, with statistical significance (both Chi square=0.96, both P=0.032). Conclusion:Compared with non-metastatic SPT, the loss rate of MLH1 protein expression and MLH1 gene methylation are increased in metastatic SPT. MLH1 methylation may occur before metastasis, which can be used as a predictor of SPT metastasis.

Objective:To Investigate the application strategy and effect of cuffed tracheostomy tube with inner cannula in the treatment of postoperative complications of laryngeal and hypopharyngeal cancer.Methods:A total of 60 patients with laryngeal and hypopharyngeal cancer occurred serious postoperative complications, including 31 cases of severe postoperative neck infection, 8 cases of dyspnea, 5 cases of massive hemorrhage and 16 cases of seriously intractable aspiration. The tracheal cannula with inner cannula and outer cuff was immediately worn on these patients and the cuff was inflated. Different treatments were carried out according to different complications. The outer cuffs were inflated for patients with severe neck infections to prevent a large amount of neck secretions inhaled to the trachea. Patients with dyspnea immediately received ventilator-assisted ventilation. For those with massive hemorrhage on the wound, doctors should prevent bleeding and stop bleeding under general anesthesia. Patients with severely coughing should perform eating training to prevent food aspiration. The inner cannula was regularly replaced once a month for all of these patients.Results:Through targeted treatment, the complications of 60 patients with cuffed tracheostomy tube with inner cannula were effectively controlled. After dressing change, the neck wounds of 31 patients with neck infection were shrunk or healed. Finally, all of the patients were replaced with metal tracheal tubes. Eight cases with dyspnea were rescued with the symptomatic and related special treatment, and finally replace by metal tracheal tube. Five cases with massive bleeding in the neck wound were successfully rescued and replaced with metal tracheal cannula. Thirteen patients among 16 cases with intractable aspiration were removed the tracheal cannula and other 3 cases of old and severely ill were replaced with metal tracheal cannula.Conclusions:The cuffed tracheostomy tube with inner cannula is of great value in the treatment of severe postoperative complications of laryngeal or hypopharyngeal cancer. It is strongly recommended that the operators should fully understand and use it reasonably after the operation of laryngeal or hypopharyngeal cancer.

Objective:To explore the influencing factors of long-term survival for hepatocellular carcinoma (HCC) treated by radiofrequency ablation (RFA).Methods:A retrospective analysis of 255 patients who underwent RFA as the main treatment modality for HCC from May 1, 2004 to Feb 28, 2015 was performed. All patients were divided into two groups according to the postoperative survival time: the 5-year or more survival group and the less than 5-year survival group. Clinical indicators such as age, maximum tumor size and number, and frequency of radiofrequency ablation were compared between the two groups. Cox single factor and multiple factors were used to analyze the influencing factors of long-term survival.Results:The median overall survival of all the 255 patients was 4.3 years (range 0.5-15.5 years). There were 115 patients (45.1%) who survived for 5 years or more and 140 patients (54.9%) who survived for less than 5 years. The 1-, 3-, 5-, and 10-year survival rates of all the patients were 86.7%, 61.2%, 44.8% and 34.8%, respectively. There were no significant differences in gender, age, accompanying symptoms, aetiology of liver disease, level of alpha fetoprotein and treatment ( P>0.05), but there were significant differences in Child-Pugh class, liver cirrhosis, maximum diameter of tumor, tumor number, tumor stage, and frequency of RFA ( P<0.05) between the 2 groups of patients. Multivariate analysis showed that age ≥70 years old, Child-Pugh class B, maximum diameter of tumor >5.0 cm, multiple tumor were independent risk factors of long-term survival, but the number of sessions of RFA was a protective factor. Conclusions:For medium sized HCC and solitary large HCC, RFA combined with other therapeutic modalities could achieve satisfactory therapeutic results. Age, Child-Pugh class, maximum diameter of tumor, tumor number and RFA frequency were influencing factors for long-term survival of HCC patients.