Objective To analyze the clinical significance of aberrant hepatic artery which originated from superior mesenteric artery in liver cancer and gastric cancer operations.Method Four hundred liver cancer patients who underwent digital subtraction angiography (DSA) and multislice spiral computed tomography angiography (MSCTA) and 86 gastric cancer patients who underwent MSCTA between June 2008 and June 2010 and operated at the First Affiliated Hospital of Guangxi Medical University were included in this study.Preoperatively,the origins of the aberrant hepatic arteries from superior mesenteric arteries were detected by medical imaging.Postoperatively,immunohistochemistry of lymphoid tissues around the aberrant hepatic arteries of the gastric cancer patients were performed using recombinant human cytokeratin 20 (CK20) and carcino-embryonic antigen (CEA) to determine the incidence of lymph node metastases around the aberrant arteries.Results Among 486 patients,49 patients with liver cancer and 14 patients with gastric cancer had an aberrant hepatic artery which originated from the superior mesenteric artery.The rate was 12.96％ (63/486).The hepatic artery ran in front of the pancreas in 2 patients (3.17％) and behind the pancreas in 61 patients (96.83％).Immunohistochemical analyses of CK20 and CEA were negative which revealed no metastases in the lymphoid tissues surrounding the aberrant arteries.Conclusions Aberrant hepatic artery originated from the superior mesenteric artery can be classified into the pre-pancreas type and postpancreas type.The majority of aberrant hepatic artery belonged to the post-pancreas type.The clinical significance of aberrant hepatic artery is that the hepatic hilar lymph nodes should be dissected in liver cancer and gastric cancer operations.

Objective To compare the safety and effectiveness of duodenum-preserving pancreatic head resection (DPPHR) with pylorus-preserving pancreaticoduodenectomy (PPPD) in the treatment of chronic pancreatitis with a pancreatic head mass.Methods Medline,Biosis,Cochrane Library,Science Citation Index Database,CBM Database,Wan Fang and CNKI were searched systematically.The bias risk of the included trials was assessed according to the assessing tools as suggested by the Cochrane Handbook.Review Manage 5.2 was used to perform the statistical analysis.Results 7 RCTs with 226 patients were included in the meta-analysis which showed that there were no significant differences between PPPD and DPPHR in overall postoperative morbidity,postoperative hospital stay,complete pain relief,pancreatic fistula,exocrine insufficiency,symptom score at 5 to 7-year follow-up,and quality of life score at 14 to 15-year follow-up (P ＞ 0.05).While DPPHR had significant superiorities in operation time,blood replacement,delayed gastric emptying,occupational rehabilitation after the operations,weight gain,quality of life score at 1 to 2-year follow-up,symptom score at 5 to 7-year follow-up,and physical functioning score at 14 to 15-year follow-up.Conclusions DPPHR is more favourable than PPPD in reducing the use of blood replacement,shortening operation time,delayed gastric emptying,occupational rehabilitation after the operations,weight gain,physical functioning,and in improving quality of life of patients.

Objective To explore the diagnostic value of endoscopic retrograde cholangio-pancreatiography (ERCP),ultrasonography (US) and CT scanning on cholagio-pancreatic diseases caused by clonorchis sinensis infection.Methods The results of US,CF and ERCP examination in 65 cases of obstructive jaundice caused by clonorchiasis and confirmed by presence of imagoes or eggs in feces or bile juice were analyzed and compared retrospectively.Results US examination was the simplest and most convenient which was characterized by diffuse even dilatation,thickening of walls,strengthened echo with the shape of“equal sign”intrahepatic bile ducts.The characteristic findings of CT included saccular dilatation of bile ducts of the periphery of the liver,thickening of the walls of bile ducts.Under duodenoscopy,32.3% (21/65) of cases presented as abnormal papilla such as small opening,mucosa outward turned,trapping or stiffness.Alterations in ERCP were characterized by shm or oval filling defect,diffuse saccular dilatation of terminal intrahepatic bile ducts.The most common complications included cholangiolithiasis (40%,26/65),carcinoma of bile duct on papilla (9.8%,6/65),and pancreatitis (1.5%,1/ 65).Conclusions Three methods were all useful for diagnosis of cholangio-pancreatic diseases caused by clonorchis sinensis infection,which were identically characterized by diffuse saccular dilatation of terminal intrahepatic bile ducts.The gold standard of diagnosis was the presence of imagoes or eggs in bile juice aspirated by the route of ERCP.Endoscopic sphincterectomy with postoperative vermifugal was the first choice of the treatment.

ObjectiveTo study the dissecting necessity of lymph node around normal and abnormal hepatic artery in distal gastric cancer undergoing D2 lymphadenectomy.MethodsSixty gastric cancer patients receiving distal D2 lymphadenectomy by the same surgeon between June 2008 to June 2010 at the Department of Gastrointestinal Surgery, First Affiliated Hospital of the Guangxi Medical University were included in this study. The lymph adipose tissue around the anatomically normal and aberrant hepatic artery was carefully dissected, and the lymph nodes sent for recombinant human cytokeratin 20 (CK20) and carcino-embryonicantigen( CEA )micrometastasisimmunohistochemistry.ResultsWiththe micrometastasis immunohistochemistry of CK20 and CEA, we found the metastasise rate of lymph node around the normal hepatic artery was 27％.Patient age, tumor size, Borrmann type, TNM staging were correlated with the lymph node metastase. There were 7 cases with abnormal hepatic artery originating from the superior mesenteric artery. The hepatic artery ran in front of the pancreas in 1 case and behind the pancreas in 6 cases. We found there are no metastases in the lymph adipose tissue surrounding the abnormal artery.ConclusionsCK20,CEA are suitable immunohistochemical targets for estimating the lymph node micrometastasis. In distal gastric cancer age at 60 or older years, tumor larger than 3 cm and Borrmann Ⅲ-Ⅳ type were risk factors for metastasis of lymph nodes around normal hepatic artery, while aberrant hepatic arteries originating from the superior mesenteric artery are much less likely to have positive lymph nodes in D2 lymphadenectomy.

Objective To study the localizations and the quantity of GnRH receptor in stomach of Sprague-Dawley (SD) rats under stress.Methods The model of stress SD rats was established by fear. Then, stomachs were taken from the rats in acute stress group (2h-12h), chronic stress group (1d-4w) and the control group respectively.The localizations and the quantity of GnRH receptor in stomachs were detected using immunohistochemistry and Western blotting.Results The results of immunohistochemistry showed that immunoreactivity of GnRH receptor was displayed in the gastric parietal cells and the epithelial cells of the gastric pits in stomachs of rats in all groups. The immunoreactive materials were distributed in membrane and cytoplasm of all positive cells, but not in nuclei. Meanwhile, the results of Western blotting showed that the number of GnRH receptor decreased significantly when SD rats were in stress from 2h to 2w (P

Objective To discuss the value of double contrast-enhanced ultrasound(DCEUS) as a method to predict the pathologic grade of regression to preoperative neoadjuvant chemotherapy(NAC) in advanced gastric cancer(AGC) patients,the contrast parameters of gastric carcinoma were measured and its correlation with pathologic response degree was analyzed.Methods Fifty seven patients with endoscopic biopsy-proven AGC were considered for a complete resection of the lesion and had a DCEUS prior to and following XELOX pre-operative NAC therapy for 3 cycles.The arrival time (AT),time-to-peak (TTP), baseline intensity(BI) and peak intensity(PI) of the primary gastric tumor were measured.The enhanced intensity(EI)was defined as PI minus BI.The percentage of change of DCEUS parameters before and after NAC therapy and its correlation with phathologic grades of regression was calculated.Patients were divided into responder and nonreponder group according to different pathologic response grade.The differences of DCEUS parameters between two groups were compared.The diagnostic accuracy of DCEUS in prediction of benefit from preoperative NAC was represented by means of receive operating characteristic(ROC)curves. Results After NAC,the PI and EI values of local gastric cancer were significantly lower than before NAC. There were significant differences in PI and EI after NAC between the responder and nonresponder groups. Among the DCEUS parameters showed significant correlation with pathologic grade of regression,the correlation factor was highest in percentage of EI reduction of primary gastric tumor(ρ= -0.501 ,P =0.007).When the optimal cutoff value of EI reduction rate of gastric tumor determined was 27%,a sensitivity of 81 .8% and specificity of 66.7% were achieved.Conclusions DCEUS might be a novel, noninvasive,liable and potential method to select the benefit responder from the preoperative NAC in AGC patient.

Objeetive To explore the mechanism of drug resistance of New Delhi metallo-β-lactamase-1 (NDM-1) producing Enterobacteriaceae,and to investigate the characteristics of blaNDM-1 carrying plasmid and its gene environment.Methods A total of 48 strains of carbapenem-resistant Enterobacteriaceae were successively collected from six general hospitals in south China during August 2011 and January 2013.Escherichia coli J53 was used for plasmid conjugation.Modified Hodge test was performed,and PCR method was used for the detection of carbarpenase-related genes.The relative molecular mass of the blaNDM-1 carrying plasmid was determined using pulsed field gel electrophoresis (PFGE)assay,and enzyme digestion was performed to investigate the homology and incompatibility group of the plasmid.Clinical feature of blaNDM-1 producing Enterobacteriaceae infection was also investigated.Results Among 48 strains of carbapenem-resistant Enterobacteriaceae,43 were positive in modified Hodge tests.blaVIM,blaGIM and blaSPM genes were negative in all strains,while blaNDM-1 was positive in 19 strains including 3 strains of Escherichia coli,5 strains of Klebsiella pneumoniae,6 strains of Enterobacter cloacae,3 strains of Citrobacterfreundii,1 strain of Klebsiella oxytoca and 1 strain of Providencia rettgeri.All the 19 strains were resistant to imipenem,cefotaxime,ceftazidime,cefepime,aztreonam and piperacillin/tazobactam,47.3％ strains were resistant to ciprofloxacin and levofloxacin,but 68.4％ strains were sensitive to amikacin.Conjugation experiment showed that,blaNDM-1 carrying plasmids in 13 strains were transmitted to the Escherichia coli J53.The conjugants were resistant to imipenem,ceftazidime,cefotaxime and piperacillin/tazobactam,but were sensitive to amikacin,ciprofloxacin and levofloxacin.All genes in conjugant J-FR90 (Providencia rettgeri) were negative,while the remaining 12 conjugants carried blaNDM-1,blaSHV and aac-(6')-Ib genes.PFGE showed that,the sizes of all blaNDM-1 carrying plasmids were about 50 kb,and more than 80％ of their macrorestriction maps were similar.The plasmid belonged to incompatibility group IncX3,and exhibited 100％ passage stability after 500 generations of propagation.Among 19 patients infected with NDM-1 producing Enterobacteriaceae,6 died and 13 survived.Conclusions NDM-1 producing Enterobacteriaceae is emerging in south China,and blaNDM-1 is transmitted to Enterobacteriaceae through IncX3.Patients infected with NDM-1 producing Enterobacteriaceae usually have good prognosis.

Objective To evaluate the postoperative complications and safety of pancreaticogastrostomy (PG) versus pancreaticojejunostomy (PJ) after pancreaticoduodenectomy (PD).Methods Medline,EMBASE,Science Direct,Springer link,CBM,Cnki,Wan fang and VIP database were retrieved by computer search between 1st January 2004 and 31st March 2014 to collect all the RCT articles on pancreaticojejunostomy versus pancreaticogastrostomy after pancreaticoduodenectomy.The quality of the included trials was studied by assessing the inclusive and exclusive criteria (the PRISMA statement) by 2 researchers independently,then the data were extracted and analyzed using the RevMan 5.2.10 software.Results A total of 6 prospective randomized controlled trials which involved 976 patents were included in the study.There were significant differences between PG and PJ in terms of postoperative pancreatic fistula (RR:0.51 ; 95 ％ CI:0.37-0.70 ; P ＜ 0.0001),intra-abdominal fluid collection (RR:0.55 ; 95 ％ CI:0.34-0.89; P =0.01),and postoperative biliary fistula (RR:0.14; 95％ CI:0.03-0.59; P =0.0008).There was no significant difference in postoperative complications,mortality,delayed gastric emptying,postoperative hemorrhage,reoperation and length of hospital stay (P ＞ 0.05).Conclusions Pancreaticogastrostomy after pancreaticoduodenectomy is superior to pancreaticojejunostomy in safety and practicability.However,large,multicenter prospective randomized controlled trials are still needed to confirm the findings of this meta-anlaysis.

The optimization on liquid fermentation and purification of the fibrinolytic enzyme from Stenotrophomonas maltophilia(DR-929) was investigated.The results showed the best fermentation are amidulin 2.0%,soya flour 1.0%,yeast extract 0.5%,NaCl 1.0%,CaCl2 0.02%,MgSO4 0.05%,inoculum of 36 hours,fermental time 4d,initial pH 8.0 or 9.0,temperature 25℃,volume of media 30ml,volume of inoculum 5% or 6%.The purification process includes the following steps: removing cells by the centrifugation,25%~70% saturation ammonium sulfate precipitation,HIC with Phenyl FF(high sub),IEC with Q-Sepharose FF,gel filtration chromatography with Superdex 75.SDS-PAGE electrophoresis was used to examine the purification effect,and the results indicated that homogeneous strap in SDS-PAGE and has a molecular weight around 28.3kDa.The purification factor and activity recovery of the fibrinolytic enzyme are 271.5 and 24.5%,respectively.

Objective To study the lysozyme activity in Oncomelania hupensis and observe its inhibitory effect on bacterial growth.Methods Soft tissues of Oncomelania hupensis were initially homogenized and immersed in Tris-HCl-TritonX-114 buffer solution for 24 hours then the supernatant was collected after centrifugation at 10 000 × g for 10 minutes.The supernatant was incubated in a 37 ℃ water bath for 15 minutes and centrifuged again at 2000 × g for 10 minutes.The precipitate was put into ultrafiltration tube (relative retention molecular mass =3000) and centrifuged at 4 ℃,5 000 × g for 30 minute to obtain concentrated enzyme.The protein content,lysozyme activity and the antibacterial effect on Micrococcus lysodeikticus,Shigella dysenteriae,Staphylococcus aureus,Escherichia coli and Candida albicans were measured with bicinchonininc acid(BCA) method,turbidimetric method and agar diffusion (K-B) method,respectively.Results The antibacterial protein lysozyme was identified in gastropod protein concentration of the concentrated enzyme was 3.428 g/L.Average activity,total activity,and specific activity were (760 ± 120) × 103 U/L,(1520 ± 240) × 103 U/L and (221.70 ± 35.00)U/mg,respectively.The enzyme had produced exclusive inhibitory effects on growth of Micrococcus lysodeikticus and Shigella dysenteriae.Average inhibitory diameters were 10-12 and 12-15 mm,respectively.No inhibition zone was observed in saline control,Staphylococcus aureus,Escherichia coli and Candida albicans.Conclusions Lysozyme can be extracted from soft tissues of Oncomelania hupensis with Tris-HCl-TritonX-114 buffer solution,and the enzyme has inhibitory effect on growth of Micrococcus lysodeikticus and Shigella dysenteriae but has no antibacterial effect on Staphylococcus aureus,Escherichia coli and Candida albicans.