As a stressor, trauma can trigger local tissue lesions and reactive stress. And it give rise to a series of neuroendocrinic reactivations dominant with sympathetic activation and increased secretion of pituitary-adrenocortex. Hormone changes during stress have deep effect on nutritional substance metabolism.

Objectives:To evaluate the correlation of preoperative albumin level(PAL) and surgical prognostic risk for digestive tract diseases. Methods:This is a retrospective study of 1009 surgical patients who were undergoing elective esophageal,gastric,pancreaticoduodenal,or colon surgery between January 1998 and December 2003.Patients were subdivided into 7 groups based on the first PAL by different 5 g/L in hospital,whose incidence of complications,mortality,postoperative stay,intensive care unit(ICU) stay,and resumption of oral intake were statistically analyzed. Results:Incidence of complications and mortality increased significantly as PAL decreased(P35 g/L.Patients with PAL≤35 g/L undergoing esophageal or pancreatic procedures sustained a significantly higher complication rate and mortality than those of colonic or gastric surgery.The delay of postoperative stay,ICU stay,and resumption of oral intake were related to these complication rates.Esophageal and pancreatic procedures had the longest stay days and colon procedures had the shortest in patients with PAL≤35 g/L. Conclusions:Esophageal or pancreatic procedures performed in patients with PAL≤35 g/L who could have had surgery result in higher risk than colon or gastric surgery.PAL and surgical site identify surgical risk for digestive tract diseases.

Objective To study the effect of growth hormone (GH) combined with parenteral nutrition on skeletal muscle proteolysis for surgical critical patients. Methods Twenty surgical patients with APACHE II scores from 10 to 20 were divided randomly into two groups: parenteral nutrition group (PN group,n = 10) ; PN + GH ( GH group,n = 10). At the 5th day and 8th day during the study, urinary output of 3-methylhistidine ( 3-MH ) in 24 h urine were assessed with high performance liquid chromatography; at the 8th day the protein expressions of ubiquitin in quadriceps femoris muscle were determined by immunohistochemistry and the expressions of ubiquitin and C2 mRNA were determined by Northern blot analysis, the ultrastructure of quadriceps femoris muscle was observed under electronic microscope. All data were collected down in the form as mean ? standard deviation and analyzed with SPSS 11.5 for Windows. Results The urine level of 3-MH and the protein, mRNA and C2 mRNA expression of ubiquitin in quadriceps femoris muscle decreased in GH group as compared with PN group ( t = 4. 886, 6. 846,7. 314,5. 588,P

Objective To investigate the effect of enteral and parenteral nutrition on gut microecology in rats with abdominal infection. Methods Fourteen Sprague-Dawley (SD) model rats of abdominal infection, which had survived for more than 6 days were divided into two groups: PN group ( n =7) and PN+EN group ( n =7) via jejunostomy and jugular vein respectively for another 5 days. The nutrition support in the two groups was isonitrogen and isocaloric. At sacrifice on the sixth day, occludin and IgA level in plasma cells of intestine epithelium of the gut were measured by immunohistochemistry. Vena cava blood and homogenated tissue of liver, lung and mesenteric lymph nodes were cultured to determine bacterial translocations, and portal vein blood was tested for endotoxin. Results The expression of occludin and IgA in the small and large intestine in PN+EN group were stronger than PN group ( P

Objective To explore the clinical efficacy and safety of complex splenectomy.Methods The retrospective cohort study was adopted.The clinical data of 235 patients including 135 from Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine,67 from Shanghai Jiaotong University Affiliated First People's Hospital,26 from Shanghai Jiaotong University Affiliated Sixth People's Hospital,7 from 85 Hospital of PLA who underwent complex splenectomy from January 2005 to December 2015 were collected.All the patients received total splenectomy after splenic artery ligation.The observation indexes included:(1) surgical situations,(2) major complications including intraperitoneal hemorrhage,pulmonary complication,left subphrenic abscess and peritoneal effusion,(3) follow-up situations:portal vein (PV) complications (splenic venous thrombophlebitis,thrombosis of splenic vein and main portal vein thrombosis),survival of patients.The follow-up using outpatient examination and telephone interview was performed up to March 2016,and patients received regularly ultrasound reexamination,computed tomography (CT) rescan,routine blood retest and coagulation function.Measurement data with normal distribution were presented as-x ± s,and count data were analyzed using the chisquare test.Results (1) Surgical situations:of 235 patients,200 patients underwent secondary spleen pedicle severance and 35 patients underwent non-secondary spleen pedicle severance.Volume of intraoperative blood loss and duration of splenic resection were (268 ± 103) mL and (82 ± 29) minutes.(2) Major complications:of 31 patients with postoperative complications,intraperitoneal hemorrhage was detected in 12 patients,pulmonary complication in 17 patients,left subphrenic abscess in 3 patients and massive peritoneal effusion in 21 patients.Some patients were combined with multiple symptoms.The patients with above complications were cured after reoperations and non-operative treatments.(3) Follow-up situations:PV complications:splenic venous thrombophlebitis was detected in 16 patients,thrombosis of splenic vein in 17 patients,thrombosis of splenic vein combined with main portal vein thrombosis in 7 patients,and they were improved after the treatments of antiinflammation,anti-coagulation and thrombolysis.The thrombi rate after splenectomy was 32.4％ (12/37) in patients with schistosoma-related cirrhosis and 8.1％ (12/149) in patients with HBV-related cirrhosis,with a statistically significant difference (x2 =10.9,P ＜ 0.05).Survival of patients:of 235 patients,228 were followed up for (7.9 ± 4.2) years,with good survival.Conclusion Complex splenectomy is safe and effective,and the key procedure determining the safety of complex splenectomy includes careful preoperative evaluation,delicate surgical technique,proper splenic pedicle severance and peritoneal wounds.

Objective To study the regulation mechanism of bone mesenchymal stem cell (MSC)combined co-translation of islets in differentiation of Follicular Helper T cell (Tfh),and its roll on immunotolerence induction in non-obese diabetic (NOD) mice transplantation model.Methods The NOD mice were divided into 4 groups:Group A with islet transplantation alone;Group B with MSC co-transplantation with islets (MSC:0.5 × 106);Group C with MSC co-transplantation with islets (MSC:2 × 106);Group D with MSC co-transplantation with islets (MSC:3 × 106).ELISA was used to test the expression level of diabetes autoantibody GAD65Ab and IAA.Tfh cell count was detected by FACS.Results The survival time of transplantation groups was much longer in MSCs co-transplantation group than islet-alone group;the level of GAD65Ab,IAA and Tfh cell count were much lower in MSCs co-transplantation group than islet-alone group.Conclusion MSC may protect the islet transplants by regulating the Tfh cell differentiation.

ObjectiveTo determine the prevalence of nutritional risk and application of nutrition support in hospitalized patients in the department of general surgey,and to evaluate the relationship between nutrition support and clinical outcome as well as between nutritional risk and clinical outcome.MethodsHospitalized patients in the department of general surgery were enrolled from September 2009 to April 2010.The patients were screened using Nutritional Risk Screening 2002 ( NRS 2002) on admission.Data were collected on the application of nutrition support within 2 weeks,complication rate,length of stay,and hospital charges.ResultsAltogether 3000 patients were included in the present study.The overall prevalence of nutritional risk was 18.5％,in which gastric cancer patients showed the highest prevalence (48.3％ ).The proportion of patients receiving nutrition support was 44.1％ in those with nutritional risk and 14.3％ in those without nutritional risk.The ratio of parenteral nutrition to enteral nutrition was 1.2:1.The patients with nutritional risk had higher complication rate,longer length of stay,and higher hospital charge [24.1％ vs.14.2％,(11.1 ±4.8) daysvs.(9.6±3.7) days,(12891.5±4831.2) yuan vs.(9982.7 ±3996.4) yuan,all P=0.0000].Among the gastric cancer,colorectal cancer,and hepato-biliopancreatic cancer patients with nutritional risk,the complication rate,length of stay,and hospital charge were significantly lower in the patients receiving nutrition support than those in the patients receiving no nutrition support ( all P ＜ 0.05 ).ConclusionsA number of inpatients in general surgery department are at nutritional risk.The prevalence of nutritional risk is considerably high in gastric cancer patients.Nutritional risk is correlated with the clinical outcome of the patients.Nutrition support may improve the clinical outcome of gastric cancer,colorectal cancer,and hepato-bilio-pancreatic cancer patients.

ObjectiveTo investigate the effect of anti hepatitis B virus (HBV) therapy on patients with HBV associated hepatocellular carcinoma (HCC) after resection.MethodsClinical data of 87 patients with HBV associated HCC after resection treated in Shanghai Jiao Tong University Afifliated Sixth People's Hospital, Afifliated First People's Hospital and Ruijin Hospital, Shanghai Jiaotong University from January 2008 to January 2013 were retrospectively analyzed. There were 40 males and 47 females, 32 cases were<55 years old and 55 cases were≥55 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. According to the tumor diameter, the patients were divided into the tumor diameter≤3 cm group (n=36) and>3 cm group (n=51). According to whether the patients had received anti HBV therapy, each group was divided into anti HBV subgroup and non-anti HBV subgroup. Patients with anti HBV therapy began to receive treatment of entecavir 14 d after operation. The changes of alanine aminotransferase (ALT) and inhibition rate of hepatitis B virus-deoxyribonucleic acid (HBV-DNA) 6 months after operation were observed in each group. The ALT and inhibition rate of HBV-DNA were compared usingt test, survival analysis was conducted using Kaplan-Meier method and Log-rank test, and influencing factors analysis was conducted using Cox proportional hazard regression model.ResultsIn the tumor diameter≤3 cm group, the inhibition rate of HBV-DNA in the anti HBV subgroup was (47±6) %, which was higher than (9±3) % in the non-anti HBV subgroup (t=3.142,P<0.05). And in the anti HBV subgroup, the ALT level decreased from (46±10) U/L before treatment to (34±8) U/L after treatment, where signiifcant difference was observed (t=-2.339, P<0.05). In the tumor diameter≤3 cm group, the median of disease-free survival (DFS) time of the patients in the anti HBV subgroup was 48 months, and was 35 months in the non-anti HBV subgroup, and signiifcant difference was observed between two groups (χ2=13.09,P<0.05). Anti HBV therapy after operation and serum alpha-fetoprotein (AFP) level>400 μg/L were the independent factors for the DFS of patients with tumor diameter≤3 cm (OR=0.220, 2.657;P<0.05). ConclusionsPostoperative anti HBV therapy is an independent inlfuencing factor for the DFS of patients with small HCC. Anti HBV therapy can raise the survival rate by improving the residual liver function of patients.

Background::Compared with human leukocyte antigen (HLA)-matched sibling donor (MSD) transplantation, it remains unclear whether haploidentical donor (HID) transplantation has a superior graft-versus-leukemia (GVL) effect for Philadelphia-negative (Ph-) high-risk B-cell acute lymphoblastic leukemia (B-ALL). This study aimed to compare the GVL effect between HID and MSD transplantation for Ph- high-risk B-ALL.Methods::This study population came from two prospective multicenter trials (NCT01883180, NCT02673008). Immunosuppressant withdrawal and prophylactic or pre-emptive donor lymphocyte infusion (DLI) were administered in patients without active graft-versus-host disease (GVHD) to prevent relapse. All patients with measurable residual disease (MRD) positivity posttransplantation (post-MRD+) or non-remission (NR) pre-transplantation received prophylactic/pre-emptive interventions. The primary endpoint was the incidence of post-MRD+.Results::A total of 335 patients with Ph- high-risk B-ALL were enrolled, including 145 and 190, respectively, in the HID and MSD groups. The 3-year cumulative incidence of post-MRD+ was 27.2% (95% confidence interval [CI]: 20.2%-34.7%) and 42.6% (35.5%-49.6%) in the HID and MSD groups (P = 0.003), respectively. A total of 156 patients received DLI, including 60 (41.4%) and 96 (50.5%), respectively, in the HID and MSD groups ( P= 0.096). The 3-year cumulative incidence of relapse was 18.6% (95% CI: 12.7%-25.4%) and 25.9% (19.9%-32.3%; P = 0.116) in the two groups, respectively. The 3-year overall survival (OS) was 67.4% (95% CI: 59.1%-74.4%) and 61.6% (54.2%-68.1%; P = 0.382), leukemia-free survival (LFS) was 63.4% (95% CI: 55.0%-70.7%) and 58.2% (50.8%-64.9%; P= 0.429), and GVHD-free/relapse-free survival (GRFS) was 51.7% (95% CI: 43.3%-59.5%) and 37.8% (30.9%-44.6%; P= 0.041), respectively, in the HID and MSD groups. Conclusion::HID transplantation has a lower incidence of post-MRD+ than MSD transplantation, suggesting that HID transplantation might have a superior GVL effect than MSD transplantation for Ph- high-risk B-ALL patients.Trial registration::ClinicalTrials.gov: NCT01883180, NCT02673008.

The present study was designed to investigate the mechanisms by which P2X7 receptors (P2X7Rs) mediate the activation of vasopressinergic neurons thereby increasing sympathetic hyperactivity in the paraventricular nucleus (PVN) of the hypothalamus of rats with acute myocardial ischemia (AMI). The left anterior descending branch of the coronary artery was ligated to induce AMI in rats. The rats were pretreated with BBG (brilliant blue G, a P2X7R antagonist), nelivaptan (a vasopressin V1b receptor antagonist), or diphenyleneiodonium (DPI) [an nicotinamide adenine dinucleotide phosphate (NADPH) oxidase inhibitor]. Hemodynamic parameters of the heart were monitored. Myocardial injury and cardiomyocyte apoptosis were assessed. In the PVN of AMI rats, P2X7R mediated microglial activation, while reactive oxygen species (ROS) and NADPH oxidase 2 (NOX2) were higher than in the sham group. Intraperitoneal injection of BBG effectively reduced ROS production and vasopressin expression in the PVN of AMI rats. Moreover, both BBG and DPI pretreatment effectively reduced sympathetic hyperactivity and ameliorated AMI injury, as represented by reduced inflammation and apoptosis of cardiomyocytes. Furthermore, microinjection of nelivaptan into the PVN improved cardiac function and reduced the norepinephrine (AE) levels in AMI rats. Collectively, the results suggest that, within the PVN of AMI rats, P2X7R upregulation mediates microglial activation and the overproduction of ROS, which in turn activates vasopressinergic neuron-V1b receptors and sympathetic hyperactivity, hence aggravating myocardial injury in the AMI setting.