Glutamine,a coding amino acid in the process of synthesis of protein,could be absorbed by endothelial cells of the small intestine in most cases,or converted from other amino acid and glucose in the assistance of concerned enzyme.This nonessential amino acid maintains homeostasis in rivo.In recent years,a large number of researches reveal that glutamine plays an extremely important role in the tumor metabolism and therefore influences the process and treatment of cancer.In the study,the netabolism of glutamine in normal cells and tumor cells and its effects on tumor therapy were reviewed.

Metabolic deregulation is a major essential feature in the development of cancer,wbich also correlates with invasion and metastasis of tumor.Metabolic characteristic of tumor cells which deviate significantly from those of normal cells.In this review,we summarize the research about the relationship between cellular metabolic abnormalities and capability of tumor's invasion and metastasis.

Objective To establish a high performance size esclusion chromatography (HPSEC) method for the determination of high molecular weight impurities of cefotiam hydrochloride for injection.Methods A TSK G2000 SWXL column(7.8 mm × 30 cm,5μm) was used,the mobile phase consisting of phosphate budder solution [0.1 mol·L-1 disodium hyrogen phosphate-0.1 mol·L-1 sodium dihydrogen phosphate (61:39)],the flow rate was 0.7 mL· min-1,the detection wavelength was 254 nm,the column temperature was 30 ℃,the injection volume was 20 μL,and the concentration of polymers was quantified by external standard method.Results For HPSEC method,the calibration curves were linear in the range of 5.0-25.0 μg·mL-1 for cefotiam,and the LOD and LOQ was 0.1 μg·mL-1 and 0.246 μg· mL-1,the RSD for replicate for injections of reference solution was 0.50％,the sample solution was not stable in room temperature.Conclusion The method has high separation efficiency and good specificity,which provides reference for the further study of the polymer of cefotiam hydrochloride for injection.

Objective To explore the surgical skills and clinical efficacy of laparoscopic splenectomy (LS). Methods The operative duration, perioperative blood loss and postoperative complications were determined in 42 patients receiving LS in our hospital from October 2006 to May 2008 were retrospectively analyzed. Of the 42 patients, 12 suffered from splenomegaly due to blood disease, 1 from splenic tuberculosis, 1 from splenic cyst, 4 from traumatic splenic rupture,1 from malignant lymphoma and 23 from hypersplenism due to portal hypertension. Results LS was successfully performed in all the 42 patients. The mean perioperative blood loss was (300±110.60)ml, average operative duration (170±45.65) min (60-260 min) and mean postoperative inhospitalization duration (8.10±3.52)d. There was no severe complication after the operation. Conclusion For most types of splenic diseases, LS is safe and feasible. It is crucial to manage the splenic pedicle according to disease type, size, morphology and splenic hilus.

Objective To explore the operative main point and clinical effects of laparoscopic treatment for hepatic cyst. Methods Between August 2006 and April 2009, Forty-eight cases of laparoscopic treatment for hepatic cyst were performed, and the data were analyzed retrospectively. Of these treatments, there were laparoscopic fenestration (46 cases) and laparoscopic anatomical resection of left hepatic lobe (2 cases). Of the patients, there were solitary cyst (41 cases) and multiple cyst (7 cases). Results Fortyeight cases all performed laparoscopic treatment successfully. There were no converting to open operation, no biliary leakage and no bleeding. Except for resection of left hepatic lobe, the operating time was 30 -96 minutes (mean, 45 minutes), the intraoperative blood loss was 10 -90 mL (mean, 26 mL) and the postoperative hospital stay was 3 - 9 days (mean, 5 days). All the 48 patients were followed up for 6 to 36 months (mean, 32 months), 2 cases were found recurrence. Conclusions Affluent experience and proper standard of operation are key points for avoiding recurrence and complication in laparoscopic treatment for hepatic cyst. Laparoscopic treatment for hepatic cyst is safe, characterized by less pain and rapid recovery.

Objective To explore the operative main points and clinical effects of LC treatment for acute calculous cholecystitis. Methods Between August 2006 and June 2008, LC treatment for acute calculous cholecystitis in 120 cases as performed, the data of which were analyzed retrospectively. Of these patients, there were gallbladder with adherent omentum (72 cases), gallbladder with adherent hepatic flexture of the colon (9 cases), gallbladder with duodenum (5 cases), obstruction of the cystic duet by a gllstone (68 cases), and Mirizzi syndrome(2 cases). Results All the 120 cases performed LC successfully. There were no converting to open operation, and no biliary leakage. The mean operating time was (45. 0 ± 13. 1) minutes. Conclusions Acute calculous cholecystitis was not a contraindication for LC. Rich experience and skilled technique were key points for the success of operation. It shows advantages of less pain, less complications and more rapid recovery.

Objective To explore the feasibility and effect of spleen-preserving distal pancreatectomy in patients with distal pancreatic injures and its outcome.Methods Retrospectively analysed the follow up results of 18 patients undergoing spleen-preserving distal pancreatectomy in Clinical Medical College of Yangzhou University from March 2008 to November 2012.Results The operations were successful in all of these 18 patients,B-mode ultrasonography and CT scan follow-up revealed that there were no significant changes in the size and structure of the spleens.The operation time was 152 to 188 minutes (mean,172 minutes),and the intraoperative blood loss was 155 to 356 mL (mean,191 mL).The length of postoperative hospital stay was 13 to 19 days (mean,15 days).No bleeding after operation,no pancreatic leakage,and no intraabdominal infection occurred.Conclusions Distal pancreatectomy with spleen and supply vessel preserving is effective and feasible methods for the patients with distal

Exosomes are produced by multivesicular bodies,they are extracellular lipid nano-vesicles carrying a variety off bioactive substances,containing lipids,RNA,DNA and proteins.Exosomes produced by tumor cells carry important information about tumor cells.Exosomes produced by hepatocellular carcinoma can participate in the formation of a microenvironment suitable for the proliferation,growth,invasion,metastasis and drug resistance of tumor cells.Meanwhile,circulating exosomes can be used as non-invasive biomarkers for early diagnosis of tumors and as drug delivery vectors for treatment.This review summarizes the characteristics of exosomes in the growth,invasion and metastasis,immune escape,and drug resistance biology of hepatocellular carcinoma,as well as the potential clinical application of early detection and treatment.

Objective: To investigate the clinical efficacy of laparoscopic splenectomy combined with pericardial devascularization in the treatment of cirrhotic patients with cirrhotic portal hypertension. Methods: The retrospective and descriptive study was conducted. The clinicopathological data of 425 patients with cirrhotic portal hypertension who were admitted to Northern Jiangsu People′s Hospital Affiliated to Yangzhou University were collected. There were 289 males and 136 females, aged (53±11)years, with a range from 21 to 79 years. All the patients were allocated into 3 periods according to the operation time, including 100 patients of early period from February 2012 to March 2014, 156 patients of mature technology period from April 2014 to August 2016, and 169 patients of technology innovation period from september 2016 to December 2018. The patients of early period and mature technology period underwent laparoscopic splenectomy combined with pericardial devascularization, and the patients of technology innovation period underwent vagus nerve-preserving laparoscopic splenectomy combined with pericardial devascularization. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Patients were followed up by outpatient examination to detect the upper digestive rebleeding, gastric retention, and diarrhea up to March 2019. Sequential therapy of endoscopic variceal ligation (EVL) was slectively performed on patients based on results of gastroscopy. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using ANOVA, and paired comparison was analyzed using the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was anlyzed using the Kruskal-Wallis rank sum test, and paired comparison was analyzed using the rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test and Fisher exact probability. Results: (1) Surgical situations: the operation time, volume of intraoperative blood loss, cases with intraoperative blood transfusion, cases with conversion to open surgery, and cases with emergency operation for bleeding were (187±46)minutes, 150 mL (range, 50-1 300 mL), 2, 2 , 1 for patients of early period, (164±22)minutes, 50 mL (range, 30-100 mL), 1, 1, 1 for patients of mature technology period, and (150±18)minutes, 50 mL (range, 10-300 mL), 0 , 0 , 0 for patients of technology innovation period, respectively. There were significant differences in the operation time and volume of intraoperative blood loss between the three groups (F=55.482, χ²=94.620, P<0.05). There was no significant difference in the cases with intraoperative blood transfusion, cases with conversion to open surgery, or cases with emergency operation between the three groups (P>0.05). (2) Postoperative situations: 425 patients had oral aspirin enteric-coated tablets for prevention of thrombus, with no perioperative death. Duration of postoperative hospital stay, cases with portal vein thrombosis at postoperative 7 days, cases with pancreatic fistula, cases with pulmonary infection, and cases with abdominal infection were (11.0±2.9)days, 46, 2, 1, 0 for patients of early period, (9.9±1.7)days, 81, 3, 0, 0 for patients of mature technology period, and (8.8±1.3)days, 83, 2, 1, 1 for patients of technology innovation period, respectively. There was a significant difference in the duration of postoperative hospital stay between the three groups (F=39.836, P<0.05), between patients of mature technology and patients of early period (t=3.329, P<0.05), between patients of mature technology period and patients of technology innovation (t=6.502, P<0.05). There was no significant difference in the cases with portal vein thrombosis at postoperative 7 days between the three groups (χ²=0.865, P>0.05) and no significant difference in the cases with pancreatic fistula, cases with pulmonary infection, or cases with abdominal infection between the three groups (P>0.05). Patients with portal vein thrombosis at postoperative 7 days had oral aspirin enteric-coated tablets or warfarin for treatment. Patients with pancreatic fistula, pulmonary infection, and abdominal infection were cured and discharged after conservative treatment. (3) Follow-up: all the 425 patients were followed up for 1-72 months, with a median follow-up of 36 months. Of the 425 patients, 261 underwent postoperative sequential therapy of EVL, including 133 patients of mature technology period and 128 patients of technology innovation period. The incidence rate of upper digestive rebleeding was 3.83%(10/261) of the 261 patients undergoing postoperative sequential therapy of EVL and 17.68%(29/164) of 164 patients without postoperative sequential therapy of EVL, showing a significant difference between them (χ²=23.185, P<0.05). The incidence rates of gastric retention and diarrhea were 96.24%(128/133) and 61.65%(82/133) for 133 patients undergoing sequential therapy of EVL in mature technology period, and 1.56%(2/128) and 3.91%(5/128) for 128 patients undergoing sequential therapy of EVL in technology innovation period, showing significant differences between them (χ²=233.876, 97.883, P<0.05). Conclusions It is safe and feasible of laparoscopic splenectomy combined with pericardial devascularization for patients with cirrhotic portal hypertension, and intraoperative vagus nerve-preserving can reduce volume of intraoperative blood loss and incidence of postoperative complications.

Objective To investigate the clinical value of enhanced recoverv after surgery (ERAS) in radical resection of primary liver cancer.Methods In this study 68 patients were randomly assigned into the ERAS group (n =35),and control group (n =33).Results Comparing with control group,there was significant differences in ERAS group with less volume of intraoperative intravenous fluid (t =2.812,P ＜0.05),lower visual analogue scale (VAS) scores (t =2.023,P ＜ 0.05),the shorter time to flatus (t =2.354,P ＜ 0.05),shorter postoperative hospital stay (t =2.056,P ＜ 0.05),and higher satisfaction degree of patients (t =2.227,P ＜ 0.05),while there was no significant differences between the two groups in postoperative complications (x2 =0.032,P ＞ 0.05).Conclusion ERAS was safe and effective for patients undergoing radical resection of primary liver cancer.