Objective To compare early enteral with parenteral nutrional support in patients after hepatectomy. Methods In this study, 59 patients were randomized into 2 groups to respectively receive enteral or parenteral nutritional support beginning the first day post-op for a week. The general nutrition condition, liver function, gut function, dosage of albumin, mortality, complication rate and expense were recorded. Results Patients were given same quantity of heat and nitrogen. At the end of the study, serum albumin, body weight and upper arm circumference had not reached the preoperative level in patients receiving enteral mutrition while all except for serum prealbumin had not reached the level in parenterally nutritional patients. Furthermore, the time of gut begins functional (29?12) h in enterally nutritional patients was shorter than in parenterally nutritional patients (38?14) h. Enteral nutrition was more economic than parenteral nutrition (P

Background:Tripterygium glycosides(TG)is effective for treatment of ulcerative colitis(UC)in clinical practice, however,the underlying mechanism has not been clarified yet. Aims:To investigate the therapeutic effect of TG on dextran sulfate sodium(DSS)-induced experimental colitis in mice and its possible mechanisms. Methods:Sixty healthy male BALB/ c mice were randomly divided into six groups:model control group,low,medium and high-dose TG group,blank control group and normal control group. Mice in the first four groups drank 5% DSS freely for 7 days to induce experimental colitis;simultaneously,distilled water,9. 01,27. 03 or 81. 09 mg/(kg·d)TG were given intragastrically for 21 days in these four groups,respectively. Histopathological changes of colonic mucosal tissues were observed;expressions of TLR4 mRNA and protein were determined by RT-PCR and Western blotting;expression of NF-κB p65 was detected by immunohistochemistry;concentrations of IL-1α,TNF-α and IL-13 were measured by ELISA. Results:Tissue damage and inflammation in varying degrees were observed in colonic mucosal tissues in TG groups with different dosage,but all were less severe than those in model control group. Expressions of TLR4 mRNA,TLR4 protein,and NF-κB p65 in colonic mucosal tissues,as well as concentrations of IL-1α and TNF-α in supernatant of colonic homogenate were significantly lower in TG groups than those in model control group(P < 0. 01). These parameters in medium and high-dose TG groups were significantly lower than those in low-dose TG group(P < 0. 05),but higher than those in blank control group and normal control group(P < 0. 05). Except for TNF-α,no significant differences were seen between medium and high-dose TG groups(P > 0. 05). Conclusions:TG exerts a protective effect on DSS-induced experimental colitis in mice. The underlying mechanism of its anti-inflammatory effect might be related with the inhibition of TLR4 / NF-κB signaling pathway activation and subsequently suppressing downstream proinflammatory cytokines expression and secretion.

Objective To assess the activity of Crohn’s disease (CD)by using the quantitative parameter of dynamic contrast-enhanced MRI (DCE-MRI).Methods 50 CD patients with ileocecal solitary lesion were recruited in this study.All of patients underwent con-ventional and DCE-MRI.The quantitative parameter of volume transfer constant (Ktrans )and the clinical data including Harvey-Brad-show index (HBI)and C-reactive protein (CRP)were recorded.(1)the reliability and repeatability of Ktrans measurement were analyzed. (2)the correlation between Ktrans value and clinical data was analyzed by using Pearson analysis.(3)according to HBI,all of the CD patients were divided into severe group,mild-moderate group,and static group.The differences of Ktrans values among the three groups were compared by using Mann-Whitney U test.Results (1)the reliability of Ktrans measurement was high (Cronbach’s Alpha=0.993).(2)there was positive correlation between HBI and Ktrans(r=0.635,P<0.001),and between CRP and Ktrans(r= 0.764,P<0.001).(3)there was significant difference of Ktrans value between the static group and the mild-moderate group (P<0.001),be-tween the static group and the severe group (P<0.001),and.between the mild-moderate group and the severe group (P<0.001). Conclusion Quantitative parameter of DCE-MRI (Ktrans )had a high reliability and can be used to assess the inflammation activity of CD.

AIM: To observe the effect of Tripterygium glycosides on NOXs-ROS-NLRP3 inflammatory signa-ling pathways in the colon tissue in dextran sulphate sodium (DSS)-induced ulcerative colitis (UC) mice, and to investi-gate the underlying mechanisms.METHODS: BALB/c mice were used and the mouse model of UC was established by DSS induction.The mice were randomly divided into 5 groups (model group, low-, medium-and high-dose Tripterygium glycosides groups, and normal group).The colon tissues were collected 21 d after Tripterygium glycosides gavage.The mRNA expression of NLRP3, ASC and caspase-1 in the colon tissues was detected by real-time PCR.The caspase-1 ex-pression in the colorectal mucosa was observed by immunohistochemical method.ELISA was used to detect the protein le-
vels of IL-1α, TNF-αand IL-13.The production of reactive oxygen species (ROS) was measured by chemiluminescence technique, and the consumption rate of NADPH, which was inhibited by DPI, was analyzed to determine the activity of NADPH oxidases (NOXs).The neutrophils were isolated, and the ROS production, NOXs activity, and the mRNA ex-pression of NLRP3, ASC and caspase-1 were also detected.RESULTS: The colon tissues were abnormal with different de-grees in Tripterygium glycosides groups, and histopathological scores were lower than that in model group.In Tripterygium glycosides groups, in addition to the mRNA expression levels of caspase-1 in the colon tissues between normal group and high-dose group, ROS production, NOXs activity and the mRNA expression levels of NLRP3, ASC and caspase-1 in the colon tissues and colon-isolated neutrophils were lower than those in model group (P <0.05), and higher than those in normal group (P <0.05).The results of pairwise comparison for the efficacy of Tripterygium glycosides administration showed that the above indexes were statistically significant except the mRNA expression levels of caspase-1 between middle-dose group and high-dose group.Tripterygium glycosides administration significantly decreased the expression levels of proinflammatory cytokines IL-1αand TNF-αin the homogenates of colon tissues in the model mice (P <0.05).No differ-ence of IL-13 expression among the groups was observed.CONCLUSION: Tripterygium glycosides inhibits NOXs-ROS-NLRP3 inflammatory signaling pathways to reduce the expression of IL-1α, TNF-αand other proinflammatory cytokines, and attenuates DSS-induced ulcerative colitis in mice, by which the neutrophils might be involved in the process.

Objective To investigate the diagnostic value of urinary light chain detection in essential hypertension renal injury. Methods According to "National Prevention and Treatment Guide of Hypertension" (2005 Edition) and the diagnostic criteria of essential hypertension renal injury, patients'medical history and damage of target organs, we selected 60 patients with essential hypertension and divided them into two groups: 28 patients without renal injury and 32 patients with renal injury. Meanwhile, Thirty healthy individuals were included in a control group. Urinary proteins and light chains were detected by immuonephelometry and the activity of NAG was determined by liquid kinetic rate assay with MNP as substrate. The urinary light chains concentration of each group were compared and analyzed with those of Alb and α1-MG. Results The results of lamU in renal injury group [8. 89(3.84-33. 30) mg] were higher than those of non renal injury group [3. 84(3. 84-10. 4) mg] and control group [3.84(0. 00-3.84) mg]. There was statistically significant difference ( H = 37.97, P ＜ 0. 01 ). The levels of kapU in renal injury group [26. 65 (6. 97-62. 5 ) mg] were higher than those of non renal injury group [6. 97 (6. 97-23.7 )mg] and control group [6. 97(6. 97-7. 20) mg], which also had statistical significance (H =40. 09,P ＜0. 01 ). All the other results in renal injury group ( Alb, α1-MG, IgG, TRF and NAG) were higher than those of non renal injury group and control group ( H =21.02, 32. 65, 25.50, 30. 45 and 30. 57, P ＜0. 01 ). Correlation analysis showed that Alb levels were highly correlated with urinary IgG and TRF levels [Correlation coefficient (r) =0. 911, 0. 965, P ＜ 0. 01]. The levels of urinary light chain lamU and kapU were also highly correlated with α1-MG ( r = 0. 804, 0. 827, P ＜ 0. 01 ). However, There was no correlationship between NAG and α1MG levels (r=0. 398,P＞0. 05). Conclusion The urinary light chain lamU and kapU can be used as indicators for evaluation of renal injury in essential hypertension, especially renal tubular injury.

The target of rapamycin ( TOR) , a Ser/Thr protein kinase of PIKKs ( phosphatidylinositol kinase-related kinases ) , is the central factor of a highly conserved signaling pathway in eukaryotes , and regulates cell growth in response to nutrients , hor-mones, and stresses.It controls temporal growth by activating anabolic processes such as translation , ribosome biogenesis , protein syn-thesis, transportation of amino acid and metabolic enzymes .The advances in TOR pathway in the most pervasive human fungal patho-gen Candida albicans.

Objective To explore the value of serum IgA,serum C3 and IgA/C3 ratio in the diagnosis and clinical monitoring of IgA nephropathy,which provide new insight for the alternatives of renal biopsy. Methods In the first affiliated hospital of Dalian Medical University,60 patients with IgAN,60 patients with non-IgAN and 40 healthy people were detected by blood biochemical indexes and immune indexes,such as the Urea,serum IgA and serum C3,IgA/C3 ratio. According to the healthy condition and Lee grading,we divided all the 160 patients into different groups. By comparing the blood biochemical indexes and immune indexes among these different groups,we investigated the relationship between the serum IgA/C3 ratio and the IgAN.Results Firstly,the level of serum IgA and IgA/C3 were obviously different among the patients with IgAN,patients with non-IgAN and healthy people(P<0.01).Secondly,the serum IgA and IgA/C3 have high specificity and sensitivity when distin-guishing between IgAN and non IgAN. Thirdly,the level of serum IgA and IgA/C3 have significant deference be-tween the patients with Lee Ⅰ-Ⅱ grading and the patients with Lee Ⅲ-Ⅴ grading,while the level of C3 is very similar between different groups in all the three situations mentioned above. Conclusion Our research provides stronge evidence demonstrates that the level of serum IgA/C3 ratio have close relationship with IgAN and they can serve as the reference index when diagnosising and grading IgAN.

Objective To summarize the experience of one case of anastomotic leakage after simultaneous pancreas-kidney transplantation (SPK ) with enteric drainage .Methods One case of type 2 diabetes mellitus complicated with end-stage nephropathy undergoing SPK was retrospectively analyzed .Iliac venous systemic circulation was employed for pancreatic venous reflux ,transplanted pancreas exocrine via enteric drainage and side-to-side anastomosis between donor pancreaticoduodenum and recipient jejunum . Pancreatoduodenal anastomotic leakage occurred at 12 days post-operation .During re-operation ,Roux-en-Y anastomosis was established between donor pancreaticoduodenum and recipient jejunum .And the relevant domestic and foreign literatures were searched .Results The follow-up time was 3 month after a second operation .Recipient pancreas and kidney transplantation survived well . There was no onset of enteric leakage .The incidence of anastomotic leakage varies greatly between different transplantation centers both at home and abroad .The incidence ranged from 3 .6％ to 11 .3％ .And the risk of pancreatic loss was as high as 54 .6％ .Conclusions As a severe postoperative complication ,anastomotic fistula after SPK may cuase abdominal infection . Even after reparing enteric fistula , the risk of leakage remains high . Roux-en-Y anastomosis is other therapeutic option .