Humans ; Irritable Bowel Syndrome ; physiopathology ; Sensation ; Serotonin ; physiology ; Signal Transduction ; Viscera ; physiology

Objective To review the clinical,histological and diagnostic aspects of 12 documented cases of nodular regenerative hyperplasia of the liver(NRHL),to make this condition be understood and dealt with better. Method Twelve NRHL cases were diagnosed based on liver biopsy from 300 portal hypertension patients who had been underwent splenectomy.Imaging studies were performed as part of the diagnostic evaluation.Clinical manifestation and biochemical tests were recorded at the time of diagnosis.Management and prognosis were also reviewed.Results Most patients were complicated with autoimmune disease,6 cases were diagnosed systemic lupus erythematosus and 1 was Crohn's disease and 1 suspected ulcerative colitis.Six cases were treated by prednisone and 3 cases by immunosuppressant.Eleven cases had suffered from portal hypertension.All cases had no history of viral hepatitis.Biochemical tests showed mild increase of liver enzyme and relative normal synthetic liver function.The histological finding was nodular in the hepatic parenehyma,with mild periportal fibrosis,intraportal lymphocytic infiltration,narrow and obstruction of branch of portal vein,and lack of hepatocyte necrosis.All cases were diagnosed liver cirrhosis and portal hypertension before operation.Management was directed to portal hypertension and varices bleeding with satisfactory results.Most of them keep a stable condition during the follow-up. Conclusion The NRHL was uncommon and its cause and pathogenesis was unclear,may be related with immune and hepatic blood circulation disorder.It should be considered in patients with unexplained portal hypertension and distinguished it from liver cirrhosis.Liver biopsy confirms the diagnosis.Management directed to portal hypertension may improve clinical condition.

0.05). Conclusion When TOFR recovers to 0.55,antagonism of residual neuromuscular blockade is still necessary.Different doses of neostigmine may antagonize vecuronium-induced residual neuromuscular blockade,and lower dose of neostigmine(10-20 ?g/kg) is recommended.

Objective To study on the effectiveness of endoscopic ultrasonography(EUS)in detec- ting insulinoma preoperatively.Methods Fifteen patients with clinical and biochemical signs of insulinoma were examined by EUS using a radial-scanning ultrasound endoscope and abdominal ultrasonography,CT, DSA prior to surgery.The outcome was evaluated on the basis of surgery and examination of the resected specimens.Results Fifteen patients with 16 lesions of insulinoma were identified by surgery and pathology. The aceuraey of diagnosis with EUS was 13/15(86.7%),and that with B-US,CT,DSA was 3/15(20%), 5/15(33.3%),9/14(64.3%)respectively.In the 14 lesions identified by EUS,10 lesions were depicted to be hypoechogenic,1 lesion was isoechogenic and 3 lesions were hyperechogenie.All 14 lesions were well demarcated and surrounded by normal pancreatic tissue.The minimum size of the lesion visualized by EUS was 0.5cm.Ten lesions were correctly detected by EUS with size of 0.5～2.0cm.EUS missed diagnosis in 2 lesions not for their small size.EUS falsely indicated a 10mm lesion from two lesions inside the head of pancreas.One lesion outside the pancreatic tail and one lesion in the pancreatic head were missed by EUS in another case.Conclusion EUS is superior in assessing the location of pancreatic insulinoma than other ima- ging methods such as B-US,CT,DSA.

Objective To evaluate the diagnostic value of EUS in patients with chronic abdominal pain of suspected pancreatic origin.Methods The EUS findings and related clinical data of 106 patients with chronic abdominal pain of suspected pancreatic origin(excluding the patients with suspected pancreatic malignancies)from 1991 to 2004 in PUMCH were retrospectively analyzed.Results(1)The principal dis- ease interpreting the chronic abdominal pain of suspected pancreatic origin(excluding pancreatic malignan- cies)was chronic pancreatitis(CP)(57.5%),the following contributions were other pancreatic diseases (18.9%)and unknown diseases(11.3%).(2)The sensitivity and specificity of EUS for diagnosing CP was 95.1% and 64.4% respectively,the positive predictive value(PPV)and negative predictive value (NPV)was 78.4% and 90.6% respectively.(3)Abhormalities of pancreatic parenchyma structure based on EUS were the main findings(90.2%)in patients with CP and non-homogeneous echo pattern combined with hyper echoic dots or calcification was the predominant feature(52.5%).The value of isolated inhomo- geneity and focal enhanced eehogenicity for diagnosing CP were limited(P＞0.05).Abnormalities of pan- ereatic ductal system were presented in 63.9% of patients with CP and dilation of pancreatic duct was the major feature(34.4%).CP with focal mass(inflammatory pseudotumor)was usually presented as hypo e- choic mass in the pancreatic head based on EUS(90%),which was similar to the EUS feature of pancreatic cancer.(4)The general accordant rate based on EUS with ERCP or BT-PABA were 77.8% and 70.4% re- spectively,and the correct rate based on combine diagnosis were 100% and 95.2%.Conclusion CP is the main source of chronic abdominal pain of suspected pancreatic origin(excluding pancreatic malignancies). EUS has good sensitivity but inadequate specificity for diagnosing CP,while ERCP may be more sensitive than EUS for detecting pancreatic ductal lesions.Pancreatic parenchymal abnormalities contribute the major EUS features of CP but the value of isolated inhomogeneity and focal enhanced echogenicity for diagnosing CP are limited.

The efficacy of conventional drug therapy for inflammatory bowel disease (IBD) is not satisfactory. As monoclonal antibody has been widely used and increasingly understood, biological agent therapy has been proved as ideal strategy in attaining mucosal healing, preventing complications, improving quality of life, and reducing hospitalization and surgical intervention. Furthermore, different randomized clinical trials assessed the efficacy in reducing the need for repeat surgery because of recurrence. Besides, biological agent therapy dose not increase most of postoperative side effects such as infection. However, adverse events of biological agents including serious infection, infusion reactions, delay type allergic reaction and myelosuppression should be paid attention to.
Biological Products ; adverse effects ; therapeutic use ; Humans ; Inflammatory Bowel Diseases ; drug therapy

Objective To study the feature of MRI in ureter transitional cell carcinoma,to evaluate the diagnostic value in transitional cell carcinoma of ureter with MRI.Methods Heavily T_2-weighted fast spin echo pulse sequence,fat suppression pulse and MR urography(MRU)were performed.The MRI finding of the ureter transitional cell carcinoma were anlysed in 32 cases and were discssed with the review of literature.Results Fifteen lesions were located at the upper portionof the ureter,7 at mid portion and 10 at lower portion.Each case presented urinary obstruction,distention and uretal hydrocele.21 retrograde urleropyelogrhpy of nodular shaperal irregular,11 irregular the ureteral wall,10 dilate the ureter in 21 cases,11 infitrative lesion to grow in location,9 lymphanode to enlarge in surrounding of major arterial of abdominal and renal out in 11 cases.17—72 mm length the lesion,39 mm average,6—50 mm width the leion,17 mm average.Hypointense on T_1 WI and hyperintense on T_2 WI image in 23 cases,hyperintense on both T_1 WI and T_2 WI image in 5 cases,hypointense on T_1 WI and isointense on T_2 WI image in 2 case, slightly hypointense on both T_1 WI and T_2 WI images in 2 case.Ninteen homogeneous and 13 non homogeneous of signal in lesion,22 reliable and 5 suspicious diagnosis and 5 misdiagnosis in MRI. Conclusion The location,the shape,the spectrum of the tumor and change of surrounding tiessue were clear cuted in MRI,but further research in confirmation of the diagnosis.

Objective To investigate the clinical features and management of pancreatic disease- associated portal hypertension.Methods A retrospective analysis was carried out in patients with portal hypertension complicating with pancreatic diseases in our hospital from January 1986 to April 2005. Medical records of these patients were reviewed,including data of demographics,etiologies,venous involvement,clinical presentation,laboratory tests,imaging studies,therapeutic modalities and out- comes.Results There were 59 cases of portal hypertension resulted from pancreatic diseases in our hos- pital,accounting for 4% of all portal hypertension in 19 years.The underlying pancreatic diseases were chronic pancreatitis(21 cases,35.6%),pancreatic carcinoma(20 cases,33.9%),acute pancreatitis (8 cases,13.6%),pancreatic pseudocyst(3 cases,5.1%).Of the 40 patients whose venous involve ment was identified,splenic vein obstruction occurred in 27 cases(67.5%),followed by portal vein obstruction(16 cases,40.0%).Mild or moderate splenomegaly was present in 48 cases(81.4%),with leukocytopenia as the most common manifestation of the 31 cases(52.5%)of concomitant hyper- splenism.Forty-five patients(76.3%)developed gastroesophageal varices(including 35 isolated gastric varices),among them,19 had bled(32.2%).Conservative treatment was effective in controlling acute bleeding,but could not prevent re-bleeding.Splenectomy was performed in 18 patients,mainly because of gastrointestinal hemorrhage.No postoperative bleeding occurred in the period of follow-up from 8 months to 9 years.Conclusions Pancreatic diseases may compromise portal vein and its tributaries, leading to generalized or regional portal hypertension.Pharmacological therapy can effectively control acute variceal bleeding,while surgical treatment is the appropriate procedure of choice in case of hemor- rhage recurrence.

OBJECTIVETo investigate the effect of antidepressant on irritable bowel syndrome (IBS).

METHODSA self-control and follow-up study on subclinical dosage of antidepressants therapy (fluoxetine 10 mg/d, paroxetine 10 mg/d or doxepin 45 mg/d) for 9-12 wks in 46 patients with refractory IBS symptoms according to Rome II criteria was performed, the clinical outcomes were evaluated by scales changes of symptom-related-anxiety, severity index of symptom, and quality of life specific of IBS, as well as general psychiatric health by SCL-90 during treatment and follow-up periods.

RESULTSAll 46 cases completed therapy and first follow-up unit (12 wks after treatment) (FFU), at the end of FFU, clinical symptoms in all patients were improved (P < 0.01). Comparison of the scores of symptom-related-anxiety, index of symptom, and quality of life specific of IBS at the end of FFU with that at basal level, indexes of the severity (3.4 +/- 1.5 vs 1.8 +/- 0.84) and frequency (3.8 +/- 1.60 vs 2.0 +/- 0.76) of symptoms were subsided significantly (P < 0.01, respectively); the scores of symptom-anxiety questionnaire including body anxiety (16.04 +/- 1.65 vs 10.83 +/- 1.64, P < 0.001), cognitive anxiety (18.78 +/- 2.12 vs 11.17 +/- 1.89, P < 0.001), fear (15.80 +/- 1.76 vs 10.78 +/- 1.85, P < 0.001) and avoiding (15.47 +/- 1.53 vs 10.16 +/- 1.59, P < 0.001) were also subsided significantly. In the meantime, IBS-QoL improved significantly (P < 0.05), dysphoria, body image, interference with activity, health worry, social reaction and overall scores were improved significantly (P < 0.01, respectively). The status of general psychiatric health was also improved significantly (P < 0.01).

CONCLUSIONSTreatment of refractory IBS with subclinical dosage antidepressant is rational and effective, However a further study on its mechanisms is suggested.

Adult ; Antidepressive Agents ; administration & dosage ; Doxepin ; administration & dosage ; Female ; Fluoxetine ; administration & dosage ; Follow-Up Studies ; Humans ; Irritable Bowel Syndrome ; drug therapy ; Male ; Middle Aged ; Paroxetine ; administration & dosage ; Quality of Life

OBJECTIVETo investigate the effects of crypotanshinone (CPT) on the proliferation and apoptosis of DU145 prostate cancer cells as well as on the metadherin expression and the downstream PI3K/AKT signaling pathway in the DU145 cells.

METHODSWe treated DU145 prostate cancer cells with different concentrations of CPT for 24, 48, and 72 hours followed by evaluation of the proliferation and apoptosis of the cells by MTT assay and TUNEL, respectively. We determined the expressions of metadherin protein and mRNA in the DU145 cells by Western blot and RT-PCR respectively at different time points after CPT treatment. We also detected the expressions of the proteins metadherin, AKT, p-AKT, and Bcl-2 in the CPT-treated DU145 cells at 48 hours.

RESULTSCPT significantly inhibited the proliferation of the DU145 cells in a dose- and time-dependent manner (P < 0.05). After treatment with 10 µmol/L CPT for 24, 48, and 72 hours, the apoptosis rates of the DU145 cells were (29.42 ± 4.51), (55.07 ± 5.67) and (70.84 ± 4.66)%, respectively, significantly higher than (3.1 ± 2.48)% in the control group (P < 0.05). The expression of metadherin was remarkably downregulated at the transcription and translation levels (P < 0.05) and the expressions of the AKT signaling pathway and the Bcl-2 protein were markedly inhibited in the DU145 cells after treated with 10 µmol/L CPT for 48 hours (P < 0.05).

CONCLUSIONCPT can inhibit the proliferation and induce the apoptosis of DU145 prostate cancer cells, which may be associated with its suppression of the downstream PI3K/AKT signaling pathway by reducing the expression of metadherin in the DU145 cells.

Apoptosis ; drug effects ; Cell Adhesion Molecules ; metabolism ; Cell Line, Tumor ; Cell Proliferation ; drug effects ; Diterpenes, Abietane ; pharmacology ; Down-Regulation ; Drugs, Chinese Herbal ; pharmacology ; Humans ; In Situ Nick-End Labeling ; Male ; Neoplasm Proteins ; metabolism ; Phosphatidylinositol 3-Kinases ; metabolism ; Prostatic Neoplasms ; metabolism ; pathology ; Proto-Oncogene Proteins c-akt ; metabolism ; Proto-Oncogene Proteins c-bcl-2 ; metabolism ; RNA, Messenger ; metabolism ; Signal Transduction ; drug effects ; Time Factors