Objective To investigate the influent factors on normal intraabdominal pressure (IAP) and establish the IAP regressive equation. Methods The IAPs of 106 hospitalized patients were determined through monitoring the bladder pressures. The relationship between IAP and 14 factors including age, gender, height, weight, body mass index (BMI), previous and recent abdominal surgical history, reasons for admission,complications and their quantities were analyzed,respectively Results The mean IAP of the hospitalized patients was 5.5 mm Hg with a range from 0.4 mm Hg to 12.8 mm Hg. The difference among IAPs of different grades of BMIs had statistical significance ( F =5.550, P 0.05). Conclusion Normal IAP is possibly influenced by gender and BMI,and it is individually different.

Objective To investigate the protective effect of Klotho on renal ischema-reperfusion injury (IRI).Methods Plasmid expression vector of secreting type Klotho (pV5-sKlotho) was injected through the tail vein 24 h before operation.The renal ischemia-reperfusion model was established and the experiment was divided into 6 groups:sham group of young mice,sham group of aged mice,control group of young mice,control group of aged mice group,Klotho transfected group of young mice and Klotho transfected group of aged mice.The serum creatinine (Cr) and blood urea nitrogen (BUN) levels were determined at 1st,3rd,7th,and 14th after reperfusion.The mRNA expression of Klotho and P53 in the renal tissue,concentration of the malondialdehyde (MDA),superoxide dismutase (SOD) and pathological changes in the renal tissue were examined.Results As compared with young mice group,the Cr and BUN levels were significantly increased after reperfusion (P<0.05),the expression of Klotho mRNA was significantly decreased (P<0.05) and the expression of P53 mRNA was significantly increased (P<0.05),the MDA level in the renal kidney tissue was significantly increased and SOD level was significantly decreased (P<0.05) in aged mice.Vacuolar degeneration and necrosis in tubules were major pathological changes 24 h after operation in aged mice,and at 14th day after IRI renal tubular atrophy,fibrosis and inflammatory cell infiltration were seen in aged mice.After transfection with pV5-sKlotho,as compared with control group of aged mice,the kidney function was significantly improved in Klotho transfected group of aged mice (P<0.05),and the up-regulated expression of Klotho and down-regulated expression of P53 were detected in Klotho transfected group of aged mice (P<0.05),also the MDA level in the renal tissue was obviously reduced and SOD level was obviously increased (P<0.05).Vacuolar degeneration and necrosis in tubules at 24th h after IRI and tubular atrophy,fibrosis and inflammatory cell infiltration at 14th day after IRI were significantly improved in Klotho transfected group of aged mice.Conclusion Transfection with Klotho can protect the acute kidney injury and chronic kidney disease induced by IRI in aged mice.

Objective To explore the effect of back Tuina on motor behavior,oxidative stress and in-flammation in rats with chronic fatigue syndrome(CFS).Methods Twenty-four Sprague-Dawley rats were randomly divided into a blank group,a model group and a Tuina group,each of 8,according to a random number table.The CFS rat model was prepared by means of forced weight-bearing swimming combined with chronic stress stimulation in 21 days.After modeling,the Tuina group was given daily 20-minute Tuina for 14 days.The general condition semi-quantitative score,exhaustion swimming time and open field experiment(OFE)distance of all groups were recorded.After the experiment,sam-ples were collected,and the histopathological changes of the vertical spine muscles were observed by hematoxylin and eosin(HE)staining.The cross-sectional area and diameter of muscle fibers were calcu-lated using Image Pro Plus software,and the frequency distribution diagram of cross-sectional area of muscle fibers was processed by using the Origin software.The contents of superoxide dismutase(SOD),glutathione peroxidase(GSH-Px)and peroxisome proliferator-activated receptor γ-coactivator 1α(PGC-1α)and tumor necrosis factor(TNF)-α,interleukin(IL)-1β,IL-6 in the serum of rats were mea-sured.Results After the intervention,the general condition semi-quantitative score of the Tuina group was significantly lower than the model group(P<0.01),while the exhaustion swimming time and OFE distance were significantly higher than the latter group(P<0.05,P<0.01).(2)HE staining showed that the significant atrophy of erector spinal muscle cells in the model group,was significantly relieved in the Tuina group.(3)Compared with the blank group,the contents of SOD,GSH-Px and PGC-1α in erectus muscles decreased significantly(P<0.01),while those of TNF-α,IL-1β and IL-6 in the se-rum of the model group increased significantly(P<0.01).However,compared with model group,the contents of SOD,GSH-Px and PGC-1α in erectus muscle increased significantly(P<0.05,P<0.01),while those of TNF-α,IL-1β and IL-6 of the Tuina group decreased significantly(P<0.05,P<0.01).Conclusion Tuina in the back can regulate the oxidative stress response,reliever the inflammatory re-sponse and improve the motor behavior of CFS rats.

ObjectiveTo compare the safety of cavitron ultrasonic surgical aspirator (CUSA) combined with high-frequency electrotome versus harmonic scalpel in hepatectomy.MethodsClinical data of 102 patients undergoing hepatectomy using CUSA combined with high-frequency electrotome or harmonic scalpel in Sun Yat-sen Memorial Hospital of Sun Yat-sen University between January 2011 and January 2014 were retrospectively studied. The patients were divided into the hepatectomy using CUSA combined with high-frequency electrotome group (the CUSA group,n=53) and the hepatectomy using harmonic scalpel group (the harmonic scalpel group,n=49). In the CUSA group, 32 were males and 21 were females with the average age of (48±11) years old. In the harmonic scalpel group, 31 were males and 18 were females withthe average age of (49±13) years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. Porta hepatis was occluded by selective porta hepatis exclusion during hepatectomy. The interval of selective portal hepatis exclusion, intraoperative blood loss and postoperative complications of the two groups were observed. The observation indexes of the two groups were compared usingttest or Chi-square test.ResultsThe interval of selective portal hepatis exclusion of the CUSA group was (13±2) min, which was signiifcantly shorter than (23±3) min of the harmonic scalpel group (t=-19.946, P<0.05). The intraoperative blood loss of the CUSA group was (293±53) ml, which was signiifcantly less than (468±54) ml of harmonic scalpel group (t=-16.510,P<0.05). The incidence of biliary leakage of the CUSA group was 4% (2/53), which was signiifcantly lower than 16% (8/49) of the harmonic scalpel group (χ2=4.537, P<0.05).ConclusionsCompared with harmonic scalpel, CUSA combined high-frequency electrotome in hepatectomy has the advantages of less intraoperative blood loss, shorter interval of selective portal hepatis exclusion and lower incidence of biliary leakage. Thus, the safety of hepatectomy is enhanced signiifcantly.

Objective To investigate the application value of hepatectomy via anterior approach in the surgery of primary liver cancer. Methods Clinical data of 138 patients with primary liver cancer undergoing hepatectomy in Sun Yat-sen Memorial Hospital and Lingnan Branch, the Third Afifliated Hospital of Sun Yat-sen University from June 2011 to June 2014 were retrospectively analyzed. There were 97 males and 41 females, aged 36 to 87 years with a median age of 52 years. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients were divided into the anterior approach hepatectomy group (anterior group, n=63) and traditional approach hepatectomy group (traditional group, n=75). Preoperative general data, intra-, post-operative parameters of two groups were compared using t test or Chi-square test. Results In the anterior group, the percentage of patients with Child-Pugh liver function grade B and C, multiple tumors and tumor diameter>10 cm was 73%(46/63), 44%(28/63) and 16%(16/63) respectively, which were signiifcantly higher compared with 37%(28/75), 17%(13/75) and 5%(4/75) in the traditional group (χ2=20.444, 12.051, 8.144;P<0.05). In the anterior group, the average intraoperative blood loss, transfusion volume of plasma and red blood cells were (428±17), (470±14) and (300±7) ml, which were signiifcantly lower compared with (517±11), (630±15) and (420±11) ml in the traditional group (t=-6.097,-2.927,-8.928;P<0.05). The rate of postoperative complications in anterior group was 10%(6/63), which was signiifcantly lower compared with 17%(13/75) in the traditional group (χ2=1.759, P<0.05). Conclusion For patients with poor liver function, multiple and large tumors, hepatectomy via anterior approach is a preferential surgical procedure rather than the traditional approach hepatectomy.

Objective To investigate the effect of multidrug resistance-associated protein (MRP) 5 silenced by small interfering ribonucleic acid (siRNA) on the multi-drug resistance of human hepatocellular carcinoma (HCC) cells. Methods Multi-drug resistance human HCC cells HepG2/epirubicin(ADM) were constructed and MRP5-siRNA fragment was synthesized. The cells were transfected with Lipofectamine 2000. The experiment was divided into three groups. HepG2/ADM cells transfected with MRP5-siRNA were allocated in the siRNA group, HepG2/ADM cells in the drug resistance group and HCC cells HepG2 in the common group. The cellular sensitivity to chemotherapy agents was detected by MTT assay. The relative expression of MRP5 messenger ribonucleic acid (mRNA) was detected by real-time fluorescence quantiifcation RT-PCR. The expression of MRP5 protein was detected by Western blot. Cellular apoptosis was detected by flow cytometry. Multiple groups were compared by one-way ANOVA and two groups were compared by LSD-t test or t test. Results The half-inhibitory concentration (IC50) of cells for ADM, lfuorouracil (5-FU) and oxaliplatin (OXA) in the drug resistance group was (0.317±0.035), (3.785±0.523) and (0.129±0.009) mg/L, significantly higher compared with (0.022±0.008), (0.163±0.010) and (0.080±0.012) mg/L in the common group (t=14.202, 11.993, 13.937;P<0.05). The IC50 for the three chemotherapy drugs in the siRNA group was (0.180±0.008), (1.657±0.014) and (0.055±0.007) mg/L, signiifcantly lower than those in the drug resistance group (LSD-t=-6.609,-7.044,-11.257;P<0.05). The relative expression level of MRP5 mRNA in the drug resistance group was 3.858±0.481, signiifcantly higher compared with 1.000±0.374 in the common group (LSD-t=9.600, P<0.05). The relative expression level of MRP5 mRNA in the siRNA group was 1.377±0.141, signiifcantly lower than that in the drug resistance group (LSD-t=-11.669, P<0.05). The gray value of MRP5 protein was 2 245 in the drug resistance group, signiifcantly up-regulated compared with 58 in the common group. The gray value of MRP5 protein was 816 in the siRNA group, signiifcantly down-regulated compared with that in the drug resistance group. The cell apoptosis rate in the siRNA group was (25.1±3.7)%, significantly higher compared with (3.3±0.7)% in the drug resistance group (t=9.950, P<0.05). Conclusions MRP5 is associated with the multi-drug resistance of human HCC cells. MRP5 gene silenced by siRNA can enhance the sensitivity of HCC cells towards chemotherapy drugs.

Benign anastomotic stenosis remains a common complication after bilojejunal anastomosis. Its pathogenesis includes the histology of bile duct, bile erosion, and inappropriate choice of surgical anastomosis or suture materials. Biliojejunal anastomotic stenosis can be determined preoperatively by MRCP, CT, and three-dimensional image reconstruction. Surgery remains treatment of choice for most cases, including surgical reconstruction and minimally invasive treatment, while the incidence of restenosis, residual stone, and reoperation is still high. Surgeons are still in search of optimal treatment modality to avoid anastomotic stenosis. In this article, we review the literature and summarize the latest clinical progress in the diagnosis and treatment of biliojejunal anastomotic stenosis combined with hepatic ductal stones.