OBJECTIVETo establish a RP-HPLC-PDA method for determination of five triterpenic acids (pomolic acid, hawthorn acid, corosolic acid, oleanolic acid and ursolic acid) in different parts of Salvia chinensis.

METHODThe isocratic elution and separation was achieved on a Kromasil C18 column (4.6 mm x 250 mm, 5 microm), using acetonitrile-water (90:10) as the mobile phase at a flow rate of 0.8 mL x min(-1). The detection wavelength and column temperature were set at 205 nm and 28 degrees C, respectively.

RESULTThe calibration curves of pomolic acid, hawthorn acid, corosolic acid, oleanolic acid and ursolic acid were linear over the ranges of 0.096 0-2.400, 0.1230-3.075, 0.2420-6.050, 0.2830-7.075 and 0.2730-6.825 microg (r = 0.9998, 0.9997, 0.9999, 0.9995, 0.9999), respectively. The average recoveries were 98.43%, 98.13%, 100.6%, 98.19% and 99.15%%, respectively, with RSD (n=6) being 1.3%, 0.67%, 1.2%, 0.87% and 0.43%.

CONCLUSIONThe proposed method is so simple and highly reproducible that it promises to be applicable for determination of major triterpenic acids in S. chinensis.

Chromatography, High Pressure Liquid ; methods ; Drugs, Chinese Herbal ; chemistry ; Plants, Medicinal ; chemistry ; Salvia ; chemistry ; Triterpenes ; chemistry

OBJECTIVETo compare curative effects of various surgical procedures of bile duct stones.

METHODSTwo thousand nine hundred and fifty-five patients with intrahepatic bile duct lithiasis who had undergone various surgical procedures were analysed with Meta-analysis. Some of these cases were reported in Chinese Medical Journals from January 1990 to March 2001 and others were from Tongji Hospital.

RESULTSThere was a significant difference between curative effects of non-hepatectomy and that of hepatectomy (chi(2) = 62.945, P < 0.01), and the outcomes of hepatectomy were much better than those of non-hepatectomy with OR(S) equalled to 0.303 (0.222 - 0.413). There was not a significant difference between curative effect of interposed jejunum and that of hepatectomy (95% CI of RR from 0.98 to 1.04). All the other operation, effects were worse than hepatectomy (upper limit of 95% CI of RR < 1).

CONCLUSIONSHepatectomy is the most ideal surgery for intrahepatic bile duct stones and operation methods should be diversified since good effect could also be obtained when other operations are performed on suitable cases.

Bile Duct Diseases ; surgery ; Bile Ducts, Intrahepatic ; Choledochostomy ; statistics & numerical data ; Cholelithiasis ; surgery ; Follow-Up Studies ; Hepatectomy ; statistics & numerical data ; Humans ; Treatment Outcome

OBJECTIVETo investigate the technique of radical pancreaticoduodenectomy for malignant tumor in pancreatic head with pressed superior mesenteric blood vessel or portal vein.

METHODSFrom March 2005 to March 2007, thin slice scan and vessel-reconstruction of 56 patients of malignant tumor in pancreatic head with pressed superior mesenteric blood vessels or portal vein were carried out using multidetector spiral CT to evaluate whether peripheral vessels of pancreatic tumor were invaded and whether the tumor was resectable. During the operation, 3 vascular blocking bands for superior mesenteric vein, portal vein and spleen vein or 4 vascular blocking bands (additional one for inferior mesenteric vein) were preset. Under the cross and traction between superior mesenteric vein and superior mesenteric artery, resected the uncinate process of pancreas thoroughly. Using those methods, radical pancreaticoduodenectomy for 56 patients above-mentioned were successfully accomplished.

RESULTSThe accuracy for preoperative judging by using multidetector spiral CT whether the peripheral vessels of pancreatic cancer were invaded and whether the tumor was resectable was 98% and 100% separately. Thirty-seven of 56 patients, whose superior mesenteric blood vessels or portal veins were pressed by the tumor of pancreatic head, were operated using 3 vascular blocking bands and 2 patients using 4 vascular blocking bands, followed by suturing the bleeding points of the superior mesenteric vein with 5-0 vascular suture Proline. One patient's superior mesenteric vein was partially resected and restored. The operations cost 5-8 h each and the blood loss was 200-600 ml. There were no operative or postoperative hemorrhage or pancreatic juice leakage. According to the follow-up up to now, 2 patients died of multiple live tumor metastases 7 and 9 months separately after operation, the other 54 patients were still alive.

CONCLUSIONSThin slice scan and vessel-reconstruction using multidetector spiral CT can accurately judge whether the blood vessels near the pancreatic tumor were invaded and whether the tumor was resectable, using 3 vascular blocking bands or 4 vascular blocking bands and cross, traction of the superior mesenteric blood vessels, operator can easily accomplish the radical pancreaticoduodenectomy of malignant tumor in pancreatic head with pressed superior mesenteric blood vessels and portal vein, which was not resectable or need combined resection of the blood vessels in the traditional opinion.

Adult ; Aged ; Female ; Humans ; Male ; Mesenteric Artery, Superior ; pathology ; surgery ; Mesenteric Veins ; pathology ; surgery ; Middle Aged ; Neoplasm Invasiveness ; Pancreas ; pathology ; Pancreatic Neoplasms ; pathology ; surgery ; Pancreaticoduodenectomy ; methods ; Portal Vein ; pathology

BACKGROUNDBudd-Chiari syndrome with hepatic vein occlusion (HVBCS) can induce severe portal hypertension and liver damage. We retrospectively analyzed hepatic CT features of HVBCS and evaluated the usefulness of triphasic enhancement of CT examinations and CT angiography (CTA) in its diagnosis.

METHODSTwenty-five cases with HVBCS, confirmed by digital subtraction angiography (DSA), received a triphasic enhancement CT scan within one week before DSA. The CTA images of the relevant blood vessels were reconstructed with maximum intensity projection, volume rendering and oblique reformat techniques.

RESULTSCompared with DSA, the detection rate of transverse CT and CTA images for abnormal hepatic vein were 81.7% (58/71) and 95.8% (68/71) (chi(2) = 7.044, P = 0.008), for membranous obstruction were 47.4% (9/19) and 84.2% (16/19) respectively (chi(2) = 5.729, P = 0.017), for segmental obstruction were 88.0% (22/25) and 100% (25/25) respectively (chi(2) = 1.418, P = 0.234). The detection rates for hepatic vein stenosis were 100% with each method. Diffuse hepatomegaly was found in all 6 cases in acute phase and 3 of 19 cases in chronic phase who had severe obstruction of three hepatic veins without patent intrahepatic collaterals. The other 16 cases in chronic phase had hepatatrophia to different extents related to the obstructed hepatic vein. All in acute phase and 15 in chronic phase presented typical patchy enhancement initially in caudate lobe and perihilar areas and enlarged with time delay. In all cases, parenchyma areas with atrophy, necrosis and congestion demonstrated lower and later enhancement. In all the parts, which had normal enhancement at least one patent outflow hepatic vein, accessory hepatic vein or collateral vessel was detected.

CONCLUSIONDynamic enhancement CT examination by multislice spiral CT not only could improve the diagnosis of HVBCS by CTA technique, but also could noninvasively provide anatomical information and reveal damage to the hepatic parenchyma.

Adult ; Angiography, Digital Subtraction ; Budd-Chiari Syndrome ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tomography, Spiral Computed ; methods

Objective To investigate the prevalence ofperioperative depression and anxiety in patients who underwent acoustic neuroma resection (ANR) and to analyze their associated factors.Methods This survey recruited 62 patients who accepted ANR from June 2010 through June 2011 in our department. Participants were interviewed one day preoperation and one day pre-discharge with 2questionnaires:the Zung self-rating depression scale (SDS) and the Zung self-rating anxiety scale (SAS).Personal information and clinical data were also documented. Facial nerve outcomes were reported according to the House-Brackmann scale.Statistical analysis was performed with the SPSS,version 13.0,using two-sample t-test,paired t-test,pearson Chi-square test and Binary classification unconditional logistic regression analysis.Significance was accepted at P＜0.05. Results Thirteen patients (20.9％)had depression and/or anxiety preoperation while 24 patients (38.7％) had postoperation.Patients with a long preoperative hospital stay,young in age (Wald=5.958,OR=0.910,P=0.015) and associated with chronic diseases (Wald=6.578,OR=14.591,P=0.010) were prone to preoperative depression and/or anxiety.Female patients (Wald=4.258,OR =4.572,P=0.039),young patients (Wald=8.152,OR=0.913,P=0.004) and patients with facial paralysis of H-B grade Ⅳ-Ⅵ (Wald=6.310,OR=7.630,P=0.012) had a higher incidence of postoperative depression and/or anxiety.Occupation,educational level,economic status,hearing loss or balance dysfunction of the patients showed no statistically significant impact on the incidence of the condition. Conclusions Patients undergoing ANR tend to have a high incidence of perioperative depression and/or anxiety.Surgeons should pay special attention to and take effective measures for female,young patients and those with facial dysfunction because they,in particular,are prone to postoperative depression and/or anxiety.

OBJECTIVETo explore the improvement of typing and reasonable surgical treatment for pancreatic ductal stone (PDS).

METHODSTotally 89 patients with pancreatic ductul stone treated underwent surgeries from January 2000 to December 2012 were involved into this study. There were 57 male and 32 female patients, the average age was (52 ± 23) years. According to the magnetic resonance cholangiopancreatography imaging and finding during surgery, pancreatolithiasis was classified into three types: type I, the stones were located in the main pancreatic duct; type II, the stones were located both in main and branch pancreatic duct; type III, the stones were diffusely scattered in the branch pancreatic duct; the position of PDS within pancreatic parenchyma were subtitled. In this group, 43 type I PDS were extracted with endoscopic papillotomy or endoscopic pancreatic sphincterotomy, or pancreatolithotomy plus pancreato-jejunal lateral anastomosis with wide anastomotic stoma; 39 type II cases were treated by pancreatolithotomy plus pancreato-jejunal lateral anastomosis or/and resection of pancreatic section; 7 type III PDS were managed with resection of pancreatic section.

RESULTSAll surgeries were performed successfully. Among complications, 6 cases (6.7%) were pancreatic leakage which recovered after systematic non-surgical treatment, 2 cases (2.2%) were anastomotic bleeding which led to 1 death, 6 cases (6.7%) were residual pancreatolithiasis in branch pancreatic duct type. Seventy-eight patients were followed up for 6 to 131 months, 57 cases were still alive so far. Five cases were intermittent abdominal pain, 7 cases were diabetes resulted from 2 subtotal pancreatectomy and 5 distal pancreatectomy, 5 cases occurred pancreatolithiasis recurrence and 3 underwent secondary surgeries.

CONCLUSIONSThe basis of this modified typing of pancreatolithiasis is the position of stone in pancreatic duct rather than pancreas parenchyma. It is more important and valuable for surgical principle of taking stones out completely and maintaining pancreatic function.

Adult ; Calculi ; classification ; surgery ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Diseases ; classification ; surgery ; Pancreatic Ducts ; pathology ; Sphincterotomy, Endoscopic ; Young Adult

OBJECTIVETo investigate the causes and the measures of prevention and cure of the dangerous complications (bleeding, pancreatic fistula, biliary fistula and death) after radical pancreatoduodenectomy (RPD) for periampullary malignant tumor.

METHODSThe rate and management of dangerous complications of 156 cases with RPD which were continuous performed by Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology between January 2006 and June 2008 were analyzed retrospectively, including 97 males and 59 females with 37 - 79 years old, the mean age was 56.9 years old.

RESULTSAmong the 156 cases with RPD, four patients had massive hemorrhage of gastrointestinal tract due to stress ulcer, two patients had bleeding in the pancreas-intestinal anastomosis after the operation, the rate of postoperative bleeding was 3.9% (6/156). One patient with massive hemorrhage of gastrointestinal tract due to stress ulcer had severe pulmonary infection and ARDS, and died of respiratory failure finally (the overall mortality rate was 0.7%) after ICU for two months. One patients with bleeding in the pancreas-intestinal anastomosis had pancreatic fistula (the rate of pancreatic fistula was 0.7%) 3 days after the second laparotomy to open the jejunum of the pancreas-intestinal anastomosis and make a transfixion of the bleeding points in the stump. Another patient who had the tumor located in the inferior segment of the bile common duct had biliary fistula 11 days after the operation (the rate of biliary fistula was 0.7%). Two patients with fistula had good recovery by expectant treatment of ultrasound-guided puncture and drainage.

CONCLUSIONSPrompt and effective treatment of the complications of bleeding, pancreatic fistula, biliary fistula could maximally decrease the perioperative death rate.

Adult ; Aged ; Ampulla of Vater ; Biliary Fistula ; etiology ; prevention & control ; Common Bile Duct Neoplasms ; surgery ; Duodenal Neoplasms ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pancreatic Fistula ; etiology ; prevention & control ; Pancreatic Neoplasms ; surgery ; Pancreaticoduodenectomy ; adverse effects ; mortality ; Postoperative Complications ; prevention & control ; Postoperative Hemorrhage ; prevention & control ; Retrospective Studies

Objective　To explore the effect of nordihydroguaiaretic acid (NDGA) on the expressions of vascular endothelial growth factor (VEGF) and its receptor, kinase-inserted domain containing receptor(KDR) and the possible mechanism. Methods　The expression of VEGF in human malignant glioma cell line SHG-44 and that of KDR in human umbilical vein endothelial cell (HUVEC) line ECV-304 were observed 1～3 d after NDGA treatment with immunohistochemistry, in situ hybridization and image analysis. Results　The expression of VEGF was declined at protein or mRNA levels in SHG-44 cells after treated with 100 μmol/L NDGA for 1 to 3 d. The expression of KDR in endothelial cells with 100 μmol/L NDGA treatment for 1 to 3 d was decreased too, in a more obvious way compared with the decline of VEGF expression in SHG-44 cells. Conclusion　The results suggest that NDGA inhibits the expression of VEGF in glioma cells as well as that of VEGF receptor KDR in endothelial cells, which may be the important molecular mechanism of anti-angiogenesis of NDGA.

Objective To detect the immunogenicity of the recombinant DNA vaccine that encoded for neurite growth inhibitors: Nogo-A, oligodendrocyte myelin glycoprotein (OMgp), tenascin-R (TN-R) and myelin-associated glycoprotein (MAG) after the nerve injury under the help of pAdEasy, a kind of adenovirus plasmid being the vector of the DNA. Methods Sixteen 5-w-old Lewis rats were randomized into DNA vaccination group (vaccine group) and pAdEasy group. Rats in the vaccine group were immunized once weekly for a consecutive 8 w by bilateral injection of the recombinant plasmid into the musculus tibialis. The immunized animals in the 2 groups were exsanguinated each time before the vaccination for sera collection, and the qualitation and quantitation of the antibodies in the serum were detected by Dot-blot analysis and ELISA. Results The vaccine group could produce fusion-protein antibodies against Nogo-A, MAG, OMgp and TN-R at the 6th w of vaccine injection, while pAdEasy group could not. The valency of antiserum was shown by ELISA as 1:1 000 000 at the 6th w of vaccine injection and kept this level stably. Conclusion The DNA vaccine exclusively induces the generation of the fusion-protein antibodies against Nogo-A, MAG, OMgp and TN-R in vivo, which controls the favorable immunogenicity.

To further explore the role of rituximab when added to the CHOP-like regimen in the treatment of immunohistochemically defined non-germinal center B-cell subtype (non-GCB) diffuse large B-cell lymphoma(DLBCL), 159 newly diagnosed DLBCL patients were studied retrospectively based on the immunohistochemical evaluation of CD10, Bcl-6, MUM-1, and Bcl-2. Altogether, 110 patients underwent the CHOP-like regimen, and rituximab was added for the other 49 patients. Cox regression analysis showed that compared with the CHOP-like regimen, the rituximab-based regimen(R-CHOP regimen) significantly decreased the risk of disease relapse and progression in CD10-negative patients (P=0.001), Bcl-6-negative patients (P=0.01), and MUM-1-positive patients (P=0.003). The risk of disease relapse in patients with non-GCB subtype (P=0.002) also decreased. In contrast, patients with the opposite immunohistochemical marker expression profile and GCB subtype did not benefit from treatment with the R-CHOP regimen. In addition, non-GCB subtype patients had a significantly higher expression rate of Bcl-2 than GCB subtype patients (P=0.042). Although univariate analysis found that both Bcl-2-positive and -negative patients had significantly higher event-free survival rates with the R-CHOP regimen, only Bcl-2 positivity (P=0.004) maintained significance in the Cox regression analysis. We conclude that the addition of rituximab can significantly improve the prognosis of patients with non-GCB subtype DLBCL, which is closely related to the expression of CD10, Bcl-6, MUM-1, and Bcl-2.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antibodies, Monoclonal, Murine-Derived ; therapeutic use ; Antineoplastic Agents ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Cyclophosphamide ; therapeutic use ; Disease Progression ; Disease-Free Survival ; Doxorubicin ; analogs & derivatives ; therapeutic use ; Female ; Follow-Up Studies ; Germinal Center ; pathology ; Humans ; Interferon Regulatory Factors ; metabolism ; Lymphoma, Large B-Cell, Diffuse ; drug therapy ; metabolism ; pathology ; Male ; Middle Aged ; Neprilysin ; metabolism ; Prednisone ; therapeutic use ; Proportional Hazards Models ; Proto-Oncogene Proteins c-bcl-2 ; metabolism ; Proto-Oncogene Proteins c-bcl-6 ; metabolism ; Recurrence ; Retrospective Studies ; Rituximab ; Survival Rate ; Vincristine ; therapeutic use ; Young Adult