Objective To explore risk factors relating to occurrence of spontaneous rupture (SR)of hepatocellular carcinoma (HCC). Methods We retrospectively reviewed medical records of 409 HCC patients treated in our department from Jan. 1st 2005 to Aug. 31st 2009. Clinicopathologic factors were explored for their possible association with occurrence of SR by univariate and multivariate analysis using Logistic regression model. Results Among 409 patients, SR occurred in 40 patients (9. 8% , 40/409).Type of SR was defined according to presentation of acute abdominal emergency, especially unstable hemodynamic status. Nineteen cases (4. 7%, 19/409) were grouped as type of HCC-SR Ⅰ and 21 cases (5. 1% ,21/409) as HCC-SR Ⅱ. Patients in the two groups possessed similar hepatitis infection status,severity of background liver disease and tumoral factors except for tumoral location, while HCC-SR Ⅰ group often needed emergency treatment demonstrating elevated values of aspartate aminotransferase (AST) and WBC, decreased PLT counts and worse Child-Pugh classification. Patients in the HCC-SR Ⅱ group had more opportunities of receiving curative hepatectomy and had longer overall survival. The 1,2 and 3 year survival rates were 26. 3 % (5/19), 5. 3% ( 1/19 ) and 0% (0/19)in the HCC-SR Ⅰ group and 66. 7% ( 14/21 ),42.9% (9/21)and 19. 5% (5/21) in the HCC-SR Ⅱ group, respectively. Differences reached statistical significance( P = 0. 011,0. 009,0. 049). Multivariate analysis identified that severity of concomitant liver cirrhosis , WBC ＞ 10 × 109/L and AST level more than twice normal (2N) as independent risk factors associating with occurrence of HCC-SR Ⅰ , while elevated values of AFP and presence of tumor thrombi in portal vein branch related to HCC-SR Ⅱ. Conclusions HCC-SR includes two different types, since different risk factors predict occurrence of each HCC-SR type.

Objective To compare the clinical outcomes of segmental pulmonary veins isolation (SPVI) and circumferential pulmonary veins ablation (CPVA) for patients with paroxysmal atrial fibrillation. Methods Sixty-eight patients with paroxysmal atrial fibrillation from January 2004 to April 2008 were divided into SPVI group (30 cases) and CPVA group (38 cases).The mean procedure time,the mean fluoroscopy time and relapse rate were compared. Results The mean procedure time in CPVA and SPVI group had no significant difference [(171.0 ± 25.8) min vs (168.2 ± 21.7) min, P = 0.579], but the mean fluoroscopy time in CPVA group [(38.5 ± 8.4) min]was less than that in SPVI group [(45.8 ± 16.1) min (P= 0.019). Mean term of the follow up was (17.1 ± 7.8) months. Relapse rate in CPVA group was less than that in SPVI group (5.3% vs 23.3%, P= 0.029). Both groups had no severe complications. Conclusion In patients with paroxysmal atrial fibrillation, CPVA strategy provides a more favourable clinical outcomes and less fluoroscopy time.

Air ; Animals ; Diving ; Male ; Rats ; Rats, Sprague-Dawley ; Reactive Oxygen Species ; metabolism ; Spleen ; metabolism

OBJECTIVETo analyze the changes of patients with type 2 diabetes in different stages in glucagon (GC) and free fatty acid (FFA) in fasting, OGT and L-Arg experiments, and discusses the role of pancreatic alphabeta cells in diabetes pathogenesis by studying the relations among indexes such as glucagon (GC), free fatty acid (FFA) and blood glucose (BG), insulin, insulin homeostasis model (HOMA) and glucose metabolism hormone secretion curve, in order to provide theoretical basis for the treatment of diabetes.

METHODStudy objects were divided into the T2DM group (45 cases), the IGT group (28 cases) and the NGT group (30 cases) for an OGTT experiment and then an L-Arg experiment on the next day. Under the fasting state, their blood glucose (FBG), insulin (F), glucagon (FGC), free fatty acid (FFA) were detected to calculate HOMA-beta, insulin sensitivity index (ISI) and HOMA-IR of different groups. Meanwhile, efforts were made to calculate different time quantum detected in OGTT and L-Arg experiments and area under the curve AUC(BG), AUC(INS) and AUC(GC).

RESULTObvious overall differences were observed in FFA and FGC of the three groups. FGC of each group was negatively correlated with HOMA-beta and ISI. Among all of the 103 study objects, FGC was positively correlated with FBG and HOMA-IR and negatively correlated with HOMA-beta and ISI, with no correlation with FINS; FFA was positively correlated with FBG, HOMA-IR and negatively correlated with FINS, HOMA-beta, ISI. FGC and FFA were positively correlated in the T2DM group and the IGT group, but with no statistical correlation in the NGT group. The sequence of the three study objects was T2DM > IGR > NGT in AUC(GC) in the OGTT experiment and T2DM > IGR > NGT in in AUC(GC) in the L-Arg experiment, with the significant positive correlation between AUC(GC) and AUC(BG) and significant negative correlation with AUC(INS).

CONCLUSIONGlucagon and free fatty acid of T2DM and IGT patients increased, which was positively correlated with blood glucose and HOMA-IR and negatively correlated with INS, HOMA-beta and ISI. The increase in glucagons of T2DM and IGT patients indicated inappropriate secretion of pancreatic alphabeta cells among patients with type 2 diabetes.

Adult ; Blood Glucose ; metabolism ; Diabetes Mellitus, Type 2 ; metabolism ; Fatty Acids, Nonesterified ; metabolism ; Female ; Glucagon ; blood ; Humans ; Insulin ; secretion ; Islets of Langerhans ; secretion ; Male ; Middle Aged

Objective: To study the relation of plasma Se to oxidative stress in the patients with primary glomerular diseases (PGS) and its clinical significance. Methods: Plasma Se concentration ,GSH-Px and SOD activities and contents of MDA in 45 patients with PGS and 20 normal control (NC)were measured by catalytic polarography and colorimetric assay. Serum creatinine, urea nitrogen and uric acid concentrations in these patients were determined simultaneously. Results: 1. Plasma Se contents of both PGS patients of normal(groupⅠ) and impaired renal function (groupⅡ) were significantly lower than those in NC;2. PGS patients of groupⅠandⅡhad significantly lower plasma GSH-Px and SOD activities than NC and their MDA contents were siginificantly higher. 3. Plasma GSH-Px and SOD activities and MDA contents between groupⅠand Ⅱ were not different; 4. Multiple logistic regression analysis showed that plasma Se content in patients with PGS was positively related to plasma GSH-Px , SOD activities and negatively correlated with MDA. Serum creatinine concentrations were negatively correlated significantly with plasma Se, GSH-Px, SOD and positively related to MDA. Conclusion: Plasma Se deficiency may be an important non-immune factor resulting in or worsening PGS through weakening body抯 antioxidative defence. It is suggested that sufficient Se supplementation in practice may be obviously beneficial to oxidative stress in the patients with PGS.

Objective:To assess the effects of different fluid therapies on myocardial function,blood-spinal cord barrier and water content of spinal cord after acute high level spinal cord injury(SCI) in rats.Methods: Thirty-two male SD rats, weighing (300?20) g, were anesthetized intraperitoneally with pentobarbital (40 mg/kg). A cervical laminectomy extending from C6-T1 was performed and the experimental acute cervical 7 spinal cord injury model was created by modified Allen’s method,and then the rats were randomly divided into 4 groups(n=8): control group(C group) with no fluid resuscitation, 7.5% hypertonic saline group(HS group), 6% hydroxyethyl starch group(HES group) and banlanced solution group (BS group).Fifteen minutes after injury, rats of each treatment groups were given (iv. at 4 ml/kg) above-mentioned fluids in 4 min,then continuously infused at a rate of 10 ml?kg -1 ?h -1 over for 30 min.MAP,HR,left ventricular systolic pressure (LVSP),and ?dp/dt max were recorded at 5,15 and 30 min.At 30 min, 0.5% Evan's blue(EB) 1 ml was injected iv.Two hours later the animals were sacrificed and the injured segments of spinal cords were removed for determination of water content and EB content.Results:After SCI there were no differences of HR at different time points in each group. At 5 min,HS significantly increased MAP,LVSP and ?dp/dt max compared with control group(P

Objective:To observe the changes of ? 1 -adrenergic receptors expression in a high-level spinal cord injury (SCI) rat model,providing information for studying the mechanisms of severe hypertension of autonomic dysreflexia.Methods: Adult male Wistar rats were divided into 2 groups: sham-lesion group(n=6) and SCI group(n=36). Severe spinal crush injury was induced at T 4 using modified Allens device in SCI group, while sham-lesion group received laminectomy at T 4 only.The expression of ? 1 -adrenergic receptors mRNA in different segments of spinal cord:injured segment(I), above(A) and below(B) the injured site, were measured by reverse-transcription polymerase chain reaction (RT-PCR) 1 d, 3 d, 7 d, 2 weeks, 3 weeks and 4 weeks after SCI. Results: Compared with sham-lesion group,the express of ? 1 -adrenergic receptors mRNA in group A decreased 3 d after SCI and dropped to the least 1 week later,and restored to the normal level 2 weeks later.The impairment of ? 1 -adrenergic receptors mRNA expression in group I occured immediately after SCI and hit the lowest value 3 d later,and did not recover to the nomal 4 weeks later.Decrease of ? 1 -adrenergic receptors mRNA expression in group B were detected 1 d after SCI,but began to increase on 3 d and exceeded that of group C 4 weeks later.Conclusion: In chronic SCI rat models ? 1 -adrenergic receptors expression increases below the level of SCI,which might be a contributing factor to the severe hypertension of autonomic dysreflexia.

AIM: The study aimed to observe the difference in hypertrophy responses in cardiomyocytes of cultured neonatal endothelial nitric oxide synthase (eNOS) gene knockout mice and wild mice by RNA quantitation detection and cell area estimation. METHODS: The experiment was performed at the Empirical Study Center of Medicine Department in Shunde Profession and Technique Institution in August 2007. ①Male or female C57BL/6 stock neonatal eNOS knockout mice and wild mice aged 1-3 days were selected. ②Cultivated Mouse cardiomyocytes were divided into experimental and control groups 72 hours later. Adrenergic receptor agonist phenylephrine was cultured with cardiomyocytes. DMEM of the same volume as the experimental group was added in the medium in the blank control group. ③DNA, RNA quantitation detection and cell area estimation methods was used to observe the responses contrast in cell proliferation and hypertrophy of cardiomyocytes in cultured neonatal eNOS gene knockout mice and wild mice. RESULTS: ①The oval or rhombus cardiomyocytes were observed 72 hours after phenylephrine incoporation under a microscope. ②RNA fluorescence value increased in cultured neonatal cadiomyocyte and collagenoblast in the experimental group compared to the control group (P

Objective　To investigate the clinical feasibility of robotic-assisted laparoscopic radical cystectomy (RARC) by da Vinci surgical system and to summarize the operative technique and outcomes.Methods　From December 2007 to March 2012,22 patients (20 males and 2 females) with the bladder urothelial carcinomas were enrolled.Patient age was from 37 -72 years (rnean 62 years) ; the body mass index was 22.5 - 30.1 kg/m2 ( mean 26.1 kg/m2 ) ; and the American Society of Anesthesiologists score was 1 -2. All patients were diagnosed preoperatively with muscle -invasive or high-risk non-muscle-invasive bladder urothelial carcinomas in cystoscopic biopsy.There were no adjacent organ infiltration,pelvic lymph node involvement or dístant metastasis found on preoperative examinations.The clinical stage of all cases was under T2 N0 M0.Patients were under general anesthesia for RARC with urinary diversion.Extracorporeal urinary diversions (orthotopic ileal neobladder for 2 patients and ileal conduit urinary diversion for 13 patients)were performed on 15 patients and intracorporeal urinary diversions ( ileal conduit urinary diversion for 2 patientsand orthotopic ileal neobladder for 5 patients) were performed on 7 patients.　Results　All RARC procedure were completed on patients as planned.The operative time was 300 - 667 min ( mean 480 min)with estimated blood loss of 100 - 1200 ml (mean 550 ml),and the number of removed lymph nodes was 6 -25 (mean 15). All patients resumed ambulation on the 2nd to 3rd day postoperatively,and bowel function recovered on the 3rd or 4th day postoperatively.The length of hospital stay was 8 - 35 days ( mean 16 days).For patients underwent orthotopic ileal neobladder,the ileoureteral stents and the urethral catheter were removed 1 month after a cystogram confirming watertight healing.During the follow up of 4 -49 months (mean 32 months),2 patients had disease recurrence and 1 patient died of disease development and 2 patients had developed hydronephrosis.The other patients were with good urinary continence and normal renal functions.　Conclusions　RARC with urinary diversion are feasible and safe treatment option for bladder urothelial carcinoma.This technique will be more popular with more extensive surgical experiences and large randomized clinical trials.

Objective Basing on overall survival(OS)of HBsAg-positive hepatocellular carcinoma(HCC)patients we evaluate several currently used HCC staging systems for OS predictivity.Methods This retrospective study included 775 patients with HBsAg-positive HCC treated in our department during 11-year period from Jan.2000 to Feb.2010.Clinicopathologic factors were evaluated for their possible association with OS in univariate and multivariate analysis using Cox proportional hazard model.Receiver operating characteristics(ROC)analysis with calculation of the area under the curve (AUC),sensitivity,and specificity was applied to define cutoff point values where appropriated and to assess HCC staging systems for their predictive ability of OS.Results The 1-,2-,3-and 5-year OS rates were 21.3％(165/775),9.4％(73/775),4.9％(38/775)and 1.7％(13/775),respectively.Multivariate analysis identified that severity of concomitant liver cirrhosis(B =4.519),treatment modality (B =4.888),ALT≥2N(B =4.068),portal vein tumor thrombi(B =0.537),spontaneous rupture(B =5.033)and inferior vena cava tumor thrombi(B =7.049)as independent risk factors influencing OS.NSMCS(North Sichuan Medical College Score)exhibited best performance predicting OS with AUC 0.801 (95％ CI 0.761-0.840),sensitivity of 78.8％,specificity of 69.3％ at NSMCS ≥-2.Median survival time reached statistically significant difference(13.6 mons,3.4 mons vs.1.3 mons,x2 =467.636,P =0.000).Conclusions Multiple factors determine OS in patients with HBsAg-positive HCC.NSMCS staging system demonstrates better predictability for the survival of HBsAg positive HCC patients.