Parenteral nutrition associated cholestasis (PNAC) mainly occurs in children. Currently identified risk factors include premature infants, lack of enteral feeding, repeated infections, and toxicity or nutrient deficiency of parenteral nutrition solution. Recent studies have shown that nuclear receptor-mediated bile acid transporter may be the key site of PNAC pathogenesis, in which some cytokines play important roles. New anti-cholestatic therapy based on the regulation of expression of these molecules may prevent end-stage liver disease caused by PNAC.

Objective To explore a simple, effective and stable method for the isolation and purification of Kupffer cells from rat liver, enabling further study on the structure and function of these cells in vitro. Methods After laparotomy, a catheter was inserted into the portal vein and secured with artery clamp. Then, the rat liver was perfused and digested with solution Ⅰ and solution Ⅱ containing 0.05% collagenase Ⅳ respectively. The cell suspension was centrifuged with isopycnic sedimentation in a two-step Percoll gradient to harvest Kupffer cells. The isolated Kupffer cells were purified by selective adherence after 30 min of cultivation, and identified by evaluation of phagocytosis of India ink and peroxidase staining with DAB through light and electron microscopy. Results It was verified that the viability of isolated Kupfffer cells was more than 90% through Trypan blue staining. Those Kupffer cells could attach to plastic quickly and phagocytose ink, and had the appearance of "fried eggs" in positive peroxidase staining with a purity of 95%. Under the light microscopy, the appearance of newly isolated Kupffer cells was round with uniform shape and size. After two days of culture, Kupffer cells appeared to distend with irregular or stellate shape. The typical features were observed in the transmission electron micrographs. There were numerous pseudopods and occasional cup-like indentations in the cell membrane of Kupffer cells. The cytoplasm contained numerous types of lysosomes and other phagocytotic vesicles. Conclusion The method for isolating and culturing Kupffer cells in this study is effective and stable, and the biological characters are preserved in the cultured cells.

Obesity is a risk factor for colorectal cancer,but the underlying mechanism remains unclear.Adiponectin as an adipocyte-derived protein might play an important role between obesity and colorectal cancer.Here we review the current progress on molecular characteristics of adiponectin,the association of adiponectin with colorectal cancer,and the possible anti-tumor mechanism.

Objective To explore the feasibility and indications of T tube free laparoscopic common bile duct exploration (LCBDE). Methods The therapeutic results of LCBDE in 175 cases were reviewed retrospectively regarding the cure rate, complications, and postoperative hospital stay. Results LCBDE was performed successfully in 169 cases. Laparoscopic stone removal was failed in 6 out of the 175 cases. Two were converted to open exploration, the remaining 4 cases received intraoperative EST, the procedure failed in one case and it was converted to open surgery. T tube free LCBDE was performed successfully in 104 cases, in 36 out of the 104 cases laparoscopic transcystic common bile duct exploration was successful, the mean operation time was 140 minutes and the mean hospital stay after operation was 2 days; in other 68 cases laparoscopic choledochotomy with primary duct closure was performed, the mean operation time was 135 minutes and the mean hospital stay after operation was 3 days. T tubes were placed in 65 cases, the mean operation time for those patients was 150 minutes and the mean hospital stay after operation was 4 days, the mean T tube drainage time was 38 days. Retained stone was found in one out of the 65 cases, and was removed by EST. Bile leakage after removal of T tube developed in one case, and was cured by conservative therapy. No mortality nor complications such as bleeding or bile leakage occurred in remaining cases, asymptomatic hyperamylasia was found in 4 cases postoperatively. No stone recurrence or duct stricture were found at a mean follow-up of 13 months. Conclusions T tube free LCBDE as an alternative to the treatment of CBD stones is safe and feasible, with shorter hospitalization and avoiding the potential complications related to the T tube placement.

Objective To evaluate multiple instrument guide (MIG) in the use of laparoscopic choledochotomy (LCD). Methods The common bile duct (CBD) exploration time,surgical outcome,complications and damage of choledochoscope with or without MIG were compared retrospectively. Results MIG assisted LCD was performed successfully in all 25 cases,no complication such as bleeding,bile leakage or retained stones happened. CBD exploration time were 30 minutes,the mean number of removed stones was 6,no damage of choledochoscope was encountered. In 38 cases receiving traditional LCD,an average 5 pieces of stone were removed,the duct exploration time was 60 minutes. Two cases were complicated with hyperamylasia,stones were retained in one case. Choledochoscope was damaged in 6 times. Conclusions MIG facilitates LCD procedure,shortens operative time,and protects choledochoscope.

Objective:To establish a preoperative forecasting model for the nature of duodenal papillary tumors and to discuss its main predictors.Methods:A case-control study was conducted;the case group included patients with malignant duodenal papillary tumors and the control group included patients with benign duodenal papillary tumors.All the patients were from Changhai Hospital. Data of patients,including the demographic characteristics,clinical symptoms during onset,laboratory findings,and radiological data, were collected by face-to-face interviews or by reviewing the medical history.Chi-square,t-test or ANOVA were employed to performed univariate analysis.All factors with P values less than or equal to 0.25 in the univariate analysis were used as independent variables for multivariate analysis,and a Logistic regression forecasting model for the nature of duodenal papillary tumors was established.Results: Totally 199 patients with pathologically-confirmed duodenal papillary tumors were included in the present study,with 166 in the case group and 33 in the control group.Multivariate analysis showed that hemoglobin(Hb),total bilirubin(Tbil),direct bilirubin(Dbil), aspartate transferase(AST),alkaline phosphatase(AKP),gamma glutamyl transpeptidase(GGT),and carcinoembryonic antigen(CEA) were independent predictors for nature of duodenal papillary tumors,with their odds ratios(95% confidence interval)being 0.981 (0.959,1.003),0.867(0.794,0.948),1.207(1.075,1.355),1.028(1.008,1.048),0.996(0.992,1.000),1.002(1.000,1.004),and 0.974(0.953,0.994),respectively.Conclusion:The Logistic regression model,which takes into consideration of Hb,Tbil,Dbil,AST, AKP,GGT,and CEA,can be used to predict the nature of duodenal papillary tumors,and its clinical value need to be further studied.

Objective To explore the competency of community health administrators in a survey of such administrators at large in Shanghai. Methods McClelland's Competency Dictionary was used to set two benchmark positions, while the behavioral event interviewing and questionnaires were made to survey 19 community health service centers in Shanghai. Results The competency model benchmarking on the head of a medical branch consists of 6 character clusters, 11 characteristic items, 27 evaluation dimensions and 27 typical behavior descriptions. The model benchmarking on the community team leader consists of 5 character clusters, 8 characteristic items, 21 evaluation dimensions and 21 typical behavior descriptions. Conclusion Findings of the survey provide objective criteria for competence appraisal of community health administrators, and serve as reference for formulating their development plans as well.

Child ; Child, Preschool ; Humans ; Leukemia ; immunology ; prevention & control ; Vaccination

Objective To study the effect of preoperative selective arterial infusion chemotherapy (PSAIC) on large intestine cancer. Methods 63 patients with colorectal cancer underwent PSAIC with 5 fluorouracil,mitomycin and E adriamycin; the changes of clinical manifestation and pathology were observed and analyzed. Results (1)clinical manifestation:abdominalgia relieved in 18 patients and abdominal distention relieved in 16 patients.Improvement of hematochezia was found in 7 patients.In addition, of 13 patients with partial ileus, the clinical symptoms relieved in 9 patients. (2) pathology: there were karyopyknosis,karyorrhexis,coagulation and necrosis of cytoplasm in cancer cells. infiltration of inflammatory cells, edema and fibroelastosis in mesenchyne of cancer tissue. Proliferous intima and thrombus were also observed in the vessels. Most of these changes were moderate,and marked changes could also be seen in necrosis of cytoplasm and vessel intima proliferation. Conclusion PSAIC can control the focus of primary disease and the micrometastatic foci as well as improve the clinical symptoms, such as intestinal obstruction, and hematochezia, so PASIC is helpful to subsequent operation,and can improve the survival rate of patients with colorectal cancer.

Objective To investigate the therapeutic effects of traditional Chinese medicinal herbs(TCMH) on benign prostate hyperplasia(BPH) and their influence on proliferation and apoptosis of prostate cells in experimental mice. Methods A total of 120 male Kunming mice(weight,30 to 40 g)were randomly divided into 5 groups:①normal control group;②hyperplastic group;③normal saline(NS)(negative control)group;④TCMH group;⑤finasteride (positive control) group.Each group included 24 mice.The mice in normal control group were killed and their prostates were weighed.The BPH model was induced by implanting the urogenital sinus in the mice in other 4 groups.In the 61st day,the prostate weight of the mice in hyperplastic group was examined after they were killed;and the mice in the remaining groups were fed with NS,TCMH and finasteride,respectively.In the 91st day,the mice in these 3 groups were killed and their prostates were weighed.The proliferation and apoptosis of the prostate cells of mice in the 3 groups were determined by flow cytometry(FCM). Results The prostates in hyperplastic group [(149.30?8.46)mg] were heavier than those in TCMH group [(85.60?17.97)mg] ( P 0.05). Conclusions The TCMH has a significant therapeutic effects on experimental mice with BPH.The mechanisms may be as follows:TCMH can regulate the relevant genes of the prostate cells so that they can promote the apoptosis of the prostate cells and as a result,the volume and weight of the prostate of the mice are reduced.