Objective To investigate the curative effects of partial internal sphincterotomy in the posterior midline and lateral position in treatment of chronic anal fissure. Methods One hundred and fifty cases chronic anal fissure patients with stageⅡ or Ⅲ were randomly divided into observation group(80 cases)and control group(70 cases),who were hospitalized in the Shunyi District Hospital of Beijing from Dec. 2009 to Oct. 2012. The patients of two group were treatment by internal sphincterotomy either in the posterior midline or lateral position respectively. The efficacy,healing time,complications and recurrence of the two groups were recorded and compared. Results There were 76 cases with cure,6 cases with improvement and 2 with ineffective effect in the observer group. There were 49 cases with cure,12 cased with improvement and 9 cases with ineffective effect in control group. The difference of the efficacy was statistically significant( P =0. 025). Wound healing time of observation group and control group were(9. 9 ± 0. 8)d and(17. 1 ± 0. 9)d,and the difference was significant( P =0. 048 ). The incidence of anal exudates in observer group was lower than the control group(2. 5%(2/80)vs. 24. 3%(17/70);P=0. 032). The incidence of recurrence in observer group was 5. 0%(4/80),lower than the control group(24. 3%(17/70),P=0. 046). The degree of the postoperative pain,voiding dysfunction and wound edema in observer group were lower than the other group( P =0. 025, 0. 025,0. 049). Conclusion The effect of internal sphincterotomy in the lateral position in treatment of chronic anal fissure is better with quickly repair,fewer complications.

Objective To explore the changes of hepatocyte proliferation in rats during the progression of nonalcoholic fatty liver disease (NAFLD). Methods Rat models of NAFLD were established by giving a fat-rich diet. The rats fed with normal diet were taken as normal control at the same stage during the study. These rats were sacrificed at week 4, 8, and 12 respectively and collected the liver tissues. The cell cycle and the changes of the S-phase cell fraction (SPF), proliferation index (PI) was measured by flow cytometry. The expression of proliferating cell nuclear antigen (PCNA) was detected by immunohistochemistry. Results There was no significant difference between NAFLD group and the control group at week 4, 8. But as compared with the control group, SPF and PI of 12-week group were significantly increased and PCNA labeling index were also higher. Conclusion Hepatic hyperplasia occurred after the nonalcoholic steatohepatitis was established in the rat models of NAFLD. Hepatic hyperplasia probably was the reaction of inflammation and necrosis, but whether it was the early incident of hepatocarcinoma should be paid attention.

ObjectiveTo investigate the in vitro effect of ghrelin on membrane membrane potentail of GH3 cells.MethodsNystatin-perforated whole-cell recording configuration was used.ResultsThe membrane potentail of GH3 was decreased from-(72±4.78) mV to(54.8±4.58) mV(P<0.01) after application of ghrelin(10-7～10-8 M)ConclusionGhrelin can transiently and significantly decreased the amplitude of membrane potentail,which may contribute to the ghrelin-stimulated GH secretion from GH3 cells.

Objective To discuss the influence of drug compatibility on the components of the volatile oil in Flos Lonicerae and Fructus Forsythiae. Methods GC-MS system was used to analyze the volatile oil in Flos Lonicerae, Fructas Forsythiae and their combination. The effect of compatibility on the components and content of volatile oil was evaluated. Results The results of GC-MS showed that gerani]o, tetradecanoic acid methyl ester, hexadecanoic acid ethyl ester, fluoranthene, 9, 12, 15-Octadeeatrienoic acid ethyl ester and linoleic acid was detectable in Flos Lonicerae but was undetectable in the drug pair; camphene, alpha-terpinene, perillaalcohol, 2-beta-pinene, beta-hexadecanal, phellandrene was de-tectable in Fructus Forsythiae but was undetectable in the drug pair; limonene, isolongifolene, nonadecane was detectable in the drug pair but was undetectable in the two single drugs. Conclusion The compatibility of the drug pair has an effect on components and contents in the volatile oil of Flos Lonicerae and Fructus Forsythiae.

ObjectiveTo explore the effective way of first aid skill standard training in regional central hospital.Methods60 residents from different regional central hospitals were received aid skills training based on two ways:namely OSCE ( multi-station structured skills test ) which lay particular em phasis on skills and traditional face to face way; and were assessed by uniform standards.ResultsThe scores of residents who received OSCE training were significantly better than those which received traditional face to face training ( P＜0.05 ),including.ECG,cardiopulmonary resuscitation,endotracheal intubation and doctor examination.ConclusionFirst aid skills standard training used by OSCE approach in regional central hospital can improve their first aid skills and should be promoted.

Objective To investigate the expression of high mobility group box 1 (HMGBI) of TLR4 endogenous ligand and distant organ tissue injury after intestine ischemia/reperfusion and drainage of lymph fluid in rats. Methods Twenty-four Sprague-Dawley (SD) male rats (SPF grade) were evenly divided into 3 groups:Sham surgery group,intestine ischemia-reperfusion (I/R) group,and intestine ischemia-reperfusion with drainage of intestine lymph fluid (IR + drainage) group.The injury of distant organs such as lungs,liver,kidney was evaluated;The expression of high mobility group box 1 (HMGBI) of TLR4 endogenous ligand in intestine,lung and liver after the ischemia-reperfusion injury was measured by immunohistochemistry.Result HE stained sections,as well as HMGB1 immunohistochemistry results showed that the injury of ischemia/reperfusion (I/R) group and ischemia/reperfusion (I/R) + drainage group were more severe than that in the sham group.A large number of cells stained in I/R group,indicating that HMGB1 expression increased.The injury in I/R + drainage group was significantly less severe than I/R group.Western blot tests showed that the expression of HMGB1 in jejunum,ileum,liver,lung increased significantly in I/R group after L/R injury.Gray-scale values of HMGB1/β-actin were 0.3145 ± 0.0549、 1.7352 ± 0.3280、1.4443 ± 0.0926、3.1382 ± 0.4202.Lymph drainage significantly alleviated the damage,the expression of HMGB1 were significantly lower (P ＜0.05).Gray-scale values of HMGB1/β-actin were 0.1745 ± 0.0327、 1.1083 ± 0.2098、 1.1862 ± 0.1221、2.1095 ± 0.1993. Conclusion Increased expression of HMGB1 of TLR4 endogenous ligand is associated with intestinal and distant tissue injury during intestinal ischemia-reperfusion injury.Drainage of lymph fluid can block the gutlymph pathway and thus reduce the source of HMGB1 from the intestinal as well as the injury of distant tissue.

TLR4 mediates I/R injury involving endogenous ligands.Interaction of TLR4 with endogenous ligands provides a critical link between tissue damage and activation of the innate immune response.In the early phase of liver,kidney,heart,or lung I/R injury,endogenous ligands are secreted from several kinds of cells,they are recognized by TLR4.Interaction of TLR4 with endogenous ligands,such as HMGB1,seems to be the most important trigger of inflammation and initiates signaling cascades leading to inflammatory and immune responses.Blocking the interaction of TLR4 with endogenous ligands may be useful in clinical management of inflammation and cellular necrosis caused by ischemic insults.

Objective To prepare mouse polyclonal antibody against human Nanog by genetic immunization and to identify this antibody by Western blot and immunofluorescence. Method The antigenicity fragment (A16-V101) of human Nanog (hNanog) was chosen by analysis of Accelrys software, and its cDNA (258bp) was amplified from plasmid containing full-length cDNA of hNanog, then it was cloned into pBQAP-TT to construct recombinant plasmid pBQAP-TT-hNanog for genetic immunization. Mice were immunized with this recombinant plasmid and two other adjuvant plasmids-pCMVi-GMCSF and pCMVi-FIT3L, which help to enhance the antibody's generation. After 12 weeks, we obtained mouse anti-hNanog antibody from mice blood serum. The antibody titer was determined by enzyme-linked immunoadsordent assay (ELISA), and its specificity was identified by Western blot in human renal protein. Using this antibody, we detected hNanog expression in HKC cells of hNanog-AAV2 transfection. Results Recombinant plasmid pBQAP-TT-hNanog for genetic immunization was confirmed to be correct by restriction digestion and sequencing. The result of ELISA showed that the antibody titer was 1∶3 200. This antibody recognized a band of 34kD hNanog protein in human renal protein by Western blot. Immunofluorescence showed that Nanog protein was mainly located in the nuclei in hNanog transgene HKC cells. Conclusion Genetic immunization can offer mouse anti-hNanog polyclonal antibody of high titer and high specificity.

Objective To investigate the clinical value of penetrating-suture type pancreaticojejunostomy (PPJ) after pancreaticoduodenectomy (PD).Methods The clinical data of 77 patients who received pancreaticoduodenectomy from Taixing People's Hospital from June 2002 to March 2012 were retrospectively analyzed.Of all the patients,34 received PPJ after PD (PPJ group),and the other 43 patients received PJ anastomosis (control group) based on the texture and size of the pancreas,pancreatic duct diameter (duct-to-mucosa pancreaticojejunostomy for pancreatic duct diameter ≥ 4 mm,end-to-end or binding pancreaticojejunostomy for pancreatic duct diameter ≤3 mm).Pancreatic fistula was diagnosed according to the criteria of the International Study Group on Pancreatic Fistula,including grade B or C pancreatic fistula with clinical value.Patients were followed-up through outpatient examination and telephone interview till May 2012.Data were presented by x ± s or median (range) and the t-test and Wilcoxon rank-sum test were used to evaluate quantitative data with or without normal distribution,respectively.Qualitative data were analyzed using Pearson x2 test or Fisher's exact test.Results The mean diameter of the pancreatic duct was 3 mm for both the PPJ group and the control group.The external drainage via the pancreatic duct stent was not used in the PPJ group,compared with 4 cases in the control group,showing a statistically significant difference between the 2 groups (x2=3.632,P ＜ 0.05).The duration of pancreaticojejunostomy was 12 minutes (range,8-25 minutes) in the PPJ group,while no records in the control group.The operation time and intraoperative blood loss in the PPJ group and the control group were (304 ± 60)minutes and (475 ± 75) mL,(304 ± 60) minutes and (500 ± 97) mL,respectively.Twenty-four (70.6％) patients in the PPJ group and 29 (67.4％) patients in the control group received intraoperative blood transfusion,with volume of 400 mL (range,300-800 mL) and 600 mL (range,300-1 200 mL),respectively.The median duration of postoperative hospital stay were 18 days (range,11-32 days) in the PPJ group and 20 days (range,9-44 days) in the control group.None of these comparisons were statistically significant between the 2 groups (t =1.293,0.619,x2=0.088,Z =0.165,0.074,P ＞0.05).The rate of grade B or C pancreatic fistula were 0 for the PPJ group and 27.9％ (12/43) for the control group,and the mortality rate of patients who had pancreatic fistula were 0 and 11.6％ (5/43) for the PPJ group and the control group,with statistical significance (x2=11.232,4.237,P ＜0.05).The overall incidence of bile leakage,peritoneal bleeding and delayed gastric emptying in the PPJ group and the control group were 5.9％ (2/34),2.9％ (1/34),5.9％ (2/34) and 11.6％ (5/43),7.0％ (3/43),14.0％ (6/43),with no significance difference (P ＞0.05).Fifty-six patients were followed up after operation from 9 months to 5 years.Pancreatic duct dilation was detected by imaging examination for 26 patients in the control group.Conclusions PPJ is a simple and feasible approach with better clinical efficacy after PD.

Objective To compare the diagnostic value of magnetic resonance cholangio pancreatography (MRCP), endoscopic ultrasonography (EUS) and endoscopic retrograde cholangio pancreatography (ERCP) in obstructive jaundice. Methods MRCP, EUS and ERCP were performed in 39 patients with obstructive jaundice. MRCP was performed by the technique of T2 weighted fast spin echo fluid imaging. EUS and ERCP were performed with conventional method. Results The over all concordance rates of MRCP, EUS and ERCP were 87.2%(34/19), 94.9%(37/39) and 97.4(38/39), respectively. In malignant common duct stricture the concordance rates of MRCP, EUS and ERCP were 61.5%(8/13), 84.6%(11/13) and 92.3%(12/13), respectively. In choledocholithiasis the concordance rates of MRCP, EUS and ERCP were 100.0%(21/21). Conclusion The non invasive examination, MRCP can be the first choice as a diagnostic method for obstructive jaundice, but it can not replace ERCP currently. As an important approach to diagnose the cholangiopancreatic disease, EUS combine with MRCP and ERCP, can improve the diagnostic accuracy in obstructive jaundice.