Objective To study the anatomy of the caudate lobe and to apply the knowledge in caudate lobe resection and piggyback liver transplantation. Methods Dissection of the caudate lobe was carried out in 35 fresh adult livers. Before dissection, the portal venous system was injected with barium sulfate emulsion to show the portal branches of the caudate lobe. Results The caudate lobe was shown to consiste of 3 portions: (1) the Spigelian lobe, the paracaval portion and the caudate process. The Spigelian lobe was pyramidal in shape with 3 faces, a peak and a base; (2) the paracaval portion was situated to the right and to the front of the vena cava; (3) the caudal process was the liver parenchyma between the hepatic hilum and the anterior aspect of the vena cava. Conclusions The entire caudate lobe is situated at the posterior part of the liver and it surrounds the vena cava. The key point in resecting the entire caudate lobe or in performing a piggyback liver transplantation is adequate mobilization and division of all the outflowing veins of the caudate lobe.

Objective To compare the efficacy of stents 7 F and 10 F in drainage of pancreatic pseudocyst via EUS-FNA.Methods A retrospective analysis of patients with pancreatic pseudocyst who received endoscopic ultrasonography guided puncture drainage by using 7 F and 10 F double pigtail plastic stent respectively in Drum Tower Hospital of Nanjing University Medical School from 2010 to 2014 was conducted.Patients' hospitalization period, the time for 50％ cyst reduction, removal time, infection rate, and recurrence rate were compared.Results Twenty three patients with pancreatic pseudocyst were included, among whom 14 were male and 9 were female.The age ranged from 13 to 70 with an average of 45.1 years.Eleven patients were treated with 7 F pigtail plastic stents whereas 12 patients with 10 F pigtail plastic stents.All patients were treated with additional 8.5 F joint nose cyst drainage.Four cases in 7 F group got fever, 3 of whom were successful in anti-infection and 1 failed, having to change the stent.One case (9.1％) relapsed without symptoms after 52 months during the follow-up and received no intervention.Five cases in 10 F group got fever, 4 of whom were successful in anti-infection and 1 failed, having to change the stent.One case (8.3％) was identified as mild hemorrhage, and replantation needed to be performed in 1 case (8.3％) because stent was found to slip after 12 days.Two cases (16.7％) relapsed without symptoms after 11 and 24 months respectively and no intervention was received.There was no significant difference in patients' age, cyst size, removal time, infection rate and recurrence rate between the two groups.However, patients in group 10 F had a markedly shorter hospitalization period and time for cyst reduction by at least 50％ than those in group 7 F (P ＜ 0.05).Conclusion 10 F double pigtail plastic stents can drain the cyst faster, shorten the hospital stay, but there is no significant difference in infection or recurrence rate of cyst compared with 7 F stents.

Objective:To elucidate the role of ERK1/2 MAPKs signal transduction in the protective effects of ischemic preconditioning during liver transplantation. Methods: Twenty-four rats were equally randomized into 4 groups: sham control (group A); liver transplantation (group B); ischemic preconditioning+liver transplantation (group C), and MEK inhibitor intervention+ischemic preconditioning+liver transplantation (group D). Serum AST and ALT were detected after operation and cellular ultrastructures were observed by transmission electron microscopy. Liver tissue ERK1/2 MAPKs phosphorylation activities were evaluated through determining ERK-1 protein phosphorylation by Western blotting. Results: Serum ALT and AST activity in group B and group D was significantly higher than those in group A, and remained normal in group C. Liver tissue ERK1/2 MAPKs phosphorylation activity increased significantly in group C, and the activation effect was inhibited in group B and D. Cellular ultrastructure was obviously damaged in group B and group D, and the damage was prevented in group C.Conclusion: Ischemic preconditioning has a protective effect on transplanted liver cells in which ERK1/2 MAPKs pathway plays a pivotal role.

Objective To observe the effects of Wu-Yao,Da-Huang combination on severe acute pancreatitis gut barrier protection,and on the clinical treatment of severe acute pancreatitis.Methods In the past 10 months,45 casea of severe pancreatitis those treated in our department were randomly divided into 3 groups.group A:on the basis of conventional treatment of inhibiting trypsin secretion and anti-infection,50%magnesium sulfate 50 mL were insected via stomach tube,twice a day;group B:on the basis of conventional treatment,Da-Huang decoction 100 mL high retention enema,twice a day;group C:on the basis of conventional treatment were given by Wu-Yao decoction 50 mL.as well as 100 mL Da-Huang decoction enema,twice a day.Three groups were observed the release of abdominal distension,abdominal(bladder pressure measurement),ACAPHE-Ⅱ score,indicators of neutrophils(N),C-reactive protein(CRP),and the blood levels of D-lactic acid in 1,3,5,7,9 days etc.Results The abdomenal circumference,abdominal pressure,APACHE-Ⅱ score,N and other indicators of the three groups after treatment had the significantly different(P<0.05),with group C the most significant decrease,while no significant difference in CRP.Endotoxin content in three groups was significantly different(P<0.05),and each diminished with time(P<0.05).Conclusion Wu-Yao,Da-Huang combination on gut barrier dysfunction in severe acute pancreatitis showed synergistic protective effect.

Objective To analyze the clinical effect of debridement in the treatment of Kashin-Beck disease under an ankle arthroscopy.Methods Totally 40 patients with ankle Kashin-Beck disease who had underwent surgery in the Fifth Hospital of Daqing from January 2015 to October 2016 were selected as the research subjects.All patients were treated with cleaning treatment under arthroscopy,evaluated via the visual analogue scale method,and compared pain before and 6,12 month after the treatment.Walking function and ankle motion of the patients were evaluated via an ankle-scoring system,and the quality of life of patients was investigated before and after the treatment through a questionnaire survey.Results The visual analogue scale of before and 6,12 months after the treatment was (6.2 ± 1.0),(2.3 ± 1.2) and (1.6 ± 0.4) scores,respectively;ankle foot score (53.3 ± 6.8),(86.6 ± 5.1) and (88.7 ± 6.2) scores,respectively;ankle activity score (15.9 ± 4.1),(36.9 ± 4.9) and (41.8 ± 6.4) scores,respectively;and life quality score (53.1 ± 4.0),(75.4 ± 6.6) and (88.7 ± 10.5) scores,respectively.The differences between groups were statistically significant (F =2.1,2.6,2.3,2.5,P ＜ 0.05).Visual analogue scale of 6 and 12 months after the treatment was significantly lower than that before the treatment,ankle foot score and ankle activity score and life quality score were significantly higher than those before the treatment (P ＜ 0.05).Conclusion The debridement under an ankle arthroscopy can effectively reduce the pain of patients with Kashin-Beck disease,and improve the walking function of the patients obviously,significantly improve the patients' life quality,and the method should be widely applied in clinical treatment.

Objective To analyze the clinical features of patients with IgG4-associated biliary and pancreatic diseases,and to improve the understanding of these diseases.Methods Nine cases of patients with IgG4-associated pancreatitis and cholangitis were analyzed retrospectively,which included clinical manifestations,serological examination,imaging test,pathology,treatment and prognosis.Results Of the 9 patients,8 were male,1 was female,the average age was 61 years old.Four cases were presented with jaundice,2 cases with jaundice and abdominal pain,2 cases with abdominal pain,and 1 case with diabetes.Serum IgG4 levels were 3.46-21.3 g/L (mean 9.743 g/L) in 6 cases,and which were higher than normal value,3 patients did not undergo blood test of IgG4.Nineteen auto-antibodies (including ANCA) were all negative in 9 cases.CA19-9 was increased in 4 cases.CT manifestations showed 5 cases with low density pancreas mass (2 cases with biliary tract dilatation);1 case had pancreas swelling with dilatation of bile duct,and 2 cases with bile duct dilatation only,and CT findings in 1 case were negative.Four patients underwent EUS-FNA,and EUS features included hypoechoic lesions without peripancreatic lymph nodes.FNA results indicated 2 cases with IgG4 related chronic inflammation,2 cases with chronic inflammation with negative IgG4.Seven cases were confirmed to have IgG4 related pancreatitis,and 2 cases with IgG4 related cholangitis.Six patients received glucocorticoid treatment,and the dose ranged from 8-40 mg;3 patients underwent surgery and the surgical pathology indicated IgG4 positive plasma cell.Follow-up showed the serum IgG4 returned to normal,clinical symptoms improved remarkably,and pancreatic mass decreased.Conclusions IgG4 positive plasma cell infiltration is the main feature of IgG4-associated cholangitis and pancreatitis.The diagnosis should combine image,serology with pathology.Glucocorticoid is an effective treatment.

ObjectiveTo investigate the diagnostic value of single balloon enteroscopy (SBE) for obscure gastrointestinal bleeding.MethodsA total of 78 SBE procedures was conducted on 72 patients with obscure gastrointestinal bleeding,with 40 via oral route and 38 via anal route.The procedure time,insertion depth and rate of positive finding were recorded.ResultsFor 40 SBE procedures performed via oral route,the mean procedure time was 60 minutes ( 15-110 minutes),and the mean insertion depth was 195 cm at the distal end of Trentz ligament (30-240 cm).For 38 SBE procedures performed via anus,the mean procedure time was 75 minuets (30-120 minutes),and the mean insertion depth was 160 cm at the proximal end of ileocecal valve (50-200 cm ).The whole diagnostic yield of obscure gastrointestinal bleeding was 62.5％.ConclusionSBE is a safe and useful tool for the diagnosis of obscure gastrointestinal bleeding.

Objective To study the feasibility of Bama miniature pig model establishment of type 2 diabetes mellitus (T2DM) by high-fat and high-sugar diet combined with streptozotocin (STZ), and observe the changes in protein kinase B (PKB) and phosphorylation expressions in skeletal muscle, liver, and pancreatic tissues of the miniature pig model. Methods A total of 10 healthy male Bama miniature pigs were randomly divided into two groups:control group (n=5, fed normal diet) and diabetic model group (n=5, fed high-fat and high-sugar diet combined with STZ to establish T2DM Bama miniature pig model). The fasting plasma glucose (FPG) and fasting insulin (FINS) levels were measured, and insulin resistance (HOMA-IR) was calculated in two groups. The PKB and phosphorylation expressions in skeletal muscle, liver and pancreatic tissues were measured using Western blot assay. Results (1) After 10 months of high-fat and high-sugar diet, the body weight, FPG, FINS and HOMA-IR were significantly higher in model group than those of control group (P<0.01). (2) After STZ treatment, compared with control group, there was a further increased level of FPG and a significantly decreased level of FINS in model group (P<0.01). (3) Compared with control group, the PKB and phosphorylation expression levels in skeletal muscle, liver and pancreas were significantly lower in model group (P<0.05). Conclusion The high-fat and high-sugar diet combined with STZ can successfully establish the T2DM miniature pig model. The PKB and phosphorylation expression levels in skeletal muscle, liver, and pancreatic tissues are decreased in model pigs.

The concentrations of berberine (BBR) and 8-cetylberberine (8-BBR-C16) in rat plasma and tissue were determined by RP-HPLC. Both the plasma pharmacokinetics characteristic and tissue distribution differences of BBR and 8-BBR-C16 were compared to provide experimental data for the mechanism research and further drug development. After the oral administrations of BBR and 8-BBR-C16 at the dose of 80 mg x kg(-1) for rats, the pharmacokinetics result showed that compared with BBR, the C(max) and AUC(0-t), of 8-BBR-C16 increased by 2.8 times and 12.9 times respectively, t1/2 extended from 3.61 h to 11.90 h. The tissue distribution result showed that compared with BBR, the concentration of 8-BBR-C16 in various organizations increased and the retention time extended remarkably. The maximum concentration was achieved in lung and the highest concentration in it was 3 731.82 ng x g(-1). After being derived, the C(max) in plasma and bioavailability of 8-BBR-C16 increased remarkably and the circulation time in vivo extended. The drug concentration in tissue increased remarkably, and the distribution ratio changed too, with strong targeting selection in lung.
Administration, Oral ; Animals ; Berberine ; analogs & derivatives ; pharmacokinetics ; Biological Availability ; Chromatography, High Pressure Liquid ; Rats ; Tissue Distribution

Objective To observe the effect of dexamethasone(Dex)on the proliferation and os- teogenic differentiation of human marrow stromal cells(MSCs)in vitro.Methods The primary human MSCs were isolated and cultured by Ficoll seperation culture in vitro.In subcultures,human MSCs were respectively treated with dexamethasone 10~(-9),10~(-8) and 10~(-7) mol/L.The proliferation of human MSCs was measured using MTF method;cytoplasmic alkaline phosphatase(ALP)activity was measured;the osteogenic marker osteopontin (OPN)mRNA were examined by reverse transcriptase polymerase chain reaction(RT-PCR).Results The op- tical density values in cultures treated with dexamethasone 10~(-8) and 10~(-7) mol/L for 8 days were significantly lower than those in the controls(P＜0.05).Treatment of cells with Dex for 12 days led to a significant increase in cytoplasmic ALP activity(P＜0.05)in a dose-dependent manner.Dex induced OPN mRNA.Conclusion Dex inhibits the proliferation of human MSCs and dexamethasone 10~(-7) mol/L leads to a strong decrease in cell number.Dex induces human MSCs differentiate to osteoblastic cells.