Objective To analyze and investigate the diagnosis method and treatment measures of insulinoma.Methods The clinical data in 16 cases of insulinoma in the hepatobiliary surgery of our institute from Dec.2008 to Dec.2015 were retrospectively analyzed.Results All cases had typical Whipple′s triad,the biochemical examination suggested that all cases had plasma glucose decrease and plasma insulin increase during the onset period.The imaging examinations included preoperative ultrasonography,enhanced CT,MRI,EUS and intraoperative ultrasound (IOUS).Their diagnosis positive rates were 56.3% (9/16),77.8% (7/9),80.0% (8/10),100.0%(2/2) and 100.0%(5/5) respectively.Sixteen cases all received surgical treatment,including local tumor excision in 6 cases,simple distal pancreatectomy in 3 cases,distal pancreatectomy plus splenectomy in 5 cases and pancreaticoduodenectomy(PD) in 2 cases.Plasma glucose level in all cases was significantly increased after tumor removal.Postoperative follow-up lasted for 1-5 years without recurrence and metastasis.Conclusion The first choice of insulinoma localization diagnosis is CT and MRI,intraoperative palpation combined with IOUS is the main method of intraoperative localization,and the surgical resection is the only effective method for treating this disease.

Objective To explore a better method to repair cervical cicatricle contracture deformity.Methods The cervicai cicatrical contraction deformity was repaird by the cervico-shoulder island skin flap with blood supply crossing and abundant anastomotic branches of the neck-shoulder blood vessels. After removing the cervical scar, the flaps were designed according to the size of the wound to be repaired, and the clinical anatomy of crossing and abundant anastomotic branches of the neck-shoulder blood vessels. The secondary wound of donor site was closed directly if the donor region was small, or closed by skin graft. Results Sixteen patients in this clinic were operated with this method, and venous return dysfunction occurred in 1 case, but blood circulation was improved after treatment. All the flaps survived with good appearance and texture. The extensive flap was created and transferred to the anterior neck by one stage without pre-expansion which met some patients'requirement of repairing cervical cicatricle contracture deformity. Conclusion The cervico-shoulder island skin flap, with abundant blood supply, is a new method to repair cervical cicatricle contracture deformity.

Background and purpose:Liver cancer resection and splenectomy are the main methods to treat hepatocellular carcinoma and hypersplenism. The aim of this study was to discuss the safety and feasibility of simultaneous radiofrequency ablation (RFA) and laparoscopic splenectomy (LS) for the treatment of small hepatocellular carcinoma with hypersplenism.Methods:Twenty-seven patients with small hepatocellular carcinoma and cirrhotic hypersplenism underwent RFA and LS. The clinical data were also analyzed.Results:The surgery was converted to an open surgery in 1 patient, while laparoscopic splenectomy in a hand-assisted manner was performed in 2 patients. There were 31 liver tumors treated with RFA. Blood loss were 110-900 mL (mean=320 mL). Operation time were 72-127 min (mean=107 min). Subcutaneous emphysema occurred in 1 patient, and pancreatic leakage in another patient. Nine patients developed ascites. one patient suffered from massive haemorrhage, and emergency operation was adopted to stop bleeding. This patient recovered well after operation. No death was found during the hospitalization. Conclusion:Combining RFA with LS for the treatment of liver cancer and hypersplenism is minimally invasive, safe, and feasible.

Ergosterol is the important component of the fungal membrane, and having stable structure. This makes it a suitable indicator for growth of fungi. In the paper, isolation and determination techniques of ergosterol as the indicator of the fungal biomass were reviewed. The methods of extracting ergosterol include traditional saponification and refluxing, rapid physical disruption, rapid ultrasonication, supercritical fluid extraction and so on. The ergosterol determination methods are high performance liquid chromatography, gas chromatography-mass spectrometry, liquid chromatography-mass spectrometry, and thin-layer chromatography, et al. The application of these techniques was also introduced. Finally, the paper prospected the feasibility of applying the ergosterol as the indicator of fungal biomass in composting.

OBJECTIVETo observe the effect and mechanism of curcumin derivative B06 on kidney from rats with hyperlipidemia and type 2 diabetes.

METHODSThirty five male SD rats were randomly divided into five groups(n = 7): the normal control group, high-fat group, high-fat + B06-treatd group, diabetic group, diabetic + B06-treated group. After fed with high-fat diet for 4 weeks, the later two groups were in- jected with streptozotocin intraperitoneally to induce type 2 diabetes mellitus. B06-treated groups were given B06 by gavage at a dosage of 0.2 mg/kg . d for 8 weeks. After the treatment, the serum creatinine, blood urea nitrogen and uric acid were detected biochemically, the morphology of kidney was observed with light and transmission electron microscopy, the expression of collagen fibers was observed with Masson staining, the protein expression of collogen IV and fibronectin in kidney were determined by Immunohistochemistry.

RESULTSIt was showed that the levels of the serum creatinine and blood urea nitrogen elevated significantly in diabetic group. In high-fat and diabetic groups, increased glomerular mesangial matrix and collagen fiber and thicken glomerular basal membrane were observed under light microscopy, swelling and fusion of foot process were found under electron microscope; increased green matrix within glomeruli was observed under Masson staining. collogen IV and fibronectin protein expression were significantly enhanced in high-fat group and diabetic group. After B06's intervention, the levels of serum creatinine and blood urea nitrogen were decreased in diabetic groups, the morphological change of kidney was obviously relieved, Collogen IV and fibronectin protein expression reduced.

CONCLUSIONCurcumin derivative B06 exerts a protective effect on kidney in type 2 diabetic rats, reduced expressions of collogen IV and fibronectin, inhibition of the accumulation of extracellular matrix and glomerular mesangial proliferation, and then prevention of renal fibrosis may be the mechanism.

Animals ; Blood Urea Nitrogen ; Collagen Type IV ; metabolism ; Creatinine ; blood ; Curcumin ; pharmacology ; Diabetes Mellitus, Experimental ; complications ; drug therapy ; Diabetes Mellitus, Type 2 ; Drugs, Chinese Herbal ; Fibronectins ; metabolism ; Kidney ; metabolism ; physiopathology ; Kidney Diseases ; drug therapy ; Male ; Rats ; Rats, Sprague-Dawley ; Streptozocin ; Uric Acid ; blood

Objective To compare mobilization effects of endogeneous MSCs in the treatment of ulcerative colitis rats by Shenling Baizhu Powder and Tongxie Yaofang Decoction. Methods Twenty SD male rats were randomly divided into blank group, model group, Shenling Baizhu Powder group and Tongxie Yaofang Decoction group. TNBS/ethanol method was used to build the ulcerative colitis model. Administration groups were given Shenling Baizhu Powder and Tongxie Yaofang Decoction for gavage and model group and blank group were given normal saline for gavage. After gavage, MSCs from peripheral blood and bone marrow were extracted for primary culture. MSCs of bone marrow and peripheral blood were detected by flow cytometry. Results MSCs from bone marrow showed: Compared with the blank group, the percentage of positive cells in the model group decreased (P<0.05); Compared with the model group, the percentage of positive cells in Shenling Baizhu Powder group and Tongxie Yaofang Decoction group increased, and the expression of Shenling Baizhu Powder group was more obvious (P<0.05). MSCs from peripheral blood showed: Compared with the blank group, the percentage of positive cells in the model group increased (P<0.05); Compared with the model group, the percentage of positive cells in Shenling Baizhu Powder group and Tongxie Yaofang Decoction group decreased, and the expression of Shenling Baizhu Powder group was more obvious (P<0.05). Conclusion Shenling Baizhu Powder and Tongxie Yaofang Decoction have the function of promoting the increase of bone marrow-derived MSCs and the reduction of peripheral blood source of MSCs in model rats, and Shenling Baizhu Powder is better than Tongxie Yaofang Decoction.

OBJECTIVETo investigate the epidemiologic features of disseminated histoplasmosis (PDH) in Hubei province.

METHODSBone marrow smears of 12 patients diagnosed as Kala-azer in Hubei province including 4 patients in Jingsan, 2 patients in Shashi and each 1 in Yichang, Jinmen, Zhongxiang, Luotian, Xianning and Guanghua respectively were re-examed under microscope. Peripheral blood and bone marrow smears of several patients were detected. After inoculated the bone marrow, peripheral blood, liver and spleen tissue of patients in MLI, the single colony was trans-inoculated in BHIB, SDA and CMA and incubated at 25 degrees C and 35 degrees C. Bone marrow, peripheral blood and bacterial fluid of yeast-phase Histoplasma capsulatum (H.cap) were injected into the abdominal cavity of Kunming mice and nude mice. When symptoms and signs developed, the spleen tissue was separated, then observed under microscope and cultured. Mycelium-phase and Yeast-phase H.cap were inoculated in urase and gelatin medium, then incubated at 25 degrees C and 35 degrees C. Histoplasmin was injected subcutaneously into patients, and then followed for 48 - 72 hours. Amphotericin B was selected to treat the PDH patients.

RESULTSMoriform cell cluster and sausage-shaped cell were not observed in mononuclear-macrophages in the bone marrow smears from 12 patients. Leishman-Donovan body was found only in one patient. There wasn't kinetoplast in the cellular plasm of spores in 11 patients and no transeptae was found. The reaction of H.cap to urease was positive and H.cap did not liquefy the gelatin. It appeared to be mycelium-phase at 25 degrees C but no penicillus and catenulate conidia was found. The characteristic denticle macroconidia was observed but produced red coloring matter. It also appeared to be yeast-phase at 35 degrees C. Yeast-phase spores were observed under microscope. No sausage-shaped spore and transeptae were identified. H.cap could be acquired in the spleen tissue in Kunming mice and nude mice. Bacterium forms, characteristics under microscope and biochemical reaction of mycelium-phase and yeast-phase H.cap were different from some other kinds of dimorphic fungi such as Penicillium marneffei and Histoplasm duboisii etc.

CONCLUSIONThere were scattered epidemics of PDH in Hubei province. The detection rate of PDH was higher in the southeast area then in the northwest area. The golden standards of clinic diagnosis were mycological culture and inoculation to animals. Amphotericin B was necommended as the first choice for treatment.

Adolescent ; Adult ; Amphotericin B ; therapeutic use ; Animals ; Antifungal Agents ; therapeutic use ; China ; epidemiology ; Female ; Histoplasma ; isolation & purification ; Histoplasmin ; immunology ; Histoplasmosis ; drug therapy ; epidemiology ; microbiology ; Humans ; Male ; Mice ; Mice, Nude ; Middle Aged ; Skin Tests

OBJECTIVETo observe mid- and long-term changes in the histopathology and electron microscopic characteristics of the acellular dermal matrix engrafted with thin split-thickness skin autograft.

METHODSTwenty-three biopsy samples were collected from 17 patients undergoing extremity scar resection, who received subsequent grafting using allogenic dermal matrix dressed with thin split-thickness skin autografts. Six months to 2 years after the grafting, the grafts were sampled for histopathological and electron microscopic observations of the layer of the epidermis, thickness of the basal membrane, structural components of the dermis, and infiltration of fibroblasts and revascularization. The data were compared with those of the normal skin samples from the patients.

RESULTSOnly the number of epidermal layers showed statistically significant difference between the skin grafts and the normal skin (16.33-/+5.89 vs 26.57-/+3.46, P=0.007). The thickness of the basal membrane of the skin grafts was similar to that of normal skin, and no significant difference was found in the number of fibroblasts and newly generated capillaries between them.

CONCLUSIONThe mid- and long-term histopathology and ultrastructures of the composite skin graft in the extremities are similar to those of normal skin, suggesting satisfactory effect of the skin grafts.

Adolescent ; Burns ; surgery ; Child ; Child, Preschool ; Cicatrix ; surgery ; Dermis ; transplantation ; ultrastructure ; Female ; Follow-Up Studies ; Graft Survival ; Humans ; Male ; Skin ; ultrastructure ; Skin Transplantation ; methods ; Skin, Artificial ; Transplantation, Autologous

OBJECTIVETo evaluate the roles of cell adhesion, multidrug resistance and cell proliferation in short-term recurrent cases with superficial bladder cancer, and the prognostic value of the three indexes.

METHODSImmunohistochemical staining for E-cad, P-gp and Ki-67 was performed on the tumors of 100 patients with stage T0-T1 transitional cell carcinoma of the bladder who had been included in a retrospective research by follow-up.

RESULTSE-cad and P-gp expression was positive in 51 (43.2%)and 17 (14.4%) of the tumors, respectively and mean proliferation index (PI) was 22.1%. The decrease in E-cad expression was accompanied with the increasing recurrent episodes (P < 0.05), while increase of P-gp expression and PI were accompanied with the increasing recurrence episodes (P < 0.05). There was significant difference according to E-cad, P-gp positivity and between T(1)G(3) patients and no-T(1)G(3) patients (P < 0.05). There was negative correlation of E-cad expression with P-gp expression and PI.

CONCLUSIONSMinimum adhesion, strong drug resistance and maximum proliferation are the main factors that promote short-term recurrence of superficial bladder cancer and also the inherent reasons for easy recurrence and high malignancy of T(1)G(3) tumors. During this course, the three aspects may interact.

ATP-Binding Cassette, Sub-Family B, Member 1 ; analysis ; Adult ; Cadherins ; analysis ; Cell Adhesion ; Cell Division ; Drug Resistance, Multiple ; Drug Resistance, Neoplasm ; Female ; Humans ; Ki-67 Antigen ; analysis ; Male ; Neoplasm Recurrence, Local ; etiology ; Urinary Bladder Neoplasms ; drug therapy ; etiology ; pathology

OBJECTIVETo evaluate the efficacy and security of anti-platelet and anticoagulant therapy on prevention of ischemic stroke in patients with nonvalvular atrial fibrillation (NAF).

METHODSWe searched PubMed, EMbase, CENTREN and its affiliated clinical trial registration data center, CBMdisc, VIP, and CNKI databases from establishment to Dec 2009 to identify randomized controlled trials (RCTs) covering the use of anti-platelet agents and anticoagulants for patients with NAF. Meta-analysis was performed by using RevMan 5.0 software after the strict evaluation of the methodological quality of the included RCTs.

RESULTSFourteen RCTs involving 15 880 patients were include. Compared with placebo or no use of anti-platelet drugs, antiplatelet therapy didn't reduce ischemic stroke (RR = 0.83, 95%CI 0.68 to 1.00, P = 0.05), systemic emboli (RR = 0.71, 95%CI 0.34 to 1.51, P = 0.38) and all-cause mortality (RR = 0.88, 95%CI 0.73 to 1.07, P = 0.21) while significantly increased the major bleeding (RR = 2.88, 95%CI 1.21 to 6.86, P = 0.02) in patients with NAF, intracranial hemorrhage was not affected by antiplatelet therapy in patients with atrial fibrillation (RR = 3.25, 95%CI 0.84 to 12.62, P = 0.09). Compared with anti-platelet therapy, anticoagulant therapy significantly reduced the incidence of ischemic stroke (RR = 1.84, 95%CI 1.48 to 2.28, P < 0.01) and systemic emboli (RR = 1.94, 95%CI 1.24 to 3.03, P = 0.004) but significantly increased the incidence of intracranial hemorrhage (RR = 0.49, 95%CI 0.31 to 0.78, P = 0.003), did not affect all-cause mortality (RR = 1.06, 95%CI 0.90 to 1.23, P = 0.50) and the incidence of major bleeding (RR = 0.95, 95%CI 0.76 to 1.19, P = 0.66) in NAF patients.

CONCLUSIONSCompared with the placebo and no use of anti-platelet drugs, anti-platelet therapy didn't reduce ischemic stroke and systemic emboli but increased the risk of major bleeding in NAF patients. Compared with anti-platelet therapy, anticoagulant therapy significantly reduced the ischemic stroke and systemic emboli without increasing the risk of major bleeding, but significantly increased the incidence of intracranial hemorrhage in NAF patients. Since the study included RCTs with limited and less uniform outcome endpoints, the conclusions should be verified with RCTs with more uniform endpoints and longer follow-up time.

Anticoagulants ; therapeutic use ; Atrial Fibrillation ; complications ; therapy ; Humans ; Platelet Aggregation Inhibitors ; therapeutic use ; Stroke ; etiology ; therapy ; Treatment Outcome