Objective To find the effect of chronic renal failure on the development of neointimal hyperplasia and the role of monocyte chemokine-1 (MCP-1) after arteriovenous fistula in mice.Methods We created AVF (common carotid artery to jugular vein in an end-to-end anastomosis) in mice with or without chronic renal failure (renal ablation or sham operation).The outflow of AVF was harvested at 3 weeks postoperative the vascular tissue.The pathological changes were examined.The level of blood urea nitrogen (BUN) and the degree of intimal hyperplasia were analysed.The protein and mRNA expression of alpha smooth muscle actin (SMA), Ki-67,NF-κB and MCP-1 were detected by immunohistochemistry, RT-PCR and Western blot.Results 1)Compared with the control group, the blood BUN level of the experimental group was significantly higher and the intimal hyperplasia was more serious, meanwhile, the lumen was more narrow (P<0.05).2)In the experimental group, the expression of α-SMA, Ki-67, NF-κB and MCP-1 was significantly increased (P<0.05).3)MCP-1 promoted the proliferation of vascular smooth muscle cells.Conclusions Chronic renal failure promote the development of neointimal hyperplasia, which may be related to the increase of MCP-1 expression.

Objective To investigate the effect of ultrasound-guided serratus plane block onefficacy of postoperative analgesia in patients undergoing radical mastectomy. Methods From January 2013 to December 2016, sixty-eight ASA physical statusⅠorⅡ patients scheduled for radical mastectomy under general anesthesia were randomly divided into two groups (n = 34 each): SP block group (observation group) and control group. After induction of anesthesia, ultrasound-guided homolateral SP block was performed, and 0.375% ropivacaine 20 ml was injected in observation group, while the equal volume of normal saline was used instead in control group. The patients received patient-controlled intravenous analgesia (PCIA) with sufentanil after operation in two groups. The scores of prince henry pain scale (PHPS) were evaluated at the 2nd, 4th, 8th, 12th and 24th hour (T1, T2, T3, T4, T5) after operation. The consumption of sufentanil, propofol and remifentanil was recorded.Meantime, the times of successfully delivered doses (D1) and attempts (D2) within 24 h after operation were added up, and D1/D2 was calculated. The adverse effects were also recorded. Results The scores of PHPS at T1 [(1.4 ± 0.5) scores vs. (3.1 ± 0.6) scores], T2 [(1.5 ± 0.6) scores vs. (2.9 ± 0.8) scores], T3 [(1.7 ± 0.5) scores vs. (2.8 ± 0.7) scores], and the consumption of sufentanil [(53.4 ± 16.7)μg vs. (87.8 ± 24.5)μg], remifentanil[(288.7 ± 42.1)μg vs. (376.5 ± 61.6)μg] were significantly lower in observation group than those in control group, while D1/D2 (0.89 ± 0.12 vs. 0.57 ± 0.18) was higher (P<0.05). The incidence of adverse reactions was significantly lower in observation group: 0 vs. 20.6% (7/34), P<0.05. Conclusions Ultrasound-guided SP block reduces the perioperative opioids consumption and enhances the efficacy of postoperative analgesia in patients undergoing radical mastectomy.

Objective To investigate the role of glucose-regulated protein 78 (GRP78) in sevoflurane preconditioning-induced inhibition of apoptosis in cardiomyocytes of rats.Methods The cultured cardiomyocytes of Sprague-Dawley rats were randomly divided into 5 groups (n =30 each) using a random number table:control group (group C),hypoxia-reoxgenation (H/R) group,sevoflurane preconditioning group (group S),siRNA-GRP78 group and siRNA control group.H/R was produced by 2 h exposure of cells to 95％ N2-5％ CO2 in an air-tight chamber at 37 ℃,followed by reoxygenation with 95％ O2-5％ CO2 in an air-tight chamber at 37 ℃ for 1 h.In group S,the cells were incubated with 2.5％ sevoflurane for 20 min,followed by 10-min washout before H/R.In siRNA-GRP78 group,the cells were transfected with siRNA-GRP78 100 nmol/L,and 24 h later preconditioning with sevoflurane was performed and H/R was produced.In siRNA group,cells were transfected with siRNA,and the other treatments were similar to those previously described in siRNA-GRP78 group.After treatment in each group,the expression of GRP78 in myocardial cells and cytochrome c in cytoplasm and mitochondria was detected by Western blot.Lactic dehydrogenase (LDH) and creatine kinase (CK) activities in the culture medium of each group were determined by ELISA.The apoptosis in myocardial cells was assessed by flow cytometry.Apoptotic rate was calculated.Intracellular free Ca2+ concentration ([Ca2+]i) was measured with the fluorescent probe Fura-2/ AM.The opening of mPTP was measured by fluorescence spectrophotometry.Results Compared to group C,the expression of GRP78 in myocardial cells and cytochrome c in cytoplasm was significantly up-regulated,LDH and CK activities in the culture medium,apoptotic rate and [Ca2+]i were increased,and the expression of cytochrome c in mitochondria was down-regulated in H/R group.Compared to group H/R,the expression of GRP78 in myocardial cells and cytochrome c in mitochondria was significantly up-regulated,LDH and CK activities in the culture medium,apoptotic rate,[Ca2+] i and opening of mPTP were decreased,and the expression of cytochrome c in cytoplasm was down-regulated in group S,and no significant change was found in the parameters mentioned above in siRNA group.Compared to group S,the expression of GRP78 in myocardial cells and cytochrome c in mitochondria was significantly down-regulated,LDH and CK activities in the culture medium,apoptotic rate,[Ca2+] i and opening of mPTP were increased,and the expression of cytochrome c in cytoplasm was up-regulated in group siRNA-GRP78.Conclusion GRP78 is involved in sevoflurane preconditioning-induced inhibition of apoptosis in cardiomyocytes of rats,and the mechanism is related to maintenance of intracellular Ca2+ stability and inhibition of opening of mPTP.

Objective To analyze the clinicopathological characteristics of upper gastrointestinal submucosal tumors ( SMTs ) . Methods Clinicopathological data of 1 743 patients with 1 775 upper gastrointestinal SMTs in our department from January 2008 to December 2012 were retrospectively analyzed. Results The first finding was that in 702 esophagus cases,leiomyoma(92?59%,650/702) was the most common type of esophageal SMTs. Second, in 1 045 gastric cases, there were 405 lesions at gastric fundus, the most common type of SMTs were 249 ( 61?48%) GISTs and 144 ( 35?56%) leiomyoma. In 307 lesions located at body,the most common type of SMTs were 143( 46?58%) GISTs and 90( 29?32%) leiomyoma. In 191 lesions located at antrum, the most common type of SMTs were 83( 43?46%) heterotopia pancreas and 45(23?56%) hamartoma, followed by 28(14?66%) lipoma and 20(10?47%) GISTs. In 142 lesions located at cardia, the most common type of SMTs was 110 ( 77?46%) leiomyoma. Third, in 28 duodenum cases, there were 19 lesions at duodenal bulb, the most common type of SMTs was 10 heterotopia pancreas, 4 Brunner gland adenoma and 3 GISTs. In 9 lesions located at descending duodenum,the most common type of SMTs was 4 lipomyoma, followed by 2 ectopic pancreas,1 GISTs and 2 others. Conclusion Leiomyoma is the most common type of esophageal SMTs. In gastric fundus and body, the most common type of SMTs are GISTs and leiomyoma. In antrum, the most common type of SMTs are heterotopia pancreas and hamartoma, but in cardia, that is leiomyoma.In duodenal bulb, the most common type of SMTs are heterotopia pancreas, Brunner gland adenoma and GISTs,and in descending duodenum, is lipomyoma.

Objective To investigate the risk factors associated with gastroparesis syndrome after laparoscopic pancreatoduodenectomy which provide reference for clinical prevention.Methods Ninety cases of laparoscopic pancreatoduodenectomy admitted from August 2013 to December 2016 in Traditional Chinese Medicine Hospital of Guangdong Province were studied retrospectively,57 were male(63.3%),the average age was 54.6 years old.Twenty cases were diagnosed postoparative gastroparesis syndrome(22.2%).To screen out the risk factors,31 independent variables were analyzed by univariate analysis and logistic regression.Results Univariate analysis showed that malnutrition,hypoproteinemia,anemia,pylorus-preserving,extensive lymph nodes dissection,anxiety,high blood sugar before operation,delay of enteral nutrition,abdominal infection and postoperative high blood sugar were associated with postoperative gastroparesis(The value of OR were 3.143,3.587,2.852,2.889,3.231,7.071,2.889,5.359,6.000,6.263,P<0.05).Multivariate Logistic regression analysis showed that extensive lymph nodes dissection,anxiety,pylorus-preserving,abdominal infection,delay of enteral nutrition,hypoproteinemia,postoperative high blood sugar were risk factors of postoperative gastroparesis(The value of OR were 17.574,8.931,6.637,6.461,6.446,5.414,5.200;P<0.05).Conclusion Multiple risk factors can lead to gastroparesis after laparoscopic pancreatoduodenectomy,measures should be taken aimed at these risk factors during perioperative period.

Objective To observe the meshed capillary pattern(CP)on the surface of colorectal lesions by narrow-band imaging system with magnifying endoscopy(NBI-ME),and to distinguish neoplasm from non-neoplasm by the change of capillary patterns.Methods A total of 144 colorectal lesions in 102 patients detected by conventional colonoscopy were evaluated by NBI-ME to observe the CP on surface,and by staining magnifying colonoscopy to observe the pit pattern.Results All lesions were resected endoscopically (129/144)or by surgery(15/144),and the pathological evaluation diagnosed 30 cases of non-neoplasm (including 20 cases of hyperproliferative polyps and 10 of inflammatory polyps)and 1 14 cases of neoplasm (including 95 cases of adenoma and 19 cases of adenocarcinoma).The diagnostic accuracy rate,sensitivity and specificity of conventional colonoscopy were 75.7%,85.1%and 40.O%,respectively,which were significantly lower than those of NBI-ME and staining magnifying colonoscopy(P＜0.005),while there was no significant difference between NBI-ME and staining magnifying colonoscopy.The CP of type Ⅰ,Ⅱ,Ⅳ and Ⅵa were totally correspondent with pit pattern of type Ⅰ,Ⅱ,Ⅳ and ⅤI. Conclusion NBI-ME findings of colorectal lesions correlated with those of staining magnifying colonoscopy.These two techniques are both helpful in differentiating colorectal neoplasms from non-neoplasms.

With the development and maturation of endoscopic management, endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), submucosal tunneling endoscopic resection (STER) and laparoscopic-endoscopic cooperative surgery (LECS) show absolute advantages in minimal invasion and functional preservation in the treatment of colorectal neoplasms. More and more endoscopic managements are carried out to treat colorectal neoplasms. The aim of this article is to summarize the application of endoscopic management for colorectal neoplasms.
Colonoscopy ; Colorectal Neoplasms ; Humans ; Laparoscopy

In August 2018, The Chinese Consensus on Endoscopic Diagnosis and Management of Gastrointestinal Submucosal Tumors, which was formulated by the Surgical Group of Chinese Society of Digestive Endoscopology, the Chinese Physicians Association Endoscopy Branch Digestive Endoscopy Professional Committee, the Gastrointestinal Surgery Group of Chinese Society of Surgery, was published in Chinese Journal of Gastrointestinal Surgery. This consensus is the first guideline in the area of gastrointestinal submucosal tumors (SMTs) in China, and it proposed the diagnosis and management procedure of SMTs from the endoscopists′ viewpoint. This consensus presents case selection principles and technical principles of endoscopic treatment of SMTs. For and the indication and contraindication of endoscopic treatment of SMTs, it is suggested that clinician choose optimal procedure according to disease′s characteristics and techniques of the clinician. In this review, the key contents of consensus are interpreted in detail. The application of endoscopic snare resection, endoscopic submucosal excavation, endoscopic full-thickness resection and submucosal tunneling endoscopic resection at different SMTs was summarized. At the same time, the controversies in endoscopic diagnosis and management of the SMTs, such as biopsy, indication of endoscopic treatment and new techniques of endoscopic therapy, were analyzed.

Objective To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD)for colorectal SMTs. Methods In this retrospective study, 412 consecutive patients with colorectal SMTs who underwent ESD at Zhongshan Hospital of Fudan University from January 2008 to July 2014 were enrolled. Tumor histopathology,resection rate and complications were analyzed.Results Complete resection was achieved in 358(86.9%)lesions. Adverse events occurred in 13(3.2%)patients including bleeding and perforation. Multivariate analysis showed that the SMTs in the colon(OR=0.460,95%CI:0.232-0.911, P=0.014)and number of ESD procedures for colorectal SMTs(OR=0.421, 95% CI:0.211-0.837, P=0.026)were independent risk factors for non-complete resection.Moreover,SMTs in the colon(OR=0.253, 95%CI:0.067-0.957,P=0.043),tumors in the muscularis propria(OR=5.459,95%CI:1.162-25.638, P=0.032)and number of ESD procedures for colorectal SMTs(OR=0.198, 95% CI:0.058-0.674, P=0.010)were independent risk factors for adverse events. Conclusion ESD is safe and effective for resection of colorectal SMTs. Tumor location and the experience of endoscopists may influence the complete resection rate and the development of adverse events.

Objective To study the effects of acetated ringer's solution resuscitation in hemorrhagic shock rats on inflammatory mediators on lung tissue and their JNK (c-Jun N-terminal kinase) signaling pathways. Methods Thirty-two SD rats were randomly(random number) divided into four groups: shock without resuscitation group (CR, n=8), saline group (NR, n=8), lactated ringer's solution group (LR, n=8) and acetated ringer's solution group (AR,n=8). The rats of NR group, LR group and AR group were prepared into shock models (mean arterial blood pressure maintained at 40-45 mmHg),The rats of NR group, LR group and AR group were in the shock for 60 min and then the corresponding kinds of liquid were administered for 30 min and observation was carried out for 4 hours. The rats of CR group without liquid resuscitation were observed for 4 hours after shock. After that, the lung tissues of rats were taken from NR group, LR group and AR group as well as from CR group 4 hours after shock (if the rats died, the lung tissues were immediately taken). The levels of TNF-α, IL-4 and IL-10 mRNA in lung were measured by real-time polymerase chain reaction (RT-PCR),and Western blot was used to measure the levels of JNK phosphorylation and MKP-1 acetylation. The one-way ANOVA was used for comparison among groups. Between the two groups, the comparison was analyzed by using LSD-t test. Results The IL-4 mRNA expression of lung tissue in AR group was higher than that in CR group, NR group and LR group (CR group:0.42±0.34; NR group:2.60±0.66; LR group:6.24±2.95; AR group: 11.08±4.24; P＜0.05).The IL-10 mRNA expression of lung tissue in AR group was significantly higher than that in CR group, NR group and LR group (CR group:0.25±0.25; NR group:2.79±1.62; LR group:3.51±1.66; AR group:9.35±2.86;P＜0.01).The TNF-a mRNA expression in AR group was significantly lower than that in CR group, NR group and LR group (CR group:4.98±1.26; NR group:2.50±0.76; LR group:3.87±3.00; AR group:0.19±0.09; P＜0.01). The level of JNK phosphorylation in lung tissue of rats in AR group was significantly lower than that in CR group, NR group and LR group (CR group:0.52±0.12; NR group:0.42±0.08; LR group:0.30±0.08; AR group:0.17±0.06;P＜0.01). The level of MKP-1 acetylation in lung tissue of rats in AR group was significantly higher than that in CR group, NR group and LR group (CR group:0.14±0.07; NR group:0.30±0.07; LR group:0.37±0.02; AR group:0.48±0.06;P＜0.01). Compared with normal saline and lactated ringer's solution, acetated ringer's solution used in hemorrhagic shock rats could promote MKP-1 acetylation, inhibit the phosphorylation of JNK, significantly inhibit the lung tissue TNF-a released, promote the release of anti-inflammatory factors, IL-4 and IL-10. Conclusions The acetated ringer's solution for resuscitation of hemorrhagic shock in rats could reduce inflammation of lung tissue in a certain extent, probably by enhanced the acetylation of MKP-1 to inhibited JNK signaling pathway and reduced lung tissue inflammation.