Severe acute pancreatitis is the systemic inflammatory reaction caused by the preternatural activation of trypsogen. The necrotizing pancrea as the antigen or stimulant, activiates immunocyte and in-flammatory cell to release a great deal of cytokines, including proinflammatery factor and anti-inflammatory factor. The former aggravates the damage of constitution, the latter could antigonize the damage of anti-inflam-matory factor. The unbalance of pro-and anti-inflammatory cytokines ,leads to the occurrence of systemic in-flammatory syndrome, even the mutiple organ failure.

Objective To explore the emergent measures for hematomyelia during microendoscopic discectomy (MED). Methods Different measures, such as electrocoagulation, compression, irrigation, or hemostatic administration, were directed against different types of hematomyelia during MED. Results No conversions to open surgery for hematomyelia were required in all the 287 cases in the study. A follow-up for 4~30 months (mean, 17 months) was carried out. According to the MacNab criteria, excellent results were achieved in 219 cases, good results in 59 cases, fair in 7, and poor in 2. Conclusions Measures for hematomyelia during MED include the decrease of abdominal pressure, strict hemostatic performance, keeping off varicose veins when the protruded intervertebral disc is resected, compression by using gelfoam or styptic cotton, and intravenous administration of thrombin. These measures can effectively improve the surgical safety and the curative effect.

OBJECTIVE:To systematically review the efficacy of cetuximab combined with chemotherapeutics versus chemo-therapeutics alone in the treatment of metastatic colorectal cancer,and provide evidenced-based reference for clinical treatment. METHODS:Retrieved from Medline,PubMed,EMBase,CJFD,VIP,WanFang database and Cochrane Library,randomized con-trolled trials(RCT)about the efficacy of cetuximab combined with chemotherapeutics(test group)versus chemotherapeutics alone (control group) in the treatment of colorectal cancer were collected. Meta-analysis was performed by using Rev Man 5.2 software after data extract and quality assessment. RESULTS:A total of 12 RCTs were included,involving 8 514 patients. Results of Me-ta-analysis showed progression free survival in test group was significantly longer than control group,the difference was statistical-ly significant [HR=0.87,95%CI(0.79,0.95),P=0.002];compared with control group,there were no significant differences in the disease control rate[OR=1.06,95%CI(0.88,1.27),P=0.54] and overall survival[HR=0.92,95%CI(0.85,1.00),P=0.05] in test group. Results of subgroup analysis showed cetuximeb could significantly prolong the progression free survival of KRAS wild-type patients,the difference was statistically significant[HR=0.80,95%CI(0.66,0.98),P=0.03]. CONCLUSIONS:Compared with che-motherapeutics alone,chemotherapeutics combined with cetuximab can significantly prolong the progression free survival of pa-tients with metastatic colorectal cancer. Due to the limits of quality and sample size,more strict designed,long-term follow-up of large scale RCTs are needed for the further verification of the conclusion.

Objective To study the expression and clinical significance of survivin in acute leukemia. Methods By using semi-quantitative RT-PCR technique, survivin gene expression was detected in 43 acute leukemia(AL). Results Survivin gene expression rate in the cells of AL patients at diagnosis was 69.77%(30/43). Survivin mRNA expression rate in both 18 acute lymphocytic leukemia (ALL) and 25 acute nonlymphocytic leukemia(ANLL) (72.22% and 68.0% respectively) was signficantly higher than that in control group (33.33%,P0.05). Conclusions Survivin gene was highly expressed in AL patients and could be a potential target for treatment of AL.

It was found that the proliferation of mice L7712 leukemic cells in vitro was markedly inhibited by 5 mg/L GP1 and VP10 The inhib itory rate increased with the incubation time. At a concentration of 0 .04-20mg/L, the mitotic index ( MI ) of GP1 group increased, but the MI of VP16 group decreased. After L7712 cells were treated with GP, 5 mg/L for 12 h the MI reached the highest point which was 8 times as high as that of the control, at the same time, the MI of VP16 ( 5 mg/L) group was about one-third of that of the control. The result of the combination of GP1 with VP16 showed that VP16 could antagonize the effect of GP on MI of L7712 cells. After being treated by GP1 and VP18 for 24 h, serious damage of L7712 cells could be observed. Both drugs inhibited the incorporation of (3H) TdR into DNA of S180, ascitic hepatoma (AH), L1210 and L7712 cells incubated for 24 h. It was further observed that S180 and L7712 cells were more sensitive than other cells to both drugs.

Aim To investigate the effects of paeonol on lipopolysaccharide ( LPS) and adenosine 5′-triphos-phate ( ATP) induced NLRP3 inflammasome activation in primary rat microglia and the mechanisms responsi-ble for this anti-inflammatory effects. Methods Pri-mary rat microglia were identified immunohistochemi-cally using the cluster of differentiation 11 b ( CD11 b ) antibody. Proinflammatory cytokine IL-1β was deter-mined by ELISA. Western blot was performed to ob-serve the protein expression of NLRP3 , ASC and caspase-1 in cultured primary rat microglia. The level of intracellular reactive oxygen species ( ROS) was mo-nitored by using the fluorescent probe 2′, 7′-dichlo-rofluorescein diacetate ( DCFH-DA ) . Results LPS (0. 5 mg · L-1 )/ATP ( 5 mmol · L-1 ) significantly increased intracellular ROS level and IL-1β secretion and upregulated NLRP3 , ASC and caspase-1 protein expression in primary rat microglia. Paeonol signifi-cantly decreased intracellular ROS level and IL-1β se-cretion, and inhibited LPS/ATP induced overexpres-sion of NLRP3 , ASC and caspase-1 in cultured primary rat microglia. Conclusion Paeonol can inhibit LPS/ATP induced NLRP3 inflammasome activation in pri-mary rat microglia, and this inhibitory effect may be through the suppression of intracellular ROS.

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 investigate the effect of small intestine exclusion surgery on blood glucose and oral glucose tolerance test (OGTT) in Goto-Kakizaki (GK) rat with type Ⅱ diabetes mellitus.Methods 40 GK rats were randomly divided into 5 groups:duodenal bypass (Group A,n = 8),duodenaljejunal bypass (Group B,n = 8),duodenum and total jejunum exclusion (Group C,n = 8),sub-total small intestine exclusion (Group D,n = 8),and sham-operation (Group SO,n=8).All rats were observed for 24 weeks after surgery.Fasting blood glucose was tested at 0,1,3,6,12,and 24 wk.OGTT was performed at 0,1,and 24 wk.After the administration of 3 g/kg glucose by oral gavage,blood glucose was measured in conscious rats before (baseline) and after 30,60,120,and 180 minutes.Areas under curves (AUC) were calculated by trapezoidal integration.Results Rats in group A,B,C and D had lower fasting blood glucose levels and better oral glucose tolerance as shown by lower peak and area-under-thecurve (AUC) glucose values through the entire follow-up period[group B (fasting blood glucose:(9.0±2.4) mmol/L vs.(4.4±1.0) mmol/L;OGTT peak:(20.8±3.1) mmol/L vs.(10.3±2.0) mmol/L;AUC:(2658±417) mmol·min/L vs.(1324±317) mmo·min/L,P ＜0.05 or P ＜0.01].Fasting blood glucose had no differences before 12 wk and significantly increased at 12 (9.1±2.4) mmol/L and 24 wk (10.0±2.3) mmol/L in group SO (preoperative values were (8.1±1.9) mmol/L,P ＜ 0.01.There was no differences in oral glucose tolerance as shown by lower peak and area-under-the-curve (AUC) glucose values between 0 and 1 wk (P＞0.05),while the oral glucose tolerance become worse as shown by the delay of peak,higher peak (25.6±2.0) mmoL/L vs.(21.4±2.7) mmoL/l,and AUC (3422±360) mmol·min/L vs.(2667±377) mmol·min/L.Glucose values in group SO at 24 wk compared to preoperatively (P＜0.01).Rats in group A,B,C,and D had lower fasting blood-glucose and better oral glucose tolerance compared with sham-operated group through the entire follow-up period (P＜0.05 or P＜0.01).Rats in group B had lower fasting blood-glucose and better oral glucose tolerance compared to those in group A while the effect on diabetes control in group B,C and D were similar to one another (P＞0.05).Conclusion Small intestinal exclusion containing proximal gut was effective for glucose control and improving gucose tolerance,duodeno-jejunal bypass may be applicable for diabetes control in clinical setting.

Objective: To observe the effects of early enteral nutrition(EEN) on incidence of postoperative complication in gastric cancer patients. Methods: 150 patients with gastric cancer were randomly divided into early enteral nutrition group (n=82) and non-early enteral nutrition (N-EEN) group (n=68). The patients in group EEN were given enteral nutrition after operation, and the patients in group N-EEN were given total parenteral nutrition support. The postoperative complications were recorded. The serum albumin, prealbumin and transferrin were measured on postoperative day 1, 5 and 9. The serum level of alanine aminotransferase(ALT), bilirubin, blood urea nitrogen(BUN), creatinine, glucose, cholesteroland triglyceridewere monitored. Results: The complications occurred in 21patients. 5 of these patients belonged to EEN group and the other belonged to N-EEN group. In EEN group, the serum albumin, prealbumin and transferrin were significantly higher than in N-EEN group on postoperative day 9 (P

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.