Effect of Helicobacter pylori infection on gastric epithelial cell proliferation

INTRODUCTION Helicobacter pylori(H.pylori)infection is one ofthe main pathogens of chronic gastritis and duodenalulcer(DU),and it may be considered as a riskfactor in the incidence of gastric cancer.H.pylori infection may lead to the anomaly of gastricepithelial cell proliferation which is closely relatedto the development of gastric cancer.Vacuolatingcytotoxin(VacA)is an important virulence andvacA subtype determines the toxic activity.According to its signal sequence,it can be groupedinto type sla,slb,slc and s2.Strains harboringvacAsla are more closely related with digestivediseases and may be the strains with high toxicity.The effect of H.pylori infection on

Staging of liver fibrosis in chronic hepatitis B patients with a composite predictive model:A comparative study

AIM:To evaluate the efficacy of 6 noninvasive liver fibrosis models and to identify the most valuable model for the prediction of liver fibrosis stage in chronic hepatitis B(CHB) patients.METHODS:Seventy-eight CHB patients were consecutively enrolled in this study.Liver biopsy was performed and blood serum was obtained at admission.Histological diagnosis was made according to the METAVIR system.Significant fibrosis was defined as stage score ≥ 2,severe fibrosis as stage score ≥ 3.The diagnostic accuracy of 6 noninvasive liver fibrosis models,including serum aspartate aminotransferase(AST) to platelet ratio index(APRI),FIB-4,Forn's index,Fibrometer,Hepascore,and Shanghai Liver Fibrosis Group's index(SLFG),was investigated.RESULTS:The APRI,FIB-4 and Forn's index under receiver operating characteristic curve(AUROC) for sig-nificant fibrosis were 0.71,0.75 and 0.79,respectively,with a diagnosis accuracy of 67%,77% and 80%,respectively,and 0.80,0.87 and 0.86,respectively,under the AUROC for severe fibrosis.The Hepascore,SLFG,and Fibrometer were 0.80,0.83 and 0.85,respectively under the AUROC for significant fibrosis(P < 0.01).The diagnosis accuracy of Hepascore and SLFG was 86% and 88%,respectively.The Hepascore,SLFG,and Fibrometer were 0.95,0.93,and 0.94,respectively,under the AUROC for severe fibrosis(P < 0.01).CONCLUSION:The models containing direct serum markers have a better diagnostic value than those not containing direct serum markers.

JNK1,JNK2,and JNK3 are involved in P-glycoprotein-mediated multidrug resistance of hepatocellular carcinoma cells

BACKGROUND:Multidrug resistance(MDR)is extremely common in hepatocellular carcinoma(HCC)and is a major problem in cancer eradication by limiting the efficacy of chemotherapy.Modulation of c-Jun NH2-terminal kinase(JNK)activation could be a new method to reverse MDR.However,the relationship between JNK activity and MDR in HCC cells is unknown.This study aimed to explore the relationship between MDR and JNK in HCC cell lines with different degrees of MDR.METHODS:A MDR human HCC cell line,SMMC-7721/ ADM,was developed by exposing parental cells to gradually increasing concentrations of adriamycin.The MTT assay was used to determine drug sensitivity.Flow cytometry was used to analyze the cell cycle distribution and to measure the expression levels of P-glycoprotein(P-gp)and MDR-related protein(MRP)-1 in these cells.JNK1,JNK2 and JNK3 mRNA expression levels were quantified by real-time PCR.Expression and phosphorylation of JNK1,JNK2,and JNK3 were analyzed by Western blotting.RESULTS:The MDR of SMMC-7721/ADM cells resistant to 0.05 mg/L adriamycin was mainly attributed to the overexpression of P-gp but not MRP1.In addition,these cells had a significant increase in percentage in the S phase,accompanied by a decrease in percentage in the G0/G1 phase,which is likely associated with a reduced ability for cell proliferation and MDR generation.We found that JNK1,JNK2,and JNK3 activities were negatively correlated with the degree of MDR in HCC cells.CONCLUSION:This study suggests that JNK1,JNK2,and JNK3 activities are negatively correlated with the degree of MDR in HCC cells.

CT and MRI diagnosis of hepatic epithelioid hemangioendothelioma

BACKGROUND: Hepatic epithelioid hemangioendothelioma (EHE) is a rare, low-grade malignant vascular tumor. Although its unusual imaging and pathologic findings are being recognized with increasing frequency, diagnosis is still difficult. This study aimed to analyze the CT and MRI features of hepatic EHE with a pathological study in order to improve the diagnostic accuracy and knowledge of this disease in daily practice. METHODS: Nine patients with hepatic EHE confirmed pathologically underwent plain and dynamic contrast-enhanced multi-detector row CT examination. Of these patients, four underwent additional MRI (plain Ti-weighted imaging (T1WI), T2-weighted imaging (T2WI), and dynamic contrast-enhanced scanning) and one had selective hepatic arteriography. The imaging findings were reviewed retrospectively together with the pathological results. RESULTS: A total of 79 lesions, ranging from 3.0 to 44.6 mm in maximum diameter, with an average of 16.8 +/- 7.1 mm, were found in various segments of the liver. Thirty of the 79 lesions grew adjacent to the hepatic capsule. In the 4 patients receiving MRI, 39 lesions were found with low signal intensity on unenhanced T1WI and intermediate to high signal intensity on T2WI. The 'capsular retraction' sign was found in all the 4 patients. Nine of the 39 lesions showed the 'halo' sign after contrast enhancement on MRI. Of the 79 lesions (hypodense nodules) in the 9 patients shown by unenhanced plain CT, 26 were confluent. Calcification was found in 2 patients and the 'capsular retraction' sign in 7. Thirty-eight of the 79 lesions demonstrated the 'halo' sign after contrast enhancement on CT, and this sign was more clearly demonstrated in the portal venous phase. In one patient, selective hepatic arteriography showed patchy stain in the peripheral liver parenchyma with small vessels around them. Histology in all patients revealed proliferation of abnormal fibrous tissue and vessel-like structures scattered with irregular epithelioid cells having a signet ring-like structure. Immunohistochemically, all patients were positive for CD34, 4 were positive for CD31, and 3 were positive for factor VIII-related antigen. CONCLUSIONS: Hepatic EHE may manifest as solitary or diffuse nodular lesions with a predilection for peripheral subcapsular growth and nodular confluence, together with the 'halo' and 'capsular retraction' signs. These imaging findings can help to improve the diagnostic accuracy of this rare hepatic tumor. (Hepatobiliary Pancreat Dis Int 2010; 9: 154-158)

Focal nodular hyperplasia of the liver in 86 patients

BACKGROUND: Focal nodular hyperplasia (FNH), the second most common benign hepatic tumor after hemangioma, is characterized by a stellate central scar and hyperplastic nodules. Although some large FNH may be associated with significant symptoms, more frequently they are discovered incidentally on physical examination or the work-up of unrelated symptoms. Since its nature and pathogenesis are still controversial, accurate diagnosis of FNH based on clinical presentation and radiographic studies is difficult. The purpose of this study was to explore the diagnosis and treatment of FNH. METHODS: Eighty-six FNH patients confirmed pathologically were treated at the Liver Cancer Institute in our hospital from 1996 to 2006. Their clinical manifestions, imaging presentation, pathological findings, and surgical results were analyzed retrospectively. RESULTS: Of the 86 patients with 99 foci, 54 were male and 32 female, with a mean age of 37 years. Eighty patients had a single solitary focus and 6 had multiple foci. Tumor diameter was less than 5 cm in 69 patients, 5-10 cm in 15, and more than 10 cm in 2. The overall rate of correct preoperative diagnosis was 59.3% (51/86) including 32.9% (26/79) by color Doppler flow imaging (CDFI), 60.3% (35/58) by CT, and 77.4% (24/31) by MRI. All the 86 patients underwent resection with good curative effect. CONCLUSIONS: CT and MRI are important diagnostic methods for FNH but it is difficult to make a definite preoperative diagnosis for partial classical and all non-classical FNH patients. We suggest that patients with clinical symptoms or with indefinite diagnosis should accept surgical removal.

Glyco-poly-L-lysine is better than liposomal delivery of exogenous genes to rat liver

AIM To compare the effects of liposomes andglyco-poly-L-lysine on liver targeted uptake andexpression of plasmid in rat liver.METHODS After binding with lipofectamine orgalactose-terminal glyco-poly-L-lysine,theplasmid could be expressed in eukaryotic cellswhen injected into Wistar rats by intravenousroute.At different time intervals after the injection,the distribution and expression of the plasmid inliver of rats were observed and compared using insitu hybridization and immunohistochemistry.RESULTS The expression of the plasmid bindingto liposomes or G-PLL could be markedly observed24 h later,and began to decrease one week later,but it still could be observed up to three weeks.Both liposomes and G-PLL could deliver theplasmid to the liver effectively,but the effect of thelatter was better than the former concerning thedistribution and expression of the plasmid targeteduptake in the liver.CONCLUSION G-PLL is better than liposome asthe targeted carrier for delivering exogenous genesto the liver.

A comparison between intravenous and peritoneal route on liver targeted uptake and expression of plasmid delivered by Glyco-poly-L-lysine

AIM To compare the effects of intravenous routeand peritoneal route on liver targeted uptake andexpression of plasmid delivered by galactose-terminal glyco-poly-L-lysine(G-PLL).METHODS The plasmid pTM/MMP-1 which couldbe expressed in eukaryotic cells was bound to G-PLL,and was then transferred into Wistar rats byintravenous and intraperitoneal injection.Theexpression and distribution of the plasmid wereobserved at different time periods by in situhybridization and immunohistochemistry.RESULTS The plasmid could be expressedsignificantly within 24 h after being transferred invivo by both intravenous and intraperitonealroutes.One week later the expression began todecrease,and could still be observed three weekslater.Although both the intravenous andintraperitoneal route could target-specificallydeliver the plasmid to the liver,the effect of theformer was better as compared to that of the latter.CONCLUSION Intravenous route is better for livertargeted uptake and expression of G-PLL-boundplasmids than the peritoneal route.

肢体毁损伤保肢治疗的体会

目的通过对肢体毁损伤保肢治疗的回顾性总结,探讨治疗过程中的经验与教训。方法 2015年6月-2018年10月,对10例肢体毁损伤患者进行保肢治疗,急诊行重建肢体血运与固定骨折,Ⅱ期行软组织修复,术后观察创面愈合及肢体的功能恢复情况。结果保肢成功8例,术中截肢1例,术后保肢失败截肢1例。保肢成功后的患肢,随访0.6~1.5年,均有保护性感觉恢复,无疼痛,上肢以中华医学会上肢断肢再植功能评定试用标准评定:优2例,良3例,可3例。下肢行走稍有跛行3例,明显跛行1例,均无需辅助工具可独立行走。大腿近端截肢病例安装假肢后需拐杖辅助行走,小腿中段截肢病例安装假肢后可独立行走。结论对肢体毁损伤的治疗,术前应谨慎进行保肢评估,让患者及家属参与保肢与截肢的决策过程中,做到细心保肢,果断截肢。

Clinical value of contrast-enhanced ultrasonography in the characterization of focal liver lesions:a prospective multicenter trial

BACKGROUND: Contrast-enhanced ultrasonography (CEUS) is increasingly accepted in clinical settings for diagnostic imaging of focal liver lesions (FLLs). This study aimed to assess the efficacy of CEUS in the characterization of FLLs in comparison with final diagnosis based on gold standard assessment. METHODS: The study was approved by the local ethics committee and participating patients provided written informed consent. A total of 148 patients with 164 FLLs were studied. Unenhanced ultrasonography (US) and CEUS were performed using fundamental and harmonic imaging, respectively. Contrast enhancement was assessed during the arterial, portal and late vascular phases after intravenous administration of contrast (SonoVue (R), Bracco, Italy). Sensitivity, specificity and diagnostic accuracy of US and CEUS were compared in identifying the lesion as benign, malignant or indeterminate and its actual tumor type. Final diagnosis was established by biopsy (129/164), MR imaging (11/164) or medical history (24/164). RESULTS: When compared to the gold standard, the number of indeterminate diagnoses was reduced from 56.7% (93/164) as assessed by fundamental imaging to 6.1% (10/164) after SonoVue (R) enhanced US examination. Sensitivity and specificity improved from 49% and 25% at baseline US to 93% and 75% with CEUS, respectively (P<0.01). Diagnostic accuracy of CEUS was 88% in contrast to 41% of baseline US. CONCLUSION: SonoVue (R) enhanced US improves the characterization of FLLs and may limit the need for further investigations.

Current status of radiology in China

INTRODUCTIONRadiology has been greatly advanced in China sinceits founding in 1949 and has been developed fasterand further more since China adopted the policy ofsocioeconomic reform in 1978.It plays anincreasingly important role in the medical healthcare and treatment in the country and has reachedthe world’s advanced level in certain fields.We nowbriefly review the history of China’s radiology so asto give a clear picture of its development.

Immunological protection of small bowel by simultaneously transplanted liver graft in pigs

BACKGROUND: A simultaneously transplanted liver shields a bowel graft from immunologic attack in small animals, while the possible immuno-tolerance induced by the liver in liver and small bowel transplantation (LSBT) is uncertain in large animal models. To investigate the clinically suspected beneficial effect of the liver on small bowel allograft, we developed a new model of composite LSBT in the pig. METHODS: Seventy outbred long-white pigs were randomized into four groups. LSBT without immunosuppressive treatment (n=10, group A); LSBT with routine immunosuppressive treatment (n=10, group B); LSBT with a lower dose of immunosuppressive treatment (n=10, group C); and small bowel segment allotransplantation without immunosuppressive treatment (n=10, group D). RESULTS: There was no remarkable difference in survival time between groups A and D (10.33 vs. 12.89 days, P>0.05), but the initial time of acute rejection of the intestinal graft in group A was clearly delayed when compared to group D (8.22 vs. 4.33 days, P<0.05), and the rejection scores in group A were remarkably lower than those in group D at each postoperative time point (0 vs. 0.44 on day 3, P<0.05; 0.22 vs. 1.78 on day 5, P<0.05; 1.11 vs. 2.56 on day 7, P<0.05). There were evident differences in postoperative survival time, initial time of acute rejection and postoperative rejection scores between groups A, B and C. Postoperative survival time (30.00 vs. 28.13 days, P>0.05), initial acute rejection time (25.40 vs. 22.13 days, P>0.05) or rejection score did not differ between groups B and C within one postoperative month. CONCLUSIONS: Compared to isolated segment small bowel allotransplantation, the intestinal graft in LSBT (group A) had a delayed initial time of acute rejection and a lower postoperative acute rejection score, and a lower dose of immunosuppressive treatment led to persistent graft immuno-tolerance in LSBT. Thus the simultaneously transplanted liver graft may reduce the risk of intestinal rejection and protect the bowel graft from severe acute rejection.

Preparation and Application of Polymyxin B Affinity Membrane Cartridge

Affinity membrane was used for the endotoxin adsorption. The matrix macropore membrane was prepared from filterpaper by chemically crosslinking, and polymyxin B was immobilized as affinity ligand. The prepared membrane cartridge can be used for the removal of endotoxin from aqueous solutions. With a cartridge of 40 sheets affinity membrane containing, the endotoxin level of the processed solution can be reduced to a minimum of 4 pg/mL.

Image-guided extended endoscopic endonasal transsphenoidal approach for removal of craniopharyngiomas in the suprasellar region and the third ventricle

Objective To investigate the feasibility and efficacy of image-guided extended endoscopic endonasal transsphenoidal approach(EEETA) for the removal of craniopharyngiomas in the suprasellar region and the third ventricle. Methods A pure EEETA with image-guided system was used. Three patients with a craniopharyngioma

Sixteen years' home parenteral nutrition for a patient with total small bowel resection

Objective To study the metabolic changes and complications of a patient on long term home parenteral nutrition ( HPN ). Methods Clinical data were summarized on a female patient with total small bowel plus right colon resection receiving home parenteral nutrition support for 16 years. Results The patient became pregnant on the 5 th year of HPN,and gave birth to a healthy baby. Her liver function remains almost normal during the 16 years. Each central vein catheter averagely lasted for 240 days, with the longest one more than 26 months. Catheter related sepsis rate was very low. Several complications occurred during the 16 years, including anaemia, zinc deficiency and increased serum iron level. Lipid peroxidation increased significantly. Conclusion Long-term HPN support patient could suffer many metabolic abnormalities complications. Catheter related sepsis and occlusion should be prevented. The HPN formula should be adjusted according to the patient’s condition.5 refs, 1 tab.

The protective effects of verapamil and SOD on ESW-induced kidney damage

Objective To investigate the protective effects of calcium channel blockade and oxygen free radical catalase on ESWL-nduced kidney damage. Methods 120 female uninephrectomized rat models were randomizedly divided into six groups. After verapamil and (or) SOD injection, the kidneys were shocked 1 000 times at 14 kV by ESW. Then ET level in kidney tissue,levels of NAG,MDA,ET in urine, variation of creatinine clearance (Ccr) and the kidney histopathological changes were evaluated. Results The variation of NAG and MDA level in urine and the Ccr in the therapeutic groups were significantly lower and the histopathological changes were also much slight than those in the control group. There was no significant difference of the biochemical and pathological changes when the dose of SOD increased from 20 thousang units to June 2003 Vol12 No2 40 thousand units per kg body weight. If verapamil was used, the levels of ET in kidney tissue and in urine both decreased. Combined use of SOD and verapamil can induce

The intermediate outcome of mitral valvuplasty in treatment of moderate ischemic mitral regurgitation

Objective To determine whether mitral valvuplasty （MVP） concomitant with CABG was preferable to CABG alone in patients with moderate IMR in terms of intermediate outcome. Methods Case-match study was caried out in sixty patients who were with moderate IMR and were undertaken either CABG with MVP （ n = 30, MVP group） or CABG alone （ n = 30, C group）. Two groups were homogeneous for preoperative characteristics and comorbidities,

The treatment of mesenteric ischemia from Stanford B aortic dissection aneurysm

Objective To explore the treatment of mesenteric ischemia resulted from Stanford B aortic dissection aneurysm （ADA）.Methods From Jan2005 to Feb 2006, eight Stanford aortic dissection cases with the involvement of the opening of superior mesenteric artery （SMA） were admitted. Among them,5 cases with the opening of SMA within the false channel received visceral artery reconstruction through right or left iliac arter-SMA graft bypass for the prevention of intestinal ischemia before endovascular repair （EVR） of AD.

Efficacy of radiofrequency Maze Ⅲ procedure for atrial fibrillation combined with mitral valve surgery：a controlled study

Objective To evaluate the effcacy of radiofrequency Maze Ⅲ procedure for atrial fibrillation combined with mitral valve surgery.Methods From January 2003 to October 2004,66 patients underwent radiofrequency Maze Ⅲ procedure for atrial fibrillation combined with mitral valve surgery （study group）.They were compared to 66 patients with atrial fibrillation who underwent mitral valve surgery without Maze procedure during the same period （control group）.

THORACIC AND CARDIOVASCULAR SURGERY——Pleura, pleural cavity, mediastinum, diaphragm 208494 Clinical and pathological analysis of solitary fibrous tumor of the pleura

Objective To investigate appropriate diagnosis and treatment of solitary fibrous tumor of the pleura （SFTP）. Methods CIinical and pathological data of ten patients treated in our hospital from 2002 to 2007 were reviewed. Results Our series consisted of three men and seven women. In two patients correct diagnosis was made before operation through ultrasonugraphy-guided core needle biopsy. All the patients were treated surgically including three resected by video-assisted thoracic surgery （VATS）.

Influence of organic anion transporting potypeptide(SLCO1B1 and SLCO1B3)genetic polymorphisms on mycophenolic acid in Chinese kidney transplantation patients

Objective To analyze the relationship between genetic polymorphisms of organic anion transporting polypeptide ( SLCO1B1 and SLCO1B3) and mycophenolic acid ( MPA) pharmacokinetics in Chinese kidney transplant recipients. Methods Gene mutations ( SLCO1B3 T334G,SLCO1B1 A338G) were detected in 68 recipi-