目的 探讨腹腔镜胆总管探查术(laparotomy and laparoscopy combined with choledochoscopy,LCDE)在胆道结石复发行二次手术治疗中的临床疗效.方法 回顾性收集南阳市中心医院胆道普外科于2019年8月至2022年3月期间收治的68例有一次胆道结石手术史的胆道复发结石行二次手术治疗患者的临床资料,根据接受的手术类型分为LCDE组(n=36)和开腹组(n=32),对两组患者个人资料、临床数据及随访资料进行统计分析,比较LCDE组和开腹组患者的手术疗效.结果 LCDE组和开腹组治愈率和近、远期并发症无明显差异(P＞0.05);LCDE组中转开腹率低,且在患者手术时间、术中出血量、术后排气时间、住院时间、住院费用等方面均优于开腹组,差异均有统计学意义(P＜0.05).结论 腹腔镜胆总管探查术二次手术治疗胆道复发结石安全可行有效,且在一定程度上利于患者术后康复、减少医疗费用,对于术前诊断明确的患者可首选LCDE.

目的 探讨超声引导经皮经肝胆囊穿刺引流术(PTGBD)后腹腔镜胆囊切除术(LC)治疗急重症胆囊炎(SAC)的效果和安全性.方法 回顾性分析柘城县人民医院普外科2020-01—2022-10行LC的96例SAC患者的临床资料,分为LC组和PTGBD+LC组,每组48例.记录LC的手术时长、术中出血量、中转开腹率数、术后视觉模拟评分法(VAS)疼痛评分和并发症发生率.分别于LC术前和术后24 h检测患者的高迁移率族蛋白-1(HMGB-1)、白细胞介素-6(IL-6)炎症因子水平.结果 PTGBD+LC组患者LC的手术时长短于LC组,术中出血量和中转开腹率、术后VAS评分、并发症发生率,以及术后24 h的血清HMGB-1、IL-6水平均低于LC组.差异均有统计学意义(P<0.05).结论 PTGBD后适时行LC治疗,有助于优化SAC患者的围术期临床指标和术后恢复,且对机体的炎症因子影响较小.但需严格掌握PTGBD的指征和LC及中转开腹胆囊切除术的时机.

目的 观察中晚期肝细胞癌患者应用仑伐替尼联合卡瑞利珠单抗治疗后临床缓解情况,探讨未缓解的影响因素.方法 2021年1-12月河南省人民医院诊治无法行手术治疗的中晚期肝细胞癌患者41例,均采用仑伐替尼联合卡瑞利珠单抗方案治疗,至疾病进展或出现不可耐受的不良反应停药.治疗期间每4～6周评估疗效,随访至2022年12月记录肿瘤缓解情况和不良反应发生情况.根据末次随访结果将41例患者分为缓解组(完全缓解+部分缓解)和未缓解组(疾病进展+疾病稳定).比较2组入院时血管内皮生长因子、谷草转氨酶、谷丙转氨酶、血小板计数,糖类抗原125(CA125)、糖类抗原19-9(CA19-9)、甲胎蛋白等指标及肿瘤直径、肝硬化、肝外转移、门静脉癌栓、BCLC分期、肝功能Child-Pugh分级、联合肝动脉栓塞化疗情况等.多因素logistic回归分析中晚期肝细胞癌患者采用仑伐替尼联合卡瑞利珠单抗治疗未缓解的影响因素.结果 末次随访时41例患者中完全缓解4例,部分缓解6例,疾病稳定21例,疾病进展10例,总缓解率为24.39％.未缓解组血管内皮生长因子[176.00(103.00,318.80)ng/L]、谷草转氨酶[50.40(32.10,72.80)u/L]水平均高于缓解组[101.72(77.36,119.15)ng/L、30.20(23.43,37.45)u/L](U=-2.215,P=0.034;U=-2.338,P=0.019;),BCLC 分期 C 期(67.7％)、有门静脉癌栓(58.1％)、血小板计数＞350×109/L(45.2％)比率均高于缓解组(20.0％、20.0％、10.0％)(x2=6.998,P=0.008;x2=4.385.P=0.036;x2=4.029,P=0.045),肿瘤直径[78.00(31.00,115.00)mm]大于缓解组[30.82(27.50,40.71)mm](U=-2.672,P=0.009);2 组血清白蛋白、谷丙转氨酶、CA125、CA19-9、甲胎蛋白、总胆红素水平,乙型及丙型肝炎病毒感染、联合肝动脉栓塞化疗、肝硬化、肝外转移比率及肝功能Child-Pugh分级比较差异均无统计学意义(P＞0.05).肿瘤直径(OR=1.042,95％CI:1.015～1.069,P=0.022)、血小板计数(OR=1.413,95％CI:1.007～1.982,P=0.042)、BCLC 分期(OR=1.363,95％CI:1.123～1.664,P=0.016)、门静脉癌栓(OR=2.044,95％CI:1.518～4.973,P=0.014)是中晚期肝细胞癌患者采用仑伐替尼联合卡瑞利珠单抗治疗后未缓解的影响因素.结论 肿瘤直径大、血小板计数＞350× 109/L、有门脉癌栓、肿瘤分期晚的中晚期肝细胞癌患者采用仑伐替尼联合卡瑞丽珠单抗治疗效果差.

目的 探讨T1b期胆囊癌(GBC)患者采用腹腔镜胆囊切除(LC)联合肝组织楔形切除、区域淋巴结清扫术治疗的临床效果.方法 选取 2016 年 2 月至 2020 年 1 月在河南省人民医院接受治疗的T1b期GBC患者共计 86 例,以随机数字表法分为研究组(n=44,LC联合肝组织楔形切除、区域淋巴结清扫术治疗)与对照组(n=42,LC治疗),对两组围手术期指标、疼痛程度[痛觉模拟评分法(VAS)]、肿瘤标志物、生活质量[世界卫生组织生存质量测定量表简表(WHOQOL-BREF)]、并发症发生率、生存率进行比较.结果 研究组手术时间、胃肠功能恢复时间、住院时间长于对照组,且出血量多于对照组,差异有统计学意义(P＜0.05);研究组术后 24 h、72 h VAS评分与对照组比较,差异无统计学意义(P＞0.05);两组术后 72 h癌胚抗原(CEA)、血清糖类抗原 19-9(CA19-9)水平降低,差异有统计学意义(P＜0.05),但研究组与对照组比较,差异无统计学意义(P＞0.05);两组术后 1 个月WHOQOL-BREF评分提高,且研究组评分高于对照组,差异有统计学意义(P＜0.05);研究组并发症发生率(11.36%)与对照组(7.14%)比较,差异无统计学意义(P＞0.05);研究组术后3年生存率(36.36%)较对照组(16.67%)更高,差异有统计学意义(P＜0.05).结论 LC联合肝组织楔形切除、区域淋巴结清扫术应用于T1b期GBC患者治疗中,能够提高生活质量,提高远期生存率,不会增加术后并发症,但手术时间更长,术中出血量更多,恢复时间更长.

Objective:To analyze the different clinicopathological features of intrahepatic cholangiocarcinoma with and without viral hepatitis.Methods:The clinicopathological data of 79 intrahepatic cholangiocarcinoma cases from Mar 2012 to Sep 2018 at Henan Provincial People's Hospital were retrospectively analyzed.Results:Twenty-five of the 79 patients with intrahepatic cholangiocarcinoma were accompanied by viral hepatitis. Those with viral hepatitis had a lower mean age at onset than those without [(53±11) years vs. (60±11) years, P=0.011], higher proportion of male patients (80% vs. 52%, P=0.017), higher AFP positive rate (40% vs. 19%, P=0.041), lower CA19-9 positive rate (48% vs. 72%, P=0.036), tend to occur in the right liver lobe (76% vs. 44%, P=0.009), a lower rate of bile duct invasion (16% vs. 41%, P=0.03), and were more likely to be mass type (mass type proportion 96% vs. 72%, P=0.032). Conclusions:Viral hepatitis is common in intrahepatic cholangiocarcinoma. Intrahepatic cholangiocarcinoma with and without viral hepatitis differ in clinicopathology. Intrahepatic cholangiocarcinoma with viral hepatitis is more likely to have the characteristics of hepatocellular carcinoma, while intrahepatic cholangiocarcinoma without viral hepatitis is more likely to have the characteristics of cholangiocarcinoma.

目的 加强对气肿性胰腺炎的临床认识,合理实施外科干预,提高治愈率.方法 分析2009年7月—2014年7月河南省人民医院收治的8例气肿性胰腺炎的临床资料.结果 8例重症急性胰腺炎患者腹部CT检查提示胰腺及胰周游离气体存在.在营养支持基础上给予积极抗感染治疗,仍有反复发热等感染征象.8例患者均实施胰腺、胰周坏死组织及感染灶清创术并置管冲洗引流,全部治愈出院.结论 气肿性胰腺炎在营养支持、抗生素应用以及影像学动态评估的基础上,掌握合理的手术时机实施外科清创引流术,能获得较好的预后.

目的 探讨妊娠期高脂血症性急性胰腺炎(hyperlipidemia acute pancreatitis,HLAP)的临床特征、主要病因及预后.方法 41例妊娠期急性胰腺炎患者,按病因分为HLAP组20例和非HLAP组21例,记录并比较2组一般资料,采用多因素logistic回归分析妊娠期HLAP的危险因素.比较2组患者病情严重程度、预后情况及母婴结局.结果 41例妊娠期急性胰腺炎患者HLAP发生率为48.78％.HLAP组孕前高脂血症(35.0％)、孕期体质量增长过多(45.0％)发生率高于非 HLAP 组(4.76％、14.29％)(P＜0.05).孕前高脂血症(OR= 15.304,95％CI:1.533～152.738,P = 0.02)、孕期体质量增长过多(OR = 6.863,95％CI:1.356～34.731,P = 0.02)是妊娠期发生HLAP的独立危险因素.HLAP组患者中、重度急性胰腺炎(90.0％)、胸腔积液(60.0％)、局部并发症(50.0％)、全身炎症反应综合征(60.0％)、器官衰竭(45.0％)发生率高于非 HLAP 组(14.3％、9.5％、4.8％、9.5％、9.5％)(P＜0.05),胎儿窘迫(60.0％)、终止妊娠(75.0％)比率高于非HLAP组(19.0％、38.1％)(P＜0.05).结论 高脂血症是妊娠期急性胰腺炎的首要病因,孕前高脂血症、孕期体质量增长过多是妊娠期发生HLAP的独立危险因素;相对于妊娠期非HLAP,HLAP的母婴结局更差.

Objective:To understand the nutritional risk and application of nutritional support in the middle-aged and elderly inpatients in hepatobiliary surgery department, so as to provide evidence for the rational nutritional support.Methods:Totally, 259 middle-aged and elderly patients in Department of Hepatobiliary Surgery of Henan Provincial People′s Hospital from April to May in 2019 were selected and investigated with nutritional risk screening scale (NRS) 2002, and the malnutrition and nutritional support were analyzed. The serum albumin (ALB) and prealbumin (PA) were measured. Descriptive analysis, chi square test and t-test were used for the statistical analysis. Results:The malnutrition rate and at-risk were 38.6% and 57.9%, respectively. The malnutrition rate and at-risk in men were 57.2% and 40.8%, and 58.8% and 35.5% in women, respectively. There were no statistically significant differences in nutritional risk by sex or age. The body mass index (BMI), ALB and PA in the patients with nutritional risk were significantly lower than those without non-nutritional risk group [BMI: (23.06±3.02) kg/m 2 vs. (24.12±3.45) kg/m 2, t=2.626, P<0.05; ALB: (34.92±6.76) g/L vs. (40.46±6.76) g/L, t=7.118, P<0.01; PA: (127.20±23.95) g/L vs. (163.17±24.88) g/L, t=11.739, P<0.01]. The nutritional support rate in the elderly patients with nutritional risk (150 cases) and no-nutritional risk (109 cases) was 42.0% and 11.9% respectively. Conclusion:The rate of malnutrition and nutrition risk was higher in the patients with hepatobiliary surgery department, and the nutritional support rate was low. The NRS 2002 should be carried out in early stage to improve the nutritional support rate of positive patients, so as to effectively correct the malnutrition of patients and improve the clinical outcome.

淋巴管瘤是一种良性淋巴管畸形,90％以上发生于颈部和腋窝,10％以下的病例发生于其他部位,如纵隔、胃肠道和后腹膜等,脾淋巴管瘤临床罕见[1-2].本研究分析脾淋巴管瘤病人8例的临床资料,探讨淋巴管瘤临床表现、影像学表现、病理特点及治疗.

目的 探讨分支胰管型胰腺导管内乳头状黏液瘤(BD-IPMN)的治疗策略.方法 结合最新文献复习回顾性分析2例BD-IPMN患者的临床资料.对BD-IPMN的治疗策略、恶变预测等进行探讨,以提高对BD-IPMN的认识和治疗水平.结果 2例患者手术过程顺利.患者1术后出现B级胰瘘,患者2出现一过性生化瘘,均经通畅引流、对症及支持治疗后顺利出院.患者1病理提示IPMN伴局灶导管周围腺体不典型增生.患者2病理提示IPMN伴上皮轻-中度异型增生.随访6～12个月,2例患者均未发生复发、转移.结论 BD-IPMN作为一种低恶性潜能的肿瘤,尚缺乏有效的指标或方法精准预测其恶性潜能.手术是目前唯一有效的治疗方法,但外科治疗策略的制定需结合患者的依从性、意愿,以及预期寿命和手术风险等因素.应谨慎把握老年及有严重合并症患者的手术指征.

目的 探讨90岁以上超高龄胆总管结石患者的临床治疗.方法 回顾性分析我院2018年7月至2019年6月收治的90岁以上超高龄胆总管结石患者26例,总结其临床特点和治疗选择,并结合文献进行研究.结果 超高龄患者往往合并症多,保守治疗15例中,1例死亡,2例保守效果差且不同意手术治疗转入当地医院治疗,余12例患者均缓解,顺利出院.手术治疗11例患者均好转出院,无死亡病例,术后1例患者出现皮下气肿,1例LCBDE患者出现胆瘘,1例出现肺部感染,1例出现尿潴留,1例LCBDE及1例OCBED患者出现术后谵妄症状.术后2例OCBED及6例LCBDE复查行T管造影均无结石残留,顺利拔除T管.结论 90岁以上的超高龄胆总管结石患者往往病情复杂,风险高,其治疗选择受多方面因素的影响,药物治疗、内镜治疗及外科手术治疗应根据患者的具体情况实施个体化治疗.

Objective:To investigate the surgical methods for biliary liver abscesses related with biliary tract obstruction, and summarize the characteristics of etiology.Methods:The clinical data of 43 cases of biliary liver abscesses related with biliary tract obstruction in Henan Provincial People’s Hospital from January 2017 to January 2020 were analyzed retrospectively. Among them, 8 cases underwent simple biliary tract surgery to remove obstruction, 13 cases underwent biliary tract operation combined with liver abscess incision and drainage, and 22 cases underwent biliary tract operation combined with partial hepatectomy. The operation and etiological characteristics were analyzed.Results:The leukocytes of patients undergoing biliary tract operation alone, biliary tract operation combined with liver abscess incision and drainage before operation were higher than those of patients with biliary tract operation combined with partial hepatectomy, the differences were significant ( P<0.05). All the patients were cured and discharged without death. There were no significant differences in operation time, bleeding volume, blood transfusion status, and laboratory indexes on the first day after operation among the three treatment methods ( P>0.05), but the postoperative hospitalization time in the simple biliary operation group was significantly longer than that by the other two treatment methods, and the difference was significant ( P<0.05). Escherichia coli was the main pathogen, and 72.73% (8/11) of the produce extended spectrum β-lactamases (ESBL). Conclusions:It is more important to remove the primary disease and remove the biliary obstruction in the surgical treatment of biliary liver abscesses related with biliary tract obstruction. The combination of incision and drainage of liver abscesses during the operation is helpful to accelerate the recovery and shorten the postoperative hospital stay, multiple factors lead to long-term difficulty in closure after drainage, and the abscess is multi-septum which can not be fully drained, partial hepatectomy should be considered. Escherichia coli is the main pathogen of biliary liver abscess related with biliary obstruction. The possibility of Gram-negative bacteria infection should be considered first when antibiotics are selected empirically, and the possibility of producing ESBL should be warned at the same time.

目的 探讨腹腔镜下放射性粒子植入联合热灌注化疗治疗无法切除胰腺癌的效果.方法 收集行碘125粒子植入联合腹腔热灌注化疗的47例胰腺癌患者的临床资料,观察术后疼痛缓解情况、肿瘤局部控制率及生存期,对治疗效果予以分析.结果 疼痛缓解率为76.3％(29/38),肿瘤局部控制率为74.5％ (35/47),中位生存期为7个月.结论 腹腔镜下碘125粒子植入与腹腔热灌注化疗联合治疗不可切除胰腺癌,可以明显缓解晚期胰腺癌患者的临床症状,提高患者生存率,且具有创伤小,恢复快等优点.

Objective To explore the safety, feasibility, validity and superiority of accelerated rehabilitation in laparoscopicsurgery concept accurate liver resection. Methods Totally 126 cases of hepatectomy in the patients of hepatobiliary surgery in Henan provincial people's hospital from January 2015 to February 2017, of which 63 cases were treated by ERAS, were treated as control group. The personal data, clinical data and follow - up data of two groups were analyzed statistically. Results The experimental group and control group cure rate and postoperative1, 3, 7days no difference between the white blood cells (P ＞ 0.05); Experimental operation time, postoperative exhaust time, defecation time and hospital stay were shorter than those of the control group, on the day of surgery transfusion volume and hospitalization cost less than the control group, postoperative1, 3, 7days CRP was lower than those of control group, the differences were statistically significant (P ＜ 0.05). Conclusion The eras in laparoscopic accurate hepatectomy is safe, feasible and effective, and has obvious advantages in postoperative rehabilitation, hospital cycle and medical cost. However, require the joint efforts of multidisciplinary integrated treatment group, actively carry out multi - center clinical study under the guidance of evidence - based medicine.

Cligosiban is a highly-affinity nonpeptide oxytocin receptor antagonist. In this study, a simple an sensitive LC-MS/MS method was developed and validated for the determination of cligosiban in rat plasma. The plasma samples were pretreated with acetonitrile as precipitant and then separated on an ACQUITY BEH C-18 column (2.1 x 50 mm, 1.7 mu m) with 0.1% formic acid in water and acetonitrile as mobile phase. The analytes were monitored using selected reaction monitoring (SRM) mode with transitions at m/z 420.1 -> 248.1 for cligosiban and m/z 304.1 -> 161.1 for IS. The developed method showed good linearity over the concentration range of 1-1000 ng/mL with coefficient of correlation > 0.996. The lower limit of quantification (LLOQ) is 1 ng/mL. The method was validated for selectivity, precision, accuracy, recovery, and stability in accordance with FDA's guidance. The validated assay has been successfully applied to the pharmacokinetic study of cligosiban in rat plasma after intravenous and oral administration. According to the current results, the oral bioavailability of cligosiban was 63.82%. Furthermore, the metabolites present in rat liver microsomes (RLM), human liver microsomes (HLM) and rat plasma were analyzed by UHPLC-LTQ-Orbitrap-MS method, and four metabolites structurally identified based on their accurate masses, and fragment ions. The proposed metabolic pathways of cligosiban were demethylation and glucuronidation. This study is the first report on the pharmacokinetic and metabolic information of cligosiban, which would provide insights into the effectiveness and toxicity of cligosiban. (C) 2018 Published by Elsevier B.V.

目的 探讨先天性胆管扩张症(congenital biliary dilation,CBD)的影像学特点及临床治疗方法.方法 回顾性分析河南中医药大学第三附属医院及河南省人民医院于2010年1月至2015年1月期间收治并经手术病理学检查证实的70例CBD患者的临床资料.结果 70例均行超声检查,57例(81.4％)诊断为CBD,示于胆总管走行区有不甚规则球形、纺锤形、棱形,且与胆总管近端相连通的无回声区,其内腔壁光整,部分有斑点状细密回声或稍强回声结石声影,其中1例还合并有与部分肝内胆管分布、走向一致且与其连通的纺锤形或囊状无回声区.45例(64.3％)行CT检查,43例诊断为CBD,示部分肝内胆管及胆总管有不甚规则扁圆形、囊柱状或梭形扩张的低密度影,增强后无强化,轻度占位效应,周围组织结构受压、推移、变形.65例(92.8％)行MRI及磁共振胰胆管成像(MRCP)检查(均诊断为CBD),示肝内部分胆管、胆总管呈蝌蚪样、不甚规则囊柱状或梭形扩张,呈长T2信号影;MRCP图像呈高信号,且扩张胆管与胆道树相贯通.70例患者中,Ⅰ型66例(94.3％),Ⅱ型1例(1.4％),Ⅳa型1例(1.4％),Ⅳb型2例(2.9％).68例患者(Ⅰ型65例,Ⅱ型1例,Ⅳb型2例)行扩张胆管+胆囊切除、肝总管空肠Roux-en-Y吻合术;1例Ⅰ型患者行扩张胆管切除+胰十二指肠切除术;余1例Ⅳa型患者行扩张胆管切除+肝总管空肠Roux-en-Y吻合术+左肝外叶部分切除术.术后患者均顺利康复,无严重并发症及死亡病例,13例(18.6％)发生轻微并发症,包括术后短期腹痛、腹胀6例,胆汁漏1例,切口感染2例,肺部感染3例,肠道菌群失调1例.术后全部患者获访,随访时间为6～56个月,平均36个月.随访期间死亡2例;发生单纯性胆管炎4例,胆管炎合并肝内胆管结石3例,胆管炎合并肝内胆管结石、吻合口稍有狭窄、轻度黄疸2例,胆管感染2例.结论 CBD的临床表现一般不甚典型,而影像学表现具有相对特征性,首选B超检查,CT及MRI检查对其诊断及分型也起重要作用,MRI和MRCP能对CBD作出准确分型及定位.CBD的治疗原则为完全切除扩张胆管并重建胆道,对扩张胆管的彻底切除+肝总管空肠吻合是该病的首选治疗方法.

目的 探讨腹腔镜联合射频消融微创化治疗多发肝腺瘤的可行性、安全性及其治疗效果.方法 回顾性分析4例肝腺瘤患者的临床资料,并结合文献报道.结果 4例肝腺瘤患者中2例为多发肝腺瘤,男性患者3例,女性患者1例,中位年龄36.5岁,2例单发患者均给予行传统开腹肝腺瘤切除术,多发肝腺瘤患者均给予腹腔镜联合射频消融治疗,术后4例患者均痊愈出院,无并发症发生,经随访3-16个月,无复发.结论 腹腔镜联合射频消融治疗多发肝腺瘤是安全有效可行的,不失为微创化治疗多发肝腺瘤的一个良好选择,但其长远疗效需进一步多中心、长期随访研究.

Objective To analyze the expression changes of regulatory T cells and forkhead/ winged helix transcription factor P3 (Foxp3) levels in patients with gastric cancer.Methods Eighty patients with gastric cancer in our hospital from March 2011 to October 2014 were selected as the study group,and the 80 healthy controls for medical examination in the same period in our hospital were selected as the control group.The expression levels of CD4 + CD25 + Foxp3 + T cells in the peripheral blood were detected by flow cytometry.Immunohistochemistry was used to detect the expression of Foxp3 + T cells in gastric carcinoma and adjacent gastric tissues.The expression of CD4 + CD25 + Foxp3 + T cells,expression of Foxp3 + T cells in gastric cancer,TNM stage,CD4 + CD25 + Foxp3 + T cells in peripheral blood of patients with lymph node metastasis were statistically analyzed.Results The proportion of CD4 + CD25 + Foxp3 + T cells in peripheral blood of the study group and the control group was (6.99 ± 1.24) ％ and (3.87 ± 0.94) ％ (P ＜ 0.05).The expression levels of Foxp3 + T in the gastric cancer tissues and adjacent tissues in study group were (71.44 ± 15 64)/mm2 and (21.56 ±9 43)/mm2 respectiely (P ＜0.05).The expression of CD4 + CD25 + Foxp3 + T cells in peripheral blood was related with TNM stage and lymph node metastasis (P ＜ 0 05).The expression of Foxp3 + T cells in gastric cancer tissues was related with TNM stage,differentiation,and lymph node metastasis (P ＜ 0.05) There was a positive correlation between the expression ofCD4 + CD25 + Foxp3 + T cells in peripheral blood and that of Foxp3 + T cells in gastric carcinoma (r =0.786,P ＜ 0 05).Conclusion Regulatory T cells and Foxp3 expression levels in gastric cancer patients are up-regulated.

Objective To investigate the effects of ω-polyunsaturated fatty acids (ω-PUFA) on the inflammatory mediators and p38 mitogen-activated protein kinase (p38MAPK) in rats with severe acute pancreatitis (SAP).Methods 150 Sprague Dawley rats were randomized into SAP group,enteral nutrition (EN) group and ω-PUFA EN group.SAP model was induced by low pressure retrograde infusion of biliopancreastic duct with 3.5％ sodium taurocholate solution (0.1 ml/100 g).The rats were sacrificed at 1st,4th,7th and 14th day after operation.The serum amylase (AMY),tumor necrosis factor-α (TNF-α) and interleukin (IL)-10 were determined.The expression of p38MAPK in the pancreas was detected by immunohistochemistry.Pancreas tissue samples were stained with hematoxylin and eosin for histopathological evalution.Results The serum TNF-α was significantly increased,and IL-10 was significantly reduced in SAP group at all time points,and they reached the peak at 4th day after operation [for TNF-α,(257.40 ±4.52) ng/L;for IL-10,(3.40 ±4.52) ng/L],and the expression of p38MAPK the pancreatic tissue was significantly increased.After treatment,serum TNF-α was significantly reduced in EN group [(207.40±0.65) ng/L],and ω-PUFA EN group [(96.51 ±0.92) ng/L],and IL-10 increased in EN group [(9.40 ±0.61) ng/L],and ω-PUFA EN group [(4.35 ± 1.91) ng/L] as compared with SAP group (P ＜ 0.01 for all).The p38MAPK expression in pancreatic tissues was also significantly reduced in EN group andω-PUFA EN group.The animals in SAP group were died at 7th day after operation,and those in EN group and ω-PUFA EN group survived.Conclusion The activation and over-expression of p38MAPK in pancreas tissue may be one of the reasons for SAP,and ω-PUFA can be used to treat the SAP through downregulating the expression of p38MAPK in the pancreas tissue.

Objective To investigate the secretion of inflammatory cytokines in lipopolysaccharide (LPS)-induced aveolar epithelium type Ⅱ cells (AT-Ⅱ) cells exposed to various oxygen concentrations,and the possible mechanism.Methods Primary cultured AT-Ⅱ cells were randomly divided into five groups:A,B,C,D,and E,and then placed in sterilized incubators:37 ℃,21％ O2,5％ CO2 ;37 ℃,21％ O2,5％ CO2; 37 ℃,40％ O2,55％ N2,5％ CO2; 37 ℃,60％ O2,35％ N2,5％ CO2;37 ℃,90％ O2,5％ N2,5％ CO2.Towenty-four h later,the supernatant fluid was used to assay the content of interleukin-8 (IL-8) by enzyme linked immunosorbent assay (ELISA).The expression of p38 mitogen-activated protein kinase (p38MAPK) mRNA and protein was detected in AT-Ⅱ cells by reverse transcription-polymerase chain reaction and Western blotting.Results ELISA,reverse transcriptase-polymerase chain reaction (RT-PCR) and Western blotting showed that the content of IL-8 was (40.22±7.25),(109.35 ±10.19),(213.98±30.51),(369.71 ±21.73) and (489.32± 42.35) ng/L,p38MAPK mRNA expression level was 0.066 ± 0.010,0.163 ± 0.008,0.228 ± 0.027,0.268 ±0.016 and 0.292 ±0.010,and p38MAPK protein expression level was 0.055 ±0.005,0.124 ± 0.006,0.182 ±0.009,0.227 ±0.013 and 0.303 ±0.010 in groups A,B,C,D and E respectively.As compared with group A,the content of IL-8 in the supernatant fluid,and the expression of p38MAPK mRNA and protein were significantly increased in groups B,C,D and E (P ＜ 0.05).As compared with groups B,the content of IL-8 in the supernatant fluid,and the p38MAPK mRNA and protein expression level in groups C,D and E were gradually increased with the difference being statistically significant (P ＜ 0.05).In different oxygen concentration groups,with the increases in oxygen concentrations,the content of IL-8 in the supematant fluid,and the expression of p38MAPK mRNA and protein expression level were gradually increased with the difference being statistically significant (P ＜ 0.05).Condusion 40％-90％ oxygen could concentrasion-dependently increase the LPS-induced secretion of IL-8 in AT-Ⅱ cells probably by up-regulating the intracellular p38MAPK expression.