Glucagon-like peptide-2 (GLP-2), a key factor in intestinal rehabilitation therapy of short bowel syndrome (SBS), may require cell-to-cell communication to exert its biological functions. However, understanding of the mechanism remains elusive. Here, we report participation of exosomal miR-125a/b in GLP-2 mediated intestinal epithelial cells-myofibroblasts cross-talk in intestinal microenvironment. Methods: The effects of GLP-2 on the proliferation and apoptosis of intestinal epithelial cells in SBS rat models were evaluated. Exosomes were extracted from residual jejunum tissue of GLP-2 or vehicle treated SBS rats using ultracentrifugation method, and identified by nanoparticle trafficking analysis (NTA), transmission electron microscopy and western blotting. miRNA sequencing combined with qRT-PCR validation were used to identify differentially expressed miRNAs. miRNAs, which might be involved in proliferation and apoptosis of intestinal epithelial cells, were screened and further verified by miRNA functional experiments. Moreover, the proliferation-promoting and anti-apoptosis effects of GLP-2 on intestinal myofibroblasts, which expressing GLP-2 receptor, and whether GLP-2 could influence the content of miRNAs in the derived exosomes were studied. The downstream pathways were explored by miRNA function recovery experiment, luciferase reporter assay, pull down experiment, knockdown and overexpression of target gene and other experiments based on the bioinformatics prediction of miRNA target gene. Results: GLP-2 significantly promoted intestinal growth, facilitated the proliferation of intestinal crypt epithelial cells and inhibited the apoptosis of intestinal villi epithelial cells in type II SBS rats. GLP-2 significantly down-regulated exosomal miR-125a/b both in residual jejunums derived exosomes and in exosomes secreted by GLP-2R positive cells. Exosomal miR-125a/b was responsible for GLP-2 mediated intestinal epithelial cells proliferation promotion and apoptosis attenuation. miR-125a/b inhibited the proliferation and promotes apoptosis of intestinal epithelial cells by suppressing the myeloid cell leukemia-1 (MCL1). Conclusions: miR-125a/b shuttled by intestinal myofibroblasts derived exosomes regulate the proliferation and apoptosis of intestinal epithelial cells. GLP-2 treatment significantly decreases the level of miR-125a/b in the exosomes of intestinal myofibroblasts. miR-125a/b modulates the proliferation and apoptosis of intestinal epithelial cells by targeting the 3'UTR region of MCL1. Hence, this study indicates a novel mechanism of genetic exchange between cells in intestinal microenvironment.

Objective: To analysis the clinical and nutritional outcomes of 8 patients with short bowel syndrome (SBS) who underwent the serial transverse enteroplasty procedure (STEP). Methods: We performed a retrospective analysis of the medical records of 8 patients who underwent STEP in our center during 2013-2019. Then, we used the percentage of total dietary energy received by the enteral route before and after STEP as the primary outcome measure. Other outcome measures included the small intestine length, laboratory test results, BMI and fecal defecation frequency. Questionnaire (SF-36) was used to evaluate health related quality of life in patients with short bowel syndrome. Results: We collected 5 male patients and 3 female patients (age 43±14.36 year-old), all of whom had been dependent on parenteral nutrition since the last operation. The courses of SBS included mesenteric vascular embolism (n=6) and abdominal trauma (n=2). The small intestine length was 52.37±5.95cm (range 45-61 cm) preoperatively vs 85.13±6.27 cm (range, 77-95 cm) postoperatively (p=0.002). There were no serious surgical complications (such as fistula, hemorrhage and death). The mean postoperative follow-up period was 357 days (range, 245– 429 days). By using model-based mean estimates, the mean enteral nutrition intake was 34% preoperatively vs 78% postoperatively (p=0.05). By the increasing of enteral nutrition intake, the liver function (DB, ALT, AST, ALT and γGT) in 1 month after operation was decreased significantly (p=0.021). Meanwhile, the nutritional status index (ALB, Prealbumin and BMI) was increased significantly (p<0.05). In a month after STEP, fecal defecation frequency in 75% patients (6 in 8) was less than 4 times every day. The BMI was increased in the three months after operation (p=0.017). Compared with the preoperative SF-36 score, the SF-36 score in 6 months after surgery was increased significantly (p=0.022). Conclusions: The STEP was associated with improved nutritional status and quality of life among 8 patients with SBS in the face of a decreasing need for parenteral nutrition. Among patients with SBS, the STEP is associated with improved clinical and nutritional outcomes in the first year after surgery.

目的 系统性红斑狼疮肠系膜血管炎(LMV)可导致小肠广泛坏死,且疾病早期极易误诊漏诊.文中旨在评估就诊首日血清D-二聚体水平在LMV早期诊断中的临床意义. 方法 回顾性分析2006年1月至2019年1月南京鼓楼医院收治的38例系统性红斑狼疮(SLE)患者.其中15例LMV患者(LMV组),非LMV患者23例(非LMV组).统计分析主要观察指标为2组患者就诊首日血清D-二聚体水平,次要观察指标包括患者一般情况、SLE活动度评分(SLEDAI)、增强CT检查结果、实验室检查结果及治疗后血清D-二聚体水平. 结果 2组患者年龄、SLE患病周期及SLEDAI等指标差异无统计学意义(P＞0.05).入院时CT可见LMV患者肠管扩张、肠系膜水肿及典型“靶”样征,大剂量激素治疗后,扩张肠管及肠壁显著缓解,出院前CT“靶”样征消失.LMV组患者就诊首日血清D-二聚体水平[917 (756,1848) μg/L]显著高于非LMV组[570(356,896) μg/L],差异有统计学意义(P=0.006).ROC曲线分析结果显示,血清D-二聚体早期诊断LMV的临界值为624μg/L,敏感性与特异性分别为93％、61％,AUC=0.77. 结论 血清D-二聚体水平可作为LMV患者早期诊断的有效指标.

Objective To explore the clinical value of human acellular dermal matrix (HADM) in giant complex abdominal wall reconstruction (GCAWR) after open abdomen.Methods The retrospective crosssectional study was conducted.The clinical data of 6 patients with severe trauma who were admitted to the Nanjing General Hospital of Nanjing Military Command of Nanjing University School of Medicine between January 2013 and January 2014 were collected.After open abdomen,fascia of the abdominal wall was fully freed using the component separation,and abdominal wall defects were reconstructed using HADM in the rectus abdominis anterior sheath and peritoneal layers bridge-type suture.Observation indicators:(1) intra-and post-operative situations:operation time,volume of intraoperative blood loss,removal time of postoperative drainage-tube,postoperative complications,duration of hospital stay and hospital expenses;(2) follow-up situations:recurrence of abdominal wall hernia at postoperative year 2.Follow-up using outpatient examination and telephone interview was performed to detect the recurrence of abdominal wall hernia up to April 2016.Measurement data with normal distribution were represented as ~±s.Results (1) Intra-and post-operative situations:6 patients underwent successful surgery.Operation time,volume of intraoperative blood loss and removal time of postoperative drainage-tube were respectively (77±9)minutes,(225±57)mL and (8±3)days.Two patients with postoperative seroma were cured by conservative treatment.One patient with postoperative anastomotic leakage received continuously irrigation and drainage,and leakage was stopped using the biomedical fibrin glue.There was no abdominal bulge of the 6 patients in hospital.Duration of hospital stay and hospital expenses were respectively (10±3) days and (12±7) × 104 yuan.(2) Follow-up situations:6 patients were followed up for 14-28 months,with a median time of 23 months.Two patients had relaxation and bulge of HADM in peritoneal layer at postoperative 2 years,without bulge of HADM in the rectus abdominis anterior sheath layer.There were no occurrence of abdominal wall hernia,chronic pain,paraesthesia,swelling in the local area and other adverse reaction.Conclusion Using of HADM in the rectus abdominis anterior sheath and peritoneal layers bridge-type suture is safe and feasible for GCAWR,with good short-term outcomes.

Objective To investigate the effect of acellular dermal matrix (ADM) for abdominal closure to prevent abdominal high pressure after intestinal transplantation.Method ADM was used for abdominal closure following intestinal transplantation in a 17-year-old man with ultra-short bowel syndrome.Two ADMs with 12 cm 20 cm were reconstituted intraoperatively with warm sterile normal saline.After flattened under peritoneum,the ADM was pruned and then sewn to the muscular layer of abdominal wall by interrupted transfixing suture with absorbable suture.A negative pressure drainage tube was placed over an area of native fascia in the subcutaneous space.Skin and soft tissues were closed by interrupted suture.Result The intra-abdominal pressure was not higher than 7 cmH2O 90 h post-operation.The ventilator has been withdrawn 18 h after operation.Enternal nutrition was given from postoperative day 6.He required surgical exploration for abdominal abscess on the postoperative day 19.The ADM closely adhered to the abdominal wall and no abscess in abdomen was related to ADM.Conclusion ADM can be safely used for abdominal closure and effectively prevent intraabdominal high pressure in this intestinal transplantation.No infection or graft loss occurred in the early postoperative period.More observations are needed to study the long-term results and complications in the future.

OBJECTIVE To determine the feasibility and possible superiority of laparoscopic surgery for chronic adhesive small bowel obstruction(CASBO). METHODS Clinical data of 36 CASBO patients who underwent laparoscopic surgery in Jinling Hospital from March 2011 to August 2014 were retrospectively reviewed. In addition, 36 cases, matched by age, gender, previous abdominal surgery history, body mass index(BMI) and abdominal adhesion grade, who underwent open surgery from April 2007 to February 2011 were used as controls. General information, operative findings and short-term outcomes were compared between two groups. RESULTS There were no statistically significant differences in baseline data between the two groups (all P>0.05). Among 36 cases in laparoscopic surgery group, 17 underwent complete laparoscopic surgery, 10 underwent laparoscopic assisted surgery and 9 were converted to open surgery, respectively. The conversion rate was 25%(9/36). Reason of laparoscopic assisted surgery in 3 cases was uncertainty of small bowel injury, in 5 cases was further dissection of intra-loop adhesion and in 2 cases was intestinal resection. Reasons for conversion were small bowel injury in 3 cases and severe adbesion at the abdominal wall in 6 cases. There were no differences between two groups in terms of adhesion score, intra-operative blood loss, operation time, need for small bowel resection, total hospital charge and intra- or post-operational complications. As compared to open surgery, laparoscopic surgery significantly shortened the incision length [median 2 (0 to 10) cm vs. 12(7 to 16) cm, P=0.000], and hospital stay [median 5 (2 to 28) days vs. 7 (4 to 26) days, P=0.001], and improved postoperative recovery of bowel movement [median 2(1 to 20) days vs. 3 (2 to 10) days, P=0.001]. CONCLUSION Laparoscopic surgery can improve postoperative recovery of CASBO with similar morbidity as open surgery.

[Abstract ] Objective Pelvic radiation disease(PRD) is multiple injuries in more than one organ resulted by pelvic radio-therapy.Patients have the symptoms of frequent feces and fecal incontinence after the resection of small bowel lesion .Sugeries on PRD patients were mainly distal ileum and ilieocecal valve resections , while the most susceptible part of pelvic radiation injury is rectum . However , little research has been done concerning PRD patients′anorectal functions .This study was mainly to evaluate the anorectal function of cervical cancer patients with PRD in order to provide evidence for the therapy and prognosis of PRD . Methods Cervical cancer patients with PRD in need of small bowel resection who hospitalized in our department from January 2014 to January 2015 were collected as patient group , while people from outpatient physical exam group were selected as control group according to the exclusion criteria of hypertension , diabetes, constipation and unrelaxed pelvic floor syndrome .PDR group and control group were matched according to age.All subjects underwent colonoscopy and anorectal manometry .Rectal radiation injury was estimated on the basis of colonoscopy results.Anorectal manometry results of PRD group and control group were analysised statistically . Results PRD group and control group both included 20 women without stenosis or obstruction in rectum .Significant difference was found between PRD group and con-trol group in anal resting pressure (47.23 ±9.08 mmHg vs 58.25 ±9.24 mmHg, P<0.05), anal maximum squeezing pressure (47.23 ±9.08 mmHg vs 58.25 ±9.24 mmHg, P<0.01), anal distension pressure (23.30 ±12.49 mmHg vs 39.10 ±9.99 mmHg, P<0.01), rectal defecation pressure(22.85 ±16,69 mmHg vs 50.90 ±9.14 mmHg, P<0.01) and maximum tolerated rectal volume (112.85 ±51.34 mL vs 173.50 ±48.15 mL, P<0.01).There was no significant difference between the two groups as to the lenghth of functional sphincters(P=0.313),rectum initial threshold(P=0.416) and rectal defecation threshold(P=0.161). Conclusion Ionization radiation that injures PRD patients′internal anal sphincters and external anal sphincters also reduces maximum tolerated rec -tal volumes preoperatively .It′s necessary to assess the muscles and nerve functions of anorectum before intestinal surgery in order to make a proper operation plan which will improve PRD patients′life quality.

Objective To explore the value of conventional ultrasound and contrast-enhanced ultrasound (CEUS) in the diagnosis of Crohn′s disease (CD). Methods From December 2012 to June 2015, totally 19 patients with CD were examined with conventional ultrasound and CEUS in Department of Ultrasound, Jinling Hospital, Medical School of Nanjing University. All patients were confirmed by endoscope and surgical pathology, including 12 cases of active CD and 7 cases of quiescent CD. The characteristics were analyzed and the quantitative parameters of time-to-peak (TTP) and peek intensity (PI) were gained according to the time-intensity curve (TIC). The difference of TTP and PI between active CD and quiescent CD was compared by Wilcoxon rank sum test. Results In these 19 patients, conventional ultrasound revealed stiff and thickened bowel walls with loss of normal peristalsis, the layers had ill-defined internal margins, and color Doppler identified the increased vascularization in mural or extra-visceral. In CEUS, the enhancement patterns of submucosal prevalent enhancement (5 cases) and complete transmural enhancement starting from mucosa and involving the entire bowel wall (7 cases) were generally related to active CD (12 cases), while complete transmural enhancement starting from perivisceral vessels and involving the entire bowel wall (5 cases) and low or absent enhancement (2 cases) were generally related to quiescent CD (7 cases). The quantitative analysis of TIC showed patients with active CD presented a reduced TTP enhancement and an increased PI in comparison to patient with quiescent CD [(8.33±0.92) s vs. (10.62±1.61) s, (27.67±1.61) dB vs. (25.48±1.49) dB] , and there was statistically difference between them (Z=-2.537, -2.451, both P<0.05). Conclusions Conventional ultrasound and CEUS is useful in diagnosing CD. In addition, CEUS is valuable in the evaluation of CD activity. Key words: Ultrasonography; Contrast media; Crohn disease; Diagnosis

BACKGROUND:Fundamental researches suggest that ileum presents greater adaptive potential than the jejunum. However, few studies estimate the association between ileum and adaptive potential in human. To discover the association, we conducted this matched case-control study.METHODS:A 1:2 pair-matched, case-control study was conducted from January 1, 2001 to January 1, 2015 in Intestinal Rehabilition and Transplant Center. The case group was ileum predominated (IP) group and the control group was jejunum predominated (JP) group. Demographic data, medical history and progression of each patient were collected.RESULTS:There were 24 IP cases and 48 JP controls in this study. The cumulative probabilities of parenteral nutrition (PN) weaning in IP group were higher than that in JP group. The Bristol stool scale scores of IP group were lower than that of JP group at third month. The Cox proportional hazards regression model confirmed that IP had a higher odds of PN weaning (OR = 2.69; 95 % CI: 1.27, 5.70, p = 0.01) as compared with JP group. The conditional logistic regression with 1:2 matching also confirmed IP group had a higher odds (OR = 4.84; 95 % CI: 2.02, 11.56, p <0.01).CONCLUSIONS:Our results indicated that ileum presents greater adaptive potential than the jejunum in nutrition and fluid absorption. And a potential anatomic subtype of short bowel syndrome was proposed. Further research need to be conducted to more fully understand the adaptive potential of ileum besides nutrition and fluid absorption.

Background. Short bowel syndrome (SBS) patients need long-term parenteral nutrition or intestine transplantation. With the development of medicine, society, and economy over the past decade, characteristics of these patients might have undergone some changes. To study the issue, we conducted this retrospective study.Methods. A retrospective study was conducted from January 1, 2004, to January 1, 2014, in an intestinal rehabilitation and transplant center. A total of 335 SBS patients were hospitalized at our center. The patients in the 1st 5 years were classified into group A (n = 123) and the next 5 years into group B (n = 212). Demographic data, medical history, and etiology of each patient were collected.Results. The average age of group B (45.5 +/- 20.5 y) was significantly higher than that of group A (39.6 +/- 15.5 y). In both groups together, the average residual small intestine was 63.3 +/- 44.3 cm and body mass index (BMI) was 18.1 +/- 3.6 kg/m(2). The BMI of group B was significantly higher than that of group A. In serum biochemical indexes, indirect bilirubin, serum transferrin, fibronectin, cholesterol, blood urea nitrogen, and creatinine of the 2 groups were significantly different. In the etiology of SBS, the mesenteric vascular disease and trauma decreased but radiation enteritis and nonterminal cancer increased.Conclusions. During the past decade, SBS patients had changed a lot, especially in etiology and nutritional status. In the future, the increasing number of nonterminal cancer and radiation enteritis patients might compromise the choice of intestine transplantation, and more new methods to prevent cholestasis need to be explored.

Prosthetic mesh used for ventral incisional hernia makes hernia repair surgery simple, effective, and safe. The mesh infection is a formidable complication and bimodal distribution. The differences between early- and late-onset are unknown. This is a cohort study of patients undergoing ventral incisional hernia (VIH) repair from January 2003 to September 2013. Data of specific risk variables were collected from electronic medical record systems in Jinling Hospital. And, the quality of lives was evaluated by WHO Quality of Life-BREF. A total of 102 VIH repair patients were analyzed and followed including the noninfection group and early- and late-onset group. There were significant differences between the early- and late-onset group in clinical manifestation, descriptive analysis of the study population, and postoperative quality of lives. These differences might imply the different pathophysiologic process of early- and late-onset mesh infection. Permanent prosthetic mesh should be used with caution, and the study of intraperitoneal onlay mesh is still needed in long-term follow-up.

Early enteral feeding within 24-48 h of intensive care unit admission is recommended for critically ill patients. This study aimed to determine if early enteral feeding could be safely implemented with purported benefits in patients with abdominal trauma.A retrospective cohort study was performed that included 88 adult patients with abdominal trauma. Patients receiving enteral feeding within 72 h of surgical intensive care unit (SICU) admission (early-initiation group, n = 28) were compared to those receiving enteral feeding later (delayed-initiation group, n = 60).The two groups were comparable in demographic characteristics and injury severity. There were no differences in feeding intolerance (53.6 vs. 43.3 %, p = 0.37) and mortality at 28 days (0 vs. 5 %, p = 0.55) between the early-initiation group and the delayed-initiation group. However, patients in the early-initiation group had fewer infectious complications (17.9 vs. 40 %, p = 0.04) and shorter length of stay in SICU and hospital (p < 0.01) than patients in the delayed-initiation group.Early enteral feeding administered within 72 h of SICU admission was associated with improved clinical outcomes without risk of increasing feeding intolerance in patients with abdominal trauma. Our results support the implementation of early enteral feeding in abdominal trauma management.

Radiotherapy is an important method of tumor treatment .The incidence of complications caused by radiotherapy is high, which seriously effect patients′quality of life.The current terms of radiation enteritis , radiation proctitis and radiation cystitis can not reflect the changes of physiopathology after radiotherapy .Nowadays , a consensus has been gradually reached that 'pelvic radiation disease'is a more accurate description .This article mainly introduces the definition evolution , significance and current status of pelvic radiation disease to draw the attention of domestic related professionals .A new starting point is opening for the curing of radiotherapy-related complications .

Objective To investigate the procedures for establishing a stable model of intestinal xenotransplantation from pig to cynomolgus, with the purpose of providing a good experimental tool for the xenograft rejection study in intestinal xenotransplantation. Methods White wild-type pigs were used as donor and cynomolguses used as recipients. The procedure of segmental heterotopic intestinal xenotransplantation in recipients was performed as following: the donor`s anterior mesenteric artery was anastomosed end-to-side to the recipient`s infrarenal abdominal aorta, and the donor`s tributary of anterior mesenteric venous was anastomosed end-to-side to the recipient`s infrarenal inferior vena cave. Subsequently, both the proximal and distant ends of the graft intestine were stayed ligated. Results Segmental intestinal xenotransplantation was performed in 5 cynomolguses, with an average graft intestine length of (52.0 ± 5.7) cm. The success rate of vascular anastomosis was 100%, and the intestinal xenograft survival was 152±72(55~245) minutes. Conclusions A stable, repeatable model of segmental intestinal xenotransplantation from pig to cynomolgus was established, which would provide an ideal tool for further research on intestinal xenotransplantation from transgenic pig to cynomolgus.

Starl等［1］自20世纪60年代即开始应用激素（GC）治疗肾移植术后排斥反应，至今已有50余年的历史。毫不为过的说，正是由于GC的出现，器官移植才得以从动物实验阶段真正开始向临床应用过渡。时至今日，GC仍是预防及治疗器官移植术后严重排斥反应的首选方案。然而，长期应用GC治疗可能产生一系列严重并发症，主要包括消化性溃疡、骨质疏松、股骨头坏死等［2］。此外，由于过量使用GC所产生的严重免疫抑制、糖耐量减低、高脂血症、高血压等，可显著增加严重感染及心血管疾病的发生率，降低患者及移植物的存活率［3］。为了避免以上严重并发症，提高移植患者的长期生存率，在随后的几十年间，靶向性更强的免疫抑制剂不断问世，如何应用新型免疫抑制剂代替GC成为了当今移植界广泛研究的首要问题。自20世纪90年代开始，肝肾移植领域逐渐开始采用不包含GC的免疫抑制方案，或在术后早期逐渐减少、最终停用GC的免疫抑制方案，目前已成为包括胰腺、小肠等实体器官在内的多种移植免疫抑制首选方案［4］。

目的 研究猪到食蟹猴异种小肠移植后,不同时间点受体凝血功能的变化,并探讨其与超急性异种排斥反应(HAXR)的关系.方法 建立猪到食蟹猴异位节段小肠移植模型,分别在移植前及移植小肠再灌注后15,30,60,120 min各时间点行常规凝血指标检查和血栓弹力图(TEG)检查,分析小肠移植术后受体凝血功能的变化,判断移植肠存活情况.结果 共行猪到食蟹猴异种节段小肠移植5例,血管吻合成功率为100％,移植小肠中位存活时间为165 min(33～245 min).移植小肠再灌注后30 min,抗凝血酶Ⅲ由术前(100±19)％降至(54±16)％,凝血酶原时间由术前(11 ±2)s升至(20±5)s,部分活化的凝血酶时间由术前(21±3)s升至(88±29)s,国际标准化比值由术前1.0±0.2升至1.7±0.3.再灌注后60 min,D-二聚体由术前(0.09±0.07) mg/L升至(0.70±0.49) mg/L.再灌注后120 min,受体纤维蛋白原由术前(1.81±0.24) g/L降至(0.76±0.17) g/L,血小板计数由术前(340±81)×109逐渐降低至(155±7) ×109.移植小肠再灌注后60 min,TEG指标与术前相比,LY30由(4±2)％升至(31±7)％,最大振幅由(63±5) mm降至(25±16) mm.再灌注后120 min,受体R值由(6.9±1.3) min升至(16.8±2.7) min,K值由(2±1) min升至(15±5) min.TEG曲线提示,移植前受体凝血功能正常,移植小肠再灌注15,30 min后,受体凝血功能呈现高凝状态,合并纤溶亢进;移植小肠再灌注后60,120 min,受体凝血功能表现为消耗性低凝状态.所有受体在移植后均出现典型的超急性异种排斥反应(HAXR)病理表现,主要为移植小肠黏膜充血、水肿、散在出血点以及间质出血表现.结论 受体凝血功能随HAXR发生而出现逐渐恶化的趋势,凝血功能检测可以在一定程度上反映HAXR的发生情况.