查看更多>>摘要：AIM:To investigate the safety and feasibility of our original single-incision laparoscopic cholecystectomy (SILC) for acute inflamed gallbladder (AIG).METHODS:One hundred and ten consecutive patients underwent original SILC for gallbladder disease without any selection criteria and 15 and 11 of these were diagnosed with acute cholecystitis and acute gallstone cholangitis,respectively.A retrospective review was performed not only between SILC for AIG and non-AIG,but also between SILC for AIG and traditional laparoscopic cholecystectomy (TLC) for AIG in the same period.RESULTS:Comparison between SILC for AIG and nonAIG revealed that the operative time was longer in SILC for AIG (97.5 min vs 85.0 min,P =0.03).The open conversion rate (2/26 vs 2/84,P =0.24) and complication rate (1/26 vs 3/84,P =1.00) showed no differences,but a need for additional trocars was more frequent in SILC for AIG (5/24 vs 3/82,P =0.01).Comparison between SILC for AIG and TLC for AIG revealed no differences based on statistical analysis.CONCLUSION:Our original SILC technique was adequately safe and feasible for the treatment of acute cholecystitis and acute gallstone cholangitis.
查看更多>>摘要：AIM:To demonstrate the imaging findings of biliopancreatic and pancreatico-biliary reflux in patients with anomalous union of the pancreatico-biliary duct (AUPBD)on gadoxetic acid-enhanced functional magnetic resonance cholangiography (fMRC).METHODS:This study included six consecutive patients (two men and four women; mean age 47.5 years) with AUPBD.All subjects underwent endoscopic retrograde cholangiopancreatography (ERCP); one subject also underwent bile sampling of the common bile duct (CBD) to measure the amylase level because his gadoxetic acidenhanced fMRC images showed evidence of pancreatico-biliary reflux of pancreatic secretions.Of the five patients with choledochal cysts,four underwent pyloruspreserving pancreaticoduodenectomy.RESULTS:The five cases of choledochal cysts were classified as Todani classification I.In three of the six patients with AUPBD,injected contrast media reached the distal CBD and pancreatic duct on delay images,suggesting biliopancreatic reflux.In two of these six patients,a band-like filling defect was noted in the CBD on pre-fatty meal images,which decreased in size on delayed post-fatty meal images,suggesting pancreatico-biliary reflux of pancreatic secretions,and the bile sampled from the CBD in one patient had an amylase level of 113 000 IU/L.In one of the six patients with AUPBD,contrast media did not reach the distal CBD due to multiple CBD stones.CONCLUSION:Gadoxetic acid-enhanced fMRC successfully demonstrated biliopancreatic reflux of bile and pancreatico-biliary reflux of pancreatic secretions in patients with AUPBD with and without choledochal cysts.
查看更多>>摘要：AIM:To describe the clinical characteristics of patients with gastric or intestinal bezoars recently treated in our hospital.METHODS:In this study,a retrospective chart review of consecutive patients with gastrointestinal bezoars,who were treated at the Samsun Education and Research Hospital between January 2006 and March 2011,was conducted.Data on demographic characteristics,clinical presentation,history of risk factors,diagnostic procedures,localization of bezoars,treatment interventions,and postoperative morbidity and mortality rates were collected and evaluated.RESULTS:Forty-two patients [26 (61.9％) males and 16 (31.1％) females] with a mean ± SD (range) age of 55.8 ± 10.5 (37-74) years were enrolled in this study,.Thirty-six patients (85.7％) had one or more predisposing risk factors for gastrointestinal bezoars.The most common predisposing risk factor was a history of previous gastric surgery which was identified in 18 patients (42.8％).Twenty three patients (54.8％) had multiple predisposing risk factors.Phytobezoars were identified in all patients except one who had a trichobezoar in the stomach.Non-operative endoscopic fragmentation was performed either initially or after unsuccessful medical treatment in 14 patients with gastric bezoars and was completely successful in 10 patients (71.5％).Surgery was the most frequent treatment method in our study,which was required in 28 patients (66.7％).Intestinal obstruction secondary to bezoars was the most common complication (n =18,42.8％) in our study.CONCLUSION:The presence of multiple predisposing factors may create a synergistic effect in the development of bezoars.
查看更多>>摘要：AIM:To investigate the genetic characteristics and pathogenicity of hepatitis E virus (HEV) and assess the potential risk factors for sporadic hepatitis E.METHODS:Sixty-two serum samples from the patients with acute hepatitis E were collected,including 23 cases coinfected with hepatitis B virus.Anti-HEV detection and partial HEV RNA amplification were performed by enzyme immunoassays and reverse transcriptionnested polymerase chain reaction (RT-nPCR) method,respectively,and PCR products were sequenced.The isolated human HEV sequences were analyzed phylogenetically.RESULTS:The positive rate of serum HEV RNA were 21.0％ (13/62),including 5 cases of liver failure.All the 13 isolates shared a 82.1％-98.0％ nucleotide homology with each other and had identities of 74.7％-81.0％,75.3％-78.6％,75.3％-80.0％ and 82.1％-96.1％ with the corresponding regions of HEV genotypes 1-4,respectively.The human HEV strain GS-NJ-12 shared a 100％ nucleotide identity with the swine HEV strain swIM6-43 isolated from Inner Mongolia,China.CONCLUSION:Swine may be a principal risk factor for occurrence of sporadic hepatitis E in eastern China,and genotype 4 HEV can induce acute liver failure.
查看更多>>摘要：AIM:To investigate the expression of B7-H1 in human colorectal carcinoma (CRC) to define its regulating effects on T cells in tumor microenvironment.METHODS:One hundred and two paraffin blocks and 33 fresh samples of CRC tissues were subject to this study.Immunohistochemistry was performed for B7-H1 and CD3 staining in CRC tissues.Ficoll-Hypaque density gradient centrifugation was used to isolate peripheral blood mononuclear cells of fresh CRC tissues; flow cytometry and immunofluorescence staining were used for detection of regulatory T cells.Data was analyzed with statistical software.RESULTS:Costimulatory molecule B7-H1 was found strongly expressed in CRC tissues,localized in tumor cell membrane and cytoplasm,while weak or none expression of B7-H1 was detected in pared normal colorectal tissues.Meanwhile,CD3 positive T cells were found congregated in CRC tumor nest and stroma.Statistic analysis showed that B7-H1 expression level was negatively correlated to the total T cell density in tumor nest (P ＜ 0.0001) and tumor stroma (P =0.0200) of 102 cases of CRC tissues.Among the total T cells,a variable amount of regulatory T cells with a clear Foxp3+ (forkhead box P3) staining could be detected in CRC tissues and patients' blood.Interestingly,in the 33 samples (15 cases of B7-High CRC tissues and 18 cases of B7-H1low CRC tissues) of freshly isolated mononuclear cells from CRC tissues,the percentages of CD4+Foxp3+ and CD8+Foxp3+ regulatory T cells were found remarkably higher in B7-H1high CRC tissues than in B7-H1ow CRC tissues (P =0.0024,P =0.0182),indicating that B7-H1 expression was involved in proliferation of regulatory T cell.No significant difference was found in CRC peripheral blood (P =0.0863,P =0.0678).PD-1 is the specific ligand for B7-H1 pathway transferring inhibitory signal to T cell,which is expressed by activated T cell.Our further analysis of PD-1 expression on T cells in CRC tissues showed that conventional T cells (CD4+Foxp37 CD8+Foxp3-),which was thought to contribute to the anti-tumor immune response,highly expressed PD-1;while regulatory T cells (CD4+Foxp3+/CD8+Foxp3) almost failed to express PD-1.The average percentage of PD-1 expression on regulatory T cells was significantly higher than the percentage of PD-1 on conventional T cells (CD4+Foxp3 T cell,P ＜ 0.0001; CD8+Foxp3 T cell,P ＜ 0.0001).The diverse expression of PD-1 might lead to different fate of T cell subsets in B7-H1 over-expression CRC tumor microenvironment.CONCLUSION:B7-H1 expression in tumor cells can inhibit the conventional T cell proliferation in tumor microenvironment through the PD-1 expression on conventional T cells.
查看更多>>摘要：AIM:To investigate the relationship between Interleukin-8 (IL-8) and proliferation,adhesion,migration,invasion and chemosensitivity of gastric cancer (GC) cells.METHODS:The IL-8 cDNA was stably transfected into human GC cell line MKN-45 and selected IL-8-secreting transfectants.The expression of IL-8 in human GC cell line KATO-Ⅲ was inhibited by RNA interference.The expressions of mRNA and protein of IL-8 in GC cells were detected by real-time reverse transcriptionpolymerase chain reaction or enzyme-linked immunosorbent assay (ELISA).RESULTS:The overexpression of IL-8 resulted in an increased cell adhesion,migration and invasion,and a significant resistance to oxaliplatin in MKN-45 cells.Inhibition of IL-8 expression with small interfering RNA decreased the adhesion,migration and invasion functions and oxaliplatin resistance in KATO-Ⅲ cells.IL-8 increased NF-кB and Akt activities and adhesion molecules ICAM-1,VCAM-1,and CD44 expression in GC cells.CONCLUSION:Overexpression of IL-8 promotes the adhesion,migration,invasion,and chemoresistance of GC cells,indicating that IL-8 is an important therapeutic target in GC.
查看更多>>摘要：AIM:To investigate the seroprevalence and molecular characteristics of hepatitis E virus (HEV) in the illegal blood donors (IBDs) of central China in the early 1990s.METHODS:A total of 546 blood samples were collected from the IBDs in Maanshan city,a questionnaire was completed by each subject,detailing the age,sex,and periods of blood or plasma donation.Anhui Province and tested for the anti-HEV antibodies.The seropositive samples were subjected to nested reverse transcriptionpolymerase chain reaction and sequencing to analyze HEV partial genome.RESULTS:The prevalence of IgG and IgM HEV antibody in IBDs was 22.7％ and 1.8％,and genotype 4 was the dominant circulating HEV type in IBDs.The prevalence of anti-HEV IgG was significantly related to sex (OR =4.905,P =0.004) and increased with age (OR =2.78,P =0.022),which ranged from 13.0％ in those ＜ 40 years old to 30.6％ among older persons aged ＞ 60 years.Moreover,frequency of blood donation was significantly associated with HEV seropositivity (OR =2.06,P =0.006).HEV partial sequences of ORF2 and obtained 3 sequences in serum samples of 10 IBDs which developed HEV specific IgM CONCLUSION:This study helps define one of the possible routes of transmission of sporadic HEV infection and provides guidance to screen HEV in the blood donors so as to guarantee safe blood banks in China.
查看更多>>摘要：AIM:To evaluate the prophylaxis of chronic kidney disease (CKD) after liver transplantation (LT) with low-dose calcineurin inhibitor (CNI) and mycophenolate mofetil (MMF).METHODS:From March 1999 to December 2009,a total of 572 patients (478 males and 94 females) underwent LT enrolled in the study.Initial immunosuppression was by triple-drug regimens that included a CNI,MMF,and prednisone.The initial dose of CNI was 0.05-0.10mg/kg per day for tacrolimus (TAC) and 5-10 mg/kg per d for cyclosporine A (CSA) respectively,and was gradually reduced based on a stable graft function.The serum trough level of CNI was 6-8 ng/mL for TAC and 120-150 ng/mL for CSA 3-mo post-operation,4-6 ng/mL for TAC and 80-120 ng/mL for CSA 1-year after transplantation was expected with stable liver function.MMF was personalized between 1.0-1.5 g/d.Glomerular filtration rate (GFR) was estimated by an abbreviated Modification of Diet in Renal Disease formula.Risk factors of CKD were examined by univariate and multivariate logistic regression.RESULTS:With a definition of GFR ＜ 60 mL/min per 1.73 m2,the incidence of CKD was 17.3％ 5-year after LT.There were 68.3％ (293 of 429 cases) patients managed to control their TAC trough concentrations within 8 ng/mL and 58.0％ (83 of 143 cases) patients' CSA trough concentrations within 150 ng/mL.Of the 450 recipients followed-up over 1 year,55.5％ (183 of 330 cases) of which were treated with TAC had a trough concentration ≤ 6 ng/mL while 65.8％ (79 of 120 cases) of which were treated with CSA had a concentration ≤ 120 ng/mL.The incidence of CKD in the groups of lower CNI trough concentrations was significantly lower than the groups with CNI concentrations above the ideal range.Patients with CKD had much higher CNI trough concentrations than that of patients without CKD.MMF was adopted in 359 patients (62.8％).Patients administrated with MMF had a relatively low CNI trough concentrations but with no significant difference.The graft function remained stable during follow-up.No difference was found between different groups of CNI trough concentrations.Pre-LT renal dysfunction,ages,acute kidney injury,high blood trough concentrations of CNI in 3 mo (TAC ＞ 8 ng/mL,CSA ＞ 150 ng/mL) and hypertension after operation were associated with CKD progression,while male gender and adoption of MMF were protection factors.CONCLUSION:Low dose of CNI combined with MMF managed to prevent CKD after LT with stable graft function.
查看更多>>摘要：Three cases of transient proximal small bowel angioedema induced by intravenous administration of nonionic iodinated contrast media (CM) are presented.Computed tomography (CT) images in the venous phase displayed the proximal small bowel with circumferential thickening of the wall including the duodenum and proximal segment of the jejunum.The bowel wall was normal in non-enhanced images,and normal or inconspicuous in arterial phase enhanced images.In one of the three cases,the bowel wall was thickened in venous phase but disappeared in the 40 s delayed phase images.No filling defect was seen in the lumen of the superior mesenteric artery and vein.No peritoneal effusion or mesentery abnormality was found.Each of these patients reported only mild abdominal discomfort and recovered without specific treatment within a short time.Only one patient suffered mild diarrhea after scanning which had resolved by the following day.The transient anaphylactic small bowel angioedema due to intravenous iodinated contrast media was easily diagnosed based on its characteristic CT findings and clinical symptoms.Differential diagnosis may include inflammatory and ischemic bowel disease,as well as neoplasms.A three-phase CT protocol and good understanding of this disorder are fundamentally important in the diagnosis of this condition.The supposed etiology behind the transient anaphylactic reaction to intravenous administration of iodinated CN in small bowel is similar to other CM-induced hypersensitive immediate reactions.The predilection location of transient anaphylactic bowel angioedema is the small intestine,particularly the proximal segment.A speculated cause may be the richer supply of vessels in the small intestine,ample mucous folds and loose connective tissue in the duodenum and the jejunum.
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