Objective To observe the expression and distribution of transforming growth factor-β1 (TGF-β1) in the healing process of bile duct and discuss its function and significance in the process of benign biliary stricture formation. Methods An injury to bile duct of dog was made and then repaired. The expression and distribution of TGF-β1 in the tissue at different time of the healing process were studied after operation with immunohistochemical SP staining. Results TGF-β1 staining was observed in the granulation tissue, fibroblasts and endothelial cells of blood vessels. High expression of TGF-β1 was observed in the healing process lasting for a long time. Conclusion The high expression of TGF-β1 is related closely with the fibroblast proliferating activity, extracellular matrix overdeposition and scar proliferation in the healing process of bile duct.
Objective To evaluate the relationship between endothelin (ET) in bile and peripheral blood with systemic and hepatobiliary injury in patients with acute cholangitis of severe type (ACST). Methods ET, ALT and total bilirubin in bile and peripheral veinous blood of 25 patients with acute cholangitis of severe type (ACST) were detected during operation, one week and two weeks after operation. Results The contents of ET, ALT and total bilirubin were significantly lower on 7-day and 14-day after operations as compared with that during operations (Ｐ＜0.05 and Ｐ＜0.01). The concentration of ET in peripheral veinous blood paralleled with that in bile. Conclusion This suggests that ET is tightly related with the pathologic process of ACST. So, in patients with ACST, the dynamic measurement of ET in peripheral veinous blood can be an index for judging the degree of pathological damage either to the hepatobiliary or systemic systems.
Objective To investigate the clinical significance of routine application of choledochoscope during operation of biliary duct. Methods The clinical data of 136 patients with the routine application of intraoperative choledochoscope dealing with bile duct diseases in this hospital from October 2003 to July 2009 were analyzed and summarized. Results Intraoperative choledochoscope inspection, taking stones and targeted surgery were performed in 116 cases with extrahepatic and (or) intrahepatic bile duct stones. The taking out rate of extrahepatic bile duct stones was 100% (85/85), the residual stone rates of extrahepatic and intrahepatic bile duct were 0 (0/85) and 22.6% (7/31), respectively, with the total residual stone rate was 6.0% (7/116). By using intraoperative choledochoscope, benign intrahepatic bile duct stricture was found in 13 cases, malignant extrahepatic and intrahepatic bile duct stricture in 8 cases. Four cases of hilar cholangiocarcinoma and 4 cases of common bile duct cancer, 2 cases of lower segment of common bile duct polyp, 3 cases of hepatolithiasis with the left hepatic bile duct carcinoma were diagnosed by biopsy via choledochoscope. Causes were confirmed by applying choledochoscope in 16 patients with obstructive jaundice. The use of choledochoscope with surgical treatment enabled benign and malignant bile duct stricture to achieve good results, without serious complications such as bile duct dilaceration, subphrenic abscess or acute cholangitis. Conclusions Using choledochoscope can tremendously reduce the residual rate of stone in biliary duct surgery, increase the definite diagnosis rate of biliary duct diseases and play a role of reasonable instruction in its treatment options. It has unique advantages in identifying causes of jaundice. It is remarkable that the role of applying choledochoscope to diagnose and cure biliary duct diseases. It should be widely used.
Objective To detect the bile acid profile in serum based on liquid chromatography-tandem mass spectrometry, and construct a combined biomarker diagnostic model for differentiating acute myocardial infarction (AMI) from unstable angina (UA). Methods A total of 180 patients with acute coronary syndrome who visited Huludao Central Hospital between August 2023 and February 2024 were randomly selected, and there were 117 patients with UA and 63 patients with AMI. Using liquid chromatography-tandem mass spectrometry, 15 bile acid subtypes in serum were detected. Orthogonal partial least squares discriminant analysis was used to compare the serum bile acid metabolic profiles of the subjects. Differences in metabolites were screened based on a significance level of P<0.05 and variable importance in projection (VIP)>1. Multiple logistic regression analysis was performed to construct a diagnostic model for differentiating AMI from UA, and the diagnostic performance of the model was evaluated using receiver operating characteristic (ROC) curve and other statistical methods. Results The differential bile acid biomarkers in the serum of UA and AMI patients included glycodeoxycholic acid, glycochenodeoxycholic acid (GCDCA), deoxycholic acid (DCA), glycocholic acid, and aurodeoxycholic acid (TDCA) (P<0.05, VIP>1). A binary logistic stepwise regression analysis showed that three bile acid biomarkers (GCDCA, DCA, and TDCA) and three common biochemical indicators (aspartate aminotransferase, creatine kinase, and total bile acid) were factors differentiating AMI from UA (P<0.05). The area under the ROC curve of the model was 0.986 [95% confidence interval (0.973, 0.999), P<0.001], demonstrating a good diagnostic performance. Conclusions GCDCA, DCA, and TDCA can serve as potential biomarkers for distinguishing AMI from UA. The model combining these three bile acids with aspartate aminotransferase, creatine kinase, and total bile acid can effectively identify AMI.
Objective To observe the influence of connexin 43 (Cx43) on bystander effects induced by cytosine deaminase (CD) and herpes simplex virus thymidine kinase (HSV-tk) coexpression suicide genes system in human cholangiocarcinoma QBC939 cells and transplantation tumors in nude mice. Methods In vitro, the CD+tk+ and CD+tk+Cx+ cells were respectively treated with 5-fluorocytosine (5-FC) and ganciclovir (GCV). The cytotoxic efficacy was evaluated by microculture tetrajolium test (MTT) method. In order to investigate the influence of Cx43 on bystander effects, the volumes of transplantation tumors of the CD+tk+ and CD+tk+Cx+ cells were measured before and after application of 5-FC and GCV. Results CD and tk gene were stably expressed in transfected QBC939 cells. Increasing expression of Cx43 was determined by testing for the presence of Cx43 mRNA by RT-PCR and the presence of Cx43 protein by Western blot in CD+tk+Cx+ cells. The killing effect of 5-FC and GCV on CD+tk+Cx+ cells was more effective than that on CD+tk+ cells both in vitro and in vivo. Conclusion Double suicide genes system CD/5-FC+tk/GCV could induce remarkable killing effect on cholangiocarcinoma cells in vitro and transplantation tumors in vivo. The cotransfection of Cx43 gene is able to enhance the bystander effects and the inhibition of carcinoma cells.
ObjectiveTo study the clinical manifestations, pathologic characteristics, imaging features, diagnosis and treatment of adenomas of extrahepatic bile duct.MethodsTwo cases of adenomas of extrahepatic bile duct in our hospital and 14 cases reported in the literatures were analyzed retrospectively.ResultsThe patients’(male 5, female 11) mean age was 58.4 years (range 21-85). The main manifestations included jaundice (n=11), abdominal pain (n=8),fever (n=6),dyspepsia (n=4),body weight loss (n=3) and claycolored stool (n=1). The locations of tumors were in the left hepatic duct (n=1), right hepatic duct (n=3), hepatic common bile duct(n=3）,the junction of cystic duct and common bile duct (n=1），distal common bile duct (n=8). The pathologic types were tubular adenomas (n=5), papillary (villous) adenomas (n=10),and mucous adenoma (n=1). All the patients underwent surgical therapy. The tumors were identified by postoperative histopathologic examination.ConclusionIt is difficult to correctly diagnose adenomas of extrahepatic bile duct before operation, because the clinical manifestations are usually atypical. The definite diagnosis should depend on histopathologic examination. It is the key to completely resect the tumors. Postoperative followup should be done on regular basis.
Objective To explore the pathogen distribution and the characteristics of antibiotics use of patients with positive bile culture in order to provide evidence for appropriate antibiotic use. Methods Using a patient-based approach, the clinical and laboratory data of patients with positive bile culture between December 1st 2016 and November 30th 2017 were retrospectively analyzed. The pathogen distribution and antibiotics use of patients with bililary duct infections and colonizations were analyzed. Multidrug-resistant organism infections of patients with bililary duct infections were studied. Results There were 299 submitted bililary samples and in which 158 were culture-positive (52.8%). One hundred and ten strains of pathogens were found in 79 patients with positive bile culture, including 66 strains of Gram-negative (G–) organisms (60.0%), 37 strains of Gram-positive (G+) organisms (33.6%), and 7 strains of fungi (6.4%). The top three G– organisms were Escherichia coli (25 strains, 22.7%), Klebsiella pneumoniae (9 strains, 8.2%), and Acinetobacter baumanii (7 strains, 6.4%). The top three G+ organisms were Enterococcus faecium (10 strains, 9.1%), Enterococcus faecalis (6 strains, 5.5%), and coagulase negativeStaphylococcus (6 strains, 5.5%). The number of patients with bililary duct infections and colonizations were 42 and 37, respectively, with pathogens occupied mainly by G– bacteria. Ten strains of multidrug-resistant organisms were isolated from patients with bililary duct infections. Compared to patients with non-multidrug-resistant organism infections, the length of antibiotics use was longer in patients with multidrug- resistant organism infections (t=2.129, P=0.039). The rate of target therapy for antibiotics in patients with bililary duct infections was 76.2%. The rate of proper antibiotics use was 16.2% before positive bile culture and 78.4% after positive bile culture in patients with bililary duct colonizations. Conclusions Pathogens isolated from bile culture of infection and colonization are predominantly G– organisms. The bile culture and blood culture should be done for patients with suspected bililary duct infection. Infection and colonization should be distinguished for positive bile culture and antibiotic should be chosen according to drug susceptibility test results.
Objective To explore the effects of bile from patients with cholecystolithiasis on the growth of human gallbladder carcinoma cells GBC-SD and the potential correlation between cholecystolithiasis and gallbladder carcinoma. Methods Cholecystolithiasis bile (CB) and normal bile (NB) specimens were used for this study. The proliferative effects of bile were measured by methabenzthiazuron (MTT) assay and cell cycle and apoptosis were analyzed by flow cytometry. Results CB can significantly promote the proliferation of GBC-SD cells, GBC-SD proliferative index increased significantly after treated with 1% CB for 48 h （P＜0.05）.The Sphase fraction of CB 〔（49.26±8.07）%〕 increased remarkably (P＜0.05) compared with that of NB 〔（25.54±6.57）%〕, and the CB percentage of G0/G1 phase 〔（40.59±9.12）%〕 decreased remarkably (P＜0.05) compared with NB 〔(60.64±13.42）〕%. Conclusion CB can promote the proliferation of human gallbladder carcinoma GBC-SD cells.
Objective To investigate the therapeutic effects of biphasic positive airway pressure (Bilevel) ventilation and volume ventilation plus [VV+，including volume control plus (VC+) and volume support (VS)] on respiratory failure in patients with chronic obstructive pulmonary disease (COPD).Methods 63 patients with COPD complicated by acute respiratory failure were intubated and underwent mechanical ventilation for at least 24 hours.At the first patients were underwent assist-control (A/C) ventilation for 2 to 4 hours to obtain the suitable basic ventilatory parameters.Meanwhile，the hemodynamics and oxygen dynamic parameters were measured.Then the patients were randomly allocated to three groups with 21 patients in each group and the ventilation mode was switched to Bilevel，VC+ and A/C mode correspondingly.The setting parameter was identical in three modes.In the process of weaning，patients in Bilevel group were ventilated with Bilevel and pressure support ventilation (PSV) mode at each pressure level，and subdivided into Bilevel and PSV 1 group accordingly.In VC+ group，the mode was switched to VS and PSV mode and subdivided into VC+ group and PSV 2 group,respectively.Every mode was run for 30 minutes while the ventilation function，blood gas exchange and lung mechanics index were measured.Results In the initial stage，the airway peak pressure (PIP) of Bilevel and VC+ mode obviously decreased，and the respiratory compliance was higher compared to the A/C mode. The effectiveness of Bilevel and A/C was equivalent in improving alveolar ventilation and oxygenation.The difference in the change of circulation function and blood gas between the two groups were not significant (Pgt;0.05).In the process of weaning，the effectiveness of Bilevel and VV+ was equal to PSV.The changes of breathing mode and blood gas between the two groups had no significant differences.Conclusions Bilevel and VV+ mode ventilation can be used in the whole mechanical ventilation for acute respiratory failure due to COPD with lower PIP，higher respiratory compliance compared to A/C model and similar performance as PSV during mechanical ventilation withdrawn.
【Abstract】Objective To investigate the imaging features of malignant invasion of major intrahepatic ductal structures (the portal and hepatic venous vasculature, the bilie duct) by primary hepatocellular carcinoma (HCC) using multidetector-row spiral CT (MDCT). Methods We retrospectively analyzed 68 documented HCC patients with tumorous invasion of the major intrahepatic ductal structures who had undergone contrast-enhanced dual-phase MDCT scanning of the upper abdomen.The morphological changes of the portal and hepatic venous vasculature, the bile duct, and the liver parenchyma at both the hepatic arterial phase and portal venous phase images were carefully observed and recorded. Results Among the 68 patients, 47 patients had malignant invasion of the intrahepatic portal venous vessels with secondary tumor thrombus formation; 12 patients had tumor involvement of the hepatic veins and intraheptic segment of the inferior vena cava; Tumor invasion of the bile duct was seen in 9 patents. The direct CT signs of tumor invasion of intrahepatic venous vessels included: ①dilatation or enlargement of the involved vein with intraluminal softtissue “filling defect”； ②enhancement of the tumor thrombus at hepatic arterial phase, the so-called “venous arterialization” phenomenon. The indirect CT signs included: ①arterial-venous shunt, ②early and heterogeneous enhancement of the hepatic parenchyma adjacent to HCC focus, ③cavernous transformation of the portal vein. The CT signs suggesting tumor invasion of the bile duct included: ①dilation of the bile ducts near or proximal to HCC lesion, ②soft-tissue nodule or mass inside the bile ducts. Conclusion Invasion of major intrahepatic ductal structures by HCC will present corresponding CT imaging features. Contrast-enhanced MDCT dualphase scanning combined with appropriate image postprocessing techniques can better evaluate the malignant invasion of major intrahepatic ductal structures.