梗阻性胆管损伤一期修复时机的选择

Objective To observe the pathological changes of tissues of the injured bile duct, and to provide theoretical basis for bile duct repair. Methods Dog models of obstructive biliary injury were established.Sixty dogs were equally divided into five groups according to the duration of biliary obstruction: biliary obstruction for 5 days (BDL5 group), 10 days (BDL10 group), 15 days (BDL15 group), 20 days (BDL20 group) and 30 days (BDL30 group). The morphological and pathological changes of bile duct and local tissues were observed, and biliary-enteric Roux-en-Y anastomosis was applied to repair the injured bile duct and postoperative complications were observed. All data were analyzed by LSD test, independent sample t test, one-way analysis of variance and chi-square test. Results Proximal bile duct rapidly expanded as the pressure increased in the early stage, and the bile duct expanded to ( 15.6 ± 1.8)mm in the BDL10 group. The expansion rate decreased in the later stage,and the bile duct expanded to (18.9 ± 1.9)mm in the B DL15 group. Acute inflammation was observed in injured local tissues. The acute inflammation was severe in the BDL5 group with white blood cell count of 54 ± 6, and the acute inflammation was relatively mild in the BDL15 group with white blood cell count of 42 ± 7. There was a significant difference between the BDL5 group and BDL15 group in the degree of acute inflammation (t =4. 688,P ＜ 0. 05). The content of the collagen was increased in the injured bile duct as time passed by. Bile duct repair was successfully performed on 57 dogs. Ten dogs ( three in the BDL5 group, four in the BDL10 group, one in the BDL15 group, one in the BDL20 group and one in the BDL30 group) died of bile leakage after the operation. The incidences of bile leakage was 30% (7/23) within 10 days and 9% (3/34) beyond 10 days, with a significant difference between the two groups (x2 =4.429, P＜0.05). Conclusion Ten days after obstructive biliary injury,an obvious reduction of bile duct expansion and edema of the bile duct is observed, the difficulty of the operation is reduced and the incidence of bile leakage is low, so 10 days after the incidence of obstructive biliary injury is the proper timing for the surgical repair.     

神经生长因子对胆管癌细胞67-kDa层黏连蛋白受体表达的影响

Objective To investigate the effects of nerve growth factor (NGF) on the expression of 67-kDa laminin receptor (67LR) in human bile duct carcinoma QBC939 cells, and study the possible mechanism of perineural invasion and metastasis of bile duct carcinoma. Methods ( 1 ) The expression of a high-affinity receptor for NGF, TrkA, was detected by immunofluorescence staining. ( 2 ) QBC393 cells were pretreated by β-NGF at different concentrations ( 1, 10, 100,200 μg/L), and then the mRNA and protein expressions of 67LR were examined by Real-Time PCR and Western blot assay. QBC939 cells were divided into control group and β-NGF (1, 10, 100,200 μg/L) groups. (3) The ideal concentration of β-NGF was selected according to the results of previous tests, and then the mRNA and protein expressions of 67LR were re-examined by adding specific TrkA inhibitor K252a at different concentrations ( 100,200,300 nmol/L). QBC939 cells were divided into control group, β-NGF 100 μg/L group and K252a ( 100,200,300 nmol/L) groups. All data were analyzed by one-way analysis of variance or LSD-test. Results (1) A strong expression of TrkA was detected in the membrane of QBC939 cells. (2) The mRNA and protein expressions of 67LR in QBC939 cells were 0.35 ± 0.06 and 0. 32 ± 0.05 in the control group, 0.38 ±0.14 and 0.50 ±0.09 in the β-NGF 1 μg/L group, 0.62 ±0.14 and 0. 69 ±0. 13 in β-NGF 10 μg/L group, 0.90 ± 0.08 and 0.93 ± 0.07 in the β-NGF 100 μg/L group, and 0. 70 ± 0. 10 and 0. 76 ±0.07 in the β-NGF 200 μg/L group, there were significant differences among the five groups (F = 22. 4, 14. 6,P ＜0.05). The mRNA and protein expressions of 67LR in the β-NGF 100 μg/L group were significantly higher than those in the control group ( t = 19. 0, 21.0, P ＜ 0. 05 ). (3) The mRNA and protein expressions of 67LR in the QBC939 cells were 0.35 ±0.10 and 0.41 ±0.10 in the control group, 0. 88 ±0. 14 and 0.84 ±0.10 in the β-NGF 100 μg/L group, 0.80±0.08 and 0.76 ±0.04 in the K252a 100 nmol/L group, 0.67 ±0.12 and 0.61 ± 0.09 in the K252a 200 nmol/L group, and 0. 43 ± 0.07 and 0. 50 ± 0. 12 in the K252a 300 nmol/L group, there were significant differences among the five groups ( F = 14. 1, 8. 9, P ＜ 0.05 ). There were no significant differences in the mRNA and protein expressions of 67LR between the K252a 300 nmol/L group and the control group (t =1.02, 0. 85, P＞0.05). Conclusion In bile duct carcinoma cells, NGF enhances the expression of 67LR by combining with TrkA, which might be the mechanism of NGF mediating perineural invasion of bile duct carcinoma.     

Transwell侵袭实验测定M受体对胆管癌细胞侵袭的影响

Objective To explore the experiment condition and method for the application of in vitro in vasive Transwell chamber and to observe muscarinicreceptor stimulant and muscarinicreceptor antagonist's influence to cholangiocarcinoma's invasiveness.Methods Two hundred microliter cell suspension of various concentrations(0.5×105/mL,1.0×105/mL,1.5×105/mL and 2.0×105/mL)was added into the upper chamber of the Transwell chamber,and the cells were allowed to penetrate the matrigel for 12,18,24and 48 hours respectively.The numbers was gotten as the invasive cells on the under surface of the membrane.After optimal cell concentration and time were gotten,pilocarpine of various concentrations(0 mmol/L,0.1 mmol/L,0.3 mmol/L and 0.5 mmoL/L)was added into the upper chamber of the Transwell chamber,then the cells on the matrigel were stained and counted.So did the cells when atropine of various concentrations(0.01 mmol/L,0.01 mmol/L,0.05 mmoVL and 0.1 mmol/L)were added into the upper chamher of the Transwell chamber in according to pilocarpine of various concentrations(0 mmol/L,0.3 mmol/L,0.3 mmol/L and 0.3mmol/L).Results With the increase of the time and cell concentrations，the cells couts that penetrated the matrigel increased，while the increase tended to he stable when the culture time exceeded 36 hous and the cell concentration Was over 1.0×105/mL.By adding pilocarpine,there were significant differences between the control and experimental groups(P＜0.05)，but there were no significant differences in experimental groups with various concentrations.There were no significant differences in blank group and experimental groups with atropine added(P＞0.05).When added pilocarpine and atropine,there were significant differences between blank and experimental groups(P＜0.05)，but there were no significant differences in experimental groups with various concentrations.Conclusions Thirty-six hours as invasive time,and one cell concentration 1.0 × 105/mL were optimal to test invasion abilities of cholangiocarcingma cells to different medicines or reagents.There is the possibility that museariniereceptor exists in cholangiocarcinoma cells，and may play an important role in cholangiocarcinoma's invasiveness and metastasis.     

肝移植术后血清降钙素原监测的临床意义

Objective To investigate the changes of procalcitonin (PCT) in patients after liver transplantation and explore their significance for diagnosis and differential diagnosis among bacterial infection, viral infection and acute rejection.Methods PCT was measured in serum of 25 liver trans-plant patients by immunofluorescence sandwich method and the patients were divided into the non-complication group, viral infection group, acute rejection group and bacterial infection group.Results The concentrations of PCT in the 1st, 2nd and 3rd day after transplantation were(24.50 ± 4.6)ng/ml, (21.40± 3.3)ng/ml and (12.25 ± 3.1)ng/ml, respectively and they presented a decreasing tendency.The concentrations of PCT in non-complication group, viral infection group and acute rejection group decreased gradually and were near the normal level of (0.51±0.11) ng/ml after 7～10 days.Moreo-ver, the concentrations of PCT in viral infection group and acute rejection group were (0.44 ± 0.16)ng/ml and(0.53±0.14)ng/ml when the patients were in fever.The concentration of PCT in the viral infection group were(15.70±5.1)ng/ml, which was significantly higher than that in other 3 groups (P<0.05) in the early days of fever.The statistical differences among the other three groups were not significant (P>0.05).Conclusion The concentration of PCT in serum is high in the 1st, 2nd and 3rd day then decreased gradually soon.The concentration of PCT is not high in viral infection or acute rejection while significantly high in bacterial infection, so it can be used to differentiate the bacterial infection from acute rejection and virus infection after liver transplantation.     

肝移植术后血清降钙素原监测的临床意义

Objective To investigate the changes of procalcitonin (PCT) in patients after liver transplantation and explore their significance for diagnosis and differential diagnosis among bacterial infection, viral infection and acute rejection.Methods PCT was measured in serum of 25 liver trans-plant patients by immunofluorescence sandwich method and the patients were divided into the non-complication group, viral infection group, acute rejection group and bacterial infection group.Results The concentrations of PCT in the 1st, 2nd and 3rd day after transplantation were(24.50 ± 4.6)ng/ml, (21.40± 3.3)ng/ml and (12.25 ± 3.1)ng/ml, respectively and they presented a decreasing tendency.The concentrations of PCT in non-complication group, viral infection group and acute rejection group decreased gradually and were near the normal level of (0.51±0.11) ng/ml after 7～10 days.Moreo-ver, the concentrations of PCT in viral infection group and acute rejection group were (0.44 ± 0.16)ng/ml and(0.53±0.14)ng/ml when the patients were in fever.The concentration of PCT in the viral infection group were(15.70±5.1)ng/ml, which was significantly higher than that in other 3 groups (P<0.05) in the early days of fever.The statistical differences among the other three groups were not significant (P>0.05).Conclusion The concentration of PCT in serum is high in the 1st, 2nd and 3rd day then decreased gradually soon.The concentration of PCT is not high in viral infection or acute rejection while significantly high in bacterial infection, so it can be used to differentiate the bacterial infection from acute rejection and virus infection after liver transplantation.     

膝关节单室置换的近期疗效

Objective To explore the indication and observe short-term clinical outcome of the medial Oxford Ⅲ mobile bearing unicompartmental knee replacement (UKR) through a minimal invasive approach for the patients with osteoarthritis of the knee. Methods A retrospective study of the clinical outcomes from May 2006 to May 2008 was done on 30 knees in 21 patients after receiving the UKR with the mobile bearing Oxford Ⅲ prosthesis. There were 9 males (12 knees), 12 females (18 knees), with the mean age of (61.4±7.3) years (ranged 46-76 years). All patients were evaluated pre and postoperatively using X-ray image, the Knee Society Score (KSS) and the WOMAC osteoarthritis index and examined the ROM and the varus deformity of the knee with osteoarthritis. Results The average follow-up time was 17 months. The mean operation time was (83.0±12.9) min and the mean hospital stay was (9.3±2.0) days. No complications of infection, thrombosis, mobile beating dislocation were found. The loss of flexion of the operated knee was not significant. The average femorotibial angle decreased from 182.0°±4.3° preoperatively to 177.0°±3.5° postoperatively in the anterioposterior view of X-ray. The KSS clinical score and function score were improved from average 44.0±3.7 and 54.0±5.1 to 93.0±3.2 and 92.0±2.4 respectively. The WOMAC Score was average 48.0±4.2 preoperatively, 14.0±2.5 at the last evaluation. Statistically significant differences were found pre and postoperatively from the aforementioned evaluation criterions. Conclusion The short-term clinical outcomes of medial Oxford Ⅲ mobile bearing UKR through a minimally invasive approach are ideal, and it is a good therapy choice for the patients with medial osteoarthritis of the knee. But it is also important to choose the suitable patients with indications.     

膝关节单室置换的近期疗效

Objective To explore the indication and observe short-term clinical outcome of the medial Oxford Ⅲ mobile bearing unicompartmental knee replacement (UKR) through a minimal invasive approach for the patients with osteoarthritis of the knee. Methods A retrospective study of the clinical outcomes from May 2006 to May 2008 was done on 30 knees in 21 patients after receiving the UKR with the mobile bearing Oxford Ⅲ prosthesis. There were 9 males (12 knees), 12 females (18 knees), with the mean age of (61.4±7.3) years (ranged 46-76 years). All patients were evaluated pre and postoperatively using X-ray image, the Knee Society Score (KSS) and the WOMAC osteoarthritis index and examined the ROM and the varus deformity of the knee with osteoarthritis. Results The average follow-up time was 17 months. The mean operation time was (83.0±12.9) min and the mean hospital stay was (9.3±2.0) days. No complications of infection, thrombosis, mobile beating dislocation were found. The loss of flexion of the operated knee was not significant. The average femorotibial angle decreased from 182.0°±4.3° preoperatively to 177.0°±3.5° postoperatively in the anterioposterior view of X-ray. The KSS clinical score and function score were improved from average 44.0±3.7 and 54.0±5.1 to 93.0±3.2 and 92.0±2.4 respectively. The WOMAC Score was average 48.0±4.2 preoperatively, 14.0±2.5 at the last evaluation. Statistically significant differences were found pre and postoperatively from the aforementioned evaluation criterions. Conclusion The short-term clinical outcomes of medial Oxford Ⅲ mobile bearing UKR through a minimally invasive approach are ideal, and it is a good therapy choice for the patients with medial osteoarthritis of the knee. But it is also important to choose the suitable patients with indications.     

肝移植术后血清降钙素原监测的临床意义

Objective To investigate the changes of procalcitonin (PCT) in patients after liver transplantation and explore their significance for diagnosis and differential diagnosis among bacterial infection, viral infection and acute rejection.Methods PCT was measured in serum of 25 liver trans-plant patients by immunofluorescence sandwich method and the patients were divided into the non-complication group, viral infection group, acute rejection group and bacterial infection group.Results The concentrations of PCT in the 1st, 2nd and 3rd day after transplantation were(24.50 ± 4.6)ng/ml, (21.40± 3.3)ng/ml and (12.25 ± 3.1)ng/ml, respectively and they presented a decreasing tendency.The concentrations of PCT in non-complication group, viral infection group and acute rejection group decreased gradually and were near the normal level of (0.51±0.11) ng/ml after 7～10 days.Moreo-ver, the concentrations of PCT in viral infection group and acute rejection group were (0.44 ± 0.16)ng/ml and(0.53±0.14)ng/ml when the patients were in fever.The concentration of PCT in the viral infection group were(15.70±5.1)ng/ml, which was significantly higher than that in other 3 groups (P<0.05) in the early days of fever.The statistical differences among the other three groups were not significant (P>0.05).Conclusion The concentration of PCT in serum is high in the 1st, 2nd and 3rd day then decreased gradually soon.The concentration of PCT is not high in viral infection or acute rejection while significantly high in bacterial infection, so it can be used to differentiate the bacterial infection from acute rejection and virus infection after liver transplantation.     

肝移植术后血清降钙素原监测的临床意义

Objective To investigate the changes of procalcitonin (PCT) in patients after liver transplantation and explore their significance for diagnosis and differential diagnosis among bacterial infection, viral infection and acute rejection.Methods PCT was measured in serum of 25 liver trans-plant patients by immunofluorescence sandwich method and the patients were divided into the non-complication group, viral infection group, acute rejection group and bacterial infection group.Results The concentrations of PCT in the 1st, 2nd and 3rd day after transplantation were(24.50 ± 4.6)ng/ml, (21.40± 3.3)ng/ml and (12.25 ± 3.1)ng/ml, respectively and they presented a decreasing tendency.The concentrations of PCT in non-complication group, viral infection group and acute rejection group decreased gradually and were near the normal level of (0.51±0.11) ng/ml after 7～10 days.Moreo-ver, the concentrations of PCT in viral infection group and acute rejection group were (0.44 ± 0.16)ng/ml and(0.53±0.14)ng/ml when the patients were in fever.The concentration of PCT in the viral infection group were(15.70±5.1)ng/ml, which was significantly higher than that in other 3 groups (P<0.05) in the early days of fever.The statistical differences among the other three groups were not significant (P>0.05).Conclusion The concentration of PCT in serum is high in the 1st, 2nd and 3rd day then decreased gradually soon.The concentration of PCT is not high in viral infection or acute rejection while significantly high in bacterial infection, so it can be used to differentiate the bacterial infection from acute rejection and virus infection after liver transplantation.     

肝移植术后血清降钙素原监测的临床意义

Objective To investigate the changes of procalcitonin (PCT) in patients after liver transplantation and explore their significance for diagnosis and differential diagnosis among bacterial infection, viral infection and acute rejection.Methods PCT was measured in serum of 25 liver trans-plant patients by immunofluorescence sandwich method and the patients were divided into the non-complication group, viral infection group, acute rejection group and bacterial infection group.Results The concentrations of PCT in the 1st, 2nd and 3rd day after transplantation were(24.50 ± 4.6)ng/ml, (21.40± 3.3)ng/ml and (12.25 ± 3.1)ng/ml, respectively and they presented a decreasing tendency.The concentrations of PCT in non-complication group, viral infection group and acute rejection group decreased gradually and were near the normal level of (0.51±0.11) ng/ml after 7～10 days.Moreo-ver, the concentrations of PCT in viral infection group and acute rejection group were (0.44 ± 0.16)ng/ml and(0.53±0.14)ng/ml when the patients were in fever.The concentration of PCT in the viral infection group were(15.70±5.1)ng/ml, which was significantly higher than that in other 3 groups (P<0.05) in the early days of fever.The statistical differences among the other three groups were not significant (P>0.05).Conclusion The concentration of PCT in serum is high in the 1st, 2nd and 3rd day then decreased gradually soon.The concentration of PCT is not high in viral infection or acute rejection while significantly high in bacterial infection, so it can be used to differentiate the bacterial infection from acute rejection and virus infection after liver transplantation.