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Gastroesophageal variceal bleeding and hypersplenism caused by portal hypertension seriously threaten the life of patients with liver cirrhosis. At present, devascularization is still one of the important surgical procedures for the treatment of portal hypertension; however, the development of the treatment methods such as drugs, endoscopy, and interventional treatment has caused the controversies over the role, surgical indications, and surgical timing of devascularization in the treatment of portal hypertension, as well as whether splenectomy is needed. This article reviews the role of devascularization and related controversies and points out that devascularization is still irreplaceable. Individualized, comprehensive, and minimally invasive treatment regimens should be developed for portal hypertension, so as to bring maximum benefits to patients with minimal invasiveness.
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OBJECTIVE@#To construct and validate an individualized nomogram to predict the probability of occurrence of portal vein thrombosis (PVT) after splenectomy in patients with hepatitis B cirrhosis.@*METHODS@#We retrospectively collected the clinical data from 180 patients with hepatitis B cirrhosis undergoing splenectomy with postoperative anticoagulation therapy during the period from January, 2014 to January, 2020 in our hospital. The patients were randomized into modeling group (= 120) and validation group (=60), and the former group was further divided into PVT group (=49) and non-PVT group (=71) according to the occurrence of PVT occurred within 1 month after splenectomy. The independent risk factors of PVT after splenectomy were screened in the modeling group using univariate and multivariate binary logistic regression analyses and were used for construction of the nomogram prediction model. The area under the receiver-operating characteristic (AUROC) curve (C-index), GiViTI calibration belt and Hosmer-Lemeshow test, and the DCA curve were used to estimate the discrimination power, calibration and clinical efficiency of the prediction model in both the model construction group and validation group.@*RESULTS@#Univariate and multivariate logistic regression analyses showed that a history of hemorrhage, portal vein diameter, spleen vein diameter, spleen volume, varicose, postoperative platelet change, and postoperative D-dimer differed significantly between PVT group and non-PVT group ( < 0.05), and portal vein diameter, spleen vein diameter, and postoperative platelet change were independent risk factors of PVT after splenectomy ( < 0.05). The prediction model had a good discrimination power with AUROC (C-index) of 0.880 (95% : 0.818-0.942) in the modeling group and 0.873 (95% : 0.785-0.960) in the validation group. The 80% and 95% region of GiViTI calibration belt did not cover the 45-degree diagonal bisector line (=0.965 and 0.632, respectively), and the P-values of the Hosmer-Lemeshow test were 0.624 and 0.911, respectively, suggesting a high reliability of the predicted probability by the model. DCA curve analysis showed a threshold probability of 30.5%, with a net benefit of 30% in the modeling group and 34% in the validation group, indicating a good clinical efficiency of the model.@*CONCLUSIONS@#The model for predicting the risk of PVT after splenectomy in patients with hepatitis B cirrhosis can help in early identification of patients having high risks of PVT.
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The treatment of severe acute pancreatitis (SAP) is a difficult clinical problem.Hemofiltration has been used in the treatment of SAP for more than 20 years.Hemofiltration can clear excessively activated inflammatory factors of blood and block systemic inflammatory response syndrome (SIRS),while maintaining water-electrolyte balance.It plays an more and more important role in the treatment of SAP.At the same time,the application of hemofiltration in the treatment of SAP is also controversial and requires further study.This paper will summarize recent advances in hemofiltration for SAP so as to achieve better application of hemofiltration in clinical practice.
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Traditionally,splenectomy is the second-line treatment method of primary thrombocytopenic purpura and a choice after the ineffectual treatment of glucocorticoid,but doctors never evaluate the curative effect of splenectomy before the operation and assess the necessity of splenectomy.In light of recent progresses on this topic,the current review summaries and pinpoints traditional application of splenectomy,side effects,new drug,and predicted factors of evaluation of operation,aiming to make accurate splenectomy for idiopathic thrombocytopenic purpura.
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Objective To study the effect of de novo donor-specific antigen (DSA) on transplant heart function and recipient survival after heart transplantation.Methods 195 recipients went through heart transplantion from March 2013 to January 2016 in our center,13 patients with preoperative panel reactive antibody (PRA) and 10 patients suffered from in-hospital death were exclude from this study,and the actual number of patients enrolled in this study was 172.By detecting HLA typing and DSA,recipients were divided into DSA positive group,anti-HLA antigen positive but DSA negative group (DSA negative group) and anti-HLA negative group.Cardiac dysfunction,coronary heart disease and cardiovascular death were recorded as cardiac events during the follow-up period.By analyzing the cardiac events rate among 3 groups,the relationship between DSA and cardiac events was acknowledged.Results The mean follow-up period of all patients was (1.3 ± 0.8) years.Among 172 patients,6 were positive for DSA (3.4％).In the DSA positive group,66％ of DSA were directed at HLA Ⅱ,mainly against HLA-DQ,1 developed only anti-HLA I antibody,1 developed both anti-HLA Ⅰ and Ⅱ antibody.The median developing time of DSA was (256 ± 125) days,and the distribution was centralized in the first half year.84％ of patients in DSA positive group were witnessed cardiac events.One patient was diagnosed as coronary heart disease and received PCI at 145th days after DSA was developed.Four out of 6 patients experienced cardiac dysfunction with median developing time of (54 ± 13) days,and the cardiac function restored after treatment with immunosuppression modification,high-dose glucocorticoid and IVIG.In the DSA negative PRA positive group,the incidence of cardiac events was 13％.There was one cardiovascular death,and 2 cases of cardiac dysfunction.In the HLA antigen negative group,the incidence of cardiac events was 4％.Cox regression analysis revealed that DSA could be seen as an independent risk factor in leading to cardiac events and affecting mid-long term survival of recipients (P =0.02).Significant difference was observed in Kaplan-Meier analysis among 3 groups (P＜0.001).Conclusion DSA has strong impact on outcome after heart transplantation.Routine surveillance and appropriate treatment should be attached to DSA.
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<p><b>OBJECTIVE</b>To compare the safety and effectiveness of DPPHR with PPPD/PD for treating chronic pancreatitis with an inflammatory mass in the head of pancreas.</p><p><b>METHODS</b>The relative data bases such as Medline, EMBase, Biosis, COCHRANE Library, Science Citation Index, SinoMed, Chinese Journal Full-text Database, Wangfang, CNKI were searched systematically, researchers selected randomized controlled trials (RCT) and prospective clinical controlled trials (CCT) . The assessment of the bias risk of the included trials was according to the assessing tools suggested by Cochrane Handbook 5.1. The Review Manage 5.2 was used to perform the statistical analysis.</p><p><b>RESULTS</b>In total, 5 RCTs and 2 CCTs were included, 381 patients involved. Comparing with PPPD/PD procedure, DPPHR has no significant difference in terms of the mortality of perioperative period (RD = 0.01, P = 0.51), the incidence of bleeding (RD = -0.01, P = 0.72), pancreatic fistula(RD = -0.01, P = 0.59) and delayed gastric emptying (RD = -0.15, P = 0.10), the ration of complete pain relief after operation (RR = 1.06, P = 0.32) and the score of global quality of life (WMD = 10.31, P = 0.19).While DPPHR had significant superiorities in terms of the total morbidity of perioperative period (RR = 0.60, P = 0.008), the duration of the operations(WMD = -71.60, P = 0.03), the postoperative hospitalization duration(WMD = -3.95, P < 0.01), weight gain(WMD = 3.68, P < 0.01), occupational rehabilitation after the operations (RR = 1.38, P = 0.008).</p><p><b>CONCLUSIONS</b>In terms of reducing the morbidity of perioperative period, shortening the duration of the operations and the postoperative hospitalization duration, weight gain, occupational rehabilitation after the operations, the DPPHR is more favorable for improving patients' life qualities comparing with PPPD/PD.</p>
Subject(s)
Humans , Duodenum , General Surgery , Pancreas , General Surgery , Pancreatectomy , Methods , Pancreaticoduodenectomy , Methods , Pancreatitis, Chronic , General Surgery , Prospective Studies , Quality of LifeABSTRACT
<p><b>BACKGROUND</b>Osteosarcoma (OS) is the most common primary malignant tumor of bone. Mouse models of human OS can invariably provide greater insight into the complex mechanisms that underlie the development and pathogenesis of this aggressive tumor. Bioluminescence technology favored tracing cancer cells in vivo. In this study, an OS model was described and evaluated using human OS cell line, Saos2, labeled with luciferase (Saos2-luc).</p><p><b>METHODS</b>Saos2 cells were infected by lentivirus loading a firefly luciferase gene. Luciferase expression of Saos2-luc cells was characterized both in vitro and in vivo. Specific biologic and oncologic features of Saos2-luc cells were analyzed. The OS was established as orthotopic xenografts in nude mice. Both orthotopic tumors and spontaneous lung metastasis were analyzed.</p><p><b>RESULTS</b>Tumorigenesis and spontaneous lung metastasis in nude mice could be monitored in vivo through in vivo imaging system. The enhancement in proliferation, migration and invasion abilities and the attenuation in adhesion ability were observed in Saos2-luc cells compared with Saos2 cells. Furthermore, there were the up-regulation of Osteocalcin, CCR10, CXCR1 and ID1 and the down-regulation of ALP, collagen I, CCR1, CCR3, CXCR3, NID and N-cadherin in Saos2-luc cells compare to Saos2 cells. The rate of spontaneous lung metastasis in Saos2-luc cells was higher than that in Saos2 cells, although without significant difference.</p><p><b>CONCLUSIONS</b>Lentivirus transfection may cause alteration of gene expression profiles and further biological functions. This model can be used in the elucidation of molecular mechanisms of tumorigenesis and the screening of new therapeutic agents.</p>
Subject(s)
Animals , Humans , Male , Mice , Carcinogenesis , Pathology , Cell Line, Tumor , Mice, Inbred BALB C , Mice, Nude , Neoplasm Metastasis , Pathology , Osteosarcoma , Pathology , Real-Time Polymerase Chain Reaction , Reverse Transcriptase Polymerase Chain Reaction , Transplantation, HeterologousABSTRACT
<p><b>OBJECTIVE</b>To explore the possible mechanism of the inhibitory effect of liver X receptor alpha (LXRalpha) on lipopolysaccharide (LPS)-induced inflammation in mouse Kupffer cells (KCs).</p><p><b>METHODS</b>The KCs isolated from the liver of male KM mice and cultured in RPMI 1640 containing 20% FBS for 24 h were divided into control, LPS, T0901317, and LPS+T0901317 groups with corresponding treatments. The expressions of LXRalpha, interferon regulatory factor 3 (IRF3) and glucocorticoid receptor interacting protein 1 (GRIP1) in the KCs were detected by Western blotting. The levels of interferon beta (IFNbeta), tumor necrosis factor-alpha (TNF-alpha) and interleukin-1beta (IL-1beta) in the supernatant were detected by enzyme-linked immunosorbent assay (ELISA).</p><p><b>RESULTS</b>The level of LXRalpha protein was highest in T0901317 group and lowest in LPS group, and was significantly higher in LPS+T0901317 group than in LPS group but lower than in T0901317 group (P<0.05). The levels of IRF3 and GRIP1 protein were the highest in LPS group, and significantly lowered by T0901317 treatment (P<0.05). The expression of IRF3 and GRIP1 proteins in LPS group and LPS+ T0901317 group were significantly higher than those in the control and T0901317 groups (P<0.05). The concentration of IFN-beta was significantly higher in LPS group than in the control and T0901317 group (P<0.05), and decreased in LPS+T0901317 group in comparison with that in LPS group (P<0.05). IFN-beta was the lowest in T0901317 group. The levels of TNF-alpha and IL-1beta were the highest in LPS group (P<0.05), and comparable between the other 3 groups (P>0.05).</p><p><b>CONCLUSION</b>Pre-treatment with T0901317 before LPS stimulation can suppress the expressions of IRF3 and GRIP1 to inhibit the inflammation and hence Kupffer cell activation.</p>
Subject(s)
Animals , Male , Mice , Cells, Cultured , Hydrocarbons, Fluorinated , Pharmacology , Inflammation , Interferon Regulatory Factor-3 , Metabolism , Kupffer Cells , Cell Biology , Metabolism , Lipopolysaccharides , Pharmacology , Liver X Receptors , Nuclear Receptor Coactivator 2 , Metabolism , Orphan Nuclear Receptors , Physiology , Sulfonamides , PharmacologyABSTRACT
Objective To investigate the changes and significance of serum nitric oxide levels in the early stage after rat liver transplantation.Methods Male Sprague Dawley rats were used as do- nors and recipients of orthotopic liver transplantation,and the time of cold preservation and anhepatic phase was 4 h and 25 min respectively.Forty-eight rats were randomly divided into groups A,B and C (n=16 each).The samples of blood were taken from vena cava and hepatic tissues from left lobe 2 h, 4 h,6 h in groups A,B and C respectively after liver graft reperfusion.ALT and NO levels in serum were detected,and the expression of NF-?B in hepatic tissue was examined by immunohistochemical technique.Amounts of bile flow in 5 min after liver graft reperfused initially were measured.The pathological changes in liver tissues were observed.Results Amounts of bile flow in 5 min in group A (3.73?1.11?l) were greater than those group B (2.35?0.92?l) and group C (2.23?0.81?l) (P
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<p><b>OBJECTIVE</b>To investigate the expression of lipopolysaccharide binding protein (LBP) and its gene in rats with endotoxemia and explore the role of LBP in the response of host to endotoxin.</p><p><b>METHODS</b>Thirty Wistar rats were divided randomly into five groups: the normal group and the endotoxemia groups (1, 3, 6, 12 hours after LPS injection, respectively). The level of plasma endotoxin was determined by the Limulus Amebocyte Lysate assay. The expression of LBP mRNA in hepatic tissue was examined by reverse transcription polymerase chain reaction (RT-PCR). Plasma levels of LBP, tumor necrosis factor (TNF)-alpha and interleukin (IL)-6 were measured by enzyme-linked immunosorbent assay (ELISA). Morphologic changes of hepatic tissue were observed under transmission electron microscope.</p><p><b>RESULTS</b>The level of plasma endotoxin peaked at 1 h after LPS injection, then declined, but was still higher than that of the normal group at 12 h; intrahepatic expression of LBP mRNA and plasma LBP increased with time after LPS stimulation; TNF-alpha and IL-6 in plasma increased with upregulation of LBP expression; there were significant differences between the normal group and endotoxemia groups (P<0.05). Activation of Kupffer cells and injury of hepatocytes could be seen in rats with endotoxemia.</p><p><b>CONCLUSIONS</b>LPS can upregulate the intrahepatic expression of LBP mRNA and increase the plasma LBP level. Under certain conditions, LBP may enhance the sensitivity of host to the toxic effects of LPS.</p>
Subject(s)
Animals , Rats , Acute-Phase Proteins , Analysis of Variance , Carrier Proteins , Genetics , Metabolism , Endotoxins , Blood , Enzyme-Linked Immunosorbent Assay , Gene Expression , Interleukin-6 , Metabolism , Membrane Glycoproteins , Microscopy, Electron , Rats, Wistar , Tumor Necrosis Factor-alpha , Metabolism , Up-RegulationABSTRACT
Objective To investigate the effect of peer-education model on clinical practice of undergraduate interns.Methods Thirty-six undergraduate interns were arranged into control and experimental group.Twelve postgraduates were selected as peer-educators.Medical ethics and style,attitude,clinical thoughts,operations and satisfactory of patients were used to judge their work.They had to take exams at the end of the clinical practice.Results Undergraduate interns in experi-mental group got higher scores than control group.Conclusion Peer-education model has a posi-tive effect on clinical practice of undergraduate interns.
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Ethylglucoside lactate, a novel Alpha-Hydroxy Acids Derivative, was synthesized by transesterification in non-aqueous phase using immobilized lipase as biocatalyst. Based on the studies of the factors effecting initial rate and conversion under atmospheric pressure (solvent, acyl donor, different immobilized lipase, substrate concentration, enzyme concentration and temperature), the results show that solvent-free medium using butyllactate as acyl donor is suitable to the ester synthesis. The reaction conditions have been optimized as the following: the amount of enzyme = 75 g/L, the ethylglucoside concentration = 0.4 mol/L, 70 degrees C, 200 r/min, 50 h, which the conversion was 71%. A 90% conversion and a 60.7 mmol.L-1.h-1 initial rate can be obtained under reduced pressure, which the conditions are enzyme 75 g/L, ethylglucoside 0.35 mol/L, 65 degrees C, 200 r/min and 40 h. The product purified by extraction and SIO2 chromatography was identified by infrared spectroscopy and 1H NMR.
Subject(s)
Candida , Enzymes, Immobilized , Metabolism , Esters , Metabolism , Glucosides , Metabolism , Kinetics , Lactates , Metabolism , Lactic Acid , Metabolism , Lipase , Metabolism , Substrate Specificity , TemperatureABSTRACT
ObjectiveTo investigate the effect and mechanism of ischemic preconditioning (IP)on preservation/reperfusion injury of rat liver graft.MethodsOne hundred and twenty eight male Sprague Dawley rats undergoing orthotopic liver transplantation were randomly divided into 4 groups: group A (control group), group B (IP group), group C (adenosine,Ado group), and group D (inhibitor of NO synthesis,NAME group).ResultsPosttransplantation one week survival rate, 2 hrs reperfusion serum NO, and hepatic tissue adenosine in IP group and Ado group were 88%(7/8) and 88%(7/8), (33 0?6 1)??mol/l and (29 1?6 5)??mol/l, ( 7 2? 1 8)??mol/g and (5 7?1 3)??mol/g, respectively, while in control group they were 38%(3/8),( 15 4? 3 0)?mol/l, and (3 69?0 54)??mol/g, respectively(all P 0 05). However, hepatic tissue adenosine level was (5 56?1 19)??mol/g, higher than that in control group( P
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Objective To investigated the expression of scavenger receptor A(SR-A) and lipopolysaccharide(LPS) receptor CD14 in endotoxin-induced acute liver injury.Methods Ninety Wistar rats were randomly divided into endotoxaemia group(LPS group) and normal saline group(NS group).The model of endotoxaemia and acute endotoxin-induced liver injury was established by injection of endotoxin(5mg/kg) via tail veins in LPS group,while the rats in NS group received injection of 0.2ml normal saline as control.At 0,1.5,3,6,12h after injection,the levels of endotoxin,TNF-?,IL-1,alanine transaminase(ALT) and total bilirubin(TB) in plasma,SR-A and CD14 expressions in liver tissues were determined,pathological changes of liver tissues and ultrastructural changes of Kupffer cells(KCs) were observed by light and electron microscopy respectively,while the phagocytosis of KCs was determined too.Results Compared with NS group,KCs were activated on morphology and functions(proliferated diffusely,enlarged in size and increased in phagocytosis function),levels of TNF-? and IL-1 increased markedly,the pathological changes of cell degeneration and necrosis and the liver function were gradually aggravated,while SR-A expression decreased and CD14 expression increased obviously(P
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Gastroesophageal variceal bleeding and hypersplenism caused by portal hypertension seriously threaten the life of patients with liver cirrhosis. At present, devascularization is still one of the important surgical procedures for the treatment of portal hypertension; however, the development of the treatment methods such as drugs, endoscopy, and interventional treatment has caused the controversies over the role, surgical indications, and surgical timing of devascularization in the treatment of portal hypertension, as well as whether splenectomy is needed. This article reviews the role of devascularization and related controversies and points out that devascularization is still irreplaceable. Individualized, comprehensive, and minimally invasive treatment regimens should be developed for portal hypertension, so as to bring maximum benefits to patients with minimal invasiveness.