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Objective:To study the optimal timing of laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGBD) for grade Ⅱ-Ⅲ acute cholecystitis.Methods:A multicenter, single blind and randomized controlled study was conducted at Shanghai Fifth People's Hospital Affiliated to Fudan University, Shanghai Pudong Hospital, and Shanghai Minhang District Central Hospital from October 2018 to September 2021. Patients who underwent LC after PTGBD were divided 1∶1 into the early group and the late group. LC was performed 4-6 weeks after PTGBD in the early group and 7-8 weeks after PTGBD in the late group. Gender, age, AC grade, complications after PTGBD, body mass index, complications before LC, operation time of LC, intraoperative bleeding, total treatment cost, conversion rate to open surgery and complications after LC were compared between the two groups. The 36-Item Short Form Health Survey (SF-36) before and after LC was also compared.Results:Of 248 patients who were eligible for the study, there were 52 males and 196 females, with ages ranging from 18 to 89 years, and mean ±s.d. of (52.5 ± 20.2) years. There were 126 patients in the early group and 122 patients in the late group. There were no significant differences in gender, age, AC grade, body mass index and complications before LC between the two groups (all P>0.05). The preoperative score of SF-36 in the early group was significantly better than that in late group, and the complications of PTGBD in the late group were significantly higher than the early group (both P<0.05). The operation time and total treatment cost of the early group were significantly less than those of the late group (37.2±12.8 min vs. 48.5±19.7 min, 20 856±2 136 yuan vs. 2 2207±2 049 yuan) (both P<0.05). The intraoperative bleeding volume of LC in the early group was [ M( Q1, Q3)] 40 (40, 60) ml and the late group was [ M( Q1, Q3)] 35 (25, 40) ml. The difference was also significant ( P<0.05). There was no significant differences in the conversion rates to open surgery, complications and SF-36 scores after LC between the two groups (all P>0.05). Conclusion:LC should be performed 4-6 weeks after PTGBD for grade Ⅱ-Ⅲ acute cholecystitis. Although the amount of intraoperative bleeding was higher, the operation time was shorter, the burden on patients was reduced and there was more rapid recovery.
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Objective@#To analyze perioperative serum high mobility group box-1 protein (HMGB1) levels in patients with acute cholangitis and its clinical significance.@*Methods@#118 cases of choledocholithiasis with acute cholangitis were retrospectively analyzed, admittd in Minhang Hospital from Jan 2017 to Dec 2017. Enzyme linked immunosorbent assay (ELISA) was used to detect serum HMGB1 levels before and after ERCP. The relationship between serum HMGB1 levels and severity of the disease was analyzed.@*Results@#The serum HMGB1 levels in the healthy controls, mild cholangitis group, moderate cholangitis group and severe cholangitis group were(1.74±0.79) μg/L, (9.19±4.86) μg/L, (12.62±4.13) μg/L, (18.02±3.84) μg/L, respectively. The serum HMGB1 levels were significantly different in these four groups (F=63.348, P<0.05). The serum HMGB1 levels in the three groups after ERCP were significantly lower than those before ERCP(t=10.978, t=35.682, t=42.649; P<0.05). The serum HMGB1 levels were positively correlated with WBC, CRP, total bilirubin, direct bilirubin and alanine aminotransferase.@*Conclusion@#Serum HMGB1 levels were significantly higher in patients with acute cholangitis, and the more serious the disease, the higher the HMGB1 levels. After ERCP, serum HMGB1 levels were significantly lower than before. HMGB1 is an effective parameter for evaluating the severity of acute cholangitis.
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Objective To analyze perioperative serum high mobility group box-1 protein (HMGB1) levels in patients with acute cholangitis and its clinical significance.Methods 118 cases of choledocholithiasis with acute cholangitis were retrospectively analyzed,admittd in Minhang Hospital from Jan 2017 to Dec 2017.Enzyme linked immunosorbent assay (ELISA) was used to detect serum HMGB1 levels before and after ERCP.The relationship between serum HMGB1 levels and severity of the disease was analyzed.Results The serum HMGB1 levels in the healthy controls,mild cholangitis group,moderate cholangitis group and severe cholangitis group were(1.74 ±0.79) μg/L,(9.19 ±4.86) μg/L,(12.62 ± 4.13) μg/L,(18.02 ±3.84) μg/L,respectively.The serum HMGB1 levels were significantly different in these four groups (F =63.348,P ＜ 0.05).The serum HMGB1 levels in the three groups after ERCP were significantly lower than those before ERCP (t =10.978,t =35.682,t =42.649;P ＜ 0.05).The serum HMGB1 levels were positively correlated with WBC,CRP,total bilirubin,direct bilirubin and alanine aminotransferase.Conclusion Serum HMGB1 levels were significantly higher in patients with acute cholangitis,and the more serious the disease,the higher the HMGB1 levels.After ERCP,serum HMGB1 levels were significantly lower than before.HMGB1 is an effective parameter for evaluating the severity of acute cholangitis.
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Objective To explore the correlation between gait parameters at 14 days and knee function and quality of life at 3 months after total knee arthroplasty (TKA). Methods Eighteen patients who underwent TKA were analyzed by using three-dimensional gait analysis system to observe their gait parameters. Knee joint function and life quality of the patients at 3 months after TKA were evaluated with WOMAC (Western Ontario and McMaster Universities Arthritis Index) and SF-36 (short form 36-item health survey scores) assessment scale and their correlations were analyzed simultaneously. Results At 14 days after TKA, single support time (SST) and peak knee flexion at swing (PKF) of the operated side of the leg were significantly smaller than those of the healthy side of the leg. The knee flexion angle at mid-stance (MKF) and knee valgus angle at mid-stance (MKV) of the operated side of the leg were significantly larger than those of the healthy side of the leg. There was a moderate negative correlation between the spatiotemporal parameters of the operated side of the leg and the WOMAC score during gait, while a high correlation between the WOMAC score and peak knee flexion at swing (PKF), MKF and MKV. Except for the step length and forward velocity, the other gait parameters were significantly correlated with SF-36 life quality score. The single support time (SST) and PKF had a highly positive correlation, while the MKF and MKV had a moderate negative correlation with SF-36 life quality score. Conclusions The SST, MKF, MKV and PKF in postoperative early gait analysis (14 days) results can be used as the effective indicators to judge postoperative knee function and rehabilitation efficacy of life quality after TKA surgery.
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@#Through providing rhythmic stimulation to movement center, rhythmic auditory stimulation (RAS) may encourage hemiplegic patients to adjust movement pattern and external rhythm in time to improve the walking function after stroke. As an emerging intervention to treat the hemiplegic patients after stroke, RAS could effectively improve temporospatial gait parameters (gait velocity, stride length, cadence, and symmetry, etc.), joint movement pattern (angle of pelvis anterior tilt, and peak angle of knee flexion in mid-swing, etc.) and balance, which may be related to rhythmic entrainment movement system and the theory of auditory-movement synchronization. Simultaneously, frequency and dosage of RAS and the patient's lesions all have effect on the outcome of intervention.
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@#Objective To explore whether there is significant difference in the oral-pharyngeal resonance function between children with spastic and athetoid cerebral palsy. Methods The acoustic parameters (F1、F2) of /ɑ/、/i/、/u/ were compared between these two kinds of children. Results The incidence of oral-pharyngeal resonance disorder were 71% and 95% in the children with spastic cerebral palsy and athetoid cerebral palsy respectively. There was no significant difference in F1 and F2 of /ɑ/、/i/、/u/ between these two kinds of children. Conclusion The incidence of oral-pharyngeal resonance disorder is high in both two kinds of children, and there is no significant difference in the oral-pharyngeal resonance function between them.
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Objective To observe the process of polyamidoamine dendrimer modified single walled carbon nanotubes complexes (CNT-PAMAM-D) entering into pancreatic cancer BxPC3 cells, and to evaluate its safety as a vector. Methods The CNT-PAMAM-D were prepared by ultrasound, mixing and rinsing, and the morphology was characterized by atom force microscopy and transmission electron microscope. Then the prepared CNT-PAMAM-D was incubated with human pancreatic cancer cell line BxPC3 cells for 12, 48, 72hours, and then the cells were collected. Distribution of CNT-PAMAM-D in cells and cell ultrastructure was observed by transmission electron microscopy. Results After the combination of PAMAM-D and CNT, the surface of CNT was surrounded by dendrimer and nanocomposite particles with a size of 20 nm was formed. It was showed that CNT-PAMAM-D could be transfected into human pancreatic cancer cells by cell pinocytotic way, and it entered cytoplasm at 12 h. With the extension of the transfecting time, CNT-PAMAM-D could enter lysosomal and nucleus, but the morphology and ultrastructure ocf BxPC 3 cells was not significantly changed. Conclusions The CNT-PAMAM-D is a highly effective and safe nano vector.
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@# ObjectiveTo study the effects of individualized scalp acupuncture based on the focus and syndrome differentiation in traditional Chinese medicine on mobility ability of children with spastic cerebral palsy. Methods55 cases were randomly divided into 2 groups: treatment group (n=29) and control group (n=26). Treatment group received individualized acupuncture combined with rehabilitation and the control group received Jin's acupuncture combined with rehabilitation for 3 month. They were assessed with the mobility domains of the Pediatric Evaluation of Disability Inventory (PEDI). ResultsThe improvement of PEDI scores was more in treatment group than in control group （P＜0.01）.ConclusionScalp acupuncture combined with rehabilitation has active effects on mobility abilities of children with spastic cerebral palsy, and the individualized acupuncture do better than the Jin's acupuncture.
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Objective To investigate the variation of procalcitonin(PCT) in blood and tissue level of acute pancreatitis rats and probe its significant. Methods One hundred and two male Wistar rats were randomly divided into control group ( n = 6 ), lipopolysaccharide group ( LPS, n = 24 ), acute edematous pancreatitis (AEP) group ( n = 24), acute necrotizing pancreatitis (ANP) group ( n = 24), AN P + LPS group ( n = 24). Subcutaneous injection of cerulein was used for AEP induction, while ANP model was induced by retrograde injection of sodium taurocholate into the biliary and pancreatic duct. The rats were sacrificed at 3,6, 18 and 24 hours after model induction. Pancreatic tissue was harvested and the pathological scores were assessed. Levels of PCT in serum, liver, lung, spleen, pancreas, small intestine, large intestine tissue was harvested and tissue levels of PCT were determined. Results AEP and ANP models were established successfully. At 6 h, the serum levels of PCT in control group, LPS group, AEP group, ANP group and ANP +LPS group were (0.0144 ±0.0082) ng/ml, (0. 1722 ±0.0449) ng/ml,(0.4751 ±0.0572) ng/ml, (0.7070 ±0. 1040) ng/ml and ( 1. 1960 ±0.8644) ng/ml, respectively; and the difference was statistically significant (P < 0.05 ). PCT could be detected in liver, lung, spleen, pancreas, small intestine and large intestine tissue of normal rats. PCT levels in liver and pancreas of ANP group were not statistically different, but the PCT levels in lung, spleen, and large intestine tissue significantly decreased, and the corresponding values were (5.63 ±0.62) ng/ml vs. (6.85 ±0.46) mg/ml, (4.73 ±1.27) mg/ml vs. (6.88 ±0.37) ng/ml, (1.08 ±0.52) ng/ml vs. (4.12 ± 1.02) ng/ml (P <0.01 ). However, the PCT levels in small intestine significantly increased, which were (2.51 ±0.90) ng/ml vs (0.98 ±0. 12) ng/ml (P<0. 01). Conclusions Serum PCT level was associated with the severity of AP and infection; the changes of PCT levels in different tissues may be related with the changes of organ's function.
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With the development of cell separation technique, hepatocyte transplantation becomes a hot topic; however, the application is limited by donor deficiency and immunological rejection. Microencapsulated hepatocytes contribute to the promotion and application for liver cell transplantation, for which provide a large amount of high activity and good function of liver cells, in this paper, liver cell microencapsulation technology and its progress in applications were reviewed, providing prospective way for large-scale and high-active culture in vitro and long-term cryopreservation.
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OBJECTIVE: To analyze the research literatures related to bioartificial liver, and to make a conclusion concerning the development of bio-artificial liver.DATA SOURCES: Using bioartificial liver, liver cell, hepatocyte culture and bioreactor as search terms, searching Ovid, Springer Link database, and China National Knowledge Infrastructure, Vip Information database and Wanfang Date (1990.09-2008.09). Literatures search was limited to English and Chinese languages.DATA SELECTION: Researches regarding liver cells of bioartificial liver, reactors and auxiliary equipment was included, and the studies about immune and animal infection studies of bioartificial liver were excluded.MAIN OUTCOME MEASURES: ①The source, quantity and culturing of bio-artificial liver hepatocytes. ②Bioreactor type, nature and type of films. ③Composition of oxygen and temperature control devices of bioartificial liver.RESULTS: Totally 3898 documents seized initially in the searching by computer, according to inclusion and exclusion criteria, 29 were analyzed. Bioartificial liver was a hybrid device in which can culture hepatocytes in vitro, when the patient's blood flows through the device, material exchange with the cultured hepatocytes through semi-permeable membrane or direct contacting can take place, which can perform the same roles of detoxification, synthesis, biological transformation and other functions as real liver cells, so as to achieve the purpose of support and treatment. Bioartificial liver can also be involved in metabolism of the three major nutritive substances, as well as secretion of hepatocyte growth promo ting substances. So it is an effective alternative to the real liver as the function of detoxification and synthesis, and can fills the essential gap between the transplantation and acute liver failure.CONCLUSION: Although the bioartificial liver research has made significant progress, it still faces the problems such as limited liver cells sources, long-term maintenance of liver cell activity and function, and further optimization of the reactor design.
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Hepatocyte transplantation may be a viable alternative treatment to liver transplantation for acute/chronic liver failure and metabolic liver disorders. Hepatocyte transplantation is an effective treatment to support liver function around liver transplantation due to its relatively easy manipulation and mild wound. In recent two decades, hepatocyte transplantation have been applied in clinical treatment and showed some effect in acute/chronic liver failure and metabolic liver disorders. Here, we sum up the status of clinical hepatocyte transplantation, discuss its value in clinical application and some challenges need to resolve.
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BACKGROUND: Membrane materials of bioreactor have exchange of substance and good physiochemical characteristics as well as good biocompatibility.OBJECTIVE: To evaluate the biocompatibility of interface of human hepatocyte/microporous polypropylene, i.e. graft modified microporous polypropylene semipermeable ultrafiltration membrane (MPP).DESIGN, TIME AND SETTING: Animal observation was performed at the Organ Transplantation Center, Ruijin Hospital of Shanghai Jiao Tong University Medical School and Polymers Institute of Zhejiang University between September 2005 and October 2007.MATERIALS: The microporous polypropylene ultrafiltration plane thin membranes, 0.2 μm diameter, M<,r> 50 000-100 000 molecular blockage, were used. Photochemical graft polymerization modification technique was adopted to graft hydrophilic acrylamide group through chemical bonds on MPP surface and succeeded in constructing an interface of human hepatocyte/microporous polypropylene, i.e. bioreactor membrane of bioartificial liver, graft modified MPP.METHODS: The biocompatibility of modified MPP was evaluated by hemolysis test, cytotoxicity test, acute systemic toxicity test, pyrogen test, skin sensitization and percutaneous stimulation test according to the requirements and biological evaluation criteria of medical device of ISO10993-1:1992.MAIN OUTCOME MEAURES: The experimental results of hemolysis, cytotoxicity, general acute toxicity, pyrogen, skin sensitization and percutaneous stimulation of modified MPP.RESULTS: The hemolytic rate of modified MPP was 1.90% (<5%), which showed that modified MPP did not lead to hemolysis. The extract solution of modified MPP exhibited no significant inhibition on the proliferative activity of L929 cells. At 24, 48 and 72 hours after MPP injection, no mice death, significant changes in body mass, or acute systemic toxicity were observed, such as ptosis, dyspnea, eyanosis, abdominal stimulation, diarrhea, decreased movement or tremor. In rabbit pyrogen test, the body temperature changed in a range from -0.2 to 0.4, which was consistent with the evaluation criteria of biomedical materials without pyrogen. Only one case was found with very slight erythema in skin sensitization test; its integral was 1 and primary stimulation index was 0.25 (<0.4), and the primary stimulation index of percutaneous stimulation test was 0.2; the average primary stimulation index was 0.068, indicating that modified MPP had no skin irritation.CONCLUSION: Modified MPP has no haemolytieus, cytotoxicity, pyrogenicity or skin sensitization, suggesting good biocompatibility by photochemical graft acrylamide on the surface of MPP.