ABSTRACT
Objective To investigate the role of heat shock protein 70 (HSP70) in liver flbrosis in infants with biliary atresia (BA) and its impact on prognosis. Methods Fourty-six (46) cases of infants with BA undergoing elective Kasai surgery were selected. In the same period, 30 cases of children with choledochal cyst and 17 cases of children with portal vein cavernous transformation were selected. The expressions of HSP70 in liver tissues were detected using immunohistochemical staining. The liver flbrosis in children with BA was detected using Sirius red-saturated picric acid staining. The expressions of HSP70 proteins in different flbrotic liver tissues were detected by using double staining. All postoperative BA infants were followed up and ended at June 30, 2016.Results The proportion of high expression of HSP 70 proteins in BA infants were signiflcantly higher than that in children with choledochal cyst and vein cavernous transformation (P<0.05). Rank correlation analysis showed that the expressions of HSP70 in liver tissues were positively correlated with the degree of liver flbrosis (r=0.861,P<0.05). 15 patients died among 46 cases of BA infants. The survival rate in BA children with mild liver flbrosis was 82.4%, which was signiflcantly higher than 58.6% in the severe group (P<0.05). The survival rate in HSP70 protein low expression group was 85.0%, while in HSP70 protein high expression group was 53.8%. Kaplan-meier survival analysis showed that the median survival time in the HSP70 protein low expression group was (34.0±2.6) months, while in the HSP70 protein high expression group was (18.3±2.2) months, the difference was statistically signiflcant (χx2=4.765,P=0.029).Conclusions The expressions of HSP70 proteins in liver tissues in infants with BA were high and were positively correlated with the degree of hepatic flbrosis. It suggested the possible involvement of HSP70 in the process of liver fibrosis. The upregulated expressions of HSP70 often indicated poor prognosis in children. It could be used as determining biomarker for prognosis.
ABSTRACT
Objective To evaluate the clinical value of laparoscopy in the diagnosis and treatment of intestinal duplication for children. Methods From June 2002 to May 2007, 15 children (aged 27 days to 10 years) with intestinal duplication were treated by laparoscopy in our hospital. The lesions were explored by laparoscopy, and then pulled out through the umbilical hole or the trocar hole at the right lower abdomen. The anastomosis was performed outside the abdominal cavity. Results The operation was successfully accomplished in all the patients. No serious postoperative complications occurred. Among the cases, end-to-end anastomosis was performed on 12 patients, resection of the duplicated intestine on 2, and demucosation on 1. Simultaneously, appendectomy was performed on 2 cases, and ring suturing for inguinal hernia on 1. The patients were followed up for 3-18 months (mean, 12 months), during which no patients had symptoms of intestinal adhesion (abdominal distension, vomiting), hemorrhage, or incisional hernia. Conclusions Laparoscopy is effective and reliable with a high diagnostic rate and low complication rate in the diagnosis and treatment of intestinal duplication for children.