Surgical management of choledochal cyst: status quo and hot issues / 中华外科杂志

Choledochal cyst is one of the most common congenital diseases in biliary tract system,which can affect children as well as adults. While the surgical management has markedly evolved in recent years,our understanding related to the nomenclature,diagnosis and classification of choledochal cysts remains to be inadequate. Anatomic variations and intrahepatic bile duct stricture are prone to be overlooked during surgery. Besides,it is still controversial in the treatment of intrapancreatic choledochal cyst and the extent of resection related to intrahepatic dilated bile ducts. Along with the advancement of laparoscopic or robot-assisted procedures,there is also an increased number of reoperations for patients with choledochal cyst,which underscores the importance of long-term biliary patency. This state-of-the-art review on choledochal cyst aims to further improve the diagnosis and treatment for this benign but intractable disease.

miR-133a mediates Bcl-xl expression to regulate endothelial cell apoptosis / 医学研究生学报

ObjectiveThe specific mechanism of microRNA-133a (miR-133a) involved in the pathological process of atherosclerosis (As) remains an open question. This study aims to explore the role of miR-133a in the regulation of endothelial cell apoptosis.MethodsCultured human coronary endothelial cells (HCAECs) were treated with oxidized low density lipoprotein (ox-LDL). The cell viability was detected by MTT assay. The mRNA levels of Bcl-xl and miRNA (miR-133a, etc) were detected by qRT-PCR method. The expression of anti-apoptotic protein Bcl-xl and cleaved-caspase3 was detected by Western blotting, and the apoptosis rate was detected by flow cytometry. The transient transfection technique was used to observe the effect of overexpression and silencing of miR-133a, on the expression of target gene Bcl-xl protein and endothelial cell apoptosis.Results Ox-LDL was observed to decrease the viability of HCAECs cells and induce HCAECs apoptosis; miR-133a increased abnormally in the apoptosis model; after silencing miR-133a, the decrease of Bcl-xl and the increase of apoptosis rate induced by ox-LDL were partially reversed; the overexpression of miR-133a, Bcl-xl decreased and the apoptosis rate increased, and the difference was statistically significant.Conclusion miR-133a might target and regulate the anti-apoptotic protein Bcl-xl, to induce endothelial cell apoptosis and promote the formation of AS.

Differences of brain pathological changes and cognitive function after bilateral common carotid artery occlusion between Sprague-Dawley and Wistar rats / 生理学报

The aim of the present study was to investigate the differences of the pathological changes and cognitive function after bilateral common carotid artery occlusion (BCCAO) between Sprague-Dawley (SD) and Wistar rats. Male SD and Wistar rats were randomly divided into 2 groups, respectively: sham operated (S-sham and W-sham) and operated (S-BCCAO and W-BCCAO) groups. The survival rate and the rate of loss of pupillary light reflex (PLR) were observed on day 1, 3, 7, 14 and 28 after the operation, and the light-dark box, Y-maze and odor recognition tests were performed to detect cognitive function on day 28 after the operation. HE and Luxol fast blue staining were used to observe the pathological changes of gray matter (hippocampus), white matter (optical tract), optic nerve, and retina. The results showed that the survival rate of the W-BCCAO group was 62.5%, and PLR loss rate was 100%; whereas the survival rate of the S-BCCAO group was 100%, and PLR loss rate was 58.3%. In the W-BCCAO group, percentages of time spent and distance traveled in the light box were more than those in the W-sham group, but there was no statistical significance between the S-BCCAO and S-sham groups. In the S-BCCAO group, the percentages of time spent and distance traveled in the III arm (labyrinth arm) of the Y-maze were less than those in the S-sham group, but no statistical significance was found between the W-BCCAO group and W-sham group. In the S-BCCAO group, the discrimination ratio of the odor recognition task was less than that in the S-sham group, but no statistical significance could be seen between the W-BCCAO and W-sham groups. Ischemic injury was observed in the CA1 area of the hippocampus in the S-BCCAO group, but no readily visible damage was observed in the W-BCCAO group. Ischemic injury of the visual beam and optic nerve was observed in both the S-BCCAO and W-BCCAO groups. Compared with the corresponding sham groups, the S-BCCAO and W-BCCAO groups showed serious retinal damage with significant thinner retina. The ganglion cell layer (GCL), inner plexiform layer (IPL), and outer plexiform layer (OPL) were thinner in the S-BCCAO group, but no statistical significances were shown in the other layers. All the layers, except the outer nuclear layer (ONL), were significantly thinner in the W-BCCAO group. The results indicate that there are differences of the pathological changes in the hippocampus and visual conduction pathway after BCCAO between SD and Wistar rats, and the degree of learning and memory injury was also different, which suggests that the vascular dementia model of different rat strains should be selected according to research purpose.

Analysis of risk factors for postoperative complications of hepatic hilar cholangiocarcinoma after extensive hepatectomy / 中国实用外科杂志

OBJECTIVE: To analyze the relationship between clinical characteristics and postoperative complications in patients with hilar cholangiocarcinoma(HCCA) who underwent major liver resection(MLR).METHODS: Clinical characteristics and postoperative complications of 335 patients with HCCA who underwent MLR from January 2010 to October 2017 were retrospectively analyzed.According to the severity of complications,the patients were divided into two groups:low clavien-dindo group(LCD)and high clavien-dindo group(HCD).RESULTS: There were 219 patients in LCD group and 116 patients in HCD group.Elevated INR,Bismuth Ⅲa/Ⅳ type and the right liver/expanding right/right trilobites resection were high risk factors of postoperative serious complications.The incidence of severe postoperative complications in the group with preoperative biliary drainage was 34.18%(67/196),which was not statistically significant different from that in the group without preoperative biliary drainage [35.25%(49/139),P=0.8396].The dose-response curve and Logistic regression indicated that there was a statistical difference in postoperative complication risk between patients with total bilirubin(TB)<140 mol/L and patients with TB≥ 140 mol/L(OR=1.917,95% CI 1.147～3.203,P=0.0130).After statistical correction,the statistical correlation remained,among which,the preoperative biliary drainage rate was 59.2%(151/255) in the group with TB<140 mol/L,and 56.3%(45/80)in the group with TB≥ 140 mol/L.CONCLUSION: In patients with HCCA combined with MLR,patients with TB ≥ 140 mol/L should be routinely treated with preoperative biliary drainage.Especially for the right liver resection,preoperative high INR patients,more attention should be paid to.METHODS: of preoperative biliary drainage have no significant effect on the overall postoperative complications and can be flexibly selected according to the needs of the disease.

Epidemiologic characteristics of typhoid and paratyphoid fever on related drug resistance and molecular types regarding Salmonella typhi and S.paratyphi, in Jiangsu province / 中华流行病学杂志

Objective To explore the distribution of prevalence rates of typhoid and paratyphoid,with drug resistance and molecular types ofSalmonella(S.) typhi and S.paratyphi in Jiangsu province.Methods Data,collected by the national infectious disease reporting system in Jiangsu province from 2007 to 2011,was analyzed.K-B method was used to test the sensibility to 9 kinds of antibiotics among 210 stains of S.typhi and S.paratyphi.81 strains of S.typhi were classified by pulse-field gel electrophoresis (PFGE).Results The annual average incidence of typhoid and paratyphoid was 0.47 per 100 000 in the last five years,showing a decreasing trend.Highest incidence (1.70 per 100 000)was seen in the ＜ 1 year age group,with S.typhi and S.paratyphi A accounted for 66.19％ and 23.81％ among the 210 stains.The rate of drug resistance to nalidixic acid appeared to be the highest as 66.19％.The drug resistant rates to 6 kinds of antibiotics were on average,lower than 10.00％.The multi-drug resistant rate of S.typhi and S.paratyphi was 30.00％.In the last 3 years,37 types from 81 S.typhi strains had been classified into 4 clusters by PFGE.The predominant type was JPPX01.JS0027,accounted for 11.11％.JPPX01.JS0001 type had a specific regional distribution,but JPPX01.JS0014,JPPX01.JS0018 and JPPX01.JS0024 strains were widely spread.Results from the clustering analysis showed that cases in the 3 events tended to have a clustering nature.Conclusion The morbidity of typhoid and paratyphoid was in a relatively low level in Jiangsu province.Although S.typhi and S.paratyphi were sensitive to most of the commonly used antibiotics,the resistance rates to some kinds of antibiotics were increasing.The distribution of typhoid was sporadic in Jiangsu and without the dominant strain,it was unlikely that typhoid could become epidemic in the future,in Jiangsu.

Biopathological characteristics of hilar cholangiocarcinoma and the clinical significance / 中华外科杂志

<p><b>OBJECTIVE</b>To approach the biopathological features of hilar cholangiocarcinoma and surgical pathological factors which influence the long-term survivals of patients with hilar cholangiocarcinoma.</p><p><b>METHODS</b>A systemic and retrospective multi-parameter analysis was performed on 205 patients of hilar cholangiocarcinoma who received surgical treatments and had complete clinicopathological data as well as follow-up results during a ten-year-period from April 1998 to April 2008. The single factor analysis was performed on age, sex, content of pre-operative serum CA19-9, Child-pugh grading, TNM classification, operation pattern, resection margin status of bile duct, vascular invasion, adjacent liver involvement, grade differentiation, infiltration-depth of bile duct, lymph node metastasis and perineural infiltration. A multivariate analysis was performed through Cox proportional hazard model.</p><p><b>RESULTS</b>The single factor analysis showed that except age, sex and content of pre-operative serum CA19-9, the mainly significant factors influencing the survivals were Child-Pugh grading, TNM classification, operation pattern, bile duct margin, vascular invasion, adjacent liver involvement, grade differentiation, infiltrating-depth of bile duct, lymph node metastasis and perineural infiltration (P < 0.05). Lymph node metastasis and infiltration-depth of bile duct wall were found to be the two independent factors influencing overall survival by multivariate analysis through the Cox model.</p><p><b>CONCLUSIONS</b>The most important prognostic factors influencing the long-term survivals of patients with hilar cholangiocarcinoma after operation are lymph node metastasis and depth of tumor-infiltrating of involved bile duct. During the operation, standardized evaluation through frozen section should be carried out for detection of lymph node metastasis and depth of tumor-infiltrating of involved bile ducts, which can be used as the histological indicator for surgical expansion, and could be helpful to maximize avoiding the tumor cell residues and therefore, to improve the long-term effects of surgical resection.</p>

Analysis on the epidemiological and genetic characteristics of enterovirus type 71 and Coxsackie A16 virus infection in Jiangsu, China, 2008 / 中华流行病学杂志

Objective To determine the epidemiological features of hand-foot-and-mouth disease (HFMD) outbreaks and the genetic characteristics of enterovirus type 71 (EV71) isolates from patients in Lianyungang, Jiangsu province in May, 2008. Methods Epidemiological, microbiological, cellular and molecular methods were performed to investigate pathogens and to describe the homogeneity of isolated strains. Results 21 cases were reported in this HFMD outbreak with the attack rate as 20.0%. 3 EV71 virus strains were isolated from 10 stool samples. The nucleotide and amino acid homogeneity of these 3 Jiangsu strain with Anhui Fuyang strains were 97.9%-100.0% and 99.7%-100.0%, respectively. These 4 Jiangsu strains were within genotype C sub-geno group C4 in phylogenetic tree. Data from the follow-up study showed that shedding of EV71 and Coxsackie A 16 virus (CA 16) in the latent period appeared in the outbreak of HFMD. Human beings could be infected by both EV71 virus and CA16 at the same time and could also carry the two viruses. We also discovered that EV71 virus could be expelled out of the human body through stool in the fast week and last for 10 weeks. Conclusion The recently identified EV71 isolates from this HFMD outbreak belonged to sub-geno group CA. Facts as: the release of viruses in the latent period, co-infection or coexisting of two viruses at the same time and super long period of expulsion of toxin exist in EV71 and CA16 did exist.

Support of acellular porcine corneal stroma for growth of corneal epithelium and stromal cell in vitro / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To determine whether acellular porcine cornea stroma (APCS) could support the growth of the rabbit corneal cells in vitro.METHODS: APCS was prepared. The rabbit's corneal epithelium and stromal cells were cultured and seeded on, APCS in vitro.The observation of phase contrast photograph and histological examination were performed.RESULTS: Histological examination showed the epithe- lium grew on the scaffold of APCS in 2-3 layers at 10th day. The stromal cells adhered to the surface of the scaffold after 24 hours and invaded into the interlaminar of the material at 5th day.CONCLUSION: These results indicate that APCS can support the growth and proliferation of the corneal epithelium and stromal cells in vitro.

A study on the effect of the chitosan thermosensitive hydrogel loading recombinant human bone morphogenetic protein-2 on repairing periodontal defects / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To observe the effect of the chitosan thermosensitive hydrogel loading recombinant human bone morphogenetic protein-2 (rhBMP-2) on repairing periodontal defects.</p><p><b>METHODS</b>To prepare artificial furcation defects model in the posterior area in 3 healthy male dogs, and then to inject chitosan thermosensitive hydrogel loading of rhBMP-2 after fast suturing tissue flap. The groups filled with nothing or filled only with chitosan thermosensitive hydrogel were the controls. The dogs were sacrificed after 5 weeks and the periodontal regeneration was observed histologically.</p><p><b>RESULTS</b>The histological observation showed that the chitosan thermosensitive hydrogel loading rhBMP-2 group achieved apparent periodontal tissue regeneration occupying the majority of the defects and the control groups got only a small amount of periodontal tissue regeneration.</p><p><b>CONCLUSION</b>The chitosan thermosensitive hydrogel loading rhBMP-2 can effectively promote the periodontal tissue regeneration, while simplifying the surgical operation. It might be a potential means for periodontal regeneration.</p>

Evidence of bacterial biofilms in chronic rhinosinusitis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To observe the presence of bacterial biofilms in mucosal specimens in patients operated for chronic rhinosinusitis.</p><p><b>METHODS</b>A total of 12 subjects undergoing endoscopic sinus surgery were included. The control group was 6 patients with obstructive sleep apnea-hypopnea syndrome. Six patients with chronic rhinosinusitis were enrolled in the study group. Mucosa of uncinate process, ethmoid bulla or maxillary sinus was obtained during endoscopic sinus surgery. All the samples were prepared using standard methods for scanning electron microscopy. Patients' information such as age, gender, symptoms, sinus CT, endoscopic examination, skin prick test were recorded in detail.</p><p><b>RESULTS</b>Standard-preparation scanning electron microscopy displayed denuded epithelium and disarrayed cilia in chronic rhinosinusitis patient's mucosa. In the study group, bacterial biofilms of different morphology were seen in five samples; One sample showed filamentous structure like fungi. Using strict scanning electron microscopy morphologic criteria, 83.3% samples in the study group were found to have micrographic evidence of biofilms. No bacterial biofilms were detected in the control group.</p><p><b>CONCLUSIONS</b>In the patients undergoing surgery for chronic rhinosinusitis, different degree of mucosal injury could be found. Bacteria biofilms of different life stages were demonstrated to be present. No bacterial biofilms were detected in the control group.</p>

An animal experiment for the regeneration of periodontal defect by application of the dual-release chitosan thermosensitive hydrogel system / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To observe the effect of the self-made chitosan thermosensitive hydrogel system with dual-release bone morphogenetic protein and chlorhexidine on periodontal defects repair.</p><p><b>METHODS</b>The furcation defect model was established on dog premolar. The models were divided into five groups, including three experimental groups, one control group and one blank control group. The hydrogel with the chlorhexidine/3-cyclodextrin inclusion complexes (IC) /rhBMP-2, hydrogel with rhBMP-2, hydrogel with IC, the pure hydrogel were applied to the defects of the four groups, respectively, and the blank control group did not receive any agent. The dogs were sacrificed 8 weeks later and the periodontal regeneration and gingival condition were observed by histological examination.</p><p><b>RESULTS</b>Obvious periodontal tissue regeneration was found in group one and two. The heights of new bone reached 99.2% of the defects in group one, 87.8%, 63.6%, 37.0% and 34.3% in group two, three, four and blank control groups, respectively. The inflammation of the affected gingiva showed less significant in group one and group three than in the other groups.</p><p><b>CONCLUSIONS</b>rhBMP-2 and chlorhexidine played their independent role in repairing periodontal defects and the dual-release chitosan thermosensitive hydrogel system is effective and convenient to use.</p>

Characteristics of computed tomography of allergic fungal sinusitis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To sum up the characteristics of computed tomography of allergic fungal sinusitis (AFS) and to compare the CT changes with the findings in the operation. The diagnostic role of CT scan was discussed.</p><p><b>METHODS</b>The CT scans of 21 patients diagnosed as AFS were analyzed. The patients ranged from 15 to 50 years old,there were 17 males and 4 females. The CT was scanned with both bony and soft tissue windows. The preoperative examinations included nasal endoscopy, skin prick test, total serum IgE and nasal secretion smear. The findings in the operation were compared with the preoperative CT scans. Histopathology and fungal smear were done postoperatively.</p><p><b>RESULTS</b>Endoscopy showed that all patients had polyps with wasfy yellow or inspissated white secretion. Nine cases (11 sides) showed yellow-to-brown material similar to peanut butter in the nasal cavities. Nasal CT scan demonstrated unilateral lesion in 10 cases (10 sides) and bilateral lesions in 11 cases (22 sides), who were all pansinus diseases. CT scan demonstrated a sheet areas of high-attenuation like "ground glass" within sinuses coupled with soft tissue image around them. Bone erosion of anterior skull base was encountered in 3 cases (4 sides). One case showed the intracranial extension. Twenty cases had conceived nasal endoscopic sinus surgeries. One case underwent endoscopic sinus surgery combined with coronal approach. The yellow-to-brown material (allergic mucin) was detected in the cavities of 17 cases. Four cases had green-to-brown secretion like mud. After follow-up of 6 months to 7 years, 14 cases were cured, 7 cases improved. Among them, 3 cases had to get revision surgeries because of recurrence 2 years after surgery.</p><p><b>CONCLUSIONS</b>The characteristic of a sheet area of high-attenuation like " ground glass" within sinuses coupled with soft tissue image around them in computed tomography of nasal sinus, accompanied with invasive expansion or bone erosion, has a diagnostic significance for AFS.</p>

Endoscopic surgery for nasal septal perforation / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To describe the relevant factors of endoscopic surgery in patients with nasal septal perforation.</p><p><b>METHODS</b>Twenty-three patients with nasal septal perforation were treated under nasal endoscope. Four kinds of reconstruction materials were used to accomplish the closure of perforation: residual osseous septum or temporalis fascia, inverting septal mucoperichondrial flap, autologous connective tissue insert overlaid with mucous flaps and turbinate flap. The reconstructed septum was packed by moist dressing with silicone or plastic splints.</p><p><b>RESULTS</b>Seven patients underwent direct closure. Inverting flap repair for five cases, shifting flap closure for ten cases, and repair with turbinate flap in one case. During the follow-up ranging from four weeks to seven months, the successful reconstruction was achieved in 19 cases (82.6%). The problems in the remaining four cases were: mucosal flap displacement, fascia flap shrank and so caused reperforation, two perforations present with only the larger one repaired, the mucosal flap was smaller in size than the perforation.</p><p><b>CONCLUSIONS</b>Intranasal endoscopic reconstruction surgery is a reasonable management for nasal septal perforation.</p>

Modified intranasal endoscopic Lothrop procedure / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To report the experience of modified endoscopic Lothrop procedure (MELP) in 6 cases and to discuss the operative technique and indications.</p><p><b>METHODS</b>Six patients (four males and 2 females) aged from 6 to 63 years old with frontal sinus diseases were enrolled in this study, including 3 cases of frontal mucocele, 1 case of recurrent hemangioma, 1 case of recurrent inverted papilloma and 1 case of osteoma. All patients were underwent intranasal modified Lothrop procedure with the guidance of nasal endoscope. The image-guided navigational system was used for the location of frontal sinus in 2 cases.</p><p><b>RESULTS</b>The operation was successful in all 6 patients without any operative and postoperative complications. The average operation time was 3.2 h. The endoscopic examination demonstrated the wide communicational frontal sinus openings and well epithelization after 6-40 months follow-up. The patients were asymptomatic up to now and no recurrence was found.</p><p><b>CONCLUSIONS</b>The modified intranasal endoscopic Lothrop procedure is an ideal surgical approach for recalcitrant frontal sinus disorders on the basis of proper selection of surgical equipments and patients by the experienced surgeon.</p>

Analysis of the relation between surgery and prognosis of hilar cholangiocarcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the prognosis factors of hilar cholangiocarcinoma, and investigate the relation between operative procedure and prognosis of it.</p><p><b>METHODS</b>A retrospective cohort study was investigated in 198 patients with hilar cholangiocarcinoma, who were treated in our hospital from December 1997 to December 2002. There were 117 males and 81 females. The age ranged from 27 to 81 years old with a mean of 56. Jaundice (94.5%), pruritus (56.6%) and abdominal pain (33.8%) were the main present symptoms. According to Bismuth-Corlette classification, there were 14 type I cases, 19 type II cases, 12 type IIIa cases, 15 type IIIb cases, 112 type IV cases and 26 unclassifiable cases. One hundred and forty four cases received open operative treatment, and the others only were treated with endoscopic approach (including ERBD or EMBE 21 cases, ENBD 31 cases) or percutaneous transhepatic cholangiodrainage (2 cases). Tumor resection was performed on 120 cases with a resection rate of 83.3%, included radical resection 59 cases (41.0%). Twenty-four cases underwent paunched biliary exploration and drainage.</p><p><b>RESULTS</b>The Cox's regression model analysis showed that occupation, preoperative maximum total serum bilirubin level, operative procedure and postoperative adjuvant radiation affected postoperative survival significantly, but gender, age, choledocholithiasis, hepatitis, preoperative serum CA19-9 level, Bismuth-Corlette type, histopathologic grading and postoperative chemotherapy were not significant prognostic factors. The postoperative survival of biliary drainage group, palliative resection group and radical resection group, which statistically differed pairwise. Between ERBD or EMBE group and palliative resection group, there was no statistical difference. So was between ERBD or EMBE group and biliary drainage group, or between ENBD group and biliary drainage group. The survival differed statistically between ERBD or EMBE group and ENBD group.</p><p><b>CONCLUSIONS</b>Operative procedure was the most important prognosic factor of hilar cholangiocarcinoma, radical resection still was the primary measure to cure and long term survival. For irresectable hilar cholangiocarcinoma, the effect of ERBD or EMBE could not be considered to be worse than that of open operative treatment.</p>

Prognostic analysis of patients suffering from distal bile duct cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To study prognostic factors after surgical procedure for distal bile duct cancer.</p><p><b>METHODS</b>A retrospective clinical analysis was made in 173 cases of distal bile duct cancer, admitted to our hospital from February 1996 to December 2002. Fourteen clinicopathologic factors that could possibly influence survival were selected. A multivariate analysis of these individuals was performed using the Cox Proportional Hazards Model.</p><p><b>RESULTS</b>There were 99 males and 74 females. The age ranged from 27 to 74 years old with a mean of 55.5. Radical resection was performed on 152 cases with radical resection rate of 87.9%. 29 cases died of liver metastasis with a rate of 46.8% in total death cases. The statistical analysis showed that surgical procedure, lymph node metastasis and pathological differentiation grade affected postoperative survival significantly, but transfusion, invasion of pancreas, postoperative radiotherapy and chemotherapy, ERCP, diameter of tumour, serum level of CA-19-9, preoperative total serum bilirubin level (TBIL), ratio of albumin to globulin (A/G), sex and age are not significant factors influencing postoperative survival.</p><p><b>CONCLUSIONS</b>Radical resection is only curative treatment modality. Aggressive treatment and prevention on postoperative liver metastasis is a important strategy to improve the survival for distal bile duct cancer.</p>