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Objective:To investigate the effects of different preoperative biliary drainage methods on bile bacterial culture and drug resistence of malignant obstructive jaundice.Methods:The retrospective and descriptive study was conducted. The clinical data of 317 patients with malignant obstructive jaundice who were admitted to the First Medical Center of Chinese PLA General Hospital from January 2015 to December 2018 were collected. There were 216 males and 101 females, aged (62±10)years. Of 317 patients, 158 cases had no preoperative biliary drainage, 115 received preoperative biliary drainage by percutaneous transhepatic choledochal drainage (PTCD), 44 received preoperative biliary drainage by endoscopic retrograde biliary drainage (ERBD). Observation indicators: (1) bile bacteria in different preoperative biliary drainage methods; (2) clinicopathological characteristics of patients with positive bile bacteria; (3) drug resistance of bile bacteria in different methods of preoperative biliary drainage. Measurement data with normal distribution were expressed as Mean± SD. Count data were expressed as absolute numbers or percen-tages, and comparison between groups was analyzed by the chi-square test. Bonferroni correction was used for pairwise comparison. The inspection level was 0.016 7 in the multiple comparison. Results:(1) Bile bacteria in different preoperative biliary drainage methods: of 317 patients, 116 cases were positive for bacterial culture, including 168 strains of 43 bacterial types. There were 46 strains from 36 patients without preoperative biliary drainage, 49 strains from 39 patients with preoperative PTCD and 73 strains from 41 patients with preoperative ERBD. ① The positive rate of bacteria for 317 patients was 36.59%(116/317). The positive rates of bacteria for patients without preoperative biliary drainage, patients with preoperative PTCD and patients with preoperative ERBD were 22.78%(36/158), 33.91%(39/115) and 93.18%(41/44). There was a significant difference in the positive rate of bacteria among the three groups ( χ2=74.066, P<0.05). There was no significant difference between patients with preoperative PTCD and patients without preoperative biliary drainage ( χ2=4.137, P>0.016 7), but there were significant differences between patients with pre-operative ERBD and patients without preoperative biliary drainage or patients with preoperative PTCD ( χ2=72.305, 44.718, P<0.016 7). ② The overall multiple bacterial rate was 36.21%(42/116). The multiple bacterial rates for patients without preoperative biliary drainage, patients with preoperative PTCD and patients with preoperative ERBD were 19.44%(7/36), 23.08%(9/39) and 63.41%(26/41). There was a significant difference in multiple bacterial rate among the three groups ( χ2=20.431, P<0.05). There was no significant difference between patients with PTCD and patients without preoperative biliary drainage ( χ2=0.147, P>0.016 7), but there were significant differences between patients with preoperative ERBD and patients without preoperative biliary drainage or patients with preoperative PTCD ( χ2=15.133, 13.215, P<0.016 7). ③ The overall prevalence rate of multi-drug resistant organism was 30.95%(52/168). The prevalence rates of multi-drug resistant organism for patients without preoperative biliary drainage, patients with preoperative PTCD and patients with preoperative ERBD group were 15.22%(7/46), 26.53%(13/49) and 43.84%(32/73). There was a significant difference in the prevalence rate of multi-drug resistant organism among the three groups ( χ2=11.447, P<0.05). There was no significant difference between patients with PTCD and patients without preoperative biliary drainage ( χ2=1.827, P>0.016 7). There was a significant difference between patients with preoperative ERBD and patients without preoperative biliary drainage ( χ2=10.497, P<0.016 7), but there was no significant difference between patients with preoperative ERBD and patients with preoperative PTCD ( χ2=3.772, P>0.016 7). (2) Clinicopatho-logical characteristics of patients with positive bile bacteria: age, the history of abdominal surgery, degree of jaundice and location of biliary obstruction of patients were not related to the positive rate of bacterial culture ( χ2=4.865, 1.423, 4.922, 0.030, P>0.05). (3) Drug resistance of bile bacteria in different methods of preoperative biliary drainage: for patients without preoperative biliary drainage, the drug resistance rate of Gram-positive bacteria to nitrofurantoin, linezolid and tigecycline was 0, and the drug resistance rate of Gram-negative bacteria to piperacillin/tazobactam, gentamicin, tobramycin, amikacin and imipenem was 0. For patients with PTCD, the drug resistance rate of Gram-positive bacteria to linezolid and tigecycline was 0. For patients with ERBD, the drug resistance rate of Gram-positive bacteria to linezolid and tigecycline was 0. In terms of Gram-positive bacteria, linezolid, tigecycline, vancomycin and nitrofurantoin were the top four antibiotics with the lowest resistance rate. In terms of Gram-negative bacteria, imipenem, piperacillin/tazobactam, amikacin and tobramycinn were the top four antibiotics with the lowest resistance rate. Seven strains of fungi showed no resistance to antifungal drugs. Conclusions:Patients with preoperative ERBD are more vulnerable to infectious complications, and more likely to form drug resistant organism and multi-drug resistant organism. For Gram-positive bacteria infection, linezolid, tigecycline and vancomycin can be used for treatment. For Gram-negative bacteria infection, imipenem, piperacillin/trzobactam, amikacin and tobramycin can be used for treatment.
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Objective:In order to optimize the mode of biliary drainage, we compared the different drainage methods of preoperative biliary drainage in the treatment of malignant obstructive jaundice of distal bile duct.Methods:From January 2015 to December 2018, 166 cases of distal biliary malignant obstructive jaundice treated by operation in the First Medical Center of PLA General Hospital were collected. According to the preoperative biliary drainage mode, 85 cases were divided into non drainage group, 56 cases in PTBD group and 25 cases in ERBD group; according to the operation mode, 116 cases were divided into radical pancreatoduodenectomy group and 50 cases were divided into palliative cholangiojejunostomy group, each group was divided into three groups according to the drainage mode. Chi square test and ANOVA were used to compare the results of bile bacterial culture and perioperative conditions of each group.Results:The positive rate of bile bacteria culture in non drainage group, PTBD group and ERBD group is 22.4% (19/85), 28.6% (16/56) and 100% (25/25). The positive rate in ERBD group is higher than that in PTBD group and non drainage group, the difference is statistically significant ( P<0.05). The proportion of multiple bacteria in ERBD group is higher than that in PTBD group and non drainage Group [64.0% (16/25) vs. 12.5% (2/16) vs. 5.3% (1/19)], the difference is statistically significant ( P<0.05). The proportion of common pathogens in ERBD group is higher than that in PTBD group and non drainage Group [97.8% (45/46) vs. 89.5% (17/19) vs. 66.7% (14/21)], the difference is statistically significant ( P<0.05). In pancreatoduodenectomy group, the operation time of ERBD group is significantly longer than that of PTBD group and non drainage group [(334.5±48.3) min vs. (289.4±39.5) min vs. (303.9±57.1) min], the difference is statistically significant ( P<0.05). The amount of bleeding in PTBD group is less than that in ERBD group and non drainage group [(268.8±128.4) ml vs. (388.2±181.6) ml vs. (366.1±220.4) ml], the difference is statistically significant ( P<0.05). There is no significant difference in the incidence of complications after pancreatoduodenectomy among three ways of drainage ( P>0.05). The incidence of clinically relevant postoperative pancreatic fistula is 6.8% (4/59), 10.0%(4/40) and 29.4%(5/17) in non drainage group, PTBD group and ERBD group. ERBD group is higher than non drainage group, the difference is statistically significant ( P<0.05). In palliative cholangiojejunostomy, there is no significant difference in operation time, amount of bleeding, postoperative hospital stay and complications among all groups ( P>0.05). Conclusion:Compared with ERBD, PTBD is a more suitable choice for patients who need preoperative biliary drainage before pancreatoduodenectomy.
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Objective To investgate the effect of PTCH1-3'-UTR on the expression of long noncoding RNAs (lncRNAs) and analyze regulatory networks so as to indicate the function of PTCH1-3'-UTR.Methods We screened PTCH1-3'-UTR regulated lncRNAs in non-small cell lung cancer (NSCLC) by using microarray,and validated the expression by qPCR.To explore the potential mechanisms of these lncRNAs underlying NSCLC progression,we performed GO and KEGG pathway analysis of the dysregulated lncRNAs.We also conducted a bioinformatic analysis in TCGA database to identify the association of PTCH1-3'-UTR regulated lncRNAs and the overall survival of NSCLC patients.Results The expression of seven PTCH1-3'-UTR up-regulated lncRNAs (LOC100507547,FAM41C,DOCK4-AS1,AC009305.1,KLF7-IT1,RP11-749H20.1,LINC01511) were validated by qPCR.The GO and KEGG pathway analysis of the dysregulated lncRNAs indicated that a series of biological progresses were involved in the function of PTCH1-3'-UTR regulated lncRNAs,including transcription,signal transduction,protein transport and translational elongation,and several pathways,such as calcium signaling pathway,Jak-STAT signaling pathway,p53 signaling pathway and insulin signaling pathway.Among the lncRNAs regulating PTCH1-3'-UTR,6 were shown to be associated with the overall survival of NSCLC patients.High expression of lncRNA-CDKN2BAS and FAM66D related to the probability of lower survival,while high expression of lncRNA-LINC00240,LOC400027,ABCC6P2 and FLJ10038 might have a higher probability of survival.Conclusions The study would provide an insight of the function of PTCH1-3'-UTR,and PTCH1-3'-UTR dysregulated lncRNAs may be potential prognostic biomarkers for NSCLC.
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PURPOSE: To develop a simple and reliable rat model of in situ reversible obstructive jaundice with low morbidity and mortality rates. METHODS: Rats were divided into 4 groups with 8 rats each: the sham-operated (SH) group only underwent laparotomy, the control internal drainage (ID-C) group underwent choledochoduodenostomy, the new internal drainage (ID-N) group and the long-term internal drainage (ID-L) group underwent choledochocholedochostomy. Common bile duct ligation was performed in all the drainage groups 7 days before reversal procedures. All rats were sacrificed for samples 7 days after the last operation except rats of the ID-L group that survived 28 days before sacrifice. Body weight, liver function, histopathological changes, morbidity and mortality were assessed. RESULTS: One rat died and 2 rats had complications with tube blockage in the ID-C group. No death or complications occurred in the ID-N and ID-L groups. The drainage tube remained patent in the long-term observation ID-L group. Body weight showed no significant difference between the ID-C and ID-N groups after 7 days drainage. Liver function was not fully recovered in the ID-C and ID-N groups after 7 days drainage, but statistical differences were only observed in the ID-C group compared with the SH and ID-L groups. Periportal inflammation and bile duct proliferation showed severer in the ID-C group than in the ID-N group. CONCLUSION: The present study provided an efficient, simple, and reliable rat model that is especially suitable for long-term or consecutive studies of reversible obstructive jaundice.
Subject(s)
Animals , Rats , Bile Ducts , Body Weight , Choledochostomy , Common Bile Duct , Drainage , Inflammation , Jaundice, Obstructive , Laparotomy , Ligation , Liver , Models, Animal , MortalityABSTRACT
PURPOSE: To develop a simple and reliable rat model of in situ reversible obstructive jaundice with low morbidity and mortality rates. METHODS: Rats were divided into 4 groups with 8 rats each: the sham-operated (SH) group only underwent laparotomy, the control internal drainage (ID-C) group underwent choledochoduodenostomy, the new internal drainage (ID-N) group and the long-term internal drainage (ID-L) group underwent choledochocholedochostomy. Common bile duct ligation was performed in all the drainage groups 7 days before reversal procedures. All rats were sacrificed for samples 7 days after the last operation except rats of the ID-L group that survived 28 days before sacrifice. Body weight, liver function, histopathological changes, morbidity and mortality were assessed. RESULTS: One rat died and 2 rats had complications with tube blockage in the ID-C group. No death or complications occurred in the ID-N and ID-L groups. The drainage tube remained patent in the long-term observation ID-L group. Body weight showed no significant difference between the ID-C and ID-N groups after 7 days drainage. Liver function was not fully recovered in the ID-C and ID-N groups after 7 days drainage, but statistical differences were only observed in the ID-C group compared with the SH and ID-L groups. Periportal inflammation and bile duct proliferation showed severer in the ID-C group than in the ID-N group. CONCLUSION: The present study provided an efficient, simple, and reliable rat model that is especially suitable for long-term or consecutive studies of reversible obstructive jaundice.
Subject(s)
Animals , Rats , Bile Ducts , Body Weight , Choledochostomy , Common Bile Duct , Drainage , Inflammation , Jaundice, Obstructive , Laparotomy , Ligation , Liver , Models, Animal , MortalityABSTRACT
Objective To compare the clinical utility of alpha-fetoprotein (AFP) and des-gammacarboxyprothrombin (DCP) in diagnosing hepatocellular carcinoma (HCC) in patients with a hepatic mass.Methods From January 2015 to May 2015,141 patients were diagnosed to have a liver tumor after imaging examinations in the Hepatobiliary Surgical General Hospital of PLA,Beijing,China.Preoperative AFP and DCP were measured using commercial assay kits.The reference standard was either pathologic or clinical diagnosis of HCC.The performance of AFP and DCP in diagnosing HCC was determined using receiver operating characteristic curve analysis.Results Of 141 patients,98 were diagnosed to have HCC and 43 without.The levels of AFP were significantly higher in patients with HCC than those without [80.0(3.9-1 375.0) μg/L vs.2.1 (1.6-3.2) μg/L,Z =6.98,P ＜ 0.01].Similar results were observed in the levels of DCP [141.5 (24.0-978.0) AU/L vs.19.0 (14.0-25.5) AU/L,Z =5.18,P ＜ 0.01].Receiver operating curves (ROC) indicated the cut-off value with the best sensitivity and specificity was 3.6 μg/L for AFP and 35 AU/L for DCP.The difference in the area under ROC between AFP and DCP was not statistically significant (0.87 vs.0.78,Z =1.72,P =0.085).The sensitivity and specificity for detection of HCC in patients with a hepatic mass were 56.1％ and 95.4％ for AFP ＞ or =20 μg/L,69.4％ and 83.7％ for DCP ＞ or =40 AU/L,respectively.The level of AFP was associated with DCP in patients with HCC (x2 =9.12,P ＜ 0.01,r =0.292) and parallel testing of AFP and DCP gave an optimal sensitivity of 79.6％ with a specificity of 81.4％ in diagnosing HCC.Conclusions DCP is a useful biomarker and it gave an equal performance as AFP in diagnosing HCC in patients with a liver mass in this study.Parallel testing of AFP and DCP effectively increased the diagnostic sensitivity.Although the biomarkers only marginally improved the diagnostic results,it could be useful in diagnosing HCC in individuals who had atypical imaging results.
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BACKGROUND: It is discovered by administrating different emetics to vomiting animals, like cats, that there are a large amount of Fos positive neuronal expressions in the arc region from nucleus of solitary tract, lateral tegmentum to ventrolateral area. And it has been viewed that the arc region from area postrema, nucleus of solitary tract to ventrolateral reticular structure is the main emetic region. Whether do the non-vomiting animals reflect in response or not after emetic injection?OBJECTIVE: To observe the distribution of Fos positive neurons in relevant emetic regions of brain and spinal cord in rats after abdominal injection of emetic, cisplatin.DESIGN: Randomized controlled experiment based on animals.SETTING: Neural Physiological Research Room of Life Science College in Hebei Normal University and Physiological Room of Basic Medicine Institute in Hebei Medical University.MATERIALS: The experiment was performed in Neural Physiological Research Room of Life Science College in Hebei Normal University and Physiological Room of Basic Medicine Institute in Hebei Medical University from March to August 2003. Twelve SD male rats were employed, body weighted varied from 220 to 250 g, of clean-grade. They were randomized into experimental group of 6 rats and the control of 6 rats.INTERVENTIONS: In experimental group, the emetic, cisplatin, was injected abdominally 10 mg/kg. In the control, the physiological saline of same dose was injected. Afterwards, the activity changes in rats were observed at room temperature, quiet and light-avoided environment. Six hours later, the brain tissue was collected for frozen continuous sectioning. Immunohistochemical staining method was used to observe the distribution of Fos positive neurons in brainstem and forebrain nuclei and to count positive cell.MAIN OUTCOME MEASURES: ① Behavior observation in rats after emetic injection. ② Counts of Fos positive cell in relevant regions of brain in rats.RESULTS: Twelve rats all entered result analysis. ① In 20 minutes after injection, the rats in both groups were in tranquilizing state, lying prone with body curled, almost without any movement. In 60 minutes after injection, the rats in the control were recovered to normal, free of eating or drinking. The rats in experimental group were in prone-lying state with body curled. They rose up or shook the heads occasionally, and they breathed fast and uneven.In 2 hours after injection, in experimental group, the rats were still in abdominal prone tightly in the cage, with heads lowed and irregular shaking of noses. In 5 hours, the rats in experimental group began standing up and moving, with normal breathing, but they still did not eat or drink. ② Fos positive neurons in solitary tract, area postrema and lateral parabrachial nucleus and paraventricular nucleus, supraoptic nucleus and arc nucleus in hypothalamus (64.3 ±9.6, 83.4 ±15.0, 148.8 ±19.9, 80. 2 ± 11.8, 20.7 ±3.8, 86. 6 ± 10.8) were remarkably higher than those in the control(56. 2 ±6.3,73.5±9.9,136.9±17.8,66. 1±10.3,17.3±3.4,78.8±10.5).CONCLUSION: Emetics induce discomforts in internal organs of rats, due to which, there probably exist emetic regions similar to vomiting animals in central neural system. But it is probably lack of vomiting-related adjusting mechanism. Emetics irritate the increase of Fos positive neurons in relevant regions in the brain of rat, which suggests that there exist relevant neural chemical pathways similar to nausea in the brain of non-vomiting rats.