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Objective:To study the clinical application of a new classification on location of hepatolithiasis in guiding treatment using percutaneous transhepatic choledochoscopic lithotomy (PTCSL).Methods:The clinical data of 85 consecutive patients with preoperatively diagnosed hepatolithiasis who underwent PTCSL at the First Affiliated Hospital of Nanjing Medical University from January 2017 to July 2021 were prospectively collected. There were 27 males and 58 females, aged from 15 to 86(62±14) years. Hepatolithiasis was classified into five types of stone location based on preoperative imagings: type Ⅰ ( n=12) , stones located in central bile duct, including hilar bile duct and common hepatic duct; type Ⅱ ( n=17) in unilateral hepatic duct with multiple branches; type Ⅲ ( n=24) in unilateral hepatic duct with multiple branches plus central bile duct; type Ⅳ ( n=31) in bilateral hepatic ducts with multiple branches; and type Ⅴ ( n=1) in unilateral hepatic duct with a single branch. Fistulation path, number of procedures, number of bile duct fistula, and complications were recorded. The residual stone rate and stone recurrence rate were compared among the five types. The follow-up was performed to analyse prognosis. Results:A total of 99 biliary fistulae were performed, with one single tract created in 74 patients, two tracts in 9 patients, three tracts in 1 patient, and four tracts in 1 patient. The fistulation path was B2 in 12 patients, B3 in 18 patients, B4 in 1 patient, B5 in 4 patients, B6 in 10 patients, B7 in 4 patients, and B8 in 50 patients. Altogether, 151 choledochoscopic lithotomy procedures were performed (1-3 times per patient, mean 1.78 times). For the 9 patients with residual stones (10.6%, 9/85), there were 3 patients with type Ⅱ and 6 patients with type Ⅳ. There were significant differences in the residual stone rates among the 5 types (χ 2=11.13, P=0.025). Stone recurrence developed in 33 (38.8%) patients, including 2 patients with type Ⅰ, 7 patients with type Ⅱ, 10 patients with type Ⅲ and 14 patients with type Ⅳ (χ 2=9.07, P=0.046). The total intraoperative and postoperative complications rates was 28.2% (24/85). The follow-up period was 4-58 months with the median follow-up time of 30 months. Twelve patients died during the follow-up period, including 1 patient who died from postoperative bleeding, 3 cholangiocarcinoma, 7 biliary cirrhosis-related liver failure, and 1 stone-unrelated disease. Conclusion:Type Ⅳ in the location classification of hepatolithiasis based on PTCSL had significantly higher rates of residual stones and stone recurrence. This new classification is helpful for clinicaians to determine the optimal path using a smaller number of fistulation tracts to clear stones. It improved the efficacy of PTCSL in treating hepatolithiasis.
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OBJECTIVE To explore the resistance of Pseudomonas aeruginosa isolated in clinic against five antiseptics involving in povidone iodine(Iodophor),glutaraldehyde,chlorhexidine,symclosene(trichloroisocyanurate) and benzalkonium bromide.METHODS The susceptibility test of P.aeruginosa was determined by PhoenixTM-100 system.Minimun inhibitory concentration(MIC) of povidone iodine,glutaraldehyde,chlorhexidine,symclosene and benzalkonium bromide was detected by liquid dilution method.RESULTS The resistant rates of ampicillin/sulbactam,chloramphenicol,tetracycline and trimethoprim-sulfamethoxazole in 190 isolates of P.aeruginosa were all more than 98.0%.However,P.aeruginosa was to imipenem and meropenem were 15.3% and 6.8%.It was found that P.aeruginosa possessed the most resistant to glutaraldehyde and symclosene with its MIC50 being 32 ?g/ml and 64 ?g/ml.But the MIC50 of chlorhexidine and benzalkonium bromide were only 1 ?g/ml and 2.4 ?g/ml.Meanwhile,time-kill assays indicated that chlorhexidine could still produce rapid and powerful bactericidal effects at a concentration of 1MIC after 10 min treatment.CONCLUSIONS There are distinct differences in P.aeruginosa against povidone iodine,glutaraldehyde,chlorhexidine,symclosene and benzalkonium bromide.It is very important that antiseptics should be used rationally.Measurements should be taken to decrease dissemination of resistant bacteria and prevent nosocomial infection.
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AIM: To study the effects of acute HIV-1 infection on gene expression in U937 human promonocyte for understanding the pathogenecis of AIDS. METHODS: The expression levels of 550 host cell RNA transcripts in U937 human promonocyte at 2-3 d after HIV-1 infection were assessed using cDNA microarray analysis, and the results were confirmed by semiquantitative RT-PCR. RESULTS: Our results showed that 38 genes were differentially regulated in the infected U937 cells at 2-3 d post infection: 26 genes were down-regulated and 12 genes were up-regulated. These genes encode a host of proteins with divergent functions in a variety of cellular processes including receptor-mediated signaling transduction, subcellular signal trafficking, apoptosis, transcriptional regulation, and chemotaxis. CONCLUSION: HIV-1 infection alters gene expression in U937 human promonocytes.