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ObjectiveTo investigate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) during pregnancy and puerperium through a comparative analysis. MethodsA retrospective analysis was performed for the clinical data of 22 patients in pregnancy and 39 patients in puerperium who received ERCP in Digestive Endoscopy Center of The First Affiliated Hospital of Nanchang University from January 2007 to August 2022. The two groups of patients were compared in terms of baseline data, diagnosis during ERCP, interventions, laboratory results before and after ERCP, post-ERCP complications, and delivery and fetal outcomes. The independent-samples t test was used for comparison of continuous data between two groups, and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. ResultsThere were no significant differences between the patients in pregnancy and those in puerperium in all baseline data (all P>0.05) except the rate of CT examination (22.73% vs 58.97%, χ2=7.44, P=0.006). During the ERCP procedure, compared with the patients in puerperium, the patients in pregnancy had a significantly lower proportion of the patients who underwent biliary stone extraction or endoscopic papillary balloon dilation (χ2=4.007 and 4.315, both P<0.05) and a significantly higher proportion of the patients who did not receive X-ray fluoroscopy (χ2=12.103, P=0.001). After ERCP, both groups had significant improvements in white blood cell count, total bilirubin, direct bilirubin, alanine aminotransferase, and aspartate aminotransferase (all P<0.05). The overall incidence rate of post-ERCP complications was 7.04% (5/71) for all patients, with post-ERCP biliary infection as the most common complication (3/71,4.23%), and there was no significant difference in the incidence rate of post-ERCP complications between the two groups (P>0.05). As for delivery and fetal outcomes, compared with the patients in puerperium, the patients in pregnancy had a significantly higher proportion of patients with early termination of pregnancy (50.00% vs 0,χ2=20.528, P<0.001) and a significantly lower proportion of patients with cesarean section (36.36% vs 76.92%, χ2=4.756, P=0.029). There were no significant differences in the incidence rates of adverse events such as abnormal fetal development and stillbirth between the two groups (P>0.05). ConclusionWith strict control of ERCP indications and timing, ERCP is effective and relatively safe in both pregnancy and puerperium and has a comparable incidence rate of post-ERCP complications to that in the general population, with relatively good delivery and fetal outcomes.
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AIM:Early calcification of atherosclerotic plaques are colocalized with macrophage and high mobility group box 1 (HMGB1), a cytokine associated with biomineralizing process under physiological and pathological conditions .Our study aims to evaluate whether HMGB1 induces ectopic mineralization via promoting the secretion of matrix vesicles ( MVs) from macrophages .METHODS:HMGB1 was added to the medium of macrophages , the secretion of MVs in the supernatant was tested by flow cytometry analysis .The mineral deposition in calcifying medium was detected by Alizarin Red staining and von Kossa staining .Transmission electron microscopy showed the formation of hydroxyapatite crystals in MVs .Then we subcutaneous injection into mice with MVs to induce regional minera-lization.RESULTS:HMGB1 significantly promoted secretion of MVs from macrophages as raveled by flow cytometry analysis .TNAP activity, considered as a marker of MVs maturation , was higher in HMGB1-induced MVs compared to the control-MVs.HMGB1-MVs also led to mineral deposition in an in vitro MVs-collagen mineralization model .Subcutaneous injection into mice with MVs derived from HMGB1-treated cells showed a greater potential to initiate regional mineralization .Mechanistic experiments revealed that HMGB 1 activated neutral sphingomyelinase 2 ( nSMase2 ) that involved the receptor for advanced glycation end products ( RAGE ) and p38 MAPK (upstream of nSMase2).Inhibition of nSMase2 with GW4869 or p38 MAPK with SB-239063 prevented MVs secretion and min-eral deposition .CONCLUSIONS: HMGB1 induces MVs secretion from macrophages at least in part , via the RAGE/p38 MAPK/nSMase2 signaling pathway .Our findings thus reveal a novel mechanism by which HMGB 1 may participated in the early calcification of atherosclerotic plaques .
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Astract:Objective To investigate the ultrastructural changes and HSP70 expression in liver of mice after microwave irradiation with lethal dose and to explore the application of these indexes as the basis of medical identification in microwave irradiation induced death. Methods The mice were divided into the control group and the irradiation group. Mice of the irradiation group were induced death by whole body exposure to 129 W/cm2 microwave irradiation for 30 minutes. The ultrastructure of liver was observed by transmission electron micro-scope;changes of the HSP70 mRNA and protein expression in liver were detected by reverse transcription polymerase chain reaction ( RT-PCR) and Western blotting respectively. Results Liver cytoplasm was observed dissolved with points and sheets and there were mitochondri-al crest and membrane solution in the irradiation group. And the HSP70 mRNA and protein expression level increases significantly compared with the control group with statistically significant difference (P<0. 01). Conclusion Death induced by microwave irradiation could lead to liver cytoplasm dissolution, mitochondria damage, mRNA and protein expression of HSP70 up-regulation, which may be used as important diagnostic indicators of microwave irradiation induced death.
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Objective To explore the ideal choice of feeding artery which is used for regional arterial infusion (RAI) in severe acute pancreatitis. Methods Forty-five patients with SAP were treated with RAI. The ideal feeding artery was that can supply entire pancreas according to arteriography and can maximize concentration of drug at pancreatic tissue. The pancreatic arteriography was considered as the final objective evidence for choice. Results (1)Gastroduodenal artery was chosen as feeding artery in forty-four cases, and superior mesenterlc artery was chosen in only one case because of vascular abnormity. (2)According to splenic arteriography, blood of splenic artery was supplied to spleen chiefly, and only partial tail of pancreas was applied by splenic artery. (3)According to celiac trunk arteriography, blood of celiac trunk could be supplied to entire pancreas, but a considerable proportion of the total blood was supplied to spleen through splenic artery and liver through hepatic artery proper.Therefore, the drug utilization index was lower. (4)According to gastroduodenal arteriography, blood of gastroduodenal artery could be supplied to entire pancrea, and almost all of the blood that contains drug flowed into pancreas. Therefore, the drug utilization index was higher. Conclusions Gastroduodenal artery is the ideal choice of artery which is used for regional intra-arterial infusion in sever acute pancreatitis. Pancreatic arteriography should be applied routinely when yever acute pancreatitis was treated with RAI.
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Objective To investigate the clinical features and management of hepatolithiasis associated with intrahepatic cholangiocarcinoma. Methods Data of 84 patients of hepatolithiasis associated with intrahepatic cholangiocarcinoma in our hospital from 1990 to 2009 were retrospectively analyzed.Results The incidence of intrahepatic cholangiocarcinoma in patients of hepatolithiasis was 4. 6%(84/1840), among them only 47 patients got a definite diagnosis before operation. All cancer located in the bile duct containing cholelith. In 20 patients intrahepatic cholangiocarcinoma was identified 6 - 16 years after lithotomy. The clinical manifestation of hepatolithiasis associated intrahepatic cholangiocarcinoma included:refractory hepatic abscess, incurable infection of intrahepatic biliary tract, and progressive obstructive jaundice. Only 35 patients received radical excision, 26 patients received palliative excision, 4 patients received radiofrequency ablation therapy, 19 patients received biopsy only. Conclusions There has been a considerable high coincidence between intrahepatic cholangiocarcinoma and hepatolithiasis. Resection of the lobe containing intrahepatic stones may help to prevent the development of intrahepatic cholangiocarcinoma.
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Objective To evaluate the curative effect of selective decongestive devascularization shunt of gastrosplenic region(SDDS-GSR) for the treatment of portal hypertension. Methods From September 2000 to June 2008, 44 patients with portal hypertension had received SDDS-GSR in our hospital. Twenty-nine of them had been followed up for 12-85 months (mean=44months). Results Operative mortality was 0 %. Mesenteric area pressure(33.82±5.12 cm H_2O) was higher than splenic area pressure(24.57±4.63 cm H_2O)soon after the operation finished(P<0.01). No re-bleeding ca-ses were found, and the encephalopathy occurred in 2.27% of the patients in the early stage of post-operation. However, the rates of 3.45% for re-bleeding and 3.45% for encephalopathy were noticed in long-term follow-up. The 1-, 3- and 5-year survival were 100%, 95% and 95%, respectively. Dur-ing the long-term follow-up, the platelet counts markedly increased from (49.2±21.8 × 10~9/L) of preoperative value to (77.2±29.5×10~9/L) (P<0.01), while spleen size was significantly reduced.Conclusion SDDS-GSR is a reliable and reasonable surgical procedure for the management of portal hypertension.
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Objective To explore the incidence and risk factors of acute graft-versus-host disease (aGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods The clinical data of 72 cases allo-HSCT from Oct 2004 to Dec 2008 were analyzed. Thirteen factors possibly correlated with the development of aGVHD were analyzed. Results aGVHD was developed in 32 cases (44.4 %), in which grades Ⅰ aGVHD was 11.1%, gradesⅡaGVHD was 18.1%, and grades Ⅲ-Ⅳ aGVHD was 15.3 %. The univariate analysis showed that diagnosis, the status of disease, use ATG, conditioning regimen, donor type,ABO blood group disparity between donor and recipient, CD34+ cell number, early engraftment and neutropenic infection, HLA locus were associated with the occurence of aGVHD (P <0.1). On the COX regression mode, an increased risk of aGVHD was associated with HLA mismatch (HR =2.58, P <0.005), GVHD prophylaxis without ATG (HR =2.94, P < 0.001), and unrelated donor (HR =1.97, P <0.01). Conclusion aGVHD is a common complication after allo-HSCT, and HLA mismatch and unrelated donor are independent risk factors for aGVHD.
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Objective To investigate the role of PI_3 K/Akt signal pathway in Ephrin-Al gene mediated invasion,metastasis of Huh-7 cells.Methods Western blot was used to test the protein expression of phosphatidylinositol 3-kinase(PI_3 K)and mitogen-activated protein kinase(MAPK)after Huh-7 cells were treated with Ephrin-A1/Fc fusion protein.According to the protein expression,LY294002 was used to block PI_3 K/Akt pathway specifically,then p-Akt protein expression,mobility and invasive ability of Huh-7 cells were examined.Results In Huh-7 cells actived by Ephrin-Al/Fc fusion protein,p-Akt expression was higher than that in control group(t=4.564,P<0.05),but there was no difference of p-p38MAPK expression between Ephrin-Al/Fc fusion protein group and IgG/Fc fusion protein group(P>0.05).PI_3 K/Akt pathway was specifically blocked by LY294002,the p-Akt protein expression decreased in Huh-7 cells,and the mobility and invasive ability mediated by Ephrin-Al in Huh-7 cells decreased(P<0.05).Conclusions PI_3 K/Akt pathway effects an important role in mobility and invasive ability of Huh-7 cells mediated by Ephrin-A1.
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Objective To evaluate the changes of splanchnic hemodynamics after selective decongestive devascularization shunt of gustrosplenic region (SDDS-GSR) in the treatment of patients with portal hypertension. Methods All these 41 portal hypertensive patients underwent a combination surgery including partially occlusion of the splenic artery, Warren distal splenorenal shunt and devascularization. Postoperative patients were followed-up by ultrasonography for changes of splanchnic hemodynamics. Results were compared with that of 21 healthy volunteers. Results The thickness of spleen 2 weeks and 1 year after surgery (47±8) mm, (46±8) nun decreased from preoperative (60±9) mm (P<0.01). The diameter of portal vein (1.13±0.19) cm and splenic artery (0.49±0.08) cm 2 weeks after surgery decreased (P<0.05) and that of hepatic artery (0.40±0.07) cm increased (P<0.05). Patients' preoperative portal vein blood flow volume (1716±1262) ml/min and splenic artery (1269±570) ml/min were larger than that of normal group (P<0.05), while that of hepatic artery (321±126) ml/min was significantly less than that of normal group (P<0.05). The portal blood flow (649±294) ml/min and that of splenic artery (446±254) ml/min 2 weeks after surgery decreased significantly (P<0.01). The hepatic artery blood flow (612±295) ml/min increased significantly (P<0.01). When reevaluated at 1 year the hepatic artery blood flow (401±152) ml/min was not significantly different compared with that before surgery and that in normal group (P>0.05). Conclusions There are significant alterations in hepatic and splenic hemodynamics in patients with portal hypertension, and that SDDS-GSR can partially reverse the chaos of the hepatic and splenic hemodynamics in cirrhotic portal hypertensive patients.
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Objective To study the effects of decoy strategy targeted to NF-KB on the development of trauma-associated liver inflammation in rats. Methods In this study, 108 Wistar rats were randomized into 3 groups: control group, traumatic inflammation group and traumatic inflammation plus decoy ODN group. Rats were sacrificed on 3,6,12,24,48 and 72hrs in each group respectively. Liver functions and structural changes were examined and compared between the groups. DNA binding activity of NF-KB in liver tissue was measured by EMSA. TNF-α and IL-6 gene expressin in liver tissue was assessed by RT-PCR and TNF-α and IL-6 protein level was determined by ELISA. Results The DNA binding activity of NF-kB in liver rose at 3 hours after induction of liver inflammation following trauma and peaked at 12 hours. Correspondingly, both the mRNA and protein levels of TNF-α and IL-6 elevated significantly, as well as the serum alanine aminotransferase level culminating at 24 hours after surgery. Hepatocytes was edematous, degeneration and necrosis, with dramatic destruction of lobular structures. All these changes were significantly inhibited with NF-KB decoy oligodeoxynucleotides. Conclusions Decoy oligodeoxynucleotides specifically inhibit the activity of NF-kB, and the release of pro-inflammatory cytokines, TNF-α and IL-6 release from the liver in response to traumatic inflammation decrease, hence the injury on liver structures and functions were alleviated.
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<p><b>OBJECTIVE</b>To study the role of catecholamine(CA) in the mechanism of bio-effect of electromagnetic irradiation.</p><p><b>METHODS</b>The contents of norepinephrine (NE), epinephrine (E) and dopamine (DA) in serum and hippocampus of rats at 0, 8, 24, 48 hours after electromagnetic irradiation were measured by using high performance liquid chromatography with electrochemical detector(HPLC-ECD), and the influence of two kinds of shelter on CA was studied.</p><p><b>RESULTS</b>The levels of CA in serum and hippocampus increased obviously in an instant, decreased at 8 h and increased significantly again at 24 h after irradiation without shielding irradiation. But at 48 h, the levels of NA, DA in hippocampus were still higher and the serum's NA, DA were not different from the control. After irradiation with whole body shielding, the levels of CA had no changes. The contents of CA increased significantly only at 24 h after irradiation by 65 W/cm2 electromagnetic wave with trunk shielding. After irradiation by 129 W/cm2 with trunk shielding, the change of CA were similar to that of no shielding.</p><p><b>CONCLUSION</b>CA may take part in the injury to central nervous system and cardiovascular system after electromagnetic irradiation. And the injury to central nervous system may sustain longer than that of cardiovascular system. The protective effect of whole body shielding is the best, while trunk shielding may have some protective effect following lower and middle power electromagnetic wave. The most important protective measure is to shield the head.</p>
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Animales , Ratas , Catecolaminas , Sangre , Cromatografía Líquida de Alta Presión , Electroquímica , Fenómenos Electromagnéticos , Hipocampo , Química , Efectos de la RadiaciónRESUMEN
Objectives In this retrospective study we investigated the causes of misdiagnosis and incorrect treatment of hepatic cholangiocarcinoma and ways helpful in the improvement of correct diagnosis.Methods There were altogether pathollgy proved 40 cases of hepatic cholangiocarcinoma. The preoperative diagnostic procedures and surgical measurcs adopted were reviewed. Results The primary misdiagnosis rate was 68%. Patients were misdiagnosed as cholelithiasis complicated by intrahepatic inflammatory mass, hepatic abscess, hepatic hydrocyst, and hepatic adenoma;The surgical procedure performed were: choledocholithotomy, hepatophyma incision drainage or liver puncture drainage on B mode ultrasound localization, and hepatic cyst fenestration. Conclusions The hepatic cholangiocarcinoma can mimic many other benign diseases leading to misdiagnosis and improper surgery. Hence clinical features,history and laboratory evidence characteristic of the cancer must be sought preoperatively and intraoperative biopsy should be taken before definite surgical procedure. [
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Objective To study the effects of decoy strategy targeted to NF-?B on IL-6 in rat's liver after traumatic inflammatin. Methods Ninty six Wistar rats were randomly divided into 4 groups: control group,traumatic inflammation group, decoy ODN group, and mutant decoy ODN group. Rats were killed on 3 , 6, 12, 24, 48 , and 72 h respectively, for the determination of plasma ALT. Hepatocytes were isolated and nuclear protein was extracted, DNA binding activity of NF-?B was measured by EMSA. Decoy ODN's competition inhibition effect was assayed by EMSA. IL-6 gene expression in liver tissue was assessed by RT-PCR and IL-6 protein level was determined by ELISA. Results After traumatic inflammation, DNA binding activity of NF-?B in the liver increased. IL-6 mRNA and protein level also significantly increased and was in positive correlation with the activity of NF-?B. Decoy ODN effectively inhibited the activity of NF-?B ex vivo. After using decoy ODN, IL-6 mRNA and protein levels of liver tissue significantly decreased, plasma ALT levels were also significantly decreased. Conclusions Decoy strategy targeted to NF-?B could effectively inhibit rat's liver IL-6 release by inhibiting specifically the activity of NF-?B.
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With the development of economy and coming of information eva,the whole living space has been filled with electromagnetic wave with various frequencies.The chance of exposure to electromagnetic field for people grows with each pass-ing day.Environmental pollution by electromagnetic radiation has become the forth public muisance after the occurance of at-mospheric pollution,water pollution and noise pollution,and has brough t about the potential hazardous effects on the health of residents and individuals occupationally exposed to electromagnetic field.The effects of electromagnetic radiation on peoples health and living are versatile.The present paper mainly summarized the effects of electromagnetic radiation on neurobehaviour,electrocardiogram and oncephalogram in order to more understand the hazard of electromagnetic radiation.
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The animal models of the combined injuries of mild, medium or severe hemorrhage and cyanide intoxication were produced by bleeding to 9.33, 6.67, or 5.33 kPa of arterial systolic pressure and administrating NaCN 2.5 mg/kg intravenously. Dogs with the combined injury of acute mild hemorrhage and cyanide intoxication in control group did not receive DMAP treatment whereas dogs in DMAP treatment groups receiveed DMAP 2 mg/kg iv at 3 min after administrating cyanide. The changes of hemodynamics and blood gases and methemoglobin were determined. The dogs receiving no DMAP treatnent in control group died within 5 min after intoxication. DMAP has an excitatory effect on hemodynamics after giving to dogs with the combined injury of acute mild hemorrhage and cyanide intoxication. It can save the dogs from death. The excitatory effect of DMAP on hemodynamics becomes weaker while the level of acute hemorrhage increases. The results of blood gas and methemoglobin analysis indicated that DMAP can disturb the oxygen-carrying capacity of hemoglobin because of the formation of much higher concentration of methemoglobin when DMAP is used as an antidote for the combined injury of acute hemorrhage and cyanide intoxication. The results suggested that methemoglobin formers should not be used as the antidotes for the combined injury of acute hemorrhage and cyanide intoxication.
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The preventive effects of some drugs on pulmonary lipid peroxi-dation and inborn oxidation protectant system in the lungs were observed in rats after the animals were exposed to 200 ppm of hydrogen sulfide (H2S) for 3 hours.Malondialdehyde (MDA) level of the lungs and bronchoalveolar lavage fluid (BALF),superoxide dismutase (SOD) activity,glutathione(GSH) and vitamin E (VE) levels of the lungs were determined in the 6th and 12th hour after H2S inhalation.It was found that a significant increase of MDA level of both the lungs and BALF and a significant decrease of SOD activity and GSH and VE level occured after a single exposure to 200 ppm of H2S inhalation.On the contrany,the MAD level of every group of which the animals had been medicated for prevention was lower than that of the intoxicated groups.Among the premedicated groups,the MDA level of 4-dimethylaminophenol(DMAP) group,VE group,and NaNO2 group was not different from that of the normal except that the MDA level in BALF was higher in VE and NaNO2 group than in the control.In every premedicated groups,SOD activity was increased and GSH and VE levels were elevated.These facts suggest that DMAP,NaNO2,VE,dexamethasone and anisoda-mine all could reduce the MDA level and elevate the capacity of the oxidation protectant system of the lungs after H2S inhalation.It is concluded that there are drugs to protect victims from H2O intoxication while DMAP,NaNO2 and VE are relatively more potent among the drugs used in this study.
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The effects of acute hemorrhage complicated with cyanide posisoning on the hemodynamics were studied and compared with those simple cyanide poisoning in 24 dogs.Cyanide poisoning was induced by intravenous injection a lethal dose of NaCN of 2.5mg/kg,Acute hemorrhage was created by bleeding the dogs to an arterial pressure of 9.33 kPa(70mm Hg)within 2 minutes through a cannulated femoral artery.HR,CO,MAP,LVP,LVP (?)dp/bt max,and ECG were recorded.It was found that the excitatory response of cardiovascular functions was observed within 1 minute after cyanide poisoning,then a significant failure of the cardiavascular functions resulted in the rapid death of the animal 7~10 minutes after cyanide administration.In case when cyanide poisoning was complicated with acute hemorrhage,no excitatory response of the cardiovascular functions could be observed.An early cardiovascular collapse occurred which was characterized by a rapid fall of CO,MAP,LVP,LVP(?)dp/dt max as well as arrhythmia.All the dogs in this group died of acute failure of cardiovascular functions 4- 6 minutes after cyanide poisoning.The results of this study suggest that the failure of the cardiovascular functions is the main cause of death in case of acute hemorrhage complicated with cyanide poisoning.
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The effects of 4-DMAP and NaNO2 on the hemodynamics of dogs suffering from acute hemorrhage complicated with cyanide poisoning were studied. It was found that the administration of 4-DMAP could brought about an increase of the cardiovascular functions in the experimental animals. Although the increase was temporal and not very impressive, it played an important role to prevent the dogs from developing cardiovascular collapse during the period of observation. On the other hand, the administration of NaNO2 resulted in a transient excitation for 1-2 minutes and then a prolonged and progressive depression of the cardiovascular functions, and all the experimental animals died from cardiovascular failure within 13-19 minutes after NaNO2 injection.The results of this study indicate that 4-DMAP as a therapeutic agent for acute hemorrhage complicated with cyanide poisoning is superior to NaNO2 since the former can produce an excitation of the cardiovascular functions while the latter a progressive depression and eventually a failure of the cardiovascular functions.
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In order to study the effects of soman intoxication on hemodynamics,the left ventricular pressure(LVP),the maximal changing rate of LVP(?dp/dt max),the aortic pressure(AP),the pulmonary arterial pressure(PAP),the cardiac output(CO),the cardiac index(CD and the heart rate(HR)were determined in anesthetized,chest -opened and mechanically-ventilated dogs at a simulated high altitude of 4 000m before and after an intravenous injection of 10?g/kg of soman.It was found that the toxicity of soman on cardiac functions was more severe at high altitude than at sea level.
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The pulmonary toxicology after H2S inhalation was studied with bronchoaleveolar lavage (BAL),ultracentrifuge.and optical and electron microscopy in rats.The changes of the activities of lactate dehydrogenase,alkaline phosphatase,acid phosphatase and angiotension converting enzyme in BAL fluid were used as indicators of cellular damages.those of leucocytic count as the indicator of inflammatory response,and those of the concentration of protein and Evans blue as the indicator of the alterations of vascular permeability.In addition,the effects of H2S on lipid peroxidation,natural antioxidative system and energy substances and the changes of phospholipid concentration in BAL fluid were also studied.The results were as follows:(1)Inhalation of H2S exerted a severe cytotoxic effect on the lung tissues resulting in damages on various types of cells and a severe edematogenic effect on lung parenchyma.(2)The development of pulmonary edema in H2S intoxication resulted from a combination of different pathogenic factors.(3)The biochemical changes and their recovery occurred earlier than those of the pathological changes.The effecacy of 6 categories of drugs including 25 medicaments against H2S intoxication was e-valuated in mice,and 10 drugs were found prophylactically effective.The effects of various methe-moglobin-forming substances and some other drugs were also investingated in their treatment for H2S intoxication in rabbitsand dogs.It was concluded that methemoglobin-forming substances could be used as specific antidotes but could not prevent or diminish the lung damages due to H2S inhalation unless they were administered in association with dexamethasone,vitamin E,and anisodamine.Eventually,a postulated scheme of the medical treatment for H2S intoxication was presented.