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Objective:To analyze the factors influencing prognosis of intrahepatic cholangiocarcinoma (ICC) after surgical resection.Methods:The clinical data of patients diagnosed with ICC and who underwent surgical resection from December 2015 to December 2019 at the Fifth Medical Center of PLA General Hospital were retrospectively analyzed. Of 39 patients who were included in this study, there were 23 males and 16 females, with age of (54.1±7.2) years old. The body mass index, hepatitis B virus infection status, tumor diameter, degree of differentiation, microvascular tumor thrombus, lymph node metastasis, and serum levels of carbohydrate antigen 19-9 (CA19-9) were analyzed as risk factors affecting postoperative recurrence and survival.Results:The median times to recurrence were significantly better in patients with a tumour length <5 cm (11 vs. 5 months), patients without microvascular tumor thrombus (54 vs. 6 months) and patients without lymph node metastasis (8 vs. 5 months) (all P<0.05). The median survival of patients with CA19-9≥100 U/ml was significantly shorter than that of patients with CA19-9<100 U/ml, (9 vs. 27 months, P<0.05). Tumor diameter>5 cm, microvascular tumor thrombus, lymph node metastasis, and CA19-9 ≥100 U/ml are risk factors affecting the recurrence time after ICC resection, CA19-9 ≥100 U/ml is a risk factor affecting survival time after ICC resection. Conclusion:Tumor diameter, microvascular tumor thrombus, lymph node metastasis and CA19-9 can be used to estimate the risk of ICC recurrence, and CA19-9 level can be used to estimate postoperative survival of ICC patients after resection.
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Objective@#To analyze the recent postoperative and long-term postoperative complications of open-splenectomy and disconnection in patients with portal hypertension.@*Methods@#There were 1 118 cases with portal hypertension who underwent open splenectomy and azygoportal disconnection from April 2010 to September 2015 at Department of Surgery, People′s Liberation Army 302 Hospital. Retrospective case investigation and telephone follow-up were conducted in October 2016. All patients had history of upper gastrointestinal bleeding before operation. Short-term complications after surgery were recorded including secondary laparotomy of postoperative abdominal hemostasis, severe infection, intake disorders, liver insufficiency, postoperative portal vein thrombosis and perioperative mortality. Long-term data including postoperative upper gastrointestinal rebleeding, postoperative survival rate and incidence of postoperative malignancy were recorded, too. GraphPad Prism 5 software for data survival analysis and charting.@*Results@#Postoperative short-term complications in 1 118 patients included secondary laparotomy of postoperative abdominal hemostasis(1.8%, 21/1 118), severe infection(2.9%, 32/1 118), intake disorders(1.0%, 11/1 118), liver dysfunction (1.6%, 18/1 118), postoperative portal vein thrombosis(47.1%, 526/1 118)and perioperative mortality(0.5%, 5/1 118). After phone call following-up, 942 patients′ long-term data were completed including 1, 3, 5 years postoperative upper gastrointestinal rebleeding rate(4.4%, 12.1%, 17.2%), 1, 3, 5-year postoperative survival rate(97.0%, 93.5%, 90.3%); the incidence of postoperative malignant tumors in 1, 3 and 5 years were 1.7%, 4.4% and 6.2%.@*Conclusions@#Reasonable choosing of surgical indications and timing, proper performing the surgery process, effective conducting perioperative management of portal hypertension are directly related to the patient′s short-term prognosis after portal hypertension. Surgical intervention can reduce the rates of patients with upper gastrointestinal rebleeding, improve survival, and do not increase the incidence of malignant tumors.
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Objective To evaluate the safety,effectiveness and clinical factors of re-intervention of transjugular intrahepatic porto-systemic shunt (TIPS).Methods A retrospective study of safety and longterm outcomes of TIPS was made in 771 patients from August 1994 to August 2010.The 625 patients had follow-up data.The patients who received TIPS once,twice,and more than twice were divided into group 1,group 2 and group 3,respectively.Clinical symptoms,survival rate and restenosis rate of each group were analyzed.Clinical influencing factors of re-intervention effect were discussed.Results The success rate of first intervention was 98.2％ (757/771),the death rate was 0.7％ (5/757) and severe complication rate was 2.5％ (19/757).The success rate of re-intervention was 98.7％ (457/463),no death and severe complications occurred.The restenosis rate in group 3 decreased significantly than group 1 ( x2 =7.908,P ＜0.05 ) in the first year of TIPS.The restenosis rates in group 2 and group 3 were lower than group 1 from 2 to 5 years of TIPS ( x2 values were 27.046,25.724,37.002 and 19.046,respectively,P ＜ 0.05 ). The survival rate in group 3 was higher than group 1 (x2 =9.114,P＜0.05)and group 2 was higher than group 1 ( x2 =4.929,P ＜ 0.05 ) in the first year of TIPS,while there was no statistical difference between group 2 and group 3 ( x2 =2.678,P ＞ 0.05).The patients in group 2 and group 3 also had higher survival rates than group 1 from 2 to 5 years of TIPS (x2 value were 41.314,26.920,13.692 and 6.713,respectively,P ＜ 0.05 ).19.4％ (79/406)of patients who received re-intervention had symptom recurrence and shunt stenosis or occlusion. 11.6％ (47/406) of patients had symptom recurrence with portal hypertension signs,62.8％ (255/406) had shunt stenosis or occlusion with portal hypertension signs.Conclusions Restenosis or occlusion of TIPS,symptom recurrence and portal hypertension signs were important factors for re-intervention.Re-intervention of TIPS was safe and effective,and could improve the survival rate of patients with TIPS.
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Objective To investigate the changes of Bcl-2 and Bax expression in white matter of fetal rats after maternal endotoxin administration. Methods Pregnant rats were randomly divided into two groups: infection group and control group. The infection group was established by intraperitoneal injection of endotoxin in pregnant rats when gestation was 70% complete (15 days). The control group was treated with normal saline. The fetal rats were killed at 2, 4, 12, 24 and 72 hours after maternal endotoxin administration. The pathological changes in placenta and in fetal rat brain were determined by HE staining. Immunohistochemical method was used to detect the expression of Bcl-2 and Bax proteins in fetal rat brains. Results The major pathological changes in fetal rats niter maternal endotoxin administration included neutrophil infiltration in the placenta, weak staining of white matter and focal infarction. After maternal endotoxin administration, the expression of Bcl-2 gradually decreased from 2 h and arrived at the valley at 12 h, while that of Bax gradually increased 2 h and reached a peak at 12 h. Between the endotoxin-gronp and the control group, the number of positive cells of Bcl-2 and Bax in brain of the fetal rat had significant difference at 4, 12, 24 and 72 hours (P< 0.01 ), and there was no significant difference at 2 h (P > 0.05). The ratio of Bax to Bcl-2 in the endotoxingroup was significantly higher than that in the control group at each time point (P<0.01).Conclusion Endotoxin can be used to eatablish intrauterine irfection models and the infection may cause damage to the white matter. Overexpression of Bcl-2 protects cell from apoptosis, but Bax may function as a cell death effector pro-tein. The ratio of Bax to Bcl-2 may play an important role for apoptosis in the lesion of the white matter.
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Objective To Study if aortic smooth muscle cells(ASMC) can produce elastic fibers in three-dimensional culture imitating the dermis substitute. Methods Primary culture of ASMCs were obtained by explanting of thoracic aortae from one-week old SD rats. ?-actin immunocytochemistry was used to approve the smooth muscle cells. After subculture, ASMCs were mixed with gels composed of collagen, chitin and glucosaminoglycans, then, three-dimensional culture was carried out. After 1 week and 2 weeks, Gomori aldehyde fuchsin staining and elastin immunocytochemistry were applied to detect the elastic fibers in the ASMC-collagen gels. Results More than 98% of the cultured cells were approved as smooth muscle cells by ?-actin immunocytochemistry. After both 1 and 2 weeks of three-dimentional culture, elastic fibers were detected in the ASMC-collagen gels by both stainings.Conclusion ASMCs can synthesize elastin and produce elastic fiber in three-dimentional culture imitating the dermis substitute.
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Objective To investigate if aortic smooth muscle cells (ASMCs) cultured three-dimentionally with collagen gel can still produce elastic fibers and the acceptance of hosts after transplantated in subcutaneous of rats. Methods AMSC-collagen gels that had been cultured for 2 weeks by three-dimentionally imitating the dermis substitute were transplanted to rats subscutaneous. After 4,7,10,14 and 28 days, the transplantations were examined via HE staining, Gomori aldehyde fuchsin staining, ?-actin immunohistochemistry and elastin immunohistochemistry. Results The amount of elastic fibers increased significantly in the week, whereas on the 28th day, no elastic fibers were detected.There was no remarkable leucocyte infiltration around the ASMC-collagen gel during 28 days.Conclusion Further studies are needed to explore the ASMC-collagen gels as a kind of elastic dermis substitute.