Objective To study on the effectiveness of endoscopy in diagnosing the gallbladder-intestine fistula. Methods The clinical datum of 24 patients with gallbladder-intestine fistula from January 1982 to March 2004 were reviewed and analyzed retrospectively. All patients were examined by endoscopy and confirmed from operation. Results Twenty-one out of 24 patients were finally diagnosed by endoscopy while 3 of them were misdiagnosed. Other examinations among the 24 patients included B ultrasound 11 , computer tomography (CT) 5, and abdominal plain films 7; none of them was finally diagnosed by these measures. Two out of 8 patients were finally diagnosed by barium meal or enema roentgenogram. Conclusion Endoscopy was an important method in diagnosing the gallbladder-intestine fistula. The diagnostic level would be improved if the specific characters of endoscopies in this entity were fully recognized.

Objectives To establish real-time fluorenscence quantitative polymerase chain reaction ( RFQ-PCR ) for measurement of the expression level of guanylyl cyclase-C(GC-C) in the Peripheral blood mononuclear cell(PBMC)in 30 blood donors, 10 cases colorectal cancer tissue and 1 case T84 human colon cancer cell line. Methods Specific primers and TaqMan probe have been designed,and fluorenscence of the PCR product was detected continuously during amplification. According to the standard curve created by plasmid DNA, the expression level of GC-C in clinical samples has been determined using software, and the results were presented as the ratios of GC-C mRNA to?2-microgluobulin(?2M)mRNA. Results The detection range of the assay was from 101 pg/ml to109pg/ml,the coefficient of variation values of both intra-experimental and inter- experimental reproducibility were 6. 87% to 11. 12% and 8. 86% to 15. 19% . None of 30 blood donors and 11 benign intestinal patients expressed GC-C mRNA,it was expressed in 31/37 colorectal cancer patients. The expression level of GC-C mRNA in colorectal cancer patients was 0. 88?0.06,and the expression level of its in colorectal carcinoma tissue and T84 cells were 0. 86?0.07/ug tissue and 0.0082/per cell. Conclusions This assay had high sensitivity,specificity and reproducibility.

BACKGROUND:The complex relationship between bone marrow mesenchymal stem cels and cancers severely limit the clinical application of mesenchymal stem cels. So it is urgent to study the role of mesenchymal stem cels in tumor growth and metastasis.
OBJECTIVE:To explore the effect of human bone marrow mesenchymal stem cels on epithelial mesenchymal transition in non-smal cel lung cancer A549 and PAa cels.
METHODS:The A549 and PAa cels were cultured with mesenchymal stem cel supernatant (mesenchymal stem cel conditioned medium, MSCs-CM). The celular morphology was observed under a microscope. The mRNA and protein expression of E-cadherin, N-cadherin, Vimentin, Slug, Snail, and Twist were determined by RT-PCR and western blot. Transwel and wound healing assay were used to detect the change of migration and metastatic ability.
RESULTS AND CONCLUSION:Compared with the control group, the celular morphology of experimental group showed mesenchymal-like changes. In response to MSCs-CM, there was decreased E-cadherin but increased N-cadherin, Vimentin and Slug, Snail, Twist at mRNA and protein levels compared with the control group (P < 0.05). The migration and metastatic abilities of the experimental group were also increased. So, human bone marrow mesenchymal stem cels can promote epithelial mesenchymal transition in A549 and PAa cels, and enhance the migration and metastatic abilities of A549 and PAa cels.

Objective To discuss the safety and efficacy of transcatheter arterial chemoembolization (TACE) in treating patients with inoperable hepatocellular carcinoma (HCC) who has a history of hepatic failure. Methods A total of 7 HCC patients who had a history of hepatic failure (study group) were enrolled in this study. TACE was carried out in all these 7 patients. Other 51 patients who had no liver failure history were used as the control group. All the patients were followed up for at least six months. The postoperative adverse events, changes of liver function and the prognosis were recorded, and the results were compared between the two groups. Results In the study group, neither treatment-related death nor severe adverse events occurred. No significant difference in the occurrence of mild adverse events existed between the two groups. After TACE the liver functions, including alanine aminotransferase, total bilirubin, prolonged prothrombin time, albumin, etc. in the study group were significantly worse than those in the control group,groups. Conclusion For patients with inoperable hepatocellular carcinoma who has a history of hepatic failure, TACE is a safe and effective treatment.

This paper is aimed to investigate the effect of rest-inserted loading on the mechanosensitivity of osteocytes. In the investigation, cultured MLO-Y4 osteocyte-like cells were strained on cyclic compressive force (CCF) by the self-made compressive loading device. Then we observed the effect of different rest periods-inserted loading (5 s, 15 s, 30 s, respectively) on the mechanosensitivity of osteocytes. We then determined the levels of secreted nitric oxide (NO) and prostaglandin E2 (PGE2) by Griess method and enzyme linked immunosorbent assay (ELISA), respectively. We then stained the cytoskeleton F-actin using immunofluorescence. We found that the expressions of NO and PGE2 in rest-inserted strained groups (> 15 s) were significantly increased compared to those in the continuous strained group. And rest-inserted loading promoted the parallel alignment of stress fibers. It indicates that rest-inserted loading could promote the mechanosensitivity of osteocytes, and this might be related to the parallel alignment of stress fibers.
Actins ; metabolism ; Animals ; Cell Culture Techniques ; Cell Line ; Cytoskeleton ; metabolism ; Dinoprostone ; secretion ; Mice ; Nitric Oxide ; secretion ; Osteocytes ; secretion ; Stress, Mechanical

Objective To understand the immune regulatory function of monocyte-derived dendritic cells (MoDC) in patients with chronic severe hepatitis B (CSHB) and its roles in the severe illness progression of chronic hepatitis B (CHB) by detecting surface phenotype of MoDC and expression level of cytokines in MoDC after polyl : C treatment. Methods The peripheral blood mononuclear cells (PBMC) were isolated by Ficoll density gradient separation from 37 patients with CSHB, 20 patients with CHB, and 20 healthy controls (NC). Purified PBMC were acquired using immunomagnetic anti-CD14-beads. Then PBMC were induced to immature dendritic cell (iDC) in vitro. PolyI : C was added to induce DC maturation. The mean fluorescence intensity (MFI) of the phenotype marker molecules including HLA-DR, CD83, CD86 and CD80 on surface of iDC and mature DC (mDC) were detected by flow cytometry. The supernatants of MoDC culture were collected at 12,24 and 48 h after polyI : C treatment, respectively and the release levels of interleukin (IL)-12, IL-6and tumor necrosis factor (TNF)-α were determined by enzyme linked immunosorbent assay (ELISA). Comparisons among groups were done by single factor analysis of variance and homogeneity of variance was tested. Results There were no significant differences of phenotype marker molecules on cell surface of iDC, including HLA-DR, CD83, CD86 and CD80 in CSHB, CHB and NC groups.However, the expressions of HLA-DR, CD83, CD86 and CD80 on cell surface of mDC in CSHB group were lower than those in CHB and NC groups (F=59.73, 13.95, 34.80 and 73.02, respectively; all P＜0. 05). The secretions of IL-12 at three time points of 12 h, 24 h and 48 h after polyI : C treatment in group NC were higher than those in CHB and CSHB groups (F= 151.34, 126.65 and 72.76, respectively; P＜0.05), and peaked at 24 h which were (48.2±7.6), (56.7±11.8) and (97.8±16.2) ng/L, respectively. The secretions of IL-6 at the above three time points were CSHB＞CHB＞NC (F=92.50, 86.89 and 64.57, respectively; all P＜0. 05) and peaked at 12 h which were (1698.3±340.4), (965.8±231.7), (697.8±213.6) ng/L, respectively. The secretions of TNF-αat the above three time points were CSHB＞CHB＞NC (F=58.66, 122.36 and 44.73, respectively;all P＜0. 05) and were (19 672. 7±4214. 7), (9946. 1 ± 2586 5), (6659. 2±955. 8) ng/L,respectively at 24 h after treatment. Conclusions MoDCs of CSHB patients show mature defection and abnormal cytokine secretion. The expression level of IL-12 which mediates cellular immune is low.Meanwhile, the productions of IL-6 and TNF-α which mediate inflammatory response are up-regulated. This may be one of the major factors which lead to exacerbation of liver inflammation and ultimately development of severe hepatitis.

Objective To analyze the miss rates of colorectal adenomas during colonoscopy as well as risk factors influencing the adenoma miss rates and to take corresponding measures. Methods A total of 432 patients who underwent index and follow-up colonoscopy in 18 months were randomized and investigated. The results of two colonoscopies were compared and the missed adenomas were defined as the adenomas de-tected only during the second colonoscopy. Miss rates were calculated according to patient-based methods. Chi-square test was used to analyze the relative factors influencing the adenoma miss rate of per-patient. Then the meaningful factors were chosen into the logistic regression model for multiple factors analysis. Results Of 432 patients,116(26. 9%)had missed adenomas on first colonoscopy. Single factor analysis found that the size of adenoma( χ2 = 89. 686,P = 0. 000),the shape of adenoma( χ2 = 68. 488,P = 0. 000),the location of adenoma(χ2 = 77. 055,P = 0. 000)and adenoma tissue types(χ2 = 417. 000,P = 0. 000)were the risk factors for miss rates of colorectal adenomas. Number of polyps(χ2 = 8. 450,P= 0. 038),the organi-zation type of polyp(χ2 = 10. 718,P= 0. 013)and proficiency of colonoscopists(χ2 = 56. 069,P= 0. 000), the quality of bowel preparation(χ2 = 39. 195,P = 0. 000),insertion time(χ2 = 13. 133,P = 0. 001)were also the risk factors for miss rates of colorectal adenomas. Logistic regression analysis showed that the bigger the adenoma size,the less missed adenomas(OR= 0. 341,95%CI:0. 173-0. 671). Also,the longer insertion time took,the lower the adenoma miss rate(OR = 0. 987,95% CI:0. 981-0. 994). Per-patient miss rates were lower for high-risk adenomas compared with low-risk adenomas(OR = 0. 324,95%CI:0. 154-0. 680). Adenomas happening in multiple parts of bowel easily leads to missing(OR= 3. 791,95%CI:1. 505-9. 546). Conclusion The missed diagnosis of adenomas is not only significantly associated with features of missed adenomas,but also with skills of colonoscopists,insertion time,and bowel preparation. The key is high-quality index colonoscopy to avoid adenomas missing.

Objective To explore the association of immune suppression with the severity of HBV-related acute-on-chronic liver failure(ACLF) patients.Methods From August 2009 to April 2010 in Shanghai Public Health Clinical Center, the peripheral blood samples and clinical data of 27 HBV-related ACLF patients (ACLF group), 28 patients wit h chronic active hepatitis B (CHB group)and 8 healthy individuals (Control group) were collected.APACHE Ⅲ score and the grade of hepatic encephalopathy were as quantitative index to evaluate the severity degree of the disease.The absolute counts of the subsets of T lymphocytes and human leukocyte antigen (HLA)-DR expression on the surface of monocyte in patients' peripheral blood were examined by flow cytometry, the proinflammatory cytokines and anti-inflammatory cytokines(IFN-γ, TNF-α, IL-2, IL-4, IL-10) in patients' plasma were detected by cytometric bead array (CBA) kit.The data was analyzed with SPSS 16.0 software.Results Compared with CHB group and control group, the level of anti-inflammatory eytokire IL-10 markedly increased ir HBV-related ACLF patients (Z= -4.279 ,U= 124, P＜0.01;Z= - 3.871, U= 9.5, P= 0.0001 ), however the level of pro-inflammatory cytokines IFN-γ、 TFN-α、IL-2 、 IL-4 in plasma were at low limit of detectable value.Meanwhile the expression quantity of HLA-DR on the peripheral blood monocytes significantly down-regulated (Z= -4.714, U= 98, P＜0.01;7= - 4.086, U = 4, P＜ 0.01), and there was negative correlation between HLA-DR expression quantity and APACHE Ⅲ score (R2 =0.2667, P=0.0167).In addition, the absolute counts of CD4+T lymphocytes in adaptive immune cells significantly decreased (Z= -4.411, U= 116, P＜0.01; Z=-3.575, U= 17, P= 0.0004).Conclusions The immune system of HBV-related ACLF patients displays immune dysfunction like monocyte function inhibition; CD4+ T lymphocytes depletion and high level of anti-inflammatory eytokines, the persistent down-regulation of the HLA-DR expression on monocyte is an indicator for the severity of disease.

Objective To study apoptosis and antigen presentation changes of monocytes in HBV-related acute-on-chronic liver failure (ACLF) patients under immune dysfunction state.Methods Peripheral blood samples of 26 HBV-related ACLF patients (ACLF group),20 active chronic hepatitis B patients (CHB group) and 18 healthy individuals (control group) were collected.The changes of apoptosis and proliferation (Ki67) in monocytes and the expression of surface markers including human leukocyte antigen (HLA)-DR and B7 molecules (CD86) of monocytes were analyzed by flow cytometry. Results The percentage of Annexin V expressed monocytes of ACLF group (64％) was significantly higher than that of CHB group (28％) and control group (20％),and the difference was statistically significant (x2 value was 11.75 and 27.23 ; both P＜0.01),which indicated that monocytes apoptosis increased.The Ki67 expression in monocytes of ACLF group was lower than that of CHB group and control group,and the difference was statistically significant (x2 value was 4.71 and 4.83; both P＜ 0.05),which indicated that activated monocytes reduced. The mean fluorescence intensity (MFI) of HLA-DR and CD86 of monocytes in ACLF group was 22.85 and 11.63,which was significantly lower than that of CHB group and control group,indicating the antigen presentation ability of monocytes injured. The percentage of Annexin Ⅴ positive monocytes in survivals (62 ％ ) was significantly higher than that of dead patients (46 ％ ) in ACLF group.Conclusion In HBV-related ACLF patients under immune dysfunction state,the apoptosis of peripheral blood monocytes increased,and the quantity of activated cells reduced,resulting in the decline of the antigen presentation ability of monocytes.

Objective To study the therapeutic effects of human umbilical cord mesenchymal stem cells (hUCMSCs) on acute liver failure ( ALF) induced by D-galactosamine (D-gal) and lipopolysaccharide (LPS) in rats. Methods The ALF model was obtained through intraperitoneal injection of D-gal(300 mg/kg)and LPS (20μg/kg)in Wister rats. The hUCMSCs were transplanted after intoxication. All rats were divided into four groups, and each group received either hUCMSCs or 0.9% NaCl solution through intraperitoneal or tail-intravenous injection. To evaluate the liver function of each group, the levels of alanine aminotransferase (ALT), total bilirubin (TBil) and serum albumin (Alb) were measured on the day of hUCMSCs transplantation and the following 1, 2, 3, 5 and 7 days. All rats were then sacrificed to examine the liver histology at day 7. Analyses were done by using Fisher's exact test, unpaired t test and Mann-Whitney U test. Results There were no significant differences of survival rates among four groups (Fisher's exact test, both P = 1. 00). The levels of ALT, TBil and Alb in group receiving hUCMSCs intraperitoneally were (804. 9 ± 88. 0) U/L,(17. 4±2. 7) μmol/L and (20. 9±0. 8) g/L, respectively after 2 days of injection, whereas in the corresponding control group, those were (1294. 3± 171. 4) U/L, (32. 3±5. 5) μmol/L and (16. 1±0. 9) g/L, respectively, which indicated that hUCMSCs transplantation significantly improved the liver function (t = 2. 640, P =0.020;t=2.529, P = 0. 025;t= - 3. 833, P = 0. 002). Both of hUCMSCs-transplanted groups showed no significant differences. Liver histological data showed that transplantation of hUSMSCs through either intraperitoneal or tail-intravenous injection alleviated liver damage (U=4. 500, P = 0. 005;U=4. 500, P = 0. 008) and the mitotic index also increased in hUCMSCs-transplanted groups (U=4. 000, P = 0. 005; U=5. 500, P = 0. 013). Conclusions The levels of ALT, TBil and Alb can rapidly normalize in ALF rats after injected with hUCMSCs either intraperitoneally or tail-intravenously. hUCMSCs application raises the mitotic index, enhances hepatocellular regeneration and improves histological status.