Objective To discuss the early diagnosis of severe perioperative biliary infection complicated with DIC and efficacy of comprehensive treatment for it. Methods Comprehensive treat-ment was conducted in 21 patients who had intensive biliary infection complicated with DIC. The he-moglutination function was monitored before and after treatment. Results Of the 21 patients, 19 were cured and 2 dead. The curative rated was 90.5 %. The hemorrhage tendency was controlled, abdomi-nal bleeding stopped, prothrombin time (PT) obviously reduced, content of fibrinogen (Fbg)in-creased, level of D-dimer and FDPs obviously dropped. Conclusion The patients who have biliary in-fection in the perioperative period are easy to suffer from DIC and the mortality is high. Early diagno-sis and comprehensive therapy, especially the application of the cryofibrinogen and heparin, are very important.

Objective To elucidate the mechanisms of disruption of intestinal mucosa barrier in obstructive jaundice.Methods The obstructive jaundice model of rats was set up.At 10 d and 20 d after operation,immunohistochemistry and Western-blot techniques were used to examine the distribution and expression of tight junction proteins(ZO-1,Occludin) and myosin light chain kinase(MLCK)in intestinal mucosa.Results In normal control groups,the staining of ZO-1 and occludin was predominantly localized to the margins of the epithelial cells and the apex of the cell membrane,and displayed a continuous and uniform distribution along the under surface of the villae.MLCK was distributed mainly in cytoplasm.In obstructive jaundice groups,ZO-1 and occludin staining appeared discontinuous and vague,with rough edges and spiculate processes.The staining of MLCK was also discontinuous and scanty.The strong positive express ratio of ZO-1,Occludin and MLCK were obviously lower in two experiment group than those in the control group all P

Objective To evaluate the value of imaging means on preoprative diagnosis for patients with malignant obstruction of the biliary and pancreatic ducts.[WT5”HZ]Method [WT5”BZ]44 cases underwent preoperative MR/MRCP/MRA examination. The accurate rate of diagnosis was compared with that derived from B us, CT and ERCP. Results 28 of 44 cases were diagnosed as with pancreatic and periampullary carcinoma, 5 cases as with pancreatic body and tail carcinoma,11 cases as with biliary duct carcinoma. The accurate rates of MR/MRCP/MRA for tumor locating and cause were 100% and 96% respectively. Blood vessel invasion, adjacent organ infiltration and matastasis were detected preoperatively in 17 cases. In contrast, the accurate rate for tumor locating and cause were 82% and 76% with CT, 73% and 68% with B us, 96% and 84% with ERCP. [WT5”HZ]Conclusions [WT5”BZ] MR/ MRCP /MRA combined has advantage over B us, CT and ERCP in preoperative diagnosis especially for detecting organ matastasis and blood vessel infiltration. It has an important value in the establishment of tumor staging and decision making of clinical therapy.

ObjectiveTo investigate the effects of splenectomy on the intestine mucosa barrier in rats with obstructive jaundice. Methods50 Wistar rats were divided randomly into the obstructive jaundice group (OJ), in which the animals underwent operation to ligate common bile duct, and the obstructive jaundice + splenectomy group (OJ+ S). Seven days post-operation, plasma endotoxin levels were detected. Intestinal mucosa permeability was measured by the ratios of lactulose and mannitol (L/M). Immunohistochemistry and Western blot were used to examine the expression of tight junction proteins (ZO-1 and occludin) in the distal ileum mucosa. Western blots images were analyzed quantitatively. ResultsAverage ratios of L/M and plasma endotoxin were decreased obviously in the OJ+S group compared to those in the OJ group (all P=0. 001). Compared with the OJ group, the average intestinal villus height and mucosa thickness were upgraded somewhat in the OJ + S group (P = 0.019, 0. 001 ). By immunohistochemistry staining seven days post-operation, same comment as above the amounts of strong positive expression of ZO-1 were significantly decreased in the OJ group (6/18, P-0. 021). There wewas no difference between the OJ+S group(8/17) and the OJ group.The amount of strong positive expression of occludin was higher in the OJ + S group than that of the OJ group(10/17 vs 4/18, P= 0. 026). The same outcomes were obtained by quantitative Western blot images. Conclusion The intestinal epithelial permeability was increased in rats with obstructive jaundice,and intestinal barrier was damaged. After excising spleen, the amount and distribution of tight junction proteins were changed and the impairment of intestinal barrier was abated.

Objective To investigate the effects and mechanisms of bile on small intestine mucosal barrier.Methods Fifty Wistar rats were assinged into 3 groups randomly: obstructive jaundice(OJ) group(n=20),biliary external drainage group(n=20) and control group(n=10).Ten days after operation,the plasma endotoxin level was determinated,the terminal ileum mucosas was obtained to be morphologically measured by light microscope,and immunohistochemistry and Western blot were uesd to examine the expressions of tight junction proteins zona occludens-1(ZO-1) and occludin in the mucosas.Results Atrophy significantly appeared in the distal ileum mucosas in OJ group.Compared with control group,the intestinal villus height,mucosa thickness and crypt depth in OJ group were obviously decreased 27.8%,21.7%,and 25.4%(P=0.001,0.001,0.040).There were no differences between external drainage group and control group(P=0.050,0.070,0.080);While the values of external drainage group were significantly higher than those in OJ group(all P=0.001).The level of plasma endotoxin was up to(1.49?0.27) EU/ml in OJ group compared with control group((0.27?0.09) EU/ml),P=0.001.In external drainage group,the value was(0.91?0.25) EU/ml,which was obviously higher than that in control group and lower than that in OJ group(all P=0.001).Immunohistochemical study showed strong positive expression of ZO-1 dropped from 7/10 in the control group to 6/20 in OJ group(P=0.040),occludin expression was 8/10 in control group and 7/20 in OJ Group(P=0.020);expressions of them in external drainage group(8/20(P=0.100,0.210) and 9/20(P=0.060,0.200)) displayed no significant differences compared with the other twogroups.Quantitative testing of Western blot showed the expressions of ZO-1 and occludin in OJ group were significantly lower than those in control group(P=0.001,0.010),the values in external drainage group were higher than those in OJ group(P=0.005,0.014).The expression of ZO-1 was lower in external drainage group than that in control group(P=0.001),and there was no significant difference of occludin between the two groups(P=0.062).Conclusion Lack of intestinal bile will undermine the intestinal tight junction protein composition,and make intestinal mucosal barrier impaired.The intestinal barrier more severely injured when biliary tract obstructs because of multiple factors.Bile plays an important role in the maintenance of intestinal mucosal barrier.

Objective To explore the effects of glucagon-like peptide-2(GLP-2) on intestinal mucosa epithelium myosin light chain kinase(MLCK)of the rat with obstructive jaundice.Methods The obstructive jaundice models of rats were set up.At postoperative 10 d,the control group rats were subcutaneously injected with 0.5 mL PBS;experiment group A with 250g/(kg?d) GLP-2 (0.5 mL),and experiment group B with 125 g/(kg?d) GLP-2 (0.5 mL),b.i.d?7 d,then all the rats were killed The villus height,mucosa thickness and crypt depth of the terminal ileum mucosa were detected.Immunohistochemistry and Western-blot were used to examine the distribution and expression of MLCK.Image analytical system and statistics software were used to analyze the results quantitately.Results The intestinal villi of the distal ileum mucosa were short and sparse in control group.Compared with control group,the average intestinal villus height,mucosa thickness and crypt depth were increased 27.8%,21.7% and 25.4%(all P0.05).The same outcomes were obtained by quantitative analysing Western blot images.The degression of intestinal villus height and absorbance of MLCK images presented direct correlation.Conclusions The intestinal mucous membrane shows obvious atrophy in obstructive jaundice.Exogenous supplemented GLP-2 can enhance the quantity and distribution of MLCK in intestinal mucosa in obstructive jaurdice,and can restore the morphology of intestinal mucosa epithelium.

Objective:To compare the calculation result and analyzes the reasons for their differences so as to provide reference for the revision and improvement of the current national standards on radiation shielding design for the room of brachytherapy.Methods:For the initial activity 10 Ci (1 Ci=3.7×10 10 Bq) of radioactive sources, the shielding schemes of brachytherapy room were designed in accordance with UK Institnte of Physics and Engineering in Medicine(IPEM) Report 75, USA NCRP Report 151 and the national standard GBZ/T 201.3-2014, respectively. The differences in shielding limits, occupancy factors and other relevant factors are compared in detail. Results:The annual exposure time in a typical brachytherpy room was about 330 h. The point-specific concrete thickness were 70, 65, 61, 70, 50 cm as required by NCRP Report 151, 41, 43, 30, 40, 39 cm by IREM regulations and 84, 79, 46, 88, 39 cm by GBZ/T 201.3, respectively. The concerned concrete shielding thickness calculated under the GBZ/T 201.3-2014 was generally thicker, with lesser difference from NCRP Report 151 result, whereas that from the IPEM75 report was thinnest. The equivalent lead shielding thicknesses of the protective doors calculated using the three method are 1.170, 0.854 and 1.040 cm, respectively.Conclusions:The shielding thickness calculated using the calculation method and evaluation index recommended by the current Chinese shielding standards for brachytherapy bunker is similar to that reported in NCRP151, but is conservative. In particular, the evaluation index of instantaneous dose equivalent rate required by the current national standards and the relative conservative value of occupancy factor will significantly increase the shielding thickness required by the main shielding area.