Objective To investigate the effective strategies to prevent and treat biliary complications after orthotopic liver transplantation.Methods The clinical data of 316 patients who received orthotopic liver transplantation at the Fuzhou General Hospital of Nanjing Military Command from November 2001 to March 2012 were retrospectively analyzed.Cold perfusion with HTK + UW solution was applied when obtaining the liver graft,and then the liver graft was preserved in the UW solution.The bile duct was perfused with UW solution thereafter.Orthotopic liver transplantation or piggyback liver transplantation were adopted in the cadaver liver transplantation.Left liver transplantation and right liver transplantation were adopted in the living donor liver transplantation.Choledochojejunal Roux-en-Y anastomosis or duct-to-duct choledochostomy were used for biliary reconstruction.Ordinary T tubes were used for drainage before 2006,and then 6 F pediatric suction catheter or epidural catheter were applied for drainage thereafter.The Ttube was pulled out 3-6 months after the operation.Enteral nutrition was applied to patients at the early phase after operation.The immunosuppressive agents used including tacrolimus + mycophenolatemofetil + adrenal cortical hormone,and for some patients,tacrolimus + mycophenolatemofetil + sirolimus + hormone were used.Patients were followed up for 2 years to learn the incidence of biliary complications and guide the medication.The difference in the incidence of bile leakage between patients who wcrc admitted before 2006 and those admitted after 2006 were compared using the chi-square test.Results The warm ischemia time was 2-6 minutes,and the cold ischemia time was 3-10 hours.For patients who received cadaver liver transplantation,orthotopic liver transplantation was carried out for 291 times and piggyback liver transplantation for 24 times; biliojejunal Roux-en-Y anastomosis was carried out for 5 times and bile duct end-to-end anastomosis for 310 times.For patients who received living donor liver transplantation,1 received left liver transplantation and 1 received right liver transplantation,and they received bile duct end-to-end anastomosis.A total of 311 patients received immunosuppressive treatment with tacrolimus + mycophenolatemofetil + adrenal cortical hormone,and 5 patients reveived tacrolimus + mycophenolatemofetil + sirolimus + hormone.Of the 316 patients who received orthotopic liver transplantation,38 had biliary complications after the operation,including bile leakage in 18 patients,intra-and extra-hepatic bile duct stricture in 6 patients,anastomotic stricture in 6 patients,biliarycomplications included cholangitis in the portal area and cholestasis in 4 patients,choledocholithiasis and cholangitis in 2 patients and biliary infection in 2 patients.The incidence of bile leakage before 2006 was 14.00％ (7/50),which was significantly higher than 4.12％ (11/267) of bile leakage after 2006 (x2-7.676,P ＜ 0.05).Of the 38 patients with biliary complications,the condition of 35 patients was improved,and 3 patients died.Of the 18 patients with bile leakage,15 was cured by conservative treatment,3 received surgical treatment (the condition of 1 patient was improved by drainage,anti-infection treatment and nutritional support,but died of peritoneal hemorrhage at postoperative 1 month; 2 patients received peritoneal drainage,1 was cured and 1 died of peritoneal infection).For the 6 patients with intra-and extra-hepatic bile duct stricture,1 was cured by liver retransplantation and 5 were cured by conservative treatment,endoscopic retrograde cholangio-pancreatography (ERCP) or balloon dilation.For the 6 patients with anastomotic stricture,the condition of 3 patients was improved by conservative treatment,balloon dilation or stent implantation,1 gave up treatment due to hepatic cancer recurrence and died thereafter,1 received anastomosis + T tube drainage,1 was cured by recurrent tumor resection and choledochojejunostomy.Four patients with cholangitis in the portal area and cholestasis were cured by conservative treatment.For the 2 patients with choledocholithiasis and cholangitis,1 was cured by stent implantation with ERCP,and 1 received conservative treatment,and the level of total bilirubin was decreased.Two patients with biliary infection were cured by anti-infection treatment.Conclusions Most of the biliary complications could be treated by non-surgical treatments.For patients with severe biliary complications or those could not be treated by non-surgical treatment,re-exploration of the bile duct is effective.Liver re-transplantation is the only choice for patients with dysfunction of liver graft caused by severe ischemic biliary injury.

ObjectiveTo investigate the association of single nucleotide polymorphisms (SNPs)of rs11833579 and rs12425791 on chromosome 12pl3 with cerebral infarction in the Fujian Han population.MethodsA case-control association study containing a total of 216 cases and 279 controls was carried out.The genotypes of two polymorphisms were evaluated by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and direct DNA sequencing followed by association analysis.Results The frequency of G ＞ A genotype of rs12425791 in patients with cerebral infarction was lower than that in the controls (34. 3％ vs 43.4％ , x2 = 4. 298 ,P ＜ 0. 05 ) after stratified by causes of cerebral infarction, there was no significant difference in this genotype between large-artery atherosclerosis and controls.Association analysis was performed by logistic regression model after adjusting by sex, age, hypertension, diabetes mellitus, dyslipidemia, smoking and drinking. Rs12425791 G ＞ A genotype was significantly associated with both cerebral infarction ( OR = 0. 627, 95％ CI 0. 417-0. 941, P = 0. 024 ) and large-artery atherosclerosis ( OR =0. 613, 95％ CI 0. 396-0. 949 ,P =0. 028). G ＞ A genotype might be a potential protective factor in male( OR =0. 597, 95％ CI 0. 364-0. 978, P =0. 041 ). rs11833579 G ＞ A genotype frequency was similar between cases and controls.Conclusion rs12425791 G ＞ A on chromosome 12p13 might be a genetic marker for atherothrombotic brain infarction in Han population of Fujian.

Objective To investigate the methods for reconstructing portal vein in liver transplantation patients with grade Ⅳ portal vein thrombosis.Methods Clinical data of 6 patients with grade Ⅳ portal vein thrombosis who underwent liver transplantations were analyzed retrospectively.Different portal vein reconstructing approaches were applied: 4 patients underwent portal vein anastomosis with internal organ varicosis vein (group A),and 2 patients underwent portal vein arterialization (group B). Portal venous flow was monitored by intraoperative ultrasound and postoperative liver function was tested periodically during follow-up.Results In group A,one patient died of celiac infection 2 months post-transplantation.The remaining three patients were followed up for 14-17 months,and their portal veins remained smooth without thrombosis and with mitigated esophageal varicosity.In group B,one patient,with recurrent upper gastrointestinal bleeding,died of celiac infection 47 days after liver transplantation.The patient was followed up for 33 months with satisfactory liver and kidney functions although stomach esophagus varicosity was aggravated.Portal vein blood flow in groups A and B was 1258 ± 345 and 2275 ± 247 ml/min respectively after anastomosis by intraoperative color Dopplar ultrasound monitoring. Aspertate aminotransferase (AST) in group B was significantly lower on the fourth day after liver transplantation,and alanine aminotransferase (ALT) in group B was significantly lower on the 3rd,4th,5th and 6th day after liver transplantation than in group A (all P＜0.05).Serum total bilirubin (TBIL) had no statistically significant difference during the 10 days post-operation (P＞0.05).Conclusion Patients with grade Ⅳ portal vein thrombosis may achieve a satisfactory clinical effect by reconstructing portal vein through anastomosis of donor portal vein with internal organ? varicosis vein.PVA may be associated with early recovery of graft function and may be an effective remedial measure for patients with grade Ⅳ portal vein thrombosis who undergo liver transplantation.

OBJECTIVETo investigate the effects of the quinoline derivative PQ1 combined with cisplatin on the proliferation and gap junction communication of prostate cancer PC3 cells.

METHODSWe cultured in vitro prostate cancer PC3 cells and divided them into DMSO blank control, cisplatin control, and cisplatin (10 mg/ml) plus PQ1 (1, 2, 5, 10, and 15 μmol/L) groups. We measured the proliferation of the prostate cancer PC3 cells, determined the expressions of the connexin 43 (Cx43) mRNA and protein by RT-PCR and Western blot, and compared the indexes among different groups.

RESULTSCisplatin combined with PQl at 1 - 10 μmol/L significantly inhibited the proliferation of the PC3 cells and the inhibition rate rose in a concentration- and time-dependent manner, from (48.72 ± 0.98)% vs (50.33 ± 0.62)% at 0 μmol/L to (77.38 ± 1.12)% vs (83.50 ± 1.05)% at 15 μmol/L at 24 and 48 hours (P < 0.05). Compared with the cisplatin control, cisplatin combined with PQ1 at 1, 2, 5, 10, and 15 μmol/L increased the expression of Cx43 mRNA from 0.379 ± 0.113 to 0.669 ± 0.031, 0.831 ± 0. 127, 0.769 ± 0.100, 0.532 ± 0.086, and 0.475 ± 0.134, respectively (P < 0.05), and cisplatin combined with PQ1 at 1, 2, 5, and 10 μmol/L elevated that of Cx43 protein from 0.138 ± 0.146 to 0.263 ± 0.111, 0.306 ± 0.152, 0.415 ± 0.280, and 0.643 ± 0.310, respectively (P < 0.05).

CONCLUSIONThe quinoline derivative PQ1 can promote the gap junction communication of prostate cancer PC3 cells and enhance the killing effect of cisplatin on PC3 cells by upregulating the expressions of Cx43 mRNA and protein.

Aminoquinolines ; pharmacology ; Antineoplastic Combined Chemotherapy Protocols ; pharmacology ; Cell Line, Tumor ; Cell Proliferation ; drug effects ; Cisplatin ; pharmacology ; Connexin 43 ; genetics ; metabolism ; Dose-Response Relationship, Drug ; Gap Junctions ; drug effects ; physiology ; Humans ; Male ; Prostatic Neoplasms ; metabolism ; pathology ; physiopathology ; RNA, Messenger ; metabolism ; Time Factors

Objective: To analyze the clinical pathologic characteristics of cases with fluorescence in situ hybridization (FISH) positive of exfoliated urothelial cells, so as to evaluate the clinical utility of FISH in the diagnosis of urothelial carcinoma (UC).Methods: A total of 271 cases of FISH positive in Department of Urology of Peking University First Hospital from Apr.2012 to Sep.2015 were recruited in this study.Retrospective analysis was made on their clinical data.For FISH analysis, labeled probes specific for chromosomes 3, 7, 17, and the p16 (9p21) gene were used to assess chromosomal abnormalities indicative of malignancy.The positive predict values (PPV) of all the techniques were analyzed.Results: Of the 271 patients, 207 cases were UC, 7 cases were non-UC, and 57 cases were benign diseases.The PPV of FISH in detecting UC was 76.4%, while the 95% confidence interval (CI) 71.3% to 81.5%.In the cohort of FISH positive, this value was similar to that of urinary cytology (PPV 86.8%, 95% CI: 78.5%-95.0%).The PPV of FISH was lower than that of cystoscopy and ureteroscopy (PPV 96.1%, 95% CI: 91.7%-100.0%).There were significant differences between this study and the PPV of FISH reported abroad (PPV 53.9%, χ2=33.048, P<0.001).Of all the UC with FISH positive, bladder cancer showed an earlier pathological stage versus renal pelvic carcinoma and ureteral carcinoma, with significance (χ2=5.894, P=0.015, and χ2=13.601, P<0.001, respectively).However, no difference was found in the size, pathological stage and pathological grade of tumors between the urinary cytology positive group and the urinary cytology negative group.The rate of high-grade UC in ureteral carcinoma of FISH positive was 92.3%, much higher than that of ureteral carcinoma reported domestically.Conclusion: The PPV of FISH in detecting UC is higher relatively, with a better clinic value for Chinese patients.The ureteral carcinoma with FISH positive obtains a higher pathological grade, which is of great guiding significance for UC.

OBJECTIVETo investigate the factors upgrading the International Society of Urological Pathology (ISUP) Gleason score using the specimens from preoperative prostatic biopsy and radical prostatectomy.

METHODSA total of 164 patients diagnosed with prostate cancer by biopsy underwent radical prostatectomy. We retrospectively analyzed their age, prostate volume, preoperative PSA level, PSA density (PSAD) , the time interval between biopsy and surgery, the number of positive punctures, positive surgical margin, seminal vesicle invasion, lymphatic invasion, and Gleason scores from biopsy and prostatectomy. We also determined the predictors of Gleason score upgrading by logistic regression analysis.

RESULTSOf the 164 cases analyzed, 95 (57.93% ) showed a consistency between the Gleason score of preoperative prostatic biopsy and that after radical prostatectomy, 55 (33.54% ) increased and 14 (8.52%) decreased after prostatectomy as compared with preoperative biopsy. The prostate volume (P < 0.01) and biopsy score (P < 0.05) were independent predictors of Gleason score upgrading. The risk of Gleason score upgrading was 27 times higher in the patients with the prostate volume ≤ 25 ml and 9 times higher in the 25-40 ml group than in the > 60 ml group (P < 0.05).

CONCLUSIONLow Gleason score of biopsy (≤ 6) and small prostate volume (≤ 40 ml) may be the predictors of Gleason score upgrading after radical prostatectomy.

Biopsy ; Humans ; Male ; Neoplasm Grading ; Organ Size ; Prostate-Specific Antigen ; blood ; Prostatectomy ; Prostatic Neoplasms ; classification ; surgery ; Retrospective Studies ; Risk Factors

OBJECTIVETo assess micronutrients level in children with short bowel syndrome.

METHODSClinical data of 17 children with short bowel syndrome from April 2004 to July 2006 were collected. They received the measurement of serum vitamin A, E and - carotene by high performance liquid chromatography (HPLC).

RESULTSThere were 9 boys and 8 girls with age range of 3 months to 18 years. Eleven children did not need parenteral nutrition (PN), and 6 still depended on PN. Six cases were free of ileocolic valve and 11 cases had ileocolic valve. The length of remaining intestine was more than 75 cm in 5 patients and less than 75 cm in 12 patients. Among 11 cases without PN, 9 were tested for serum iron, zinc and copper levels. Their incidences of below the reference value of vitamin A, E and beta - carotene were 23.5%, 35.3% and 58.8%, respectively. The incidences of below the reference value of vitamin A and beta - carotene were higher in patients with weaned PN, less than 75 cm remaining intestine and without ileocolic valve. The patients with more than 75 cm remaining intestine and still with PN had a higher incidence of below the reference of vitamin E, but the incidence was similar in the patients with or without ileocolic valve. Serum zinc was lower than normal level in 3 cases and serum iron was low in 1 case.

CONCLUSIONSupplement of extra micronutrients is essential for short bowl syndrome patient whatever they receive the PN or have normal diets, and follow- up is recommended.

Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Micronutrients ; blood ; Nutrition Assessment ; Nutritional Status ; Parenteral Nutrition ; Short Bowel Syndrome ; blood ; therapy ; Treatment Outcome

Berberine, an isoquinoline alkaloid isolated from some Chinese medicinal herbs such as Coptidis rhizoma, has been used for the treatment of diarrhea and other gastrointestinal infections as an antibacterial drug in Chinese medicine. In recent years, it was reported to have beneficial effects on the metabolism disorders states of diabetes. The mechanisms involve many aspects of the diabetes, including regulating the blood cholesterol and triglyceride, lowering blood glucose, ameliorating the insulin resistant state and influencing the function of the pancreatic beta cell.
Animals ; Berberine ; isolation & purification ; pharmacology ; Blood Glucose ; metabolism ; Coptis ; chemistry ; Diabetes Mellitus ; metabolism ; Drugs, Chinese Herbal ; isolation & purification ; pharmacology ; Humans ; Insulin ; metabolism ; secretion ; Insulin-Secreting Cells ; drug effects ; Metabolic Diseases ; metabolism ; Nicotinamide Phosphoribosyltransferase ; biosynthesis ; genetics ; Plants, Medicinal ; chemistry ; Protein Kinases ; metabolism ; RNA, Messenger ; metabolism ; Receptors, LDL ; genetics ; metabolism ; Signal Transduction

OBJECTIVETo investigate the essential role and mechanism of TRPC6 gene in the development of gastric cancer.

METHODSThe expression of TRPC6 protein was assessed in gastric cancer tissues and normal tissues adjacent to the cancer from 30 patients with gastric cancer. The inhibiting effect of TRPC6 activity on cell growth, cell cycle of a human gastric cancer cell line AGS cells, tumor progression and development of xenografted human gastric cancer in a mouse model was tested using dominant-negative mutant TRPC6 (DNC6). The survival of mice bearing xenografted tumors in the GFP and DNC6 was compared using Kaplan-Meier analysis. All statistical tests were two-sided.

RESULTSThe TRPC6 protein in the tumor tissues and para-tumor tissues was (21.60 ± 8.32)% versus (7.14 ± 2.24)%. After transfection of DNC6 virus for 24 hours, 48 hours, 72 hours and 96 hours, the growth inhibition rates of gastric cancer cells were (36.90 ± 1.13)%, (44.06 ± 2.17)%, (52.12 ± 2.76)% and (50.89 ± 1.97)%, respectively. The clone formation rates of control group and DNC6 group were (14.70 ± 3.00)% versus (43.80 ± 7.00)%. After transfection with DNC6 virus for 0, 24, 36 and 48 hours, the G(2)/M phase arrest was (20.34 ± 1.98)%, (24.31 ± 2.37)%, (27.70 ± 2.36)%, (35.10 ± 3.0)% in the DNC6 group and (18.40 ± 2.01)%, (18.0% ± 1.72)%, (17.50 ± 1.74)%, (16.80 ± 1.71)% in the control group, respectively. Inhibition of TRPC6 activity also reduced the subcutaneous tumor volume in the mouse models with xenografted human tumors (P < 0.05).

CONCLUSIONIn the preclinical models tested, TRPC6 channels are essential for gastric cancer development via regulation of G(2)/M phase transition.

Adenoviridae ; genetics ; Animals ; CDC2 Protein Kinase ; Cell Cycle ; Cell Line, Tumor ; Cell Proliferation ; Cyclin B ; metabolism ; Cyclin-Dependent Kinases ; Humans ; Male ; Mice ; Mice, Inbred BALB C ; Mice, Nude ; Neoplasm Transplantation ; Recombinant Proteins ; metabolism ; Stomach Neoplasms ; genetics ; metabolism ; pathology ; TRPC Cation Channels ; metabolism ; TRPC6 Cation Channel ; Transfection ; Tumor Burden

OBJECTIVETo investigate the value of laparoscopic virtual reality simulator in laparoscopic suture ability training of catechumen.

METHODSAfter finishing the virtual reality training of basic laparoscopic skills, 26 catechumen were divided randomly into 2 groups, one group undertook advanced laparoscopic skill (suture technique) training with laparoscopic virtual reality simulator (virtual group), another used laparoscopic box trainer (box group). Using our homemade simulations, before grouping and after training, every trainee performed nephropyeloureterostomy under laparoscopy, the running time, anastomosis quality and proficiency were recorded and assessed.

RESULTSFor virtual group, the running time, anastomosis quality and proficiency scores before grouping were (98 ± 11) minutes, 3.20 ± 0.41, 3.47 ± 0.64, respectively, after training were (53 ± 8) minutes, 6.87 ± 0.74, 6.33 ± 0.82, respectively, all the differences were statistically significant (all P < 0.01). In box group, before grouping were (98 ± 10) minutes, 3.17 ± 0.39, 3.42 ± 0.67, respectively, after training were (52 ± 9) minutes, 6.08 ± 0.90, 6.33 ± 0.78, respectively, all the differences also were statistically significant (all P < 0.01). After training, the running time and proficiency scores of virtual group were similar to box group (all P > 0.05), however, anstomosis quality scores in virtual group were higher than in box group (P = 0.02).

CONCLUSIONThe laparoscopic virtual reality simulator is better than traditional box trainer in advanced laparoscopic suture ability training of catechumen.

Adult ; Computer Simulation ; Humans ; Inservice Training ; Laparoscopy ; education ; Male ; Suture Techniques ; education