Objective To explore the role of choledochofiberscopy in the diagnosis and treatment of biliary complication after orthotopic liver transplantation.Methods The patients with continuous biliary infection and obstructive jaundice in 6 cases subject to orthotopic liver transplantation were treated by choledochofiberscopy through T tube sinus tract. The findings from choledochofiberscope at different periods after operation were recorded.Results Three to five months after operation, there were a lot of flocs in the bile duct cavity under the choledochofiberscopy, and mucous membrane of bile duct was pale or coarse. On the postoperative month 6, 11 and 18, choledochofiberscopy revealed there were funicular, columned and brown biliary stones in bile duct cavity which mostly located in porta hepatis, and there existed stenosis in anastomotic stoma of bile duct to varying degrees; the wall of bile duct was coarse, with congestion of the mucous membrane. The flocs and stones could be extracted conveniently by the choledochofiberscope.Conclusion We can observe the transplanted liver’s bile duct through the T tube sinus tract by the choledochofiberscopy and treat the biliary complications conveniently.

BACKGROUND: Complications, caused by bile duct injury after liver transplantation, are difficult for diagnosis and treatmerit and the bottlenecks for the development of liver transplantation. OBJECTIVE: To observe and record bile duct injury and do biopsy in parallel with treating biliary complications following liver transplantation successfully with choledochoscope, and to analyze the relationships between various bile duct injuries, histopathological types and biliary complications following liver transplantation. DESIGN, TIME AND SETTING: Case analysis was carried out at Dalian Institute of Hepatobiliary Surgery, Department of Hepatobiliary Surgery. Dalian Friendship Hospital between July 2001 and October 2005. PARTICIPANTS: Nineteen patients after liver transplantation were divided into three groups according to the occurrence of biliary complications: four cases for normal group, twelve cases for bile duct injury group, three cases for hepatic artery miury group. METHODS: They were observed. diagnosed and recorded respectively and take biopsy for pathological analysis through the choledochoscope. With regard to the cases without T-tube. Choledochoscope combined duodenoscope were used to take biopsies. MAIN OUTCOME MEASURES: Choledochoscope was used to observe T-tube cholangiography, the appearances and pathological changes of intemal and external bile duct mucous membrane. healing of the donor-receptor bile duct stoma. Patients in the bile duct injury group were done examinations described above after endoscopic stone extraction and stenosis expansion. RESULTS: The intemal and extemal bile duct anatomy of the patients in the normal group were normal, without bile ductstenosis and scar, their bile duct mucous membrane lookcd good, and the anastomosis of the donor-receptor bile duct healed well. Restored mucous tissue coating with intact epithelium was found by pathological examination. Various kinds of bile duct stones, simple, multiple and casting mould stones, were found in patients of the bile duct injury group. Bile duct mucous membranes were injured at different degrees and repaired after removing stones and relieving obstruction by endoscope. Contrast examination demonstrated that bile duct tree regained normal. In hepatic artery injury group, patients had bile duct wall ischemic necrosis and lost bile duct normal structure, congestion was obvious, biliary sludge and stones completely filled in the bile duct tree. Interrupted bile duct structure were found in Ⅲ grade bile ducts.Pathological examination revealed extensive bile duct wall necrosis,indistinct strcture,more bile infiltration,proliferative granulation tissue and suppuration focus.CONCLUSION:Bile ducts are injured at different degrees in orthotopic liver transplantation;cold preservation/repeffusion injury is the most important initiating agent leading to bile duct tree injuries;the vessel plexus damage and microcirculatory disturbance surrounding the bile ducts maybe one of the mechanisms of the bile duct injury.

Objective To provide information and assistance for research of bile duct injury in OLT through endoscopic observation and treatment of biliary complications after liver transplantation.Methods After OLT, all the cases in normal group, bile duct injury group and hepatic artery injury group were observed, diagnosed and recorded respectively. Meanwhile, the biopsy was performed through the endoscopy for pathological examination. For those cases without T tube, the biopsy was conducted by choledochoscopy in combination with duodenoscopy. Results The exterior and interior bile duct anatomy of the 9 cases in the normal group was normal. They had no bile duct stenosis and scar, their bile duct mucous membrane looked good and the anastomosis of the donor-receptor bile duct healed well. Restored mucous tissue coating with intact epithelium was found by pathological examination. Fibrous tissue and small vascular proliferation happened under epithelium scattered with plasmocyte and lymphocyte. Various kinds of bile duct stones-simple, multiple and casting mould type, were found in 12 cases with bile duct injury. Bile duet mucous membrane injured in different degrees was repaired after stone removed and obstruction relieved by endoscope. Bile duct tree becoming normal was seen by pacification examination. Three cases in the hepatic injury group had bile duct ischemic necrosis, losing of normal structure without bile duct wall and mucous membrane. Conclusion Bile ducts are injured in different degrees in OLT. The choledochofibroscopy is of the first choice for diagnosis and treatment of complications after OLT.

Objective To investigate the prognostic significance of extended resection for locally advanced colorectal carcinoma. Methods Clinical data of 960 cases of colorectal cancer hospitalized for surgery between Jan 1995 and Dec 2002 were reviewed, and complication rates, perioperative mortality, 5-year survival were calcualated, prognostic factors were analyzed using Cox regression model. Results Sixty-six patients with locally advanced colorectal carcinoma were treated with extended resection, accounting for 6.9% of the total cases. Surgical complication rate in this subgroup was 27.3% (18/66), relatively higher than that of conventional resection for colorectal carcinoma (?~2 =8.82, P=0.002). The perioperative mortality was zero. Pathology showed that carcinoma invasion into the adjacent organs resected en bloc was 31% (27/88), the 5-year survival rate was 62%. The tumor spreading into the adjacent organ (Wald=7.42,P=0.005) and lymph node status (Wald=4.55, P=0.035) were found to be the independent prognostic factors. Conclusions Extended resection for locally advanced colorectal carcinoma resulted in a favorable prognosis. Postoperative complication was relatively high, but still acceptable.

BACKGROUND:Biliary stricture following liver transplantation is mainly focus on biliary stoma stricture; while, balloon dilatation temporarily keeps biliary tract open but not works out a solution at all.OBJECTIVE: To discuss the diagnosis and treatment of postoperative biliary stricture after orthotopie liver transplantation by the endoscope technique.DESIGN, TIME AND SETTING: A case analysis, which was performed at Dalian Liver and Gall Surgical Institute. Ten patients hospitalized from the Department of Liver and Gall Surgery of Dalian Friendship Hospital and four patients hospitalized from the Department of Organ Transplantation of Tianjin First Central Hospital were diagnosed as biliary stricture after orthotopic liver transplantation.PARTICIPANTS: Among 14 patients, 10 males and 4 females with mean age of 46 years provided end-to-end biliary anastomose.METHODS: Fourteen cases of postoperative biliary stricture after orthotopic liver transplantation were analyzed and diagnosed by endoscope technique. And by endoscope technique, the stricture was supported with tube after balloon dilatation.MAIN OUTCOME MEASURES: Bile duct mucous membrane under T-tube radiography and endoscope; calculary distribution and bile duct mucous membrane at stoma; healing of biliary stoma of donors and recipients; inflammatory edema and stricture; recheck of above-mentioned parameters after stricture expansion by endoscopic stone extraction technique.RESULTS: Thirteen cases of postoperative biliary stricture after orthotopic liver transplantation were analyzed and diagnosed by endoscope technique, including one was induced by calculus, and one non-stoma stricture. One case was treated with balloon dilation; biliary infection and jaundice occurred in 2 cases after endoscopic sphincterotomy (EST) + basket lithotripsy + endoscopic nasobiliary drainage (ENBD), so operations or fibrocholedochoscope treatments had to be carried out. By T tube radiography, in 1 case there was strip-like negative simulacrum or no stricture, well-healed anastomosis and good mucous membranel transition; poor or no intrahepatic visualization were found in 2 cases, so anastomosis dilation was processed after the calculi removal by fibrocholedochoscope, stricture disappeared in 3 or 4 months; in 8 cases there were blur extrahepatic or intrahepatic biliary visualization, cord-like, column or branch-like negative simulacrum in biliary ducts and sign of non-anastomosis stricture, after removal of calculi, anastomosis stricture and congestion, edema were found, all these disappeared after average 2.5 months of dilation; the other 1 case was found stricture by T the radiography, but no calculi was found with fibrocholedochoscope, finally the Ttube was removed after 2 months of stricture dilation.CONCLUSION: Endoscopy is significant to directly reflect and reliably diagnose postoperative biliary stricture and effectively treat biliary stricture by anastomosis dilation.

Carcinoma, Non-Small-Cell Lung ; diagnosis ; surgery ; Humans ; Lung Neoplasms ; diagnosis ; surgery ; Pneumonectomy ; methods ; Prognosis ; Thoracic Surgery, Video-Assisted ; methods

Objective The pathogenesis of urinary tract infection and the preventive effect of Bacillus Calmette Guerin on bladder cancer imply the importance of bladder as a unique mucosal surface research. This article discussed that after bladder infected by bacteria,the way in which the microenvironment produce adaptive immunity. Once in the past, bladder is widely considered to be a sterile environment, the concept has been recently shaken. It is suggested that we should further study the influence of urinary tract pathogen infection or BCG immune response. In this paper, bladder biology has been illustrated, and bladder organ immunity is urgently needed to be explored and defined.

Background: Androgenetic alopecia (AGA) leads to thinning of scalp hair and affects 60%~70% of the adult population worldwide. Developing more effective treatments and studying its mechanism are of great significance. Previous clinical studies have revealed that hair growth is stimulated by 650-nm red light. Objective: This study aimed to explore the effect and mechanism of 650-nm red light on the treatment of AGA by using ex vivo hair follicle culture. Methods: Human hair follicles were obtained from hair transplant patients with AGA. Hair follicles were cultured in Williams E medium and treated with or without 650-nm red light.Real-time RT-PCR and immunofluorescence staining were used to detect the expression level of genes and proteins in hair follicles, respectively. RNA-sequencing analysis was carried out to reveal the distinct gene signatures upon 650 nm treatment. Results: Low-level 650 nm red light promoted the proliferation of human hair follicles in the experimental cultured-tissue model. Consistently, 650 nm red light significantly delayed the transition of hair cycle from anagen to catagen in vitro. RNA-seq analysis and gene clustering for the differentially expressed genes suggests that leukocyte transendothelial migration, metabolism, adherens junction and other biological process maybe involved in stimulation of hair follicles by 650-nm red light treatment. Conclusion The effect of 650-nm red light on ex vivo hair follicles and the transcriptome set which implicates the role of red light in promoting hair growth and reversing of miniaturization process of AGA were identified.

Damp-heat syndrome is one of the common syndromes of various clinical diseases.Current studies have shown that intestinal flora is closely related to damp-heat syndrome,but the specific molecular biological mechanism related to intestinal flora and damp-heat syndrome is not yet clear.In this paper,the molecular biological mechanism of damp-heat syndrome is discussed from the perspective of intestinal flora related signaling pathways,so as to provide ideas for the essence of damp-heat syndrome and clinical diagnosis and treatment.

Objective:To compare the effects of thoracoscopic anatomical segmentectomy and thoracoscopic lobectomy on patients' respiratory function.Methods:Retrospective analysis of 326 patients who underwent thoracoscopic surgery from July 2016 to July 2019(209 patients underwent anatomical segmentectomy, 117 patients underwent lobectomy). According to variables including gender, age, tumor location, smoking history and BMI, two propensity score-matched cohorts including 89 patients respectively were constructed. The patients’ baseline data and respiratory function date of the patients pre-operation and post-operation were analyzed. The measurement data that obey the normal distribution were described by mean±standard deviation, and the t-test was used for comparison between groups; the measurement data of non-normal distribution was described by the median value( P25, P75), and the Wilcoxon rank sum test was used for the comparison between groups; The data was described by frequency, and the chi-square test or Fisher's exact probability method was used for comparison between groups. Results:At the first-month follow-up after surgery, there was no significant difference in the variation of FVC[(0.48±0.40)L vs.(0.34±0.37)L, P=0.215)and FEV1[(0.52±0.46)L vs.(0.43±0.77)L, P=0.364), and in the change rate of FVC(%)[15.23(8.74, 21.25) vs. 14.58(7.75, 19.40), P=0.122], FEV1(%)[17.25(9.56, 22.78) vs. 16.42(9.15, 20.28), P=0.154]and DLCO(%)[18.54(10.88, 25.68)vs. 17.45(9.58, 23.75) P=0.245]. Between the segmentectomy group and lobectomy group, there was a significant difference in the alteration of FVC[(0.50±0.47)L vs. (0.29±0.31)L, P=0.031] and FEV1[(0.44±0.34)L vs.(0.24±0.23)L, P<0.001], the change rate of FVC(%)[14.27(7.87, 22.32) vs. 9.95(5.56, 17.24), P=0.008]、FEV1(%)[15.23(8.36, 22.17)vs. 10.05(5.15, 18.54), P<0.001]and DLCO(%)[13.74(6.24, 19.78) vs. 4.45(-2.32, 13.75), P=0.023]in the 6th month after surgery. The lobectomy group had a higher variation of FEV1[(0.34±0.49)L vs.(0.18±0.26)L, P=0.006] and change rate of FVC(%)[9.28(2.15, 18.94) vs. 5.24(0.52, 11.45), P=0.0032] and FEV1(%)[10.45(3.15, 21.32) vs. 6.50(1.55, 14.24), P<0.001] in the first year after surgery. However, the variation of FVC[(0.29±0.36)L vs.(0.21±0.24)L, P=0.176) and the change rate of DLCO(%)[8.35(2.15, 16.45) vs. 6.23(2.12, 14.54), P=0.143] didn't show a significant difference between the two groups. Conclusion:Whether in the short or the middle postoperative period, segmentectomy can preserve postoperative respiratory function than lobectomy.