Objective:To study the clinical efficacy of percutaneous transhepatic cholangial drainage (PTCD) and primary closure of common bile duct after laparoscopic common bile duct exploration (LCBDE) in treatment of choledocholithiasis complicated with moderate and severe cholangitis.Methods:The clinical data of 127 patients with choledocholithiasis complicated with acute cholangitis admitted to Yantai Affiliated Hospital of Binzhou Medical University from January 2021 to August 2023 were retrospectively analyzed. Finally, 45 patients were enrolled, including 20 males and 25 females, aged (71.3±8.2) years. All 45 patients were treated with sequential PTCD and primary closure of common bile duct after LCBDE. The interval from PTCD to primary closure, white blood cell count, total bilirubin, alanine transaminase before and after PTCD, operation time of primary closure, intraoperative blood loss, postoperative retention time of abdominal drainage tube, postoperative hospitalization time, postoperative complications (bile leakage, bleeding, etc.) were analyzed.Results:The serum total bilirubin, alanine transaminase and white blood cell count of 45 patients were (143.2±32.1) μmol/L, (173.6±23.4) U/L, (16.3±2.9)×10 9/L at admission, and (100.5±21.4) μmol/L, (103.5±12.7) U/L, (8.6±1.7) ×10 9/L after PTCD, respectively. The interval between PTCD and primary closure of common bile duct after LCBDE was (4.3±1.1) d, the operative time of primary closure was (123.4±20.5) min, the amount of intraoperative blood loss was (32.6±8.7) ml. The postoperative hospitalization time was (6.8±1.6) d, and the postoperative retention time of abdominal drainage tube was (4.5±1.3) d, and postoperative complications occurred in 7 cases (15.6%), including biliary leakage in 4 cases (8.9%), subxiphoid incision infection in 1 case (2.2%), and effusion in gallbladder fossa with infection in 2 cases (4.4%). Conclusion:The sequential application of PTCD and primary closure of common bile duct after LCBDE in treatment of choledocholithiasis complicated with moderate and severe cholangitis is a safe, effective and minimally invasive method, and primary closure of common bile duct after LCBDE is safe and reliable within 1 week after PTCD.

Objective To investigate whether the gene polymorphisms of cytochrome P450(CYP) 2E1 are associated with the risk of anti-tuberculosis drug induced hepatotoxity (ADIH).Methods In this case control study, 339 patients who matched the diagnosis criteria of tuberculosis were included. The gcneral healthy status and liver biochemical parameters were checked in all these patients. Polymerase chain reaction-restriction fragment length polymorphism (PCR RFLP) technique was used to determine CYP 2Et polymorphisms. The statistic analysis were performed by using both univariate and multivariate Logistic regression analysis. Results The allele frequencies of CYP 2E1 7632T/A, 1019C/T and 1259G/C in 103 tuberculosis patients of ADIH group were 17.5%, 26.2%and 27.2 % respectively, while those in 236 tuberculosis patients of control group were 29.7 % ,39.4 %and 40.7%, respectively (x2 =5.539, P＜0.05; x2 =5.458, P＜0.05; x2 =5.628, P＜0.05). The results of univariate analysis demonstrated that the risk of concurrent ADIH was significantly higher in patients with wild genotypes of CYP 2E1-7632T/A, CYP 2E1-1259G/C, CYP 2E1-1019C/T than in patients with other genotypes. After adjusted for sex, occupation and alcohol consumption status, the results of multivariate Logistic regression analysis also showed that wild genotypes of CYP 2E1-7632T/A, CYP 2El-1259G/C, CYP 2E1-1019C/T were significantly associated with higher risk of ADIH. The results of interaction analysis indicated that the wild genotypes of CYP 2E1-7632T/A and CYP 2E1-1259G/C or CYP 2E1-1019C/T had synergetic effects on the development of ADIH.Conclusions The risk of concurrent ADIH is significantly higher in patients with wild genotypes of CYP 2E1-7632T/A, CYP 2E1-1259G/C, CYP 2E1-1019C/T compared to patients with othergenotypes. Wild genotypes of CYP 2E1-7632T/A and CYP 2E1-1259G/C or CYP 2El-1019C/T have synergetic effects on the development of ADIH.

Objective:To compare the therapeutic and toxic profile of topotecan given intraperitoneally with intravenously in human ovarian cancer xenografted into athymic nude mice.Methods: Eighty female Balb-c/nu-nu mice were randomized assigned into eight groups (n=10). Xeneografts resulted from intramesentery injection of cultured human ovarian cancer cells SKOV3 in athymic mice. Onset of intraperitoneal treatment with either topotecan or cisplatin (7.5 mg/kg) was on day 7. Animals scheduled for topotecan i.p. received intraperitoneal application of topotecan (1.5 mg/kg×2, 3.0 mg/kg×2, 6.0 mg/kg×2 or 10.0 mg/kg×1). Animals scheduled for topotecan i.v. received intravenous administration of topotecan (6.0 mg/kg×2 or 10.0 mg/kg×1). Two weeks after drug application animals were killed. Tumor growth inhibition were assessed and compared with untreated mice and cisplatin intraperitoneally administered mice. Acute toxicity was determined by loss of body weight. Cell cycle division and apoptosis after drug administration was determined by flow cytometric analysis.Results: In a panel of ten tumour xenografts, intraperitoneal topotecan was significantly more effective than intravenous administration. The toxicity profile suggested a better tolerability in terms of weight loss after intraperitoneal administration than cisplatin control. Topotecan 10.0 mg/kg i.p. per day (1 day) schedule was an optimal treatment for ovarian cancer and well tolerated by mice with no signs of acute toxicity. Topotecan and cisplatin induce cells G0-G1 arrest and apparent apoptosis. No significant difference among mice treated with topotecan intraperitoneally or intravenously or cisplatin was observed in term of apoptosis and cell cycle perturbation.Conclusion:The results may have implications for the future design of clinical studies on intraperitoneal application of topotecan. It suggests that apoptosis and cell cycle perturbation play an limited role in the mechanism of topotecan administration.

Objective To investigate surgical techniques and results of arthroscopic reduction and fixation for the treatment of avulsion fracture of the posterior cruciate ligament from the tibia through an additional posterolateral portal. Methods An additional posterolateral portal was established by using the inside-out technique under arthroscopic view.After a protective sleeve was placed through the portal and the displaced fracture was reduced,the fragment was fixed by the guide wire drilled through the sleeve temporarily.If the fluoroscopic control showed an anatomic reduction of the fragment and good placement of the wire,the self-attacked cannulated screw and washer was placed intra-articularly over the guide wire through the sleeve for the directive internal fixation of the avulsion fracture.Aggressive rehabilitation programs were recommended postoperatively.Results Except 1 case with 11 mm displacement and rotation of the fragment treated by the arthrotomy after the failure of arthroscopic reduction,the arthroscopic operation was accomplished in all the remaining 10 cases.The operative time was 63～98 min(mean,87.3 min).No injuries of popliteal vessels or nerves occurred.The postoperative X-ray firms showed an anatomic reduction of the fragment and good placement of the screw and washer.With the negative posterior drawer test confirmed by the physical examination,normal range of motion of the injured knee joint and gait were achieved in the 10 patients at 4～7 weeks after surgery.The bone union was confirmed by X-ray films at the 3 months postoperatively.The computer KT-2000 arthrometer measurements of posterior tibial displacement of both knee joints showed side-to-side difference not more than 1.2 mm in 6 patients at 5 months after surgery.Conclusions The additional posterolateral portal can be established by the arthroscopic inside-out technique safely.The displaced fragment of the avulsion fracture of the posterior cruciate ligament from the tibia can be reduced and fixed with the self-attacked cannulated screw and washer arthroscopicly.

AIM:To investigate the effect of neuropeptide Y(NPY) on intracellular free calcium([Ca2+]i) and Ca2+ sarcoplasmic reticulum of cardiomyocytes in rats.METHODS:Cardiomyocytes of neonatal Sprague-Dawley rats were incubated with NPY at concentration of 100 nmol/L for 24 h.Fluorescent indicator Fluo-4 AM was used to detect [Ca2+]i and Fluo-5N AM was used to detect Ca2+ in sarcoplasmic reticulum(SR).Calcium image was recorded by laser scanning confocal microscope.The SR Ca2+ load was estimated by caffeine-induced Ca2+ transient(CCT).RESULTS:24 h after incubation with NPY,compared with control group,the concentration of [Ca2+]i was significantly elevated(P

AIM: To investigate the effect of cycloheximide on the T cells activation by mitogen in vitro with CD69 expression as activation marker for the application of this drug clinically. METHODS:Lymphocytes were isolated from lymphoid nodes of C57BL/6 mouse. The cells were preincubated with cycloheximide(CHX), 5% serum containing CHX respectively for an hour, then further incubated with polyclonal activators (Con A or PDB). Harvesting the cells after whole incubation for 24 h, we estimated the expression rates of CD69 on T cells by flow cytometry following two-color immunofluorescent staining. RESULTS: The expression rates of CD69 on the T cells preincubated with CHX, serum containing CHX after the stimulation in response to Con A or PDB all showed significant difference with the expression rates of control group, respectively ( P

AIM To study the effects of ternatolide(tern) on expression of granulysin mRNA in the activated peripheral blood lymphocytes(PBLS) of the adults and children with pulmonary Mycobacterium tuberculosis(PMTB). METHODS Using competitive quantitative reverse transcription polymerase chain reaction(QC TR PCR)analyze granulysin gene expression in the PBLs. RESULTS The dosage of 100 mg?L -1 , 200mg?L -1 of ternatolide significantly enhanced the granulysin mRNA experession in PBLs in vitro stimulated phytohemagglutinin (PHA) from adults and children with PMTB (P0 05). CONCLUSION The molecular mechanism of tern. against intracellular pathogens might be associated with the inducting highly level on the expression of granulysin mRNA, a anti bacterial peptide in activated human cytotoxic lymphocytes.