Odontogenic Carcinosarcoma: An Updated Literature Review and Report of a Case.

BACKGROUND: Odontogenic carcinosarcoma (OCS) is an exceptionally rare malignant mixed odontogenic neoplasm, which mostly arises from recurrent benign odontogenic tumour that undergoes malignant transformation. METHODS: A literature review was conducted using the keyword of "Odontogenic carcinosarcoma" and all relevant articles were screened. The data collected include demographic profile (age, gender), clinical information (symptoms, location, size), radiologic features, histopathological examination, management, recurrence, metastases, and survival status. RESULTS: A total of 17 OCS cases including a new case from our hospital. The incidence of OCS was highest in the third decades of life with predilection for male and posterior region of mandible. Clinically, patients may present with swelling and neurological symptoms. Radiographic examination often showed radiolucency with ill-defined border. This tumour demonstrates an aggressive behaviour with reported cases of distant metastases to the lung, lymph nodes, rib, and pelvis. Here, we report an interesting case of OCS in a 38-year-old man with a previous diagnosis of ameloblastoma. The patient was diagnosed with ameloblastoma but refused surgical intervention and returned after 10 years with rapidly enlarging mass on the right side of mandible. Microscopically, the lesion appears as biphasic odontogenic tumour with malignant cytological features seen in both epithelium and mesenchymal components. The spindle to round mesenchymal tumour cells were only positive for vimentin. Ki67 proliferation index was high in both epithelium and mesenchymal components. CONCLUSION: This case showed the tendency of untreated ameloblastoma to undergo malignant changes in the long term.

Multivariate Analysis on Orofacial Odontogenic Infection in Northern Peninsular Malaysia.

PURPOSE: This regional 2-center study was designed 1) to analyze the clinical features of all patients with odontogenic orofacial infection as per type of visit, 2) to analyze the clinical features of diabetic patients compared with nondiabetic patients, and 3) to identify potential variables that may associate with long length of stay (LOS) of patients admitted for orofacial odontogenic infection in Northern Peninsular Malaysia. PATIENTS AND METHODS: All adult patients with orofacial odontogenic infections who attended the Oral and Maxillofacial Department of Hospital Raja Permaisuri Bainun and Hospital Sultan Abdul Halim from March 2015 to February 2019 were included. Data on patients' demography, medical history, smoking status, clinical presentation, and LOS were collected. Multivariate logistic regression analysis was performed using the dichotomous dependent variable, namely, short LOS (LOS <5 days) and long LOS (LOS ≥5 days). RESULTS: A total of 355 patients were reported with the mean age of 39.93 ± 15.95 years old. Multivariate analysis revealed that diabetes (adjusted odds ratio = 4.387, 95% confidence interval = 1.453 to 13.241, P value = .009) and multiple space involvement (adjusted odds ratio = 4.859, 95% confidence interval = 1.280, 18.454, P value = .020) were responsible for long LOS. CONCLUSIONS: Judicious treatment is recommended when treating patients of such infection that involves multiple spaces with underlying diabetes mellitus.

Role of osteopontin in diet-induced brown gallstone formation in rats.

BACKGROUND: Although osteopontin (OPN) is expressed in the liver and pigment gallstones of patients with hepatolithiasis, its role in pigment gallstone formation remains unclear. This study aimed to explore the function of OPN in pigment gallstone formation. METHODS: Rats were fed a chow diet (CD) or lithogenic diet (LD) for 10 consecutive weeks; blocking tests were then performed using an OPN antibody (OPN-Ab). Incidence of gallstones and levels of several bile components, OPN, tumor necrosis factor alpha (TNF-α), and cholesterol 7 alpha-hydroxylase (CYP7A1) were analyzed. To determine TNF-α expression in hepatic macrophages and both CYP7A1 and bile acid (BA) expression in liver cells, recombinant rat OPN and recombinant rat TNF-α were used to treat rat hepatic macrophages and rat liver cells, respectively. Chi-square or Fisher exact tests were used to analyze qualitative data, Student t-test or one-way analysis of variance were used to analyze qualitative data. RESULTS: Incidence of gallstones was higher in LD-fed rats than in CD-fed rats (80% vs. 10%, P < 0.05). BA content significantly decreased in bile (t = -36.08, P < 0.01) and liver tissue (t = -16.16, P < 0.01) of LD-fed rats. Both hepatic OPN protein expression (t = 9.78, P < 0.01) and TNF-α level (t = 8.83, P < 0.01) distinctly increased in the LD group; what's more, CYP7A1 mRNA and protein levels (t = -12.35, P < 0.01) were markedly down-regulated in the LD group. Following OPN-Ab pretreatment, gallstone formation decreased (85% vs. 25%, χ2 = 14.55, P < 0.01), liver TNF-α expression (F = 20.36, P < 0.01) was down-regulated in the LD group, and CYP7A1 expression (F = 17.51, P < 0.01) was up-regulated. Through CD44 and integrin receptors, OPN promoted TNF-α production in macrophage (F = 1041, P < 0.01), which suppressed CYP7A1 expression (F = 48.08, P < 0.01) and reduced liver BA synthesis (F = 119.4, P < 0.01). CONCLUSIONS: We provide novel evidence of OPN involvement in pigmented gallstone pathogenesis in rats.

Unilateral Zygomatic Complex Fracture - A Comparison Between Nonsurgical Treatment and Surgical Treatment.

BACKGROUND: Medical advances have enabled zygomatic complex (ZMC) fractures to be treated by various approaches. This study aims to analyze the demographics and treatment outcomes of unilateral ZMC fractures, treated nonsurgically or surgically. METHODS: This 5-year nonrandomized prospective study had included 65 cases of unilateral ZMC fractures from October 2014 until December 2019. Patients were treated and divided into nonsurgical and surgically treated group. Treatment outcomes in terms of step deformities, malar depression, diplopia, infraorbital hypoaesthesia, and mouth opening were evaluated up to six months post-trauma/intervention. RESULTS: Road traffic accident (96.9%) was the main cause, with predominant male involvement (80%) and median age of 28 years. Significant improvements (P < 0.05) were observed for step deformities and malar depression among the surgically treated group at postoperative day 1 and week 1. Throughout the six months review, infraorbital hypoesthesia and diplopia showed no significant differences between both groups, (P > 0.05). Besides, all patients showed significant mouth opening improvement (P < 0.05) over six months period. CONCLUSION: The authors found that infraorbital hypoaesthesia and limited of mouth opening should not be the absolute indications for surgical treatment of ZMC fractures. Nonsurgical treatment that included early jaw exercise and symptomatic treatment had potential value for satisfactory functional gain.

Sample-Sample Correlation Asynchronous Spectroscopic Method Coupled with Multivariate Curve Resolution-Alternating Least Squares To Analyze Challenging Bilinear Data.

An approach to construct a secondary asynchronous spectrum via sample-sample correlation (SASS) is proposed to analyze bilinear data from hyphenated spectroscopic experiments. In SASS, bilinear data is used to construct a series of two-dimensional (2D) sample-sample correlation spectra. Then a vertical slice is extracted from each 2D sample-sample correlation spectrum so that a secondary 2D asynchronous spectrum is constructed via these slices. The advantage of SASS is demonstrated by a model system with the following challenging situations: (1) Temporal profiles of different components severely overlap, making spectra of pure components difficult to directly obtain from either original bilinear data or multivariate curve resolution-alternating least squares (MCR-ALS) with non-negativity and unimodality constraints. (2) Every peak in the spectra of the eluted samples contains contributions from at least two components. Hence, two-dimensional correlation spectroscopy (2D-COS) and n-dimensional (nD) asynchronous spectroscopic method developed in our previous work, which previously worked so well, are now invalid. SASS managed to reveal different groups of systematic absences of cross peaks (SACPs) that reflect the lack of spectral contributions of different components at different regions in the second asynchronous spectrum. Spectra of different components can still be faithfully retrieved via MCR-ALS calculation using constraints revealed by different groups of SACPs. The results demonstrate that implicit but intrinsic information revealed by SASS is indispensable in solving challenging bilinear data as the model system. We applied SASS on two real-world examples from thermogravimetry-Fourier transform infrared spectroscopy (TG-FT-IR) experiments of mixtures (H2O/HOD/D2O and H2O/isopropanol/pyridine). FT-IR spectra of different components were successfully recovered. Moreover, FT-IR spectrum of HOD, which is difficult to obtain, was successfully extracted. SASS can be applied in the analysis of gaseous mixtures from TG-FT-IR experiment and a combination of quantum cascade lasers with substrate-integrated hollow waveguides in environmental monitoring and biomedical diagnosis. Furthermore, SASS is also useful in various advanced hyphenated spectroscopic experiments.

Distribution and diversity of endophytic fungi in Gentiana rigescens and cytotoxic activities.

Objective: In the present study, Gentiana rigescens was screened for fungi communities to clarify their diversity and community assemblage in hosts. Meanwhile, the identification and activity assays of the strains were also conducted. Methods: By culture-dependent (endophytic fungi isolations from plant sections) and culture-independent (metagenomic library and cloning from plant sections) techniques, fungi communities were studied. The metagenomic library was generated using direct DNA isolation of whole plants, plant radixes, plant stems, plant leaves, plant flowers and soils around the plant. Meanwhile, endophytes were isolated from all parts of G. rigescens plants. After fermentation of the fungi isolations, all the isolates were evaluated for their cytotoxicity against four kinds of human cancer cell lines (HCT116, BEL7404, A549, MDA-MB-231). Results: Eventually, 200 strains were isolated and 103 strains were further identified through the internal transcribed spacer (ITS, ITS1 and ITS2 regions) sequence by using the universal primers ITS5 and ITS4. A total of 59,106 fungal sequences corresponding to 374 putative operational taxonomic units (OTU) were identified by 454 pyrosequencing. Through 454 pyrosequencing, the main fungal genera were Sebacina, Botrytis, Mycosphaerella, Boletus and Gibberella, and the major fungal genera which were directly isolated were Aspergillus, Fusarium, Penicillium and Alternaria. Activity assays showed strains 5-26 (Aspergillus sp.) and 6-2 (Fusarium avenaceum) had the outstanding cytotoxicity to all the tested cell lines with IC50 values <5 µg/mL. Conclusion: This study revealed the abundance of endogenetic fungal resources and a variety of genetic information in G. rigescens by high-throughput 454 sequencing technology and fungi isolation methods. Activity assays indicated that endophytes were a promising natural source of potential anticancer agents.

Analysis of Characteristic Parameters of the Surface Fourier Transform Infrared Spectra from Normal Human Breast.

A total of two hundred cases of surface Fourier transform infrared (FTIR) spectra from normal female breast were obtained by scanning two hundred enrolled healthy volunteers' upper limit of the right breast outside the skin with two mid-infrared optical fibers and an attenuated total reflectance (ATR) probe. Twelve characteristic bands of the above FTIR spectra, related to deoxyribonucleic acid, ribonucleic acid, proteins, lipids and carbohydrate were analyzed. Thirty-six spectral parameters of these characteristic bands, including peak positions (P), intensities (I) and full width at half maximum (F) of FTIR spectrums, were statistically analyzed. Meantime, 90% normal reference value range, mean value, standard deviation of above characteristic parameters was obtained and calculated. In present study, we had establish the normal reference range of spectral parameters of characteristic bands in the surface Fourier transform infrared spectra scanned from normal female breast, for the first time. Meanwhile, for further implementation of Fourier transform infrared spectroscopy technique in noninvasive, fast and efficient characteristic clinical diagnosis of breast benign and malignant diseases, these research results was of great importance. Eventually, this study also had made an attempt to explore the profound theoretical basis in the biomedical application of Fourier transform infrared spectroscopy technique.

Characteristics Analysis of the Thyroid Gland Surface of Normal Human with Fourier Transform Infrared (FTIR) Spectra.

In order to obtain 240 cases of the surface Fourier transform infrared (FTIR) spectra of normal human thyroid gland, 120 healthy volunteers were enrolled in this study and scanned by using two mid-infrared optical fibers equipped with an attenuated total reflectance (ATR) to probe through the skin of two lobes of thyroid gland. Then whether there were differences between the surface FTIR spectra of the right lobe and that of the left part of the normal human thyroid gland was explored by comparing the 35 variables of 12 bands, including peak positions, relative intensity ratios and full width at half maximum of FTIR spectrums. Also the spectra characteristics of unique absorbent bands that represent changes of structure and quantity of variance biochemical substances such as nucleic acids, proteins and carbohydrates were illustrated. Results indicated that the surface FTIR spectra of the right part and that of the left part of the normal human thyroid gland were generally coincided, with statistically significant differences in four spectrum parameters, includingF1 640, P2 920, P1 040 and I2 920/I1 460. A series of data about the 90% normal reference range of the unique spectrum parameters in the surface FTIR spectra of normal human thyroid gland was gained, and a standard average infrared spectrogram which can fully represent the basic features of normal human thyroid gland was plotted. The conclusions above could be used as a reference for clinical diagnosis of thyroid diseases with FTIR spectroscopy.

Oddi sphincter preserved cholangioplasty with hepatico-subcutaneous stoma for hepatolithiasis.

AIM: To evaluate the long-term outcomes of Oddi sphincter preserved cholangioplasty with hepatico-subcutaneous stoma (OSPCHS) and risk factors for recurrence in hepatolithiasis. METHODS: From March 1993 to December 2012, 202 consecutive patients with hepatolithiasis underwent OSPCHS at our department. The Oddi sphincter preserved procedure consisted of common hepatic duct exploration, stone extraction, hilar bile duct plasty, establishment of subcutaneous stoma to the bile duct. Patients with recurrent stones can undergo stone extraction and/or biliary drainage via the subcutaneous stoma which can be incised under local anesthesia. The long-term results were reviewed. Cox regression model was employed to analyze the risk factors for stone recurrence. RESULTS: Ninety-seven (48.0%) OSPCHS patients underwent hepatic resection concomitantly. The rate of surgical complications was 10.4%. There was no perioperative death. The immediate stone clearance rate was 72.8%. Postoperative cholangioscopic lithotomy raised the clearance rate to 97.0%. With a median follow-up period of 78.5 mo (range: 2-233 mo), 24.8% of patients had recurrent stones, 2.5% had late development of cholangiocarcinoma, and the mortality rate was 5.4%. Removal of recurrent stones and/or drainage of inflammatory bile via subcutaneous stoma were conducted in 44 (21.8%) patients. The clearance rate of recurrent stones was 84.0% after subsequent choledochoscopic lithotripsy via subcutaneous stoma. Cox regression analysis showed that residual stone was an independent prognostic factor for stone recurrence. CONCLUSION: In selected patients with hepatolithiasis, OSPCHS achieves excellent long-term outcomes, and residual stone is an independent prognostic factor for stone recurrence.

[Influence of Concentration Sequence on the Signal-to-Noise Ratio of Cross Peaks of 2D Asynchronous Spectra Generated by Using the DAOSD Approach].

In the present work, computer simulation was performed on a model chemical system where two solutes (denoted as P and Q, respectively) are dissolved in the same solution. Under intermolecular interaction between P and Q, part of P undergoes subtle structural variation and converts into U while part of Q converts into V. The strength of intermolecular interaction can be characterized by the corresponding equilibrium constant K. Our preliminary studies indicate that the S/N ratio of cross peak increases considerably as n increases. Moreover, the S/N ratio of the cross peak from the asynchronous spectra can be improved significantly when the suitable concentrations of P and Q are adopted. This work is helpful for a selection of suitable concentration sequence to maximize S/N ratio of cross peaks in the 2D asynchronous spectra generated by using the DAOSD approach proposed in our previous study so that weak intermolecular interaction can be probed.

[Research on Application of Fourier Transform Infrared Spectrometry in the Diagnosis of Lymph Node Metastasis in Gastric Cancer].

To explore the feasibility of quick intraoperative in situ and noninvasive diagnosis of lymph node metastasis in gastric cancer by Fourier transform infrared (FTIR) spectrometry. FTIR spectra of surgically removed fresh lymph nodes were measured by FTIR via probe of attenuated total reflection (ATR). For each spectrum, 13 bands were indentified and assigned between 3 000 and 1 000 cm(-1). Peaks in the spectra were measured and relative intensity ratios were calculated and compared between the spectra of Metastatic lymph nodes (MLN) and Non-metastatic lymph nodes (NMLN). Standard statistic analysis was performed. 720 lymph nodes were measured in 38 gastric cancer patients. Results show that there were significant differences between the FTIR of 540 MLN and 180 NMLN. (1) For the band related to nucleic acid: The ratios of I1240/I1460 (p = 0.015) and I1080/I1460 (p = 0.034) increased in MLN, which shows that the relative quantity of nucleic acid was more in MLN than that in NMLN. (2) For the bands related to protein: The ratios of I1640 /I1460 (p = 0.001) and I146/I1460 (p = 0.027) increased in MLN, which shows that the relative quantity of protein was more in MLN. (3) For the bands related to lipid: The ratio of I2855/I460 and I1740/I1460 decreased in MLN FTIR spectrum, indicating the lower relative quantity of lipid in MLN. (4) For the bands related to carbohydrate: The ratio of I1160/I1460 (p = 0.023) decreased in MLN FTIR spectrum, indicating the lower relative quantity of carbohydrate in MLN. The results demonstrate that the FTIR spectroscopy technique maybe develop into a promising method for in situ and quick intraoperative differential diagnosis of lymph node metastasis in gastric cancer.

Laparoscopic hepaticoplasty using gallbladder as a subcutaneous tunnel for hepatolithiasis.

AIM: To investigate the feasibility, efficacy and safety of laparoscopic hepaticoplasty using gallbladder as subcutaneous tunnel and sphincter-of-Oddi preservation for hepatolithiasis. METHODS: From January 2010 to July 2013, six patients with hepatolithiasis were treated at our institution. All the patients underwent laparoscopic surgery. The procedures included common hepatic duct exploration, stone clearance by fiberoptic choledochoscopy, hilar bile duct hepaticoplasty with preservation of the sphincter of Oddi, anastomosis between the hilar bile duct and neck of the gallbladder, and establishment of a subcutaneous tunnel with the gallbladder. Two patients underwent left lateral hepatectomy simultaneously. Clinical data including operation time, intraoperative blood loss, operative morbidity, hospital mortality, stone clearance, and recurrence rate were analyzed. RESULTS: All patients successfully completed laparoscopic surgery. The mean length of hospital stay was 4.5 ± 0.9 d (range: 3-6 d). The mean blood loss of the hepatectomy was 450 mL (range: 200-700 mL), and the blood loss of the other four was 137 ± 151 mL (range: 50-400 mL). The mean operative time was 318 ± 68 min (range: 236-450 min). The operative morbidity and hospital mortality were zero. The immediate stone clearance rate was 100%. All patients were followed up for an average of 17 mo (range: 7-36 mo). One of the six patients had abdominal mass with pain, and subcutaneous tunnel cholangiography showed severe gallbladder-biliary anastomotic stricture at 4 mo postoperatively. There was no stone recurrence and no cholangitis during follow-up. CONCLUSION: Laparoscopic hepaticoplasty using gallbladder with a subcutaneous tunnel and preserving the sphincter of Oddi is feasible, safe and effective for hepatholithiasis.

Donor-site morbidity of free fibula and DCIA flaps.

PURPOSE: This study evaluated and compared the long-term donor-site morbidity of the free fibula flap with the deep circumflex iliac artery (DCIA) flap in maxillofacial reconstruction. MATERIALS AND METHODS: Thirty-four patients (19 in the fibula group and 15 in the DCIA group) were evaluated for long-term morbidity. All clinical data were analyzed, including primary disease, type of defect, type of flap, length of bone harvested, total blood loss, operating time, length of hospitalization, and postoperative unaided gait. Subjective evaluation included cosmesis, function, and pain. Objective evaluation included physical examination, neurosensory assessment, Stony Brook Scar Evaluation, gait assessment, and goniometric measurement of range of movement. RESULTS: In the subjective evaluation, no significant differences in cosmetic outcome, functional loss, wound healing, or pain between the 2 groups were noted (P > .05). However, neurosensory deficit was worse in the DCIA group (P ≤ .05). In the objective evaluation, 4 patients (27%) in the DCIA group had neurosensory deficit in the lateral thigh region. The DCIA group had a better Stony Brook Scar score (median, 5) than the fibula group (median, 4; P ≤ .05). However, there was no difference in walking ability between the 2 groups (P > .05). Goniometric measurement showed a significant difference between the operated and unoperated sites in the 2 groups; however, it was not severe enough in either group to affect patients' function. In the fibula group, 7 patients (38.9%) had claw toe deformity and 2 patients (12.1%) had weakness of the great toe, and the mean American Orthopedic Foot and Ankle Society score was 96.89. In the DCIA group, 1 patient (8.3%) had a hernia and the mean Harris Hip score was 98.33. CONCLUSION: Given that these 2 options present donor-site concerns, the authors consider the fibula free flap the first choice for maxillofacial reconstruction in most cases and the DCIA free flap a reliable complementary flap in selected patients.

Strategies for diagnosis of xanthogranulomatous cholecystitis masquerading as gallbladder cancer.

BACKGROUND: Patients with xanthogranulomatous cholecystitis sometimes exhibit imaging and intraoperative findings that are similar to those of advanced gallbladder cancer, thus these patients are easily misdiagnosed. The present study aimed to investigate the characteristics of xanthogranulomatous cholecystitis masquerading as gallbladder cancer that could potentially aid in the correct diagnosis of this condition. METHODS: The clinical, serological, radiological and operative features of twelve patients with obviously wall-thickening or mass-forming xanthogranulomatous cholecystitis were retrospectively analyzed. Additionally, the patient preoperative features were compared to those of 36 patients with advanced gallbladder cancers. RESULTS: Twelve patients with xanthogranulomatous cholecystitis exhibited one to three episodes of acute cholecystitis within 0.5 to 7 months prior to admission to the hospital. Five of these patients exhibited concomitant choledocholithiasis, whereas no concomitant choledocholithiasis was identified in patients with advanced gallbladder cancer. The incidence of abdominal pain (χ(2) = 6.588, P = 0.010), acute cholecystitis (χ(2) = 29.176, P = 0.000), acute cholangitis (χ(2) = 6.349, P = 0.012), choledocholithiasis (χ(2) = 16.744, P = 0.000), carcinoembryonic antigen test (P = 0.007), CA125 (P = 0.001), and diffuse gallbladder wall thickening (χ(2) = 6.031, P = 0.014), continued mucosal line (χ(2) = 15.745, P = 0.000), homogeneous enhancement of mucosal line (χ(2) = 19.947, P = 0.000), submucosal hypoattenuated nodules or band (χ(2) = 18.607, P = 0.000) in computed tomography demonstrated statistically significant differences between cases of xanthogranulomatous cholecystitis and gallbladder cancer. Furthermore, all the twelve patients with xanthogranulomatous cholecystitis exhibited at least one positive computed tomography imaging feature aside from past acute cholecystitis episode, and no patient with advanced gallbladder cancer simultaneously exhibited past acute cholecystitis episode and at least one positive computed tomography imaging feature. CONCLUSIONS: The accurate preoperative diagnosis of xanthogranulomatous cholecystitis includes an integrated review of past acute cholecystitis episode, choledocholithiasis, and positive computed tomography imaging features. Besides, we present an algorithm for intraoperative diagnosis.

What is the price to pay for a free fibula flap? A systematic review of donor-site morbidity following free fibula flap surgery.

BACKGROUND: A number of donor-site morbidities following free fibula flap surgery, although usually minor and transient, have been documented. The primary aim of this systematic review was to identify the incidence of donor-site morbidity after free fibula flap surgery, to discuss the causes of these morbidities, and to identify the best methods of prevention and treatment available. METHODS: A systematic search of the English and Chinese literature was performed of the PubMed, MEDLINE, Cochrane Library, and Embase databases. The study selection process was adapted from the PRISMA statement, and 42 articles complied with the study inclusion criteria. RESULTS: Forty-two relevant articles were included in the final analysis. Regarding early donor-site morbidity, the weighted mean incidences were as follows: wound infection, 1.07 percent; wound dehiscence, 7.0 percent; wound necrosis, 7.3 percent; delayed wound healing, 17.4 percent; partial skin graft loss, 8.1 percent; and total skin graft loss, 4.7 percent. The weighted mean incidence of early wound morbidity in surgical wounds that were closed primarily was 9.9 percent, compared with skin graft closure at 19.0 percent. In late donor-site morbidities, the weighted mean incidences were as follows: chronic pain, 6.5 percent; considerable gait abnormality, 3.9 percent; ankle instability, 5.8 percent; limited range of motion in the ankle, 11.5 percent; reduced muscle strength, 4.0 percent; claw toe, 6.1 percent; dorsiflexion of the great toe, 3.6 percent; and sensory deficit, 6.95 percent. The mean American Orthopaedic Foot and Ankle Society score was 85.5 percent. CONCLUSION: One would expect to pay a low price for free fibula flap surgery with adequate surgical experience, refinements in surgical technique, and comprehensive postoperative care. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

HIV-1 Tat increases oxidant burden in the lungs of transgenic mice.

Chronic human immunodeficiency virus infection is associated with higher incidence of pulmonary complications including hypertension, vasculopathy, lymphocytic alveolitis, and interstitial pneumonitis not attributed to either opportunistic infections or presence of the virus. The Tat (transactivator of transcription) protein, a required transactivator for expression of full-length viral genes, is pleiotropic and influences expression of cellular inflammatory genes. Tat-dependent transactivation of cellular genes requires specific mediators, including NF-κB, widely recognized as sensitive to changes in cellular oxidant burden. We hypothesized that overproduction of Tat leads to increased oxidant burden and to alterations in basal inflammatory status as measured by NF-κB activation. We engineered transgenic mouse lines that express Tat (86-amino-acid isoform) in the lung under the control of the surfactant protein C promoter. Tat-transgenic mice exhibit increased pulmonary cellular infiltration, increased nitrotyrosine and carbonyl protein modifications, and increased levels of NF-κB, MnSOD, and thioredoxin-interacting protein. These data indicate that Tat increases oxidant burden and resets the threshold for inflammation, which may increase susceptibility to secondary injuries.

[Treatment of hepatolithiasis by multiple operative methods with hepatico-subcutaneous stoma].

OBJECTIVE: To evaluate the mid-term and long-term outcomes of patients with hepatolithiasis after receiving multiple operative methods with hepatico-subcutaneous stoma. METHODS: A retrospective analysis was performed based on 156 patients with hepatolithiasis who underwent multiple operative methods with hepatico-subcutaneous stoma from Apr. 1993 to Mar. 2010 in Peking University Third Hospital. Thirty-seven of them had stone in the left lobe (23.7%), 22 in the right lobe (14.1%), and 97 in bilateral lobes (62.2%). Ninety-nine patients had hepatolithiasis combined with biliary stricture (63.5%). RESULTS: All of the patients underwent successful operations and recovered well with no death in perioperative period. The rate of operative complications was 35.9%. A total of 146 patients were followed up with a median time of 7 years. The rate of patients with cholangitis, recurrent stone, and biliary stricture newly detected was 13.0% (19/146), 21.9% (32/146) and 8.2% (12/146), respectively. Draining inflammatory bile and taking out recurrent stones by hepatico-subcutaneous stoma were carried out in 35 patients (24.0%). CONCLUSION: Treatment of hepatolithiasis with biliary stricture and its recurrence by multiple operative methods with hepatico-subcutaneous stoma is safe, effective, minimally invasive, and easy to perform.

An end-to-end anastomosis model of guinea pig bile duct: A 6-mo observation.

AIM: To establish the end-to-end anastomosis (EEA) model of guinea pig bile duct and evaluate the healing process of bile duct. METHODS: Thirty-two male guinea pigs were randomly divided into control group, 2-, 3-, and 6-mo groups after establishment of EEA model. Histological, immunohistochemical and serologic tests as well as measurement of bile contents were performed. The bile duct diameter and the diameter ratio (DR) were measured to assess the formation of relative stricture. RESULTS: Acute and chronic inflammatory reactions occurred throughout the healing process of bile duct. Serology test and bile content measurement showed no formation of persistent stricture in 6-mo group. The DR revealed a transient formation of relative stricture in 2-mo group in comparation to control group (2.94 ± 0.17 vs 1.89 ± 0.27, P = 0.004). However, this relative stricture was released in 6-mo group (2.14 ± 0.18, P = 0.440). CONCLUSION: A simple and reliable EEA model of guinea pig bile duct can be established with a good reproducibility and a satisfactory survival rate.

[The application of Fourier transform infrared technology in biomedical sphere].

The authors systemically reviewed the development of FTIR technology and its innovative advances during the past fifty years. FTIR technique was once abandoned after initial exploration in biomedical fields, which could not confirm its reliability and credibility. After technological innovation and refined numerical analysis methods, FTIR technique has been applied to a wide range of fields, from single cellular to the complex biomedical tissue components. Nowadays, mature and advanced FTIR technology, such as FTIR microspectrometer and FTIR imaging system, with the aid of pattern recognition and tissue microarray, greatly facilitated the large parallel scale investigation of molecular structure. The recent development of FTIR spectroscopic imaging has enhanced our capability to examine, on a microscopic scale, the spatial distribution of vibrational spectroscopic signatures of materials spanning the physical and biomedical disciplines. The integration of instrumentation development, theoretical analyses to provide guidelines for imaging practice, novel data processing algorithms, and the introduction of the technique to new fields. FTIR technique has helped analyze the complex components of bile stones, which persisted to be a vexing problem and causing high death rate in China. Besides, FTIR technology could provide reliable information in discriminating benign and malignancy. It has been used in detecting thyroid nodules, mammary gland, gastrointestinal tract, cardiovascular and prostate diseases, and parotid gland tissue in combination with ATR detecting device, and has broad clinical application prospects. Till now, FTIR technology has achieved the fast and accurate diagnosis for freshly dissected tissues such as discriminating thyroid carcinoma from nodular goiter intraoperatively. However, further investigations need to be done in this sphere to achieve greater accomplishments.

Long-term outcomes of choledochoduodenostomy for hepatolithiasis.

BACKGROUND: Oddi sphincter plays an important role in preventing reflux cholangitis. There exists the controversy on application of choledochoduodenostomy in hepatolithiasis management. The present study aimed at evaluating long-term outcomes of choledochoduodenostomy for the treatment of hepatolithiasis. METHODS: Forty-six consecutive cases of hepatolithiasis who underwent choledochoduodenostomy were analyzed retrospectively. The pre- and postoperative rates of recurrent cholangitis and acute cholangitis severe type were compared. Paired chi-square test was applied. RESULTS: The mean follow-up time was 17.3 years ranging from 1.6 to 40 years with a follow-up rate of 97.8% (45/46). High rates of remnant stones (39.1%, 18/46), recurrent stones (31.1%, 14/45), uncorrected strictures (85%, 17/20), and mortality (24.4%, 11/45) were observed in this group. Regurgitation of food debris and duodenal content into the biliary tract through the anastomosis was observed. The rate of recurrent cholangitis was equal to the preoperative period (93.3%, 42/45). The rate of acute cholangitis severe type after choledochoduodenostomy (46.7%, 21/45) increased significantly (P<0.01) when compared to the preoperative period (20.0%, 9/45). CONCLUSIONS: Choledochoduodenostomy did not entirely achieve the goal of clearance of stones, correction of strictures, and removing of hepatobiliary lesions by itself. Choledochoduodenostomy without cholangioplasty resulted in an increase of severe reflux cholangitis due to the loss of the anti-reflux function of the sphincter of Oddi. Therefore, choledochoduodenostomy is not an ideal approach to reduce cholangitis in hepatolithiasis and is not the best choice in the management of hepatolithiasis.