Diversity and Isolation of Endophytic Fungi in Panax japonicus and Biotransformation Activity on Saponins.

OBJECTIVE: This study reports the diversity and community structure differences of the endophytic fungi of Panax japonicus of different ages to obtain novel endophytic fungi with glycoside hydrolytic activity for rare saponins production. METHODS: This study used the high-throughput sequencing method to analyze the diversity and community structure of endophytic fungi of P. japonicus. The endophytic fungi were processed by traditional isolation, culture, conservation, and ITS rDNA sequence analyses. Then the total saponins of P. japonicus were used as the substrate to evaluate the glycoside hydrolytic activity. RESULTS: The composition analysis of the community structure showed that the abundance, evenness, and diversity of endophytic fungi of nine-year-old P. japonicus were the best among all samples. A total of 210 endophytic fungi were isolated from P. japonicus samples and further annotated by sequencing the internal transcribed spacer. Then the biotransformation activity of obtained strains was further examined on total saponins of P. japonicus (TSPJ), with a strain identified as Fusarium equiseti (No.30) from 7-year-old P. japonicus showing significant glycoside hydrolytic activity on TSPJ, including ginsenoside Ro→zinglbroside R1, pseudoginsenoside RT1→pseudoginsenoside RP1, chikusetsusaponin IV→tarasaponin VI and chikusetsusaponin IVa →calenduloside E. CONCLUSION: These results reveal the diversity and community structure differences of the endophytic fungi of P. japonicus with different ages and establish a resource library of endophytic fungi of P. japonicus. More importantly, we identified a valuable endophytic fungus with glycoside hydrolytic activity and provided a promising convenient microbial transformation approach to produce minor deglycosylated ginsenosides.

Long-term outcomes of surgical approaches for bilateral hepatolithiasis: A real-world six-decade experience at a single center.

BACKGROUND: Bilateral hepatolithiasis is an intractable disease and repeated attacks of acute cholangitis seriously threaten patient health. The surgical approaches evolve along with gradually greater understanding of its pathophysiology. METHODS: This is a retrospective cohort study for bilateral hepatolithiasis from January 1958 to December 2018. Before May 1993 (Group A, n = 70), three surgical approaches were adopted: 37 patients with common bile duct exploration (CBDE), 29 with choledochoenterostomy (CE) and four with partial hepatectomy (PH). After June 1993 (Group B, n = 150), 101 patients underwent Oddi sphincter-preserved cholangioplasty with hepatico-subcutaneous stoma (OSPCHS), and 16 with CBDE, 21 with CE, 12 with PH. The perioperative and long-term outcomes were compared. RESULTS: After 1993, the cholangitis recurrence rate significantly decreased from 49.2% to 20.9%, and the stone recurrence rate from 76.3% to 37.1% (both P < .001). Also, the stone-/cholangitis-free durations were prolonged significantly (median: 50.8 vs 26.4/49.6 vs 16.2 months, both P < .001). Preoperative cholangitis was an independent risk factor for stone recurrence (hazard ratio [HR] = 1.863, P = .018), and residual stone for cholangitis recurrence (HR = 2.838, P < .001). OSPCHS and PH were protective surgical approaches for recurrent stone (CBDE: reference; OSPCHS: HR = .469, P = .016, PH: HR = .219, P = .018) and cholangitis (CBDE: reference; OSPCHS: HR = .421, P = .010, PH: HR = .283, P = .093). CONCLUSIONS: For bilateral hepatolithiasis, the management should focus on hepatobiliary lesion eradication and Oddi sphincter function preservation.

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.

Risk factors and management of primary choledocholithiasis: a systematic review.

BACKGROUND: Primary choledocholithiasis (PC) is a common disease in biliary surgery. The treatment is always challenging due to its high recurrence. A systemic review is undertaken to determine the risk factors for recurrence and provide with the individualized management strategy. METHODS: Electronic databases PubMed (Medline), Embase and Cochrane Central Register of Controlled Studies were searched for relevant articles on risk factors for PC recurrence. Its therapeutic intervention was also collected and analysed. RESULTS: A total of 36 articles were eligible for inclusion. The recurrent risk factors include abnormalities of biliary anatomy (peripapillary diverticulum), dynamics (choledochal dilation, sharp angulation and stone number), metabolism (advanced age and hypothyroidism) and bacterial infection (Enterobacter and Helicobacter pylori). These factors eventually induce cholestasis and stone formation. At present, there is no guideline and expertise consensus for PC management. The treatment mainly consists of stone retrieval approaches and internal drainage surgeries. The former are minimally invasive methods: endoscopic sphincterotomy (EST), papillary balloon dilation (EPBD) and laparoscopic common bile duct exploration (LCBDE). The latter include choledochoduodenostomy (CDS) and choledochojejunostomy (CJS) with Roux-en-Y reconstruction. By far, the internal drainage surgeries have significantly lower recurrence than stone retrieval approaches. CONCLUSION: Abnormal biliary anatomy, dynamics, metabolism and bacterial infection are the risk factors for PC. Both EST/EPBD and LCBDE can be performed as initial treatment. For recurrent PC, CDS is more suitable to the elderly, while Roux-en-Y CJS reserves for young patients or those in good conditions.

Tumour radiological appearance evaluated by enhanced CT correlates with tumour progression and survival in curable gallbladder cancer.

BACKGROUND: Surgical resection has been proposed for curable gallbladder cancer (GBCA); however, optimal preoperative evaluation and resection planning methods remain unestablished. The aim of this study was to establish the types of CT tumour radiological appearances in GBCA with a focus on its association with clinicopathologic features and its prognostic impact in curable GBCA. METHODS: In all, 118 patients surgically treated for GBCA were identified and CT tumour radiological appearances were reviewed. Models were established and internally validated. Clinicopathologic variables and prognostic impact were analysed for correlation with tumour radiological appearance. RESULTS: The classification and distribution of tumour radiological appearance in these patients was Type 1 (n = 14), Type 2 (n = 60), Type 3 (n = 21), Type 4 (n = 18), and undetermined (n = 5). Among the 113 patients, a higher tendency of T stage and incidence of lymph node metastasis was observed from Type 1 to Type 4. Most Type 1 patients were T1 stage, they have no lymph node involvement or recurrence. With a median follow-up of 25 months (range, 1-135 months), a clear prognostic difference was observed among the 4 types after surgical treatment (p < 0.001). Type 1 patients showed 100% 5-year survival rate. Among the 66 T2 tumours, both tumour location and tumour radiological appearance effectively stratified patient prognosis (p < 0.001, p = 0.007). Introducing tumour radiological appearance into tumour location enabled further prognostic stratification of the 35 T2h tumours (p < 0.001). CONCLUSIONS: Type of CT tumour radiological appearance is a predictor of tumour biology. It may improve preoperative evaluation and resection planning.

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.

The Advancement of Long Non-Coding RNAs in Cholangiocarcinoma Development.

Cholangiocarcinoma (CCA) is a malignancy with increasing incidence in recent years. CCA patients are usually diagnosed at advanced stage due to lack of apparent symptoms and specifically diagnostic markers. Nowadays, surgical removal is the only effective method for CCA whereas overall 5-year-survival rate keeps around 10%. Long-noncoding RNA (lncRNA), a subtype of noncoding RNA, is widely studied to be abnormally expressed in multiple cancers including CCA. LncRNA can promote proliferation, migration, invasion and inhibit apoptosis of CCA. Moreover, lncRNA is negatively correlated with the prognosis of CCA. LncRNA may contribute to the development of CCA via modulating gene transcription, sponging microRNA, regulating CCA-related signaling pathways or protein expression. LncRNA is thought to be potential diagnostic markers and therapeutic targets for CCA.

Laparoscopic treatment for suspected gallbladder cancer confined to the wall: a 10-year study from a single institution.

OBJECTIVE: Although laparoscopic treatment of gallbladder cancer (GBC) has been explored in the last decade, long-term results are still rare. This study evaluates long-term results of intended laparoscopic treatment for suspected GBC confined to the gallbladder wall, based on our experience over 10 years. METHODS: Between August 2006 and December 2015, 164 patients with suspected GBC confined to the wall were enrolled in the protocol for laparoscopic surgery. The process for GBC treatment was analyzed to evaluate the feasibility of computed tomography (CT) and/or magnetic resonance imaging (MRI) combined with frozen-section examination in identifying GBC confined to the wall. Of 159 patients who underwent the intended laparoscopic radical treatment, 47 with pathologically proven GBC were investigated to determine the safety and oncologic outcomes of a laparoscopic approach to GBC. RESULTS: Among the 164 patients, 5 patients avoided further radical surgery because of unresectable disease and 12 were converted to open surgery; in the remaining 147 patients, totally laparoscopic treatment was successfully accomplished. Extended cholecystectomy was performed in 37 patients and simple cholecystectomy in 10. The T stages based on final pathology were Tis (n=6), T1a (n=2), T1b (n=9), T2 (n=26), and T3 (n=4). Recurrence was detected in 11 patients over a median follow-up of 51 months. The disease-specific 5-year survival rate of these 47 patients was 68.8%, and rose to 85% for patients with a normal cancer antigen 19-9 (CA19-9) level. CONCLUSIONS: The favorable long-term outcomes demonstrate the feasibility of combined CT/MRI and frozen-section examination in the selection of patients with GBC confined to the gallbladder wall, confirm the oncologic safety of laparoscopic treatment in selected GBC patients, and favor measurement of preoperative CA19-9 in the selection of GBCs suitable for laparoscopic treatment.

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.

Detection of gastric cancer with Fourier transform infrared spectroscopy and support vector machine classification.

Early diagnosis and early medical treatments are the keys to save the patients' lives and improve the living quality. Fourier transform infrared (FT-IR) spectroscopy can distinguish malignant from normal tissues at the molecular level. In this paper, programs were made with pattern recognition method to classify unknown samples. Spectral data were pretreated by using smoothing and standard normal variate (SNV) methods. Leave-one-out cross validation was used to evaluate the discrimination result of support vector machine (SVM) method. A total of 54 gastric tissue samples were employed in this study, including 24 cases of normal tissue samples and 30 cases of cancerous tissue samples. The discrimination results of SVM method showed the sensitivity with 100%, specificity with 83.3%, and total discrimination accuracy with 92.2%.

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.

Synthesis of nanoscale zero-valent iron/ordered mesoporous carbon for adsorption and synergistic reduction of nitrobenzene.

Nanoscale zero-valent iron (NZVI) supported on ordered mesoporous carbon (OMC) was synthesized through liquid phase reduction route. The NZVI/OMC composite was characterized by X-ray diffraction, N(2) adsorption/desorption and transmission electron microscopy. Results reveal that the composite possesses ordered mesostructure with NZVI distributing homogeneously on the surface of OMC support. The removal effects of nitrobenzene (NB) in water with OMC, NZVI/OMC and non-supported NZVI were evaluated. Results indicate that NZVI/OMC shows enhanced removal efficiency, which is attributed to its adsorption and synergistic reduction for NB. The transformation process of NB was further investigated by HPLC. Nitrosobenzene and phenylhydroxylamine were detected as intermediate products and aniline was the final reductive product.

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.