Magnetic compression anastomosis for the treatment of benign biliary strictures: a clinical study from China.

BACKGROUND: Magnetic compression anastomosis (MCA) is a revolutionary minimally invasive method to perform choledochocholedochostomy in patients with benign biliary stricture (BBS). We conducted MCA for the treatment of severe BBS that could not be treated by conventional methods. PATIENTS AND METHODS: Patients with BBSs that could not be treated using conventional treatments were included. All patients underwent percutaneous transhepatic biliary drainage (PTBD) before MCA, and underwent cholangiography via simultaneous PTBD and endoscopic retrograde cholangiopancreatography (ERCP). The MCA device consisted of a parent and a daughter magnet. The daughter magnet was delivered via the PTBD route to the proximal end of the obstruction, and the parent magnet was delivered via ERCP to the distal end of the obstruction. After recanalization, the MCA device was removed, and biliary stenting (or PTBD) was performed for at least 6 months. RESULTS: Of the 9 patients (age 49 ± 12.9 years), 6 had undergone orthotopic liver transplantation. MCA was successful in all 9 patients. The stricture length was 3 ± 1.7 mm, and recanalization occurred after 16.3 ± 13.2 days. Multiple plastic stents (4 patients), fully covered self-expandable metallic stents (4 patients), or PTBD (1 patient) was used after recanalization. Two mild adverse events occurred (cholangitis, 1 patient; biliary bleeding, 1 patient), but were resolved with conservative treatment. Stents were retrieved after > 6 months, and no stenosis occurred during 2-66 months of stent-free follow-up. CONCLUSION: The MCA technique is a revolutionary method for choledochocholedochostomy in patients with severe BBS unresponsive to conventional procedures.

[Applied studies of structured triglycerides for parenteral nutrition in severe hemorrhagic shock patients after resuscitation].

OBJECTIVE: To evaluate the effects of structured triglycerides in parenteral nutrition versus a physical medium-chain triglycerides (MCT)/long-chain triglycerides (LCT) mixture on severe hemorrhagic shock patients after resuscitation. METHODS: In a randomized trial, we studied 20 critical patients with a total blood loss of over 3000 ml perioperatively and/or intraoperatively. The use of triglycerides started from Day 3 postoperation and parenteral nutrition lasted for no less than 5 days. They were allocated to receive one of two nutrition regiments: structured triglycerides in Group A (n = 10) and MCT/LCT in Group B (n = 10). There were no significant differences of general conditions in two groups. Before the start of parenteral nutrition (d0), d1 d3 and d5 after start of infusion, the following parameters were measured: hemoglobin (Hb), platelet count (Plt), alanine aminotransferase (ALT), total bilirubin (TB), direct bilirubin (DB), serum triglycerides (TG), prealbumin (PA) and transferrin (TF). And mean artery pressure (MAP), heart rate (HR) and central vein pressure (CVP) were also recorded at the same time-points. Then the post-TG changes of the above data were compared in both groups. RESULTS: After the use of triglycerides, there were no significant differences of MAP, HR, CVP, Hb and Plt in both groups (P > 0.05). At D3 and D5, the serum levels of TG ((2.1 ± 0.4) vs (1.6 ± 0.6) mg/L, (2.3 ± 0.7) vs (1.5 ± 0.3) mg/L) and alanine aminotransferase ((133 ± 58) vs (97 ± 26) U/L; (116 ± 48) vs (77 ± 31) U/L) were significantly higher in Group B versus those receiving structured triglycerides in Group A (P < 0.05). TB ((18 ± 15) vs (18 ± 11) µmol/L) and DB ((8.9 ± 3.2) vs (8.8 ± 2.5) µmol/L) had no significant differences in two groups (P > 0.05). The serum levels of such nutrition markers as PA ((195 ± 55) vs (166 ± 55) mg/L,(245 ± 53) vs (195 ± 58) mg/L) and TF ((2.6 ± 0.5) vs (2.5 ± 0.6) g/L, (3.3 ± 0.8) vs (2.9 ± 0.6) g/L)were significantly higher in Group A than those in Group B (P < 0.05). CONCLUSION: With regards to lipid metabolism, protein synthesis and hepatocyte protection, structured triglycerides in parenteral nutrition is advantageous to standard MCT/LCT emulsion in severe hemorrhagic shock patients after resuscitation.

[Altered hepatic expression of selenoprotein S1 in septic mouse induced by LPS attack].

OBJECTIVE: To investigate the change of selenoprotein S1 (SEPS1) hepatic expression in septic mouse induced by LPS attack. METHODS: The septic murine model induced by LPS attack was established. Ten mice were randomly selected as control group from 84 BALB/c mice and others as septic group. The mice were sacrificed after anesthesia in control group and 10 mg/kg LPS was injected intraperitoneally into septic group mice. Liver and blood samples were taken at 6, 12, 24, 48, 72 and 96 h after LPS injection. Ten mice were randomly selected at each time point. The levels of blood ALT, AST, LDH and liver IL-6, TNF-α were detected. And the SEPS1 expression was simultaneously detected by Western blot. RESULTS: There was liver damage in septic group compared with normal control group. The levels of ALT, AST and LDH markedly increased. And all peaked at 24 h. The levels were (99 ± 11), (299 ± 48) and (1523 ± 131) U/L respectively (versus level at zero hour, P < 0.05). Then there was a gradual decrease and the pre-damage levels were restored during 24-72 h. The levels of IL-6 and TNF-α also markedly increased. The damage deteriorated rapidly and peaked at 48 h. The levels were (30,325 ± 17,901) and (36,509 ± 20,794) ng/L respectively [versus level at zero hour (23,802 ± 11,150), (29,799 ± 8239) ng/L, P < 0.05]. Western blot showed that SEPS1 protein expression markedly increased simultaneously in liver of septic mouse. And the peak value was reached at 24 h post-injury. Then there was a gradual decrease and normal level returned at 72 h. Immunohistochemical results showed that SEPS1 protein expression in liver of septic mouse also markedly increased. And the peak value was reached at 24 h post-injury. Pathologic results showed that liver lesion was apparent in septic mouse and it was the worst during 6-12 h. CONCLUSION: Liver damage to different extents may be induced by LPS attack in septic mouse. The levels of IL-6 and TNF-α markedly increase. The SEPS1 protein expression in liver of septic mouse is also markedly elevated. And it peaks at 24 h post-injury and returns to normal at 72 h.

Osteopontin promoter polymorphisms at locus -443 are associated with metastasis and poor prognosis of human intrahepatic cholangiocarcinoma in Chinese population.

PURPOSE: Osteopontin (OPN) is known to be a secreted adhesive glycoprotein. Role of OPN in human intrahepatic cholangiocarcinoma (ICC) has not been well understood. This study explored whether genetic variations in the osteopontin gene are associated with ICC risk, progression and metastasis. MATERIAL AND METHODS: 260 patients with stages I to IV between 2008 and 2013 were recruited in this study and same number healthy persons were used as control. OPN-66 T/G, -156 G/GG and -443 C/T variants were genotyped using DNA from blood lymphocytes. Chi-square test and a Fisher's exact test were used to analyze the genotype distribution between healthy subjects and patients, and further its distribution among TNM stages and incidence metastasis in patients. RESULTS: For the variant at nt- 443 (CC), there was a significant difference between the number of patients with stage IV and those with all other stages of ICC (P < 0.01). Patients with -443 (CC) variant had significant higher incidence of lymph and distant metastasis development compared to other genotypes. For the variant at nt- 443 (CT), there was a significant difference between the number of ICC patients with stage III + IV and those with stage I + II (P < 0.01). The survival rates for ICC patients with the C/C genotype were significantly lower than for patients with the other two genotypes (C/T, T/T). CONCLUSION: OPN -443 C/T polymorphism is a potential predictive marker of metastasis and poor prognosis in ICC patients.

Protective effects of the SEPS1 gene on lipopolysaccharide-induced sepsis.

Septic shock and sequential multiple organ failure are the main cause of mortality in patients with sepsis. The induction of inflammation during sepsis is a complex biological cascade, which requires successful therapeutic intervention. Selenoprotein S (SEPS1) is a novel endoplasmic reticulum-resident protein and is important in the production of inflammatory cytokines. The present study attempted to assess the effect of SEPS1 suppression by small interfering RNA (siRNA) on mice with lipopolysaccharide (LPS)-induced sepsis. In total, 30 mice were randomly assigned to three groups: i) H group (LPS-induced sepsis group; n=10): Mice with intraperitoneal injection of LPS (10 mg/kg); ii) K group (scrambled siRNA group; n=10): Mice transfected with scrambled control siRNA 12 h prior to injection with LPS and iii) L group (SEPS1 siRNA group; n=10): Mice transfected with SEPS1 siRNA 12 h prior to injection with LPS. The effects of siRNA were evaluated by SEPS1 gene and protein expression, biochemical parameters including serum alanine transaminase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), lactic dehydrogenase (LDH), creatine kinase (CK) and myocardial kinase (CK-MB), as well as the cytokines interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). The phosphorylation of p38 mitogen-activated protein kinases (p38 MAPK) was also detected by western blot analysis. In the SEPS1 siRNA group, SEPS1 gene and protein expression decreased significantly, while the levels of TNF-α and IL-6 increased compared with the control group. The biochemical parameters of ALT, AST, BUN, LDH, CK and CK-MB were markedly increased in the SEPS1 siRNA group. The phosphorylation of p38 MAPK was also significantly activated. The decrease in SEPS1 gene and protein expression and the production of TNF-α and IL-6 may correlate with the activation of the p38 MAPK pathway. Biochemical factors and pathological results demonstrated that the damage to vital organs was aggravated. In conclusion, these findings suggested that SEPS1 may protect mice against LPS-induced sepsis and organ damage. Therefore, SEPS1 may be a new target to resolve LPS-induced sepsis.

Alcohol abuse-related severe acute pancreatitis with rhabdomyolysis complications.

Non-traumatic rhabdomyolysis is a rare complication of acute pancreatitis. One of the major risk factors of both acute pancreatitis and rhabdomyolysis is alcohol abuse. However, only a few studies have reported the prognosis and association of severe acute pancreatitis (SAP) and rhabdomyolysis in alcohol abuse patients. In the present study, we report two cases presenting with SAP complicated by rhabdomyolysis following high-dose alcohol intake. The disease onset, clinical manifestations, laboratory data, diagnosis and treatment procedure of each patient were recorded, and the association with rhabdomyolysis was analyzed. Alcohol consumption was the most predominant cause of SAP and rhabdomyolysis in these patients. SAP-related rhabdomyolysis was primarily induced by the toxicity associated with pancreatic necrosis. The laboratory tests revealed that the concentration of serum creatine kinase (CK) and myoglobin increased and acute renal failure symptoms were present, which provided an exact diagnosis for SAP-induced rhabdomyolysis. Rhabdomyolysis and subsequent hypermyoglobinuria severely impaired kidney function and aggravated hypocalcemia. The therapy of early stage SAP complicated by rhabdomyolysis involved liquid resuscitation support. When first stage treatment fails, blood purification should be performed immediately. Both patients developed multiple organ failure (MOF) and succumbed to the disease. Considering the two cases presented, we conclude that alcohol-related SAP complicated by rhabdomyolysis may have a poor clinical prognosis.

Calorimetric studies and lessons on fires and explosions of a chemical plant producing CHP and DCPO.

Cumene hydroperoxide (CHP) has been used in producing phenol, dicumyl peroxide (DCPO) and as an initiator for synthesizing acrylonitrile-butadiene-styrene (ABS) resin by copolymerization in Taiwan. Four incidents of fire and explosion induced by thermal runaway reactions were occurred in a same plant producing CHP, DCPO and bis-(tert-butylperoxy isopropyl) benzene peroxide (BIBP). The fourth fire and explosion occurred in the CHP reactor that resulted in a catastrophic damage in reaction region and even spread throughout storage area. Descriptions on the occurrences of these incidents were assessed by the features of processes, reaction schemes and unexpected side reactions. Calorimetric data on thermokinetics and pressure were used for explaining the practical consequences or which the worst cases encountered in this kind of plant. Acceptable risk associated with emergency relief system design is vital for a plant producing organic peroxide. These basic data for designing an inherently safer plant can be conducted from adiabatic calorimetry. An encouraging deduction has been drawn here, these incidents may be avoided by the implementation of API RP 520, API RP 521, DIERS technology, OSHA 1910.119 and AIChE's CCPS recommended PSM elements.

Clinical study of distribution and drug resistance of pathogens in patients with severe acute pancreatitis.

BACKGROUND: Previous researches about necrotic pancreatic tissue infections are numerous, but the study on systemic infection related to the severe acute pancreatitis (SAP) treatment period is limited. This study aimed to investigate the distribution and drug resistance of pathogenic bacteria in patients who had hepatobiliary surgery for SAP during the past three years. METHODS: A retrospective study was conducted on the distribution, category and drug resistance of pathogenic bacteria in patients who had hepatobiliary surgery for SAP from 2008 to 2011. RESULTS: A total of 594 pathogenic bacteria samples were isolated. Among them 418 isolates (70.4%) were Gram bacteria negative, 142 isolates (23.9%) were Gram bacteria positive, and 34 isolates (5.7%) were found fungi. The most common Gram negative bacteria were Escherichia coli (19.8%), and the dominant Gram positive pathogenic bacteria were Enterococcus faecium. The distribution of SAP-related infectious pathogens was mainly in peritoneal drainage fluid, sputum, bile, and wound secretions. Almost all the Gram negative pathogenic bacteria were sensitive to carbapenum. Extended-spectrum ß-lactamases (ESBLs) producing strains were more resistant to penicillins and cephalosprins than the ESBLs non-producing strains. Staphylococcus was sensitive to vancomycin and linezolid. The drug resistance of meticillin-resistant staphylococcus (MRS) to commonly used antibiotics was higher than meticillin-sensitive streptococcus (MSS). Enterococcus sp. exhibited lower drug-resistance rates to vancomycin and linezolid. CONCLUSIONS: Gram negative bacteria were the dominant SAP-related infection after hepatobiliary surgery. A high number of fungal infections were reported. Drug resistant rates were high. Rational use of antibiotics according to the site of infection, bacterial species and drug sensitivity, correctly executing the course of treatment and enhancing hand washing will contribute to therapy and prevention of SAP-related infection and decrease its mortality.