When should endovascular gastrointestinal anastomosis transection Glissonean pedicle not be used in hepatectomy? A case report.

BACKGROUND: The literature on post-hepatectomy bile duct injury (PHBDI) is limited, lacking large sample retrospective studies and high-quality experience summaries. Therefore, we reported a special case of iatrogenic bile duct injury caused by Glissonean pedicle transection with endovascular gastrointestinal anastomosis (endo-GIA) during a right hepatectomy, analyzed the causes of this injury, and summarized the experience with this patient. CASE SUMMARY: We present the case of a 66-year-old woman with recurrent abdominal pain and cholangitis due to intrahepatic cholangiectasis (Caroli's disease). Preoperative evaluation revealed that the lesion and dilated bile ducts were confined to the right liver, with right hepatic atrophy, left hepatic hypertrophy, and hilar translocation. This problem can be resolved by performing a standard right hepatectomy. Although the operation went well, jaundice occurred soon after the operation. Iatrogenic bile duct injury was considered after magnetic resonance cholangiopancreatography review, and the second operation were performed 10 d later. During the second operation, it was found that the endo-GIA had damaged the lateral wall of the hepatic duct and multiple titanium nails remained in the bile duct wall. This led to severe stenosis of the duct wall, and could not be repaired. Therefore, the injured bile duct was transected, and a hepatic-jejunal-lateral Roux-Y anastomosis was performed at the healthy part of the left hepatic duct. After this surgery, the patient had a smooth postoperative recovery, and the total bilirubin gradually decreased to normal. The patient was discharged 41 d after operation. No anastomotic stenosis was found at the 6 mo of follow-up. CONCLUSION: Not all cases are suitable for endo-GIA transection of Glissonean pedicle, especially in cases of intrahepatic bile duct lesions. PHBDI caused by endo-GIA is very difficult to repair due to extensive ischemia, which requires special attention.

Synthesizing the First Phase of Dynamic Sequences of Breast MRI for Enhanced Lesion Identification.

OBJECTIVE: To develop a deep learning model for synthesizing the first phases of dynamic (FP-Dyn) sequences to supplement the lack of information in unenhanced breast MRI examinations. METHODS: In total, 97 patients with breast MRI images were collected as the training set (n = 45), the validation set (n = 31), and the test set (n = 21), respectively. An enhance border lifelike synthesize (EDLS) model was developed in the training set and used to synthesize the FP-Dyn images from the T1WI images in the validation set. The peak signal-to-noise ratio (PSNR), structural similarity (SSIM), mean square error (MSE) and mean absolute error (MAE) of the synthesized images were measured. Moreover, three radiologists subjectively assessed image quality, respectively. The diagnostic value of the synthesized FP-Dyn sequences was further evaluated in the test set. RESULTS: The image synthesis performance in the EDLS model was superior to that in conventional models from the results of PSNR, SSIM, MSE, and MAE. Subjective results displayed a remarkable visual consistency between the synthesized and original FP-Dyn images. Moreover, by using a combination of synthesized FP-Dyn sequence and an unenhanced protocol, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI were 100%, 72.73%, 76.92%, and 100%, respectively, which had a similar diagnostic value to full MRI protocols. CONCLUSIONS: The EDLS model could synthesize the realistic FP-Dyn sequence to supplement the lack of enhanced images. Compared with full MRI examinations, it thus provides a new approach for reducing examination time and cost, and avoids the use of contrast agents without influencing diagnostic accuracy.

Rare isolated extra-hepatic bile duct injury: A case report.

BACKGROUND: Extra-hepatic bile duct injury (EHBDI) is very rare among all blunt abdominal injuries. According to literature statistics, it only accounts for 3%-5% of abdominal injuries, most of which are combined injuries. Isolated EHBDI is more rare, with a special injury mechanism, clinical presentation and treatment strategy, so missed diagnosis easily occurs. CASE SUMMARY: We report a case of unexplained abdominal effusion and jaundice following blunt abdominal trauma in our department. Of which, surgical exploration of the case was performed and a large amount of bile leakage in the abdominal cavity was found. No obvious abdominal organ damage or bile duct rupture was found. Surgery was terminated after the common bile duct indwelled with a T tube. After 2 wk, a T-tube angiography revealed the lesion in the common bile duct pancreatic segment, confirming isolated EHBDI. And 2 mo later, the T tube was pulled out with re-examined magnetic resonance cholangiopancreatography, indicating narrowing of the common bile duct injury, with no special treatment due to no clinical symptoms and no abnormality in the current follow-up. CONCLUSION: This case was featured by intraoperative bile leakage and no EHBDI. This type of rare isolated EHBDI is prone to missed and delayed diagnosis due to its atypical clinical manifestations and imaging features. Surgery is still the main treatment, and the indications and principles of bile duct injury repair must be followed.

Single-cell RNA-seq reveals the diversity of trophoblast subtypes and patterns of differentiation in the human placenta.

The placenta is crucial for a successful pregnancy and the health of both the fetus and the pregnant woman. However, how the human trophoblast lineage is regulated, including the categorization of the placental cell subtypes is poorly understood. Here we performed single-cell RNA sequencing (RNA-seq) on sorted placental cells from first- and second-trimester human placentas. New subtypes of cells of the known cytotrophoblast cells (CTBs), extravillous trophoblast cells (EVTs), Hofbauer cells, and mesenchymal stromal cells were identified and cell-type-specific gene signatures were defined. Functionally, this study revealed many previously unknown functions of the human placenta. Notably, 102 polypeptide hormone genes were found to be expressed by various subtypes of placental cells, which suggests a complex and significant role of these hormones in regulating fetal growth and adaptations of maternal physiology to pregnancy. These results document human placental trophoblast differentiation at single-cell resolution and thus advance our understanding of human placentation during the early stage of pregnancy.

PLAC8, a new marker for human interstitial extravillous trophoblast cells, promotes their invasion and migration.

Proper differentiation of trophoblast cells in the human placenta is a prerequisite for a successful pregnancy, and dysregulation of this process may lead to malignant pregnancy outcomes, such as preeclampsia. Finding specific markers for different types of trophoblast cells is essential for understanding trophoblast differentiation. Here, we report that placenta-specific protein 8 (PLAC8) is specifically expressed in the interstitial extravillous trophoblast cells (iEVTs) on the fetomaternal interface. Using model systems, including placental villi-decidua co-culture, iEVTs induction by using primary trophoblast cells or explants, etc., we found that PLAC8 promotes invasion and migration of iEVTs. Mechanistically, time-lapse imaging, GTPase activity assay, co-immunoprecipitation and RNA-seq studies show that PLAC8 increases the Cdc42 and Rac1 activities, and further induces the formation of filopodia at the leading edge of the migratory trophoblast cells. More interestingly, PLAC8 is significantly upregulated under hypoxia and expression of PLAC8 is higher in iEVTs from preeclamptic placentas when compared with those from the normal control placentas. Together, PLAC8 is a new marker for iEVTs and plays an important role in promoting trophoblast invasion and migration.

Live cell imaging of in vitro human trophoblast syncytialization.

Human trophoblast syncytialization, a process of cell-cell fusion, is one of the most important yet least understood events during placental development. Investigating the fusion process in a placenta in vivo is very challenging given the complexity of this process. Application of primary cultured cytotrophoblast cells isolated from term placentas and BeWo cells derived from human choriocarcinoma formulates a biphasic strategy to achieve the mechanism of trophoblast cell fusion, as the former can spontaneously fuse to form the multinucleated syncytium and the latter is capable of fusing under the treatment of forskolin (FSK). Live-cell imaging is a powerful tool that is widely used to investigate many physiological or pathological processes in various animal models or humans; however, to our knowledge, the mechanism of trophoblast cell fusion has not been reported using a live- cell imaging manner. In this study, a live-cell imaging system was used to delineate the fusion process of primary term cytotrophoblast cells and BeWo cells. By using live staining with Hoechst 33342 or cytoplasmic dyes or by stably transfecting enhanced green fluorescent protein (EGFP) and DsRed2-Nuc reporter plasmids, we observed finger-like protrusions on the cell membranes of fusion partners before fusion and the exchange of cytoplasmic contents during fusion. In summary, this study provides the first video recording of the process of trophoblast syncytialization. Furthermore, the various live-cell imaging systems used in this study will help to yield molecular insights into the syncytialization process during placental development.

[Analysis of related factors of premature delivery for the migrant population in local suburban Beijing areas].

OBJECTIVE: To study the health conditions of pregnant migrant women in some suburban areas of Beijing by comparing a variety of pathological, physiological and social factors and exploring the relevant factors associated with preterm birth so as to prevent effectively preterm birth. METHODS: A total of 279 cases of pregnancy in preterm birth at out hospital from January 2004 to December 2008 were reviewed. The date of maternal age, parity, prenatal examinations, history of vaginitis, history of chorioamnionitis, premature rupture of membranes, occupation, residing location and education status were recorded. And the relationship between them and preterm birth were analyzed by χ(2) test. RESULTS: The overall incidence of preterm birth was 5.34%. And the following factors had statistically significant differences with premature birth: chorioamnionitis, vaginitis, premature rupture of membranes, a lack of prenatal examinations, low education status, migrant population or maternal parity. However there was no statistical significance (P > 0.05) between preterm birth and other factors, such as occupation. CONCLUSION: The incidence of preterm birth is associated with a lack of prenatal examinations, low education status, chorioamnionitis, bacterial vaginitis and premature rupture of membranes. Therefore the migrant women in Beijing should receive targeted education programs during pregnancy. And reproductive tract inflammation should be properly treated.

[Application of proteomic models for the diagnosis of inflammatory and non-inflammatory preterm delivery].

OBJECTIVE: To establish the serum proteomic models for the identification of premature delivery with inflammation or non-inflammation. METHODS: The laboring patients from 2008 to 2010 at our hospital were divided into 5 groups according to placental pathology, including inflammatory preterm group, non-inflammatory preterm group and blind test group (n = 50 each). The control group was normal full-term. The preterm models with or without inflammation were established by the methods of SELDI-TOF-MS (matrix-assisted laser desorption/ionization-time of flight-mass spectrometry) and bioinformatics. And statistical analysis was performed after a blind test. Then differential protein fingerprints were compared and analyzed. RESULTS: A total of 36 different proteins were harvested after a comparison of inflammatory preterm and control groups. The model was established by eight markers. The rates of specificity, sensitivity, positive predictive value and negative predictive value were 80.85%, 84.44%, 93.33% and 46.67% respectively. Fifteen different proteins existed between non-inflammatory preterm and control groups. There were 4 marker proteins. The rates of specificity, sensitivity, positive predictive value and negative predictive value were 75.68%, 64.44%, 80.00% and 66.67% respectively. Different marker proteins existed between the identification models of inflammatory preterm labor and inflammatory full-term. CONCLUSION: Different serum proteomic models may be used for the diagnosis of preterm labor and the differentiation of preterm labor with or without inflammation. And different proteins are expressed during different stages of pregnancy with chorioamnionitis.

[Study of factors associated with subclinical chorioamnionitis in term pregnancy].

OBJECTIVE: To investigate the effects of various factors upon subclinical chorioamnionitis (SCCAS) during pregnancy and delivery. METHODS: A total of 796 cases of pregnancy in full-term birth at our hospital from December 2006 to December 2008 were reviewed. The data of maternal age, gravidity, parity, gestational age, prenatal care, history of vaginitis, premature rupture of membranes, occupation, educational status and delivery mode were recorded. And then the relationship between one of them and chorioamniotis were analyzed by chi(2) test. RESULTS: The overall incidence of SCCAS was 39.95% in full-term birth. The pregnant women, who had no prenatal care or no occupation, or had a history of vaginitis or premature rupture of membranes, were found to have a higher incidence (P < 0.05 or P < 0.01). However, there were no statistical significance (P > 0.05) between SCCAS and other seven factors, such as gravida age, gravidity, parity, gestational age, educational status, delivery mode and living conditions. CONCLUSION: Women with full-term birth, even in the absence of symptoms, may have already suffered from acute or chronic chorioamnionitis. The incidence is associated with prenatal care, history of vaginitis and premature rupture of membranes.

[Expression and its clinical significance of p27 protein in cervical carcinoma tissues].

AIM: To investigate the expression of p27 protein and its significance in cervical carcinoma tissues. METHODS: The p27 protein expression in 26 normal cervical tissues and 48 cervical carcinoma tissues was detected by streptavidin-peroxidase staining(SP method). RESULTS: The positive rate of p27 protein expression in 48 cervical carcinoma tissues was 39.5%, and that in 26 normal cervical tissues was 72.7%. The former was obviously lower than the latter(P<0.01). In addition, The positive rate of p27 protein in 48 cervical carcinoma tissue was correlated with the differentiation degree of the carcinoma, clinical phase of the patients and lymph node metastasis. In the poorly-differentiated cancer cells, advanced phase patients and the patients with lymph node metastasis, positive rate of p27 protein expression was the lowest. CONCLUSION: The expression of p27 protein is related to differentiation degree of cancer cells, clinical phase of the patients and lymph node metastasis. Detection of p27 protein expression may be valuable to assess prognosis of the patients with cervical carcinoma.