Congenital left intrahepatic bile duct draining into gastric wall mimicking biliary reflux gastritis

Abnormalities and variations of the biliary ducts are not rare.Most aberrant bile ducts eventually drain into the descending part of duodenum through the papilla of vater.However,drainage of the left hepatic bile duct into the stomach is extremely rare.A 29-year old man was admitted to the hospital with the diagnosis of biliary reflux gastritis.Comprehensive imaging modalities were performed including electronic endoscopy,endoscopic ultrasonography,endoscopic retrograde cholangiopancreatography and magnetic resonance cholangio-pancreatography.Finally,congenital ectopic left intrahepatic bile duct draining into the stomach was found,which caused biliary reflux gastritis.The patient did not receive any surgery.Good recovery was achieved by medical treatment.

ROLE OF CASPASE-3 IN ACUTE LIGHT DAMAGE TO RETINA OF RATS

Objective To investigate the role of Caspase-3 in retinal damage caused by light exposure in rats. Methods Light injury to retina was induced by persistent exposure to illumination (intensity:30000±50lux) of operating microscope for 30 minutes in the right eyes of Sprague-Dawley rats. The pathological changes of retina were observed under optical and electron microscopies at different time points, which were 6 hours, 1, 3, 7, and 15 days after the light exposure. Apoptosis of retinal cells was analyzed by flow cytometry. The activity of Caspase-3 was evaluated by using the Caspase-3 assay kit. At the same time, the expression of Caspase-3 protease was determined with Western blot analysis. Results The examination results of optical and transmission electron microscopes showed that edema of inner and outer segments of the retina, especially the chondriosome inside the inner segment, became obvious 6 hours after the light exposure. The change was deteriorated along with the increasing time. The structures of the discoidal valve dissociated in the outer segment simultaneously. Disorderly arranged nuclei, karyopycnosis, and thinning in the outer nuclear layer were observed. The retinal pigment epithelium almost disappeared during the later stage. The staining results of Annexin-V combined with PI demonstrated that the proportion of apoptotic cells increased with time. The proportion between 7th day (82.7%) and 15th day (80.4%), however, showed no significant difference. Caspase-3 became remarkably active with the lapse of time, which increased from 0.02 at 6th hour to the peak of 9.8 at 7th day before it started to descend. The Western blot detected a expression of the active form of Caspase-3 at 7th day and 15th day.Conclusion Apoptosis of photoreceptor cells is markedly involved in the light damage and Caspase-3 protease may play an important role in the apoptotic process of the retina after light exposure in rats.

Detection and comparison of matrix metalloproteinase in primary and recurrent pterygium fibroblasts

AIM: To detect and compare the levels of matrix metalloproteinases (MMPs) secreted by primary and recurrent human pterygium fibroblasts (HPFs). METHODS: Primary and recurrent HPFs as well as human conjunctival fibroblasts (HCF) were cultured in RPMI 1640 medium at the same conditions. The protein levels of MMP-1, MMP-3 and MMP-9 were determined by enzyme-linked immune sorbent assay (ELISA), respectively. RESULTS: 1) The protein level of MMP-1 in serum-free supernatant from cultured primary and recurrent HPFs was higher than that in normal HCFs (P <0.05); similarly, the protein level of MMP-1 in serum-free supernatant from cultured primary HPFs was higher than that in recurrent HCFs (P <0.05). 2) The protein level of MMP-3 in serum-free supernatant from cultured primary HPFs was higher than that in normal HCFs (P<0.05); meanwhile, the protein level of MMP-3 in serum-free supernatant from cultured recurrent HPFs was lower when compared with that in primary HPFs and normal HCFs (P<0.05). 3) MMP-9 was not detected in primary and recurrent HPFs in the conditioned medium. CONCLUSION: The protein levels of MMP-1 and MMP-3 in supernatant secreted by primary HPFs are different from recurrent HPFs. Different pathological mechanisms may exist between primary and recurrent pterygia.

Relationship between the high frequency of 23S rRNA point mutations in Treponema pallidum and low serological response rate to azithromycin treatment in China

Objective Although azithromycin is effective against Treponema pallidum (T.pallidum),the causative agent of syphilis,recent reports indicate that the prevalence of azithromycin resistance in China is very high,which may result in the failure of treatment.In this study,we aimed to investigate the association between azithromycin resistance and therapeutic outcomes in early syphilis patients.Methods Between February 2010 and December 2014,patients aged 18-65 years with early syphilis were enrolled.T.pallidum DNA were extracted to test the presence of A2058G and A2059G mutations.Then,eligible patients were randomly assigned to receive oral azithromycin (0.5 g,once daily for 15 days) or intramuscular BPG (2.4 million units,once weekly for 3 weeks).All patients were followed up in 2 weeks and 3,6,9,and 12 months after treatment to collect demographic and clinical characteristics and laboratory results.The differences on serological response,serological failure and serofast rate were compared between the two groups by Chi-square test.Results Among the 187 T.pallidum-infected patients enrolled,172 (92.0%) cases had a mutation associated with azithromycin resistance (A2058G,153 cases;A2059G,19 cases).During the 5-year study period,the percentage of cases enrolled with these mutations steadily increased,from 90.9% in 2010 to 95.3% in 2014.Of the 172 patients presenting with these mutations,only 78 (45.3%;all benzathine penicillin G [BPG]-treated) obtained a serological response to treatment;32.6% and 22.1% of patients presented with serological failure and serofast results,respectively.For azithromycin-treated cases,66.3% and 33.7% had serological failure and serofast results,respectively,in contrast with 1.1% and 11.3% of BPG-treated cases.However,among the A2058G-and A2059G-negative patients,the serological response rates between the two treatment groups were similar.In multivariate analyses,patients with lower rapid plasma reagin (RPR) titers (RPR,≤ 1 ∶ 8;odds ratio [OR],0.23;95% confidence interval [CI],0.09-0.37) or who received azithromycin treatment (OR,121.50;95% CI,35.38-386.17) were more likely to display serological failure and serofast results.Conclusion This prospective study found that the 23S rRNA A2058G and A2059G point mutations in T.pallidum are currently circulating with high frequency in China,suggesting a correlation between the high prevalence of macrolide resistance and a lower serolo gical response rate to azithromycin treatment.