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.

Oddi sphincter preserved cholangioplasty with hepaticosubcutaneous stoma for hepatolithiasis

AIM: To evaluate the long-term outcomes of Oddi sphincter preserved cholangioplasty with hepaticosubcutaneous 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.

Clinical application of plasma shock wave lithotripsy in treating impacted stones in the bile duct system

AIM： To verify the safety and efficacy of plasma shock wave lithotripsy （PSWL） in fragmenting impacted stones in the bile duct system. METHODS： From September 1988 to April 2005, 67 patients （26 men and 41 women） with impacted stones underwent various biliary operations with tube （or T-tube） drainage. Remnant and impacted stones in the bile duct system found by cholangiography after the operation were fragmented by PSWL and choledochofiberscopy. A total of 201 impacted stones were fragmented by PSWL setting the voltage at 2.5-3.5 kV, and the energy output at 2-3.1 for each pulse of PSWL. Then the fragmented stones were extracted by choledochofiberscopy. The safety and efficacy of PSWL were observed during and after the procedure. RESULTS： One hundred and ninety-nine of 201 impacted stones （99.0%） in the bile duct system were successfully fragmented using PSWL and extracted by choledochofiberscopy. The stone clearance rate for patients was 97% （65/67）. Ten patients felt mild pain in the right upper quadrant of the abdomen, and could tolerate it well. Eleven patients had a small amount of bleeding from the mucosa of the bile duct. The bleeding was transient and stopped spontaneously within 2 min of normal saline irrigation. There were no significant complications during and after the procedure. CONCLUSION：PSWL is a safe and effective method for fragmenting impacted stones in the bile duct system.

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-αexpression in hepatic macrophages and both CYP7A1 and bile acid(BA)expression in liver cells,recombinant rat OPN and recombinant rat TNF-αwere 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-αlevel(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%,χ^(2)=14.55,P<0.01),liver TNF-αexpression(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-αproduction 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.

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 ofG.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 IC5o values<5μg/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.

Two-dimensional correlation spectroscopic studies on coordination between carbonyl group of butanone and metal ions

Two dimensional asynchronous spectra were used to characterize coordination between carbonyl group of butanone and metal ions by using an approach proposed in our recent paper.Spectral variation of n-π^＊transition band of carbonyl group is used to probe the coordination even if metal ions does not possess any characteristic peak in spectra.Experimental results indicate that Ca^2＋ and Al^3＋ show considerable ability to coordinate with the carbonyl group of butanone and bring about spectral variation of the n-π-＊transition band,which is manifested by cross peaks in 2D asynchronous spectra.

Interactions between pyridinium and Nd^(3+)

In this paper,2D asynchronous spectra generated by using the DAOSD approach was utilized to probe interactions between Nd^3＋ and pyridinium dissolved in aqueous solution.A series of cross peaks in the resultant 2D asynchronous spectrum confirms the occurrence of intermolecular interaction between Nd^3＋and pyridinium.However,no coordination occurs between Nd^3＋ and pyridinium.Interaction between πelectron from aromatic system and/electron from lanthanide ions account for the appearance of cross peaks in 2D asynchronous spectra.Because of the interaction,the emission spectrum of pyridinium exhibits a significant change when neodymium perchlorate was introduced into the system.