Cutting balloon treatment of anastomotic biliary stenosis after liver transplantation: Report of two cases

Biliary stenosis is a common complication after liver transplantation,and has an incidence rate ranging from4.7%to 12.5%based on our previous study.Three types of biliary stenosis(anastomotic stenosis,nonanastomotic peripheral stenosis and non-anastomotic central hilar stenosis)have been identified.We report the outcome of two patients with anastomotic stricture after liver transplantation who underwent successfulcutting balloon treatment.Case 1 was a 40-year-old male transplanted due to subacute fulminant hepatitis C.Case 2 was a 57-year-old male transplanted due to hepatitis B virus-related end-stage cirrhosis associated with hepatocellular carcinoma.Both patients had similar clinical scenarios:refractory anastomotic stenosis after orthotopic liver transplantation and failure of balloon dilation of the common bile duct to alleviate biliary stricture.

Clinical Value of Trans-parenchymal Compressing Suture to Decrease the Cutting Surface Related Complications after Non-anatomical Liver Resection

Non-anatomical liver resection with appropriate resection margin is regarded as a potential curative treatment for selected major hepatic carcinoma due to preserving maximal normal liver,especially in cirrhotic patients.But occurrence of cutting surface related complications becomes a main challenge.From June 2010 to June 2016,448 patients with major hepatic carcinoma received non-anatomical liver resection in our liver surgery center.After excluding 66 cases that were incongruent with the purpose of study,235 patients undergoing transparenchymal compressing suture(TCS)to“not good”cutting surface were allocated as study group;147 patients with exposed surface(ES)were matched as control group.The characteristics of postoperative drainage,postoperative hepatic and renal functions,hospital days,and outcomes were collected retrospectively.We further compared cutting surface related complications under different levels of liver cirrhosis between the two groups.Compared with ES group,patients in TCS group had a decreased incidence of cutting surface related complications(14.3%vs.6.8%,P=0.011)and a decreased probability of interventions for cutting surface related complications(8.2%vs.3.4%,P=0.042).TCS application was much more effective to prevent cutting surface related complications in patients with moderate and severe cirrhosis(5.4%vs.15.8%,P=0.003).Postoperative hepatic and renal function,hospita 1 days and mortality did not differ between the two groups.In conclusion,TCS decreases the probability of cutting surface related complications and postoperative interventions for related complications,especially in patients with moderate and severe cirrhosis.

Use of 1.32-μm and 1.06-μm wavelength lasers for vascular cutting in a porcine model of liver and stomach bleeding

Objective The aim of this study was to analyze and evaluate 1.32-μm and 1.06-μm neodymium-doped yttrium aluminum garnet(Nd:YAG) lasers for use in liver and gastroepiploic vessel vaporization and coagulation. Methods The effects of 1.32-μm and 1.06-μm Nd:YAG lasers were compared for gastroepiploic vessel hemostasis in porcine liver.Results The results were observed and measured under the same parameters and dose conditions. The 1.32-μm laser showed greater vaporization width and depth than the 1.06-μm laser. Both lasers controlled active bleeding. The coagulation band with the 1.32-μm laser was thinner than with the 1.06-μm laser, at nearly 3 mm. After cutting of 1-and 2-mm porcine vessels, no grossly visible bleeding was apparent. Intravascular thrombus was visible under the microscope. The length of vessel thrombosis in the experimental group was 2 mm and the diameter was 2 mm; the control group exhibited thrombi as 2.3–4.9 mm in length. Thrombosis completely blocked the blood vessels.Conclusion The 1.32-μm laser had greater vaporization capability than the 1.06-μm laser and achieved hemostasis requirements for vessels less than 2 mm in diameter.

Fast Evaluation of Oxidative DNA Damage by Liquid Chromatography-Electrospray Tandem Mass Spectrometry Coupled With Precision-cut Rat Liver Slices

Objective To establish a fast and sensitive method for the detection of 8-hydroxy-2’-deoxyguanosine （8-OHdG） in precision-cut rat liver slices by HPLC-MS/MS and to investigate isoniazid （INH） -induced oxidative DNA damage. Methods Precision-cut liver slices （300 μm） were prepared from male rats, and incubated with INH （0.018 mol/L） for 2 h after 1 h preincubation. DNA in the slices was extracted and digested into free nucleosides at 37℃ . The samples were injected into HPLC-MS/MS after the proteins were removed. The level of oxidative DNA damage was estimated using the ratio of 8-OHdG to deoxyguanosine （dG）. Results The limit of detection of 8-OHdG was 1 ng/mL （S/N=3） and the intra-assay relative standard variation was 3.38% when one transition 284.3/168.4 was used as a quantifier and another two transitions 284.3/140.2, 306.1/190.2 as qualifiers. 8-OHdG and dG were well separated, as indicated by elution at 10.02 and 7.37 min, respectively. INH significantly increased the ratio of 8-OHdG to dG in rat liver slices （P〈0.05）. Conclusion 8-OHdG in precision-cut liver slices could be sensitively determined by HPLC-MS/MS. HPLC-MS/MS coupled with precision-cut tissue slices is a fast and reliable analytical technique to evaluate oxidative DNA damage of target tissues caused by procarcinogens and cytotoxins.

Application of Precision-Cut Rat Liver Slice to Study the Influence of Monocrotaline, Tussilago farfara Alkaloids on the Expression of Cytochrome P450 Enzymes

Precision-cut liver slice has been successfully used to study the mechanism of drug-induced hepatotoxicity, the prediction of liver toxicity, the discovery of early hepatic toxicity biomarker and the metabolism of drug in liver. We detected the expression of CYP3A4, CYP2B1 + CYP2B2 and CYP2E1 in precision-cut liver slice after co-cultured with monocrotaline or Tussilago farfara alkaloids to investigate the hepatotoxicity mechanism of those drugs. After co-culturing with monocrotaline or Tussilago farfara alkaloids for 6 hours, the expression of CYP3A4 in the microsome of precision-cut liver slices was detected by Western blot, and the expressions of CYP2B1 + CYP2B2 and CYP2E1 were detected by immunofluorescence. The results showed that monocrotaline induced the expression of CYP3A4 and CYP2B1 + CYP2B2, and Tussilago farfara alkaloids obviously up-regulated the expression of CYP2E1 and CYP3A4. Thus, we conclude that the up-regulation of CYP3A4, CYP2B1 + CYP2B2 and CYP2E1 may be one of the toxic mechanisms of liver injury of those drugs.

Alcohol metabolites and lipopolysaccharide: Roles in the development and/or progression of alcoholic liver disease

The onset of alcoholic liver disease (ALD) is initiated by different cell types in the liver and a number of different factors including: products derived from ethanol-induced inflammation, ethanol metabolites, and the indirect reactions from those metabolites. Ethanol oxidation results in the production of metabolites that have been shown to bind and form protein adducts, and to increase inflammatory, fibrotic and cirrhotic responses. Lipopolysaccharide (LPS) has many deleterious effects and plays a significant role in a number of disease processes by increasing inflammatory cytokine release. In ALD, LPS is thought to be derived from a breakdown in the intestinal wall enabling LPS from resident gut bacterial cell walls to leak into the blood stream. The ability of adducts and LPS to independently stimulate the various cells of the liver provides for a two-hit mechanism by which various biological responses are induced and result in liver injury. Therefore, the purpose of this article is to evaluate the effects of a two-hit combination of ethanol metabolites and LPS on the cells of the liver to increase inflamma-tion and fi brosis, and play a role in the development and/or progression of ALD.

Prevention and management of pleural effusion following hepatectomy in primary liver cancer

Postoperative pleural effusion occurs frequently after hepatectomy. The risk factors, prevention and management of postoperative pleural effusion in patients with primary liver cancer (PLC) who have undergone hepatectomy and the value of the argon beam coagulator (ABC) for the prevention of pleural effusion are studied. METHODS:A total of 523 patients with PLC at our institution who had had right hepatectomy from July 2000 to June 2004 were studied retrospectively. Comparative analysis was made to identify the factors contributing to postoperative pleural effusion and the efficacy of various managements. RESULTS:Of the 523 patients whose livers were dissociated using argon beam cutting and/or coagulation, 20(3.8%) developed pleural effusions;whereas in the other 467 patients underwent hepatectomy with suture ligation of the diaphragmatic secondary wound surface during the same period, 49(10.5%) had pleural effusion (P<0.01). The factors contributing to postoperative pleural effusion included subphrenic collection, postoperative hepatic insufficiency with ascites, duration of hepatic occlusion and underlying cirrhosis. CONCLUSIONS: Dissociation of the liver by argon beam cutting and/or coagulation can save suture ligation of the diaphragmatic secondary wound surface and may also prevent postoperative pleural effusion. Pleural drainage using an indwelling central-venous-catheter (CVC) in the pleural cavity is safe and efficacious.

基于配准分割的Graph Cuts自动分割算法在肝脏图像中的研究

临床上的肝脏疾病诊断是由医生对肝体影像进行手动分割,获得肝体的准确解剖信息对肝功能进行有效的评价,但手动分割肝脏影像是一项繁琐、费时且不可重现的工作。为了辅助医生对肝脏疾病诊断,论文提出基于配准的GraphCuts自动分割算法,对人体肝脏CT图像进行自动分割。首先使用配准分割算法,对肝脏图像进行有效的分割,然后使用权重投票将所有的配准分割结果融合为一幅预分割图像,最后利用水平集符号距离函数通过预分割图像标记前背景像素,实现Graph Cuts算法对肝脏的自动分割。实验结果表明,论文的自动分割算法精度较高,在一定程度上能够为临床的精确诊断提供科学的理论依据。

基于非线性增强和图割的CT序列肝脏肿瘤自动分割

针对腹部CT图像肝脏肿瘤对比度低、边界模糊、灰度多样等因素引起的分割困难,提出基于非线性增强和图割的肝脏肿瘤自动分割.首先根据肝脏区域灰度分布特性,采用自适应分段非线性增强和迭代卷积操作提高正常肝实质与肿瘤组织的对比度;然后将增强结果和图像边界信息有效地融入图割能量函数,实现肝脏肿瘤初步自动分割结果;最后采用三维形态学开操作对初步分割结果进行优化,去除其中的误分割区域,提高分割精度.在3Dircadb和XYH数据库上的实验结果表明,该方法能有效地自动分割腹部CT序列中的肝脏肿瘤,且综合分割性能优于现有多种方法.

醋氨酚所致精密肝切片损伤模型的建立及CYP2E1的调节作用

目的:利用精密肝切片(PCLS)技术,建立醋氨酚所致肝切片损伤的体外模型,并探讨CYP2E1活性变化对肝损伤的调节作用,为研究和筛选肝保护药物提供实验依据。方法:利用振荡切片机制备PCLS,建立培养系统。将终浓度为500μmol/L的醋氨酚分别与切片共孵育0、2、4、6h,测定培养基和切片中的谷胱甘肽S-转移酶(GST)和乳酸脱氢酶(LDH)活性。在体给予不同剂量(0.25、0.5、1.0g/kg)的CYP2E1诱导剂乙醇,每天一次,连续3d。末次给药8h后处死动物,取其肝脏制备PCLS,再与500μmol/L醋氨酚共同孵育6h,检测ALT和LDH漏出率。正常PCLS与不同浓度的二乙基二硫代氨基甲酸酯盐(DDTC,CYP2E1抑制剂)(5、10、20μmol/L)、500μmol/L醋氨酚共同孵育6h,检测ALT和LDH漏出率。结果:与常规培养组比较,醋氨酚孵育4、6h组的GST和LDH漏出率显著升高(P<0.01)。与醋氨酚模型对照组比较,乙醇中、大剂量组LDH漏出率和小、大剂量组ALT漏出率皆升高(P<0.01,P<0.05);DDTC各浓度组ALT漏出率则降低(P<0.05)。结论:PCLS与500μmol/L醋氨酚共孵育4h即能成功地建立体外肝切片损伤的模型。抑制CYP2E1活性可能对醋氨酚所致的肝损伤有保护作用,而上调CYP2E1活性则可能加重醋氨酚所致的肝损伤。

精密肝切片技术方法学的建立

目的 :建立一种新的肝脏体外研究手段———精密肝切片技术 ,摸索最佳培养条件。方法 :利用国产振荡切片机 ,制备肝切片 ,建立培养系统 ,以乳酸脱氢酶外漏、谷胱甘肽含量、噻唑蓝还原能力、蛋白含量为指标 ,观察切片厚度、培养液pH值及培养时间对肝切片活力的影响 ;观察抗氧化剂谷胱甘肽 (GSH)、阿魏酸钠 (SF)对CCl4 损伤肝切片活力的影响。结果 :切片厚度 30 0 μm ,培养液pH7.0时 ,肝切片在 4h内活力维持良好。GSH可恢复CCl4 所致肝切片多项指标的变化 ,SF也有一定逆转作用。结论 :精密肝切片技术可用于肝体外研究。切片厚度 30 0 μm ,培养液pH7.

基于核图割模型的肝脏CT图像肿瘤分割

计算机断层成像(CT)对疾病的确诊意义重大,在医学图像的自动检测中应用较多的模型为图割模型,但传统图割算法严重依赖于对复杂区域进行大量建立的模型,运算复杂且不利推广。为此,在传统图割理论基础上引入核函数,提出一种基于核图割模型的肝脏CT图像肿瘤分割算法。通过核函数将原始数据映射到高维空间,并在高维图像数据空间用图割理论对CT图像的肝区与肿瘤区域进行分割,以提取疑似肿瘤区域,解决传统图割模型中需要依赖人机交互和对复杂区域建模困难等问题。由Mercer定理得出,核空间的点积运算不需要显式指定图像各区域的具体模型,进行核推广后克服了传统模型通用性不强的弱点。利用临床CT图像数据对该算法进行分割实验,结果表明,基于核推广后的图割算法能够有效对肿瘤和肝区进行分离,可应用于临床实际中作为肿瘤辅助诊断手段。

切割式肝活检的临床应用(附750例报告)

回顾性分析750例切割式肝活检的成功率、并发症。结果显示所有。750例患者中1次成功获得肝组织735例,成功率为98.0％,未获肝组织12例(1.6％),误穿其他器官3例(0.4％)。活检后24 h内发生较严重右中上腹疼痛4例(0.5％)。无肝脏出血等严重并发症发生。由此表明,切割式肝活检成功率高,并发症发生率低,易于操作,适于临床应用。

混合重金属离子诱导的鲫鱼肝脏DNA的断裂与修复

采用凝胶电泳技术和3 H -TdR掺入实验研究了亚致死浓度的混合重金属离子诱导的鲫鱼肝脏细胞DNA断裂与修复作用。结果表明 :Zn、Pb和混合重金属离子引发了鲫鱼肝脏细胞DNA的断裂 ,相对断裂数大小顺序为混合重金属离子 >Pb >Zn ;Cd、Zn、Pb和混合重金属离子的处理中都检测到修复作用的存在 ,修复作用的大小顺序为混合重金属离子 >Pb >Zn >Cd ;重金属离子混合后 ,对鲫鱼肝脏细胞DNA的损伤作用增大 ,但DNA的断裂和修复结果不完全相同。

阿魏酸钠对乙醇损伤性大鼠肝切片的保护作用及机制

目的:采用精密肝切片技术,研究阿魏酸钠(SF)对乙醇损伤性大鼠肝切片的保护作用及机制。方法:制作大鼠乙醇损伤肝切片模型,观察不同浓度SF对切片培养液中肝损伤标志酶及胞浆苯胺羟化酶(ANH)、乙醇脱氢酶(ADH)活性的影响。结果:乙醇50mmol·L-1作用肝切片4h时,培养液中谷丙转氨酶、谷草转氨酶、乳酸脱氢酶和谷胱甘肽S-转移酶活性明显升高,同时肝切片胞浆ANH活性升高、ADH活性降低。当共处理SF463~1388nmol·L-14h后,培养液中各酶活性显著降低至正常水平,SF浓度增至694nmol·L-1以上时,肝切片胞浆ANH和ADH活性也恢复正常。结论:SF能有效拮抗乙醇所致的肝损伤,其机制与改变乙醇代谢途径有关。

γ射线辐照人类正常肝细胞染色体损伤的动态修复(英文)

应用早熟染色体凝集技术对人类正常肝脏细胞经γ射线照射导致的染色体损伤后48h内的动态修复过程进行了研究。结果显示:照射后原初染色单体断裂和等点染色单体断裂数随着照射剂量的增加而增多,染色单体断裂显著多于等点染色单体断裂;经过24h的继续培养,这两种类型的损伤都有不同程度的修复,约50%染色单体断裂得到修复,而等点染色单体断裂的修复率最多为15%;经过48h的照射后培养,染色体损伤的水平与24h相比没有显著差异。说明肝细胞经γ射线照射后染色体损伤的主要形式是染色单体断裂,易于修复;虽然等点染色单体断裂数量较少,但修复困难。由此表明,等点染色体断裂是细胞经γ射线照射后死亡和癌变的一个重要因素。

中药肝毒性及肝脏保护作用的研究方法进展

近年来,中药的肝毒性越来越被人们所了解和重视,中药的肝毒性及肝脏保护作用的研究方法已被广泛建立。与传统的动物体内药代动力学实验相比,精密肝切片法、肝细胞及亚细胞模型体外实验法得以直观地反映出药物对细胞及组织的影响。基因组学,蛋白质组学,代谢组学的方法利用质谱联用技术找出新的生物标记物,阐明肝毒性机制。这一系列的进展为广大的药学工作者对中药肝毒性及肝脏保护作用的研究提供了较大的帮助。

基于图割与概率图谱的肝脏自动分割研究

提出一种利用均值漂移算法做预处理,将概率图谱与图割算法相结合的肝脏自动分割方法。该方法一方面有效利用概率图谱所代表的形状信息,并且以无参形状建模;另一方面,均值漂移算法对灰度和形状信息组成的综合信息进行过分割处理,利用过分割的区域代替单个像素参与图割算法,降低了优化算法的复杂度。实验结果表明,该方法有效结合了概率图谱和均值漂移算法的优点,提高了图割算法的精度和速度。

甲状腺全切术治疗原发性甲状腺功能亢进疗效及对患者心脏功能和肝功能的影响

目的:观察临床应用甲状腺全切术治疗原发性甲状腺功能亢进的效果及对患者心脏及肝功能的影响。方法:选取2014年7月至2015年8月在我院进行诊治的98例原发性甲状腺功能亢进患者,按随机平行分组法随机分为对照组和观察组各49例,对照组患者给予甲状腺次全切术治疗,观察组患者则应用甲状腺全切术治疗,对比分析两组患者治疗后的临床疗效及对患者心脏及肝功能影响。结果:治疗后观察组短暂性甲减发生率高于对照组,差异具有统计学意义(P<0.05),术后复发率及术中出血量、手术时间均低于对照组,差异具有统计学意义(P<0.05);治疗前两组患者各项心脏功能及肝功能指标比较均无差异,差异具有统计学意义(P>0.05),治疗后均较治疗前下降,差异具有统计学意义(P<0.05);组间比较,观察组患者下降程度高于对照组,差异具有统计学意义(P<0.05)。结论:临床应用甲状腺全切术治疗原发性甲状腺功能亢进效果显著,可明显改善心脏及肝功能,可在临床推广应用。

针刺配合中药及人工泪液治疗肝肾阴亏型泪液缺乏性干眼症的疗效观察

目的观察针刺配合中药及人工泪液治疗肝肾阴亏型泪液缺乏性干眼症的临床疗效。方法将80例肝肾阴亏型泪液缺乏性干眼症患者随机分为A组30例、B组25例和C组25例。A组采用针刺配合中药及人工泪液治疗,B组采用中药配合人工泪液治疗,C组采用单纯人工泪液治疗。观察各组治疗前后视力、泪液分泌试验(Schirmer I test, SIT)、泪膜破裂时间(break-up time, BUT)、角膜荧光染色(fluorescein staining, FL)、眼部症状评分及中医证候评分的变化情况,并比较各组临床疗效。结果 A组治疗后双眼视力与同组治疗前比较,差异均具有统计学意义(P<0.01);B组治疗后左眼视力与同组治疗前比较,差异具有统计学意义(P<0.05)。各组治疗后双眼SIT、BUT、FL评分与同组治疗前比较,差异均具有统计学意义(P<0.01)。A组治疗后双眼视力评分、SIT与B组和C组比较,差异均具有统计学意义(P<0.01,P<0.05)。A组和B组治疗后双眼BUT、FL评分与C组比较,差异均具有统计学意义(P<0.05,P<0.01)。B组治疗后右眼FL评分与C组比较,差异具有统计学意义(P<0.05)。A组和B组治疗后各项眼部症状(干涩感、异物感、疲劳感)评分与同组治疗前比较,差异均有统计学意义(P<0.01);C组治疗后干涩感、疲劳感评分与同组治疗前比较,差异均有统计学意义(P<0.01,P<0.05)。A组治疗后各项眼部症状评分与C组比较,差异均具有统计学意义(P<0.01);B组治疗后干涩感评分与C组比较,差异具有统计学意义(P<0.05)。A组总有效率为93.3%,B组为80.0%,C组为40.0%;A组中医证候总有效率为90.0%,B组为80.0%,C组为8.0%。A组和B组总有效率及中医证候总有效率与C组比较,差异均具有统计学意义(P<0.01)。结论针刺配合中药及人工泪液是一种治疗肝肾阴亏型泪液缺乏性干眼症的有效方法,可缓解患者症状,提高视力。