【Abstract】Objective To explore the relation between the expression of telomerase and DNA ploidy with biliarypancreatic system cancer, so as to find a better way to diagnose and distinguish jaundice between malignance and benign disease.Methods Endoscopic retrograde cholangiopancreatography (ERCP) were performed before operation in patients with obstructive jaundice. The bile and pancreatice juice were collected before ERCP. Biopsy specimens from part of patients were obtained during ERCP. All cancer specimens were possessed once again during operation and were assessed by the activity of telomerase and DNA ploidy. Results ① Telomerase positive rate 〔87.50%(56/64)〕 of tissue specimens in malignant obstructive jaundice were higher than that in benign obstructive jaundice 〔3.33%(2/60)〕，P=0.000. ② Telomerase positive rate〔71.88%(46/64)〕of Bile and pancreatice juice in malignant obstructive jaundice were higher than that in benign obstructive jaundice 〔3.33%(2/60)〕， P=0.000, tissue specimens obtained by endoscopy with malignant obstructive jaundice had detectable telomerase activity, positive rate was 83.33%（20/24）. ③ The rate of DNA heteroploid with malignant obstructive jaundice was 62.50%（40/64）, that of diploid can be seen in all patients with benign obstructive jaundice, the difference was statistically significant (P=0.000). ④ The rate of telomerase positive and DNA heteroploid in high differentiation tumor were significantly lower than in middlelow differentiation tumor （P=0.028，P=0.001）.Conclusion Applying the duodenoscope we collected the bile and pancreatic fluid before operation and obtain biopsy specimens whose telomerase activity and DNA ploid were detected. This is simple, safe, quick method which can identify the malignant and benign obstructive jaundice.
Objective To investigate the effects and mechanisms of bile on small intestine mucosal barrier.Methods Fifty Wistar rats were assinged into 3 groups randomly: obstructive jaundice (OJ) group （n=20）, biliary external drainage group （n=20） and control group （n=10）. Ten days after operation, the plasma endotoxin level was determinated, the terminal ileum mucosas was obtained to be morphologically measured by light microscope, and immunohistochemistry and Western blot were uesd to examine the expressions of tight junction proteins zona occludens-1 (ZO-1) and occludin in the mucosas. Results Atrophy significantly appeared in the distal ileum mucosas in OJ group. Compared with control group, the intestinal villus height, mucosa thickness and crypt depth in OJ group were obviously decreased 27.8%, 21.7%, and 25.4% (P=0.001, 0.001, 0.040). There were no differences between external drainage group and control group (P=0.050, 0.070, 0.080); While the values of external drainage group were significantly higher than those in OJ group (all P=0.001). The level of plasma endotoxin was up to (1.49±0.27) EU/ml in OJ group compared with control group 〔（0.27±0.09） EU/ml〕, P=0.001. In external drainage group, the value was （0.91±0.25） EU/ml, which was obviously higher than that in control group and lower than that in OJ group （all P=0.001）. Immunohistochemical study showed b positive expression of ZO-1 dropped from 7/10 in the control group to 6/20 in OJ group （P=0.040）, occludin expression was 8/10 in control group and 7/20 in OJ Group （P=0.020）; expressions of them in external drainage group 〔8/20 （P=0.100,0.210） and 9/20 （P=0.060, 0.200）〕 displayed no significant differences compared with the other twogroups. Quantitative testing of Western blot showed the expressions of ZO-1 and occludin in OJ group were significantly lower than those in control group (P=0.001, 0.010), the values in external drainage group were higher than those in OJ group （P=0.005, 0.014）. The expression of ZO-1 was lower in external drainage group than that in control group (P=0.001), and there was no significant difference of occludin between the two groups (P=0.062）. Conclusion Lack of intestinal bile will undermine the intestinal tight junction protein composition, and make intestinal mucosal barrier impaired. The intestinal barrier more severely injured when biliary tract obstructs because of multiple factors. Bile plays an important role in the maintenance of intestinal mucosal barrier.
ObjectiveTo investigate the efficacy of different methods of reducing jaundice in patients with low malignant obstructive jaundice undergoing pancreaticoduodenectomy. Methods A retrospective analysis was performed on the clinicopathological data of patients admitted to the Department of Hepatobiliary Surgery of The Affiliated Hospital of Guizhou Medical University from January 2014 to June 2020 who were considered to have low malignant obstructive jaundice before operation and confirmed by postoperative pathological examination as pancreatic cancer, ampulla cancer, duodenal cancer or carcinoma of the lower segment of the common bile duct. Patients were devide into percutaneous transhepatic cholangial drainage (PTCD) group and endoscopic retrograde biliary drainage (ERBD) group according to preoperative biliary drainage (PBD) methods. In order to reduce selection bias, SPSS propensity matching module was used for propensity score matching analysis. The age, basic diseases (hypertension, diabetes), biochemical indexes, time of reduction of jaundice, total hospitalization time, and postoperative complications of PBD and pancreaticoduodenectomy were compared between the 2 groups. Then, the patients were divided into pancreatic cancer group and non-pancreatic cancer group (including ampulla cancer, duodenal carcinoma and lower common bile duct carcinoma) by tumor type, and compared the effect of two groups of patients receiving different PBD methods. Results A total of 84 patients, 43 males and 41 females, were included in this study, 58 (69.0%) patients with PTCD and 26 (31.0%) patients with ERBD. After PBD the serum total bilirubin, direct bilirubin, γ-glutamyl transferase, and alkaline phosphatase of the PTCD and the ERBD groups patients were lower than before PBD, the differences were statistically significant (P<0.05). Alanine aminotransferase did not change significantly before and after PBD with PTCD (P>0.05), but decreased significantly after PBD with ERBD (P<0.05). Aspartate aminotransferase did not change significantly before and after PBD with ERBD (P>0.05), but decreased significantly after PBD with PTCD(P<0.05). The PBD time and total hospitalization time of the ERBD group were shorter than those of the PTCD group, the differences were statistically significant (P<0.05). The incidences of PBD related complications (cholangitis and pancreatitis) in the ERBD group were higher than those the PTCD group, and the incidence of bleeding in the ERBD group was lower than that the PTCD group, but the differences were not statistically significant (P>0.05). In the patients with pancreatic cancer group, the PBD time by ERBD was shorter than that of the receiving PTCD, the difference was statistically significant (P=0.006). In the non-pancreatic cancer group, the total hospitalization time and PBD time of patients receiving ERBD were shorter than those receiving PTCD, and the differences were statistically significant (P<0.05). In all patients, the median survival time of PTCD group (14 months) was shorter than that in ERBD group (18 months), P=0.002; pancreatic cancer group (12 months) was shorter than non-pancreatic cancer group (16 months), P=0.034; in non-pancreatic cancer group, ERBD group (20 months) was longer than PTCD group (15 months), P=0.008. Conclusions ERBD can shorten the waiting time of operation and hospital stay as compared with PTCD, and has a longer median survival time. It can be used as the first choice for PBD in patients with low malignant obstructive jaundice.
Ｈｅｍｏｄｙｎａｍｉｃ ｃｈａｎｇｅｓ ｏｆ ｓｙｓｔｅｍｉｃ ａｎｄ ｐｏｒｔａｌ ｖｅｉｎ ｆｌｏｗ ａｎｄ ｒｅｇｕｌａｔｉｏｎ ｏｆ ｉｎｄｏｍｅｔｈａｃｉｎ ｈａｖｅ ｂｅｅｎ ｓｔｕｄｉｅｄ ｉｎ ７３ ｐａｔｉｅｎｔｓ ｗｉｔｈ ｏｂｓｔｒｕｃｔｉｖｅ ｊａｕｎｄｉｃｅ（ｇｒｏｕｐ Ａ）ａｎｄ ３９ ｃａｓｅｓ ｗｉｔｈ ｓｉｍｐｌｅ ｇａｌｌｂｌａｄｄｅｒ ｓｔｏｎｅｓ（ｇｕｏｕｐ Ｂ）．Ｏｂｓｔｒｕｃｔｉｖｅ ｊａｕｎｄｉｃｅ ｗａｓ ｓｕｂｇｒｏｕｐｅｄ ｉｎｔｏ ｇｒｏｕｐ Ａ１（ｎｏｉｎｄｏｍｅｔｈａｃｉｎ ａｄｍｉｎｉｓｔｒａｔｉｏｎ），ｇｒｏｕｐ Ａ２（ｐｒｅｏｐｅｒａｔｉｖｅ ａｄｍｉｎｉｓｔｒａｔｉｏｎ ｏｆ ｉｎｄｏｍｅｔｈａｃｉｎ），ｇｒｏｕｐ Ａ３（ｐｏｓｔｏｐｅｒａｔｉｖｅ ａｄｍｉｎｉｓｔｒａｔｉｏｎ ｏｆ ｉｎｄｏｍｅｔｈａｃｉｎ），ａｎｄ ｇｒｏｕｐ Ａ６（ｓｅｎｉｌｅ ｏｂｓｔｒｕｃｔｉｖｅ ｊａｕｎｄｉｃｅ）．Ｏｆ ｔｈｅｍ ｇｒｏｕｐ Ａ１ ｗａｓ ｓｕｂｇｒｏｕｐｅｄ ｉｎｔｏ ｇｒｏｕｐ Ａ４（ｍａｌｉｇｎａｎｔ ｏｂｓｔｒｕｃｔｉｏｎ）ａｎｄ ｇｒｏｕｐ Ａ５（ｂｅｎｉｇｎ ｏｂｓｔｒｕｃｔｉｏｎ）ａｇａｉｎ．Ｔｈｅ ｒｅｓｕｌｔｓ ｓｈｏｗｅｄ ｔｈａｔ ｔｈｅ ｓｔｒｏｋｅ ｖｏｌｕｍ（ＳＶ），ｃａｒｄｉａｃ ｏｕｔｐｕｔ（ＣＯ）ａｎｄ ｃａｒｄｉａｃ ｉｎｄｅｘ （ＣＩ）ｗｅｒｅ ｈｉｇｈｅｒ ｉｎ ｅａｃｈ ｇｒｏｕｐ ｏｆ ｏｂｓｔｒｕｃｔｉｖｅ ｊａｕｎｄｉｃｅ ｔｈａｎ ｔｈｏｓｅ ｉｎ ｇｒｏｕｐ Ｂ（Ｐ＜０．０１），ａｎｄ ｔｈｅ ｍｅａｎ ａｒｔｅｒｙ ｐｒｅｓｓｕｒｅ （ＭＡＰ），ｓｔｒｏｋｅ ｖｅｓｓｅｌ ｒｅｓｉｓｔａｎｃｅ （ＳＶＲ）ａｎｄ ｐｏｒｔａｌ ｖｅｉｎ ｂｌｏｏｄ ｆｌｏｗ（ＰＶＦ）ｗｅｒｅ ｌｏｗｅｒ ｉｎ ｅａｃｈ ｇｒｏｕｐ ｏｆ ｏｂｓｔｒｕｃｔｉｖｅ ｊａｕｎｄｉｃｅ ｔｈａｎ ｔｈｏｓｅ ｉｎ ｇｒｏｕｐ Ｂ（Ｐ＜０．０１）．Ｔｈｅ ＭＡＰ，ＳＶＲ ａｎｄ ＰＶＦ ｉｎ ｇｒｏｕｐ Ａ２ ａｎｄ ｇｒｏｕｐ Ａ３ ｓｈｏｗｅｄ ｂｅｔｔｅｒ ｉｍｐｒｏｖｅｍｅｎｔ ｔｈａｎ ｔｈｏｓｅ ｉｎ ｏｔｈｅｒ ｓｕｂｇｒｏｕｐｓ，ｂｕｔ ａｓ ｃｏｍｐａｒｅｄ ｗｉｔｈ ｇｒｏｕｐ Ｂ ｔｈｅｒｅ ｗｅｒｅ ｓｉｇｎｉｆｉｃａｎｔ ｄｉｆｆｅｒｅｎｃｅｓ （Ｐ＜０．０１）．Ｔｈｅ ａｕｔｈｏｒｓ ｃｏｎｓｉｄｅｒ ｔｈａｔ ｉｎｄｏｍｅｔｈａｃｉｎ ｃａｎ ｉｍｐｒｏｖｅ ｔｈｅ ｃｉｒｃｕｌａｔｉｏｎ ｆｕｎｃｔｉｏｎ，ＰＶＦ ａｎｄ ｌｉｖｅｒ ｆｕｎｃｔｉｏｎ ｉｎ ｐａｔｉｅｎｔｓ ｗｉｔｈ ｏｂｓｔｒｕｃｔｉｖｅ ｊａｕｎｄｉｃｅ．
Objective To investigate the effect of renal cell apoptosis induced by obstructive jaundice on the expression of bcl-2 in rats, and to explore the mechanism of renal impairment induced by obstructive jaundice. Methods Thirty-two male SD rats were randomly divided into 2 groups: SO group and BDL group. The rats in SO group received sham operation. Bile ducts of rats in BDL group were ligated. Pathology of kidneys was observed under the microscope. The levels of D-Bil, TBA, GOT, GPT, Cr and BUN in serum and β2-MG in urine were measured. The apoptotic rate of renal cells was calculated by flow cytometry and the forms of DNA fragmentation in renal cells were detected by agarose gel electrophoresis. The expression of inhibitory gene bcl-2 in the renal tissues was detected by immunohistochemistry. Results The color of urine in BDL group became dark yellow in day 2 after operation; The ears, tails and the muscle of abdominal wall and splanchnic organs, such as liver and kidney, also became yellow and swollen in day 7. The D-Bil, TBA, GOT, GPT, BUN of serum and β2 -MG of urine in BDL group were higher than those in SO group (P＜0.05, P＜0.01), and each value (except β2 -MG) in BDL group of 14 d was higher than that in BDL group of 7 d (P＜0.05, P＜0.01), respectively. The result of flow cytometry showed that the apoptotic rate of SO group and BDL (7 d and 14 d) group were (2.10±0.75)%， (18.17±0.86)% and (36.39±2.23)% respectively, there were significantly difference among them (P＜0.05). The expression rate of bcl-2 of renal cell in BDL group of 7 d was higher than that in BDL group of 14 d. Conclusion Obstructive jaundice could induce apoptosis of the renal cells, and activate the expression of bcl-2 of the renal tubular epithelial cells in feedback, which may regulate the process of apoptosis.
Twenty-eight cases of hepatocellular carcinoma(HCC)involving bile duct and causing obstructive jaudice in this hospital between 1987-1994 were studied.In this series cancerous cast formation in bile duct was found in 13 cases and cancerous thrombus in 15 cases which accounts for 5.7% of 487 HCC patients admitted to this hospital in the same period.According to the operative and pathological findings,characteristics of cancerous cast type are:①direct connection of cancerous cast with the primary tumor as a dumb bell-shped,②no adhesion between the cast and the thin wall of bile duct,③central location of the primary tumor in liver near the larger bile duct and ④HCC tissues seen in pathologic section of the cast.Characteristics of cancerous thrombus type are:①no connection between intraductal thrombus and the primary tumor,②segmental stenosis or obstruction of the bile duct,③adherence of cancerous thrombus to the thick ductal wall,④peripheral location of the primary tumor and⑤HCC cells scattered in the thrombus.
ObjectiveTo research the association between the prognostic nutritional index (PNI) and the prognosis of patients with malignant obstructive jaundice (MOJ) after interventional treatment. MethodsThe clinicopathologic data of patients with MOJ who were clinically diagnosed and underwent interventional treatment in the Affiliated Hospital of Southwest Medical University, from September 2018 to June 2021, were gathered retrospectively. The X-Tile statistical software was used to determine the optimal critical value of PNI before treatment, then the patients were allocated into the high PNI group (PNI was the optimal critical value or more) and low PNI group (PNI was less than the optimal critical value). The clinicopathologic characteristics of the two groups were compared. The Kaplan-Meier method was used to draw survival curve for survival analysis, and the Cox proportional hazards regression model was used to analyze the risk factors affecting the prognosis of patients with MOJ (the prognostic index was overall survival). ResultsA total of 205 patients were included in this study. The optimal critical value of PNI was 37.5. There were 154 cases in the high PNI group and 51 cases in the low PNI group, respectively. The proportions of the patients with biliary infection, CA19-9 ≥400 kU/L, hemoglobin <120 g/L, albumin <30 g/L, total bilirubin ≥300 μmol/L, and alanine aminotransferase <300 U/L were higher in the low PNI group as compared with the high PNI group (P<0.05). The median overall survival of patients in the high PNI group and low PNI group was 7.1 months and 3.6 months, respectively. The overall survival curve of the former was better than that the latter (χ2=18.514, P<0.001). The median follow-up time of 205 patients was 6.2 months, with a median overall survival of 5.3 months. The multivariate results of Cox proportional hazards regression model analysis showed that the probability of overall survival lengthening was increased for the patients with more times of PTCD, with stent implantation, with treatment for primary tumor, without metastasis, and with preoperative PNI ≥37.5 (P<0.05). ConclusionFrom the results of this study, preoperative peripheral blood PNI has a certain association with the prognosis of patients with MOJ after interventional treatment, and it is expected to be used to predict the prognosis of patients with MOJ in the future.