[Show abstract][Hide abstract] ABSTRACT: To investigate the effect of biliary drainage on inducible nitric oxide synthase (iNOS), CD14 and TGR5 expression in rats with obstructive jaundice (OJ).
Male adult Sprague-Dawley rats were randomly assigned to four groups: OJ, sham operation (SH), internal biliary drainage (ID) and external biliary drainage (ED). Rat models were successfully established by two operations and succumbed for extraction of Kupffer cells (KCs) and liver tissue collection on the 8(th) and 15(th) day. KCs were isolated by in situ hepatic perfusion and digested with collagen IV, density gradient centrifuged by percoll reagent and purified by cell culture attachment. The isolated KCs were cultured with the endotoxin lipopolysaccharide (LPS) with and without the addition of ursodeoxycholic acid (UDCA). The expression of iNOS, CD14 and bile acid receptor-TGR5 protein in rat liver tissues was determined by immunohistochemistry. The expression of iNOS and CD14 messenger RNA (mRNA) on the isolated KCs was detected by reverse transcription polymerase chain reaction (PCR) and the TGR5 mRNA level in KCs was measured by real-time quantitative PCR.
The iNOS protein was markedly expressed in the liver of OJ rats, but rare expressed in SH rats. After relief of OJ, the iNOS expression was decidedly suppressed in the ID group (ID vs OJ, P < 0.01), but obviously increased in rats of ED (ED vs OJ, P = 0.004). When interfered only with LPS, the expression of iNOS mRNA by KCs was increased in the OJ group compared with the SH group (P = 0.004). After relief of biliary obstruction, the iNOS mRNA expression showed slight changes in the ED group (ED vs OJ, P = 0.71), but dropped in the ID group (ID vs OJ, P = 0.001). Compared with the simple intervention with LPS, the expressions of iNOS mRNA were significantly inhibited in all four groups after interfered with both LPS and UDCA (P < 0.01, respectively). After bile duct ligation, the CD14 protein expression in rat liver was significantly strengthened (OJ vs SH, P < 0.01), but the CD14 mRNA level by KCs was not up-regulated (OJ vs SH, P = 0.822). After relieving the OJ, the expression of CD14 protein was reduced in the ID group (ID vs OJ, P < 0.01), but not reduced in ED group (ED vs OJ, P = 0.591). And then the CD14 mRNA expression was aggravated by ED (ED vs OJ, P < 0.01), but was not significantly different between the ID group and the SH and OJ groups (ID vs SH, P = 0.944; ID vs OJ, P = 0.513, respectively). The expression of TGR5 protein and mRNA increased significantly in OJ rats (OJ vs SH, P = 0.001, respectively). After relief of OJ, ID could reduce the expression of TGR5 protein and mRNA to the levels of SH group (ID vs SH, P = 0.22 and P = 0.354, respectively), but ED could not (ED vs SH, P = 0.001, respectively).
ID could be attributed to the regulatory function of activation of KCs and release of inflammatory mediators.
World Journal of Gastroenterology 04/2013; 19(15):2319-30. DOI:10.3748/wjg.v19.i15.2319 · 2.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Natural orifice translumenal endoscopic surgery (NOTES) has generated a surge of enthusiasm among researchers by virtue of its challenge to the dogma and potential benefits. However, no data is available in the medical literature about NOTES' acceptance by patients in Asia. The aim of the study is to survey patients' perceptions and attitudes towards NOTES.
It is a questionnaire-based multi-center study on inpatient subjects with various gastrointestinal disorders from 14 hospitals in 12 cities of China. Procedural details with the benefits and risks of NOTES, laparoscopic surgery, and conventional surgery were explained to all registered candidates. They were required to choose and cite reasons for adopting one of the above three surgical techniques as the preferred mode of treatment. The reasons for selection of the surgical treatment were: safety, efficacy, cost, postoperative pain, abdominal wounds, and scarring.
There were 1,797 cases, including 976 (54.3%) males and 821 females (45.7%). Based on their comprehension of the procedure, 802 (44.6%) patients opted for NOTES, 757 (42.1%) for laparoscopic surgery, and 238 (13.2%) for conventional surgery. NOTES was mainly selected by the young and educated persons, especially females and by those with past exposure to laparoscopy or conventional surgery. The choice of treatment was significantly correlated with age (P=0.0021), education (P=0.0209), past medical history (laparoscopy, P=0.0134; open surgery, P<0.0001), and department of admission (P=0.0173). The preference for NOTES was based on safety (37.3%), cost (17.6%), elimination of postoperative scars (16.1%), abdominal wounds (16.0%), and efficacy (13.1%).
The vast majority of patients prefer mini-invasive surgery to conventional surgery. The potential recipients of NOTES are educated and younger age groups. However, a few consider NOTES as a safe and effective intervention at present.
[Show abstract][Hide abstract] ABSTRACT: To compare the feasibility and safety of combined transgastric and transcolonic dual approach and those of transgastric single approach in endoscopic salpingectomy.
Two female Chinese Nongda miniature pigs underwent gastric and colonic lavage with tap water followed by disinfection of mucosa with 1:10 iodophor. An endoscope was inserted and the colonic wall was punctured with a needle knife, dilated with a balloon-dilator and a double-channel endoscope was advanced into the peritoneal cavity. Under direct observation through this endoscope, a trans-gastric entrance was made with the second double-channel endoscope. With the help of transcolonic endoscope, the left Fallopian tube was ligated and partially resected using the transgastric endoscope. With the help of transgastric endoscope, liver biopsy was performed using the transcolonic endoscope. Finally, the gastric incision was closed with 3 clips and the colonic incision was closed with a loop and a clip. Antibiotics were used for 3 days following the procedures. Seventeen days later laparotomy was performed to observe the infection, visceral damage and adhesion, healing of the incisions of gastrointestinal duct, etc.
Compared with the single route, the dual routes were more convenient to perform the liver biopsy and salpingectomy. The pigs drank and ate normally soon after the resuscitation. The pigs looked well and gained weight during 2 weeks after the operation. Repeat endoscopy in 2 weeks showed a well-healed gastric incision with 2 clips still in place and a healed colonic incision with 1 clip still attached. The necropsy revealed a complete transmural healing of the gastric incision with minimal adhesion and a complete healing of the colonic incision without any adhesion. Few adhesions were found around the liver biopsy site and the salpingectomy site without any intraperitoneal infection or organ damage.
Combined transgastric and transcolonic approach appears safe and feasible and facilitates translumenal intraperitoneal interventions.