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Roles of PI3K/AKT-S1PR2 pathway in systemic inflammatory response induced by acute obstructive cholangitis in rats

ObjectiveTo investigate activation of phosphatidylinositol 3 hydroxykinase (PI3K)/AKT pathway and sphingosine 1-phosphate receptor 2 (S1PR2) in peripheral blood mononuclear cells (PBMCs) of acute obstructive cholangitis (AOC) rats and their effects on systemic inflammation in rats.Methods① In vitro experiment: The isolated PBMCs from the rats were divided into 4 groups: a control group, LY294002 treatment group, lipopolysaccharide (LPS) treatment group, and LPS+LY294002 treatment group. The levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in the supernatant were detected and the phosphorylation levels of PI3K and AKT and protein level of S1PR2 in the PBMCs were detected. ② In vivo experiment: The rats were randomly divided into four groups: a control group, LY294002 treatment group, AOC model group, and AOC+LY294002 treatment group. The survival rate of rats was recorded, the liver function (ALT, AST, and TBIL), TNF-α, and IL-6 levels in the serum were detected. The phosphorylation levels of PI3K and AKT and protein level of S1PR2 in the PBMCs of the rats were detected. Results① The results of in vitro experiment: The levels of TNF-α and IL-6 in the LPS+LY294002 treatment group were significantly lower than those in the LPS treatment group (P<0.050). The phosphorylation levels of PI3K and AKT and protein level of S1PR2 in the LPS+LY294002 treatment group were significantly lower than those in the LPS treatment group (P<0.050). ② The results of in vivo experiment: The survival rate of rats in the AOC+LY294002 treatment group was higher than those in the AOC group. The serum levels of ALT, AST, TBIL, TNF-α, and IL-6 in the AOC+LY294002 treatment group were significantly lower than those in the AOC model group (P<0.050). The phosphorylation levels of PI3K and AKT and protein level of S1PR2 in the AOC+LY294002 treatment group were significantly lower than those in the AOC model group (P<0.050).ConclusionInhibition of activation of PI3K/AKT pathway in PBMCs can inhibit expression of S1PR2, then alleviate systemic inflammatory response induced by AOC in rats.

Application of The Double Cavity Casing Negative Pressure Drainage by Inside and Outside of The Intestine in The Primary Resection and Anastomosis of Left Colon Cancer Combined with Acute Obstruction

ObjectiveTo investigate the feasibility and safety of the double cavity casing negative pressure drainage by inside and outside of the intestine in the primary resection and anastomosis of left colon cancer combined with acute obstruction. MethodsEighty-one cases of left colon cancer combined with acute obstruction who underwent surgeries in our hospital from January 2009 to December 2012 were collected prospectively, and were divided into one-stage surgery group (n=41) and control group (n=40). Cases of one-stage surgery group received double cavity casing negative pressure drainage by inside and outside of the intestine in the primary resection and anastomosis, and cases of control group underwent two-stage surgeries. Comparison of operation time, blood loss, time of anal exhaust after operation, hospital stay, hospital expense, and incidence of complication between the 2 groups was performed. ResultsThere were no significant difference in the operation time[(166±19) minutes vs. (173±23) minutes], blood loss[(253±42) mL vs. (273±50) mL], and time of anal exhaust after operation[(3.24±0.73) days vs. (3.50±0.95) days]beeween one-stage surgery group and control group, but hospital stay[(15.1±2.3) days vs. (23.1±4.1) days]and hospital expense[(3.70±0.68) ×105 yuan vs. (5.77±0.95) ×105 yuan]of one-stage surgery group were lower than those of control group (P<0.05). In addition, there were no significant difference in the incidences of wound infection[7.3% (3/41) vs. 10.0% (4/40)], intraabdominal infection[4.9% (2/41) vs. 10.0% (4/10)], pulmonary infection[12.2% (5/41) vs. 15.0% (6/40)], and anastomotic leakage[2.4% (1/41) vs. 5.0% (2/40)]beeween one-stage surgery group and control group (P>0.05). All of the cases were followed up for 1-36 months, and the median time were 22 months. There were no significant difference in the mortality[0 (0/41) vs. 2.5% (1/40)], recurrence rate[2.4% (1/41) vs. 5.0% (2/40)], and metastasis rate[7.3% (3/41) vs. 10.0% (4/40)]beeween one-stage surgery group and control group too (P>0.05). ConclusionIn the case of negative pressure drainage of double cavity casing, underwent decompression of the small bowel, and irrigation of colon, the primary resection and anastomosis of left colon cancer combined with acute obstruction was safe and feasible.

回腸膀胱術后腹壁造口疝導致急性梗阻性腎衰竭一例

Experience of the Treatment of Acute Obstructive Suppurative Cholangitis

目的 探索急性化膿性梗阻性膽管炎20世紀90年代后期與80年代以前的差異，探討對本病治療的方向。 方法 收集我院1996～2000年病例，并與我院1950～1981年資料進行比較。 結果 ①發病率顯著降低，從46.08%降至15.62%； ②發病年齡延后10～20歲； ③入院時病情相對較輕，有休克者從51.39%降至22.80%； ④病死率明顯下降，從25.78%降至3.50%； ⑤再手術患者顯著增加，從12.12%增至55.20%。造成上述差異的原因與患者就診早，及時的治療，醫務人員的水平提高，藥品與醫學的發展等有關。 結論 對急性梗阻性化膿性膽管炎患者，雖然發病率和死亡率已明顯下降，仍需足夠重視，因術后T管造影和B超檢查發現肝內殘石或膽管狹窄者，高達85.1%，復發再手術率達55.2%，遠不能令人滿意。為提高遠期效果，應在急診手術引流后，待患者病情平穩后，再進一步檢查和徹底處理肝內病變。

Acute Obstruction of Left Colon Cancer OneStage Surgery and Radical Mastectomy Over the Same Period: A Comparative Analysis of Results of Operations

摘要:目的：回顧性分析比較左半結腸癌急性梗阻一期手術與同期左半結腸癌根治術患者的手術臨床資料,探討左半結腸癌急性梗阻一期手術的可行性。方法： 回顧性將我中心2004年1月至2007年3月收治的59例左半結腸癌急性梗阻一期手術病例分為A組,將同期226例左半結腸癌根治術病例分為B組,比較兩組之間清除淋巴結數、術后進食時間、吻合口漏發生率、肺部感染率、切口感染率、住院時間、復發和轉移率。結果： 在上述觀察指標中,在A組分別為（133±18）枚,（36±09）d,1/59（169%）,4/59（678%）,2/59（339%）,(124±09)d,6/59（1017%）；B組分別為128±15,32±08,1/226（044%）,8/226（354%）,6/226（265%）,117±15,23/226（1062%）；經統計學處理,兩組間沒有顯著性差異。結論：術中合理應用結腸灌洗,良好的手術技巧,術后積極輔助治療,左半結腸癌急性梗阻一期手術是安全可行的,可避免二次手術帶給患者的痛苦,術后并發癥也無明顯增加。Abstract: Objective: Retrospective analysis and comparison of acute obstruction of left colon cancer onestage surgery and the same period a radical mastectomy in patients with left colon cancer surgery clinical data,To study the possibility of acute obstruction of left colon cancer onestage surgery. Methods:A retrospective of my center from January 2004 to March 2007 were treated 59 cases of acute obstruction of left colon cancer onestage surgery patients were divided into A group, will be left over the same period 226 cases of radical resection of colon cancer patients were divided into group B, compare the number of lymph nodes removed between the two groups, after the consumption of time, the incidence of anastomotic leakage, pulmonary infection, incision infection, length of stay, recurrence and metastasis rate. Results: Observed in the above indicators, in the A group were 133±18,36±09,1/59 (169%),4/59 (678%), 2/59 (339%),124±09,6/59 (1017%); B group were 128±15,32±08,1/226 (044%), 8/226 (354%), 6/226 (265%), 117±15,23/226 (1062%); Statistical analysis between the two groups there was no significant difference. Conclusion: Rational application of intraoperative colonic irrigation, good surgical technique, postoperative adjuvant treatment of active, acute obstruction of left colon cancer onestage surgery is a safe and feasible, it may avoid the second operation to bring the patient’s pain, postoperative complications and no increased significantly.