Remodeling of Strain Energy Function of Common Bile Duct post Obstruction

Biliary duct obstruction is an important clinical condition that affects millions of people worldwide. We have previously shown that the common bile duct (CBD) undergoes significant growth and remodelling post obstruction. The mechanical stress-strain relation is expected to change due to growth and remodeling in response to obstruction and hence pressure-overload. The objective of the present study was to characterize the material properties of the CBD of the sham group and at 3 hours, 12 hours, 2 days, 8 days and 32 days (n=5 in each group) after obstruction. The Fung's exponential strain energy function was used to relate stress to strain of the normal and remodeled ducts. The Marquardt-Levenberg and genetic algorithm methods were used for the determination of material constants for the exponential strain energy function. The elastic constants obtained by the two methods did not differ (P>0.254). We obtained stable and convergent material constants at every time point. The material constant that dictates the nonlinear rate of change in the circumferential stress with respect to strain increased significantly after obstruction acutely in the first 12 hrs., decreased at 2 days and finally increased montonically during the remaining 30 days. The acute initial increase in stiffness was simply due to the elastic response. The chronic remodeling process results in an initial circumferential softening followed by stiffening of the CBD. This study has important clinical significance for patients with CBD obstruction and for endoscopists and surgeons who treat the condition.     

子宫内膜细菌L型感染与不孕症的关系

本文通过426例不孕症患者子宫内膜的病原学检查和免疫组织化学研究,发现①83.1%的患者有细菌L型感染;②主要表现为间质性子宫内膜炎(P<0.01);③内膜炎症和L型菌对精子的粘附和破坏作用可导致受孕率降低。     

胆总管结石并胆道感染患者胆汁中致病菌的分布及耐药性分析

目的:了解胆总管结石并胆道感染患者胆汁中致病菌的分布以及耐药性的情况,为临床中胆总管结石并胆道感染患者的诊治提供参考。方法:选取2012年1月至2012年12月期间被我院收治的胆总管结石并胆道感染患者内镜逆行胰胆管造影术(ERCP)抽取胆汁标本150例,对其进行细菌培养和药敏试验,观察和分析细菌分布情况和耐药性情况。结果:1细菌培养阳性的例数为123例(阳性检出率82.0%),其中,革兰氏阴性菌39例(31.71%),主要为大肠埃希菌23例(18.70%);革兰氏阳性菌64例(52.03%),主要是粪肠球菌22例(17.89%)和甲型溶血性链球菌10例(8.13%);真菌(白假丝酵母菌)20例(16.26%)。2患者胆汁中的细菌主要敏感的药物有美罗培南、亚胺培南、万古霉素、庆大霉素、头孢吡肟和阿米卡星等。结论:胆总管结石并胆道感染患者胆汁中病原菌分布出现了新的变化,临床中应根据患者胆汁药敏试验结果选择有效的治疗方法和抗菌药物。     

腹腔镜胆总管探查术在内镜取石失败后的临床应用

目的:探讨腹腔镜胆总管探查术治疗内镜取石失败的胆总管结石的临床疗效。方法:回顾性分析我院2005年-2013年实施腹腔镜胆总管探查术(LCBDE)的患者共89例,分为两组,其中A组为患者在内镜取石失败后再行LCBDE术(n=47),B组为诊断胆总管结石后立即行LCBDE术(n=42),比较两组之间手术时间、中转开腹率、结石残留率、术后并发症率(包括胆瘘、胰腺炎以及其他)、住院时间、结石复发率。结果:A组和B组相比在手术时间、中转开腹率、结石残留率、术后并发症率、住院时间、结石复发率上并没有统计学差异(P0.05)。结论:针对内镜取石失败的胆总管结石患者,腹腔镜胆总管探查术是一种安全、有效的治疗方法。