Intermittent Secretion of Abnormal Bile in Patients with Cholesterol Gall Stones

Gall bladder and hepatic bile was sampled from 66 patients undergoing elective operations on the biliary tract. Fifty-one patients had cholesterol gall stones but only 59% of these were found to have bile which was supersaturated with cholesterol. Repeated sampling of hepatic bile from patients with T-tubes showed that the secretion of supersaturated bile was intermittent.These results indicate that it is impossible to separate patients with cholesterol stones from controls simply by examination of the lipid composition of their bile, since an appreciable number of bile samples from patients with cholesterol stones were unsaturated.The fact that cholesterol gall stones form when the bile is supersaturated with cholesterol only intermittently suggests that the gall bladder may also have a part in their formation.     

Alteration of Bile Salt Metabolism by Dietary Fibre (Bran)

Feeding dietary fibre in the form of bran induced changes in bile salt metabolism in five people with intact gall bladders. There was evidence of reduced dehydroxylation of bile salts; the proportion of deoxycholate conjugates in bile was reduced and the transfer of radioactivity from labelled taurocholate to deoxycholate was decreased. These findings, which were independent of changes in intestinal transit rate, imply that bran reduced the degradation of bile salts by colonic bacteria. This property of bran accords with recent theories that fibre-depleted diets favour the degradation of bile salts in the colon. These findings may be relevant to the aetiology of large bowel cancer.     

Oblique Bile Duct Predisposes to the Recurrence of Bile Duct Stones

Background and Study Aims

Bile stones represent a highly prevalent condition and abnormalities of the biliary tree predispose to stone recurrence due to development of biliary stasis. In our study, we assessed the importance of an altered bile duct course for stone formation.

Patients and Methods

1,307 patients with choledocholithiasis in the absence of any associated hepatobiliary disease who underwent endoscopic retrograde cholangiopancreatography (ERCP) between 2002 and 2009 were analysed. The angle enclosed between the horizontal portion of the common bile duct (CBD) and the horizontal plane was measured (angle α). Oblique common bile duct (OCBD) was defined as a CBD with angle α<45°.

Results

103 patients (7.9%) were found to harbour OCBD and these were compared to 104 randomly selected control subjects. Compared to controls, OCBD patients were (i) significantly older (72±13 vs. 67±13, p<0.00001); (ii) more frequently underwent a cholecystectomy (p = 0.02) and biliary surgery (p = 0.003) prior to the diagnosis and (iii) more often developed chronic pancreatitis (p = 0.04) as well as biliary fistulae (p = 0.03). Prior to and after ERCP, OCBD subjects displayed significantly elevated cholestatic parameters and angle α negatively correlated with common bile duct diameter (r = -0.29, p = 0.003). OCBD subjects more often required multiple back-to-back ERCP sessions to remove bile stones (p = 0.005) as well as more ERCPs later on due to recurrent stone formation (p<0.05).

Conclusion

OCBD defines a novel variant of the biliary tree, which is associated with chronic cholestasis, hampers an efficient stone removal and predisposes to recurrence of bile duct stones.     

Glucose Metabolism in Healthy Subjects and in Patients with Carbohydrate and Lipid Metabolic Disorders

The rate of glucose oxidation was studied by measurement of the ¹³C concentration in expired air with simultaneous detection of the activity of the pyruvate dehydrogenase complex in subjects with obesity and patients with type II diabetes. Intake of small amounts of glucose did not change the rate of glucose oxidation in subjects with obesity as compared to healthy controls. However, intake of large amounts of glucose resulted in a considerable increase in the rate of glucose oxidation without a hypoxic shift. In patients with diabetes mellitus, the rate of glucose oxidation decreased with increasing tissue hypoxia.     

Cost-Effectiveness Analysis of Endoscopic Ultrasound versus Magnetic Resonance Cholangiopancreatography in Patients with Suspected Common Bile Duct Stones

Background

Patients with suspected common bile duct (CBD) stones are often diagnosed using endoscopic retrograde cholangiopancreatography (ERCP), an invasive procedure with risk of significant complications. Using endoscopic ultrasound (EUS) or Magnetic Resonance CholangioPancreatography (MRCP) first to detect CBD stones can reduce the risk of unnecessary procedures, cut complications and may save costs.

Aim

This study sought to compare the cost-effectiveness of initial EUS or MRCP in patients with suspected CBD stones.

Methods

This study is a model based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs) per patient from the perspective of the UK National Health Service (NHS) over a 1 year time horizon. A decision tree model was constructed and populated with probabilities, outcomes and cost data from published sources, including one-way and probabilistic sensitivity analyses.

Results

Using MRCP to select patients for ERCP was less costly than using EUS to select patients or proceeding directly to ERCP ($1299 versus $1753 and $1781, respectively), with similar QALYs accruing to each option (0.998, 0.998 and 0.997 for EUS, MRCP and direct ERCP, respectively). Initial MRCP was the most cost-effective option with the highest monetary net benefit, and this result was not sensitive to model parameters. MRCP had a 61% probability of being cost-effective at $29,000, the maximum willingness to pay for a QALY commonly used in the UK.

Conclusion

From the perspective of the UK NHS, MRCP was the most cost-effective test in the diagnosis of CBD stones.     

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。     

Metabolism and Biosynthesis of Cytokinins in Tobacco Crown Gall Cells

The metabolism of ribosylzeatin (RZ) was studied using tobaccocrown gall cells which produce RZ as one of the major endogenouscytokinins. When [8-¹⁴C]RZ was fed to the cells, it was convertedinto its phosphate (which was rigorously determined to be the5'-monophosphate), RZ-O-glucoside, inosine (or its phosphate),adenosine and adenosine-O-glucoside. When [8-¹⁴C]N⁶-(²-isopentenyl)adenosine(i⁶Ado), a probable precursor of RZ, was fed to the cells, itwas converted into (i⁶Ado)-O-glucoside, inosine (or its phosphate),adenosine, adenosine-O-glucoside and adenosine phosphate, butno incorporation of radioactivity into RZ was observed. Thepresent study led to the following conclusions: i) i⁶Ado isnot a precursor of RZ in the cells, ii) both deaminase and cytokininoxidase are involved in the catabolism of cytokinin, and iii)the metabolism of RZ is quite different from that of i⁶Ado. (Received December 24, 1985; Accepted April 1, 1986)     

腹腔镜联合十二指肠镜治疗胆结石合并胆总管结石的临床疗效

目的:探讨腹腔镜联合十二指肠镜治疗胆结石合并胆总管结石的临床疗效。方法:收集我院肝胆科2012年6月到2014年3月住院的胆结石合并胆总管结石60例,按照随机数字表法分为试验组和对照组,各30例,试验组给予腹腔镜联合十二指肠镜治疗,对照组给予传统的开腹胆囊切除以及胆总管探查取石,观察对比两组的临床疗效。结果:试验组手术时间、住院时间、术后恢复时间及术中出血量明显的短于或少于对照组,差异均具有统计学意义(均P0.05),试验组治愈率为96.7%明显的高于对照组的66.7%,差异有统计学意义(P0.05)。两组主要不良反应有:结石残留、感染、十二指肠穿孔、恶性呕吐及伤口疼痛等,试验组不良反应发生率为16.67%明显的低于对照组总的73.33%,差异有统计学意义(P0.05)。结论:腹腔镜联合十二指肠镜治疗胆结石合并胆总管结石较传统的开腹手术治疗的效果好、恢复时间短、手术创伤小,且具有一定的安全性,不良反应发生少,值得临床推广使用。     

胆管结石合并胆管癌的临床特征与诊治分析

目的：探讨胆管结石合并胆管癌的临床特征及诊治方法。方法：回顾性分析2000年1月-2009年12月我院收治的胆管结石合并胆管癌16例患者的临床病理资料。结果：胆管癌的发生率占同期胆管结石患者的3.1%,其临床表现以右上腹疼痛及反复的胆管炎发作为主,但缺乏特异性。术前胆管癌组患者AKP、γ-GT均有不同程度升高,ALT升高12例,总胆红素升高9例,与非胆管癌组相比,AKP、γ-GT、ALT、TBIL均显著升高（P〈0.01）,且胆管癌组术前血清CA19-9及CEA显著高于非胆管癌组（P〈0.01）,而两组间CA125及AFP水平比较无显著差异（P〉0.05）。16例患者中可进行手术治疗10例;其中根治性手术8例,姑息性手术2例。8例根治性手术患者的1、3年生存率分别为78.6%和36.4%;2例姑息性手术患者1、3年生存率分别为50.0%和0%,两组比较具有显著性差异（P〈0.05）。结论：胆管结石合并胆管癌的临床表现缺乏特异性,患者的疗效较差,对血清CA19-9和CEA显著升高者应行病理活检确诊,治疗手段应该力争实行根治性切除,有助于提高患者的生存期。     

Anomalies in Network Bridges Involved in Bile Acid Metabolism Predict Outcomes of Colorectal Cancer Patients

Biomarkers prognostic for colorectal cancer (CRC) would be highly desirable in clinical practice. Proteins that regulate bile acid (BA) homeostasis, by linking metabolic sensors and metabolic enzymes, also called bridge proteins, may be reliable prognostic biomarkers for CRC. Based on a devised metric, “bridgeness,” we identified bridge proteins involved in the regulation of BA homeostasis and identified their prognostic potentials. The expression patterns of these bridge proteins could distinguish between normal and diseased tissues, suggesting that these proteins are associated with CRC pathogenesis. Using a supervised classification system, we found that these bridge proteins were reproducibly prognostic, with high prognostic ability compared to other known markers.     

Transport of Salt and Water in Rabbit and Guinea Pig Gall Bladder

A simple and reproducible method has been developed for following fluid transport by an in vitro preparation of mammalian gall bladder, based upon weighing the organ at 5 minute intervals. Both guinea pig and rabbit gall bladders transport NaCl and water in isotonic proportions from lumen to serosa. In the rabbit bicarbonate stimulates transport, but there is no need for exogenous glucose. The transport rate is not affected by removal of potassium from the bathing solutions. Albumin causes a transient weight loss from the gall bladder wall, apparently by making the serosal smooth muscle fibers contract. Active NaCl transport can carry water against osmotic gradients of up to two atmospheres. Under passive conditions water may also move against its activity gradient in the presence of a permeating solute. The significance of water movement against osmotic gradients during active solute transport is discussed.     

Mucosa-Associated Bacterial Diversity in Relation to Human Terminal Ileum and Colonic Biopsy Samples

Little is known about bacterial communities that colonize mucosal surfaces in the human gastrointestinal tract, but they are believed to play an important role in host physiology. The objectives of this study were to investigate the compositions of these populations in the distal small bowel and colon. Healthy mucosal tissue from either the terminal ileum (n = 6) or ascending (n = 8), transverse (n = 8), or descending colon (n = 4) of 26 patients (age, 68.5 ± 1.2 years [mean ± standard deviation]) undergoing emergency resection of the large bowel was used to study these communities. Mucosa-associated eubacteria were characterized by using PCR-denaturing gradient gel electrophoresis (DGGE), while real-time PCR was employed for quantitative analysis. Mucosal communities were also visualized in situ using confocal laser scanning microscopy. DGGE banding profiles from all the gut regions exhibited at least 45% homology, with five descending colon profiles clustering at ca. 75% concordance. Real-time PCR showed that mucosal bacterial population densities were highest in the terminal ileum and that there were no significant differences in overall bacterial numbers in different parts of the colon. Bifidobacterial numbers were significantly higher in the large bowel than in the terminal ileum (P = 0.006), whereas lactobacilli were more prominent in the distal large intestine (P = 0.019). Eubacterium rectale (P = 0.0004) and Faecalibacterium prausnitzii (P = 0.001) were dominant in the ascending and descending colon. Site-specific colonization in the gastrointestinal tract may be contributory in the etiology of some diseases of the large intestine.     

Coupling between Neuronal and Glial Cells via Glutamate Metabolism in Brain of Healthy Persons and Patients with Mental Disorders

This review summarizes general considerations on glutamate metabolism in human brain. Biochemical coupling between neurons and glia is discussed with respect to glutamate metabolism and its compartmentation. Glutamate recycling and the role of key glutamate-metabolizing enzymes are viewed. Alterations in components of glutamatergic system and glutamate metabolizing enzymes are considered with reference to mental disorders such as senile dementia of Alzheimer's type and schizophrenia.     

手术治疗复杂性肝内胆管结石的临床分析

目的:探讨规则性肝段/肝叶切除术治疗复杂性肝内胆管结石的临床疗效。方法:2009年6月至2013年6月期间,我们共同诊治的60例复杂性肝内胆管结石患者,随机将其分为对照组(非规则性肝段/肝叶切除术)和观察组(规则性肝段/肝叶切除术),每组各30例,对两组术中出血量,以及结石清除率、并发症、复发率,进行观察和比较。结果:与对照组相比,观察组术中出血量明显减少,结石清除率明显提高,并发症发生率和复发率显著降低(P0.05),差异有统计学意义。结论:对于复杂性肝内胆管结石患者,规则性肝段/肝叶切除术治疗的疗效显著,明显提高患者的预后质量,值得临床推广。