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ELife Feb 2021Organ function depends on tissues adopting the correct architecture. However, insights into organ architecture are currently hampered by an absence of standardized...
Organ function depends on tissues adopting the correct architecture. However, insights into organ architecture are currently hampered by an absence of standardized quantitative 3D analysis. We aimed to develop a robust technology to visualize, digitalize, and segment the architecture of two tubular systems in 3D: oble resin asting micro computed omography (DUCT). As proof of principle, we applied DUCT to a mouse model for Alagille syndrome ( mice), characterized by intrahepatic bile duct paucity, that can spontaneously generate a biliary system in adulthood. DUCT identified increased central biliary branching and peripheral bile duct tortuosity as two compensatory processes occurring in distinct regions of liver, leading to full reconstitution of wild-type biliary volume and phenotypic recovery. DUCT is thus a powerful new technology for 3D analysis, which can reveal novel phenotypes and provide a standardized method of defining liver architecture in mouse models.
Topics: Alagille Syndrome; Animals; Bile Ducts; Disease Models, Animal; Mice; Mice, Transgenic; X-Ray Microtomography
PubMed: 33635272
DOI: 10.7554/eLife.60916 -
Biochimica Et Biophysica Acta.... Apr 2018In the last 25years, a number of animal models, mainly rodents, have been generated with the goal to mimic cholestatic liver injuries and, thus, to provide in vivo tools... (Review)
Review
In the last 25years, a number of animal models, mainly rodents, have been generated with the goal to mimic cholestatic liver injuries and, thus, to provide in vivo tools to investigate the mechanisms of biliary repair and, eventually, to test the efficacy of innovative treatments. Despite fundamental limitations applying to these models, such as the distinct immune system and the different metabolism regulating liver homeostasis in rodents when compared to humans, multiple approaches, such as surgery (bile duct ligation), chemical-induced (3,5-diethoxycarbonyl-1,4-dihydrocollidine, DDC, α-naphthylisothiocyanate, ANIT), viral infections (Rhesus rotavirustype A, RRV-A), and genetic manipulation (Mdr2, Cftr, Pkd1, Pkd2, Prkcsh, Sec63, Pkhd1) have been developed. Overall, they have led to a range of liver phenotypes recapitulating the main features of biliary injury and altered bile acid metabolisms, such as ductular reaction, peribiliary inflammation and fibrosis, obstructive cholestasis and biliary dysgenesis. Although with a limited translability to the human setting, these mouse models have provided us with the ability to probe over time the fundamental mechanisms promoting cholestatic disease progression. Moreover, recent studies from genetically engineered mice have unveiled 'core' pathways that make the cholangiocyte a pivotal player in liver repair. In this review, we will highlight the main phenotypic features, the more interesting peculiarities and the different drawbacks of these mouse models. This article is part of a Special Issue entitled: Cholangiocytes in Health and Disease edited by Jesus Banales, Marco Marzioni, Nicholas LaRusso and Peter Jansen.
Topics: Animals; Bile Acids and Salts; Bile Duct Diseases; Bile Ducts; Chronic Disease; Disease Models, Animal; Disease Progression; Epithelial Cells; Humans; Liver; Mice; Mice, Knockout; Rats; Species Specificity; Treatment Outcome
PubMed: 28709963
DOI: 10.1016/j.bbadis.2017.06.027 -
PLoS Computational Biology Feb 2022Biliary ducts collect bile from liver lobules, the smallest functional and anatomical units of liver, and carry it to the gallbladder. Disruptions in this process caused...
Biliary ducts collect bile from liver lobules, the smallest functional and anatomical units of liver, and carry it to the gallbladder. Disruptions in this process caused by defective embryonic development, or through ductal reaction in liver disease have a major impact on life quality and survival of patients. A deep understanding of the processes underlying bile duct lumen formation is crucial to identify intervention points to avoid or treat the appearance of defective bile ducts. Several hypotheses have been proposed to characterize the biophysical mechanisms driving initial bile duct lumen formation during embryogenesis. Here, guided by the quantification of morphological features and expression of genes in bile ducts from embryonic mouse liver, we sharpened these hypotheses and collected data to develop a high resolution individual cell-based computational model that enables to test alternative hypotheses in silico. This model permits realistic simulations of tissue and cell mechanics at sub-cellular scale. Our simulations suggest that successful bile duct lumen formation requires a simultaneous contribution of directed cell division of cholangiocytes, local osmotic effects generated by salt excretion in the lumen, and temporally-controlled differentiation of hepatoblasts to cholangiocytes, with apical constriction of cholangiocytes only moderately affecting luminal size.
Topics: Animals; Bile Ducts; Epithelial Cells; Mice; Models, Biological; Morphogenesis
PubMed: 35180209
DOI: 10.1371/journal.pcbi.1009653 -
Medical Science Monitor : International... Nov 2017BACKGROUND Major bile duct injury is the most worrisome complication of cholecystectomy. There is no detailed data about the incidence or treatment-related costs of bile...
BACKGROUND Major bile duct injury is the most worrisome complication of cholecystectomy. There is no detailed data about the incidence or treatment-related costs of bile duct injuries in Turkey. We aimed to determine prevalence and therapeutic costs of patients with major biliary duct injuries managed in our department, and further estimate a projection of these parameters at the national level. MATERIAL AND METHODS All patients admitted due to bile duct injury during cholecystectomy from 2011 to 2014 were included. Healthcare costs were calculated by summing of their all treatment-related costs in Istanbul Medical Faculty. We collected 2014-2015 data on number of patients diagnosed with cholecystitis in Turkey, the number of cholecystectomies, and the number of the interventions performed following these initial surgeries, which were obtained from the Turkish Social Security Institution. RESULTS Forty-nine patients were enrolled and bilioenteric diversion was performed in 39 patients: 20.4% of patients had Bismuth II, 38.8% had Bismuth III, and 40.8% had Bismuth IV biliary stricture. Comparison of stricture types with total costs, days of hospitalization, and outpatient clinic costs revealed significant differences. Mean total cost of corrective surgeries was 9199 TRY. We estimated that 1.5% to 2.4% of patients who underwent cholecystectomy in Turkey have bile duct injury (including 0.3% with major bile duct injury). CONCLUSIONS New preventive strategies should be used to avoid bile duct injuries, which have a huge financial impact on the national economy.
Topics: Adult; Aged; Bile Ducts; Female; Geography; Health Care Costs; Humans; Male; Middle Aged; Prevalence; Plastic Surgery Procedures; Ultrasonography; Young Adult
PubMed: 29101778
DOI: 10.12659/msm.907532 -
World Journal of Gastroenterology Jul 2015To verify the utility of fluorescent cholangiography for more rigorous identification of the extrahepatic biliary system. (Review)
Review
AIM
To verify the utility of fluorescent cholangiography for more rigorous identification of the extrahepatic biliary system.
METHODS
MEDLINE and PubMed searches were performed using the key words "fluorescent cholangiography", "fluorescent angiography", "intraoperative fluorescent imaging", and "laparoscopic cholecystectomy" in order to identify relevant articles published in English, French, German, and Italian during the years of 2009 to 2014. Reference lists from the articles were reviewed to identify additional pertinent articles. For studies published in languages other than those mentioned above, all available information was collected from their English abstracts. Retrieved manuscripts (case reports, reviews, and abstracts) concerning the application of fluorescent cholangiography were reviewed by the authors, and the data were extracted using a standardized collection tool. Data were subsequently analyzed with descriptive statistics. In contrast to classic meta-analyses, statistical analysis was performed where the outcome was calculated as the percentages of an event (without comparison) in pseudo-cohorts of observed patients.
RESULTS
A total of 16 studies were found that involved fluorescent cholangiography during standard laparoscopic cholecystectomies (n = 11), single-incision robotic cholecystectomies (n = 3), multiport robotic cholecystectomy (n = 1), and single-incision laparoscopic cholecystectomy (n = 1). Overall, these preliminary studies indicated that this novel technique was highly sensitive for the detection of important biliary anatomy and could facilitate the prevention of bile duct injuries. The structures effectively identified before dissection of Calot's triangle included the cystic duct (CD), the common hepatic duct (CHD), the common bile duct (CBD), and the CD-CHD junction. A review of the literature revealed that the frequencies of detection of the extrahepatic biliary system ranged from 71.4% to 100% for the CD, 33.3% to 100% for the CHD, 50% to 100% for the CBD, and 25% to 100% for the CD-CHD junction. However, the frequency of visualization of the CD and the CBD were reduced in patients with a body mass index > 35 kg/m(2) relative to those with a body mass index < 35 kg/m(2) (91.0% and 64.0% vs 92.3% and 71.8%, respectively).
CONCLUSION
Fluorescent cholangiography is a safe procedure enabling real-time visualization of bile duct anatomy and may become standard practice to prevent bile duct injury during laparoscopic cholecystectomy.
Topics: Anatomic Landmarks; Bile Ducts; Cholangiography; Cholecystectomy, Laparoscopic; Fluorescent Dyes; Humans; Indocyanine Green; Intraoperative Care; Luminescent Measurements; Optical Imaging; Predictive Value of Tests; Risk Factors; Wounds and Injuries
PubMed: 26167088
DOI: 10.3748/wjg.v21.i25.7877 -
BJS Open Mar 2022
Comment on: Routine versus selective intraoperative cholangiography during cholecystectomy: systematic review, meta-analysis, and health economic model analysis of iatrogenic bile duct injury.
Topics: Bile Duct Diseases; Bile Ducts; Cholangiography; Cholecystectomy; Humans; Iatrogenic Disease; Models, Economic
PubMed: 35415754
DOI: 10.1093/bjsopen/zrac053 -
BJS Open Mar 2022
Author response to: Routine versus selective intraoperative cholangiography during cholecystectomy: a systematic review, meta-analysis, and health economic model analysis of iatrogenic bile duct injury.
Topics: Bile Ducts; Cholangiography; Cholecystectomy; Humans; Iatrogenic Disease; Models, Economic
PubMed: 35415755
DOI: 10.1093/bjsopen/zrac054 -
World Journal of Gastroenterology Dec 2020Extrahepatic biliary duct injury (BDI) remains a complicated issue for surgeons. Although several approaches have been explored to address this problem, the high...
BACKGROUND
Extrahepatic biliary duct injury (BDI) remains a complicated issue for surgeons. Although several approaches have been explored to address this problem, the high incidence of complications affects postoperative recovery. As a nonimmunogenic scaffold, an animal-derived artificial bile duct (ada-BD) could replace the defect, providing good physiological conditions for the regeneration of autologous bile duct structures without changing the original anatomical and physiologic conditions.
AIM
To evaluate the long-term feasibility of a novel heterogenous ada-BD for treating extrahepatic BDI in pigs.
METHODS
Eight pigs were randomly divided into two groups in the study. The animal injury model was developed with an approximately 2 cm segmental defect of various parts of the common bile duct (CBD) for all pigs. A 2 cm long novel heterogenous animal-derived bile duct was used to repair this segmental defect (group A, ada-BD-to-duodenum anastomosis to repair the distal CBD defect; group B, ada-BD-to-CBD anastomosis to repair the intermedial CBD defect). The endpoint for observation was 6 mo (group A) and 12 mo (group B) after the operation. Liver function was regularly tested. Animals were euthanized at the above endpoints. Histological analysis was carried out to assess the efficacy of the repair.
RESULTS
The median operative time was 2.45 h (2-3 h), with a median anastomosis time of 60.5 min (55-73 min). All experimental animals survived until the endpoints for observation. The liver function was almost regular. Histologic analysis indicated a marked biliary epithelial layer covering the neo-bile duct and regeneration of the submucosal connective tissue and smooth muscle without significant signs of immune rejection. In comparison, the submucosal connective tissue was more regular and thicker in group B than in group A, and there was superior integrity of the regeneration of the biliary epithelial layer. Despite the advantages of the regeneration of the bile duct smooth muscle observed in group A, the effect on the patency of the ada-BD grafts in group B was not confirmed by macroscopic assessment and cholangiography.
CONCLUSION
This approach appears to be feasible for repairing a CBD defect with an ada-BD. A large sample study is needed to confirm the durability and safety of these preliminary results.
Topics: Animals; Bile Ducts; Bile Ducts, Extrahepatic; Biliary Tract Surgical Procedures; Cholangiography; Common Bile Duct; Plastic Surgery Procedures; Swine
PubMed: 33362386
DOI: 10.3748/wjg.v26.i46.7312 -
British Medical Journal Jun 1957
Topics: Bile Ducts; Choledochal Cyst; Common Bile Duct; Cysts; Humans
PubMed: 13436802
DOI: 10.1136/bmj.1.5032.1401 -
Annals of Surgery Jan 1955
Topics: Bile Ducts; Common Bile Duct; Hemorrhage; Humans
PubMed: 13218552
DOI: 10.1097/00000658-195501000-00019