| Objective: Research on the shape and function changes of Cajal interstitial cell(interstitial cell of Cajal, ICC) and connexin 43(Connexin 43, Cx43) in different types of appendicitis tissues, combined with radiographic severity of appendicitis comprehensive assessment for children with perioperative rational use of antibiotics to provide clinical guidance.Methods: 64 cases of appendicitis patients were collected, who were admitted in Children’s Hospital of Soochow University School of Medicine, Department of General Surgery between October 2012 to October 2014. Among them, 10 cases with simple appendicitis were taken as group A, which sick children age was 2.5 to 7.4 years old(the median age was 3.0±0.15 years old), 6 cases were boys and 4 cases were girls. 28 cases of acute suppurative appendicitis were taken as group B, which sick children age was 3.5 to11.5 years old(the median age was 6.7±0.1 years old), 12 cases were boys and 16 cases were girls. Taken 18 cases of acute gangrenous appendicitis as group C, which sick children age was 2.9 to 8.4 years old(the median age was 4.0± 0.3 years old), 11 cases were boys and 7 cases were girls. 8 cases with appendiceal abscess which were operated after 3 months of anti-infective therapy heal were taken as group D, which sick children age was 4.7 to 13.9 years old(the median age was 7.7±0.4 years old), 5 cases were boys and 6 cases were girls. The A, B, C, D group were taken as study team. 13 children of intestines malrotation and indigitation(The appendicitis are not conformitied) were taken as group E(control group), the age of these children was 18 days to 3.8 months old(the median age was 2.2 months±5 days old), 8 cases were boys and 5 cases were girls. The children of group A, B, C were diagnosed with appendicitis by pathological examination.The children of Group D were examinated the detailed disease history, physicalexamination, ultrasound B, CT and other auxiliary examination diagnosis to diagnose periappendicural absecess, and there were indications of conservative treatment, they were cured by conservative treatment after 3 months and no recurrence of appendicitis. In group E, we choose the appendix which was removed during the operation of the children with congenital intestines malrotation as control group, and the normal appendix was used to pathologic examination and immunohistochemical examination.Appendix tissue resected pathological wax block processing, using immunohistochemistry,En Vision two-step method of ICCs, Cx43 were detected, the experimental results were compared with each other by Oneway-Anova test.Results: 1. HE staining: Group A: basic integrity of mucosal surface lamina propria,crypt epithelium, obvious defects, partial no ulcer formation, the appendix shows a small amount of full-thickness infiltration of neutrophils, neutrophil subserosallymphatics;Group B: Lamina propriamucosal surface is still intact, shedding crypt epithelial defect,local ulceration, appendix whole layer visible diffuse infiltration of neutrophils, full of neutrophils within the lymphatic subserosal; Group C: Full-thicknessnecrosis congestion appendix form structure disappeared with venous thrombosis, a large number of neutrophil infiltration, inflammatory serosa see fibrinoid exudates; Group D: Appendix epithelial integrity, slight hyperplasia of lymphoid tissue, no significant neutrophil infiltration; Group E: Appendix lamina propria mucosa crypt epithelial integrity, non-shedding defect,lymphoid tissue hyperplasia slightly, all- layer quality and no neutrophil infiltration.2. The variation of the distribution and morphological in ICCs, Cx43:1) Normal appendix has a large number of ICCswhich distribute in the muscle and submucosa, the projections are interconnected with each other by forming a network-like structure,ICCs have moderate even numerous distribution in the circular muscle,nearly closedand parallel with smooth muscle cellsin the septum, can also be found in small amounts in the longitudinal muscle. The Cx43 distribution in different layers of the normal appendix may be related to the wave generation, propagation and different intestinal muscular activity patterns in the intestinal wall layers, the appendicitis after complete cure appendectomy, the number and structure of ICCsand Cx43 in inner layers through compared with the control group had no significant difference(P>0.05). 2)ICCs and Cx43 of suppurative appendicitis appendix wall layers are both reduced, local ICCshave long distance between each other, the connection is not obvious and loose, network structureof normal Cx43 was partially destroyed, ICCs and Cx43 of suppurative appendicitis appendix with in the layers compared with the control group were significant differences(P <0.05). 3) The number of ICCs, Cx43 of gangrenous appendicitis in each layers significantly reduced or even disappear, normal ICCs network structure disappeared,thenumber of ICCs,Cx43 with in layers of gangrenous appendicitis appen dectomy compared with the control group, there was a significant difference(P <0.05).Conclusion: 1. The appendix can reduce the number of c-kit+ ICCs and Cx43. As the infection aggravating, the number of ICCs and Cx43 in the c-kit+ gradually reduced or even disappeared. The reticular structure of ICC and Cx43 were damaged.2. As the control of infection and the disappearance of the inflammation, the number of ICCs and Cx43 recovered gradually, and the number of them were slightly lower than that of normal appendix, but there was no statistical significance. The Cx43 reticular structure was rebuilt.3. The abnormalities of ICC and Cx43 number and distribution may be one of the reference indexes of the appendix inflammation degree. |
PDF Full Text Request