The Influence Of Infection On The Interstitial Cells Of Cajal In Appendix

Background:Recently many scientists have recognized that interstitial cells of Cajal (ICCs) are pacemaker cells between gastrointestinal smooth muscles;which generate spontaneous slow waves of the smooth muscle layers and mediate the neurotransmission.The cellular network of ICCs is connected by Gap junctions to each other and to the smooth muscle cells. In animal models of gastrointestinal infections, the number of the regional ICC reduce, the network outages, the ultrastructural damage and slow wave generation, propagation and neurotransmission disorders.Intestinal muscle inflammation occurs, ICC number and network density reduce, ICC and nerve direct connection or close joint is little, the network associated with neural structures were damaged, leading to damage of intestinal motility of the corresponding.This study selects the appendix in the human digestive tract as an object of study,using immunohistochemical methods to mark ICCs in appendicitis during disease, cured appendicitis and normal appendix in children, learning how the numbers of the ICCs in layers change in appendicitis, cured appendicitis children and normal children's appendix,exploring the impact of infection on the appendix ICCs, to speculate the impact of the infection to gastrointestinal tract ICCs. Subjects:65 children with appendicitis were enrolled and all of them had been performed appendectomy from January 2010 to June in the department of general surgery, children's hospital of Zhejiang University, of which 38 cases of acute suppurative appendicitis is the observation group 1,children aged 3 years and 5 months to 8 years and 7 months,24 males and 14 females; 16 cases of acute gangrenous appendicitis is the observation group 2, aged 3 years 1 month to 7 years,5 months,10 males and 6 females; 11 cases appendicular abscess cured by anti-infection more than 3 months later is the observation group 3, aged 2 years 2 months to 5 years and 9 months,5males and 6 females; 15 cases of intestinal malrotation in the control group, aged 2 months to 4 years 3 months,9 males and 6 females. Appendicitis of group 1 and group 2 are both diagnosed by the pathological examination clearly.Patients in the observation group 3 were all asked about the history, done physical examination, laboratory examination and laboratory indicators, diagnosed appendicular abscess and cured conservatively,and more than 3 months after healing without appendicitis.Select appendix of children with congenital malrotation the same period as the control group, this group all be done Ladd's surgery, removal normal appendix tissue.Method:3 observation groups and the control group appendix tissue organizations were taken to observe Immunohistochemical En Vision two-step testing the ICCs. Test results need pairwise comparison by Oneway Anova.Results:1. HE staining of the control group, HE staining appendectomy specimens:the lamina propria mucosa crypt epithelial of appendix is integrity, without shedding defect, slight proliferation of lymphoid tissue, no full-thickness stromal infiltration of neutrophils. Group 1 specimens with HE staining:lamina is still intact mucosal surface, crypt epithelial defect shedding, local ulceration, full-thickness of appendix diffuse neutrophil infiltration, subserosal lymphatic vessels filled with neutrophils.Group 2 specimens with HE staining:appendix full-thickness necrosis of congestion, the structure disappear, with venous thrombosis, massive neutrophil infiltrate, fibrinoid inflammatory serous exude outside.Appendix after appendiceal abscess cured, epithelial integrity, a slight proliferation of lymphoid tissue, no significant neutrophil infiltration.2. In the normal appendix, a large number of ICCs located in muscle and submucosa, each interconnected by a network of neurite-like structure, compared the appendicitis after completely cured with normal control group, the number of ICCs in layers is no significant difference (P>0.05).3. In suppurative appendicitis, ICCs are reduced,distance between the local ICCs is long, the connection is not obvious or loose, normal findings of the network structure are partly damage, the number of ICCs in suppurative appendicitis compared with the control group, there is significant difference (P<0.05).4. In gangrenous appendicitis, ICCs are significantly reduced or even disappeared, normal ICCs network disappear, the number of ICCs in gangrenous appendicitis compared with the control group, there is significant difference (P<0.05).Conclusion:1. Appendicitis can make the c-kit+ICCs reduce, as the infection increasing c-kit+ ICCs decrease or disappear, ICCs network-like structural are damaged.2. With controlling of infection, inflammation disappearring, c-kit+ICCs recover, network-like structure re-establish.