Pathophysiological consequences and treatment strategy of obstructive jaundice

Obstructive jaundice (OJ) is a common problem in daily clinical practice. However, completely understanding the pathophysiological changes in OJ remains a challenge for planning current and future management. The effects of OJ are widespread, affecting the biliary tree, hepatic cells, liver function, and causing systemic complications. The lack of bile in the intestine, destruction of the intestinal mucosal barrier, and increased absorption of endotoxins can lead to endotoxemia, production of proinflammatory cytokines, and induce systemic inflammatory response syndrome, ultimately leading to multiple organ dysfunction syndrome. Proper management of OJ includes adequate water supply and electrolyte replacement, nutritional support, preventive antibiotics, pain relief, and itching relief. The surgical treatment of OJ depends on the cause, location, and severity of the obstruction. Biliary drainage, surgery, and endoscopic intervention are potential treatment options depending on the patient's condition. In addition to modern medical treatments, Traditional Chinese medicine may offer therapeutic benefits for OJ. A comprehensive search was conducted on PubMed for relevant articles published up to August 1970. This review discusses in detail the pathophysiological changes associated with OJ and presents effective strategies for managing the condition.

The mechanism of Yinchenhao decoction in treating obstructive-jaundice-induced liver injury based on Nrf2 signaling pathway

BACKGROUND

Obstructive jaundice (OJ) is caused by bile excretion disorder after partial or complete bile duct obstruction. It may cause liver injury through various mechanisms. Traditional Chinese medicine (TCM) has a lot of advantages in treating OJ. The recovery of liver function can be accelerated by combining Chinese medicine treatment with existing clinical practice. Yinchenhao decoction (YCHD), a TCM formula, has been used to treat jaundice. Although much progress has been made in recent years in understanding the mechanism of YCHD in treating OJ-induced liver injury, it is still not clear.

AIM

To investigate chemical components of YCHD that are effective in the treatment of OJ and predict the mechanism of YCHD.

METHODS

The active components and putative targets of YCHD were predicted using a network pharmacology approach. Gene Ontology biological process and Kyoto Encyclopedia of Genes and Genomes path enrichment analysis were carried out by cluster profile. We predicted the biological processes, possible targets, and associated signaling pathways that YCHD may involve in the treatment of OJ. Thirty male Sprague–Dawley rats were randomly divided into three groups, each consisting of 10 rats: the sham group (Group S), the OJ model group (Group M), and the YCHD-treated group (Group Y). The sham group only received laparotomy. The OJ model was established by ligating the common bile duct twice in Groups M and Y. For 1 wk, rats in Group Y were given a gavage of YCHD (3.6 mL/kg) twice daily, whereas rats in Groups S and M were given the same amount of physiological saline after intragastric administration daily. After 7 d, all rats were killed, and the liver and blood samples were collected for histopathological and biochemical examinations. Total bilirubin (TBIL), direct bilirubin (DBIL), alanine aminotransferase (ALT), and aspartate transaminase (AST) levels in the blood samples were detected. The gene expression levels of inducible nitric oxide synthase (iNOS) and endothelial nitric oxide synthase (eNOS), and the nucleus positive rate of NF-E2 related factor 2 (Nrf2) protein were measured. Western blot analyses were used to detect the protein and gene expression levels of Nrf2, Kelch-like ECH-associated protein 1, NAD(P)H quinone dehydrogenase 1 (NQO1), and glutathione-S-transferase (GST) in the liver tissues. One-way analysis of variance was used to evaluate the statistical differences using the statistical package for the social sciences 23.0 software. Intergroup comparisons were followed by the least significant difference test and Dunnett’s test.

RESULTS

The effects of YCHD on OJ involve biological processes such as DNA transcription factor binding, RNA polymerase II specific regulation, DNA binding transcriptional activator activity, and nuclear receptor activity. The protective effects of YCHD against OJ were closely related to 20 pathways, including the hepatitis-B, the mitogen-activated protein kinase, the phosphatidylinositol 3-kinase/protein kinase B, and tumor necrosis factor signaling pathways. YCHD alleviated the swelling and necrosis of hepatocytes. Following YCHD treatment, the serum levels of TBIL (176.39 ± 17.03 μmol/L vs 132.23 ± 13.88 μmol/L, P < 0.01), DBIL (141.41 ± 14.66 μmol/L vs 106.43 ± 10.88 μmol/L, P < 0.01), ALT (332.07 ± 34.34 U/L vs 269.97 ± 24.78 U/L, P < 0.05), and AST (411.44 ± 47.64 U/L vs 305.47 ± 29.36 U/L, P < 0.01) decreased. YCHD promoted the translocation of Nrf2 into the nucleus (12.78 ± 0.99 % vs 60.77 ± 1.90 %, P < 0.001). After YCHD treatment, we found a decrease in iNOS (0.30 ± 0.02 vs 0.20 ± 0.02, P < 0.001) and an increase in eNOS (0.18 ± 0.02 vs 0.32 ± 0.02, P < 0.001). Meanwhile, in OJ rats, YCHD increased the expressions of Nrf2 (0.57 ± 0.03 vs 1.18 ± 0.10, P < 0.001), NQO1 (0.13 ± 0.09 vs 1.19 ± 0.07, P < 0.001), and GST (0.12 ± 0.02 vs 0.50 ± 0.05, P < 0.001), implying that the potential mechanism of YCHD against OJ-induced liver injury was the upregulation of the Nrf2 signaling pathway.

CONCLUSION

OJ-induced liver injury is associated with the Nrf2 signaling pathway. YCHD can reduce liver injury and oxidative damage by upregulating the Nrf2 pathway.

The choice of operation timing of laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGBD) for acute cholecystitis: a retrospective clinical analysis

BACKGROUND

This study aimed to evaluate the timing of laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGBD).

METHODS

Patients with acute moderate to severe cholecystitis treated by LC after PTGBD in the Department of Hepatobiliary and Pancreatic Surgery, Nankai Hospital (N-362) between January 2017 and August 2019were retrospectively enrolled into this study. According to the interval times from PTGBD to LC, the patients were divided into six groups, including group A (105 cases, within 1 week), group B (62 cases, 1-2 weeks), group C (34 cases, 3-4 weeks), group D (54 cases, 5-8 weeks), group E (24 cases, 9-12 weeks), and group F (83 cases, over 12 weeks). The gender, age, hospital stay, duration of operation, rate of conversion to laparotomy, incidence of complications, and hospitalization expenses of the six groups were evaluated and compared.

RESULTS

Of the 362 cases of LC, 346 patients were operated successfully (95.6%), 10 were converted to laparotomy (2.8%), 16 had various complications (4.4%), and 2 died (0.6%). There were no significant differences between groups in the gender ratio, complication rate, and rate of conversion to laparotomy. The hospital stay and hospitalization expenses in group A were the least and significantly lower than those in other groups (P<0.01), and the duration of operation in group D was the longest and significantly higher than that in groups A, B, E, and F (P<0.05).

CONCLUSIONS

For non-elderly patients diagnosed with acute moderate to severe cholecystitis with an anesthesia risk score [American Society of Anesthesiologists (ASA)] ≤2, LC is recommended to be performed within 1 week after PTGBD surgery. If delayed LC is performed within 2 to 8 weeks after PTGBD, the operation time will be longer due to inflammatory edema and fibrous adhesion of the gallbladder triangle. If PTGBD is performed for more than 2 months and the clinical circumstances are good, delayed LC can be considered to reduce the inconvenience of patients with a long-term catheter as much as possible.

Prognostic value of IL-26 level in hepatocellular carcinoma tissue in postoperative patients with hepatitis B related hepatocellular carcinoma

BACKGROUND

The current hepatocellular carcinoma (HCC) staging system is not ideal for judging the prognosis of patients after surgical resection, so it is very important to find and identify the patients who are prone to recurrence and carry out targeted intervention. In recent years, the relationship between liver immunity and HCC has become a research hotspot. Interleukin (IL)-26 can predict the prognosis of patients with HCC, but there is a lack of research on the prognosis of patients 5 years after surgery.

AIM

To analyze the prognostic value of IL-26 in HCC tissues of patients with hepatitis B.

METHODS

The preoperative data of hepatitis B related HCC patients who were hospitalized and operated at our hospital from January 2006 to June 2015 were collected. The expression of IL-26 in resected HCC tissues was measured by immunohistochemistry and based on the median expression level of IL-26, the patients were divided into either a high expression group or a low expression group. The 5-year overall survival (OS) and progression free survival (PFS) were compared between the two groups by Kaplan-Meier method.

RESULTS

The percentages of patients with a tumor size > 5 cm, microvascular invasion, and TNM stage III/IV disease in the high expression group were significantly higher than those of the low expression group (P = 0.026, 0.009, and P =0.045, respectively). High expression of IL-26 (hazard ratio [HR] = 1.667, P = 0.022), tumor size > 5 cm (HR = 1.096, P = 0.002), and microvascular invasion (HR = 2.696, P = 0.006) were the influencing factors of PFS in patients with HCC resection. High expression of IL-26 (HR = 1.643, P = 0.041) and microvascular invasion (HR = 3.303, P = 0.016) were independent prognostic factors for OS in patients with HCC resection. PFS and OS in patients with high expression of IL-26 were worse than those with low expression.

CONCLUSION

The expression of IL-26 in HCC tissue correlates with the OS and PFS of patients with hepatitis B-related liver cancer after resection.

Optimal timing for laparoscopic cholecystectomy in the treatment of gallbladder calculi incarceration

Objective

Laparoscopic cholecystectomy (LC) has become a popular method in the treatment of gallbladder calculi incarceration (GCI). This study aimed to investigate the effect of early and delayed LC on patients with GCI to determine the optimal timing for LC.

Methods

The clinical data of 639 patients with GCI who had received LC were analyzed retrospectively. According to the duration of symptoms before admission and that from admission to LC, the patients were divided into different groups. The relationship between conversion and postoperative complications was compared among the different groups.

Results

Seventy-two patients (11.27%) underwent conversion to laparotomy, and 65 patients (10.17%) had postoperative complications. Patients in the LC > 15 d group were older ( p < 0.001), had a longer operation time ( p < 0.001), had a longer duration of hospitalization ( p < 0.001), had a higher proportion of conversion ( p < 0.001), and had a higher incidence of postoperative complications ( p < 0.001). Type 2 diabetes mellitus (T2DM) (RR = 1.701; 95% CI: 1.410–2.047; p < 0.001) and duration from admission to LC (RR = 7.072; 95% CI: 3.044–16.431; p < 0.001) were independent risk factors for conversion. Older age, T2DM, CRP, duration of symptoms before admission >3  m, and duration from admission to LC > 15 d were independent predictors of postoperative complications.

Conclusion

For patients younger than 65 years without contraindications, early operation should be performed within 3 d after admission to reduce the operation time, hospitalization time, conversion, and postoperative complications.

miR-499a promotes PANC-1 cell proliferation by down-regulating PDCD4 expression in pancreatic ductal adenocarcinoma

Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive digestive system tumors, but study of the molecular mechanism of occurrence and development of PDAC is considerably limited. In order to better understand the potential pathogenesis, the differentially expressed miRNAs were screened in PDAC and adjacent tissues using miRNAs microarrays. We found that miR-499a was significantly up-regulated in PDAC tissues compared with adjacent tissues, and protein-protein interaction (PPI) and gene ontology (GO) analyses indicated programmed cell death protein 4 (PDCD4) is a key target gene of miR-499a, which is involved in the regulation of transcription, cellular biosynthetic process, RNA metabolic process, and other multiple biologic processes. Moreover, PDCD4 mRNA and protein expression were obviously down-regulated in PDAC tissues compared with adjacent tissues. In vitro, up-regulating of miR-499a could decrease PDCD4 expression and promote cell proliferation in PANC-1 cells transfected with miR-499a mimics. Similarly, promoting proliferation was also observed in PANC-1 cells transfected with PDCD4 siRNA. In conclusion, we first found miR-499a was significantly up-regulated in PDAC tissues, and we promoted PANC-1 cell proliferation by down-regulating PDCD4 expression.

Yinchenhao decoction attenuates obstructive jaundice-induced liver injury and hepatocyte apoptosis by suppressing protein kinase RNA-like endoplasmic reticulum kinase-induced pathway

BACKGROUND

Chronic biliary obstruction results in ischemia and hypoxia of hepatocytes, and leads to apoptosis. Apoptosis is very important in regulating the homeostasis of the hepatobiliary system. Endoplasmic reticulum (ER) stress is one of the signaling pathways that induce apoptosis. Moreover, the protein kinase RNA-like endoplasmic reticulum kinase (PERK)-induced apoptotic pathway is the main way; but its role in liver injury remains unclear. Yinchenhao decoction (YCHD) is a traditional Chinese medicine formula that alleviates liver injury and apoptosis, yet its mechanism is unknown. We undertook this study to investigate the effects of YCHD on the expression of ER stress proteins and hepatocyte apoptosis in rats with obstructive jaundice (OJ).

AIM

To investigate whether YCHD can attenuate OJ-induced liver injury and hepatocyte apoptosis by inhibiting the PERK-CCAAT/enhancer-binding protein homologous protein (CHOP)-growth arrest and DNA damage-inducible protein 34 (GADD34) pathway and B cell lymphoma/leukemia-2 related X protein (Bax)/B cell lymphoma/leukemia-2 (Bcl-2) ratio.

METHODS

For in vivo experiments, 30 rats were divided into three groups: control group, OJ model group, and YCHD-treated group. Blood was collected to detect the indicators of liver function, and liver tissues were used for histological analysis. For in vitro experiments, 30 rats were divided into three groups: G1, G2, and G3. The rats in group G1 had their bile duct exposed without ligation, the rats in group G2 underwent total bile duct ligation, and the rats in group G3 were given a gavage of YCHD. According to the serum pharmacology, serum was extracted and centrifuged from the rat blood to cultivate the BRL-3A cells. Terminal deoxynucleotidyl transferase mediated dUTP nick end-labelling (TUNEL) assay was used to detect BRL-3A hepatocyte apoptosis. Alanine aminotransferase (ALT) and aspartate transaminase (AST) levels in the medium were detected. Western blot and quantitative real-time polymerase chain reaction (qRT-PCR) analyses were used to detect protein and gene expression levels of PERK, CHOP, GADD34, Bax, and Bcl-2 in the liver tissues and BRL-3A cells.

RESULTS

Biochemical assays and haematoxylin and eosin staining suggested severe liver function injury and liver tissue structure damage in the OJ model group. The TUNEL assay showed that massive BRL-3A rat hepatocyte apoptosis was induced by OJ. Elevated ALT and AST levels in the medium also demonstrated that hepatocytes could be destroyed by OJ. Western blot or qRT-PCR analyses showed that the protein and mRNA expression levels of PERK, CHOP, and GADD34 were significantly increased both in the rat liver tissue and BRL-3A rat hepatocytes by OJ. The Bax and Bcl-2 levels were increased, and the Bax/Bcl-2 ratio was also increased. When YCHD was used, the PERK, CHOP, GADD34, and Bax levels quickly decreased, while the Bcl-2 levels increased, and the Bax/Bcl-2 ratio decreased.

CONCLUSION

OJ-induced liver injury and hepatocyte apoptosis are associated with the activation of the PERK-CHOP-GADD34 pathway and increased Bax/Bcl-2 ratio. YCHD can attenuate these changes.

Carboxypeptidase A4 promotes proliferation and stem cell characteristics of hepatocellular carcinoma

Carboxypeptidase A4 (CPA4), a member of the metallo-carboxypeptidase family, is overexpressed in liver cancer and is associated with cancer progression. The role of CPA4 in hepatocellular carcinoma (HCC) remains unclear. In this study, we aimed to evaluate the relevance of CPA4 to the proliferation and expression of stem cell characteristics of hepatocellular carcinoma cells. Western blot analysis showed high CPA4 expression in the liver cancer cell line Bel7402 and low expression in HepG2 cells. Knock-down of CPA4 decreased cancer cell proliferation as detected by MTT and clone formation assays. The serum-free culture system revealed that downregulated CPA4 suppressed the sphere formation capacities of tumour cells. However, upregulated CPA4 increased the proliferation and sphere formation capacity. In addition, the protein expression of CD133, ALDH1 and CD44 also increased in cells with upregulated CPA4. In vivo, the overexpression of CPA4 in tumour cells that were subcutaneously injected into nude mice markedly increased the growth of the tumours. These data suggest that CPA4 expression leads to poor prognoses by regulating tumour proliferation and the expression of stem cell characteristics and may therefore serve as a potential therapeutic target of HCC.

Comparison of Clinical Efficacy and Complications Between Laparoscopic Partial and Open Partial Hepatectomy for Liver Carcinoma: A Meta-Analysis

OBJECTIVE

To contrast the clinical effects and complications for the treatment of liver carcinoma in laparoscopic partial hepatectomy (LPH) and open partial hepatectomy (OPH).

METHODS

The multiple databases were adopted to search relevant studies, and the articles eventually satisfying the inclusion criteria were included. All the meta-analyses were conducted with the Review Manager 5.3, and to estimate the quality of each article risk of bias table was performed.

RESULTS

In the end, 17 studies including 3897 patients were involved, which eventually satisfied the eligibility criteria. The number of samples in LPH group and OPH group were 1723 and 2174, respectively. The results of heterogeneity test suggested that recurrence rate (odds ratio [OR] = -20.11, 95% confidence interval, CI [-35.93 to -4.29], P = .01; P for heterogeneity <.00001, I² = 100%), hospital days (mean difference (MD) = -2.21, 95% CI [-2.53 to -1.88], P < .000001; P for heterogeneity = .41, I² = 58%), and blood loss (MD = -68.09, 95% CI [-85.07 to -51.11], P < .00001; P for heterogeneity = .13, I² = 37%) were significantly different, whereas operating time (MD = 4.00, 95% CI [-17.50 to 25.49], P = .72; P for heterogeneity <.00001, I² = 99%) and complication events (OR = 0.68, 95% CI [0.46 to 1.01], P = .05; P for heterogeneity = .34, I² = 11%) between LPH and OPH were insignificantly different.

CONCLUSION

This study demonstrated that clinical efficacy of OPH was better than that of LPH to some extent, but LPH was a quicker recovery and less harmful therapy.

Na+/H+ exchanger regulatory factor 1 overexpression suppresses the malignant phenotype of MIAPaCa-2 pancreatic adenocarcinoma cells by downregulating Akt phosphorylation

Na⁺/H⁺ exchanger regulatory factor 1 (NHERF1) is reported to be associated with the development of numerous types of tumor; however, its effects on the metastasis of pancreatic adenocarcinoma are not fully understood. In the present study, it was revealed that the expression level of NHERF1 in pancreatic adenocarcinoma is decreased compared with normal pancreatic tissue based on the analysis of a protein expression database. The present study was undertaken in order to investigate the potential effects of NHERF1 overexpression on the malignant phenotype of MIAPaCa-2 pancreatic adenocarcinoma cells. NHERF1 was stably overexpressed in this cell line, and Cell Counting Kit-8, wound healing and Transwell assays were used to detect the proliferative and migratory abilities of the cells. NHERF1 overexpression suppressed proliferation in the MIAPaCa-2 cell line compared with empty vector-transfected (negative control) cells. Additionally, NHERF1 overexpression significantly inhibited the migration of MIAPaCa-2 cells. The results of a western blot analysis identified that NHERF1 overexpression markedly decreased the expression of phosphorylated-protein kinase B (p-Akt), while no significant difference was observed between untransfected and negative control cells. Taken together, these results suggested that NHERF1 may be able to inhibit the proliferation and migration and alter the malignant phenotype of pancreatic adenocarcinoma cells via reduction of p-Akt levels. These findings indicate a potential novel approach to the treatment of pancreatic adenocarcinoma.

Sugiol (127horbar;hydroxyabieta-8,11,13-trien-7-one) targets human pancreatic carcinoma cells (Mia-PaCa2) by inducing apoptosis, G2/M cell cycle arrest, ROS production and inhibition of cancer cell migration

PURPOSE

Plants produce a diversity of molecular scaffolds with tremendous pharmacological potential. In the present study we evaluated the anticancer activity of the plant-derived natural product sugiol. We also evaluated its effects on apoptosis-related key proteins, cell cycle phase distribution, reactive oxygen species (ROS) and mitochondrial membrane potential (MMP).

METHODS

Cell viability was evaluated by MTT assay while clonogenic assay was done to determine the effects of sugiol on the cancer cell colony formation. Flow cytometric measurements were carried out in order to assess the effects of sugiol on cell cycle progression, apoptosis, MMP and ROS generation.

RESULTS

Sugiol reduced the cell viability of Mia-PaCa2 human pancreatic cancer cells in a concentration-dependent manner. The IC50 of sugiol on the cell line was 15 μM. The anticancer activity of sugiol was found to be ROS-mediated alterations in MMP, ultimately favoring apoptosis as determined by the annexin V/propidium iodide (PI). Additionally, sugiol caused cell cycle arrest in G2/M phase of the cell cycle and upregulated the expression of Bax, with concomitant downregulation of Bcl-2 expression in comparison to the untreated cells. It also inhibited the migratory capacity of Mia-PaCa2 cells at the IC50 concentration.

CONCLUSION

In conclusion our results indicate that sugiol is a potent anticancer molecule and may prove essential in pancreatic cancer therapy.

Expression and clinical significance of EGF and TGF-α in chronic pancreatitis and pancreatic cancer

BACKGROUND

The purpose of this project was to investigate the expression and clinical significance of epidermal growth factor (EGF) and the transforming growth factor-α (TGF-α) in the occurrence and development of chronic pancreatitis and pancreatic cancer.

METHODS

We recruited 31 patients with chronic pancreatitis, 42 with pancreatic cancer, and 20 with normal pancreas in our hospital. Chronic pancreatitis, pancreatic cancer, and normal pancreas expressed EGF and TGF-α mRNAs as well as EGF and TGF-α proteins.

RESULTS

Immunofluorescence showed that EGF and TGF-α were expressed in chronic pancreatitis and pancreatic cancer, but the expression levels for both proteins were higher in pancreatic cancer. Variance analysis indicated that the differences in the expression levels of EGF and TGF-α in chronic pancreatitis, pancreatic cancer, and normal pancreas were statistically significant. The abnormally elevated expression of EGF and TGF-α are closely associated with the occurrence and development of chronic pancreatitis and pancreatic cancer.

CONCLUSIONS

EGF and TGF-α have important research value as indicators to assess the progression of these conditions and provide a new basis for the clinical diagnosis.

手术治疗胰腺腺泡细胞癌伴发脂膜炎1例

天津市南开医院肝胆胰外科二收治1例首先表现为双下肢散在结节性脂膜炎, 后经影像学检查后考虑胰腺巨大占位性病变, 并与双下肢脂膜炎密切相关的罕见病例. 手术治疗后, 标本病理提示: 腺泡细胞癌, 患者原发疾病治愈, 双下肢散在脂膜炎好转. 本病实属罕见, 特报道此病例.

Effect of Yinchenhao decoction on expression of IRE1α protein in liver cells of rats with obstructive jaundice

AIM: To investigate the effect of medicated serum of Yinchenhao decoction on inositol-requiring enzyme-1-α (IRE1α) protein expression in hepatocytes of rats with obstructive jaundice.

METHODS: Common bile duct ligation was used to generate an SD rat model of obstructive jaundice. Primary hepatocytes were isolated from the rat models. Gavage administration with Yinchenhao decoction was applied to prepare serum containing the corresponding drug. Yinchenhao decoction serum was added into the medium for primary hepatocyte culture in the administrated group (Group B), while the medium containing no drug was used in the sham group (Group A). The expression of IRE1αprotein in cells as well as alanine transaminase (ALT) and aspartate transaminase (AST) in culture fluid was detected.

RESULTS: The levels of IRE1α expression, AST and ALT in group B were significantly lower than those in group A at all time points (expression of IRE1α: 6 h 1.85 ± 0.04 vs 1.58 ± 0.04, 24 h 1.95 ± 0.02 vs 1.60 ± 0.03, 48 h 2.22 ± 0.13 vs 1.99 ± 0.10, P < 0.05; AST: 6 h 17.23 U/L ± 3.01 U/L vs 13.13 U/L ± 2.41 U/L, 24 h 19.33 U/L ± 3.01 U/L vs 15.67 U/L ± 2.36 U/L, 48 h 24.40 U/L ± 3.93 U/L vs 19.18 U/L ± 1.65 U/L, P < 0.05; ALT: 6 h 17.23 U/L ± 3.01 U/L vs 13.13 U/L ± 2.41 U/L, 24 h 19.33 U/L ± 3.01 U/L vs 15.67 U/L ± 2.36 U/L, 48 h 24.40 U/L ± 3.93 U/L vs 19.18 U/L ± 1.65 U/L, P < 0.05).

CONCLUSION: Serum pharmacology test can be used for pharmacodynamic evaluation of Yinchenhao decoction. The endoplasmic reticulum stress mediated by IRE1α might be an important pathway by which Yinchenhao decoction exerts a protective effect on hepatocytes of rats with obstructive jaundice.

CSN5 silencing reverses sorafenib resistance of human hepatocellular carcinoma HepG2 cells

Hepatocellular carcinoma (HCC) is one of the most common tumor types, and is the third leading cause of cancer mortalities worldwide. A large number of patients with HCC are diagnosed at a late stage when the curative treatment of surgical resection and liver transplantation are no longer applicable. Sorafenib has been proved to improve overall survival in advanced HCC; however, drug resistance is common. The present study reported that the CSN5 is correlated with sorafenib resistance of the HCC cell line HepG2/S. Following silencing of CSN5, resistance to sorafenib was reversed, and multi-drug‑resistance proteins, including as adenosine triphosphate binding cassette (ABC)B1, ABCC2 and ABCG2 as well as CDK6, cyclin D1 and B‑cell lymphoma 2 were downregulated. In addition, it was demonstrated that the integrin beta-1, transforming growth factor‑β1 and nuclear factor‑κB pathways were modified by CSN5.

Differential diagnosis and treatment options for xanthogranulomatous cholecystitis

OBJECTIVE

To describe the differential diagnosis and treatment options for xanthogranulomatous cholecystitis (XGC), the presentations and management of 68 patients were described.

SUBJECTS AND METHODS

Demographical and clinical data from 68 cases of XGC treated between January 2004 and January 2010 were analyzed. Clinical characteristics, radiological and surgical findings, histopathological features and postoperative recoveries were recorded. Clinical features of laparoscopic cholecystectomy versus open surgery and XGC versus gallbladder (GB) cancer were compared.

RESULTS

The CA19-9 levels of XGC and coexisting GB cancer were significantly different (p = 0.0034). In radiological findings, focal thickening of the GB wall was more frequent in coexisting GB cancer, early enhancement of the GB was observed more often in coexisting GB cancer, and lymph node enlargement was seen more often in coexisting GB cancer (p < 0.05). There were also significant differences between laparoscopic and open surgery for CA19-9, intramural hypoattenuated nodule, pericholecystic invasion, lymph node enlargement and maximum thickness, focal thickening, heterogeneous enhancement and early enhancement of the GB wall (p < 0.05). These findings were confirmed by multivariate analysis.

CONCLUSIONS

Ultrasound, computed tomography scan and intraoperative frozen section were the helpful modalities for XGC diagnosis. CA19-9 (>37 kU/l), pericholecystic invasion, lymph node enlargement (>10 mm), and focal thickening and early enhancement of the GB wall were the criteria for open surgery. In some selected cases, laparoscopic cholecystectomy was preferable.

Ursodeoxycholic acid lowers bile lithogenicity by regulating SCP2 expression in rabbit cholesterol gallstone models

Aims: We designed this study to get insight into the disorder of lipid metabolism during cholesterol gallstone formation and evaluate the effect of ursodeoxycholic acid on the improvement of bile lithogenicity and on expression of lipid related genes.

Methods: Rabbit cholesterol gallstone models were induced by high cholesterol diet. Bile, blood and liver tissues were obtained from rabbits after 0, 1, 2, 3, 4 and 5 weeks. Bile and blood lipids were measured enzymatically. 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR), cytochrome P450, family 7, subfamily A, polypeptide 1 (CYP7A1) and sterol carrier protein 2 (SCP2) mRNA expressions were detected by using quantitative real-time RT-PCR. Cholesterol saturation index (CSI) was calculated by using Carey table to represent the bile lithogenicity.

Results: Rates of gallstone formation of the 4 and 5 week treatment groups were 100 %, but that of the ursodeoxycholic acid treatment group was only 33.3 %. Expression of HMGCR and SCP2 mRNA in the 4 week group was upregulated and that of CYP7A1 mRNA decreased as compared with the 0 week group. Ursodeoxycholic acid could significantly extend nucleation time of bile and lower CSI. Ursodeoxycholic acid could reduce the expression of SCP2, but couldn't influence expression of HMGCR and CYP7A1.

Conclusions: Abnormal expression of HMGCR, CYP7A1 and SCP2 might lead to high lithogenicity of bile. Ursodeoxycholic acid could improve bile lipids and lower bile lithogenicity, thereby reducing the incidence of gallstones. So it might be a good preventive drug for cholesterol gallstones.

Appraisal of diagnosis and surgical approach for Mirizzi syndrome

BACKGROUND

Mirizzi syndrome is an important and rare complication of gallstone disease. This study aims to evaluate the treatment approach by analysing the diagnostic method and the outcome of surgical treatment in our hospital.

METHODS

We retrospectively analysed the data of 198 patients with Mirizzi syndrome between January 2004 and January 2010. The records were reviewed for demography, clinical presentation, diagnostic method, operative procedure, postoperative complication and follow-up.

RESULTS

The incidence of Mirizzi syndrome was 0.66% of 29 875 patients who underwent cholecystectomy for cholelithiasis. The incidence of types I, II, III and IV was 59.1%, 24.7%, 13.1% and 3.1%, respectively. In this study, ultrasonography and magnetic resonance cholangiopancreatography (MRCP) could have the suspicion of Mirizzi syndrome in 77.8% and 82.3% of cases. Cholecystectomy also has been shown to be effective for type I Mirizzi syndrome. Our common surgical approach in Mirizzi syndrome types II and III was partial cholecystectomy without removal of the portion of gallbladder around the fistula margin. For some cases, choledochoplasty was needed. For Mirizzi syndrome type IV, we performed hepaticojejunostomy for all patients.

CONCLUSION

Ultrasound, MRCP and endoscopic retrograde cholangiopancreatography in combination with choledochoscope procedure in operation could improve the diagnostic sensitivity of Mirizzi syndrome. Intraoperative choledochoscope is effective to confirm Mirizzi syndrome during operation. Open surgery is the current standard for managing patients with Mirizzi syndrome. Laparoscopic surgery should be confined to Mirizzi syndrome type I and patients should be selected very strictly.

Risk factors in patients with hereditary gallstones in Chinese pedigrees

OBJECTIVE

We aimed to define the risk factors and to evaluate the impact of family background on the prevalence of gallstones in China.

SUBJECTS AND METHODS

Thirty-eight gallstone pedigrees were collected and a case-control study was conducted. This study consisted of 272 first-degree relatives and 201 non-first-degree relatives of index patients. The participants completed a questionnaire and underwent physical and ultrasonographic examinations. The risk factors examined included age, sex, body mass index (BMI), smoking status, alcohol consumption, pregnancy, fat content in dietary meat, history of gastrointestinal surgery, hypertension, hyperlipidemia, fatty liver, coronary heart disease and diabetes.

RESULTS

The prevalence of gallstones in first-degree and non-first-degree relatives of index patients was 38.2 and 10.9%, respectively. Age, pregnancy and BMI significantly differed between cases and controls (p < 0.05). The relative risks were: consumption of meat with a high fat content 1.4 (95% CI 1.1-1.8); hyperlipidemia 2.4 (95% CI 1.3-4.6); diabetes 1.9 (95% CI 1.1-3.2); fatty liver 4.9 (95% CI 1.0-24); coronary heart disease 2.5 (95% CI 1.7-3.9).

CONCLUSION

Data showed that age, overweight, more consumption of high-fat food, high frequency of pregnancy, fatty liver, hyperlipidemia, coronary heart disease and diabetes could increase the risk of gallstones in the first-degree relatives of index patients.

Overexpression of Sterol Carrier Protein 2 in patients with hereditary cholesterol gallstones

BACKGROUND

Lithogenic bile is the major cause of cholesterol gallstone, but its pathogenesis is not well understood. The hypersecretion of biliary cholesterol is believed to be an important cause of lithogenic bile. Sterol Carrier Protein 2 (SCP2) participates in cholesterol trafficking and lipid metabolism in hepatocytes and may play a key role in cholesterol gallstone formation.

METHODS

21 cholesterol gallstone genealogies were studied to investigate the expression of SCP2 gene in liver tissue of hereditary and non-hereditary cholesterol gallstone patients as well as non-gallstone patients. The mRNA expression of liver SCP2 in 28 hereditary patients, 30 non-hereditary cholesterol gallstone patients and 32 non-gallstone patients was measured by Reverse Transcription Polymerase Chain Reaction (RT-PCR). The protein expression of liver SCP2 was also detected in all the patients by Western blotting. At the same time, the bile was also analyzed with biochemical techniques and the Cholesterol Saturation Index (CSI) was calculated.

RESULTS

The mRNA and protein expression of SCP2 was significantly increased in cholesterol gallstone patients compared to those of non-gallstone patients. Moreover, SCP2 was expressed at higher levels in hereditary cholesterol gallstone patients than that of non-hereditary cholesterol gallstone patients. There was significant difference observed in CSI between cholesterol gallstone patients and non-gallstone patients, but not in CSI between hereditary and non-hereditary cholesterol gallstone patients.

CONCLUSIONS

SCP2 was overexpressed in hereditary cholesterol gallstone patients compared to non-hereditary cholesterol gallstone patients. This finding indicated that SCP2 might be one of the genetic factors contributing to cholesterol gallstone formation, which was always accompanied by the increase of bile lithogenicity.

Nosocomial mortality and early prediction of patients with severe acute pancreatitis

BACKGROUND AND AIMS

The aim of this study is to analyze factors (especially serum total cholesterol) that can enable early prediction of in-hospital mortality of patients with severe acute pancreatitis (SAP).

METHODS

Predictive factors (especially serum total cholesterol) for in-hospital mortality were evaluated retrospectively from the clinical data obtained from 338 SAP patients in our hospital from January 1999 to January 2008, who underwent intensive care, blood routine, blood biochemical tests and even computed tomography at the time of admission.

RESULTS

This analysis revealed that within 24 h after admission, serum total cholesterol (TC) was a mortality-reduced factor when it is between 4.37 mmol/L and 5.23 mmol/L (P < 0.05). Evaluated TC was accompanied by decreased C-reactive protein (CRP). CRP > 170 mg/L and albumin (ALB) < 30 g/L increased the fatal outcome (P < 0.05). Low albumin was a stronger predictor than CRP.

CONCLUSIONS

Within 24 h after admission, moderate elevation of TC level seemed to increase the resistance to inflammation and hence improved the survival rate in patients with SAP, and reduced the in-hospital mortality. Inflammatory reaction (with or without infection), hypoalbuminemia and TC were prognostic factors for in-hospital mortality; both high levels of CRP and low ALB levels were associated with in-hospital mortality in patients with SAP.

Microbiological findings in secondary infection of severe acute pancreatitis: a retrospective clinical study

OBJECTIVES

The aim of our study was to evaluate the bacteriologic findings in secondary infection of severe acute pancreatitis (SAP) and the potential correlation with infection.

METHODS

Three hundred thirty-six patients with acute pancreatitis admitted to our department between January 1, 2000, and April 30, 2008, were recruited. All patients were treated with Chinese standard treatment. Of these 336 patients, 65 with infected necrosis were studied according to the clinical data.

RESULTS

Sixty-five (19.35%) of 336 patients had SAP with secondary infection; the time for secondary infection was diagnosed after a mean of 14 to 20 days. One hundred thirty-three strains were found in 65 patients with SAP with infection; culture-revealed organism infection included 85 gram-negative germs, 44 gram-positive germs, and 4 fungi. In the group without infection, 271 patients were managed conservatively, of which 16 patients (5.90%) died; in the other group, 61 (93.85%) of 65 patients were treated by operation and 15 patients (23.08%) died.

CONCLUSIONS

The predominant infections were gram-negative bacterium, gram-positive bacterium, and fungi concomitantly or consecutively. Most of the infected patients had polyinfection. There were many patients with hospital-acquired infection and opportunistic infection. Multiple factors affected the outcome.