Abstract:

Objective:To establish a scoring criteria for assessment of the difficulty levels of laparoscopic cholecystectomy (LC).
Methods:The preoperative and intraopertive clinical data of 845 LC patients treated during a period of five years were analyzed. The data were firstly analyzed with univariate methods to screen out the risk factors causing the operative difficulties, which were further identified by multivariate Logistic regression analysis. Numerical values were assigned to these factors to construct the scoring criteria predicting the difficulty levels of LC.
Results:The risk factors causing operative difficulties or even converting to open cholecystectomy (OC) were identified, which included the thickness of gallbladder wall (≥4 mm),  diameter of the common bile duct (≥8 mm), size of gallbladder (≥103 cm3 and <6.3 cm3),  cholecystic inflammation and  severe adhesions in the Calot′s triangle. The scoring criteria for assessing difficulty levels of LC were obtained based on these factors.
Conclusions:The establishment of scoring criteria is clinically helpful for the selection of LC or OC convertion.

Abstract:

Objective:To establish a scoring criteria for assessment of the difficulty levels of laparoscopic cholecystectomy (LC).
Methods:The preoperative and intraopertive clinical data of 845 LC patients treated during a period of five years were analyzed. The data were firstly analyzed with univariate methods to screen out the risk factors causing the operative difficulties, which were further identified by multivariate Logistic regression analysis. Numerical values were assigned to these factors to construct the scoring criteria predicting the difficulty levels of LC.
Results:The risk factors causing operative difficulties or even converting to open cholecystectomy (OC) were identified, which included the thickness of gallbladder wall (≥4 mm),  diameter of the common bile duct (≥8 mm), size of gallbladder (≥103 cm3 and <6.3 cm3),  cholecystic inflammation and  severe adhesions in the Calot′s triangle. The scoring criteria for assessing difficulty levels of LC were obtained based on these factors.
Conclusions:The establishment of scoring criteria is clinically helpful for the selection of LC or OC convertion.

Abstract:

Objective:To assess the effectiveness of antibiotic prophylaxis in lowrisk elective laparoscopic cholecystectomy (LC) by Metaanalysis.
Methods:Literatures of randomized controlled trials (RCTs) on prophylactic administration of antibiotics in elective LC patients with low risk of infection published from 1933 to October 2010 were retrieved. Eighteen studies were included for the analysis according to predefined inclusion and exclusion criteria, of which any study with a Jadad score below 3 was considered to be of poor quality and was excluded, thus 12 eligible studies were finally selected. The details about the trial design, characters of the subjects and results of the studies were reviewed and extracted by two independent evaluators. Data were analyzed via the Peto odds ratio (OR) method by using Revman 4.2 software.
Results: In elective LC paticnts with low risk of infection, no significant differences were noted between the antibiotic treatment group and nonantibiotic treatment group in respect of overall infection (OR=1.11, 95% CI:0.68~1.82, P=0.98), wound infection (OR=1.07, 95% CI:0.59~1.94, P=0.99), abdominal infection (OR=2.88, 95% CI:0.3~28.09, P=0.98), distant infection (OR=1.0, 95% CI:0.43~2.35, P=0.65) and bacterial culture of bile (OR=0.84, 95% CI:0.55~1.12, P=1.08). However, antibiotic treatment group showed a significantly less hospital stay than that of nonantibiotic treatment group (WMD=-0.16, 95% CI:-0.22~-0.09, P＜0.01).
Conclusions:The regimen of antibiotics for perioperative prophylaxis can not reduce the infection incidence of elective LC in patients with low risk of infection.

Abstract:

Objective:To assess the effectiveness of antibiotic prophylaxis in low-risk elective laparoscopic cholecystectomy (LC) by Meta-analysis.
Methods:Literatures of randomized controlled trials (RCTs) on prophylactic administration of antibiotics in elective LC patients with low risk of infection published from 1933 to October 2010 were retrieved. Eighteen studies were included for the analysis according to predefined inclusion and exclusion criteria, of which any study with a Jadad score below 3 was considered to be of poor quality and was excluded, thus 12 eligible studies were finally selected. The details about the trial design, characters of the subjects and results of the studies were reviewed and extracted by two independent evaluators. Data were analyzed via the Peto odds ratio (OR) method by using Revman 4.2 software.
Results: In elective LC paticnts with low risk of infection, no significant differences were noted between the antibiotic treatment group and non-antibiotic treatment group in respect of overall infection (OR=1.11, 95% CI:0.68~1.82, P=0.98), wound infection (OR=1.07, 95% CI:0.59~1.94, P=0.99), abdominal infection (OR=2.88, 95% CI:0.3~28.09, P=0.98), distant infection (OR=1.0, 95% CI:0.43~2.35, P=0.65) and bacterial culture of bile (OR=0.84, 95% CI:0.55~1.12, P=1.08). However, antibiotic treatment group showed a significantly less hospital stay than that of non-antibiotic treatment group (WMD=-0.16, 95% CI:-0.22~-0.09, P＜0.01).
Conclusions:The regimen of antibiotics for perioperative prophylaxis can not reduce the infection incidence of elective LC in patients with low risk of infection.

Abstract:

Objective:To investigate the diagnosis of suspected choledocholithiasis before elective laparoscopic cholecystectomy (LC), and the value of intraoperative cholangiography and preoperative magnetic resonance cholangiopancreatography (MRCP) for diagnosis of suspected choledocholithiasis.
Methods:The clinical data of 1 758 patients undergoing elective LC from May 2005 to May 2010 were retrospectively analyzed. Of the patiens, 1 519 cases were not suspected of having choledocholithiasis (group A) and the remaining 239 cases were suspected of having choledocholithiasis, and the latter were divided into 4 groups (group B, C, D and E) according to their clinicopathological characteristics.The incidence of postoperative choledocholithiasis was compared among the groups. Meanwhile, the independent risk factors for the development of choledocholithiasis were analyzed. The coincidence rate between intraoperative cholangiography and preoperative MRCP for diagnosis of choledocholithiasis in each group with suspected choledocholithiasis was compared.
Results:The incidence of postoperative choledocholithiasis of all groups with suspected choledocholithiasis was significantly higher than that of group A (all P＜0.01), but no significant difference was noted among the four groups with suspected choledocholithiasis (P＞0.05). Multivariate unconditional Logistic regression analysis revealed that common bile duct greater than or equal to 8 mm in diameter, previous history of biliary pancreatitis and previous history of choledocholithiasis were independent risk factors for choledocholithiasis (P＜0.05). There was no significant difference in the coincidence rate between intraoperative cholangiography and preoperative MRCP for diagnosis of choledocholithiasis in each group with suspected choledocholithiasis (P＞0.05).
Conclusions:The incidence of choledocholithiasis greatly increases under the conditions of common bile duct dilation, abnormal liver function, and past history of biliary pancreatitis or of common bile duct stones detected by B ultrasounic examination. Common bile duct dilation (≥8 mm), past history of biliary pancreatitis and past history of common bile duct stones are independent risk factors for choledocholithiasis. There is no difference between intraoperative cholangiography and preoperative MRCP for diagnosis of choledocholithiasis.

Abstract:

Objective:To investigate the diagnosis of suspected choledocholithiasis before elective laparoscopic cholecystectomy (LC), and the value of intraoperative cholangiography and preoperative magnetic resonance cholangiopancreatography (MRCP) for diagnosis of suspected choledocholithiasis.
Methods:The clinical data of 1 758 patients undergoing elective LC from May 2005 to May 2010 were retrospectively analyzed. Of the patiens, 1 519 cases were not suspected of having choledocholithiasis (group A) and the remaining 239 cases were suspected of having choledocholithiasis, and the latter were divided into 4 groups (group B, C, D and E) according to their clinicopathological characteristics.The incidence of postoperative choledocholithiasis was compared among the groups. Meanwhile, the independent risk factors for the development of choledocholithiasis were analyzed. The coincidence rate between intraoperative cholangiography and preoperative MRCP for diagnosis of choledocholithiasis in each group with suspected choledocholithiasis was compared.
Results:The incidence of postoperative choledocholithiasis of all groups with suspected choledocholithiasis was significantly higher than that of group A (all P＜0.01), but no significant difference was noted among the four groups with suspected choledocholithiasis (P＞0.05). Multivariate unconditional Logistic regression analysis revealed that common bile duct greater than or equal to 8 mm in diameter, previous history of biliary pancreatitis and previous history of choledocholithiasis were independent risk factors for choledocholithiasis (P＜0.05). There was no significant difference in the coincidence rate between intraoperative cholangiography and preoperative MRCP for diagnosis of choledocholithiasis in each group with suspected choledocholithiasis (P＞0.05).
Conclusions:The incidence of choledocholithiasis greatly increases under the conditions of common bile duct dilation, abnormal liver function, and past history of biliary pancreatitis or of common bile duct stones detected by B ultrasounic examination. Common bile duct dilation (≥8 mm), past history of biliary pancreatitis and past history of common bile duct stones are independent risk factors for choledocholithiasis. There is no difference between intraoperative cholangiography and preoperative MRCP for diagnosis of choledocholithiasis.

Abstract:

Objective:To study the clinical effect and value of laparoscopic surgical treatment for acute cholecystitis in aged patients.
Methods:The clinical data of 105 aged patients with acute cholecystitis undergoing cholecystectomy were retrospectively analyzed. The patients were divided into laparoscopic cholecystectomy (LC, 68 cases) and open cholecystectomy (OC, 37 cases) group according to the operative procedure.
Results:LC was better than OC in terms of duration of operation, bowel function recovery time and postoperative hospital stay, which were statistically significant between the two groups (P＜0.01), but the indexes of blood loss,  amount of abdominal drainage and incidence of postoperative complications between the two groups showed no significant difference (P＞0.05).
Conclusions:Laparoscopic surgical treatment is safe and feasible for acute cholecystitis in aged patients.

Abstract:

Objective:To study the clinical effect and value of laparoscopic surgical treatment for acute cholecystitis in aged patients.
Methods:The clinical data of 105 aged patients with acute cholecystitis undergoing cholecystectomy were retrospectively analyzed. The patients were divided into laparoscopic cholecystectomy (LC, 68 cases) and open cholecystectomy (OC, 37 cases) group according to the operative procedure.
Results:LC was better than OC in terms of duration of operation, bowel function recovery time and postoperative hospital stay, which were statistically significant between the two groups (P＜0.01), but the indexes of blood loss,  amount of abdominal drainage and incidence of postoperative complications between the two groups showed no significant difference (P＞0.05).
Conclusions:Laparoscopic surgical treatment is safe and feasible for acute cholecystitis in aged patients.

Abstract:

Objective:To study the effect of sequential treatment by duodenoscopic and laparoscopic operation on aged patients with gallstones and concomitant extrahepatic bile duct stones.
Methods: The clinical data of 123 aged patients, who had gallstones and concomitant extrahepatic bile duct stone treated from August 2006 to August 2008, were retrospectively analyzed. The patients were divided into minimally invasive treatment group (62 cases undergoing ERCP + EST + laparoscopic cholecystectomy) and conventional treatment group (61 cases undergoing open cholecystectomy + open common bile duct stone removal surgery with T-tube drainage). The therapeutic efficacies of the two groups were compared.
Results:The length of postoperative hospital stay, time of gastrointestinal function return and overall incidence of postoperative complications in minimally invasive treatment group were significantly reduced compared with those in conventional treatment group (P＜0.05). The difference of operative time between the two groups did not reach statistical significance (P＞0.05).
Conclusions:Sequential treatment by duodenoscopic and laparoscopic operation has the advantages of safety, minimal invasiveness and effectiveness for aged patients with gallstones and concomitant extrahepatic bile duct stones.

Abstract:

Objective:To study the effect of sequential treatment by duodenoscopic and laparoscopic operation on aged patients with gallstones and concomitant extrahepatic bile duct stones.
Methods: The clinical data of 123 aged patients, who had gallstones and concomitant extrahepatic bile duct stone treated from August 2006 to August 2008, were retrospectively analyzed. The patients were divided into minimally invasive treatment group (62 cases undergoing ERCP + EST + laparoscopic cholecystectomy) and conventional treatment group (61 cases undergoing open cholecystectomy + open common bile duct stone removal surgery with T-tube drainage). The therapeutic efficacies of the two groups were compared.
Results:The length of postoperative hospital stay, time of gastrointestinal function return and overall incidence of postoperative complications in minimally invasive treatment group were significantly reduced compared with those in conventional treatment group (P＜0.05). The difference of operative time between the two groups did not reach statistical significance (P＞0.05).
Conclusions:Sequential treatment by duodenoscopic and laparoscopic operation has the advantages of safety, minimal invasiveness and effectiveness for aged patients with gallstones and concomitant extrahepatic bile duct stones.

Abstract:

Objective:To investigate the efficacy of minimally invasive endoscopic cholecystolithotomy with gallbladder preservation and cholecystectomy for gallstons, and analyze the incidences of postoperative complications and adverse reactions.
Methods:Patients with cholelithiasis undergoing gallbladder-preserving surgery or cholecystectomy in 11 hospitals from October 2009 to June 2010 were followed up. The incidences of all postoperative complications and adverse reactions were investigated.
Results:Actually, 10 449 patients were involved in this follow-up investigation, of which 3699 cases underwent gallbladder-preserving surgery and 6750 cases underwent cholecystectomy. Except for a 9.76% recurrence rate of gallstone, the incidences of the remaining complications and adverse reactions (biliary tract disorder, extrahepatic bile duct injury, bile leakage, postoperative intestinal obstruction, extrahepatic bile duct stone, colon cancer, postoperative diarrhea, reflux gastritis and reflux esophagitis) in the gallbladder-preserving surgery group were all significantly lower than those in the cholecystectomy group (0.84% vs. 11.5%, 0 vs. 0.61%, 0.03% vs. 1.90%, 0.27% vs. 2.01%, 1.65% vs. 5.67%, 0.16% vs. 0.84%, 1.95% vs. 12.19%, 2.14% vs. 5.72%, 1.03% vs.3.84%, respectively) (all P＜0.01).
Conclusions:Minimally invasive endoscopic cholecystolithotomy with gallbladder preservation is a safe and effective procedure due to its fewer postoperative complications and low recurrence rate. Postoperative diarrhea is the major adverse reaction after cholecystectomy that may, however, provide insights into treatment strategies for those with functional constipation.   

Abstract:

Objective:To investigate the efficacy of minimally invasive endoscopic cholecystolithotomy with gallbladder preservation and cholecystectomy for gallstons, and analyze the incidences of postoperative complications and adverse reactions.
Methods:Patients with cholelithiasis undergoing gallbladder-preserving surgery or cholecystectomy in 11 hospitals from October 2009 to June 2010 were followed up. The incidences of all postoperative complications and adverse reactions were investigated.
Results:Actually, 10 449 patients were involved in this follow-up investigation, of which 3699 cases underwent gallbladder-preserving surgery and 6750 cases underwent cholecystectomy. Except for a 9.76% recurrence rate of gallstone, the incidences of the remaining complications and adverse reactions (biliary tract disorder, extrahepatic bile duct injury, bile leakage, postoperative intestinal obstruction, extrahepatic bile duct stone, colon cancer, postoperative diarrhea, reflux gastritis and reflux esophagitis) in the gallbladder-preserving surgery group were all significantly lower than those in the cholecystectomy group (0.84% vs. 11.5%, 0 vs. 0.61%, 0.03% vs. 1.90%, 0.27% vs. 2.01%, 1.65% vs. 5.67%, 0.16% vs. 0.84%, 1.95% vs. 12.19%, 2.14% vs. 5.72%, 1.03% vs.3.84%, respectively) (all P＜0.01).
Conclusions:Minimally invasive endoscopic cholecystolithotomy with gallbladder preservation is a safe and effective procedure due to its fewer postoperative complications and low recurrence rate. Postoperative diarrhea is the major adverse reaction after cholecystectomy that may, however, provide insights into treatment strategies for those with functional constipation.   

Abstract:

Objective:To investigate the expression of PUMA (p53 up-regulated modulator of apoptosis) and ABCG2 (ATP-binding cassette subfamily G member 2) in adenocarcinoma of common bile duct (CBD) and adjacent non-cancerous tissue  and their clinicopathological correlations.
Methods:The surgical specimens of 40 cases of CBD adenocarcinoma and paired adjacent CBD tissue in 15 of these  cases were paraffin embedded and sectioned using conventional method. The expression level of PUMA and ABCG2 was detected with immunohistochemical staining.
Results:The positive expression rate and scores of PUMA and ABCG2 in adenocarcinoma were significantly higher than those in adjacent tissues (PUMA: 67.5% vs.13.3%, P=0.001， 2.58±1.84  vs. 0.53±1.13, P=0.000; ABCG2: 60.0%  vs. 13.3%, P=0.002，2.28±1.88  vs. 0.53±1.13, P=0.001). The adjacent CBD tissues that showed positive expression of PUMA and ABCG2 totally presented with atypical hyperplasia of slight to moderate degree. The positive expression rates of PUMA and ABCG2 in the cases of histologic grade I and lymph node without metastasis were significantly lower than those of histologic grade II or III with involved lymph node (P＜0.05 or P＜0.01). There was a closely positive correlation between the expression scores of PUMA and ABCG2 in CBD adenocarcinoma (r=0.65, P=0.000).
Conclusions:The expression of PUMA and ABCG2 is closely correlated with the carcinogenesis and clinical biological behaviors of CBD adenocarcinoma, and the high-level expression of both proteins predicts a poor prognosis.

Abstract:

Objective:To investigate the expression of PUMA (p53 up-regulated modulator of apoptosis) and ABCG2 (ATP-binding cassette subfamily G member 2) in adenocarcinoma of common bile duct (CBD) and adjacent non-cancerous tissue  and their clinicopathological correlations.
Methods:The surgical specimens of 40 cases of CBD adenocarcinoma and paired adjacent CBD tissue in 15 of these  cases were paraffin embedded and sectioned using conventional method. The expression level of PUMA and ABCG2 was detected with immunohistochemical staining.
Results:The positive expression rate and scores of PUMA and ABCG2 in adenocarcinoma were significantly higher than those in adjacent tissues (PUMA: 67.5% vs.13.3%, P=0.001， 2.58±1.84  vs. 0.53±1.13, P=0.000; ABCG2: 60.0%  vs. 13.3%, P=0.002，2.28±1.88  vs. 0.53±1.13, P=0.001). The adjacent CBD tissues that showed positive expression of PUMA and ABCG2 totally presented with atypical hyperplasia of slight to moderate degree. The positive expression rates of PUMA and ABCG2 in the cases of histologic grade I and lymph node without metastasis were significantly lower than those of histologic grade II or III with involved lymph node (P＜0.05 or P＜0.01). There was a closely positive correlation between the expression scores of PUMA and ABCG2 in CBD adenocarcinoma (r=0.65, P=0.000).
Conclusions:The expression of PUMA and ABCG2 is closely correlated with the carcinogenesis and clinical biological behaviors of CBD adenocarcinoma, and the high-level expression of both proteins predicts a poor prognosis.

Abstract:

Objective:To investigate the effect of local injection with mesenchymal stem cells (MSCs) on ischemic biliary stricture in rats and its mechanisms.
Methods:MSCs were obtained from the bone marrow of 2 to 4 week-old rats and cultured by plastic adhesion method. The extrahepatic biliary ischemia model was induced in adult rats, and then the rat models were randomly divided into transplantation group and control group. Rats in transplantation group underwent transplantation of MSCs (1×106 cells/point, a total of 8 points) by local injection around the biliary ischemic lesion and rats of control group were substituted by phosphate buffered solution (PBS) injection. Blood samples were collected from the inferior vena cava of the rats of both groups to determine the serum bilirubin 21 days after transplantation. Meanwhile, the biliary duct tissues were harvested to detect the mRNA expression of survivin and Bcl-2 by RT-PCR, and the apoptosis with TUNEL staining.
Results:The OD ratio of survivin cDNA/β-actin cDNA and Bcl-2 cDNA/β-actin cDNA of transplantation group was significantly higher than that of control group (P＜0.05), while the apoptotic index of transplatation group was significant lower than that of control group (P＜0.05). The levels of serum total and direct bilirubin of transplantation group ［(69.5±35.4) μmol/L, (52.9±32.2) μmol/L］ were significantly lower than that of control group ［(102.8±63.7) μmol/L, (82.6±55.1) μmol/L］, respectively (all P＜0.05).
Conclusions:Local injection with MSCs can upregulate the expression of survivin and Bcl-2, prevent the apoptosis of ischemic biliary epithelial cells, and thereby reduce the severity of biliary stricture after ischemia.

Abstract:

Objective:To investigate the effect of local injection with mesenchymal stem cells (MSCs) on ischemic biliary stricture in rats and its mechanisms.
Methods:MSCs were obtained from the bone marrow of 2 to 4 week-old rats and cultured by plastic adhesion method. The extrahepatic biliary ischemia model was induced in adult rats, and then the rat models were randomly divided into transplantation group and control group. Rats in transplantation group underwent transplantation of MSCs (1×106 cells/point, a total of 8 points) by local injection around the biliary ischemic lesion and rats of control group were substituted by phosphate buffered solution (PBS) injection. Blood samples were collected from the inferior vena cava of the rats of both groups to determine the serum bilirubin 21 days after transplantation. Meanwhile, the biliary duct tissues were harvested to detect the mRNA expression of survivin and Bcl-2 by RT-PCR, and the apoptosis with TUNEL staining.
Results:The OD ratio of survivin cDNA/β-actin cDNA and Bcl-2 cDNA/β-actin cDNA of transplantation group was significantly higher than that of control group (P＜0.05), while the apoptotic index of transplatation group was significant lower than that of control group (P＜0.05). The levels of serum total and direct bilirubin of transplantation group ［(69.5±35.4) μmol/L, (52.9±32.2) μmol/L］ were significantly lower than that of control group ［(102.8±63.7) μmol/L, (82.6±55.1) μmol/L］, respectively (all P＜0.05).
Conclusions:Local injection with MSCs can upregulate the expression of survivin and Bcl-2, prevent the apoptosis of ischemic biliary epithelial cells, and thereby reduce the severity of biliary stricture after ischemia.

Abstract:

Objective:To investigate the protective effect of taurine on small intestinal injury induced by liver ischemia/reperfusion in rats.
Methods:Rats were randomly assigned into sham operation control group, hepatic I/R group and taurine pretreatment plus hepatic I/R group. Hepatic I/R model was produced by occlusion of both hepatic artery and portal vein for 30 min and then followed by reperfusion. The blood samples were collected at 3, 6 and 24 h after reperfusion in each group, and the serum levels of diamine oxidase (DAO) were determined to evaluate the function of small bowels. Meawhile, the rats′small bowels were excised to measure the contents of SOD and MDA in intestinal tissues, for evaluating the degree of free radical injury. Tissues of small bowels were sectioned and the histopathological changes were observed with HE staining, TUNEL method was used to examine the apoptosis, and caspase-3 expression was detected by immunohistochemistry. 
Results:Compared with control group, the serum level of SOD in hepatic I/R group was significantly decreased (P＜0.05), while the serum level of MDA and DAO significantly increased (P＜0.05). The small bowel of hepatic I/R group showed severe injury, and its apoptotic index as well as the caspase-3 expression were significantly increased compared with control group (both P＜0.05). All indices examined at each predefined time point of the taurine pretreated group were significantly improved compared with those of the hepatic I/R group (all P＜0.05).
Conclusions:Taurine has protective effects on small intestinal injury induced by hepatic ischemia/reperfusion.

Abstract:

Objective:To investigate the protective effect of taurine on small intestinal injury induced by liver ischemia/reperfusion in rats.
Methods:Rats were randomly assigned into sham operation control group, hepatic I/R group and taurine pretreatment plus hepatic I/R group. Hepatic I/R model was produced by occlusion of both hepatic artery and portal vein for 30 min and then followed by reperfusion. The blood samples were collected at 3, 6 and 24 h after reperfusion in each group, and the serum levels of diamine oxidase (DAO) were determined to evaluate the function of small bowels. Meawhile, the rats′small bowels were excised to measure the contents of SOD and MDA in intestinal tissues, for evaluating the degree of free radical injury. Tissues of small bowels were sectioned and the histopathological changes were observed with HE staining, TUNEL method was used to examine the apoptosis, and caspase-3 expression was detected by immunohistochemistry. 
Results:Compared with control group, the serum level of SOD in hepatic I/R group was significantly decreased (P＜0.05), while the serum level of MDA and DAO significantly increased (P＜0.05). The small bowel of hepatic I/R group showed severe injury, and its apoptotic index as well as the caspase-3 expression were significantly increased compared with control group (both P＜0.05). All indices examined at each predefined time point of the taurine pretreated group were significantly improved compared with those of the hepatic I/R group (all P＜0.05).
Conclusions:Taurine has protective effects on small intestinal injury induced by hepatic ischemia/reperfusion.

Abstract:

Objective:To investigate the effects of vasonatrin peptide (VNP), a synthetic novel natriuretic peptide, on liver fibrosis.
Methods:Male Balb/c mice  were randomized into corn oil control group (control group for short, protocol: corn oil 1 mL/kg ip. twice a week for 12 weeks), liver fibrosis group (model group for short, protocol: CCl4 1 mL/kg ip. twice a week for 12 weeks, and saline 1 mL/kg iv. once daily for the last 6 weeks) and hepatic fibrosis+VNP treatment group (VNP treatment group for short, protocol: CCl4 1 mL/kg twice a week for 12 weeks, and VNP 50 μg/kg iv. once daily for the last 6 weeks). The liver samples were harvested from mice on the 3rd day of the last injection to evaluate the histopathological change and fibrotic level of the liver. The mouse hepatic stellate cell line (HSC-T6) was cultured in vitro and was exposed to VNP of different concentrations, and then the DNA and collagen synthesis of the cells were determined by ［3H］-thymidine and ［3H］-proline incorporation assay, respectively.
Results:The livers of the model group presented significant impairment and collagen accumulation compared with that of the control group. However, the hepatic impairment and collagen accumulation induced by CCl4 was effectively alleviated by treatment with VNP. Liver collagen concentration of control group, model group and VNP treatment group was (43.6±6.3) μg/mg, (93.5±7.2) μg/mg and (62.2±5.1) μg/mg, respectively, and the differences were statistically significant (P＜0.05). The ［3H］-thymidine and ［3H］-proline incorporation rate of HSC-T6 after exposure to VNP (10-7 mol/L) was decreased by 48.5% and 43.7%, respectively (both P＜0.05).
Conclusions:VNP has inhibitory effect on CCl4-induced liver fibrosis, which may probably be associated with its effect of inhibiting the proliferation and collagen production of hepatic stellate cells.

Abstract:

Objective:To investigate the effects of vasonatrin peptide (VNP), a synthetic novel natriuretic peptide, on liver fibrosis.
Methods:Male Balb/c mice  were randomized into corn oil control group (control group for short, protocol: corn oil 1 mL/kg ip. twice a week for 12 weeks), liver fibrosis group (model group for short, protocol: CCl4 1 mL/kg ip. twice a week for 12 weeks, and saline 1 mL/kg iv. once daily for the last 6 weeks) and hepatic fibrosis+VNP treatment group (VNP treatment group for short, protocol: CCl4 1 mL/kg twice a week for 12 weeks, and VNP 50 μg/kg iv. once daily for the last 6 weeks). The liver samples were harvested from mice on the 3rd day of the last injection to evaluate the histopathological change and fibrotic level of the liver. The mouse hepatic stellate cell line (HSC-T6) was cultured in vitro and was exposed to VNP of different concentrations, and then the DNA and collagen synthesis of the cells were determined by ［3H］-thymidine and ［3H］-proline incorporation assay, respectively.
Results:The livers of the model group presented significant impairment and collagen accumulation compared with that of the control group. However, the hepatic impairment and collagen accumulation induced by CCl4 was effectively alleviated by treatment with VNP. Liver collagen concentration of control group, model group and VNP treatment group was (43.6±6.3) μg/mg, (93.5±7.2) μg/mg and (62.2±5.1) μg/mg, respectively, and the differences were statistically significant (P＜0.05). The ［3H］-thymidine and ［3H］-proline incorporation rate of HSC-T6 after exposure to VNP (10-7 mol/L) was decreased by 48.5% and 43.7%, respectively (both P＜0.05).
Conclusions:VNP has inhibitory effect on CCl4-induced liver fibrosis, which may probably be associated with its effect of inhibiting the proliferation and collagen production of hepatic stellate cells.

Abstract:

Objective:To investigate the impact of IFN-γ on cardiac transplant tolerance induced by blockade of CD40-CD40 ligand costimulation pathway in mice.
Methods:IFN-γ expression in cardiac grafts and spleens from syngeneic and allogeneic recipients with or without treatment of anti-CD40 ligand monoclonal antibody (MR-1) was examined by realtime RT-PCR. The survival time of cardiac grafts in Wild type and IFN-γ-deficient recipients was investigated. Mixed lymphocyte reaction (MLR) of CD4+T cells and cytotoxic T lymphocyte assay of CD8+T cells from Wild type recipients and IFN-γ-deficient recipients administrated with MR-1 were also studied.
Results:Rejected cardiac allogafts showed significantly higher expression of IFN-γ than tolerant allogafts. Cardiac allograft survival was not prolonged in nonimmunosuppressed IFN-γ-deficient mice. In fact, graft survival time in IFN-γ-deficient mice was somewhat shorter than that observed in Wild type recipients. Administration of MR-1 induced long-term cardiac allograft survival in Wild type recipients, but failed to do so in the IFN-γ-deficient group. Our results also provided evidence that in vivo absence of IFN-γ in recipients facilitated the proliferation and CTL generation of T cells.
Conclusions:IFN-γ faciliates the formation of transplant tolerance induced by blockade of CD40-CD40 ligand costimulation pathway.

Abstract:

Objective:To investigate the impact of IFN-γ on cardiac transplant tolerance induced by blockade of CD40-CD40 ligand costimulation pathway in mice.
Methods:IFN-γ expression in cardiac grafts and spleens from syngeneic and allogeneic recipients with or without treatment of anti-CD40 ligand monoclonal antibody (MR-1) was examined by realtime RT-PCR. The survival time of cardiac grafts in Wild type and IFN-γ-deficient recipients was investigated. Mixed lymphocyte reaction (MLR) of CD4+T cells and cytotoxic T lymphocyte assay of CD8+T cells from Wild type recipients and IFN-γ-deficient recipients administrated with MR-1 were also studied.
Results:Rejected cardiac allogafts showed significantly higher expression of IFN-γ than tolerant allogafts. Cardiac allograft survival was not prolonged in nonimmunosuppressed IFN-γ-deficient mice. In fact, graft survival time in IFN-γ-deficient mice was somewhat shorter than that observed in Wild type recipients. Administration of MR-1 induced long-term cardiac allograft survival in Wild type recipients, but failed to do so in the IFN-γ-deficient group. Our results also provided evidence that in vivo absence of IFN-γ in recipients facilitated the proliferation and CTL generation of T cells.
Conclusions:IFN-γ faciliates the formation of transplant tolerance induced by blockade of CD40-CD40 ligand costimulation pathway.

Abstract:

Objective:To investigate the effect of absorbable hemostatic polysaccharide sponge on wound healing.
Methods:The open-wound animal models were established in Guangxi Bama minipigs. The porcine models were then randomized into group A (absorbable hemostatic polysaccharide sponge treatment group), group B (absorbable gelatin sponge treatment group) and group C (no treatment group). Wound healing responses were monitored at 1, 3, 5, 7, 14, 21 and 28 d after injury. The histopathological features and transforming growth factor-β 1 (TGF-β1) expression of the tissue from wound edge at each time point of each group were examined using HE and immunohistochemical staining and compared, respectively. Furthermore, the ultrastructure of the wound tissues at 7 d after injury was observed by transmission electron microscapy (TEM).
Results:The wound healing rate of group A was significantly higher than that of group B and C at the time points from 5 to 28 d after injury (P＜0.05). The positive expression rate of TGF-β1 in the specimens of group A was significantly higher than that of group B and C, especially at 7 d after injury (P＜0.05). The results of TEM demonstrated that the fibroblasts in wound tissues of group A were mainly synthetic and secretory type, while they were mainly proliferative type in wound tissues of group B and C.
Conclusions:Absorbable hemostatic polysaccharide sponge has accelerating effect on wound repair.

Abstract:

Objective:To investigate the effect of absorbable hemostatic polysaccharide sponge on wound healing.
Methods:The open-wound animal models were established in Guangxi Bama minipigs. The porcine models were then randomized into group A (absorbable hemostatic polysaccharide sponge treatment group), group B (absorbable gelatin sponge treatment group) and group C (no treatment group). Wound healing responses were monitored at 1, 3, 5, 7, 14, 21 and 28 d after injury. The histopathological features and transforming growth factor-β 1 (TGF-β1) expression of the tissue from wound edge at each time point of each group were examined using HE and immunohistochemical staining and compared, respectively. Furthermore, the ultrastructure of the wound tissues at 7 d after injury was observed by transmission electron microscapy (TEM).
Results:The wound healing rate of group A was significantly higher than that of group B and C at the time points from 5 to 28 d after injury (P＜0.05). The positive expression rate of TGF-β1 in the specimens of group A was significantly higher than that of group B and C, especially at 7 d after injury (P＜0.05). The results of TEM demonstrated that the fibroblasts in wound tissues of group A were mainly synthetic and secretory type, while they were mainly proliferative type in wound tissues of group B and C.
Conclusions:Absorbable hemostatic polysaccharide sponge has accelerating effect on wound repair.

Abstract:

Objective:To compare the efficacy of two types of preoperative biliary drainage procedure ［percutaneous transhepatic biliary drainage (PTBD) vs. stent drainage through endoscopic retrograde cholangiopancreatography (ERCP)］ for recectable hilar cholangiocarcinoma.
Methods:The clinical data of 58 patients with resectable hilar cholangiocarcinoma undergoing preoperative biliary drainage with PTBD (35 cases) or ERCP (23 cases) from January 2004 to January 2011 were analyzed. The success rate of operation, incidence of complications and biliary tract infection as well as the drainage effects between the two groups were compared.
Results:The preoperative medical data of the patients between the two groups had no statistical differences. The success rate of initial drainage was 100% in the PTBD and 87% in the ERCP group (P=0.057). Two cases of biliary tract bleeding occurred in PTBD group; while one case of duodenal perforation, 2 cases of papilla bleeding and 4 cases of acute pancreatitis occurred in ERCP group. The incidence of biliary tract infection of ERCP group was significantly higher than that of PTBD group (43% vs. 17%, P=0.028). The jaundice was reduced to a satisfactory level before surgery in both groups. However, longer drainage period and more drain
replacements were required in ERCP group than those in PTBD group (7 weeks vs. 4.5 weeks, P=0.035; 2.5 times vs. 1.2 times, P=0.029). Eight cases (34.8%) in ERCP group were converted to PTBD procdure, of which the biliary tract infection rate was 75.0%, mean drain replacement was 4 times and mean drainage period was 8 weeks before surgery, respectively. Two cases (5.7%) of PTBD group were converted to ERCP internal drainage due to large volume of bile outflow (more than 2 000 mL/d).
Conclusions:For resectalbe hilar cholangiocarcinona patients preoperaive PTBD has more advantages than ERCP stent placement, showing fewer procedure-related complications and biliary infections and requiring less drain replacements, but the selection of which procedure to perform in clinical practice should be based on the particular conditions of the patients.

Abstract:

Objective:To compare the efficacy of two types of preoperative biliary drainage procedure ［percutaneous transhepatic biliary drainage (PTBD) vs. stent drainage through endoscopic retrograde cholangiopancreatography (ERCP)］ for recectable hilar cholangiocarcinoma.
Methods:The clinical data of 58 patients with resectable hilar cholangiocarcinoma undergoing preoperative biliary drainage with PTBD (35 cases) or ERCP (23 cases) from January 2004 to January 2011 were analyzed. The success rate of operation, incidence of complications and biliary tract infection as well as the drainage effects between the two groups were compared.
Results:The preoperative medical data of the patients between the two groups had no statistical differences. The success rate of initial drainage was 100% in the PTBD and 87% in the ERCP group (P=0.057). Two cases of biliary tract bleeding occurred in PTBD group; while one case of duodenal perforation, 2 cases of papilla bleeding and 4 cases of acute pancreatitis occurred in ERCP group. The incidence of biliary tract infection of ERCP group was significantly higher than that of PTBD group (43% vs. 17%, P=0.028). The jaundice was reduced to a satisfactory level before surgery in both groups. However, longer drainage period and more drain
replacements were required in ERCP group than those in PTBD group (7 weeks vs. 4.5 weeks, P=0.035; 2.5 times vs. 1.2 times, P=0.029). Eight cases (34.8%) in ERCP group were converted to PTBD procdure, of which the biliary tract infection rate was 75.0%, mean drain replacement was 4 times and mean drainage period was 8 weeks before surgery, respectively. Two cases (5.7%) of PTBD group were converted to ERCP internal drainage due to large volume of bile outflow (more than 2 000 mL/d).
Conclusions:For resectalbe hilar cholangiocarcinona patients preoperaive PTBD has more advantages than ERCP stent placement, showing fewer procedure-related complications and biliary infections and requiring less drain replacements, but the selection of which procedure to perform in clinical practice should be based on the particular conditions of the patients.

Abstract:

Objective:To evaluate the efficacy of endoscopic retrograde biliary drainage (ERBD) in management of malignant obstructive jaundice.
Methods: The outcomes of 76 patients with malignant obstructive jaundice undergoing ERBD (n=46) or percutaneous transhepatic cholangial drainage (PTCD, n=30) were compared and analyzed.
Results:No differences were noted between the two procedures in the operation success rate and degree of postoperative jaundice decline (P＞0.05). However, the incidence of complications and length of hospital stay of ERBD group were significantly lower than those of PTCD group (both P＜0.05).
Conclusions:Either ERBD or PTCD is an effective approach to treat malignant obstructive jaundice. However, ERBD has the advantages of relatively lower complication rate and shorter hospital stay.

Abstract:

Objective:To evaluate the efficacy of endoscopic retrograde biliary drainage (ERBD) in management of malignant obstructive jaundice.
Methods: The outcomes of 76 patients with malignant obstructive jaundice undergoing ERBD (n=46) or percutaneous transhepatic cholangial drainage (PTCD, n=30) were compared and analyzed.
Results:No differences were noted between the two procedures in the operation success rate and degree of postoperative jaundice decline (P＞0.05). However, the incidence of complications and length of hospital stay of ERBD group were significantly lower than those of PTCD group (both P＜0.05).
Conclusions:Either ERBD or PTCD is an effective approach to treat malignant obstructive jaundice. However, ERBD has the advantages of relatively lower complication rate and shorter hospital stay.

Abstract:

Objective:To study the efficacy and outcome of primary suture and biliary stent insertion after choledochotomy. 
Methods:The records of 61 cases of primary suture and biliary stent insertion after choledochotomy (Group A) were reviewed retrospectively, and compared with those undergoing T-tube drainage  after choledochotomy  (Group B). The postoperative hospital stay time and the time of tube extraction were analyzed. 
Results:All the operations were successful. In group A, stent removal was 7 days and hospital stay 9-12 days (average 10 days) postoperatively; in group B (n=59), time to removal of tube was 17 days and hospital stay was 20-23 days (average 22 days) postoperatively. No severe complications occurred in either group. 
Conclusions:Primary suture and biliary stent insertion after choledochotomy is safe and reliable.

Abstract:

Objective:To study the efficacy and outcome of primary suture and biliary stent insertion after choledochotomy. 
Methods:The records of 61 cases of primary suture and biliary stent insertion after choledochotomy (Group A) were reviewed retrospectively, and compared with those undergoing T-tube drainage  after choledochotomy  (Group B). The postoperative hospital stay time and the time of tube extraction were analyzed. 
Results:All the operations were successful. In group A, stent removal was 7 days and hospital stay 9-12 days (average 10 days) postoperatively; in group B (n=59), time to removal of tube was 17 days and hospital stay was 20-23 days (average 22 days) postoperatively. No severe complications occurred in either group. 
Conclusions:Primary suture and biliary stent insertion after choledochotomy is safe and reliable.

Abstract:

Objective: To investigate the clinical characteristics, diagnosis and treatment of the primary cholesterol hepatolithiasis.
Methods:The clinical data of 38 patients with cholesterol hepatolithiasis, who were admitted and underwent surgical treatment from 2007 to 2009, were retropectively analyzed.
Results:The data included 18 male and 20 female patients. The main clinical signs of the patients were abdominal pain, fever and jaundice. Fourteen patients presented with abdominal pain and jaundice (36.8%), 12 patients had abdominal pain with fever (31.5%) and 9 patients presented with Charcot Triad (23.7%). The detection rate of hepatolithiasis before operation by B ultrasonic and CT scan was 100% (38/38) and 77.4% (24/31), respectively. All of the 38 cases underwent surgical treatment that comprised 25 cases of cholecystectomy and bile duct exploration (including re-exploration) with T-tube drainage, 5 cases of internal drainage by Roux-en-Y choledochojejunostomy (with 1 case of reconstruction) and 24 cases of hepatic lobectomy. One case developed postoperative bile leakage and 4 cases developed thoracic complications, such as reactive pleural effusion. Residual stones were found in 3 cases during the period of 6-month follow-up, two of whom had no symptoms and were followed-up by observation, and one complicated by cholangeitis was treated with antibiotics and improved.
Conclusions:Preoperative examination combined with B ultrasonic and CT scan can ascertain the locations of the intrahepatic cholesterol stones and also help in the diagnosis of concomitant diseases. Surgical treatment is the main method to manage cholesterol hepatolithiasis, and the proper employment of hepatic lobectomy and use of cholangioscope results in a low incidence of residual stone.

Abstract:

Objective: To investigate the clinical characteristics, diagnosis and treatment of the primary cholesterol hepatolithiasis.
Methods:The clinical data of 38 patients with cholesterol hepatolithiasis, who were admitted and underwent surgical treatment from 2007 to 2009, were retropectively analyzed.
Results:The data included 18 male and 20 female patients. The main clinical signs of the patients were abdominal pain, fever and jaundice. Fourteen patients presented with abdominal pain and jaundice (36.8%), 12 patients had abdominal pain with fever (31.5%) and 9 patients presented with Charcot Triad (23.7%). The detection rate of hepatolithiasis before operation by B ultrasonic and CT scan was 100% (38/38) and 77.4% (24/31), respectively. All of the 38 cases underwent surgical treatment that comprised 25 cases of cholecystectomy and bile duct exploration (including re-exploration) with T-tube drainage, 5 cases of internal drainage by Roux-en-Y choledochojejunostomy (with 1 case of reconstruction) and 24 cases of hepatic lobectomy. One case developed postoperative bile leakage and 4 cases developed thoracic complications, such as reactive pleural effusion. Residual stones were found in 3 cases during the period of 6-month follow-up, two of whom had no symptoms and were followed-up by observation, and one complicated by cholangeitis was treated with antibiotics and improved.
Conclusions:Preoperative examination combined with B ultrasonic and CT scan can ascertain the locations of the intrahepatic cholesterol stones and also help in the diagnosis of concomitant diseases. Surgical treatment is the main method to manage cholesterol hepatolithiasis, and the proper employment of hepatic lobectomy and use of cholangioscope results in a low incidence of residual stone.

Abstract:

Objective:To explore the clinical efficacy of cholecystectomy plus Roux-en-Y gastric bypass operation on cholecystolithiasis patients with concomitant type 2 diabetes mellitus (T2DM).
Methods: Fifty-five cholecystolithiasis patients with concomitant T2DM, who were hospitalized from May 2008 to June 2010, underwent open or laparoscopic cholecystectomy combined with Roux-en-Y gastrojejunal bypass operation. All patients were followed up for one year period and their clinical data that included body mass index (BMI), fasting blood glucose (FBG), fasting serum insulin (FINS), homeostasis model assessment of insulin resistance (HOMA-IR) and glycosylated hemoglobin (HbA1c) before and after surgery as well as outcomes of the diabetes were analyzed.
Results:All 55 patients were cured of cholecystolithiasis. Of the patients, no significant changes were noted between the BMI values before and after operation (P＞0.05); at the first month after surgery, the FBG level showed a sustained and steadiely descending trend (P＜0.05); meanwhile, HbA1c level also decreased significantly (P＜0.05) with the postoperative glucose level and HOMA-IR was remarkably improved.
Conclusions:The combined procedures of cholecystectomy and Roux-en-Y gastrojejunal bypass operation not only cures cholecystolithiasis, but also has beneficial effects on T2DM. 

Abstract:

Objective:To explore the clinical efficacy of cholecystectomy plus Roux-en-Y gastric bypass operation on cholecystolithiasis patients with concomitant type 2 diabetes mellitus (T2DM).
Methods: Fifty-five cholecystolithiasis patients with concomitant T2DM, who were hospitalized from May 2008 to June 2010, underwent open or laparoscopic cholecystectomy combined with Roux-en-Y gastrojejunal bypass operation. All patients were followed up for one year period and their clinical data that included body mass index (BMI), fasting blood glucose (FBG), fasting serum insulin (FINS), homeostasis model assessment of insulin resistance (HOMA-IR) and glycosylated hemoglobin (HbA1c) before and after surgery as well as outcomes of the diabetes were analyzed.
Results:All 55 patients were cured of cholecystolithiasis. Of the patients, no significant changes were noted between the BMI values before and after operation (P＞0.05); at the first month after surgery, the FBG level showed a sustained and steadiely descending trend (P＜0.05); meanwhile, HbA1c level also decreased significantly (P＜0.05) with the postoperative glucose level and HOMA-IR was remarkably improved.
Conclusions:The combined procedures of cholecystectomy and Roux-en-Y gastrojejunal bypass operation not only cures cholecystolithiasis, but also has beneficial effects on T2DM. 

Abstract:

Objective:To investigate the diagnosis and treatment of nonfunctioning islet cell tumor (NICT).
Methods:The clinical data of 29 NICT patients treated at Xiangya Hospital in the past 17 years were retrospectively analyzed.
Results:In the 29 cases, who all had no obvious clinical symptoms, the major sign was abdominal mass (25/29). B-type ultrasound and CT examination were the main approaches of preoperative detecion, and the detection rate was 100% (29/29) and 96.5% (28/29), respectively. Of these patients,  benign and malignant lesions accounted for 65.5% (19/29) and 34.5% (10/29), respectively. The surgical resection rate was 100%.
Conclusions:NICT has no typical clinical symptoms and B-type ultrasound and CT are effective detection methods. It can be diagnosed as malignant tumor, if the lesion lacks an intact capsule or shows aggressive growth. Surgery is the first option to treat NICT, and the treatment results of the NICT patients are better than those patients with exocrine tumor of pancreas.

Abstract:

Objective:To investigate the diagnosis and treatment of nonfunctioning islet cell tumor (NICT).
Methods:The clinical data of 29 NICT patients treated at Xiangya Hospital in the past 17 years were retrospectively analyzed.
Results:In the 29 cases, who all had no obvious clinical symptoms, the major sign was abdominal mass (25/29). B-type ultrasound and CT examination were the main approaches of preoperative detecion, and the detection rate was 100% (29/29) and 96.5% (28/29), respectively. Of these patients,  benign and malignant lesions accounted for 65.5% (19/29) and 34.5% (10/29), respectively. The surgical resection rate was 100%.
Conclusions:NICT has no typical clinical symptoms and B-type ultrasound and CT are effective detection methods. It can be diagnosed as malignant tumor, if the lesion lacks an intact capsule or shows aggressive growth. Surgery is the first option to treat NICT, and the treatment results of the NICT patients are better than those patients with exocrine tumor of pancreas.