Objective: To assess the clinical application value of biliary stent placement for hilar cholangiocarcinoma via percutaneous transhepatic biliary drainage (PTBD) or endoscopic retrograde cholangiopancreatography (ERCP). Methods: The clinical data of 75 patients with hilar cholangiocarcinoma undergoing metal biliary stent placement were retrospectively analyzed. Results: In PTBD group, stent placement was performed in 29 cases and stents were successfully placed in 26 of the 29 cases (89.7%), the incidence of complications was 6.5%, and the median survival time was 26 weeks respectively. In ERCP group, stents were successfully placed in 38 of the 44 cases (86.4%), the incidence of complications was 13.6%, and the median survival time was 28 weeks respectively. The median survival time of both the unilateral placement group (29 cases) and bilateral placement group (35 cases) was 28 weeks. Conclusion: Biliary stent placement for hilar cholangiocarcinoma can achieve demonstrable efficacy either by PTBD or ERCP. Unilateral placement is preferred when using PTBD, while bilateral placement is recommended when performing ERCP.

Objective: To investigate the clinical value and safety of choledochoscopy combined with holmium laser lithotripsy through T-tube tract for treatment of retained stones in the intra- or extrahepatic bile ducts. Methods: The clinical data of 300 patients with retained stones in the intra- or extrahepatic bile ducts from February 2010 to June 2011, who underwent the combination treatment of choledochoscopy and holmium laser lithotripsy through the postoperative T-tube tract, were retrospectively analyzed. Results: Two hundred and ninety-two patients were completely stone-free after the holmium laser lithotripsy in combination with choledochoscopy. The lithotripsy procedures took 4 to 12 min and were performed one to 5 times. Thirteen patients underwent lithotripsy 5 times. Lithotripsy failed in 8 patients with stones in the hepatic grade III or IV bile ducts, of whom, stone extraction was successful in 6 cases and failed in 2 cases by plasma shock wave lithotripsy after 2 months of tube retention. A total of 568 stones were fragmented and the clearance rate was 95.2% (292/300). No severe complications, such as massive biliary bleeding, perforation, biliary wall burns or biliary fistula occurred during operation, and 15 cases experienced low grade fever after operation. Follow-up was performed in 268 patients for 6 to 18 months with an average period of 10 months, and no recurrent or residual stones or biliary strictures were noted. Conclusion: Choledochoscopy combined with holmium laser lithotripsy can significantly improve the therapeutic effect on retained intra- or extrahepatic stones, and is a simple, safe and effective technique which deserves to be widely used in clinical practice.

Objective: To investigate the morbidity and clinical features of cholelithiasis in recent years in Tangshan region. Methods: The clinical data of 6 417 patients with cholelithiasis confirmed by surgery between June 2005 and June 2011 were retrospectively analyzed. Results: The total number of cholelithiasis patients showed an increasing trend over the years (P<0.01), in which cholecystolithiasis accounted for 85.29%. For the entire group of cholelithiasis patients, the male to female ratio was 1:1.65, and cholecystolithiasis was predominant in both sexes. The peak age in the cases of gallbladder stones was 41–50 years, and in those of extrahepatic as well as those of intrahepatic bile duct stones it was 51–60 years. As for the occupational composition ratio, farmers (34.19%) and office staffs (36.82%) were the main sufferers of gallbladder stones at the time of this survey, and farmers accouted for the majority of intrahepatic bile duct stones (80.00%). The proportion of farmers in the cholecystolithiasis population showed a rising tendency (P<0.01). Conclusion: Cholecystolithiasis is the most important type of cholelithiasis in Tangshan, and farmer and office staffs are the main sufferers of this disease.

Objective: To investigate the relations of vascular endothelial growth factor C (VEGF-C) expression and micro-lymphatic vessel density (MLVD) in cholangiocarcinoma tissues with the clinicopathologic features and prognosis of cholangiocarcinoma. Methods: The VEGF-C expression and D2-40 positive MLVD in 47 cases of cholangiocarcinoma tissues, 40 cases of adjacent non-tumor biliary tissues and 15 cases of normal biliary tissues were detected by immunohistochemical staining. The correlation between VEGF-C and their relations with clinicopathological characteristics and prognosis were analyzed. Results: The positive expression rate of VEGF-C in cholangiocarcinoma tissues was significantly higher than those in adjacent non-tumor and normal biliary tissues (both P<0.05), and the MLVD in both cholangiocarcinoma and adjacent non-tumor biliary tissues were significantly higher than that in normal biliary tissues (both P<0.05). The VEGF-C expression and MLVD were closely related to the depth of invasion, TNM stage and lymphatic metastasis of cholangiocarcinoma (all P<0.05), moreover, MLVD was also relevant to the differentiation degree of cholangiocarcinoma (P<0.05). MLVD in the VEGF-C positive cholangiocarcinoma tissues was significantly higher than that of the negative ones (P<0.05), and the VEGF-C expression was positively correlated with MLVD (r=0.615, P<0.05). The patients with negative VEGF-C expression had better prognosis than those with positive VEGF-C expression (P<0.05), and MLVD in the cholangiocarcinoma tissues of the recurrent cases was significantly higher than that of the non-recurrent ones (P<0.05); further, MLVD showed a negative correlation with the survival time of the patients (r=–0.542, P<0.05). Conclusion: VEGF-C expression and MLVD are closely related to the lymphatic metastasis and prognosis of cholangiocarcinoma. VEGF-C may potentially become one of the effective indicators for predicting lymphatic metastasis in patients with cholangiocarcinoma.

Objective: To investigate the growth inhibitory and apoptosis-inducing effect of icariin on hepatocellular carcinoma SMMC-7721 cells. Methods: The proliferation of SMMC-7721 cells after exposure to different concentrations of icariin (0, 6.25, 12.5, 25, 50, 100, 200, 400 and 800 μg/mL) for different time periods (24, 48 and 72 h) was determined by MTT assay. The cell cycle and apoptotic changes as well as the protein expression of PCNA, Bcl-2 and Bax in SMMC-7721 cells after incubation with different concentrations of icariin for 48 h were detected by using flow cytometry and Western blot analysis, respectively Results: Compared with the control group (0 μg/mL), each concentration of icariin significantly inhibited the proliferation of SMMC-7721 cells, and this effect acted in a time- and concentration-dependent manner (all P<0.05). In a concentration-dependent manner, icariin showed the effects of G0/G1 cell cycle arrest and apoptosis induction, up-regulating PCNA and Bcl-2 expression, and down-regulating Bax expression (all P<0.05). Conclusion: Icariin has proliferation inhibitory and apoptosis-inducing effect on SMMC-7721 cells.

Objective: To investigate the serum level of serum high mobility group protein 1 (HMGB1) in patients with acute appendicitis and its diagnostic significance. Methods: The serum HMGB1 levels of 40 subjects undergoing health maintenance examination (group A) and 129 suspected acute appendicitis patients were detected by using quantitative ELISA kit, and their white blood cell (WBC) count and C-reactive protein (CRP) level were also determined. According to the surgical findings and postoperative pathological results, the 129 suspected cases were distinguished into group B (15 cases without appendicitis), group C (63 cases of simple acute appendicitis) and group D (51 cases of acute suppurative, gangrenous, perforated appendicitis or periappendiceal abscess). The differences in above mentioned indexes among the groups were compared and the receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic efficiency of each index for acute appendicitis. Results: The WBC count, serum level of HMGB1 and CRP markedly increased in group C and group D compared with group A or group B, and all differences had statistical significance (all P<0.05); further, all the values of the indexes in group D were significantly higher than those in group C (all P<0.05). ROC curve analysis showed that area under the curve (AUC) of WBC, CRP and HMGB1 were 0.729, 0.811 and 0.850 respectively, and HMGB1 had the highest diagnostic efficiency (both P<0.05). Conclusion: Patients with acute appendicitis have a pronounced elevation of serum HMGB1 level, thus it could be reasonably expected to become an important assistant diagnostic index for acute appendicitis and severity of this disease.

Patients with obstructive jaundice are at increased risk for perioperative complications and mortality due to a general immune dysfunction. This paper, based on the recent literature, is intended to provide an overview of the alterations in immune function of the patients with obstructive jaundice and their clinical relevance.