Abstract:

Abstract:

Abstract:

Abstract:Objective: To investigate the effect of the folate-conjugated nanoparticles (drug carrier) loaded with 5-fluorouracil (5-FU) against bile duct carcinoma and its safety. Methods: The effects of nanoparticles without modification and folate-conjugated nanoparticles or their 5-FU loaded ones on the growth of the cholangiocarcinoma QBC939 cells in vitro were determined by MTT assay. In nude mice bearing QBC939 cell grafts, the inhibitory effects on the tumor grafts among 5-FU, 5-FU loaded nanoparticles and 5-FU loaded folate-conjugated nanoparticles were compared using normal saline as a control. The toxic effects of the folate-conjugated nanoparticles were tested by incubation of the rat liver BRL3A cells and renal NRK cells with different concentrations of the folate-conjugated nanoparticles for 24 h. Results: The in vitro experiments showed that both nanoparticles with or without modification exerted no obvious influence on the growth of QBC939 cells, but both had stronger inhibitory effects than that of 5-FU alone on the growth of QBC939 cells after they were loaded with 5-FU, which was more evident for the folate-conjugated nanoparticles (all P<0.05). The suppression ratios of the tumor grafts in nude mice for 5-FU, 5-FU loaded nanoparticles and 5-FU loaded folate-conjugated nanoparticles were 56.0%, 61.5% and 74.4% respectively, and the differences among them had statistical significance (all P<0.05). There were no morphological changes in BRL3A cells or NRKP cells after exposure to any of the used concentrations of folate-conjugated nanoparticles. Conclusion: The drug delivery system of folate-conjugated nanoparticles has favorable and specific targeting characteristcs, and shows remarkable therapeutic potential for cholangiocarcinoma after it is loaded with 5-FU.

Abstract:

Objective: To investigate the effect of interleukin 6 (IL-6) on the biological behaviors in gallbladder carcinoma cells and its association with JAK/STAT3 signaling pathway. Methods: The gallbladder carcinoma GBC-SD cells were treated with IL-6 orIL-6 plus AG490 (an inhibitor of JAK/STAT3 pathway); the cell proliferation and invasive ability, the matrix metalloproteinase 9 (MMP-9) activity, and protein expressions of the phosphorylated STAT3 (p-STAT3) and vascular endothelial growth factor (VEGF) in the cells were determined by MTT assay, Transwell migration assay, gelatin zymography and Western blot analysis, respectively. Results: The proliferation of GBC-SD cells was significantly increased in a concentration-dependent manner after treatment with IL-6 (10,50 and 100ng/mL), but the proliferative effect of IL-6 was abolished by AG490 treatment. Further, in GBC-SD cells after IL-6 treatment, the invasive ability and MMP-9 release were significantly elevated (both P<0.05), and both p-STAT3 and VEGF protein expressions were remarkably up-regulated, and all above effects of IL-6 were abolished by AG490. Conclusion: IL-6 can promote the growth and enhance the invasive ability of gallbladder cancer cells and these actions may be associated with its activation of the JAK/STAT3 signaling pathway, leading to the downstream MMP9 and VEGF expressions.

Abstract:

Objective: To investigate the let-7a microRNA (miRNA) expression in cholangiocarcinoma tissue and its significance. Methods: The let-7a expressions in tissues of cholangiocarcinoma and normal bile duct specimens were determined by Real-time PCR technique. The cholangiocarcinoma HuCCT-1 cells were divided into let-7a overexpression group (transfected with let-7a mimics), negative control group (transfected with negative control sequence) and blank control group (without any transfection), and then the let-7a expression, apoptosis and cell cycle in each group of cells were determined by Real-time PCR and flow cytometer, respectively. Results: The let-7a expression was significantly down-regulated in cholangiocarcinoma tissue than that in normal bile duct tissue (P<0.01). Both let-7a expression and apoptotic rate in cells of let-7a overexpression group were all significantly increased compared with blank control group (both P<0.01), while no such differences were noted between the negative control group and blank control group (both P>0.05). The difference in cell cycle showed no statistical significance among groups (P>0.05). Conclusion: The let-7a expression is down-regulated in cholangiocarcinoma tissue and inhibits cell apoptosis and, may thereby promote the occurrence and development of cholangiocarcinoma.

Abstract:

Objective: To study the expression of blood vessel epicardial substance (BVES) in human gallbladder cancer tissue and its clinical significance. Methods: The BVES expressions in gallbladder tissue specimens form 65 patients with gallbladder cancer and 55 cases with benign gallbladder diseases were determined by immunohistochemical staining, and the relations of BVES expression with clinicopathological profiles of gallbladder cancer were analyzed. Results: The high expression rate and low expression rate of BVES in gallbladder cancer tissues was 20.0% (13/65) and 80.0% (52/65), which was 74.5% (41/55) and 25.5% (14/55) in benign gallbladder tissues respectively, and the difference between the two groups had statistical significance (χ2=35.811, P<0.05). The univariate analysis indicated that the BVES expression was closely associated with the degree of differentiation, clinical stage and lymph node metastasis of the gallbladder cancer, as showed by the statistical differences of these three factors between the two groups (all P<0.05). Conclusion: The low or lack of BVES expression may be closely connected to the occurrence and development of gallbladder cancer.

Abstract:Objective: To investigate the application and clinical efficacy of precise surgical technique in surgical treatment of hilar cholangiocarcinoma. Methods: The clinical data of 44 patients with hilar cholangiocarcinoma who received precise surgical treatment from May 2007 to December 2012 were retrospectively analyzed. Results: Of the 44 patients, 19 cases (43.2%) received R0 resection, 7 cases underwent R1 resection, 5 cases had R2 resection, 5 cases were subjected to a palliative operation, and 8 cases were treated with biopsy and internal or external drainage; 18 cases underwent combined liver resection, and 2 cases had simultaneous hepatic artery resection and reconstruction. The average operative time was (5.8±1.6) h and average intraoperative blood loss was (810±509) mL. Postoperative complications occurred in 28 cases and one case (1/44) died within one month. Thirty-nine patients were followed up for 4-62 months, and the overall 1-, 3- and 5-year survival rates were 67.7%, 30.8% and 10.6%, respectively. The 1-, 3- and 5-year survival rates for patients with R0 resection were 93.3%, 43.2% and 13.9%, and for patients undergoing non-radical resection were 50.5%, 26.8% and 0, respectively, and the postoperative survival in patients with R0 resection was significantly better than that in patients with non-radical resection (χ2=4.61, P<0.05); the 1-, 3- and 5-year survival rates for patients who underwent combined lobectomy were 94.1%, 52.7% and 11.8%, and for patients without combined lobectomy were 69.2%, 25.4% and 0 respectively, and the patients who received combined lobectomy had a significantly better postoperative survival rate than those without combined lobectomy (χ2=15.26, P<0.05). Conclusion: Use of precise surgical technique in surgical treatment of hilar cholangiocarcinoma can increase the radical resection rate, reduce postoperative complications and improve the therapeutic outcomes.

Abstract:

Objective: To evaluate the methods and efficacy of surgical treatment for type III and IV hilar cholangiocarcinoma. Methods: The clinical data of 16 patients with type III or IV hilar cholangiocarcinoma undergoing surgical treatment from April 2011 to February 2013 were retrospectively analyzed. Results: Surgical resection was performed in 13 of the 16 patients, and the resection rate was 81% (13/16), with radical resection (R0 resection) in 7 cases and non-radical resection in 6 cases. Three patients underwent left hepatectomy plus caudate lobectomy with reconstruction of the right hepatic duct and Roux-en-Y hepatojejunostomy, 3 patients received right hepatectomy plus caudate lobectomy with reconstruction of the left hepatic duct and Roux-en-Y hepatojejunostomy, and 7 patients received quadrate lobectomy plus perihilar resection with basin-type cholangiojejunostomy, and two of them with total bilirubin level more than 400 mmol/L were subjected to percutaneous transhepatic cholangio-drainage (PTCD) before surgical resection. Surgical resection could not be performed in 3 patients, of whom 2 cases had involvement of the left and right branches of the portal vein, one case was found having multiple intrahepatic metastases, and all the 3 patients underwent dilatation of the intrahepatic bile ducts and tube placement for drainage. The postoperative serum total bilirubin levels in all patients were markedly decreased or even returned to normal after surgery, and the effective rate of drainage was 100%. One death occurred during the perioperative period. Conclusion: For type III and IV hilar cholangiocarcinoma, tumor resection and relief of biliary obstruction should be strongly considered. A solid knowledge of biliary anatomy in the porta hepatis, skillful surgical technique and meticulous dissection are essential for improving the resection rate.

Abstract:Objective: To compare the diagnostic value of biopsy under percutaneous transhepatic cholangiography (PTC) versus spiral CT in obstructive jaundice. Methods: The clinical records of 78 patients admitted from 2010 March to 2012 December due to obstructive jaundice were collected. All patients underwent either PTC biopsy or spiral CT examination, and the two diagnostic methods were compared according to the results of the surgical pathology biopsy. Results: Of the 78 patients, 9 cases were identified as benign obstructive jaundice, and 69 cases were diagnosed as malignant obstructive jaundice that included 46 biliary epithelial tumors and 23 non-biliary epithelial tumors. The sensitivity and specificity of PTC biopsy was 85.51% and 66.67%, and those of spiral CT was 78.26% and 77.78%, respectively. The sensitivity of PTC biopsy was higher, but its specificity was lower than that of spiral CT, and both differences were statistically significant (both P<0.05). In the 46 patients with bile duct cancer, 43 cases were positive by PTC biopsy (93.48%) and 37 cases were positive by spiral CT (80.43%); in the 23 patients with non-bile duct cancer, 19 cases were positive by PTC biopsy (82.61%), and 17 cases were positive by spiral CT (73.91%). The sensitivity of PTC biopsy in these patients was higher than that of spiral CT (P<0.05), and further, the sensitivity of PTC biopsy for biliary epithelial tumors was higher than that for non-biliary epithelial tumors (P<0.05), while no such difference was noted in spiral CT for the tumors of the two origins (P>0.05). Conclusion: The sensitivity of PTC biopsy for diagnosis of different types of obstructive jaundice, especially those due to bile duct cancer, is higher than that of spiral CT, but it has many contraindications, so other different methods also can be used according to the clinical needs.

Abstract:Objective: To investigate the relationship between XbaI polymorphism of apolipoprotein B (ApoB) gene and cholelithiasis through comparison of the allele and genotype distribution frequencies at XbaI site of ApoB gene by Meta-analysis. Methods: A literature search was performed regarding the relation of XbaI polymorphism of ApoB gene with gallstone. All trial data were combined and analyzed according to the Meta-analysis methodology using CMA2.0 software, and the publication bias of pooled studies was also assessed. Results: Thirteen related studies that met the inclusion criteria were selected, with 1 672 cases in gallstone group and 1 923 subjects in control group. The results of Meta-analyses showed that in Asian population, the frequency of X+ allele was significantly increased (OR=2.76, 95% CI=2.12–3.59), but the frequency of X–/– genotype was significantly decreased in gallstone group compared with control group (OR=0.35, 95% CI=0.27–0.47) (both P<0.05). Assessment found no evidence of publication bias that confirmed stability of this Meta-analysis. Conclusion: XbaI polymorphism of ApoB gene is associated with gallstone occurrence among Asians, in which the X+ allele is a risk factor and the g X–/– genotype is a protective factor.

Abstract:Objective: To investigate the relationship between cholesterol gallstones and cholesterol polyps. Methods: One hundred and seventy-two patients undergoing laparoscopic gallbladder-sparing surgery for gallbladder stones or polyps (more than 3 years after surgery) were selected by sampling. Of them, 119 were gallbladder stone patients, 39 were gallbladder polyp patients and 14 were gallbladder stone and polyp patients. The postoperative recurrences of stone and polyp of the patients were observed. Results: Of the 119 gallbladder stone patients, postoperative stone recurrence occurred in 24 cases, and no new polyp growth was noted. Of the 39 gallbladder polyp patients, postoperative polyp recurrence occurred in 3 cases and new stone formation was found in one patient. Of the 14 patients with gallbladder stones and polyps, postoperative polyp recurrence occurred in 2 cases, of whom, one case had simultaneous stone recurrence. The difference in recurrence between gallbladder stones and gallbladder polyps had a statistical significance (P<0.05). Conclusion: Cholesterol gallstones and cholesterol polyps may be mutually independent diseases of different pathogeneses. However, gallbladder polyps may probably influence cholesterol gallstone formation and cause relatively high postoperative stone recurrence by affecting the liquid state of the bile in the gallbladder, so preservation of the gallbladder is not recommended in surgical management for gallbladder stone patients presenting with gallbladder polyps.

Abstract:

Objective: To investigate the efficacy of ultrasound-guided percutaneous double-tract cholecystostomy and choledochoscopic gallbladder-preserving cholecystolithotomy for high-risk elderly patients with acute calculous cholecystitis. Methods: The clinical data of 30 patients with acute calculous cholecystitis, who underwent percutaneous cholecystostomy and choledochoscopic cholecystolithotomy from January 2012 to April 2013, were retrospectively analyzed. Results: Gallbladder punctures and tube placement were successfully performed in all the 30 patients. Bleeding occurred in one patient during the procedure, which was controlled by intraluminal injection of reptilase and catheter occlusion. The tube retention time was 14 d to 2 months with average of 30 d. After 4- to 8-week drainage, gallbladder stones in 28 patients were successfully removed via choledochoscope, one patient underwent open cholecystectomy because of failure of sinus tract formation, and another patient received laparoscopic cholecystectomy due to loose connection of the 16-F cholecystostomy pigtail tube. Twenty-eight patients were followed up for 3 to 19 months, and recurrence was found in one patient (3.6%) by B ultrasonic examination. Conclusion: Ultrasound-guided percutaneous double-tract cholecystostomy and choledochoscopic gallbladder-preserving cholecystolithotomy is a reliable and effective approach for high-risk elderly gallstone patients.

Abstract:Objective: To the clinical efficacy of minimally invasive combined choledochofiberscopic and laparoscopic cholecystolithotomy with gallbladder preservation. Methods: One hundred and twenty-two patients with gallstone and normal gallbladder function scheduled for surgical treatment were randomly divided into observational group (undergoing minimally invasive combined choledochofiberscopic and laparoscopic cholecystolithotomy with gallbladder preservation) and control group (undergoing laparoscopic cholecystectomy). The gastrointestinal function and gastrointestinal quality of life index (GIQLI) between the two groups of patients before operation, and 2, 4 and 8 weeks as well as 6 months after operation were compared. Results: The time to bowel sounds restoration, and anal flatus and defecation were significantly shortened, and the incidence of gastrointestinal adverse reactions and recurrence in observational group were significantly reduced compared with control group (all P<0.05). The GIQLI scores had no significant difference between the two groups before operation (P>0.05), but they were significantly higher in observational group than those in control group at 2, 4 and 8 weeks after operation (all P<0.05), and then the two groups became similar at 6 months after operation (P>0.05). Conclusion: For gallstone patients, combined choledochofiberscopic and laparoscopic cholecystolithotomy with gallbladder preservation has the advantages of faster recovery of gastrointestinal function, and better quality of life in the early postoperative period.

Abstract:

Objective: To study the feasibility, safety and efficacy of laparoscopic common bile duct exploration (LCBDE) for removal of common bile duct (CBD) stones in patients with concomitant type 2 diabetes. Methods: The clinical data of 58 CBD patients with type 2 diabetes (diabetic group), and another 58 non-diabetic CBD patients (non-diabetic group) undergoing LCBDE procedures from December 2009 to December 2012 were retrospectively analyzed. The pre-, intra- and postoperative conditions between the two groups were compared. Results: Results of the comparisons showed no signi?cant differences between the two groups in the operative time, intraoperative blood loss, time to liquid intake and length of postoperative stay (t/χ2=3.921, 6.940, 1.332, 1.270 and 0.342. all P>0.05), and also no signi?cant differences between the two groups in the incidences of postoperative electrolyte imbalance, cholangitis, bile leakage, wound infection and pulmonary infection (χ2=0.438, 0.537, 0.342, 1.036 and 0.342. all P>0.05). No residual stones, bile duct stricture or death were noted in either group after operation. Conclusion: LCBDE for CBD stone removal in patients with type 2 diabetes, based on the premise of preoperative glycemic control and meticulous surgical technique, is feasible, safe and effective.

Abstract:Objective: To investigate the efficacy of using fast-track surgery (FTS) in perioperative management of hepatolithiasis patients. Methods: The clinical data of 132 patients with hepatolithiasis undergoing surgical treatment from July 2005 to June 2012 were reviewed. According to the type of perioperative management, patients were divided into FTS group (56 cases) and control group (76 cases); patients in FTS group received the new perioperative care procedure, namely the fast-track methodology, while those in control group underwent the conventional perioperative treatment. Results: Compared with control group, the length of postoperative hospital stay, medical costs and incidence of postoperative complications and wound infection were reduced, and the times to drainage tube removal and first postoperative passage of flatus were shortened in FTS group (all P<0.05). Multivariate Logistic regression analysis for the entire group of patients revealed that age, previous history of biliary surgery, intraoperative wound edge protection and time of drainage tube removal were affecting factors for the incidence of wound infection (all P<0.05). Conclusion: The application of FTS in management of hepatolithiasis patients is safe and effective, and can reduce the incidence of postoperative complications and medical costs, as well as shorten the postoperative hospital stay and accelerate recovery of the patients.

Abstract:

Objective: To observe the changes of coagulation status in portal vein and peripheral blood in rabbits with chronic biliary infection. Methods: Twenty-four healthy adult New Zealand rabbits were equally randomized into model group and control group. All rabbits underwent indwelling cystic duct catheterization, and the rabbits in model group were subjected to E. Coli solution injection via the indwelling catheter, weekly for 3 weeks, while those in control group received normal saline instead in the same fashion. On the third day after the last injection, blood samples were taken from the marginal ear vein and portal vein of the rabbits in both groups, and liver tissues adjacent to the first porta were harvested; the blood clotting functions and D-dimer (DD) levels in the blood samples from the two sites were measured, and the pathological alteration in the portal veins were observed. Results: After model creation, rabbits in model group presented with decreased food intake, increased rectal temperature and reduced body weight, while these general conditions of those in control group showed no obvious change. Compared with control group, the blood from the marginal ear vein of model group showed that the DD level was significantly increased (P<0.01), but the indexes that included coagulation time (CT), prothrombin time (PT) and activated partial thromboplaslin time (APTT) were not significantly changed (all P>0.05), while the blood from the portal vein of model group showed significantly increased DD level, but the CT, PT and APTT levels were all significantly shortened (all P<0.01). The pathological findings showed that there was small thrombus formation in portal vein in model group, which was not noted in control group. Conclusion: Chronic biliary tract infection can result in local hypercoagulation status and microthrombosis in portal venous system, and detection of the peripheral blood DD level may have certain significance for diagnosis of biliary infection with portal vein thrombosis.

Abstract:Objective: To observe the expression of myosin heavy chain (MHC) and phosphorylated 20 kD myosin light chain (P-MLC20) in the smooth muscle of the common bile duct (CBD) from children with pancreaticobiliary maljunction (PBM). Methods: The CBD specimens from 16 PBM pediatric patients were compared with 16 CBD specimens from cadavers of neonates serving as control. The MHC and P-MLC20 protein expressions in the two tissues were examined and analyzed by image analysis system after immunohistochemical staining, and the P-MLC20 protein expression in the two tissues were also determined by Western blot analysis. Results: The immunohistochemical semi-quantitative analysis for the MHC and P-MLC20 protein expressions showed there were no differences in mean optical density (MOD) for both proteins between the two groups (both P>0.05), but the mean labeling intensity (MLI) and minimum qualifying scores (MQS) for both proteins in PBM group were all significantly higher than those in control group (all P<0.05). Western blot results showed that the expression level of P-MLC20 protein in PBM group was significantly increased compared with control group (P<0.05). Conclusion: The MHC and P-MLC20 expressions are increased in CBD smooth muscle of PBM children, which may probably lead to the compensatorily enhanced contractile ability of their CBD smooth muscle.

Abstract:

Objective: To investigate the feasibility of transumbilical single-port laparoscopic cholecystectomy (TUSPLC) through improved electric hook access. Methods: The clinical data of 517 patients undergoing TUSPLC by improved electric hook access from August 2009 to February 2013 were retrospectively analyzed. Results: Two patients were converted to open surgery due to severe adhesions of the gallbladder to neighboring tissues and Mirizzi’s syndrome, respectively. For the entire group, the operative time was 22–55 min, intraoperative blood loss was 10–30 mL, and the length of postoperative hospital stay was 1–2 d. No serious complications such as bile leakage, hemorrhage bile duct injury occurred. Follow-up was conducted in 428 patients for 1–18 months, during which no long-term complications or discomfort were noted in the patients; all scars were almost invisible, and the cosmetic results were satisfactory. Conclusion: TUSPLC using conventional laparoscopic instruments through improved electric hook access is feasible and safe, and also easy to implement in practice.

Abstract:Objective: To investigate the incidence of complications in laparoscopic cholecystectomy and the affecting factors. Methods: The clinical data of 500 patients undergoing laparoscopic cholecystectomy over the recent two years were analyzed by using self-designed investigation scale to determine the incidence of complications in laparoscopic cholecystectomy and the affecting factors. Results: The overall incidence of complications of laparoscopic cholecystectomy was 2.60%. Univariate Logistic regression analysis showed that the incidence of complications following laparoscopic cholecystectomy was associated with old age, type of surgery, type of incision, adhesions of agllbladder to adjacent viscera, adhesions in Calot’s triangle, gallbladder wall thickening, concomitant diabetes, regional distribution of the operation room and drainage tube placement (all P<0.05). Mutivariate Logistic regression analysis revealed that old age, emergency operation, adhesions of gallbladder to adjacent viscera, adhesions in Calot’s triangle and concomitant diabetes were risk factors for occurrence of complications following laparoscopic cholecystectomy, while rational arrangement of the operation room and drainage tube placement were important factors for prevention of the occurrence of complications (all P<0.05). Conclusion: The incidence of complications in laparoscopic cholecystectomy is relatively high, and is affected by various factors.

Abstract:Objective: To explore the application and technical points of total laparoscopic surgery for congenital choledochal cyst. Methods: The clinical data of 7 patients undergoing laparoscopic surgery for choledochal cyst from August 2011 to December 2012 were retrospectively analyzed. Results: Cyst excision and Roux-en-Y hepato-enteric anastomosis were successfully performed by laparoscopic procedures in 5 patients, and the operative time was 310–400 min, intraoperative blood loss was 50–100 mL and length of postoperative hospital stay was 5–7 d. Follow-up ranged from 3 to 19 months, and no postoperative complications or death occurred. Two patients were converted to open surgery due to severe inflammation of the choledochal cyst or bleeding. Conclusion: Total laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy is a safe and feasible procedure with the advantages of minimal invasiveness and fast recovery for most cases of choledochal cyst. Excellent laparoscopic skills and teamwork is crucial for surgical success.

Abstract:

Objective: To investigate the management of biliary re-stricture after an initial repair of iatrogenic bile duct injury. Methods: The clinical data of 22 patients with biliary re-stricture after repair of bile duct injury in other hospital admitted from January 2001 to December 2011 were retrospectively analyzed. The bile duct injury in all the 22 cases was caused by cholecystectomy that included 8 cases of laparoscopic cholecystectomy and 14 cases of open cholecystectomy. Results: Reoperations were performed in all the 22 patients, of whom 21 cases underwent Roux-en-Y hepaticojejunostomy (one case underwent quadrate lobectomy due to high injury site of the bile duct, and then anastomosis of the left and right hepatic ducts to the jejunum), and one case received U-tube external biliary drainage. All patients were followed up for 1 year to 11 years. Except for one patient who died of liver failure caused by biliary infection, all the remaining patients showed relatively positive short-term outcomes. Conclusion: Bile duct injury should be treated as early as possible, and attention to detail during operation and proper selection of repair method is important. Roux-en-Y hepaticojejunostomy is a reliable procedure for biliary re-stricture after repair of the bile duct injury.

Abstract:Objective: To investigate the management of severe acute pancreatitis (SAP) occurring in late pregnancy. Methods: The clinical data of 26 patients with SAP in late pregnancy treated during January 2001 to December 2011 were analyzed retrospectively. The average age of the patents was 26 (20–40) years, with average pregnancy period of 33 (29–39) weeks. Termination of pregnancy was performed by emergent cesarean section in patients carrying a full-term fetus with lung maturity. Those with preterm gestation initially underwent conservative treatments, and then were allowed to try to have a full-term delivery if SAP remitted, otherwise, they were subjected to a cesarean section combined with peripancreatic drainage. Results: Four patients of full-term pregnancy and one patient carrying a dead fetus underwent cesarean section immediately after admission, and then SAP in these cases remitted 1-5 d later. Of the 21 preterm pregnant patients, SAP remitted in 18 cases (85.7%) after 3–22 d of conservative treatment and their pregnancies were allowed to continue to go to full term, but conservative treatment failed in 3 cases (14.3%), of whom one case died of fulminant acute pancreatitis and 2 cases underwent pregnancy termination at 33 and 35 weeks of gestation respectively, and all the 3 fetuses died. Conclusion: Conservative treatment is effective in most women complicated with SAP during late pregnancy. Meanwhile, the conditions in both mother and fetus should be monitored closely, and once fetal visceral organs especially lung maturity has been achieved, or conservative treatments has failed, pregnancy termination should be performed.

Abstract:With the growth of research on hepatobiliary cancers, great progress has been achieved in the development of drugs targeting the abnormal pathways or molecules in cancer cells. At present, the drugs targeting the epidermal growth factor receptor (EGFR) has been widely used in hepatobiliary cancer therapy, and has exhibited unique advantages compared to traditional chemotherapy drugs, but may still give rise to drug resistance in long term use. This paper mainly addresses the clinical application of EGFR-targeted therapy in hepatobiliary cancers and the mechanisms of resistance, with the purpose of providing new insights for clinical practice.

Abstract:

With the continuous development and improvement in equipment and technology, the diagnosis and therapy of common bile duct stones are evolving towards the direction that is to be safer, minimally invasive, and higher efficiency. Here, the authors, based on the literature review and extraction, present the current advances in diagnosis and treatment of choledocholithiasis.