Abstract:Background and Aims: Hepatolithiasis is a complicated pathological condition, with a high postoperative recurrence rate, requiring repeated operations. In the late course of the disease, biliary cirrhosis and even intrahepatic cholangiocarcinoma may occur, which seriously affect the patients’ quality of life. This study was conducted to investigate the safety and efficacy of biliary flap transposition hilar biliary stricture repair in treatment of hepatolithiasis.  
Methods: The clinical data of 36 patients with hilar biliary stricture treated in Hunan Provincial People's Hospital from January 1, 2016 to December 31, 2018 were retrospectively analyzed. The clinical variables that included the operative time, intraoperative blood loss, hospitalization time, postoperative complications, and anastomotic restenosis observed. 
Results: Of the patients, 8 cases had the initial surgery, and the other 28 cases had surgery such as cholecystectomy, and common bile duct exploration once to 4 times previously. All patients underwent hilar biliary stricture repair by biliary flap transposition, and biliary basin Roux-en-Y internal drainage. Meanwhile, 3 cases underwent the right posterior lobe resection, 6 cases underwent the left lateral lobe resection, and 11 cases underwent the quadrate lobe resection. No perioperative death occurred. The average operative time was (256.4±98.2) min, the average intraoperative blood loss was (218.5±68.1) mL, and the average length of hospital stay was (10.3±3.2) d. After operation, residual stones were found in 3 cases (8.3%), mild bile leakage occurred in 1 case, partial intestinal obstruction occurred in 1 case, abdominal fluid collection occurred in 2 cases, and pleural effusion occurred in 2 cases, which were all resolved by conservative treatment, and no complication greater than Clavien-Dindo IIIa was noted. All patients were followed up by outpatient examination and telephone interview. The median follow-up time was 23.6 (12–46) months. Reflux cholangitis occurred in 2 patients, which were spontaneously resolved, and no anastomotic restenosis was found. Stone recurrence was found in 3 cases (8.3%).
Conclusion: Biliary flap transposition hilar biliary stricture repair is safe and effective for the treatment of hepatolithiasis, and it can be used for reference in clinical paractice.

Abstract:Background and Aims: The diagnosis and treatment of intrahepatic bile duct stones, especially the stones located in multiple hepatic segments or the complicated hepatolithiasis with a history of multiple biliary tract surgeries, is one of the difficult problems in hepato biliary surgery. How to remove the stones in one step is one of the current research interests. Considering that the computer-based three-dimensional reconstruction visualization technology has been increasingly used in hepatectomy in recent years, this study was designed to investigate the clinical application value of computer-based three-dimensional reconstruction technology in the diagnosis and treatment of complicated intra- and extrahepatic bile duct stones. 
Methods: The clinical data of patients with hepatolithiasis treated in the Department of Biliary and Pancreatic Surgery of the First Affiliated Hospital of University of Science and Technology of China, who underwent computer-based three-dimensional reconstruction before operation from January 1, 2018to July 31, 2019 were retrospectively analyzed. 
Results: A total of 19 patients with complicated hepatolithiasis admitted during above period were enrolled. Of the patients, the classification of hepatolithiasis was type I in 9 cases, type II a in 6 cases, type IIb in 3 cases and type IIc in 1 case, 12 cases had concomitant extrahepatic bile duct stones, 1 case was complicated with hepatic space-occupying lesions and 1 case was combined with right hepatic schistosomiasis. The surgical procedures including left hepatectomy performed in 3 cases, right hepatectomy performed in 7 cases, and common bile duct exploration plus drainage performed in 9 cases. The coincidence of preoperative three-dimensional reconstruction with the real intra-operative findings were that the coincidence rate of the running patterns of the portal vein and hepatic artery were 78.95%, the coincidence rates of both stone distribution in bile duct and liver volume were 84.21%, and the total accuracy rate was 73.68%. No residual stones were detected by immediate postoperative cholangiography, and no postoperative cholangitisor bile duct injuries occurred.
Conclusion: The preoperative computer-based three-dimensional reconstruction technology can accurately describe the distribution of intrahepatic bile duct stones and accurately measure the liver volume. It has important clinical application value in the diagnosis of complex hepatolithiasis and individual planning of surgical procedures, and can help achieve the greatest degree of stone removal in one step.

Abstract:Background and Aims: The diagnosis and treatment of intrahepatic bile duct stones, especially the stones located in multiple hepatic segments or the complicated hepatolithiasis with a history of multiple biliary tract surgeries, is one of the difficult problems in hepatobiliary surgery. How to remove the stones in one step is one of the current research interests. Considering that the computer-based three-dimensional reconstruction visualization technology has been increasingly used in hepatectomy in recent years, this study was designed to investigate the clinical application value of computer-based three-dimensional reconstruction technology in the diagnosis and treatment of complicated intra- and extrahepatic bile duct stones. 
Methods: The clinical data of patients with hepatolithiasis treated in the Department of Biliary and Pancreatic Surgery of the First Affiliated Hospital of University of Science and Technology of China, who underwent computer-based three-dimensional reconstruction before operation from January 1, 2018 to July 31, 2019 were retrospectively analyzed. 
Results: A total of 19 patients with complicated hepatolithiasis admitted during above period were enrolled. Of the patients, the classification of hepatolithiasis was type I in 9 cases, type II a in 6 cases, type IIb in 3 cases and type IIc in 1 case, 12 cases had concomitant extrahepatic bile duct stones, 1 case was complicated with hepatic space-occupying lesions and 1 case was combined with right hepatic schistosomiasis. The surgical procedures including left hepatectomy performed in 3 cases, right hepatectomy performed in 7 cases, and common bile duct exploration plus drainage performed in 9 cases. The coincidence of preoperative three-dimensional reconstruction with the real intra-operative findings were that the coincidence rate of the running patterns of the portal vein and hepatic artery were 78.95%, the coincidence rates of both stone distribution in bile duct and liver volume were 84.21%, and the total accuracy rate was 73.68%. No residual stones were detected by immediate postoperative cholangiography, and no postoperative cholangitisor bile duct injuries occurred.
Conclusion: The preoperative computer-based three-dimensional reconstruction technology can accurately describe the distribution of intrahepatic bile duct stones and accurately measure the liver volume. It has important clinical application value in the diagnosis of complex hepatolithiasis and individual planning of surgical procedures, and can help achieve the greatest degree of stone removal in one step.

Abstract:Background and Aims: An agreement on whether three-dimensional (3D) or two-dimensional (2D) laparoscopic cholecystectomy is more beneficial for patients with benign gallbladder diseases has not been achieved so far and also, there are no large-scale multi-center studies on that available. This study was conducted to evaluated the clinical efficacy and safety of using 3D and 2D laparoscopy in cholecystectomy by Meta-analysis, so as to provide treatment options for benign gallbladder lesions. 
Methods: The Chinese and English databases were searched systematically, and the studies comparing the clinical efficacy of 3D and 2D laparoscopic cholecystectomy were screened according to the inclusion and exclusion criteria. The search time was up to March 2020. After the methodological quality evaluation and data extraction of the included studies, Meta-analysis was performed using RevMan 5.3 software.
Results: Finally, 11 studies were included, comprising 7 randomized controlled studies (RCT) and 4 retrospective studies, involving a total of 980 patients, with 438 cases in the 3D group and 542 cases in the 2D group. The results of Meta-analysis showed that in 3D group compared with the 2D group, the operative time (MD=–8.64, 95% CI= –12.87 –4.42, P=0.000 1) and intraoperative blood loss (MD=–13.82, 95% CI=-19.98 –7.65, P=0.000 1), and the incidence of intraoperative complications (OR=0.52, 95% CI=0.32 0.83, P=0.006) were significantly reduced; in overall analysis, the length of hospital stay in 3D group was shorter than that in 2D group (MD=–0.13, 95% CI=–0.25–0.02, P=0.02), but in subgroup analysis of RCT and retrospective studies, there was no statistical difference in the length of hospital stay between the two groups (MD=–0.12, 95% CI=–0.24 0.01, P=0.06; MD=–0.20, 95% CI=–0.45 0.05, P=0.12); there were no significant differences in terms of open conversion rates (OR=0.74, 95% CI=0.30 1.79, P=0.50) and the incidence rates of postoperative complications (OR=0.67, 95% CI=0.35 1.28, P=0.23) between the two groups.
Conclusion: The clinical efficacy and safety of 3D laparoscopy are better than those of 2D laparoscopy in cholecystectomy, which is worthy of clinical promotion and application. However, this conclusion still needs to be verified by large-scale multi-center, randomized, controlled studies.

Abstract:Background and Aims: Gallbladder carcinoma (GBC) is a malignant tumor with a high mortality rate. The lack in quick and effective methods of preoperative diagnosis and prognostic assessment has increased the difficulty of operation and follow-up treatment for GBC. In recent years, the relations of the peripheral blood inflammation-related indicators with tumor prognosis have been extensively studied, but the predictive values are often limited due to the instability of the peripheral blood parameters. The purpose of this study was to investigate the role of the new peripheral blood parameter models preoperative plus postoperative neutrophil-lymphocyte ratio (PP-NLR) and Glasgow prognosis score (GPS) in prognostic assessment of GBC. 
Methods: The clinical data of 140 patients with GBC treated from January 2005 to December 2015 were retrospectively analyzed. The cut-off values of NLR before and after operation were determined by ROC curve, based which, the NLR value was assigned as 1 if it was increased, or as 0 if not, and the PP-NLR value was defined as the sum of the two assigned values and was 0, 1 and 2, respectively; the preoperative serum albumin <35 g/L and preoperative CRP >10 g/L were assigned as 1 respectively and were assigned as 0 if not, and GPS value was defined as the sum of the two assigned values and was 0, 1 and 2, respectively. The relations of PP-NLR and GPS with the prognosis and clinicopathologic factors of the patients were analyzed by Kaplan-Meier method, Log-rank test and univariate analysis, respectively. The correlations of PP-NLR and GPS with the clinicopathologic factors were determined by Spearman correlation analysis. The independent prognostic factors were determined by multivariate Cox hazard model. 
Results: The cut-off values of NLR before and after operation determined by ROC curve were 2.51 (sensitivity: 0.961, specificity: 0.788) and 2.38 (sensitivity: 0.745, specificity: 0.712). Survival analysis showed that the survival rates were significantly different among patients with different PP-NLR and GPS levels (all P<0.05), which presented a successive decrease in PP-NLR=1, PP-NLR=2 and PP-NLR=3 group, and was significantly higher in GPS=0 group than those in GPS=1 group or GPS=2 group (both P<0.05), but had no significant difference between GPS=1 group and GPS=2 group (P>0.05). Univariate analysis suggested that both PP-NLR and GPS were related to the radical resection rate, tumor invasion, lymph node or distal metastases, TNM classification and degree of differentiation as well as the inflammatory indexes and tumor markers (all P<0.05). The correlation analysis indicated that PP-NLR and GPS were significantly correlated to the radical resection rate, tumor invasion, lymph node or distal metastases, TNM classification and degree of differentiation (all P<0.05). Univariate analysis demonstrated that both the increased PP-NLR and GPS were significantly associated with low survival rate (both P<0.05), and multivariate analysis revealed that PP-NLR was an independent risk factor affecting the prognosis of the patients (PP-NLR=1: HR=0.357, 95% CI=0.221–0.575, P<0.05; PP-NLR=2: HR=0.357, 95% CI=0.221–0.575, P<0.05). 
Conclusion: Both PP-NLR and GPS are related to the prognosis of GBC patients, and PP-NLR is an independent prognostic factor, suggesting that peripheral blood parameters PP-NLR and GPS can easily, quickly and effectively assess the prognosis of the patient. In addition, PP-NLR integrates the pre- and postoperative systemic inflammation and immune status, so it is more comprehensive and reliable that that GPS and preoperative or postoperative NLR alone for prediction, and can provide a theoretical basis for follow-up treatment. 

Abstract:Background and Aims: Studies have confirmed that the extracts of Eucommia ulmoides have anti-inflammatory and antioxidant effects, and offer a protective effect against organ ischemia-reperfusion injury. However, the pharmacological effects will vary among the extracts from different parts of Eucommia ulmoides and by different extraction methods. This study was conducted to compare the protective effects of the extracts from Eucommia bark and bark as well as by different extraction methods on liver ischemia-reperfusion injury (HIRI), so as to provide reference for the prevention and treatment of HIRI in clinical practice.  
Methods: Forty-eight male SD rats were equally randomized into sham operation group, HIRI model group, and 4 different pretreatment groups. Rats in the 4 pretreatment groups underwent gavage with Eucommia bark water extract, Eucommia bark ethanol extract, Eucommia leaf water extract and Eucommia leaf ethanol extract, respectively, once per day, for 10 d, and the concentration of each extract was 80 g crude drug/kg. Rats in sham operation group and HIRI model group were given the saline of the same volume in the same fashion. On the 11th day, except the rats in sham operation group HIRI was induced in all rats in the other groups by means of 1-h occlusion of the blood supply for the left hepatic lobe and the middle hepatic lobe followed by 4-h reperfusion. After that, the specimens of left hepatic lobe and blood sample from the inferior vena cava were harvested. Then, the pathological changes of the liver were observed by HE staining, and the serum liver function parameters alanine aminotransferase (ALT) and aspartate aminotransferase (AST), and the inflammatory index tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) as well as the oxidative stress variables malondialdehyde (MDA) and superoxide dismutase (SOD) in the liver tissue were determined. 
Results: Except the sham operation group, pathological changes of the liver tissue of different degrees were presented in all remaining groups of rats, but the liver injuries were milder in all pretreatment group that that in HIRI model group, particularly in Eucommia leaf ethanol extract pretreatment group. Compared with sham operation group, the activities of serum ALT and AST were significantly increased, the TNF-α and IL-1β levels and MOD concentrations in the liver tissue were significantly increased, while the SOD activities in the liver tissue were significantly decreased in HIRI group and all pretreatment group, but the changing amplitudes in all above parameters were lower in each pretreatment group than those in HIRI group, particularly those in  Eucommia leaf ethanol extract pretreatment group (all P<0.05). 
Conclusion: The extracts from different parts of Eucommia ulmoides and by different extraction methods all have protective effects against HIRI, especially, the ethanol extract from Eucommia leaves has most evident protective effect, suggesting that the flavonoids in the Eucommia leaves is the most effective compounds against HIRI, which deserves to be further explored and developed.

Abstract:Background and Aims: Long non-coding RNAs (lncRNAs) participate in a series of biological process such as cell proliferation, apoptosis, cell cycle control, cell development and differentiation, and their differential expressions are closely related to the occurrence and development of tumors. LncRNA RAB1A-2 (RAB1A-2) is an activator for MTORC1, and was found to be attributed to aberrant DNA amplification, cell proliferation and invasion in lung cancer cells. For further understand its biological functions, this study was conducted to investigate the expression and function of RAB1A-2 in gastric cancer.
Methods: The expressions of RAB1A-2 in 68 pairs of gastric cancer samples along with their adjacent noncancerous tissues, as well as in three gastric cancer cell lines (MKN-45, BGC-823, SGC-7901) and normal gastric mucosa cell line (GES-1) were detected by qRT-PCR. The relations of the expression of RAB1A-2 with clinicopathologic factors of gastric cancer patients were analyzed. The relationship between the expression of RAB1A-2 and prognosis was determined by Kaplan-Meier survival analysis. Gastric cancer SGC-7901 cells were transfected with si-RAB1A-2 (RAB1A-2 interference group), RAB1A-2 mimics (RAB1A-2 mimics group) and negative control sequences (negative control group), respectively. Then, the cell proliferation, apoptosis, and cell invasion ability were tested by MTT assay, flow cytometry, and Transwell assay, respectively.
Results: The results of qRT-PCR showed that expression levels of RAB1A-2 in gastric cancer tissue was significantly higher than that in adjacent noncancerous tissues, and in the three gastric cancer cell lines were significantly higher than that in normal gastric mucosa cell line (all P<0.05). The expression of RAB1A-2 was significantly associated with tumor size, T classification, N classification and TNM stage (all P<0.05). Survival analysis showed that both 3- and 5-year overall survival rates in patients with high RAB1A-2 expression were lower than those in patients with low RAB1A-2 expression group (both P<0.05). Compared with the SGC-7901 cells in negative control group, the A450 nm values at 24, 48 and 72 h after transfection were significantly increased in the SGC-7901 cells in RAB1A-2 mimics group, and were significantly decreased in the SGC-7901 cells in RAB1A-2 interference group (all P<0.05); the apoptosis rate was significantly reduced in the SGC-7901 cells in RAB1A-2 mimics group and was significantly increased in the SGC-7901 cells in RAB1A-2 interference group (both P<0.05);  the number of invading cells was significantly increased in the SGC-7901 cells in RAB1A-2 mimics group and was significantly reduced in the SGC-7901 cells in RAB1A-2 interference group (both P<0.05).
Conclusion: RAB1A-2 expression is up-regulated in gastric cancer tissue and cells, and RAB1A-2 can promote the proliferation and invasion of gastric cancer cells and inhibit apoptosis. The gastric cancer patients with high RAB1A-2 expression may face a poor prognosis. 

Abstract:Background and Aims: Early postoperative recurrence is the main factor affecting the prognosis of hepatocellular carcinoma (HCC) patients. This study was conducted to investigate the risk factors for early recurrence in HCC patients after hepatectomy and establish an evaluation model, so as to provide basis for predicting recurrence risk and improving prognosis. 
Methods: The clinical data of 225 patients with HCC treated in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology between 2011 and 2016 were retrospectively analyzed. The occurrence of early postoperative recurrence (recurrence with 2 years after hepatectomy) among the patients were analyzed. The independent risk factors for early recurrence were determined by Logistic regression model, the efficiencies of the variables in predicting the early recurrence were evaluated by receiver operating characteristic curve (ROC) and area under curve (AUC), and the risk scoring model for early recurrence was established by Cox regression equation.
Results: Among the 225 patients, early postoperative recurrence occurred in 130 cases (57.8%). Tumor number, γ-glutamyl transpeptidase (γ-GT), and neutrophil-lymphocyte ratio (NLR) were independent risk factors for early postoperative recurrence in HCC patients (all P<0.05). The AUC of serum γ-GT, NLR and the combination of γ-GT and NLR for prediction early postoperative recurrence were 67.6%, 59.1% and 70.4%, respectively. After risk scoring model was created by incorporating tumor number, γ-GT and NLR into the regression equation, a code of 1 was assigned to γ-GT >108 U/L, 2 was assigned to NLR>2.11, and 3 was assigned to tumor number >1, otherwise 0 was assigned, according to the HR values. The possible score given bythe risk scoring model ranged from 0 to 6. According to this model, the 1-, 3- and 5-year disease-free survival rates were 76.9%, 44.5% and 32.8% in patients in low risk group (score <3), and were 33.4%, 20.1%, and 6.69% in patients in high risk group (score ≥3), and the difference had statistical significance (P<0.001).
Conclusion: Tumor number, γ-GT and NLR are independent risk factors for early postoperative recurrence in HCC patients. The established prediction model can be used for stratifying the risk of early recurrence in HCC patients, and thereby may help choose an appropriate treatment plan to improve the prognosis of the patients.

Abstract:Background and Aims: Ischemic colitis (IC) is a common type of ischemic bowel disease, and is also a condition with difficult clinical diagnosis. The early misdiagnosis rate is high, and some patients will rapidly deteriorate after onset, with high associated mortality. This study was conducted to summarize and analyze the clinical characteristics of IC, so as to provide a reference for the its diagnosis and treatment in clinical practice. 
Methods: The clinical data of 101 IC patients treated in Xiangya Hospital of Central South University from January 2010 to September 2019 were reviewed. The general features, clinical manifestations, endoscopic findings and outcomes of the patients were analyzed, and the clinical characteristics between different age groups of patients were also compared. 
Results: All patients had the first onset of IC, of whom, 62 cases (61.4%) were females; age ranges from 45 to 93 years old, with an average age of (63±8.8) years, and with age of 45 to <60 years in 39 cases (middle-age group) and ≥60 years in 62 cases (old-age group). The main symptoms of the patients were hematochezia, lower abdominal pain, nausea and abdominal distension. The main colonoscopic findings were mucosal erythema, edema, vascular pattern abnormalities, erosion and ulceration. Left colon involvement was found in 69 cases (68.3%), right colon involvement was found in 7 cases (6.9%), and extensive colon involvement was in 25 cases (24.8%), respectively. Eighty-one patients (80.2%) underwent abdominal vascular examination, of whom, vascular stenosis or thrombosis formation was detected in 25 cases (30.9%), simple arteriosclerosis was noted in 14 cases (17.3%) and 42 cases (51.8%) showed no obvious abnormity. Most of the patients received conservative medical treatment only, the time for symptom relief was 1 to 35 d, with an average time of (9.5±4.3) d. There were no significant differences in sex composition, location of colon involvement, time for main symptom relief, and total cure rates between old-age group and middle-age group (all P>0.05); the proportions of cases with history of hypertension, coronary heart disease and cerebral vascular disease were higher, and the proportions of cases with stenosis and arteriosclerosis of celiac arteries in old-aged group were higher than those in middle-age group (all P<0.05).
Conclusion: IC occurs frequently in elderly individuals, with a high prevalence in women. The main symptoms are lower abdominal pain and blood in stool, and the left colon is the most affected location. Timely colonoscopy is helpful for making definite diagnosis of IC. Currently, the main treatment modality for IC is conservative treatment based on internal medicine. Elderly IC patients always have underlying health conditions, with poor abdominal vascular conditions, for whom, correct diagnosis as well as early diagnosis and treatment are important for improving the prognosis.

Abstract:Background and Aims: Pancreatic head cancer is the most common type of pancreatic cancer, and pancreaticoduodenectomy (PD) is the main surgical procedure for the treatment of pancreatic head cancer. However, the high incidence of complications and poor postoperative recovery are still the difficult problems in the field of general surgery. Enhanced recovery after surgery (ERAS) is an innovative concept in perioperative management of surgery developed in recent years, it has been proven to reduce postoperative complications and speed up postoperative recovery. However, the ERAS concept has not been widely implemented in PD. Thus, this study was designated to investigate the effects of using ERAS protocol on postoperative recovery and nutritional status in patients undergoing PD for pancreatic head cancer, and evaluate its application value.  
Methods: A total of 62 patients with pancreatic head cancer scheduled to undergo PD from May 2015 to May 2019 were enrolled. Using a random number table, the patients were randomly divided into ERAS group and control group, with 31 cases in each group. Patients in ERAS group received intervention measures guided by ERAS concept during perioperative period, while those in control group were treated with conventional perioperative management. The intraoperative variables, postoperative recovery parameters, incidence rates of postoperative complications, and changes in nutritional status indexes were compared between the two groups of patients. 
Results: There were no significant differences in preoperative general data and nutritional status indexes that included transferrin (TRE), prealbumin (PAB) and albumin (ALB) between the two groups of patients (all P>0.05). There were no significant differences in intraoperative blood loss, amount of the intraoperative infusion and operative time between the two groups of patients (all P>0.05). The time to first postoperative passage of flatus, first defecation and time to ambulation in ERAS group were significantly earlier than those in control group (all P<0.05). No significant differences were noted in the incidence rates of pancreatic fistula, infection, anastomotic fistula and delayed gastric emptying (all P>0.05), but the overall incidence of postoperative complications in EARS group was significantly lower than that in control group (6.45% vs. 32.26%, P<0.05). The serum levels of TRE, PAB and ALB were significantly decreased on the postoperative day 3 in both groups, but the decreasing amplitudes of them in ERAS group were significantly lower than those in control group (all P<0.05). 
Conclusion: ERAS strategy offers a good effect in patients with undergoing PD for pancreatic head cancer. It can accelerate postoperative recovery, improve the nutritional status of patients and reduce postoperative complications. So, it is recommended to be widely used in clinical practice.

Abstract:Gallstone is one of the most common and frequently-occurring diseases of the digestive system in clinical practice. It is a disease of the biliary system affected by many factors such as genetics, environment and food preferences. It has many pathogenic factors, and its clinical symptoms are varied, and mainly characterized by the right upper abdominal pain. With the social progress and the improvement of people's living standards, the incidence of this condition is on the rise. At present, there are growing number of studies on drug and surgical treatment of gallstones, but the problems such as high recurrence rate and many complications are still unsolved. Recent studies have shown that the metabolites of intestinal flora short-chain fatty acids have a certain effect on the formation of cholesterol gallstones. In this paper, the authors address the relationship between the butyrate, one of the short-chain fatty acids, and the formation of cholesterol gallstones.

Abstract:Cholelithiasis is a common and frequently-occurring disease worldwide. Its pathogenesis is a complex process involving both genetic and environmental factors, and has not yet been fully elucidated. The studies of human microbiome discovered that the microecosystem of the gastrointestinal tract participates in maintaining multiple physiological functions, and its imbalance is also related to the pathogenesis of many diseases. Numerous studies on cholelithiasis in recent years suggested that the gastrointestinal tract microecology plays an important role in its pathogenesis. Here, the authors address the relationship between the gastrointestinal tract microecology and cholelithiasis from the perspectives of the role of the gastrointestinal tract microecology in human microecology, the general research situation of the pathogenesis of cholelithiasis, and the relations of biliary microecology and intestinal microecology with cholelithiasis.

Abstract:The liver depends on two mechanisms—hepatocyte self-renewal and proliferation and differentiation of the hepatic oval cells (HOCs) to obtain the repair of liver injury. HOCs are a group of hepatic stem cells with multipotent differentiation potential, and play an important role in liver regeneration. The regeneration ability of the hepatocytes in the cirrhotic liver is low, and HOCs participate in the repair and reconstruction of liver damage. The activation, proliferation and differentiation of HOCs are closely associated with the liver cirrhosis microenvironment. So, the in-depth study on the mechanism of the HOCs-mediated liver regeneration in liver cirrhosis and their advantages in cell transplantation in liver cirrhosis will provide a new strategy for the treatment of end-stage liver cirrhosis. Here, the authors address the general features of the HOCs and the research progress regarding such as their function in the liver cirrhosis microenvironment and the regulation of the liver cirrhosis microenvironment in HOCs-mediated liver regeneration.

Abstract:The formation of portal vein system thrombosis (PVST) after laparoscopic splenectomy has a high incidence, concealment and harmfulness. However, the optimal diagnosis, treatment plan and predictive factors for PVST formation after laparoscopic splenectomy have not yet reached an agreement either at home or abroad. At present, the mechanism for PVST after splenectomy may be related to blood hypercoagulability and hemodynamic changes, and the major causes for its formation are the systemic system diseases and the factors contributing to the hemodynamic changes. Systemic diseases include malignant tumors, hematological diseases, autoimmune diseases, etc. The factors causing hemodynamic changes include surgical methods and operation duration, plasma D-dimer, platelet count, spleen volume and its maximum diameter, preoperative splenic vein diameter and portal vein diameter. Here, the authors summarize the research results related to the predictors for PVST formation after laparoscopic splenectomy for portal hypertension, so as to provide convenience for clinicians to predict the formation of PVST after laparoscopic splenectomy, thereby to more accurately capture the timing of anticoagulation and reduce severe consequences of this condition, and meanwhile accelerate the postoperative recovery of the patients.