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Objective:To investigate the expression and significance of human ether-a-go-go related gene (HERG) protein in interstitial cells of Cajal (ICC) in patients with gallbladder stones.Methods:The gallbladder tissues of 60 patients with gallbladder diseases who underwent cholecystectomy from January 2018 to December 2020 in the Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital were collected, including 36 males and 24 females, aged (46.0±14.0) years. They were divided into two groups according to whether there were gallstones: gallstone group and control group (patients with gallbladder polyps and gallbladder adenomyosis), with 30 cases in each group. Color ultrasound was used to detect and calculate the gallbladder contraction rate. The neck, body and bottom tissues of the gallbladder were excised and sectioned. The expression of HERG protein and CD117 ( marker of ICC) was detected by immunofluorescence staining, immunohistochemistry and Western blot.Results:The gallbladder contraction rate in the gallstone group was (65.8±4.1)%, lower than that in the control group (73.8±5.3)%, with a statistically significant difference ( t=4.14, P<0.001). Immunohistochemistry showed that HERG protein was mainly distributed in the mucosal layer of gallbladder tissue, which was pale brown. The relative expression of HERG protein at the bottom of gallbladder in the gallstone group was (0.293±0.102), lower than that in the control group (0.694±0.059), with a statistically significant difference ( t=3.38, P=0.027). Immunofluorescence staining showed that HERG protein was mainly distributed in ICC of gallbladder epithelium. HERG protein expression in ICC at the bottom of gallbladder in gallstone group was lower than that in control group, while HERG protein expression at the neck and body of gallbladder had no significant difference. Conclusion:There are ICC and HERG protein in gallbladder tissue of patients with gallstone. The decrease of gallbladder contraction rate may be related to the decrease of HERG protein expression in ICC in gallbladder bottom tissue.
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Objective To study the surgical treatment of hepatic hemangiomas and the timing of surgery.Methods A retrospective study was conducted on 908 patients with giant hemangiomas who underwent surgery between December 1997 and December 2017.The clinical data,surgical indications,surgical outcomes,lesion size,and the effect of TAE were compared.Results The diameter (mean + /-S.D.)of the resected hepatic cavernous hemangiomas was (11.1 ± 6.2) cm (the longest diameter was 60 cm).585 patients (64.4％) underwent enucleation of hepatic hemangiomas and 323 patients (35.6％) underwent anatomical hepatectomy.Six patients died perioperatively (mortality rate 0.7％).The incidence of severe complication (Clavien-Dindo grade 3 ～ 5) was 3.8％.The incidence of severe postoperative complication for enucleation (2.7％) was significantly less than anatomic liver resection (5.6％,P ＜0.05).When the lesion was more than 20 cm,the complication and mortality rates were significantly higher than those less than 20 cm (P ＜ 0.05).The complication and mortality rates in patients who underwent TAE before surgery were significantly higher than those without TAE (P ＜ 0.05).Conclusions Surgical enucleation of hemangiomas was superior to anatomical hepatectomy.With increase in tumor size,the risk of surgery increased.Surgical treatment was safe and effective for giant hepatic hemangiomas.For giant hepatic hemangiomas with significant increase in size,prompt surgical treatment is recommended.
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Objective To provide the practical experience of association of liver partition and portal vein ligation for staged hepatectomy(ALPPS) procedure in portal vein tumor thrombosis(PVT) cases,and to explore its value in PVTT therapy.Methods Three cases of ALPPS were applied to PVTT in Department of Hepatobiliary Surgery of PLA General Hospital from 2015 to 2016.The patients data were retrieved and analyzed retrospectively,including the basic information,preoperative PVTT classification,preoperative Child-Pugh classification,ICG test results,future liver remnant (FLR),FLR growth rate between 2 phase operation,operation time,bleeding volume,postoperative complications,postoperative survival etc.We discussed the detail technology and discuss the surgical procedure combine our experience and the published papers.Results ALPPS was performed successfully in all 3 patients.According to the Cheng's Classification of PVTT,they were classified as type Ⅱ,1 case and Ⅲ type,2 cases.Preoperative liver function was Child-Pugh A grade,average ICG R15 was 7.3％ (4.2％-11.0％),and average FLR was 387 ml (333-484 ml).The mean time interval between 2 phases surgery was 24.7 days (9-50 days) and the average FLR growth rate was 50.3％ (24.4％-82.3％).Morbidity of Clavien-Dindo Ⅲ or more was recorded in 1 case,but no mortality occurred.During follow-up period,2 patients were treated with TACE for tumor recurrence.All patients survived with acceptable life quality till now.The portal vein tumor thrombosis necrosis was observed in all 3 specimens.Conclusions ALPPS is a valuable surgery for effective control of tumor thrombus and radical resection rate in well selected PVVT type Ⅱ and type Ⅲ patients.It is expected to improve the therapeutic effect in combination with TACE and other treatment methods.
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Objective To explore the feasibility,safety and efficacy of laparoscopy assisted ultrasound guided radiofrequency ablation (RFA) in the treatment of hepatocellular carcinoma (HCC) beneath the diaphragm.Methods Twentythree consecutive patients with solitary HCC beneath the diaphragm were treated by laparoscopy assisted ultrasound guided RFA in the Chinese PLA General Hospital from January 2013 to March 2016.We observed the p erioperative complications and followedup long-term effect.Results All the 23 patients successfully underwent laparoscopy assisted ultrasound guided radiofrequency ablation.No serious complications such as massive hemorrhage,biliary fistula and severe pleural effusion,hemopneumothorax occurred in the patients during perioperative period.CT examination 2-3 days after the operation revealed that the tumor was completely covered by the ablation area.Besides,the survival condition was satisfactory during follow-up period of 9-38 months.Conclusion Laparoscopy-assisted ultrasound-guided radiofrequency ablation is effective and safe for HCC beneath the diaphragm.
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Objective To investigate several related problems possibly affecting the measurement results in the experiment of 125I-FSH in vitro cells uptake by domestic GC-1200 gamma RIA counter.Methods Before entering the measuring room,the sample was performed the background measurement.CPM measured in the different locations of same measurement frame and the different locations in unmeasured area were performed the statistical comparison.Results In high count,the influence of single sample reaching 1.9 ×106CPM on the adjacent low counting tube count was 7%;its influence on low counting tube count in adjacent detector was 7.33%;all samples were arranged from high to low order and the high count sample holder was placed on the measured location close to the detector,its influence on low counting tube count was 5.33%.Conclusion The domestic GC-1200 γ RIA counter is suitable for the measurement of the in vitro cell uptake experiment of 125I nuclear labeling.
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Objective To observe the impact of RNA interference-induced ADAR1 down-regulation on cell proliferation of liver cancer.Methods Small interfering RNA (siRNA) was transfected into liver cancer cell line SMMC-7721.ADAR1 expression was detected by RT-PCR and Western blotting.Cell proliferation was determined by methyl thiazol tetrazolium (MTT) assay.Results After transfection for 24,48,and 72 h,ADAR1 mRNA expression was 0.612 ± 0.086,0.264 ± 0.018,0.156 ± 0.063 in experimental group and 1.032 ± 0.107,0.898 ± 0.092,0.968 ± 0.074 in control group,respectively.Experimental group had significantly lower ADAR1 mRNA than the other groups (P ＜ 0.05),and there was no statistically significant difference between control and blank group (P ＞ 0.05).ADAR1 protein relative expression was 0.684 ± 0.079,0.324 ± 0.042,0.145 ± 0.058 in experimental group and 1.002 ± 0.092,0.917 ± 0.068,0.972 ± 0.073 in control group,respectively,which was statistically significant (P ＜ 0.05).After transfection with siRNA,the proliferation ability of SMMC-7721 cells was enormously inhibited (P ＜ 0.05).Conclusion ADAR1 mRNA and protein level could be significantly decreased by specific RNA interference,and cell proliferation in SMMC-7721 cells were also greatly inhibited.
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Objective To study the pathogenesis of upper gastrointestinal rehaemorrhagia after the transjugular intrahepatic portasystemic shunt (TIPS) and its influencing factor.Methods Fifty postoperative patients with TIPS were selected.The patients were followed-up,and the effect of the various factors in the role of upper gastrointestinal rehaemorrhagia after TIPS was analyzed.Results The portal vein pressure of 50 patients with TIPS decreased from preoperative (39.8 ±9.2) cmH2O (1 cmH2O =0.098 kPa) to postoperative (25.2 ± 5.8) cmH2O,and there was statistical difference (P ＜ 0.05).Fourteen patients appeared upper gastrointestinal rehaemorrhagia after TIPS,which accounted for total of 28％ (14/50) and included 3 cases of postoperative vomiting blood within 3 days.Acute stomach mucosa lesions bleeding was considered,and bleeding was controlled within a short-term medical treatment (1 patient after more than a year in recurrent upper gastrointestinal rehaemorrhagia).Twelve cases of patients appeared upper gastrointestinal rehaemorrhagia within 2 years after TIPS,and the causes of rehaemorrhagia in 6 cases were esophageal variceal rehaemorrhagia,gastric and duodenal ulcer in 3 cases,erosive gastritis in 2 cases,coagulation abnormalities in 1 case.Esophageal variceal rehaemorrhagia rate was 12％ (6/50).Conclusions The main reasons of upper gastrointestinal rehaemorrhagia after TIPS are variceal rehaemorrhagia and non variceal rehaemorrhagia,both of which are important causes of rehaemorrhagia after TIPS.Variceal rehaemorrhagia after TIPS occurs more than 3 months,and non variceal rehaemorrhagia occurs within 3months,so it is very important to protect gastric mucosa with proton pump inhibitor in postoperative patients.
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Objective To introduce a novel technique of intracolonic shunt procedure used in the anus - preserving operation for acute intestinal obstruction resulted from cancer at low and middle portions of rectum and assess the clinical significance. Methods In total, 81 patients with acute obstruction of low and middle portion of rectum caused by cancer were randomly ( random number) divided into control group and study group. In control group, 42 patients were operated with preventive transverse colonostomy or terminal ileum stoma after low proximal resection of rectum involved in cancer, while 39 patients were operated with intracolonic shunt procedure by using a biodegradable anastomosis ring and a condom placed 5 cm above anastomosis for protection in study group. Results There were no significant differences in sex, age, tumor site, tumor size and the distance from anstomosis to anal-edge between two groups. In both groups, the bowel movement resumed in 2 ~ 5 days after operation (P > 0.05). In study group, the rate of anastomosis leakage was 7.7% (3/39), and leakages were treated with drainage for 7.1 days in average to be healed, and the biodegradable anastomosis ring detached and were discharged in 14 -23 days (17 days in average), and there were no complications of drainage happened. The anastomotic stenosis occurred in three patients (7. 7% ) within 6 months after operation. In control group, 11.9% patients (5/42) had anastomosis leakage and they treated with drainage for 18.2 days in average to get the leakage healed, and 35. 7% patients (15/42) had stoma complications, and anastomotic stenosis happened in 28.6% patients (12/42) within 6 months after operation, and 7. 1% patients need another operation because of severe anastomosis stenosis. There were no significant differences in rate of anastomosis leakage between tow groups ( P > 0. 05), but there were significant differences in drainage days after anstomosis leakage happened and 6 - months anastomosis stenosis between two groups (P<0.05). Conclusions In the anus -preserving operation for acute intestinal obstruction at low and middle portions of rectum caused by cancer , the intracolonic shunt procedure is convenient and safty, and reduces the hazard incurred by anastomosis leakage and anastomosis stenosis compared with classic stoma operation.
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Objective To evaluate the outcome of living donor liver transplantation(LDLT)for hepatocellular carcinoma(HCC).Methods We retrospectively analyzed the clinical data of 180 patients,who had received LDLT(n=34)or deceased donor liver transplantation(DDLT,n=146)for HCC,compared overall and recurrence-free survival between LDLT and DDLT,and identified the risk factors of tumor recurrence and prognosis by univariate and multivariate analysis.Results The 5-year overall survival and recurrence-free survival rate were 53 % and 58 %,respectively,in DDLT group,and 60 % and 60 %,respectively,in LDLT group.There was no significant difference in overall (P=0.85)and recurrence-free(P=0.89)survival between these two groups.The tumor recurrence rate was 26.5 % in LDLT group,and 17.8 % in DDLT group,respectively(P=0.25).Multivariate COX regression model analysis identified vascular invasion(relative risk 2.118,95 % confidential interval 1.201-4.353,P=0.032)and tumor beyond UCSF criteria(relative risk 3.490,95 % confidential interval 1.862-8.207,P=0.015)as independent risk factors of tumor recurrence,and tumor beyond UCSF criteria(relative risk 8.573,95 % confidential interval 3.016-18.261,P=0.006)as independent predictors of prognosis.Conclusion LDLT is a safe and effective procedure for patients with HCC,but further studies are required for selection criteria of recipients and higher HCC recurrence rate after LDLT.
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Objective To study the mechanism of the hyperuricemia among the middle and elderly populations. Methods Serum uric acid, creatinine (Cr), blood urea nitrogen (BUN), fasting gluose (FG), total cholesterol (TC), triglyceride (TG) were detected in 1073 subjects with hyperuricemia and 1235 subjects with normal serum uric acid as control of middle and elder groups. Results The means of Cr, BUN, FG, TG ,TC in hyperuricemia were significantly higher than those in the control group,respectively (males: t′ =7. 508,P ＜0.05;t′ =9. 484,P ＜0.05;t=6.208,P＜0.05;t′ =7.055,P ＜0.05;t = 5. 097,P ＜0.05;females;t′ = 11.221,P ＜0.05;t′= 8.314,P ＜0.05 ;t =5. 641 ,P ＜0.05 ;t′ =8. 328 ,P ＜0.05 ;t =7. 227 ,P ＜ 0.05). In males,the mean of the BUN; FG and TG were significant different among the different age groups (the control group: F = 3. 500, P ＜ 0.05; F = 5. 607, P ＜0.05 ;F =3. 378,P ＜0.05 ;the hyperuricemia group: F= 15.400,P ＜0.05 ;F =5. 111 ,P ＜0.05 ;F = 11. 143 ,P ＜0.05), the positive rate of BUN, Cr, FG and TG were significant different among the different age groups (control group:χ2 = 17. 112,P ＜ 0.05;χ2 =7. 807,P ＜0.05 ;χ2 = 17. 829,P ＜0.05;χ2=8.433,P ＜0.05; hyperuricemia group:χ2 =35. 587,P ＜0.05 ;χ2 =83. 005 ,P ＜0.05 ;χ2 =41. 639,P ＜0.05 ;χ2 =31. 466,P ＜0.05). In the same age group,the mean and the positive rate of BUN and Cr were significantly higher in the hyperuricemia group than in the control group(P ＜ 0.05). The mean of TG was significantly higher in every age group of the hyperuricemia group than controls (P ＜ 0.05), but the positive rate had no significant differences in the age group of ≥ 70 years (P ＞0.05). The mean and the positive rate of FG and TC were significant differences in middle age group between the hyperuricemia and the control group (P ＜ 0.05), but were no differences in elder age group(P ＞ 0.05). In females,the mean and positive rate of Cr, BUN, FG,TG and TC were significant different in different age groups of the controls(BUN:F = 13. 759,P ＜0.05;χ2 = 19. 491 ,P ＜0.05; FG: F = 13. 554,P ＜0.05;χ2 = 33. 438,P ＜0.05;TG:F= 18. 160,P ＜0.05;χ2 = 16. 978,P ＜0.05;TC: F = 37. 647,P ＜0.05;χ2 =60.547,P ＜0.05) ,but in the hyperuricemia group that were only significant difference in BUN, Cr and TC (BUN:F = 5. 830, P ＜ 0.05; χ2 =11.941,P＜0.05;Cr:F=4.057,P ＜0.05;χ2 =20.097,P＜0.05;TC:F=7.934,P ＜0.05;χ2 = 16.405,P ＜0.05). In same age group compared of all the indices were similar with male. Conclusions The mechanism of serum uric acid increasing are different in middle age and elderly age. In middle age, it is metabolic disturbance. However,in elderly age it is descending of the kidney function.
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Objective To investigate the effects of hepatic pedicle exclusion and low central venous pressure (LCVP) on blood loss in right lobe tumor resection and evaluate its influence on hepatic and renal function. Methods Forty-eight patients with right lobe tumor admitted from December 2006 to June 2008 were randomly allocated to the LCVP group (23 cases) and routine hepatectomy, (control group 25 cases). During the parenchymal transection phase of surgery, CVP < 5 mm Hg ( 1 mm Hg = 0.133 kPa) and SBP ≥90 mm Hg were maintained in the LCVP group by drugs. However, no special management of CVP and SBP was done in control group. The parenchymal transection blood loss, postoperative hospital stay, postoperative hepatic and renal function changes between two groups were compared, and the incidence of comphcation was also observed. Results There were no significant difference in type of hepatectomy, time of vascular clamping, period of operation, postoperative complication rate, postoperative hepatic and renal functions between two groups. Parenchymal transection blood loss in the LCVP group was significantly lower than that in the control group (326.67 ± 109.13 ) ml vs (538.33 ± 177.07 ) ml, (P < 0.01 ). Postoperative hospital stay in the LCVP group was significantly shorter than that in the control group (8.52 ± 1.78) d vs (9.40±1.68) d, (P < 0.05). Conclusions Hepatic pedicle exclusion and LCVP during hepatectomy is safe. It can reduced blood loss during parenchymal transection and decrease postoperative hospital stay. It is no detrimental effect to hepatic or renal function.