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Robot-assisted laparoscopy hepatectomy (RALH) is a new technique for surgical operation. Compared with conventional laparoscopic hepatectomy, RALH is more frequently used in complex liver tumor and liver tumor with special locations, but this technique is still under development and is limited by the burden of high costs and surgical devices. Meanwhile, there is a lack of generally accepted and confirmed clinical data, and therefore, the role of RALH is still under debate. This article reviews the surgical indication, learning curve, advantages, and limitations of RALH.
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ObjectiveTo investigate the risk factors for open pancreatic necrosectomy (OPN), an effective treatment method for severe acute pancreatitis (SAP) after the failure of percutaneous catheter drainage (PCD), in patients with SAP. MethodsA retrospective analysis was performed for 156 patients with SAP who underwent surgical intervention based on the step-up approach in The Affiliated Hospital of Zunyi Medical University from January 1, 2010 to June 30, 2018, and according to whether OPN was performed, the patients were divided into PCD group with 126 patients and PCD+OPN group with 30 patients. Related clinical data were collected, including age, sex, etiology, blood calcium on admission, white blood cell count on admission, whether CTSI score was ＞7, APACHE-Ⅱ score, Ranson score, presence or absence of peripancreatic fluid accumulation, presence or absence of infection, presence or absence of multiple organ failure (MOF), and whether PCD was performed at more than 1 week after admission. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups; a multivariate logistic regression analysis was used to determine the independent predictive factors for OPN. ResultsThe probability of OPN was 19.2% for SAP patients in the later stage. Compared with the PCD+OPN group, the PCD group had a significantly lower proportion of patients with MOF on admission ［27.0% (34/126) vs 70.0% (21/30), χ2=19.642, P＜0.01］ and a significantly higher proportion of patients undergoing PCD at less than 1 week after admission ［61.9% (78/126) vs 20.0% (6/30), χ2=17.121, P＜0.01］. MOF on admission (odds ratio ［OR］=5.343, 95% confidence interval ［CI］: 1.832-15.583, P＜0.05), initial PCD performed at more than 1 week after admission (OR= 5.518, 95% CI: 1.742-17.477, P＜0.05), and infection on admission (OR=5.016, 95% CI: 1.322-19.378, P＜0.05) were independent risk factors for subsequent OPN in SAP patients. ConclusionSAP with MOF on admission, initial PCD performed at more than 1 week after admission, and SAP with infection on admission are independent risk factors for subsequent OPN in SAP patients undergoing PCD in the early stage based on the step-up approach. Timely identification of related risk factors helps to grasp the timing of OPN in clinical practice and improve the clinical prognosis of SAP patients.
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Hepatic ischemia-reperfusion injury (HIRI) is the main cause of liver damage and even multiple organ failure after complex liver surgery.When liver ischemia reperfusion occurs,the non-coding RNAs in the liver tissue is dysregulated and part of the non-coding RNAs with abnormal expression is involved in HIRI regulation.Non-coding RNAs to may be the intervention target for reducing HIRI.This article summarized the types and related functions of non-coding RNAs,the role of different non-coding RNAs in HIRI,and the interconnections between various non-coding RNAs in HIRI.
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Hepatic ischemia-reperfusion injury is one of the most important factors affecting the prognosis of clinical hepatic surgery. Studies have shown that microRNAs can participate in the process of hepatic ischemia-reperfusion injury through multiple pathways. This article reviews the biosynthesis and function of microRNAs and the mechanisms of action of microRNAs in the regulation of hepatic ischemia-reperfusion injury through energy metabolism, apoptosis, autophagy, oxidative stress, and cellular inflammation. It is pointed out that the treatment targeting microRNAs has a promising future in the treatment of hepatic ischemia-reperfusion injury, and further studies are needed in the future.
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ObjectiveTo investigate the effect of erythropoietin (EPO) on the mRNA expression of apoptosis genes bcl-2 and bax in rats with fatty liver disease after hepatic ischemia-reperfusion injury. MethodsA total of 100 male adult Sprague-Dawley rats were fed with high-fat diet for 12 weeks. After the model was established, the rats with fatty liver disease were randomly divided into sham-operation (SHAM) group, ischemia/reperfusion (IR) group, IR+low-dose EPO group (EPO-1 group), IR+middle-dose EPO group (EPO-2 group), and IR+high-dose EPO group (EPO-3 group). The IR model was established by completely blocking the blood flow in the middle and left lobes of the liver to induce ischemia in 70% of the liver, with an ischemia time of 80 minutes. The rats were sacrificed at 1, 3, and 6 hours of reperfusion after 80 minutes of ischemia, and RT-PCR was used to measure the mRNA expression of bcl-2 and bax in liver tissue. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference test was used for further comparison between two groups. ResultsCompared with the IR group, the EPO-1, EPO-2, and EPO-3 groups had a significant increase in the mRNA expression of bcl-2 and a significant reduction in the mRNA expression of bax at each time point (all P＜0.05). The SHAM group and the EPO groups had a significantly higher bcl/bax mRNA ratio than the IR group at each time point (all P＜0.05). ConclusionEPO exerts a protective effect against hepatic ischemia-reperfusion injury in rats with fatty liver disease, possibly by promoting the mRNA expression of bcl-2 and inhibiting the mRNA expression of bax. High-dose EPO has a better effect than middle- and low-dose EPO.
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High-mobility group box B1 (HMGB1) is a DNA-binding protein widely distributed in eukaryotic cells. When tissue damage occurs, HMGB1 acts as an endogenous risk signal to activate the body’s immune system and mediate aseptic inflammatory response. Current research findings have shown that HMGB1 plays a key role in hepatic ischemia-reperfusion injury. This article summarizes the recent research advances in the proinflammatory role of HMGB1 in hepatic ischemia-reperfusion and HMGB1 as a target for the treatment of hepatic ischemia-reperfusion injury.
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High-mobility group box B1 (HMGB1) is a DNA-binding protein widely distributed in eukaryotic cells. When tissue damage occurs, HMGB1 acts as an endogenous risk signal to activate the body’s immune system and mediate aseptic inflammatory response. Current research findings have shown that HMGB1 plays a key role in hepatic ischemia-reperfusion injury. This article summarizes the recent research advances in the proinflammatory role of HMGB1 in hepatic ischemia-reperfusion and HMGB1 as a target for the treatment of hepatic ischemia-reperfusion injury.
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Objective To investigate the change of the percentage of Th17 cells and cytokine among hepatocellular carcinoma (HCC) tissues and para-carcinoma tissue and the liver tissue of hepatic hemangio-ma, and to explore its clinical significance. Methods To choose 26 of hepatocellular carcinoma patients between November 2014 and December 2016 and also include 11 cases of hepatic hemangioma as control group. The percentage of Th17cells in HCC tissue and para-carcinoma tissue and the liver tissue of hepatic hemangioma was evaluated by flow cytometric; The levels of IL-6 and IL-17 in HCC tissues, para-carcinoma tissue and the liver tissue of hepatic hemangioma were detected by RT-PCR. Results The ratio of Th17 cells to CD4 cells in peripheral blood of HCC was significantly higher than that in control group (4. 07% ± 0. 68% vs. 1. 39% ± 0. 41% ), P＜0. 05. The ratio of Th17 cells to CD4 cells in patients with hepatocellular carcinoma was significantly higher than that in paracancerous tissues and liver tissues of hepatic hemangioma (4. 76% ± 0. 75% vs. 2. 30% ± 0. 26% vs. 0. 77% ± 0. 31% , P＜0. 05). Multivariate linear stepwise regression analysis of the changes of Th17 cells in patients with HCC and their correlation with clinical parameters showed that Th17 lymphocytes in peripheral blood of patients with HCC were closely related to TNM staging(YTh17 =2. 647 +0. 687TNM. It’s indicated that the level of IL-6 and IL-17 in liver cancer tissues was significantly higher than that of the liver hemangioma in the control group through ELISA ( P＜0. 05). The proportion of peripheral blood Th17 cells to CD4 cells is different in different TNM stages(stage I＜stage II ＜stage III ～IV, the difference was statistically significant. RT-PCR analysis showed that the expression of IL-17, IL-6mRNA in hepatocellular carcinoma was significantly higher than that in adjacent tissues and hepatic hemangioma liver tissue (all P＜0. 05). Conclusion The increased proportion of Th17 cells and the increased levels of cytokines IL-6 and IL-17 may be closely correlated with occurrence and development of hepatocellular carcinoma. It can be an important target of anti-tumor therapy.
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Objective To explore the anti-inflammatory effect of erythropoietin (EPO) on hepatic ischemia reperfusion (IR) injury in fatty liver rats.Methods A total of 100 male SD rats were fed with high-fat diet for 12 weeks.After the model was successfully established,the fatty liver rats were randomly divided into sham-operation (SHAM),the ischemia-reperfusion (IR) and EPO preconditioning group.Serum ALT and AST as well as hepatic histopathological changes were measured.Xanthine oxidase method was used to detect the liver tissue SOD.Thiobarbituric acid method was used to detect the MDA.Enzyme-linked immunosorbent adsorption assay (ELISA) was used to detect the plasma tumor necrosis factor alpha (TNFαt) and interleukin 1 (IL-1).Results In the EPO preconditioning groups the swelling hepatocytes was observed,but the inflammatory cell infiltration was significantly decreased and no necrosis of hepatocytes was found.ALT and AST in the EPO preconditioning groups were significantly lower than those in IR group (P ＜ 0.05).The levels of SOD activity in the EPO preconditioning groups were significantly higher,but MDA were significantly lower than that in IR group (P ＜ 0.05).The TNF-α and IL-1 in the EPO preconditioning groups were significantly lower than those in IR group (P ＜0.05).The values of ALT,AST,TNF-α,IL-1 and MDA in the EPO groups were:EPO-1 ＞ EPO-2 ＞ EPO-3 (P ＜ 0.05);but the values of SOD in the EPO groups were:EPO-1 ＜ EPO-2 ＜ EPO-3 (P ＜ 0.05).Conclusions EPO preconditioning has a protective effect against hepatic IR injury in fatty liver rats,possibly through inhibiting the inflammatory reaction to prevent the IR injury.The anti-inflammatory effect of high-dose EPO is better than that of low-dose EPO.