Risk factors for textbook outcomes of intrahepatic cholangiocarcinoma after hepatectomy / 中华消化外科杂志

Objective:To investigate the risk factors for textbook outcomes (TO) of intra-hepatic cholangiocarcinoma (ICC) after hepatectomy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 155 ICC patients who underwent hepatectomy in the First Affiliated Hospital of Sun Yat-sen University from September 2014 to August 2019 were collected. There were 90 males and 65 females, aged 60(range, 26?82)years. Observation indicators: (1) treatment situations; (2) TO situations; (3) analysis of risk factors for postoperative TO. Follow-up was conducted using outpatient examination and telephone interview to detect postoperative sur-vival of patients up to October 2020. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the independent samples t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test, Yates' calibration chi-square test or Fisher exact probability. The Kaplan-Meier method was used to calculate survival rates and draw survival curves. The Log-rank test was used for survival analysis. The univariate analysis was conducted using the corresponding statistical methods based on data type. The Logistic regression model was used for multivariate analysis. The receiver operating characteristic (ROC) curve was used for evaluating the diagnostic value of indicators (the optimal cut-off value). Results:(1) Treatment situations. Of the 155 patients, 46 cases underwent minor hepatectomy and 109 cases underwent major hepatectomy. Twenty-one of the 155 patients underwent combined bile duct reconstruction. Ninety-five of the 155 patients underwent lymph node dissection, including 41 cases with positive lymph node by postoperative histopathological examinations. The operation time and volume of intraoperative blood loss of the 155 patients were 250.0(range, 95.0?720.0)minutes and 300.0(range, 50.0?15 000.0)mL, respectively. The optimal cut-off values of the operation time and volume of intraoperative blood loss for TO calculated by ROC curve were 247.5 minutes and 325.0 mL, respectively. Of the 155 patients, 44 cases received intraoperative blood transfusion and 10 cases received postoperative blood transfusion (5 cases with intraoperative and postoperative blood transfusion). Seventy-four of the 155 patients had postoperative complications, including 39 cases with mild complications and 35 cases with serious complications. The total duration of hospital stay of the 155 patients was 19 (range, 8?77)days. (2) TO situations. Of the 155 patients, 150 cases achieved R 0 resection, 120 cases had no major postoperative complications, 106 cases had no perioperative blood transfusion, 79 cases had no prolonged duration of hospital stay, 152 cases had no death within postoperative 30 days and 150 cases had no readmission within 30 days after discharge. Of the 155 patients, 56 cases achieved postoperative TO, while 99 patients did not achieve TO. (3) Analysis of risk factors for postoperative TO. Results of univariate analysis showed that preoperative biliary drainage, preoperative Child-Pugh grading of liver function, preoperative asymp-tomatic leukocytosis, preoperative total bilirubin, preoperative alkaline phosphatase, preoperative CA19-9, preoperative CA125, operation time, volume of intraoperative blood loss, tumor diameter, pathological T staging and pathological N staging were related factors for preoperative TO of ICC patients undergoing hepatectomy ( χ2=4.31, 4.31, 4.38, 4.80, Z=?4.15, χ2=10.74, 15.44, 16.59, 27.53, 6.53, 6.77, 9.26, P<0.05). Bile duct reconstruction was also a related factor for postoperative TO of ICC patients ( P<0.05). Results of multivariate analysis showed that preoperative biliary drainage, preoperative asymptomatic leukocytosis, preoperative CA19-9 >35 U/mL, preoperative CA125 >35 U/mL and volume of intraoperative blood loss >325.0 mL were independent risk factors for postoperative TO of ICC patients undergoing hepatectomy ( odds ratio=74.77, 11.73, 2.40,4.86, 6.42, 95% confidence intervals as 1.80?113.39, 1.19?115.54, 1.04?5.53, 1.78?13.26, 2.41?17.11, P<0.05). Conclusions:Preoperative biliary drainage, preoperative asymptomatic leukocytosis, preoperative CA19-9 >35 U/mL, preoperative CA125 >35 U/mL and volume of intraoperative blood loss >325.0 mL are independent risk factors for postoperative TO of ICC patients undergoing hepatectomy.

Risk factors analysis of pancreatic fistula after pancreaticoduodenectomy / 中华消化外科杂志

Objective To investigate the risk factors of pancreatic fistula after pancreaticoduodenectomy.Methods The retrospective case-control study was conducted.The clinicopathological data of 310 patients who underwent pancreaticoduodenectomy in the First Affiliated Hospital of Sun Yat-Sen University between January 2011 and December 2015 were collected.Observation indicators:(1) follow-up situations;(2) risk factors analysis of pancreatic fistula after pancreaticoduodenectorny.Follow-up using outpatient examination and telephone interview was performed to detect occurrence of pancreatic fistula and pancreatic fistula-induced rehospitalization or death up to June 2016.The univariate and multivariate analyses were respectively done using the chi-square test and logistic regression model.Results (1) Follow-up situations:310 patients were followed up for 6-60 months,with a median time of 31 months.During the follow-up,65 patients were complicated with pancreatic fistula,including 59 in grade B and 6 in grade C.Twenty-four patients received conservative treatment,and 41 received B ultrasound-guided catheter drainage.Of 65 patients,63 were improved and then discharged form hospital;2 in grade C of pancreatic fistula died of pancreatic fistula-related complications.(2) Risk factors analysis of pancreatic fistula after pancreaticoduodenectomy:univariate analysis showed that combined hypertension,cases with pancreaticoduodenectomy,operation time and pancreaticojejunostomy method were related factors affecting pancreatic fistula after pancreaticoduodenectomy (x2 =5.986,13.006,9.025,21.561,P＜0.05).The multivariate analysis showed that combined hypertension,operation time ＞ 6 hours and end-to-end telescopic pancreaticojejunostomy or biuding pancreaticojejunostomy were independent risk factors affecting pancreatic fistula after pancreaticoduodenectomy (Odds ratio =2.465,1.880,2.719,6.190,95％ confidence interval:1.253-4.850,1.025-3.448,1.254-5.894,2.309-16.592,P＜0.05).Conclusion The combined hypertension,operation time ＞ 6 hours and end-to-end telescopic pancreaticojejunostomy or binding pancreaticojejunostomy are independent risk factors affecting pancreatic fistula after pancreaticoduodenectomy.

Experimental study on concentrations and pharmacokinetics of antibiotics in bile and evaluation of their microbicidal potential / 中华外科杂志

<p><b>OBJECTIVE</b>To study the concentrations and pharmacokinetics of 6 different kinds of antibiotics in rabbit bile, and evaluate their microbicidal potential.</p><p><b>METHODS</b>Thirty-six health rabbits were randomly divided into 6 groups, and each group was 6 rabbits. After anaesthesia, the common bile duct of rabbit was isolated and cumulated with a silicone tube. The rabbits were administered intravenously with the equal-effect dose of antibiotics. Bile (1.5 ml) was collected at different time points after administration, and the concentration of antibiotics of bile was assayed by high performance liquid chromatography. The bile drug concentration-time data were processed by software to figure out the pharmacokinetic parameters such as maximum concentration (C(max)), peak time (T(max)), half-life time (T(1/2)), clearance (CL) and apparent volume of distribution (VD). The bile antibiotics concentration contrasted to the minimum inhibitory concentration (MIC), and attained the bactericidal index (C(max)/MIC) and the time when the drug concentration exceeded the MIC (T(>MIC)).</p><p><b>RESULTS</b>The C(max) and T1/2 of each antibiotic were as the followings: piperacillin (7 950 ± 3 023) mg/L and (1.97 ± 1.23) h, ceftriaxone (1 104 ± 248) mg/L and (3.14 ± 0.57) h, cefoperazone (5 215 ± 2 225) mg/L and (0.89 ± 0.13) h, meropenem (31.97 ± 12.44) mg/L and (0.36 ± 0.11) h, levofloxacin (66.3 ± 36.9) mg/L and (3.32 ± 2.57) h, metronidazole (28.2 ± 10.2) mg/L and (0.81 ± 0.33) h, respectively. Piperacillin/tazobactam and cefoperazone/sulbactam had the largest bactericidal index and the longest T(>MIC), and their bactericidal indexes were (62.1 ± 23.6) - (993.8 ± 377.9) and (164.8 ± 69.0) - (659.3 ± 275.9), their T(>MIC) were (6.00 ± 2.53) - (8.00 ± 0.00) h and (6.33 ± 1.97) - (8.00 ± 0.00) h. The bactericidal index and T(>MIC) of levofloxacin were the smallest, which were (2.1 ± 1.2) - (8.3 ± 4.6) and (0.54 ± 0.25) - (2.67 ± 1.03) h . Ceftriaxone and meropenem were as the medium, and their bactericidal indexes and T(>MIC) were (4.3 ± 1.0) - (69.2 ± 15.5) , (1.42 ± 0.65) - (8.00 ± 0.00) h and (2.0 ± 0.8) - (1 031.3 ± 401.4) , (0.29 ± 0.10) - (1.83 ± 0.26) h. The bactericidal index of metronidazole to anaerobic ranged from 7.4 to 294.9, and the T(>MIC) ranged from 1.88 to 5.00 h.</p><p><b>CONCLUSIONS</b>The bile concentrations of six antibiotics all exceed their effective bactericidal concentrations. The concentration-time curves of piperacillin, cefoperazone, meropenem and metronidazole conformed to one-compartment model, and ceftriaxone and levofloxacin are conformed to two-compartment model. Piperacillin/tazobactam and cefoperazone/sulbactam have the largest bactericidal index and the longest T(>MIC), so they can be chosen as the first choice for the therapy of hepatobiliary infection.For the anaerobic, the microbicidal potential of metronidazole is high.</p>

Nutritional risks in hospitalized patients with liver diseases and the countermeasures / 现代临床护理

Objective To investigate the nutritional risks in hospitalized patients with liver diseases and work out nursing countermeasures.Methods Forty patients with liver cirrhosis, 40 patients with primary liver cancer and another 40 revisiting after liver transplantation involved in the investigation with a self-designed general information questionnaire and the nutritional risk screening 2002. The three groups were compared in terms of nutritional risks.Results Among the total 120 patients,38.3%(46/120)of them took the nutritional risk and even 12.5%(15/120)had the risk of undernourishment.The risk in the patients with liver cirrhosis was higher than that in the other two groups(χ2=9.899 and 11.4299 and P=0.002 and 0.001,respectively).Conclusions The nursing staffs should pay attention to the nutritional status of patients with liver diseases, especially the patients with liver cirrhosis.It is necessary to take effective measures in order to improve the nutritional status of the patients to reduce the nutritional risks.

Analysis of complications after pancreaticoduodenectomy / 中华消化外科杂志

Objective To investigate the complications and the risk factors of pancreatic fistula after pancreaticoduodenectomy.Methods The clinical data of 339 patients who underwent pancreaticoduodenectomy at the First Affiliated Hospital of Sun Yat-Sen University from January 2000 to Decembcr 2009 were retrospectively analyzed.The risk factors of pancreatic fistula were analyzed.The incidences of complications accured from 2000 to 2004 and from 2005 to 2009 were compared.All data were analyzed by the t test,chi-square test,Fisher exact probability or Logistic regression model.Results The incidence of complications of all patients was 33.0％ ( 112/339),and the incidence of pancreatic fistula was 8.6％ (29/339).Of the 29 patients complicated with pancreatic fistula,6 patients were in grade A,8 in grade B and 15 in grade C.Soft texture of remnant pancreas and the diameter of pancreatic duct smaller than 3 mm were the independent risk factors of pancreatic fistula( OR =1.75,3.75,P ＜ 0.05 ).The number of hospital death was 12,including 1 patient died during the first period (2000-2004) and 11 patients died during the second period (2005-2009).Three patients died of pancreatic fistula and abdominal hemorrhage,3 died of postoperative upper gastrointesitnal bleeding,2 died of cardiac insufficiency,1 died of respiratory failure,1 died of pancreatic fistula,abdominal infection and necrotic pancreatitis,1 died of abdominal hemorrhage and hepatic and renal failure,1 died of bililary fistula,abdominal infection and multiple organ dysfunction syndrome.Conclusions Soft texture of remnant pancreas and the diameter of the pancreatic duct smaller than 3 mm are important risk factors of postoperative pancreatic fistula.Pancreatic fistula is the main factor causing death after pancreaticoduodenectomy.

Expression and clinical significance of hepatocyte growth factor receptor and epidermal growth factor receptor in pancreatic cancer / 中华肝胆外科杂志

Objective To determine the clinical significance of hepatocyte growth factor receptor (Met) and epidermal growth factor receptor (EGFR) in the clinicopathology and prognosis of pancreatic cancer.Methods 70 patients admitted with pancreatic cancer from 1995 to 2005 were retrospectively analyzed with clinicopathological and follow-up data.Expression of Met and EGFR in cancer nest embedded with paraffin were detected by immunohislostaining (EnVision method) and correlation with clinicopathologic parameters and mutual correlation between these two receptors were further analyzed.Prognosis and related risk factors were analyzed by Kaplan-Meier survival analysis and Cox regression analysis,respectively.Results Both Met and EGFR significantly correlated with TNM staging,tumor size and superior mesenteric vessels invasion (P＜0.05).Expression level of Met positively correlated with that of EGFR (r9 =0.658,P＜0.05).Both Met and EGFR significantly correlated with patients' survival (P＜0.05) and Met was an independent prognostic risk factor for pancreatic cancer.Conclusions Both Met and EGFR significantly affect development and prognosis of pancreatic cancer and correlate with each other.Simultaneously targeting both Met and EGFR pathways may provide an advisable strategy of targeted therapy in pancreatic cancer.

A single surgeon's experience of pancreaticoduodenectomy on 169 patients / 中华肝胆外科杂志

Objective To investigate the complications and the risk factors for pancreatic leakage after pancreaticoduodenectomy.Methods One hundred and sixty-nine patients who received pancreaticoduodenectomy in our hospital between January 2000 and December 2009 were reviewed.Chisquare and logistic statistic analysis were performed to determine the risk factors for pancreatic leakage.The difference in complication rates between different periods were analyzed.Results The mortality was 2.4％.The morbidity was 34.9％,and the pancreatic leakage rate was 7.7％.Logistic analysis revealed significant risk factors for pancreatic leakage included intraoperative bleeding of more than 400 ml(OR=2.87; 95％ confidence interval:1.17-8.19; P=0.048),soft texture of remnant pancreas(OR =1.95 ; 95 ％ confidence interval:0.87-6.19 ； P =0.032)and pancreatic duct diameter smaller than 3 mm(OR=3.78 ; 95 ％ confidence interval:1.01-10.63 ； P =0.019).There was no significant difference in mortality,morbidity,pancreatic leakage,and upper gastric bleeding between the periods 2000-2004 and 2005-2009.However,re-operation rate and postoperative hospital stay were significantly higher in the period of 2005-2009.Conclusions Intraoperative bleeding,soft texture of remnant pancreas and pancreatic duct diameter smaller than 3mm were significant risk factors for postoperative pancreatic leakage.A pancreaticojejunostomy anastomotic technique familiar to the surgeon might reduce postoperative pancreatic leakage.

Effects of ω-3 fish oil emulsion on inflammation and coagulation function of hepatocellular carcinoma patients after partial hepatectomy / 中华临床营养杂志

Objective To investigate the effects of ω-3 fatty acids on inflammation and coagulation function in hepatocellular carcinoma (HCC) patients after partial hepatectomy.Methods In this prospective randomized controlled trial,80 HCC patients were randomly divided into two groups based on the parenteral nutrition (PN) scheme that was provided 5 days after partial hepatectomy:fish oil group:20％ fish oil and 80％ mediumlong fatty acid; and control group:100％ medium-long fatty acid.The inflammation,liver function,blood coagulation indicators,and prognosis were compared between two groups.Results After 3 days of hepatectomy,the serum C-reactive protein levels in the control and fish oil groups were (119.6 ± 57.3) mg/L and (97.1 ± 46.1) mg/L(P =0.016),respectively; and on day 6 after surgery,C-reactive protein levels of two groups were (54.9 ± 26.1)and (40.7 ±21.8) mg/L,respectively (P =0.018).The plasma fibrinogen level in the fish oil group was significantly lower than that in the control group 3 days [(3.4 ± 1.1) vs.(4.1 ± 1.3) g/L,P ＜ 0.001] and 6 days [(3.3 ± 0.9) vs.(3.8 ± 1.2) g/L,P ＜ 0.001] after surgery.The retention rate of indocyanine green at 15 minutes on the 7th postoperative day were 8.6％ ±4.9％ and 9.2％ ±7.3％ in the control and fish oil groups,respectively (P=0.179).The recurrent rate (40.63％ vs.44.12％,x2 =0.082,P =0.774) and survival rate in the fish oil and control groups (90.62％ vs.88.24％,x2 ＜0.001,P =1.000) also showed no significant difference after 6 months of follow-up.Conclusion ω-3 fish oil emulsion can reduce postoperative inflammatory response and prevent thrombosis.

Early postoperative enteral nutrition compared with parenteral nutrition after hepatectomy:A prospective randomized study / 中华肝胆外科杂志

Objective To evaluate the impact of early enteral nutrition (EEN) compared with parenteral nutrition (PN) on patients after hepatectomy. Methods Seventy-eight patients undergoing liver resection were randomized prospectively into two groups: EEN group receiving early enteral nutrition (n=35) and PN group receiving parenteral nutrition (n=43). The patients in both groups received isocaloric and isonitrogenous nutritional formulas 24 h after operation and the formulas were stopped on postoperative day 7. The general conditions, liver function tests, clinical complications,and clinical nutritional variables at three time points that included preoperative phase, postoperative day 1 (POD 1) and postoperative day 8 (POD 8) were observed. Results No significant differences were found in length of hospital stay, liver function and clinical nutritional variables between the 2 groups. In the EEN group, the serum prealbumin level almost returned to the preoperative level on POD 8. The nutritional complication rate of the EEN group was increased significantly but it was milder than that of the PN group. The time of gut function recovery in the EEN group was shorter than that of the PN group. The costs of nutritional drugs showed a significant decrease in the EEN group.Conclusion Early enteral nutrition is safe, rational and effective in patients who have undergone hepatectomy. Early enteral nutrition is better than parenteral nutrition in promoting liver function recovery, liver protein synthesis, postoperative recovery of gut function and decreasing costs of nutritional drugs.

Effects of branched-chain amino acids-enriched early parenteral and enteral nutrition on the liver function and serum aminograms in cirrhotic rats after partial hepatectomy / 中华临床营养杂志

Objective To evaluate the effects of branched-chain amino acids-enriched early parenteral and enteral nutrition on the liver function and serum aminograms in cirrhotic rats after partial hepatectomy. Methods In this prospective randomized controlled study, 24 cirrhotic rats, induced by thioacetamide, were randomized into three groups: enteral nutrition (EN) group, EN + branched-chain amino acid (BCAA) group, and parenteral nutrition (PN) + BCAA group. After receiving partial hepatectomy, rats in all three groups were nutritionally supported with equal amount of calorie and nitrogen contents from the 1st postoperative day ( PO day 1 ) to PO day 5. On PO day 6, parameters including body weight, liver functions, prealbumin, transferring, and serum aminograms were measured or determined, and the level of liver albumin mRNA was detected by reversal transcription-polymerase chain reaction and morphological examinations such as HE staining and immunohistochemical staining, which were assessed by index of Ki67 protein index. Results Body weight was significantly decreased in all three groups on PO day 6 (P ＜0.05 ). Compared with EN + BCAA group, serum aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase after partial hepatectomy were significantly higher in PN + BCAA group (P ＜0.05 ). Serum alkaline phosphatase level was significantly higher in PN + BCAA group than in EN group ( P ＜0. 05). The level of prealbumin was significantly lower in PN + BCAA group when compared with EN group or EN +BCAA group ( both P ＜ 0. 05 ), although no such significant difference was noted in terms of transferrin ( P ＞0. 05 ). The levels of leucine and isoleucine elevated while those of tyrosine, phenylalanine, arginine and tryptophan declined in PN + BCAA group or EN + BCAA group when compared with EN group ( P ＜ 0. 05 ). Aminograms were not significantly different between EN + BCAA group and PN + BCAA group ( P ＞ 0. 05 ). Levels of total amino acid and aromatic amino acid (AAA) were significantly lower while BCAA and ratio between BCAA and AAA (BCAA/AAA) were significantly higher in PN + BCAA group or EN + BCAA group than in EN group (P ＜ 0. 05 ).Significantly lower level of albumin mRNA and index of Ki67 were observed in PN + BCAA group than in EN group or EN + BCAA group (P ＜ 0.05 ) on PO day 6. Conclusions BCAA-enriched EN or PN reverses amino acid disequilibrium and restores BCAA/AAA in cirrhotic rats after partial hepatectomy. Compared with PN, EN is superior in improving postoperative liver function, promoting protein synthesis, and speed up tissue regeneration in the postoperative liver. However, it still can not restore serum albumin in a short term.

Interventional treatment of bile duct injury after laparoscopic cholecystectomy / 中华消化内镜杂志

Objective To investigate the value of interventional therapy in bile duct injury (BDI) due to laparoscopie cholecystectomy (LC). Methods Data of 24 BDI patients, who received interventional treatment after LC from June 1997 to May 2007, were retrospectively analyzed. Results According to Liu Yunyi criteria of BDI classification, there were 5 cases of type Ⅰ , 11 cases type Ⅱ , 2 type Ⅲ and 6 type Ⅳ. BDI was found during LC in 2 patients and the operation was switched to open cholecysteetomy, but bile duct infection was experienced 10 months and 2 years after the operation, respectively. BDI was diagnosed postoperatively in 22 patients, in which 13 eases occurred 3-12 days after LC, 7 cases 20-60 days after LC, and 2 cases 2 years after LC. Complete remission was achieved by interventional therapy in 5 patients, the other 19 patients received curative operation after control of cholangitis and jaundice. Among 13 patients who were diagnosed BDI 3-12 days after LC, 6 underwent emergency operation and failed. Of the 7 other patients who received interventional therapy, 3 were cured and the others underwent curative operation after cholangi-tis and jaundice were controlled. Conclusion Application of interventional therapy in BDI after LC can a-chieve successful bile duct support and drainage, and can obtain complete image of bile duct system, which is effective not only in control of cholangitis and jaundice for the safety of the following surgery, but also in cure of BDI.

Bile duct injury during laparoscopic cholecystectomy / 中华普通外科杂志

Objective To investigate the cause,type,clinical manifestation,diagnosis and treatment of bile duct injury(BDI)during laparoscopic cholecystectomy(LC).Methods Data of 26 cases suffering from biliary injury during LC from 1997 to 2007 were retrospectively analyzed.Results Among 26 cases with BDI,5 cases suffered from type Ⅰ BDI,13 cases from typeⅡ,2 cases from typeⅢ,and 6 cases from type Ⅳ.Injuries were diagnosed as BDI intraoperatively in 3 cases,23 BDI cases were diagnosed postoperatively,including 13 cases diagnosed one week after LC,8 cases 20-60 days after LC,2 cases 2 years after LC.Twenty-four cases underwent interventional therapy,with 5 cases cured,19 cases were tideovered to operative treatment after cholangitis and jaundice were under control.Among all BDJ cases,20 cases underwent resection of impaired dile duct and hepatico-jejunostomy. Conclusion BDI is a serious complication of LC,temporary stent graft or bile dranage will help to put jaundice and cholangitis under control so as to buy a time for final definite surgical procedures.

Octreotide Inhibits the Growth of Hepatocellular Carcinoma Through Down-Regulation of cMet / 中国普外基础与临床杂志

Objective To investigate the inhibitory effects and the mechanisms of octreotide(OCT) on the growth of hepatocellular carcinoma(HCC).Methods Bel7402 HCC cells were studied for proliferative ability by MTT assay,morphology by light microscopy,adhesive and invasive ability by cell adhesion and "wound strack" experiments.Immunofluorescence flow cytometry was used for study of cMet expression and cell cycle as well. Furthermore,the effects of OCT on tumor growth metastasis were investigated in nude mice with implanted HCC.The expression of cMet in implanted tumor cells was studied by immunohistochemistry.Results With OCT treatment,the proliferative ability of Bel7402 cells and cell morphology didn't change.The adhesive and invasive ability decreased compared with no OCT treatment cells(P

L-arginine protects liver cancer patients on total parenteral nutrition / 中国普通外科杂志

Objectives To study the liver protective effect of L arginine for postoperative cirrhotic patients with primary liver cancer (PLC) receiving total parenteral nutrition (TPN). Methods Thirty preoperative cases were divided into two groups:Group A,TPN only( n =14);Group B,TPN+arginine( n =16). Liver function, serum lipid, immune function and serum nitric oxide were observed on preoperative phase, postoperative day 1 (POD 1) and day 7 (POD7) respectively. Liver biopsy was taken for histological study intraoperatively and on POD 7. Results Compared with group A on POD7,AST and TBIL level were near preoperative level, ALB level signiflcanly decreased, TG was lower than preoperative level, CD4 + and NO increased signiflcanly,and the degree of liver steatosis showed a signiflcant decrease in group B. Conclusions Supplement of appropriate amounts of L arginine increases hepatic NO level, reduces serverity of hepatic steatosis associated with TPN, promotes postoperative recovery of transaminase activity, ameliorates cell mediated immunity and anti infection capacity in postoperative PLC patients.

Regulation of octreotide on SSTR2 expression in hepatocellular carcinoma / 中国病理生理杂志

AIM: To observe the regulation of octreotide (OCT) on the expression of somatostatin receptor 2 (SSTR2) in Bel7402 hepatocellular carcinoma (HCC) cells, and the inhibition effect of OCT on the growth of HCC. METHODS: The effect of OCT on proliferative ability of Bel7402 cells was observed by MTT assay. The cell form was observed by light invert microscope. The adhesive and invasive ability was detected by cell adhesion and migration experiments. The cell cycle, SSTR2 expression of 7402 cells were determined by immunofluorescence flow cytometry. Nude mice bearing xenografts in situ were treated with OCT or saline control for 7 weeks since tumor implantation. The immunohistochemistry for SSTR2 was performed. SSTR2 mRNA expression in cell line and xenografts was measured by semi-quantitative RT-PCR. RESULTS: After OCT treatment, the proliferative ability and cell form of 7402 cells didn't change significantly. The adhesive and invasive ability decreased significantly. The ratio of cells in resting state (G 0/G 1) increased, but no apoptosis peak was observed. The SSTR2 expression on 7402 cell membranes decreased significantly. SSTR2 expression in cell line of OCT group was higher than control group, but there was no significant difference between them. The mean tumor weight in mice given OCT was significantly lower than that in control group. SSTR2 immunostaining in tumor cells of treatment group showed stronger positivity, compared with control group. SSTR2 mRNA expression in xenografts after OCT treatment was significantly higher than that in control group. CONCLUSIONS: OCT inhibits the growth of HCC through SSTR2. SSTR2 is regulated by its ligand, the long-term OCT treatment increases the SSTR2 expression and enhances the effect of inhibiting HCC, however, short-term treatment may induce its desensitization and the decrease in anti-tumor effect. [

Cefoperazone/sulbactam in Treatment of Biliary Tract Infections:A Prospective Multicenter Clinical Trial / 中华医院感染学杂志

OBJECTIVE To evaluate the safety and clinical efficacy of cefoperazone/sulbactam in the treatment of biliary tract infections.METHODS In this prospective multicenter study,159 hospitalized patients with biliary tract infections received cefoperazone/sulbactam,and the clinical and bacteriological efficacy as well as the side effects were evaluated.RESULTS The clinical effective rate of cefoperazone/sulbactam in the treatment of biliary tract infections was 86.78%.After treatment,the body temperature reduced to normal rapidly,the average time of defervescence was 3.09?1.81 days.Pathogen eradication rate was 85.71%.No adverse reactions were reported during the study period.CONCLUSIONS Cefoperazone/sulbactam can be used as one of antibiotics of choice in the initial empirical therapy for biliary tract infections.