Surgical treatment of cirrhotic portal hypertension: Current status and research advances / 临床肝胆病杂志

Liver cirrhosis can lead to continuous pathological elevation of portal venous pressure, resulting in various complications such as esophageal and gastric varices, ascites, hepatic encephalopathy, and secondary circulatory dysfunction. Multimodality therapy is the main treatment method for portal hypertension, among which surgical treatment is mainly used to control and prevent massive esophagogastric variceal bleeding. Currently, interventional therapy and liver transplantation have gradually become a routine method for surgical intervention and can significantly improve patients’ quality of life, but devascularization and shunt are still the mainstream surgical procedures. Each surgical strategy for cirrhotic portal hypertension has its own characteristics. It will be a trend in the future to evaluate patients’ general conditions and clinical features and select individualized treatment regimens to achieve the best treatment outcome.

Isoflurane preconditioning inhibits caspase-11-related noncanonical pyroptosis pathway to alleviate hepatic ischemia-reperfusion injury in mice / 南方医科大学学报

OBJECTIVE@#To study the protective effect of isoflurane preconditioning on hepatic ischemia-reperfusion (I/R) injury mediated by the noncanonical pyroptosis pathway.@*METHODS@#Thirty C57BL/6 mice were randomly divided into sham-operated group, isoflurane group and I/R group, and in the latter two groups, hepatic I/R injury was induced by clamping the portal vein for 30 min. In isoflurane group, the mice were pretreated with 1.4% isoflurane 30 min before the surgery. The protective effect of isoflurane preconditioning against hepatic I/R injury was evaluated by assessing the pathological score of HE staining of the liver tissue and serum ALT and AST levels. Serum IL-1β and IL-18 levels and the protein expression of GSDMS were detected by ELISA and Western blotting to evaluate the inhibitory effect of isoflurane preconditioning on pyroptosis. Western blotting and immunofluroescence were used to detect the protein expression of caspase-11 in the liver tissues to evaluate the inhibitory effect of isoflurane preconditioning on noncanonical pyroptosis pathway.@*RESULTS@#The Suzuki's score of the liver tissue was significantly higher in I/R group than in the sham group ( < 0.05), while the score in the isoflurane group was significantly lower than that in the I/R group ( < 0.05). Serum ALT and AST levels significantly increased in the sham group ( < 0.05), and were significantly lower in isoflurane group than in I/R group ( < 0.05). The serum levels of IL-1β and IL-18 were significantly higher in I/R group than in sham group ( < 0.05), and were significantly lower in isoflurane group than in I/R group ( < 0.05). The expression of GSDMD in the I/R group was significantly higher than that in sham group, and was significantly lower in isoflurane group than in I/R group ( < 0.05). The hepatic expression of caspase-11 was significantly higher in I/R group than in sham group ( < 0.05), and was significantly lower in isoflurane group than in I/R group ( < 0.05).@*CONCLUSIONS@#Isoflurane preconditioning has protective effect against hepatic I/R injury, which is related to the inhibition of the noncanonical pyroptosis pathway.

Optimize operation process and operation technique to reduce intraoperative and postoperative complications of laparoscopic splenectomy / 国际外科学杂志

Objective Laparoscopic splenectomy has become an effective method to treat the hypersplenism and splenomegaly caused by various diseases.Although laparoscopic technology is very mature at present,laparoscopic splenectomy is still associated with many complications.This study was based on the comparison of different processes and operation techniques of laparoscopic splenectomy,to summarize a more effective operation process and operation technique which can reduce the related complications of laparoscopic splenectomy.Methods The study reviewed the clinical data of 130 patients'who underwent laparoscopic splenectomy in our department from September 2015 to December 2017.According to different operation mode and operation technique these patients were divided into 6 groups.Operation process groups:group Ⅰ for arterial priority group (open the gastrocolic ligament and expose splenic artery,then dissociate ligament around the spleen,and finally divide from the spleen pedicel) had 73 cases;group 2 with the way of building a tunnel beneath spleen pedicel and dissecting spleen in situ had 57 cases.With regard to the way of breaking spleen pedicel:group 3 using stapler to break spleen's pedicel included 101 cases;group 4 using dissecting the secondary spleen pedicel included 29 cases.Whether blocking the splenic vein:group 5 whose splenic vein was not ligated had 95 cases;group 6 whose splenic vein was ligated coverd 35 cases.Analysis and comparison between groups about intraoperative and postoperative complications related to different groups were made.Measurement date were expressed as (-x ± s),t test was used for comparison between groups.Count data was expressed as rate(％),and chi-square test was used for comparison between groups.Results Group 2 has less blood loss [group 1:(356.0 ± 96.2) ml versus group 2:(220.9 ± 57.3) ml,P =0.016],shorter operation time [group 1:(156.0 ± 36) min versus group 2:(120.9 ± 55.4) min;P =0.038] and fewer complications [group 1:9.6％ (7/73) versus group 2:5.3％ (3/57);P =0.035].When compared with group 4,group 3 have more advantages in the intraoperative blood loss [group 3:(256.0 ± 85.1) ml versus group 4:(380.9 ± 107.3) ml;P=0.019],the operation time [group 3:(131.0±30.9) min versus group 4:(171.9 ±61.2) min;P=0.024],and the postoperative complications [group 3:6.95 ％ (7/101) versus group 4:10.3 ％ (3/29);P =0.048].When compared with group 5,group 6 has more advantages in the intraoperative blood loss [group 5:(250.0 ± 56.2) ml versus group 6:(320.9 ± 87.3) ml;P =0.012],the operation time [group 5:(136.0 ± 36.2) min versus group 6:(180.9 ± 57.3) min;P =0.013],and the postoperative complications [group 5:6.3％ (6/95) versus group 6:11.4％ (4/35);P=0.013].Conclusion Both the procedure of tunnel procedure in situ cutting spleen and the application of stapler can reduce the amount of bleeding,shorten the operation time,and reduce the occurrence of postoperative complications.The ligation of the splenic vein is not necessary because it increases the operation time,the risk of bleeding,and the occurrence of postoperative complications.

A safe approach to splenic hilum through first mobilizing lower pole of spleen in laparoscopic splenectomy / 局解手术学杂志

Objective To discuss the surgical skills and clinical value of laparoscopic splenectomy with a safe approach to the splenic hilum through first mobilizing the lower pole of the spleen.Methods A total of 88 patients with hypersplenism secondary to liver cirrhosis who underwent laparoscopic splenectomy in our department from September 2015 to September 2016 were selected into this study.And these patients were divided into two groups based on whether to take the safe approach to the splenic hilum through first mobilizing the lower pole of the spleen in laparoscopic splenectomy.The control group included 40 cases who underwent the traditonal laparoscopic splenectomy,while the observation group included 48 cases who took the safe approach to the splenic hilum through first mobilizing the lower pole of the spleen in laparoscopic splenectomy.The clinical data were collected retrospectively by medical clinical records review.Results There was no mortality occurred in this study.The blood loss of the observation group was (247.50±135.89)mL,which was obviously lower than (361.75±144.43)mL of the control group,and the difference was statistically significant (P0.05).Conclusion It is very crucial for a safe approach to the splenic hilum through first mobilizing the lower pole of the spleen to establish a tunnel behind the splenic hilum in laparoscopic splenectomy.It is safe and feasible to perform a safe approach to the splenic hilum through first mobilizing the lower pole of the spleen in laparoscopic splenectomy.The technique is generalized in clinics,especially for freshmen.

Postoperative complications of laparoscopic splenectomy versus open splenectomy for portal hypertension of liver cirrhosis：a Meta analysis / 重庆医学

Objective To systematically evaluate the comparison of postoperative complications of laparoscopic splenectomy (LS) versus open splenectomy (OS) for hypersplenism secondary to portal hypertension of liver cirrhosis .Methods Clinical trials ,which compared the postoperative complications of LS versus OS for portal hypertension of liver cirrhosis from the PubMed ,Cochrane Li‐brary ,EMbase ,CNKI and CBM data bases from 2000 to 2013 and the RevMan 5 .2 software was used for data analysis .Results six trials with 456 patients were included .Meta‐analysis showed that there was no significant difference in incidences of postoperative bleeding(OR=0 .52 ,95% CI 0 .25 -1 .06 ,P=0 .07)or pancreatic fistual(OR=1 .09 ,95% CI 0 .33 -3 .60 ,P=0 .89) between LS and OS groups .Incidence of postoperative infection was decreased in LS group compared with OS group (OR=0 .17 ,95% CI 0 .07-0 .38 ,P<0 .01) .However ,the incidence of postoperative portal venous thrombosis was increased in LS group compared with OS group(OR=2 .14 ,95% CI 1 .23 -3 .73 ,P=0 .00) .Conclusion LS and OS own the same incidence of postoperative bleeding and pancreatic fistual .The incidence of postoperative infection was decreased in LS group compared with OS group ,meanwhile ,LS group was increased compared with OS group on incidence of postoperative portal venous thrombosis .

Comparison of efficiency and cytotoxicity of different transfection reagents in transfecting RIP140-siRNA into Kupffer cells / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the efficiency and cytotoxicity of different transfection reagents used in transfection of RIP140-siRNA into Kupffer cells to optimize the transfection conditions.</p><p><b>METHODS</b>Kupffer cells were transfected with RIP140-siRNA labeled with GFP as the reporter gene using lipofectamine 2000, Roche reagent (X-treme GENE siRNA Transfection Reagent) and puro screening lentivirus (1.0×10(8) TU/mL) as the transfection reagents. The transfection effect was observed under a fluorescent inverted microscope, and laser scanning confocal microscopy was used to analyze RIP140 expression in trasnfected Kupffer cells. Flow cytometry was performed to detect cell apoptosis, and CCK-8 test was used to evaluate the cell proliferation inhibition. RT-RCR and Western blotting were performed to detect the expressions of RIP140 mRNA and protein in the trasnfected cells.</p><p><b>RESULTS</b>Puro screening lentivirus yielded the highest cell transfection efficiency, which exceeded 90%, followed by Roche reagent and then by lipofectamine 2000. Flow cytometry and CCK-8 test showed that the cytotoxicity was the mildest with Roche reagent, moderate with lentivirus, and severe with lipofectamine 2000. The cells trasnfected with lentivirus showed a significantly lower RIP140 expression than cells trasnfected with lipofectamine 2000 and Roche reagent (P<0.05).</p><p><b>CONCLUSION</b>In Kupffer cells, lentivirus-mediated transfection, as compared with the other two trasnfection reagents, can achieve good transfection efficiency with a relativelty low cytotoxicity, and allows for better controllability and stability of the trasnfectiion conditions.</p>

Mechanisms and therapeutic methods of HCC with PVTT / 国际外科学杂志

Hepatocellular carcinoma (HCC) is one of the most common cancers in the worldwide.In recent years,the development of imaging techniques has facilitated the detection of HCC at early stages.However,HCC has a high frequency of portal vein invasion,which is reportedly observed in 11％ to 42％ of patients with HCC.Portal vein tumor thrombus(PVTT) is a crucial factor that can worsen the prognosis of HCC because it can be wide dissemination of tumor throughout the liver and cause a marked deterioration of hepatic function.It was considered that is not appropriate with surgical treatment in the past,which is treatment conservative or even give up,most of the patients died within a few months.Even if the patients have a chance to surgical resection,and the most of patients combined with TACE,portal vein stent implantation or chemotherapy postoperative,some patients can be more prolonged survival,however,due to the small tumor thrombus and micro metastases have exist before the surgery and can not be checked out.it's difficult to clean up in the surgery,easily lead to HCC recurrence postoperative.However,with the constant awareness the PVTT formation mechanism and scientific technology progress,more and more new treatment techniques is applied to clinical.This view focuses on the portal vein tumor thrombus formation mechanisms and Classic Transcatheter Arterial Chemoembolization and new treatment methods such as:Helical tomotherapy,CIK cell therapy (cytokine-induced killer cell therapy),Chemoembolization and stent combined with iodine-125 seed.

Prevention of recurrence and metastasis of hepatocellular carcinoma following liver transplantation: a systematic review / 国际外科学杂志

At present, about one third organ transplantation recipients were hepatocellular carcinoma (HCC) patients even in the most advanced transplant center in the world. HCC especially the early primary HCC has been listed as one of the indications of liver transplantation(LT) in the most organ transplant center in the world. However, due to the tumor recurrence and metastasis following LT, many patients would be dead following transplantation in about 2 years later. Their five-year survival rate was only 50 percent in benign final phase liver disease patients. The current researches for this phenomenon were still shallow both in mechanisms and treatments. How to prevent tumor recurrence has become serious challenges and must be faced in liver transplantation surgery. Obviously, to discover the molecular mechanisms and predisposing factors of following LT recurrence, to explore appropriate standards for LT in HCC patients and to strengthen perioperative management are the only way for increasing LT efficacy.

Ectopic Over-expression of Oncogene Pim-2 Induce Malignant Transformation of Nontumorous Human Liver Cell Line L02

In order to prove that ectopic over-expression of Pim-2 could induce malignant transformation of human liver cell line L02, three groups of cells were set up including human liver cell line L02 (L02), L02 cells transfected with Pim-2 gene (L02/Pim-2) and L02 cells transfected with empty-vector (L02/Vector). Pim-2 expression levels were detected. The morphology, proliferation level, apoptosis rate and migration ability of the cells were detected respectively. Then the cells were subcutaneously inoculated into athymic mice and the microstructures of the neoplasm were observed. Compared with the controls, Pim-2 expression levels were significantly higher in L02/Pim-2 cells (P<0.05), and their morphology had obvious malignant changes. They also showed a significantly increased proliferation rate (P<0.05) and migration capacity (P<0.05), as well as a significantly decreased apoptosis rate (P<0.05). Only the athymic mice inoculated with L02/Pim-2 cells could generate neoplasm, and the morphology of the neoplasm coincided with that of the hepatoma. The results manifest that ectopic Pim-2 gene could be stably expressed in L02/Pim-2 cells. Both the morphological and biological changes of L02/Pim-2 cells demonstrate the trend of malignant transformation. L02/Pim-2 cells could generate hepatoma in athymic mice. In conclusion, Pim-2 could induce malignant transformation of human liver cell line L02.

Hemorrhage in laparoscopic cholecystectomy:the cause and management / 中国现代普通外科进展

Objective:To explore the cause and treatment of hemorrhage in laparoscopic cholecystectomy(LC).Methods:The clinical data of 112 cases of LC were analyzed to summarize the causes and treatment of hemorrhage.Results:The causes of hemorrhage in LC included subjective and objective elements.All of them were successfully hemostatic in different ways including reclamping,coagulation,suturing,packing hemostasis and suspension of falciform ligament of liver.Conclusion:Hemorrhage is the serious and most common complication in LC,but it can be avoided through an immediate and effective process.

Expression of lipopolysaccharide receptor CD14 in rat liver after acute biliary infection / 第三军医大学学报

Objective To study the expression of lipopolysaccharide(LPS) receptor,CD14 in the liver tissue during acute biliary infection and its relation with production of cytokines.Methods Rat models of acute biliary infection were established by ligating the choledochus and injecting Escherichia coli O111∶B4 into the duct.The expressions of CD14 protein and mRNA in liver tissue,the plasma levels of endotoxin,TNF-? and IL-6,and phagocytosis activity of Kupffer cells(KCs) were assayed at 0,3,6,12 and 24 h after operation.Ultrastructural changes in KCs were observed by electron microscopy.Results With the course prolonging in acute biliary infection,the plasma endotoxin level was progressively increased,KCs were activated and the levels of TNF-? and IL-6 markedly were increased,while the CD14 expression obviously increased at mRNA and protein levels.Conclusion The CD14 expression is gradually increased in liver tissue during acute biliary infection.KCs are activated and releasing more and more cytokines.It might be one of the important mechanisms of that KCs improve inflammatory response during the infection.

Significance of scavenger receptor A in rat liver tissues during acute obstructive suppurative cholangitis / 第三军医大学学报

Objective To investigate the expression of scavenger receptor A(SR-A) in rat liver tissues during acute obstructive suppurative cholangitis(AOSC) and its relations with inflammatory mediators and hepatic injury.Methods Wistar rat models of AOSC were reproduced by ligating choledochus and inside injecting Escherichia coli O111∶B4.The plasma endotoxin concentrations,TNF-? levels and expressions of SR-A protein and mRNA in liver tissues were assayed by limulus test,ELISA,immunohistochemistry and RT-PCR,respectively.Pathological changes of liver tissues were observed under light microscope.Results With the time prolonged,the plasma endotoxin concentrations and the TNF-? levels gradually increased,but the SR-A protein and mRNA expressions decreased in the rats of experimental group,significantly different with those in sham operation group and normal saline group(P

Protective effect of lipopolysaccharide preconditioning on ischemia/reperfusion injury of rat graft liver / 第三军医大学学报

Objective To investigate the protective effect and the possible mechanism of lipopolysaccharide(LPS) preconditioning on ischemia/reperfusion injury of rat graft liver.Methods Male Sprague-Dawley rats were divided into three groups(n=30 in each group): sham operation group(Sham group),orthotopic liver transplantation group(OLT group) and LPS preconditioning group(LPS group).Only dissecting hepatoduodenal ligament was perfomed in Sham group.On day one,0.1 mg/kg LPS and on day 2,3,4,5,0.5 mg/kg LPS for LPS rats and 0.5 ml PBS pathogen-free solution for OLT rats was injected through caudal vein before OLT was performed by two-cuff method in the two group rats on day 8.The levels of tumor necrosis factor-?(TNF-?),ALT, AST in inferior caval vein blood and the activities of NF-?B in hepatic tissue were detected at 0,60,180 min after dissecting hepatoduodenal ligament in Sham group and after portal vein reperfusion in OLT group and LPS group.The morphological changes of hepatic tissue were observed through light microscope and electron microscope at different time points.Results As compared with Sham group at the different time points respectively,the activities of NF-?B and the levels of TNF-? were higher in OLT group and LPS group(P

Influence of FUDR Through Retention-enema on Cell Proliferation of Rectal Carcinoma / 中国药房

AIM: To study the influence on the expression of proliferation cell nuclear antigen(PCNA) in rectal carcinoma through retention -enema with FUDR and 5 -FU. METHODS: 80 cases of rectal carcinomas were randomized into three groups: the FUDR group(30 cases), the 5-FU group(30 cases) and normal control group(20 cases), treated with FUDR(500mg), 5-FU(500mg) and normal saline(20ml ) everynight through retention - enema separately for serven days- Mucosa of rectal car cinoma were sampled and PCNA protein were simultaneously detected by imrnunohistochemical method on the first and eighth day. RESULTS: The expression of PCNA was significantly decreased in both FUDR group and 5 - FU group after treatment(P 0. 1). CONCLUSION:The cell proliferation of rectal carcinoma could be inhibited by FUDR and 5-FU through retention-enema. The effects of FUDR was more obvious than that of 5-FU in the same concentration. so the treating method through retention-enema with FUDR should be used as a routine therapeutic scheme befOre operation.

Surgical management of acute appendicitis in leukemia / 临床外科杂志

Objective To improve the level of diagnosis and treatment of acute appendicitis in leukemia.Method 17 cases of acute appendicitis in leukemia that were treated from 1980 to 2002 were reviewed.Result All 17 cases underwent appendectomy,16 survived the immediate postoperative period,only one died.Conclusions Leukemia were predisposed to acute appendicitis than normal during chemotherapy period and our experience supports the surgical management of acute appendicitis in leukemia.Because immunosuppression and thrombocytopenia were the main causes of additional surgical dangers,relative methods should be applied in perioperation period.The complications of incision were common,so the observation of incision should be emphasized.

Role of IRAK-4 activity in inhibitory effects of lipopolysaccharide pretreatment on hepatic ischemia/reperfusion injury / 中国病理生理杂志

AIM: To observe the changes of interleukin1 receptor associated kinase-4(IRAK-4) in ischemia/reperfusion(I/R) liver pretreated with lipopolysaccharide(LPS) and to explore the protective mechanisms of LPS pretreatment against hepatic I/R injury.METHODS: Male Sprague-Dawley rats,weighing 240-280 g,were divided into three groups: control,ischemia/reperfusion group(I/R group) and LPS-pretreated group(LPS group).On the first day,LPS group received 0.1 mg/kg LPS via the tail vein,followed by 0.5 mg/kg on the 2nd,3rd,4th and 5th day.I/R group received the equivalent volumes(0.5 mL) of sterile PBS.Experiments of I/R injury was induced by temporary ischemia of the left lateral liver lobe for 90 min followed by 3 h reperfusion on 2 days after the last LPS treatment.At 0 min,60 min and 180 min after reperfusion,the expression of IRAK-4 gene and protein level were determined by RT-PCR and Western blotting.The activity of NF-?B and the serum TNF-? level were also detected by ELISA.RESULTS: Although the level of IRAK-4 gene and protein were higher in the LPS group than that in I/R group and control group(P0.05) at 0 min after reperfusion.However,all those indexes were evidently lower in the LPS group than those in I/R group(P

Study of acute rejection model associated immune indicators following liver transplantation in rat / 中国现代普通外科进展

Objective:To establish the acute rejection model of orthotopic liver transplantation in rat(ROLT) and observe the basic pathophysiologic changes of acute rejection.Methods:The rats were randomly divided into three groups:control group,isotransplantation group(LEW-LEW),and allotransplantation group(LEW-BN).Recipients were sacrificed on 3,5,7,and 10 days postoperatively and liver tissues and blood samples were collected.Recipient survival rate,histopathological and ultrastructural characteristics were observed.ALT,TBIL,and Alb were measured with automatic biochemical analyser.IL-2 content in serum was assayed by ELISA.Results:There was no rejection in isotransplantation from Lewis to Lewis rat resulted and 14-day survival rate reached 100%.The IL-2 concentration in serum was at normal level.On the contrary,all recipients in allotransplantation group from LEW to BN rat died among 14 days postoperatively,and hepatic histological examination showed typical acute rejection on 7 days.Liver function was severely impaired,which was indicated by significant increase of ALT and TBIL levels and apparent decrease of Alb level.The IL-2 concentration in serum was continuously increased and reached its peak value on 7 days postoperatively.Conclusion:An acute rejection experimental model of liver transplantation in rat could be stably established using Lewis rat as donor and BN rat as recipient.

Relationship between endotoxin-induced acute liver injury and protein expression of CD14 and SR-A / 解放军医学杂志

Objective To investigated the expression of scavenger receptor A(SR-A) and lipopolysaccharide(LPS) receptor CD14 in endotoxin-induced acute liver injury.Methods Ninety Wistar rats were randomly divided into endotoxaemia group(LPS group) and normal saline group(NS group).The model of endotoxaemia and acute endotoxin-induced liver injury was established by injection of endotoxin(5mg/kg) via tail veins in LPS group,while the rats in NS group received injection of 0.2ml normal saline as control.At 0,1.5,3,6,12h after injection,the levels of endotoxin,TNF-?,IL-1,alanine transaminase(ALT) and total bilirubin(TB) in plasma,SR-A and CD14 expressions in liver tissues were determined,pathological changes of liver tissues and ultrastructural changes of Kupffer cells(KCs) were observed by light and electron microscopy respectively,while the phagocytosis of KCs was determined too.Results Compared with NS group,KCs were activated on morphology and functions(proliferated diffusely,enlarged in size and increased in phagocytosis function),levels of TNF-? and IL-1 increased markedly,the pathological changes of cell degeneration and necrosis and the liver function were gradually aggravated,while SR-A expression decreased and CD14 expression increased obviously(P

Surgical treatment of cirrhotic portal hypertension: Current status and research advances / 临床肝胆病杂志

Liver cirrhosis can lead to continuous pathological elevation of portal venous pressure, resulting in various complications such as esophageal and gastric varices, ascites, hepatic encephalopathy, and secondary circulatory dysfunction. Multimodality therapy is the main treatment method for portal hypertension, among which surgical treatment is mainly used to control and prevent massive esophagogastric variceal bleeding. Currently, interventional therapy and liver transplantation have gradually become a routine method for surgical intervention and can significantly improve patients’ quality of life, but devascularization and shunt are still the mainstream surgical procedures. Each surgical strategy for cirrhotic portal hypertension has its own characteristics. It will be a trend in the future to evaluate patients’ general conditions and clinical features and select individualized treatment regimens to achieve the best treatment outcome.