Minimal-access video-assisted retroperitoneal and/or transperitoneal debridement (VARTD) in the management of infected walled-off pancreatic necrosis with deep extension: initial experience from a prospective single-arm study.

BACKGROUND: The currently preferred minimally invasive approaches have substantially improved outcomes of infected walled-off pancreatic necrosis (iWON). However, iWON with deep extension (iWONde) still poses a tricky challenge for sufficient necrosis evacuation by one stand-alone approach, often requiring repeated interventions. The aim of this study was to assess the effectiveness and safety of a minimal-access video-assisted retroperitoneal and/or transperitoneal debridement (hereafter called VARTD) in the management of iWONde. METHODS: Patients who had developed an iWONde were recruited to receive the VARTD in this prospective single-arm study. The primary efficacy endpoint was clinical improvement up to day 28 after the VARTD, defined as a ≥ 75% reduction in size of necrotic collection (in any axis) on CT and clinical resolution of sepsis or organ dysfunction. The primary safety endpoint was a composite of major complications or death during follow-up. Six-month postdischarge follow-up was available. RESULTS: Between July 18, 2018, and November 12, 2020, we screened 95 patients with necrotizing pancreatitis; of these, 21 iWONde patients (mean [SD] age, 42.9 [11.7] years; 10 [48%] women) were finally enrolled. The primary efficacy endpoint was achieved by most participants (14/21, 67%). No participants required repeated interventions. The primary safety endpoint occurred in six patients (29%). Except one in-hospital death attributable to repeated intra-abdominal hemorrhage, others were discharged without any major complication. CONCLUSIONS: The VARTD approach appears to have a reasonable efficacy with acceptable complication rates and thus might be an option for improving clinical management of iWONde. TRIAL REGISTRATION: This study is registered with Chinese Clinical Trial Registry (chictr.org.cn number, ChiCTR1800016950).

Protective role of naringin loaded solid nanoparticles against aflatoxin B1 induced hepatocellular carcinoma.

This study examines the hepatoprotective activity of naringin loaded solid nanoparticles (NRG-SLNs) and compared with free naringin (FNRG) against aflatoxin B1 (AFB1) induced hepatocellular carcinoma. The liver's self-healing ability was studied using a self-recovery group that received no therapy. Following AFB1 therapy, rats were given NRG-SLNs produced using the ion-gelation technique. Histology, serum injury indicators, oxidative stress biomarkers, a pro-inflammatory response biomarker, and tumor indicators were used to evaluate the liver tumor and its responsiveness to therapy. At a dosage of 6.18 mg/kg BW, NRG-SLNs (128 ± 4 nm) provided substantially greater hepatoprotection than free NRG. The actions of NRG-SLNs were equivalent to those of silymarin (SILY), which was given at a dosage of 20 mg/kg BW. The lack of regeneration potential of liver tissue after the damage was verified by the self-recovery group. NRG's efficiency in treating hepatic cancer was increased by using SLN's approach. The increased impact is most likely due to: a) enhanced oral bioavailability, b) the regulated and sustained action of enclosed NRG, and c) a decrease in discomfort and toxicity if any after orally administered. NRG-SLNs may be considered as a therapeutic option for hepatic ailments as effectiveness post-induction of liver carcinoma, is demonstrated presently.

Relationship between long non-coding RNA TUG1 and prognosis of patients with gastric carcinoma: A protocol for systematic review and meta-analysis.

BACKGROUND: Long non-coding RNA (lncRNA) can predict the prognosis of patients with various cancers. The relationship between lncRNA taurine upregulated gene 1 (TUG1) and the prognosis of patients with gastric carcinoma still needs to be further explored. Therefore, this study attempted to explore the relationship between TUG1 and the prognosis of patients suffering from gastric carcinoma. METHODS: The database was retrieved from China National Knowledge Infrastructure (CNKI), Chinese Biomedical literature Database (CBM), Chinese Scientific and Journal Database (VIP), Wan Fang database, PubMed, and EMBASE. Hazard ratios (HRs) and its 95% confidence interval (CIs) were applied to assess the prognostic effects of TUG1 on overall survival (OS). RevMan 5.3 software was adopted to perform meta-analysis. RESULTS: The results of this meta-analysis would be submitted to peer-reviewed journals for publication. CONCLUSION: This review provided a comprehensive overview of the relationship between TUG1 and the prognosis of patients with gastric carcinoma, and offered recommendations for clinical practices or guidelines.

Long non-coding RNA Linc00261 as a novel potential diagnostic and prognostic biomarker for gallbladder cancer.

BACKGROUND: Linc00261 is a lncRNA that plays key roles in tumor suppression. While gallbladder carcinoma (GBC) is one of the most common cancer of the bile duct. However, the study about Linc00261's correlation with the clinicopathological characteristics and postoperative outcomes of the GBC patients is few. Therefore, we want to explore Linc00261 in GBC and assess its potential of clinical diagnosis. METHODS: Quantitative real-time PCR (qRT-PCR) was used to detect the expression of Linc00261 in specimens of GBC and adjacent tissues as well as cell lines. Chi-square test has been used to research the correlation of the Linc00261 expression in GBC with the clinicopathological features. The Cox model was used to assess the value of Linc00261 in predicting the prognosis of GBC patients. ROC curve analysis was used to test the specificity and sensitivity of diagnostic method of serum Linc00261 expression. RESULTS: The expression level of Linc00261 in GBC was significantly lower than normal tissues' and it was also up-regulated after surgery. The Linc00261 expression was significantly correlated with large tumor size (P<0.0001), late TNM stage (P=0.008), negative liver metastasis (P=0.027) and well differentiated phenotype (P=0.017). The patients with lower Linc00261 expression had significantly worse outcomes in terms of overall survival (P=0.0188) and progression-free survival (P=0.0029), and the low expression of Linc00261 was identified as an independent risk factor affecting postoperative survival rate of the patients (P<0.01). The expression of Linc00261 in serum was down-regulated of GBC patients and increased in the patients after operation. Linc00261 expressed in serum was also positively associated with its expression in GBC tissue of patients (P<0.0001). The GBC diagnosis efficacy of using the serum Linc00261 level to identify the GBC has high specificity and sensitivity (AUC 0.805). CONCLUSIONS: Linc00261 could be identified a novel gene associated with GBC development and progression. It also may serve as a new diagnostic and prognostic biomarker for patients with GBC.

A novel technique for central hepatectomy: Maintain the blood supply and biliary drainage on one side and the blood supply from the portal vein on the other.

Central hepatectomy is amongst the most difficult surgeries of liver tumors. For the routine local excision of a tumor, if the tumor has invaded the blood vessels or bile duct of the liver, then half of the liver or three lobes of the liver are resected. This results in two major drawbacks, one of which is that the residual hepatic lobe may not compensate for the damage, so it is not possible to perform conventional partial resection. The other is that the volume of normal liver tissue removed may be much more than the volume of tumor removed, causing substantial waste. In the present study, surgery was performed to resect a central liver tumor. In that surgery, the V segment and parts of the IV, VI and VIII segments were resected, and the blood supply and biliary drainage of the left hepatic lobe were kept intact. However, for the remaining VI, VII and VIII segments of the right hepatic lobe, only the blood supply from the portal vein was maintained and no arterial blood supply or biliary drainage was kept so that the patient had the opportunity to undergo radical resection and successful rehabilitation. The reason these opportunities may be possible is that the residual right liver is a temporary replacement therapy in the perioperative period. Therefore, for central hepatic tumors, particularly tumors that have invaded the neighboring bile ducts or blood vessels, if the blood supply and biliary drainage on one side is maintained and the blood supply to the other side from the portal vein is kept intact, then it is possible to perform radical resection. This provides a novel approach to the clinical resection of central liver tumors.

Analysis of mitochondrial transcription factor A SNPs in alcoholic cirrhosis.

Genetic susceptibility to alcoholic cirrhosis (AC) exists. We previously demonstrated hepatic mitochondrial DNA (mtDNA) damage in patients with AC compared with chronic alcoholics without cirrhosis. Mitochondrial transcription factor A (mtTFA) is central to mtDNA expression regulation and repair; however, it is unclear whether there are specific mtTFA single nucleotide polymorphisms (SNPs) in patients with AC and whether they affect mtDNA repair. In the present study, we screened mtTFA SNPs in patients with AC and analyzed their impact on the copy number of mtDNA in AC. A total of 50 patients with AC, 50 alcoholics without AC and 50 normal subjects were enrolled in the study. SNPs of full-length mtTFA were analyzed using the polymerase chain reaction (PCR) combined with gene sequencing. The hepatic mtTFA mRNA and mtDNA copy numbers were measured using quantitative PCR (qPCR), and mtTFA protein was measured using western blot analysis. A total of 18 mtTFA SNPs specific to patients with AC with frequencies >10% were identified. Two were located in the coding region and 16 were identified in non-coding regions. Conversely, there were five SNPs that were only present in patients with AC and normal subjects and had a frequency >10%. In the AC group, the hepatic mtTFA mRNA and protein levels were significantly lower than those in the other two groups. Moreover, the hepatic mtDNA copy number was significantly lower in the AC group than in the controls and alcoholics without AC. Based on these data, we conclude that AC-specific mtTFA SNPs may be responsible for the observed reductions in mtTFA mRNA, protein levels and mtDNA copy number and they may also increase the susceptibility to AC.

Changes in mitochondrial DNA and its encoded products in alcoholic cirrhosis.

The purpose of this study was to investigate hepatic mitochondrial DNA (mtDNA) damage and changes in its encoded products in patients with alcoholic cirrhosis (AC) in order to understand disease pathogenesis. We enrolled 23 patients with AC, 26 alcoholics without cirrhosis, and 25 normal subjects in this study. Hepatic mtDNA deletions were positioned using a combination of long and accurate polymerase chain reaction (LA PCR) and gene sequencing. The mtDNA copy number was measured using real-time quantitative PCR. The expression of the mtDNA-encoded cytochrome c oxidase 2 (cox2) was detected by western blotting. A large deletion of bases located at positions 749-15486 was identified in hepatic mtDNA from AC patients. Moreover, the mtDNA copy number was significantly reduced (P<0.05), and its encoded product, cox2, was significantly downregulated (P<0.05). Collectively, our results suggest that specific deletions and reduced copy numbers of hepatic mtDNA in patients with AC is an important pathogenetic factor.