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1.
World J Gastroenterol ; 21(5): 1588-94, 2015 Feb 07.
Article in English | MEDLINE | ID: mdl-25663778

ABSTRACT

AIM: To evaluate the feasibility, safety, and efficacy of laparoscopic pancreaticoduodenectomy (LPD) using a reverse-"V" approach with four ports. METHODS: This is a retrospective study of selected patients who underwent LPD at our center between April 2011 and April 2012. The following data were collected and reviewed: patient characteristics, tumor histology, surgical outcome, resection margins, morbidity, and mortality. All patients were thoroughly evaluated preoperatively by complete hematologic investigations, triple-phase helical computed tomography, upper gastrointestinal endoscopy, and biopsy of ampullary lesions (when present). Magnetic resonance cholangiopancreatography was performed for doubtful cases of lower common bile duct lesions. RESULTS: There was no perioperative mortality. LPD was performed with tumor-free margins in all patients, including patients with pancreatic ductal adenocarcinoma (n = 6), ampullary carcinoma (n = 6), intra-ductal papillary mucinous neoplasm (n = 2), pancreatic cystadenocarcinoma (n = 2), pancreatic head adenocarcinoma (n = 3), and bile duct cancer (n = 2). The mean patient age was 65 years (range, 42-75 years). The median blood loss was 240 mL, and the mean operative time was 368 min. CONCLUSION: LPD using a reverse-"V" approach can be performed safely and yields good results in elective patients. Our preliminary experience showed that LDP can be performed via a reverse-"V" approach. This approach can be used to treat localized malignant lesions irrespective of histopathology.


Subject(s)
Bile Duct Neoplasms/surgery , Laparoscopy/methods , Pancreatic Neoplasms/surgery , Pancreaticoduodenectomy/methods , Adult , Aged , Bile Duct Neoplasms/pathology , Blood Loss, Surgical , China , Diagnostic Imaging/methods , Feasibility Studies , Female , Humans , Laparoscopy/adverse effects , Male , Middle Aged , Operative Time , Pancreatic Neoplasms/pathology , Pancreaticoduodenectomy/adverse effects , Postoperative Complications/etiology , Predictive Value of Tests , Retrospective Studies , Time Factors , Treatment Outcome
2.
World J Gastroenterol ; 21(3): 888-96, 2015 Jan 21.
Article in English | MEDLINE | ID: mdl-25624722

ABSTRACT

AIM: To investigate the feasibility of temporary extracorporeal continuous porta-caval diversion (ECPD) to relieve portal hyperperfusion in "small-for-size" syndrome following massive hepatectomy in pigs. METHODS: Fourteen pigs underwent 85%-90% liver resection and were then randomly divided into the control group (n = 7) and diversion group (n = 7). In the diversion group, portal venous blood was aspirated through the portal catheter and into a tube connected to a centrifugal pump. After filtration, the blood was returned to the pig through a double-lumen catheter inserted into the internal jugular or subclavian vein. With the conversion pump, portal venous inflow was partially diverted to the inferior vena cava through a catheter inserted via the gastroduodenal vein at 100-130 mL/min. Portal hemodynamics, injury, and regeneration in the liver remnant were compared between the two groups. RESULTS: Compared to the control group, porta-caval diversion via ECPD significantly mitigated excessive portal venous flow and portal vein pressure (PVP); the portal vein flow (PVF), hepatic artery flow (HAF), and PVP in the two groups were not significantly different at baseline; however, the PVF (431.8 ± 36.6 vs 238.8 ± 29.3, P < 0.01; 210.3 ± 23.4 vs 122.3 ± 20.6, P < 0.01) and PVP (13.8 ± 2.6 vs 8.7 ± 1.4, P < 0.01; 15.6 ± 2.1 vs 10.1 ± 1.3, P < 0.05) in the control group were significantly higher than those in the diversion group, respectively. The HAF in the control group was significantly lower than that in the diversion group at 2 h and 48 h post hepatectomy, and ECPD significantly attenuated injury to the sinusoidal lining and hepatocytes, increased the regeneration index of the liver remnant, and relieved damage that the liver remnant suffered due to endotoxin and bacterial translocation. CONCLUSION: ECPD, which can dynamically modulate portal inflow, can reduce injury to the liver remnant and facilitate liver regeneration, and therefore should replace permanent meso/porta-caval shunts in "small-for-size" syndrome.


Subject(s)
Extracorporeal Circulation/methods , Hemodynamics , Hepatectomy , Liver Circulation , Liver Transplantation , Portacaval Shunt, Surgical/adverse effects , Portal Vein/surgery , Postoperative Complications/prevention & control , Vena Cava, Inferior/surgery , Animals , Case-Control Studies , Disease Models, Animal , Feasibility Studies , Liver Regeneration , Male , Microcirculation , Portal Pressure , Portal Vein/physiopathology , Postoperative Complications/etiology , Postoperative Complications/physiopathology , Swine , Swine, Miniature , Time Factors , Vena Cava, Inferior/physiopathology
3.
Exp Ther Med ; 8(1): 141-146, 2014 Jul.
Article in English | MEDLINE | ID: mdl-24944612

ABSTRACT

The current study explored the effects of intensive insulin therapy (IIT) combined with low molecular weight heparin (LMWH) anticoagulant therapy on severe acute pancreatitis (SAP). A total of 134 patients with SAP that received treatment between June 2008 and June 2012 were divided randomly into groups A (control; n=33), B (IIT; n=33), C (LMWH; n=34) and D (IIT + LMWH; n=34). Group A were treated routinely. Group B received continuous pumped insulin, as well as the routine treatment, to maintain the blood sugar level between 4.4 and 6.1 mmol/l. Group C received a subcutaneous injection of LMWH every 12 h in addition to the routine treatment. Group D received IIT + LMWH and the routine treatment. The white blood cell count, hemodiastase, serum albumin, arterial partial pressure of oxygen and prothrombin time were recorded prior to treatment and 1, 3, 5, 7 and 14 days after the initiation of treatment. The intestinal function recovery time, incidence rate of multiple organ failure (MOF), length of hospitalization and fatality rates were observed. IIT + LMWH noticeably increased the white blood cell count, hemodiastase level, serum albumin level and the arterial partial pressure of oxygen in the patients with SAP (P<0.05). It markedly shortened the intestinal recovery time and the length of stay and reduced the incidence rate of MOF, the surgery rate and the fatality rate (P<0.05). It did not aggravate the hemorrhagic tendency of SAP (P>0.05). IIT + LMWH had a noticeably improved clinical curative effect on SAP compared with that of the other treatments.

4.
World J Gastroenterol ; 20(4): 1021-9, 2014 Jan 28.
Article in English | MEDLINE | ID: mdl-24574774

ABSTRACT

AIM: To investigate the impact of portal inflow on liver remnants in a stable pig model of small-for-size syndrome. METHODS: Twenty pigs underwent mesocaval shunt (MCS) surgery followed by 85%-90% hepatectomy. The control group had no shunt placement; the S1 group had portal flow maintained at an average of 2.0 times the baseline values; and the S2 group had portal flow maintained at an average of 3.2 times the baseline flow. The effect of portal functional competition on the liver remnant was investigated for 48 h postoperatively. Data were presented as mean ± SD. Statistical significance was determined using Student's t test (SPSS, Chicago, IL, United States). Values of P < 0.05 were considered statistically significant. RESULTS: At 24 h after hepatectomy, biochemical and histological changes were not significantly different between the S1 and S2 groups, but changes in both sets of variables were significantly less than in the control group. At 48 h, biochemical and histological changes were significantly less in the S2 group than in the S1 or control group. The regeneration index was significantly higher in the S2 group than in the S1 group, and was similar to that in the control group. Apoptosis index, serum lipopolysaccharide, and bacterial DNA levels were significantly lower in the S2 group than in the other two groups. CONCLUSION: Diversion of portal inflow using MCS reduces portal overflow injury. Excessive diversion of portal inflow inhibits liver regeneration following major hepatectomy. Maintaining portal inflow at an average of 3.2 times above baseline helps promote hypertrophy of the liver remnant and reduce apoptosis.


Subject(s)
Liver Circulation , Liver Regeneration , Liver/blood supply , Liver/physiopathology , Portal Vein/physiopathology , Animals , Apoptosis , Blood Flow Velocity , Cell Proliferation , Disease Models, Animal , Hepatectomy , Hypertrophy , Liver/pathology , Liver/surgery , Male , Mesenteric Veins/physiopathology , Mesenteric Veins/surgery , Portal Pressure , Swine , Swine, Miniature , Time Factors , Vena Cava, Inferior/surgery
5.
Clin Res Hepatol Gastroenterol ; 38(3): 337-45, 2014 Jun.
Article in English | MEDLINE | ID: mdl-24502885

ABSTRACT

BACKGROUND/AIMS: A major hepatectomy occasionally lead to acute liver failure and death. We demonstrated the anti-oxidative and anti-inflammatory effects and functional mechanisms of hydrogen-rich saline (HS), a novel antioxidant, on an experimental model of rats after a partial hepatectomy (PH). METHODS: The rats underwent a 90% hepatectomy. HS was given intraperitoneally after the operation and every 8hours after. RESULTS: HS markedly improved the survival rate of two experimental groups after the massive hepatectomy and inhibited increases in serum levels of TBIL, DBIL, ALT and AST. The histopathological analysis demonstrated that HS attenuated inflammatory changes in the liver. HS administration markedly lowered the massive hepatectomy induced elevation of the serum hyaluronic acid (HA) concentrations. HS inhibited the formation of one of the markers of oxidative damage, malondialdehyde (MDA), and increased the activities of superoxide dismutase (SOD) in liver tissue. In the HS-treated group, increases in inflammatory cytokines, such as TNF-α, IL-6 and HMGB-1, were inhibited in the liver tissue. The NF-κB p65 staining revealed that HS inhibited the activation of the transcription factor nuclear factor kappa B (NF-kB). CONCLUSIONS: HS attenuates the massive hepatectomy induced liver injury not only by attenuating oxidative damage, but also by reducing the production of inflammatory cytokines, such as TNF-α, IL-6 and HMGB-1, in part through the inhibition of NF-kB activation.


Subject(s)
Hepatectomy/adverse effects , Hydrogen/pharmacology , Liver Failure/prevention & control , Sodium Chloride/pharmacology , Alanine Transaminase/blood , Animals , Aspartate Aminotransferases/blood , Bilirubin/blood , Cytokines/metabolism , Hyaluronic Acid/blood , Liver/metabolism , Malondialdehyde/metabolism , Models, Animal , NF-kappa B/metabolism , Rats, Sprague-Dawley , Superoxide Dismutase/metabolism
6.
Hepatogastroenterology ; 61(136): 2215-8, 2014.
Article in English | MEDLINE | ID: mdl-25699354

ABSTRACT

BACKGROUND/AIMS: Colorectal cancer (CRC) is one of the most common malignancies, and liver metastasis is one of the major causes of death of CRC. This study aimed to compare the genetic difference between metachronous lesions (MC) and synchronous lesions (SC) and explore the molecular pathology of CRC metastasis. METHODOLOGY: Microarray expression profile data (GSE10961) including 8 MC and 10 SC was downloaded from Gene Expression Omnibus. The differentially expressed genes (DEGs) between the two groups were identified based on T test. Furthermore, GO enrichment analysis was performed for the down-regulated DEGs using DAVID. Finally, Classify validation of known CRC genes based on previous studies between MC and SC samples was conducted. RESULTS: Total of 36 DEGs including 35 down-regulated DEGs and 1 up-regulated DEGs were identified. The expressional differences of the 5 informative oncogenes: EGFr, PIK3R1, PTGS2 (COX-2), PTGS1 (COX1), and ALOX5AP between SC and MC were really tiny. CONCLUSIONS: Some DEGs, such as NFAT5, OLR1, ERAP2, HOXC6 and TWIST1 might play crucial roles in the regulation of CRC metastasis (both SC and MC) and by disrupting some pathways. However, our results indeed demand further research and experiment.


Subject(s)
Colorectal Neoplasms/pathology , Liver Neoplasms/secondary , Neoplasms, Multiple Primary/pathology , Neoplasms, Second Primary/pathology , Transcriptome , Humans , Oligonucleotide Array Sequence Analysis
7.
Mol Cell Biochem ; 388(1-2): 39-49, 2014 Mar.
Article in English | MEDLINE | ID: mdl-24242138

ABSTRACT

Increasing evidence shows that dysregulation of microRNAs is correlated with tumor development. This study was performed to determine the expression of miR-141 and investigate its clinical significance in pancreatic ductal adenocarcinoma (PDAC). Taqman quantitative RT-PCR was used to detect miR-141 expressions in 94 PDAC tissues and 16 nontumorous pancreatic tissues. Correlations between miR-141 expression and clinicopathologic features and prognosis of patients were statistically analyzed. The effects of miR-141 expression on growth and apoptosis of PDAC cell line (PANC-1) were determined by MTT, colony formation, and flow cytometry assays. Potential target genes were identified by luciferase reporter and Western blot assays. The expression level of miR-141 in PDAC tissues was significantly lower than that in corresponding nontumorous tissues. Downregulation of miR-141 correlated with poorer pT and pN status, advanced clinical stage, and lymphatic invasion. Also, low miR-141 expression in PDAC tissues was significantly correlated with shorter overall survival, and multivariate analysis showed that miR-141 was an independent prognostic factor for PDAC patients. Further, functional researches suggested that miR-141 inhibits growth and colony formation, and enhances caspase-3-dependent apoptosis in PANC-1 cells by targeting Yes-associated protein-1 (YAP1). Therefore, miR-141 is an independent prognostic factor for PDAC patients, and functions as a tumor suppressor gene by targeting YAP1.


Subject(s)
Adaptor Proteins, Signal Transducing/genetics , Adenocarcinoma/genetics , Carcinoma, Pancreatic Ductal/genetics , MicroRNAs/genetics , Pancreatic Neoplasms/genetics , Phosphoproteins/genetics , Adenocarcinoma/mortality , Adenocarcinoma/pathology , Apoptosis/genetics , Carcinoma, Pancreatic Ductal/mortality , Carcinoma, Pancreatic Ductal/pathology , Caspase 3 , Cell Line, Tumor , Cell Proliferation , Down-Regulation/genetics , Female , Gene Expression Regulation, Neoplastic , Genes, Tumor Suppressor , Humans , Lymphatic Metastasis/genetics , Lymphatic Metastasis/pathology , Male , MicroRNAs/biosynthesis , Middle Aged , Pancreas/pathology , Pancreatic Neoplasms/mortality , Pancreatic Neoplasms/pathology , Prognosis , RNA Interference , RNA, Small Interfering , Transcription Factors , YAP-Signaling Proteins
8.
World J Gastroenterol ; 19(33): 5464-72, 2013 Sep 07.
Article in English | MEDLINE | ID: mdl-24023489

ABSTRACT

AIM: To investigate the effect of plasmapheresis via the portal vein for "small-for-size" syndrome (SFSS) aided by extracorporeal continuous portal diversion (ECPD). METHODS: Extensive or total hepatectomy in the pig is usually adopted as a postoperative liver failure (PLF) or SFSS model. In this study, animals which underwent 85%-90% hepatectomy were randomized into either the Systemic group (n = 7) or the Portal group (n = 7). In the Systemic group, all pigs received temporal plasmapheresis (PP) via the extracorporeal catheter circuit (systemic to systemic circulation) from 24 to 30 h post-hepatectomy (PH); in the Portal group, all pigs received ECPD to divert partial portal vein flow (PVF) to the systemic circulation after hepatectomy, then converted to temporal PP from 24 to 30 h PH, and subsequently converted to ECPD again until 48 h PH. In the Portal group, the PVF was preserved at 3.0-3.3 times that of the baseline value, similar to that following 70% hepatectomy, which was regarded as the optimal PVF to the hypertrophic liver remnant. At 48 h PH, all pigs were re-opened and the portal vein pressure (PVP), PVF, and HAF (hepatic artery flow) were measured, and then diversion of the portal venous flow was terminated. After 1 h the PVP, PVF, and HAF were re-measured. The portal hemodynamic changes, liver injury, liver regeneration and bacterial/lipopolysaccharide (LPS) translocation were evaluated in the two groups. RESULTS: The PVP in the Portal group was significantly lower than that in the Systemic group during the time period from 2 to 49 h PH (P < 0.05). Serum alanine aminotransferase (ALT), total bilirubin (TB) and ammonia were significantly reduced in the Portal group compared with the Systemic group from 24 to 48 h PH (P < 0.05). The Portal group may have attenuated sinusoidal endothelial injury and decreased the level of HA compared with the Systemic group. In the Systemic group, there was significant sinusoidal dilation, hydropic changes in hepatocytes and hemorrhage into the hepatic parenchyma, and the sinusoidal endothelial lining was partially destroyed and detached into the sinusoidal space. CD31 immunostaining revealed significant destruction of the endothelial lining. In the Portal group, there was no intraparenchymal hemorrhage and the sinusoidal endothelial cells and hepatocytes were well preserved. CD31 immunostaining was mild which indicated less destruction of the endothelial lining. HA was significantly decreased in the Portal group compared with the Systemic group from 2 to 48 h PH. The rate of liver remnant regeneration was elevated, while apoptosis was attenuated in the Portal group compared with the Systemic group. Thymidine kinase activity was much higher in the Portal group than in the Systemic group at 48 h PH. The PCNA index was significantly increased and the apoptotic index was significantly decreased in the Portal group compared with the Systemic group. Bacterial translocation and endotoxin, as well as the inflammatory response, were significantly attenuated in the Portal group compared with the Systemic group. LPS, tumor necrosis factor-α and interleukin-6 levels were all significantly decreased in the Portal group compared with the Systemic group from 24 to 48 h PH, while bacterial DNA level was significantly decreased from 2 to 48 h PH. CONCLUSION: PP plus ECPD via the portal vein can attenuate toxic load and hyperperfusion injury, and should be undertaken instead of PP via the systemic circulation in SFSS or PLF.


Subject(s)
Extracorporeal Circulation , Hepatic Insufficiency/therapy , Liver Regeneration , Plasmapheresis , Alanine Transaminase/blood , Ammonia/blood , Animals , Apoptosis , Bilirubin/blood , Hemodynamics , Male , Portal Pressure , Portal Vein , Random Allocation , Swine
9.
World J Gastroenterol ; 19(31): 5076-84, 2013 Aug 21.
Article in English | MEDLINE | ID: mdl-23964141

ABSTRACT

AIM: To investigate the capacity of shunts to relieve portal hypertension and decrease the safe minimal liver remnant in pigs. METHODS: A subtotal hepatectomy with < 60 mL blood loss and without hepatic pedicle occlusion was performed. The mesenteric venous inflow was diverted through a mesocaval shunt (MCS) constructed using the prepared left renal vein with an end-to-side running suture of 5-0 proline. All 21 animals that underwent subtotal hepatectomy and/or MCS were divided into three groups. In the 15% group, the residual volume was 14%-19% of total liver volume (TLV); in the 15%+ S group, the residual volume was also 14%-19% of TLV with a mesocaval shunt (MCS); and in the 10%+ S group, the residual volume was 8%-13% of TLV with an MCS. In the three groups, the intraoperative portal vein pressure (PVP) and portal vein flow (PVF) were monitored and compared at laparotomy and 1 h post-hepatectomy. The survival rate, sinusoidal endothelial damage, tissue analysis, and serum analysis were investigated among the three groups. RESULTS: The percentage residual liver volume was 15.9%, 16.1% and 11.8% in the 15%, 15%+ S, 10%+ S groups, respectively. After hepatectomy, PVF and portal-to-arterial flow ratio in the 15%+ S group significantly decreased and hepatic artery flow (HAF) per unit volume significantly increased, compared to those in the 15% group. The PVP in the 15%+ S group and 10%+ S group increased slightly from that measured at laparotomy; however, in the 15% group, the PVP increased immediately and significantly above that observed in the other two groups. The 14-d survival rates were 28.5%, 85.6%, and 14.2% in the 15%, 15%+ S, and 10%+ S groups, respectively. In the 15%+ S group, the shunts effectively attenuated injury to the sinusoidal endothelium, and the changes in the serum and tissue analysis results were significantly reduced compared to those in the 15% and 10%+ S groups. CONCLUSION: MCS can decompress the portal vein and so attenuate liver injury from hyperperfusion, and make extreme or marginal hepatectomy safer.


Subject(s)
Decompression/methods , Hepatectomy/adverse effects , Liver Circulation , Liver/blood supply , Liver/surgery , Mesenteric Veins/surgery , Renal Veins/transplantation , Vena Cava, Inferior/surgery , Animals , Biomarkers/blood , Liver/metabolism , Liver/pathology , Male , Mesenteric Veins/physiopathology , Models, Animal , Portal Pressure , Portal Vein/physiopathology , Postoperative Complications/physiopathology , Postoperative Complications/prevention & control , Swine , Swine, Miniature , Time Factors , Vena Cava, Inferior/physiopathology
10.
Turk J Gastroenterol ; 24(2): 127-33, 2013.
Article in English | MEDLINE | ID: mdl-23934459

ABSTRACT

BACKGROUND/AIMS: There is no consensus for laparoscopy first in patients with rectal cancer and synchronous liver metastases, whose metastases are confined to the liver. This study aimed to evaluate its indications for one-stage surgery in laparoscopy. MATERIALS AND METHODS: Eighteen patients with rectal cancer and synchronous liver metastases, who had undergone laparoscopic colorectal resection and simultaneous treatment for liver metastases, were retrospectively reviewed. RESULTS: Concomitant with laparoscopic colorectal resection, eight patients received liver resection simultaneously; 10 patients underwent a variety of down-staging management including local ablation, right hepatic portal vein ligation, and implantation of chemotherapy pumps into the hepatic artery. The colo-anal/rectal anastomoses were performed with a stapler or "pull-though" mode though the anus. Three patients underwent two-stage liver resection following tumor down-staging. Median survival time was 22.3 months. CONCLUSIONS: Laparoscopy approach for rectal cancer and synchronous liver metastases is feasible in selected patients. Colon pull-through anastomosis was a potential method to avoid abdominal incision and decrease the risk of anastomotic leakage. It is worth further investigation regarding its advantages over traditional modalities with a prospective randomized controlled study.


Subject(s)
Adenocarcinoma/surgery , Anal Canal/surgery , Colon/surgery , Liver Neoplasms/surgery , Rectal Neoplasms/surgery , Adenocarcinoma/secondary , Adult , Aged , Anastomosis, Surgical , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Female , Fluorouracil/therapeutic use , Hepatectomy , Hepatic Veins/surgery , Humans , Infusion Pumps, Implantable , Laparoscopy , Leucovorin/therapeutic use , Ligation , Liver Neoplasms/drug therapy , Liver Neoplasms/secondary , Male , Middle Aged , Organoplatinum Compounds/therapeutic use , Rectal Neoplasms/pathology , Retrospective Studies , Time Factors , Young Adult
11.
CNS Neurosci Ther ; 19(4): 235-43, 2013 Apr.
Article in English | MEDLINE | ID: mdl-23521911

ABSTRACT

BACKGROUNDS AND AIM: Microglial cells as an important part of central nervous system (CNS) have generally believed to play significant role in the process leading to a number of neurodegenerative disorders including Parkinson's disease, Alzheimer's disease, prion diseases, multiple sclerosis, HIV-dementia, and stroke. Although different diseases have quite different pathogenesis, the activation of microglia was shared with all of them. Recently, the resolvin D1 (RvD1) as an endogenous antiinflammatory lipid mediator has been confirmed to be involved in the treatment of inflammation-related neuronal injury in neurodegenerative diseases. Therefore, the inhibition of microglia-activated inflammation has been considered as a major treatment strategy in neurodegenerative disease therapy. However, the molecular mechanisms of RvD1 in microglial cells remain unknown and still do not be reported. METHODS: We taken murine microglia as the experimental sample, and Western blotting, ELISA, reverse-transcriptase PCR, real-time PCR, and electrophoretic mobility shift assay were used to study whether the RvD1 inhibit inflammation of microglial cells. The tumor necrosis factor α (TNF-α), IL-1ß, inducible nitric oxide synthase (iNOS) expression, nuclear factor-κB (NF-κB) activation, and mitogen-activated protein kinase (MAPK) pathways were investigated in lipopolysaccharide (LPS)-activated primary microglia. RESULTS: Our data suggested that RvD1 inhibited the production of LPS-induced microglia inflammatory mediators and TNF-α, IL-1ß, and iNOS expression. In addition, according to the study of related signaling pathways, RvD1 attenuated LPS-induced microglia NF-κB activation,MAPK phosphorylation, and activator protein-1 transcriptional activity. CONCLUSION: This is the first study to demonstrate that RvD1 effects on the reduction of pro-inflammatory responses in LPS-induced microglial cells. The mechanisms underlying these effects may include its potent intracellular NF-κB down-regulation and subsequent pro-inflammatory cytokines release in LPS-activated microglia.


Subject(s)
Docosahexaenoic Acids/physiology , Inflammation Mediators/antagonists & inhibitors , Lipopolysaccharides/antagonists & inhibitors , Lipopolysaccharides/physiology , Microglia/physiology , Signal Transduction/physiology , Animals , Cells, Cultured , Docosahexaenoic Acids/metabolism , Inflammation/metabolism , Inflammation/pathology , Inflammation/prevention & control , Inflammation Mediators/physiology , Mice , Microglia/metabolism , Rats , Rats, Sprague-Dawley
12.
World J Surg ; 37(3): 614-21, 2013 Mar.
Article in English | MEDLINE | ID: mdl-23283218

ABSTRACT

BACKGROUND: Bismuth type IV hilar cholangiocarcinoma (HC) tumors are usually considered unresectable. The strategies of high hilar resection while preserving liver parenchyma can achieve potentially one-stage curative resection for this condition. The aim of the present study was to investigate the feasibility and safety of available strategies. METHODS: Fifty-one consecutive patients with bismuth type IV HC who underwent one-stage resection were retrospectively reviewed with regard to curative resection rate, remnant liver volume, morbidity, mortality, and survival time. RESULTS: The total median survival time was 29 months. The R(0) (curative resection) rate was 57.8%. The ratio of the remnant liver volume (RLV) to the standard liver volume (SLV) ranged from 35.0 to 60.6%, with a mean of 44.5%. The in-hospital mortality and morbidity rates were 3.9 and 37.2%, respectively. In the R0 patients' survival, there was not a significant difference between bilioenteric anastomosis and hepatoenteric anastomosis (P = 0.714). CONCLUSIONS: Combined caudate lobe and high hilar resection (CCHR) is technically safe and oncologically justifiable and could be adopted with a high cure rate as a one-stage resection procedure for most patients with Bismuth type IV HC whose total bilirubin level is less than 20 mg/L and whose direct bilirubin is more than 60% of total bilirubin.


Subject(s)
Bile Duct Neoplasms/mortality , Bile Duct Neoplasms/surgery , Bile Ducts, Intrahepatic , Cholangiocarcinoma/mortality , Cholangiocarcinoma/surgery , Hepatectomy/methods , Adult , Aged , Aged, 80 and over , Bile Duct Neoplasms/pathology , Biopsy, Needle , China , Cholangiocarcinoma/pathology , Cohort Studies , Confidence Intervals , Disease-Free Survival , Female , Follow-Up Studies , Hepatectomy/mortality , Hospital Mortality/trends , Humans , Immunohistochemistry , Kaplan-Meier Estimate , Male , Middle Aged , Neoplasm Recurrence, Local/mortality , Neoplasm Recurrence, Local/pathology , Neoplasm Staging , Operative Time , Postoperative Complications/mortality , Postoperative Complications/physiopathology , Prognosis , Retrospective Studies , Statistics, Nonparametric , Survival Analysis , Treatment Outcome
13.
Hepatogastroenterology ; 60(122): 217-21, 2013.
Article in English | MEDLINE | ID: mdl-22945386

ABSTRACT

BACKGROUND/AIMS: Lapraoscopic era provided a new alternative for rectal cancer and synchronous liver metastases (RCLM). However, there is no established consensus for laparoscopy "first" for patients with RCLM, whose metastasis is confined to the liver. This study aimed to evaluate its indications for one-stage surgery in laparoscopy. METHODOLOGY: Sixteen patients with RCLM, who had undergone laparoscopic colorectal resection and simultaneous treatment for liver metastasis, were retrospectively reviewed. RESULTS: With concomitant laparoscopic colorectal resection, 6 patients received liver resection simultaneously; 10 patients underwent all sorts of down-staging managing including local ablation, right hepatic portal vein ligation and chemotherapy pumps implanted into hepatic artery for liver metastases. The colo-anal/rectal anastomoses were performed with a stapler or "pull-through" mode through the anus. Three patients underwent two-stage liver resection following tumor down-staging. Median survival time was 22.3 months. CONCLUSIONS: Laparoscopy approach first for rectal cancer and synchronous liver metastasis is feasible in selected patients, and can provide curative resection or benefit "down-staging" treatment. Colon "pull-through" anastomosis is a potential method to avoid abdominal incision and decrease the risk of anastomotic leakage. It is worth investigating its advantages over traditional approaches with a prospective randomized controlled study.


Subject(s)
Laparoscopy/methods , Liver Neoplasms/secondary , Liver Neoplasms/surgery , Neoplasms, Multiple Primary/surgery , Rectal Neoplasms/surgery , Adult , Aged , Female , Hepatectomy , Humans , Male , Middle Aged , Retrospective Studies
14.
Tumour Biol ; 34(1): 271-6, 2013 Feb.
Article in English | MEDLINE | ID: mdl-23055200

ABSTRACT

The aim of this study was to evaluate the association between activating enhancer binding protein 4 (AP-4) tissue expression and patient prognosis in hepatocellular carcinoma (HCC). The levels of AP-4 mRNA and protein in tumor and para-tumor tissue were evaluated in 30 HCC cases by quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot. Additionally, AP-4 protein expression in 112 HCC was analyzed by immunohistochemistry. The correlation of AP-4 expression and patients' clinicopathological parameters was evaluated. Survival analysis was performed using the Kaplan-Meier method and Cox's proportional hazards model. By RT-PCR and Western blot, the levels of AP-4 mRNA and protein were significantly higher in HCC, compared to that in para-tumor tissue (p < 0.001). Immunohistochemical staining revealed that AP-4 was highly expressed in 53.6 % of the HCC patients. The AP-4 expression level was closely associated with serum alpha fetoprotein elevation, tumor size, histological differentiation, tumor recurrence, tumor metastasis, and tumor stage. Kaplan-Meier survival analysis showed that a high expression level of AP-4 resulted in a significantly poor prognosis of HCC patients. Multivariate analysis revealed that AP-4 expression level was an independent prognostic parameter for the overall survival rate of HCC patients. These findings provide evidence that a high expression level of AP-4 serves as a biomarker for poor prognosis for HCC. Thus, we speculate that AP-4 may be a potential target of antiangiogenic therapy for HCC.


Subject(s)
Adaptor Protein Complex 4/metabolism , Carcinoma, Hepatocellular/metabolism , Carcinoma, Hepatocellular/surgery , Hepatectomy , Liver Neoplasms/metabolism , Liver Neoplasms/surgery , Adaptor Protein Complex 4/genetics , Biomarkers, Tumor/analysis , Biomarkers, Tumor/blood , Biomarkers, Tumor/genetics , Carcinoma, Hepatocellular/genetics , Female , Humans , Liver Neoplasms/genetics , Male , Middle Aged , Prognosis , RNA, Messenger/analysis , Survival Analysis , alpha-Fetoproteins/analysis
15.
World J Gastroenterol ; 18(37): 5197-204, 2012 Oct 07.
Article in English | MEDLINE | ID: mdl-23066313

ABSTRACT

AIM: To study the effect of H2 gas on liver injury in massive hepatectomy using the intermittent Pringle maneuver in swine. METHODS: Male Bama pigs (n = 14) treated with ketamine hydrochloride and Sumianxin II as induction drugs followed by inhalation anesthesia with 2% isoflurane, underwent 70% hepatotectomy with loss of bleeding less than 50 mL, and with hepatic pedicle occlusion for 20 min, were divided into two groups: Hydrogen-group (n = 7), the pigs with inhalation of 2% hydrogen by the tracheal intubation during major hepatotectomy; contrast-group (n = 7), underwent 70% hepatotectomy without inhalation of hydrogen. Hemodynamic changes and plasma concentrations of alanine aminotransferase (ALT), aspartate aminotransferase (AST), hyaluronic acid (HA), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and malondialdehyde (MDA) in liver tissue were measured at pre-operation, post-hepatotectomy (PH) 1 h and 3 h. The apoptosis and proliferating cell nuclear antigen (PCNA) expression in liver remnant were evaluated at PH 3 h. Then we compared the two groups by these marks to evaluate the effect of the hydrogen in the liver injury during major hepatotectomy with the Pringle Maneuver in the swine. RESULTS: There were no significant differences in body weight, blood loss and removal liver weight between the two groups. There was no significant difference in changes of portal vein pressure between two groups at pre-operation, PH 30 min, but in hydrogen gas treated-group it slightly decrease and lower than its in contrast-group at PH 3 h, although there were no significant difference (P = 0.655). ALT and AST in Hydrogen-group was significantly lower comparing to contrast-group (P = 0.036, P = 0.011, vs. P = 0.032, P = 0.013) at PH 1 h and 3 h, although the two groups all increased. The MDA level increased between the two group at PH 1 h and 3 h. In the hydrogen gas treated-group, the MDA level was not significantly significant at pre-operation and significantly low at PH 1 h and 3 h comparing to Contrast-group (P = 0.0005, P = 0.0004). In Hydrogen-group, the HA level was also significantly low to contrast-group (P = 0.0005, P = 0.0005) although the two groups all increased at PH 1 h and 3 h. The expression of cluster of differentiation molecule 31 molecules Hydrogen-group was low to Contrast-group. However, PCNA index (%) was not statistically significant between the two groups (P = 0.802). Microphotometric evaluation of apoptotic index (AI) in terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling-stained tissue after hepatotectomy for 3h, the AI% level in the hydrogen was significantly low to contrast-group (P = 0.012). There were no significant difference between Hydrogen-group and contrast-group at pre-operation (P = 0.653, P = 0.423), but after massive hepatotectomy, the TNF-α and IL-6 levels increase, and its in Hydrogen-group was significantly low compared with contrast-group (P = 0.022, P = 0.013, vs. P = 0.016, P = 0.012), respectively. Hydrogen-gas inhalation reduce levels of these markers and relieved morphological liver injury and apoptosis. CONCLUSION: H2 gas attenuates markedly ischemia and portal hyperperfusion injury in pigs with massive hepatotectomy, possibly by the reduction of inflammation and oxidative stress, maybe a potential agent for treatment in clinic.


Subject(s)
Anesthesia, Inhalation/methods , Hepatectomy/methods , Hydrogen/metabolism , Administration, Inhalation , Alanine Transaminase/biosynthesis , Animals , Apoptosis , Aspartate Aminotransferases/biosynthesis , Gases , Hemodynamics , Hyaluronic Acid/biosynthesis , Immunohistochemistry/methods , Interleukin-6/biosynthesis , Liver/drug effects , Liver/surgery , Male , Malondialdehyde/metabolism , Proliferating Cell Nuclear Antigen/biosynthesis , Swine , Time Factors , Tumor Necrosis Factor-alpha/biosynthesis
16.
J Dig Dis ; 13(10): 541-8, 2012 Oct.
Article in English | MEDLINE | ID: mdl-22988928

ABSTRACT

OBJECTIVE: This study was aimed to identify the potential indications for simultaneous resection of abdominal cancer and synchronous pancreaticoduodenal metastasis (SRAPM) and improve the efficacy of SRAPM. METHODS: The data of 34 patients who underwent SRAPM were retrospectively reviewed. The intraoperative findings, morbidity and mortality, patterns of tumor invasion in the pancreas and duodenum, lymph node metastases, long-term outcomes and causes of death were evaluated. RESULTS: Fourteen patients (41.2%) developed complications, and 2 died of pancreatic fistulas with abdominal bleeding. The in-hospital mortality was 5.9%. The overall 1-year, 2-year and 3-year survival rates were 52.9%, 32.3% and 21.8%, respectively. The survival rates depended on the primary tumor, the invasion pattern, the presence of metastatic lymph nodes at the paraaortic site and the presence of residual tumor. The follow-up outcomes revealed that the main causes of death were as follows: systemic metastasis (n = 7), peritoneal metastasis (n = 6) and intrahepatic metastasis (n = 6). CONCLUSIONS: SRAPM is indicated for low-grade malignant tumors and in cases with direct invasion of the pancreaticoduodenum. The presence of metastatic lymph nodes at the paraaortic site, intrahepatic metastasis, micro-peritoneal metastasis, and distinct metastasis should be contraindications for the surgical procedure.


Subject(s)
Carcinoma/secondary , Carcinoma/surgery , Digestive System Neoplasms/pathology , Digestive System Neoplasms/surgery , Hemorrhage/etiology , Pancreatic Fistula/etiology , Postoperative Complications/etiology , Aged , Duodenal Neoplasms/secondary , Duodenal Neoplasms/surgery , Female , Hospital Mortality , Humans , Kaplan-Meier Estimate , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Grading , Neoplasm Invasiveness , Neoplasm, Residual , Pancreatic Neoplasms/secondary , Pancreatic Neoplasms/surgery , Pancreaticoduodenectomy , Survival Rate , Time Factors
17.
World J Gastroenterol ; 18(23): 3020-6, 2012 Jun 21.
Article in English | MEDLINE | ID: mdl-22736928

ABSTRACT

AIM: To investigate the effects of the WWOX gene on the human hepatic carcinoma cell line SMMC-7721. METHODS: Full-length WWOX cDNA was amplified from normal human liver tissues. Full-length cDNA was subcloned into pEGFP-N1, a eukaryotic expression vector. After introduction of the WWOX gene into cancer cells using liposomes, the WWOX protein level in the cells was detected through Western blotting. Cell growth rates were assessed by methyl thiazolyl tetrazolium (MTT) and colony formation assays. Cell cycle progression and cell apoptosis were measured by flow cytometry. The phosphorylated protein kinase B (AKT) and activated fragments of caspase-9 and caspase-3 were examined by Western blotting analysis. RESULTS: WWOX significantly inhibited cell proliferation, as evaluated by the MTT and colony formation assays. Cells transfected with WWOX showed significantly higher apoptosis ratios when compared with cells transfected with a mock plasmid, and overexpression of WWOX delayed cell cycle progression from G1 to S phase, as measured by flow cytometry. An increase in apoptosis was also indicated by a remarkable activation of caspase-9 and caspase-3 and a dephosphorylation of AKT (Thr308 and Ser473) measured with Western blotting analysis. CONCLUSION: Overexpression of WWOX induces apoptosis and inhibits proliferation of the human hepatic carcinoma cell line SMMC-7721.


Subject(s)
Apoptosis/genetics , Carcinoma, Hepatocellular/metabolism , Cell Proliferation , Oxidoreductases/metabolism , Tumor Suppressor Proteins/metabolism , Carcinoma, Hepatocellular/genetics , Caspase 1/metabolism , Caspase 9/metabolism , Cell Cycle Checkpoints , Cell Line, Tumor , Humans , Oxidoreductases/genetics , Tumor Suppressor Proteins/genetics , WW Domain-Containing Oxidoreductase
18.
World J Gastroenterol ; 18(16): 1981-6, 2012 Apr 28.
Article in English | MEDLINE | ID: mdl-22563181

ABSTRACT

AIM: To investigate the correlation between peri-operative fluid therapy and early-phase recovery after liver transplantation (LT) by retrospectively reviewing 102 consecutive recipients. METHODS: Based on whether or not the patients had pulmonary complications, the patients were categorized into non-pulmonary and pulmonary groups. Twenty-eight peri-operative variables were analyzed in both groups to screen for the factors related to the occurrence of early pulmonary complications. RESULTS: The starting hemoglobin (Hb) value, an intra-operative transfusion > 100 mL/kg, and a fluid balance ≤ -14 mL/kg on the first day and the second or third day post-operatively were significant factors for early pulmonary complications. The extubation time, time to initial passage of flatus, or intensive care unit length of stay were significantly prolonged in patients who had not received an intra-operative transfusion ≤ 100 mL/kg or a fluid balance ≤ -14 mL/kg on the first day and the second or the third day post-operatively. Moreover, these patients had poorer results in arterial blood gas analysis. CONCLUSION: It is important to offer a precise and individualized fluid therapy during the peri-operative period to the patients undergoing LT for cirrhosis-associated hepatocellular carcinoma.


Subject(s)
Fluid Therapy , Liver Transplantation , Perioperative Care , Adult , Aged , Carcinoma, Hepatocellular/surgery , Female , Hemoglobins/analysis , Humans , Liver Neoplasms/surgery , Liver Transplantation/adverse effects , Logistic Models , Male , Middle Aged , Retrospective Studies
19.
World J Gastroenterol ; 18(48): 7285-9, 2012 Dec 28.
Article in English | MEDLINE | ID: mdl-23326134

ABSTRACT

AIM: To investigate the growth-inhibiting and apoptosis-inducing effects of the gene MOB2 on human hepatic carcinoma cell line SMMC-7721. METHODS: The full-length cDNA of the MOB2 gene was amplified from human umbilical vein endothelial cells. The correct full-length MOB2 cDNA was subcloned into the eukaryotic expression vector pEGFP-C1. After lipofection of the MOB2 gene into cancer cells, the levels of MOB2 protein in the cancer cells were detected by immunoblotting. To transfect the recombined plasmid vector pEGFP-CI-MOB2 into SMMC-7721 cells, the cells were cultured in Dulbecco's Modified Eagle's Medium with 10% fetal calf serum and glutamine, and then mixed with liposomes, Lipofectamine 2000 and the plasmid vector pEGFP-CI-MOB2. RESULTS: We observed the growth and proliferation of SMMC-7721 cells containing pEGFP-CI-MOB2 and analyzed their apoptosis and growth cycle phases by flow cytometry. We successfully transfected the recombined plasmid vector pEGFP-CI-MOB2 into SMMC-7721 cells and screened for a single clone cell containing MOB2. After transfection, MOB2 enhanced growth suppression, induced apoptosis, increased the ratio of G0/G1, significantly inhibited the advance of cell cycle phase, and arrested cells in G0/G1 phase. CONCLUSION: MOB2 overexpression induces apoptosis and inhibits the growth of human hepatic cancer cells, which may be useful in gene therapy for hepatic carcinoma.


Subject(s)
Carcinoma, Hepatocellular/metabolism , Gene Expression Regulation, Neoplastic , Gene Transfer Techniques , Liver Neoplasms/metabolism , Nerve Tissue Proteins/genetics , Apoptosis , Carcinoma, Hepatocellular/genetics , Cell Line, Tumor , Cell Proliferation , Cloning, Molecular , DNA, Complementary/metabolism , Flow Cytometry , Genetic Therapy , Genetic Vectors , Human Umbilical Vein Endothelial Cells , Humans , Liver Neoplasms/genetics , Nerve Tissue Proteins/metabolism , Transfection
20.
World J Gastroenterol ; 17(42): 4725-8, 2011 Nov 14.
Article in English | MEDLINE | ID: mdl-22180716

ABSTRACT

AIM: To investigate the effects of laparoscopic hepatectomy for the treatment of hepatocellular carcinoma (HCC). METHODS: From 2006 to January 2011, laparoscopic hepatectomies were performed on 30 cases of HCC at Northern Jiangsu People's Hospital. During this same time period, 30 patients elected to undergo conventional open hepatectomy over laparoscopic hepatectomy at the time of informed consent. The degree of invasiveness and outcomes of laparoscopic hepatectomy compared to open hepatectomy for HCC were evaluated. RESULTS: Both groups presented with similar blood loss amounts, operating times and complications. Patients in the laparoscopic hepatectomy group started walking and eating significantly earlier than those in the open hepatectomy group, and these more rapid recoveries allowed for shorter hospitalizations. There were no significant differences between procedures in survival rate. CONCLUSION: Laparoscopic hepatectomy is beneficial for patient quality of life if the indications are appropriately based on preoperative liver function and the location and size of the HCC.


Subject(s)
Carcinoma, Hepatocellular/surgery , Hepatectomy/methods , Laparoscopy/methods , Liver Neoplasms/surgery , Liver/pathology , Liver/surgery , Adult , Carcinoma, Hepatocellular/pathology , Disease-Free Survival , Female , Humans , Liver Neoplasms/pathology , Male , Mastectomy, Segmental , Middle Aged , Quality of Life , Survival Rate , Treatment Outcome
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