One-step Percutaneous Transhepatic Cholangioscopy Combined With High-frequency Needle-knife Electrotomy in Biliary Strictures After Liver Transplantation.

BACKGROUND: Endoscopic management is the mainstay for biliary strictures after liver transplantation. However, this method is often failed in cases associated with hepatolithiasis or refractory strictures. The aim of this study is to investigate whether 1-step percutaneous transhepatic biliary cholangiography (PTC) combined with high-frequency needle-knife electrotomy can be an alternative method in biliary strictures after liver transplantation that could not be treated by endoscopic management. METHODS: Clinical data of 14 patients suffering from biliary strictures after liver transplantation from June 2014 to January 2018 were retrospectively analyzed. One-step PTC combined with high-frequency needle-knife electrotomy was used to resolve the strictures. RESULTS: One-step PTC was successfully performed in all 14 patients. In 10 of 12 (83.3%) patients with hepatolithiasis, the stones were removed completely. Stricture resolution was detected in 13 of 14 (92.9%) patients at first postoperative choledochoscopy. Three mild adverse events occurred (cholangitis, 2 patients; delayed hemobilia, 1 patient), but were resolved with conservative treatment. The follow-up after supporting catheter removal was 15.7±4.5 months. Only 1 patient (8.3%) had stone recurrence and no stenosis occurred during supporting-catheter-free follow-up. CONCLUSIONS: One-step PTC combined with high-frequency needle-knife electrotomy seems to be a useful for treating biliary strictures after liver transplantation.

Comparison Between Percutaneous Transhepatic Rigid Cholangioscopic Lithotripsy and Conventional Percutaneous Transhepatic Cholangioscopic Surgery for Hepatolithiasis Treatment.

BACKGROUND: Percutaneous transhepatic cholangioscopy (PTCS) is one option for treating hepatolithiasis without surgical resection. This approach can use conventional biliary drainage methods over a long period, but a shorter procedure needs to be evolved. OBJECTIVE: To evaluate the short-term and the long-term therapeutic outcomes of percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) in comparison with conventional PTCS. METHODS: In this retrospective study, 118 patients with hepatolithiasis were enrolled who underwent treatment in our hospital between March 2007 and July 2014. About 67 of them received PTCSL and the remaining 51 patients received conventional PTCS. Preoperative data, surgical operation-related records, the postoperative therapeutic effect, and the long-term hepatolithiasis recurrence rate were collected for comparison between the 2 groups. RESULTS: The age, sex, and surgical history were similar between the 2 groups, but there was a significant difference in the Child-Pugh score, with more grade 3 patients in the PTCS group (P=0.002). However, the operation time, intraoperative blood infusion, and the blood loss were similar between the 2 groups. The final clearance ratio of calculus in the PTCSL group was significantly better than in the PTCS group after multivariate analysis (P=0.021; OR=0.201; 95% CI, 0.051-0.785). Calculus recurrence was 9% (PTCSL) and 22% (PTCS). The postoperative hospital stay was significantly shorter in the PTCSL group (P=0.001; OR=1.337; 95% CI, 1.132-1.58). CONCLUSIONS: PTCSL was a satisfactory therapeutic option for hepatolithiasis treatment, with less operation time and a superior long-term therapeutic effect compared with conventional PTCS.

Histone deacetylase inhibitor valproic acid (VPA) promotes the epithelial mesenchymal transition of colorectal cancer cells via up regulation of Snail.

Histone deacetylase inhibitors (HDACIs) have been shown to have antiproliferative activity through cell-cycle arrest, differentiation, and apoptosis in colorectal cancer (CRC) cells. Our present study revealed that one HDAC inhibitor, valproic acid (VPA), can obviously promote in vitro motility of HCT-116 and SW480 cells. VPA treatment significantly down regulates the expression of epithelial markers E-Cadherin (E-Cad) and Zona occludin-1(ZO-1) while up regulates the mesenchymal markers Vimentin (Vim) and N-cadherin (N-Cad), suggesting that VPA can trigger the epithelial-mesenchymal transition (EMT) of CRC cells. VPA treatment significantly increases the expression and nuclear localization of Snail, the key transcription factors of EMT. Snail knockdown by siRNAs obviously reverses VPA induced EMT of HCT-116 and SW480 cells. Further, VPA can decrease the ubiquitination, increase the acetylation, and then elevate the stabilization of Snail. VPA also increases the phosphorylation of Akt/GSK-3ß. The inhibitor of PI3K/Akt, LY2994002, significantly attenuates VPA induced phosphorylation of Akt and GSK-3ß and up regulation of Snail and Vim. Collectively, our data reveal that VPA can trigger the EMT of CRC cells via up regulation of Snail through AKT/GSK-3ß signals and post-transcriptional modification. It suggests that more attention should be paid when VPA used as a new anticancer drug for CRC patients.