Increased bile lithogenicity by SCP2 via HMGCR and CYP7A1 regulation in human hepatocytes.

BACKGROUND/AIMS: Lithogenic bile is a major cause of cholesterol gallstones, and hypersecretion of biliary cholesterol is believed to be an important cause of lithogenic bile. Sterol carrier protein 2 plays a key role in cholesterol trafficking and may regulate lipid metabolism in hepatocytes. MATERIALS AND METHODS: Human sterol carrier protein 2 cDNA was cloned and shRNAs against sterol carrier protein 2 were synthesized. Sterol carrier protein 2-modified hepatocyte models were then set up using adenoviral vectors to study its regulatory function in lipid metabolism. Following overexpression and knockdown of sterol carrier protein 2, HMGCR and CYP7A1 expression as well as the secretion of bile lipids were studied in hepatocytes. RESULTS: The expression of HMGCR was enhanced by sterol carrier protein 2 overexpression and downregulated by sterol carrier protein 2 knockdown. The concentration of cholesterol in the supernatant was elevated under sterol carrier protein 2 overexpression and decreased under sterol carrier protein 2 downregulation. Although sterol carrier protein 2 overexpression could repress the expression of CYP7A1, no changes were noted in total bile acid concentration. Thus, the expression of sterol carrier protein 2 could influence bile lithogenicity in the sterol carrier protein 2-modified hepatocyte models. CONCLUSIONS: Sterol carrier protein 2 may function as a moderator of HMGCR in human hepatocytes. Likely influences cholesterol metabolism and bile lithogenicity of human liver cells by regulating the expression of HMGCR and CYP7A1.

Risk factors of the onset of multiple organ dysfunction syndrome in patients with severe acute pancreatitis / 中华消化外科杂志

Objective To analyze the value of early evaluation in predicting the onset of multiple organ dysfunction syndrome (MODS) in patients with severe acute pancreatitis (SAP). Methods The clinical data of 338 patients with SAP who had been admitted to Tianjin Nankai Hospital from January 1998 to September 2008 were retrospectively analyzed. The patients were divided into MODS group (n = 163) and control group (n = 175) according to whether they did or did not have MODS. Risk factors causing MODS were analyzed by t test and Logistic regression analysis. Results The factors leading to the MODS included white blood cells count≥ 16 ×109/L, serum creatinine≥ 180 μmol/L, serum calcium≥2.5 mmol/L, c-reactive protein≥ 120 mg/L and pH value of blood≥7.35 (χ2 = 51.720, 21.421, 12.393, P < 0.05). The total cholesterol was a protective factor when it was 3.67-5.23 mmol/L. Conclusions Infection, renal insufficiency and hypercalcinemia are early predictive factors for MODS, and infection is the strongest predictive factor. Appropriate elevated total cholesterol can reduce the incidence of MODS.

Analysis on the relative factors of recurrence of severe pancreatitis / 中华胰腺病杂志

Infection rate and in-hospital treatment were two prognostic factors for SAP recurrence.

Nosocomial mortality and early assessment of patients with severe acute pancreatitis / 中华急诊医学杂志

Objective To analyze risk factors in order to predict the in-hospital mortality of patients with se-vere acute pancreatitis (SAP), especially the factor of total cholesterol. Method Factors for predicting in-hospi-tal mortality were evaluated retrospectively from the clinical data collected from 338 SAP patients of Tianjin Nankai Hospital between January 1999 and December 2008 according to the Guidelines for for clinical diagnosis and classi-fication of Acute Panereatitis set by the Society of Chinese Medical Association in 2003. The patients were treated with intensive care, blood routine examination, blood biochemical test and even computed tomography within 24 hours after admission. The patients were divided as per outcome into deceased and survivor group. All patients were admitted within 72 hours after the onset of symptoms. The Off-square test was used for univariate analysis and multivariate test was performed by logistic regression. Results Compared with TC≤3.67 mmol/L, when the TC was between 3.67 -4.37 mmol/L, OR was 0.664 (P = 0.412), while TC was between 4.37 mmol/L and 5.23 mmol/L, OR was 0.144 (P =0.021).The OR was 1.013 (P =0.018) when TC was ≥5.23 mmol/L. The variation of serum TC levels was accompanied with the changes of C-reactive protein (CRP). When the CRP was ≥170 mg/L, OR was 7.074 (P =0.031). When the serum ALB≤30 g/L, OR was 7.224 (P =0.029).Conclusions The CRP, ALB, TC can be used for early predicting the in-hospital mortality of SAP patients. TC is a protective factor when it was between 4.37 mmol/L and 5.23 mmol/L, while it is a risk factor when ≥5.23 mmol/L or≤3.67 mmol/L. CRP> 170 mg/L or ALB < 30 g/L increases the probability of fatal outcome. Low level of albumin is a stronger predictor than the high level of CRP. Moderate elevation of TC level seems to in-crease the resistance to inflammation and hence improving the survival rate of patients with SAP and reducing the in-hospital mortality.

Surgical treatment for cholecystolithiasis with biliary-cardiac syndrome / 中国普通外科杂志

Objective To evaluate the effect of surgical treatment for cholecystolithiasis with billiary-cardiac syndrome(BCS). Methods The clinical data of 149 cholecystolithiasis patients with BCS were retrospectively analysed. Results The incidence of BCS in cholecystolithiasis was 39.4%(149/378).All the 149 patients underwent cholecystectomy.No severe complications or death occurred in this series. Three months after operation, 123(82.6%) cases of BCS were followed up. Of them, ECG returned to normal and the symptoms disappeared in 102 cases(82.9%);ECG had no obvious change,but the symptoms improved in 15 cases(12.2%). Conclusions Cholecystectomy is the only effective method for treating cholecystolithiasis with BCS. For patients with asymtomatic cholecystolithiasis,if the patients cardiac function can tolerate operation,a cholecystectomy should also be done.

The causes for biliary duct reoperations: a report of 828 cases / 中国普通外科杂志

Objective To study the causes of reoperation after biliary duct operation, in order to decreasing the rate of biliary tract reoperation. Methods The clinical data of 828 patients who underwent reoperation of biliary duct diseases in Nankai hospital between 1990-1999 were evalated, and the causes of biliary duct reoperation were classified and analysed.Results The most common cause for reoperation was recurrent or retained bile stone(65.10% ), bile stone companied by stenosis of the sphincter of oddi (33.82%), simple stenosis of sphincter of Oddi ( 9.54%), traumatic stricture of bile duct and stricture of bilioenteric anastomosis( 10.39%), bile duct obstruction due to tumor (6.52%), and other less important factors. Conclusions Recurrent or retained bile duct stone was the main cause for biliary reoperation,and stenosis of the sphincter of Oddi was the next important factor for reoperations.Thoroughness of the initial operation and rationality of operative procedure are the chief factors to decrease bile duct reoperations.