Relationship between Increased Plasma Levels of Legumain and Properties of Coronary Atherosclerotic Plaque. / Relação entre Níveis Plasmáticos Aumentados de Legumain e Propriedades da Placa Aterosclerótica Coronária.

BACKGROUND: Many clinical studies have confirmed that legumain is closely related to atherosclerosis. Unfortunately, different conclusions have been reached, and analyses and studies on atherosclerotic plaque characteristics in patients with increased plasma levels of legumain are still lacking. OBJECTIVES: This study aimed to investigate the correlation between legumain and coronary atherosclerotic plaque characteristics. METHODS: A total of 81 patients with coronary atherosclerotic heart disease (CHD), including 43 patients with unstable angina (UA) and 38 patients with stable angina (SA), were screened by coronary angiography. Intravascular ultrasound (IVUS) was performed to evaluate the characteristics of coronary atherosclerotic plaques, and plasma legumain levels were also measured. Values of p < 0.05 were considered significant. RESULTS: Legumain concentration was significantly higher in the two CHD subgroups than in the control group (all p<0.001). Legumain concentrations in the UA group were significantly higher than in the SA group (p=0.001). The plaque area, remodeling index (RI), and eccentricity index (EI) in the UA group were significantly higher than those in the SA group (p<0.001, p=0.001, p=0.001, respectively). There was a significant positive correlation between legumain levels and RI and EI in both UA and SA patients (all p<0.05). CONCLUSIONS: High plasma levels of legumain were closely related to the occurrence and severity of CHD, and the lesions tended to be unstable. Legumain is expected to be a potential inflammatory biomarker for the diagnosis of CHD and the early identification of unstable coronary lesions.

FUNDAMENTO: Muitos estudos clínicos confirmaram que a legumain está intimamente relacionada à aterosclerose. Infelizmente, chegaram-se a conclusões diferentes e ainda faltam análises e estudos sobre as características da placa aterosclerótica em pacientes com níveis plasmáticos aumentados de legumain. OBJETIVOS: Este estudo teve como objetivo investigar a correlação entre as características da legumain e da placa aterosclerótica coronariana. MÉTODOS: Um total de 81 pacientes com doença cardíaca aterosclerótica coronariana (DCAC), incluindo 43 pacientes com angina instável (AI) e 38 pacientes com angina estável (AE), foram examinados por angiografia coronária. Foi realizado ultrassom intravascular (IVUS) para avaliar as características das placas ateroscleróticas coronarianas, e os níveis plasmáticos de legumain também foram medidos. Valores de p < 0,05 foram considerados significativos. RESULTADOS: A concentração de legumain foi significativamente maior nos dois subgrupos de doença coronariana do que no grupo controle (todos p<0,001). As concentrações de legumain no grupo AI foram significativamente maiores do que no grupo SA (p=0,001). A área de placa, o índice de remodelamento (IR) e o índice de excentricidade (IE) no grupo AI foram significativamente maiores do que no grupo AE (p<0,001, p=0,001, p=0,001, respectivamente). Houve uma correlação positiva significativa entre os níveis de legumain e IR e IE em pacientes com AI e AE (todos p<0,05). CONCLUSÕES: Níveis plasmáticos elevados de legumain estavam intimamente relacionados com a ocorrência e gravidade da doença coronariana, e as lesões tendiam a ser instáveis. Espera-se que a legumain seja um potencial biomarcador inflamatório para o diagnóstico de doença coronariana e a identificação precoce de lesões coronárias instáveis.

Relação entre Níveis Plasmáticos Aumentados de Legumain e Propriedades da Placa Aterosclerótica Coronária / Relationship between Increased Plasma Levels of Legumain and Properties of Coronary Atherosclerotic Plaque

Resumo Fundamento Muitos estudos clínicos confirmaram que a legumain está intimamente relacionada à aterosclerose. Infelizmente, chegaram-se a conclusões diferentes e ainda faltam análises e estudos sobre as características da placa aterosclerótica em pacientes com níveis plasmáticos aumentados de legumain. Objetivos Este estudo teve como objetivo investigar a correlação entre as características da legumain e da placa aterosclerótica coronariana. Métodos Um total de 81 pacientes com doença cardíaca aterosclerótica coronariana (DCAC), incluindo 43 pacientes com angina instável (AI) e 38 pacientes com angina estável (AE), foram examinados por angiografia coronária. Foi realizado ultrassom intravascular (IVUS) para avaliar as características das placas ateroscleróticas coronarianas, e os níveis plasmáticos de legumain também foram medidos. Valores de p < 0,05 foram considerados significativos. Resultados A concentração de legumain foi significativamente maior nos dois subgrupos de doença coronariana do que no grupo controle (todos p<0,001). As concentrações de legumain no grupo AI foram significativamente maiores do que no grupo SA (p=0,001). A área de placa, o índice de remodelamento (IR) e o índice de excentricidade (IE) no grupo AI foram significativamente maiores do que no grupo AE (p<0,001, p=0,001, p=0,001, respectivamente). Houve uma correlação positiva significativa entre os níveis de legumain e IR e IE em pacientes com AI e AE (todos p<0,05). Conclusões Níveis plasmáticos elevados de legumain estavam intimamente relacionados com a ocorrência e gravidade da doença coronariana, e as lesões tendiam a ser instáveis. Espera-se que a legumain seja um potencial biomarcador inflamatório para o diagnóstico de doença coronariana e a identificação precoce de lesões coronárias instáveis.

Abstract Background Many clinical studies have confirmed that legumain is closely related to atherosclerosis. Unfortunately, different conclusions have been reached, and analyses and studies on atherosclerotic plaque characteristics in patients with increased plasma levels of legumain are still lacking. Objectives This study aimed to investigate the correlation between legumain and coronary atherosclerotic plaque characteristics. Methods A total of 81 patients with coronary atherosclerotic heart disease (CHD), including 43 patients with unstable angina (UA) and 38 patients with stable angina (SA), were screened by coronary angiography. Intravascular ultrasound (IVUS) was performed to evaluate the characteristics of coronary atherosclerotic plaques, and plasma legumain levels were also measured. Values of p < 0.05 were considered significant. Results Legumain concentration was significantly higher in the two CHD subgroups than in the control group (all p<0.001). Legumain concentrations in the UA group were significantly higher than in the SA group (p=0.001). The plaque area, remodeling index (RI), and eccentricity index (EI) in the UA group were significantly higher than those in the SA group (p<0.001, p=0.001, p=0.001, respectively). There was a significant positive correlation between legumain levels and RI and EI in both UA and SA patients (all p<0.05). Conclusions High plasma levels of legumain were closely related to the occurrence and severity of CHD, and the lesions tended to be unstable. Legumain is expected to be a potential inflammatory biomarker for the diagnosis of CHD and the early identification of unstable coronary lesions.

Laparoscopic Glissonian pedicle versus hilar dissection approach hemihepatectomy: A prospective, randomized controlled trial.

BACKGROUND/PURPOSE: This over 7-year case study is the first to compare the results of laparoscopic Glissonian pedicle approach hemihepatectomy (LGAH) and laparoscopic hilar dissection approach hemihepatectomy (LHAH) in a randomized controlled trial (RCT). METHODS: Patients who had undergone laparoscopic hemihepatectomy, either LGAH or LHAH, between March 2012 and December 2019 at our center were prospectively enrolled and assigned to the LGAH or LHAH group. Both groups were stratified and compared, and the preoperative and follow-up outcomes were analyzed. The primary endpoint was total operative time. RESULTS: The groups were equally matched for age, sex, HBsAg, Child-Pugh class, benign disease, malignancy, liver cirrhosis, tumor diameter and type of resection. Ninety-six patients had undergone LGAH and 94 had undergone LHAH. No preoperative death occurred in the two groups. LGAH did not enhance the postoperative overall complication rates (P = .465) or intraoperative blood loss (P = .535) compared with LHAH. However, the overall operative time (P = .014) and hilar dissection time (P = .000) were significantly shorter in the LGAH group than in the LHAH group. No significant differences were found between the groups regarding the 1-year (P = .384), 3-year (P = .332), and 5-year overall survival rates (P = .662) or 1-year (P = .856), 3-year (P = .348), and 5-year disease-free survival rates (P = .573). CONCLUSIONS: LGAH and LHAH are both effective procedures for treating the hilar structures in selected patients. LGAH has advantages over LHAH in reducing total operation time under the condition where both procedures can be used. LGAH for selected patients is worthy of promotion owing to its simplicity and convenience. REGISTRATION NUMBER: NCT01567631 (http://www. CLINICALTRIALS: gov).

Ginsenoside Re enhances the survival of H9c2 cardiac muscle cells through regulation of autophagy.

We examined the effect of ginsenoside Re (G-Re) on autophagy in H9c2 cardiomyocytes cultured in glucose deprivation (GD). Levels of the membrane-bound autophagy-related microtubule-associated protein 1A/1B-light chain 3 (LC3) B-2 were measured via immunoblotting and immunofluorescence was conducted to assess autophagosome formation. GD H9c2 cells were treated with 100 µmol/l G-Re. Cell viability was determined in culture medium. Phosphorylated 5' AMP-activated protein kinase (AMPK)-α and mammalian target of rapamycin (mTOR) levels were measured to explore the mechanisms underlying the effects of G-Re on autophagy in GD cells. G-Re treatment inhibited autophagosome formation and may be beneficial to GD cardiomyocytes.

LncRNA CAIF was downregulated in end-stage cardiomyopathy and is a promising diagnostic and prognostic marker for this disease.

Cardiac autophagy inhibitory factor (CAIF) is a novel lncRNA with protective effects on myocardial infarction. We explored the involvement of CAIF in end-stage cardiomyopathy. Patients with end-stage cardiomyopathy and healthy volunteers were included in this study. Myocardial tissues and serum were collected. CAIF was detected by RT-qPCR. ROC curve was used for diagnostic analysis. Prognostic value of CAIF expression for end-stage cardiomyopathy was evaluated by survival curve analysis. Correlations between CAIF expression and clinicopathological data of patients with end-stage cardiomyopathy were analysed by chi-square test. Downregulated CAIF was observed in end-stage cardiomyopathy patients than in healthy controls. CAIF expression distinguished end-stage cardiomyopathy patients from healthy controls and predict the survival of patients. LncRNA CAIF was downregulated in end-stage cardiomyopathy and may serve as a promising prognostic and diagnostic marker for this disease.

Successful revascularization versus medical therapy in diabetic patients with stable right coronary artery chronic total occlusion: a retrospective cohort study.

BACKGROUND: The territory of the right coronary artery (RCA) is smaller than that of the left anterior descending artery. Previous studies have reported conflicting results when considering whether stable RCA-chronic total occlusion (CTO) should be reopened. The coexistence of diabetic and coronary artery diseases represents a severe situation. Therefore, we aimed to determine if stable RCA-CTO in diabetic patients was necessary to be reopened. To our knowledge, no studies have focused on this topic to date. METHODS: We enrolled diabetic patients with RCA-CTO who had clinical presentations of symptomatic stable angina or silent ischemia. RCA-CTO was treated with either successful revascularization (the CTO-SR group) or medical therapy (the CTO-MT group). The primary endpoint was all-cause death. Both Cox regression and propensity score matching analyses were used. Sensitivity analysis was performed based on subgroup populations and relevant baseline variables. RESULTS: A total of 943 patients were included: 443 (46.98%) patients in the CTO-MT group and 500 (53.02%) patients in the CTO-SR group. After a mid-term follow-up (CTO-SR: 48 months; CTO-MT: 42 months), we found that CTO-SR was superior to CTO-MT in terms of all-cause death (adjusted hazard ratio [HR] [model 1]: 0.429, 95% conference interval [CI] 0.269-0.682; adjusted HR [model 2]: 0.445, 95% CI 0.278-0.714). The superiority of CTO-SR was consistent for cardiac death, possible/definite cardiac death, repeat revascularization, target vessel revascularization (TVR) and repeat nonfatal myocardial infarction. Subgroup analysis confirmed the mortality benefit of CTO-SR by percutaneous coronary intervention (the successful CTO-PCI subgroup, 309 patients in total). While CTO-SR by coronary artery bypass grafting (the CTO-CABG subgroup, 191 patients in total) offered patients more benefit from repeat revascularization and TVR than that offered by successful CTO-PCI. CONCLUSIONS: For stable RCA-CTO patients with diabetes, successful revascularization offered patients more clinical benefits than medical therapy. CTO-CABG might be a more recommended way to accomplish revascularization. Trial registration This study was not registered in an open access database.

Comparison of early and delayed invasive strategies in short-medium term among patients with non-ST segment elevation acute coronary syndrome: A systematic review and meta-analysis.

BACKGROUND AND OBJECTIVES: An invasive approach is recommended as the treatment of patients with non-ST elevated acute coronary syndromes (NSTE-ACS). However, it remains unclear that the optimal time of angiography and intervention for patients with NSTE-ACS at present. This study was designed to compare the effect of early and delayed invasive strategies on short-medium term prognosis in patients with those. METHODS: Pubmed, Cochrane Library and Embase were searched up to Dec-30-2018. Randomized clinical trials comparing an early versus a delayed invasive strategy in patients with NSTE-ACS were included. The primary endpoint (all-cause death and recurrent myocardial infarction) and secondary endpoint (major bleeding and recurrent revascularization), as well as composite endpoint were assessed by random or fixed effected meta-analysis with software RevMan 5.3 version after short-medium term follow up. RESULT: A total of six randomized clinical trials involving 4,277 early or delayed invasive strategies patients with NSTE-ACS were included in the meta-analysis. Time to coronary angiography varied from 0.5 to 24 h in the early invasive strategy and from 18.6 to 72 h in the delayed invasive strategy. There was a statistical difference in the primary endpoint of all-cause death among patients with NSTE-ACS between early and delayed invasive strategies (4.6% vs 6%; OR:0.76; 95% CI:0.58 to 1.00; P = 0.05; I2 = 0%), but not for recurrent myocardial infarction (6.0% vs 6.3%; OR: 0.94; 95% CI: 0.55 to 1.61; P = 0.82; I2 = 60%). The major bleeding in patients with NSTE-ACS was similar between both invasive strategies (2.7% vs 3.1%; OR:0.88; 95% CI:0.59 to 1.31; P = 0.54; I2 = 0%). However, the composite endpoint in the early invasive strategy patients with NSTE-ACS was significantly lower than that of the delayed invasive strategy (10.9% vs 13.9%; OR:0.76; 95% CI:0.63 to 0.92; P = 0.006; I2 = 0%), and the recurrent revascularization between both strategies was just the opposite (8.7% vs 5.9%; OR:1.5; 95%CI:1.15 to 1.97; P = 0.003; I2 = 0%). CONCLUSION: The systematic review and meta-analysis demonstrated that the early invasive strategy had a beneficial trend on all-cause death and significantly reduced the composite endpoint in patients with NSTE-ACS, but increased the rate of revascularization. These data could provide a solution for patients with those.

Characterization and Risk Factor Analysis for Reoperation After Microendoscopic Diskectomy.

A population-based database of 1263 consecutive patients who underwent microendoscopic diskectomy for single-level lumbar disk herniation between 2005 and 2010 was retrospectively analyzed to identify causes and characteristics of reoperation and associated risk factors. A total of 952 patients were eligible. Of these, 58 had revision spinal surgery. Causes and clinical parameters were retrospectively assessed, and possible risk factors were evaluated by multivariate logistic regression analysis. In total, 76 disk herniations were excised with revision diskectomy, with or without interbody fusion. The overall mean interval between primary surgery and revision surgery was 39.05 months (range, 2-95 months). Cumulative overall reoperation rates gradually increased from 1.56% at 1 year to 8.17% after nearly 10 years. Reoperated patients were older and had a higher level of lumbar degeneration, with severe Modic changes (type 1, 17.2%; type 2, 34.5%), vs patients without reoperation (type 1, 1.5%; type 2, 30.6%). In addition, patients with reoperation had a higher rate of obvious adjacent disk degeneration (81.1%). Logistic regression analysis showed that adjacent segment degeneration and Pfirrmann grading for disk degeneration were significant risk factors for reoperation after primary microendoscopic diskectomy (odds ratios, 2.448 and 1.510, respectively). The current study reported a relatively low incidence of reoperation after primary microendoscopic diskectomy. Adjacent segment degeneration and Pfirrmann grading for disk degeneration were identified as risk factors for reoperation after microendoscopic diskectomy to treat lumbar disk herniation. Treatment options for patients with these factors at the first visit should be carefully evaluated.

Laparoscopic versus open liver resection for hepatocellular carcinoma in posterosuperior segments.

BACKGROUND: Traditional open liver resection remains the classic procedure for hepatocellular carcinoma (HCC) located in the posterosuperior segments of the liver (segments I, IVa, VII, and VIII). This study compared the perioperative and oncologic results for laparoscopic versus open liver resection of HCC located in the posterosuperior segments, especially in patients with cirrhosis. METHODS: This study included 41 patients who underwent laparoscopic liver resection (LLR) and 86 who underwent open liver resection (OLR) for HCC in the posterosuperior segments between January 1, 2010, and December 31, 2012. There perioperative course and oncologic outcomes were retrospectively evaluated. RESULTS: There were no significant differences between the LLR and OLR groups in length of operation (242.41 ± 73.69 vs. 235.38 ± 65.80 min), transfusion rate (7.3 vs. 14.0 %), R0 resection rate (100 vs. 97.7 %), or tumor size (4.22 ± 2.05 vs. 4.30 ± 1.49 cm). In contrast, postoperative hospital stay (9.44 ± 2.72 vs. 14.53 ± 6.03 days) was significantly shorter, and postoperative complication rates (17.1 vs. 37.2 %) and intraoperative blood loss (272.20 ± 170.86 vs. 450.12 ± 344.70 mL) significantly lower in the LLR than in the OLR group. In addition, there was no significant difference between the two groups (LLR vs. OLR) regarding 1-year overall survival rate (95.1 vs. 89.5 %), 3-year overall survival rate (78 vs. 76.7 %,), 1-year disease-free survival rate (87.8 vs. 82.6 %,), and 3-year disease-free survival rate (70.7 vs. 68.6 %). CONCLUSIONS: LLR for selected patients with HCC in the posterosuperior segments may offer the same oncologic outcomes as conventional procedures, while being associated with such advantages as lower blood loss, fewer postoperative complications, and shorter hospital stay.

A comparative study of two anti-coagulation plans on the prevention of PVST after laparoscopic splenectomy and esophagogastric devascularization.

Cirrhosis and portal hypertension (PH) has a high incidence in China. Laparoscopic splenectomy and esophagogastric devascularization (LS + ED) was confirmed as an effective and safe surgical approach. But compared to open surgery (OS + ED), the rate of portal vein system thrombosis (PVST) was found to be higher after LS + ED. PVST is a common and potentially life-threatening complication after LS + ED in patients with cirrhosis and PH. Anti-coagulation therapy should be given early, but no standard plan for PSVT prophylaxis has been developed for all patients. In this study, the efficacy and safety of early use of low molecular weight heparin (LMWH) to prevent PVST were retrospectively evaluated compared with conventional anti-coagulant therapy. Of 219 patients with cirrhosis and PH undergoing LS + ED at our hospital from January 2008 to June 2013, 139 received early anti-coagulant therapy with LMWH, and 80 received conventional anti-coagulant therapy. The rates and types of PVST, perioperative coagulation function, intra-abdominal active bleeding, and esophagogastric variceal bleeding (EGVB) were compared in these two groups. Of the 139 patients in the early anti-coagulation group, 42 (30.2 %) experienced postoperative PVST, including two (1.4 %) with main trunk. Of the 80 patients in the conventional anti-coagulation group, 40 (50.0 %) experienced postoperative PVST, including 12 (15.0 %) with main trunk; three (3.8 %) experienced recurrent EGVB due to main trunk thrombosis, and one (1.3 %) underwent an immediate second laparotomy for uncontrollable active bleeding. The rates of postoperative PVST (P = 0.004), main trunk thrombosis (P = 0.000), and EGVB (P = 0.048) were significantly lower in the early than in the conventional anti-coagulant group, but all tested perioperative indices of coagulation function and rates of intraperitoneal active bleeding were similar. Early anti-coagulation with LMWH is safe and effective in patients with LS + ED for cirrhosis and PH.

Safety and feasibility of laparoscopic hepatectomy for hepatocellular carcinoma in the posterosuperior liver segments.

BACKGROUND: Laparoscopic hepatectomy (LH) is mostly performed to treat solitary tumors in the anterolateral liver segments (II, III, IVb, V, and VI). Few reports are available on LH for the treatment of hepatocellular carcinoma (HCC) in the posterosuperior liver segments (I, IVa, VII, and VIII), especially in association with cirrhosis. The purpose of this study was to investigate the safety and feasibility of LH in this clinical setting. METHODS: From January 2008 to January 2011, LH was conducted in 56 patients with HCC in the posterosuperior liver segments (PS group) and 70 patients with HCC in the anterolateral liver segments (AL group) who were admitted to Southwest Hospital of the Third Military Medical University, Chongqing, China. The clinical data and follow-up results in the two groups of patients were retrospectively analyzed. RESULTS: No patient in either group died during the perioperative period. Statistically significant differences were found between the PS and AL groups in terms of the operation time (217.5 ± 63.7 vs 176.8 ± 48.4 min, P = 0.000), volume of blood loss (295.5 ± 186.8 vs 220.4 ± 164.2 ml, P = 0.001), conversion rate from laparoscopy to laparotomy (17.9 vs 7.1 %, P = 0.031), transfusion rate (16.1 vs 4.3 %, P = 0.025), cases of hepatic inflow occlusion (38/18 vs 28/42, P = 0.002), and duration of inflow occlusion (41.3 ± 16.3 vs 31.3 ± 12.2 min, P = 0.005). Parameters with no significant differences between the two groups of patients included tumor size (4.0 ± 1.5 vs 3.9 ± 1.7 cm, P = 0.894), resection margin (1.7 ± 0.7 vs 1.8 ± 0.6 cm, P = 0.102), postoperative complication rate (16.1 vs 17.1 %, P = 0.873), postoperative anal exhaust time (3.2 ± 0.6 vs 3.0 ± 0.6 days, P = 0.361), and postoperative hospital stay (10.5 ± 2.7 vs 10.0 ± 0.6 days, P = 0.102). The serum alanine transaminase (ALT) and aspartate aminotransferase (AST) levels on postoperative days 1 and 3 were significantly higher in the PS group than in the AL group. There were no significant differences in the postoperative levels of the serum total bilirubin, albumin, ALT, or AST levels on postoperative days 5 and 7. After 2-48 months of follow-up, no significant differences in the 1- and 3-year overall survival rates (92.9 vs 95.7 %, P = 0.487 and 76.0 vs 76.8 %, P = 0.878, respectively) or 1- and 3-year disease-free survival rates (85.7 vs 87.1 %, P = 0.797 and 57.6 vs 56.4 %, P = 0.806, respectively) were noted between the two groups. CONCLUSIONS: LH is safe and feasible for selected patients with HCC in the posterosuperior segments of the liver.

Therapeutic effects of laparoscopic splenectomy and esophagogastric devascularization on liver cirrhosis and portal hypertension in 204 cases.

OBJECTIVE: To investigate the effects and technical points of laparoscopic splenectomy and esophagogastric devascularization (LS+ED) for portal hypertension (PH) due to liver cirrhosis. SUBJECTS AND METHODS: In total, 204 PH patients who underwent LS+ED from January 2008 to April 2013 in the Southwest Hospital of the Third Military Medical University were enrolled in this study. We retrospectively analyzed the clinical data and the key technical points and compared the results with other researchers. RESULTS: LS+ED was successfully carried out on 188 patients. The mean duration of surgery was 232±59 minutes, the mean intraoperative blood loss was 189±137 mL, the rate of blood transfusion was 19.6% (40/204), and no deaths occurred during surgery. The mean postoperative interval to passing of flatus was 3.5±0.9 days, and the mean postoperative hospital stay was 8.7±2.2 days. Operative complications occurred in 100 patients, of whom 78 had portal vein system thrombosis (PVST). During a postoperative follow-up period of 2-65 months, 15 cases were lost to follow-up, esophagogastric variceal bleeding re-occurred in 7 patients, encephalopathy occurred in 2 patients, and secondary liver cancer occurred in 3 patients. Five patients died during this period. CONCLUSIONS: The technical points of LS+ED include a combined surgical approach, a reasonable surgical procedure, and an appropriate laparoscopic operating plane. LS+ED is a safe and effective treatment for minimal trauma and rapid recovery. PVST is a common and potentially life-threatening complication after LS+ED, and anticoagulation therapy should be given early.

Laparoscopic hepatectomy with bile duct exploration for the treatment of hepatolithiasis: an experience of 116 cases.

BACKGROUND: An increasing number of patients with hepatolithiasis were diagnosed at an early stage in China. Laparoscopic surgery has introduced new methods of treating this condition. AIM: To investigate the patient selection, operative technique, and efficacy of laparoscopic hepatectomy with bile duct exploration for the treatment of hepatolithiasis. PATIENTS AND METHODS: The clinical data of 116 patients who underwent laparoscopic hepatectomy (laparoscopic group) and 78 patients who underwent open hepatectomy (open group) for hepatolithiasis were retrospectively analyzed, and were compared with the recent reports. RESULTS: The laparoscopic group had a longer duration of operation (323.3 ± 103.0 min vs. 272.8 ± 66.8 min, p<0.05) and shorter postoperative hospital stay (13.1 ± 5.6 days vs. 16.5 ± 8.4 days, p<0.05) than the open group. There were no significant differences between the two groups in intraoperative blood loss or transfusion rate, postoperative complications, calculus clearance, calculus recurrence, or recurrent cholangitis (p>0.05 for all). Efficacy in the laparoscopic group was similar to that in other recently reported studies. CONCLUSIONS: Laparoscopic hepatectomy with bile duct exploration is safe and feasible for early stage localized hepatolithiasis, with an efficacy similar to that of open surgery. Anatomic hepatectomy is important for achieving good therapeutic outcomes.

The safety and feasibility of reoperation for the treatment of hepatolithiasis by laparoscopic approach.

BACKGROUND: Hepatolithiasis removal is associated with high rates of postoperative residual and recurrence, which in some cases may require multiple surgeries. The progress and development of laparoscopic techniques introduced a new way of treating hepatolithiasis. However, the selection criteria for laparoscopic hepatolithiasis surgery, particularly among patients with a history of biliary surgery, remain undetermined. This study aimed to evaluate the safety, feasibility, and efficacy of reoperation for the treatment of hepatolithiasis via a laparoscopic approach. METHODS: A retrospective analysis of the perioperative course and outcomes was performed on 90 patients who underwent laparoscopic procedures for hepatolithiasis between January 1, 2008, and December 31, 2012. Thirty-eight patients had previous biliary tract operative procedures (PB group) and 52 patients had no previous biliary tract procedures (NPB). RESULTS: There was no significant difference in operative time (342.3 ± 101.0 vs. 334.1 ± 102.7 min), intraoperative blood loss (561.2 ± 458.8 vs. 546.3 ± 570.5 ml), intraoperative transfusion (15.8 vs. 19.2 %), postoperative hospitalization (12.6 ± 4.2 vs. 13.4 % ± 6.3 days), postoperative complications (18.4 vs. 23.1 %), conversion to open laparotomy (10.5 vs. 9.6 %), or intraoperative stone clearance rate (94.7 vs. 90.4 %). There was also no significant difference in stone recurrence (7.9 vs. 11.5 %) and recurrent cholangitis (5.3 vs. 13.5 %) at a mean of 19 months of follow-up (range, 3-51 months) for PB patients compared to NPB patients. The final stone clearance rate was 100 % in both groups. CONCLUSIONS: Reoperation for hepatolithiasis by laparoscopic approach is safe and feasible for selected patients who have undergone previous biliary operations.

NGAL and NGALR overexpression in human hepatocellular carcinoma toward a molecular prognostic classification.

AIM: Neutrophil gelatinase-associated lipocalin (NGAL) and its cell surface receptor, NGALR, have been implicated in tumorigenesis and tumor progression of various human malignant neoplasms. In particularly, it has been demonstrated that NGAL is overexpressed in hepatocellular carcinoma (HCC) tissues and closely associated with the proliferation and invasion of HCC cells. The aim of this study was to investigate the clinical significance of NGAL and NGALR in HCC. METHODS: Expression of NGAL and NGALR was evaluated by immunohistochemistry in tumor tissues from 138 patients who underwent curative resection of HCC. The association of NGAL or NGALR expression with the clinicopathologic features was analyzed. Univariate and multivariate analyses were performed to evaluate the prognostic value of NGAL and/or NGALR expression for HCC patients. RESULTS: The expression levels of NGAL and NGALR were both up-regulated in HCC tissues, and to be associated with vascular invasion (both P=0.03), TNM stage (both P=0.004), and tumor recurrence (both P<0.001). A positive correlation between expression of the two markers was also observed (r=0.89; P<0.001). Additionally, survival analysis showed that high expression of NGAL or NGALR was significantly associated with poor prognosis for patients with HCC (both P=0.003). Patients with high expression of both NGAL and NGALR had a shorter overall survival (P<0.001) than those with low expression of both. Furthermore, multivariate analysis showed both NGAL and NGALR were independent predictors of overall survival. CONCLUSION: Our data demonstrate for the first time that the up-regulations of NGAL and NGALR expression in HCC were both significantly correlated with unfavorable clinicopathologic features and independent poor prognostic factor for overall survival in patients. These findings suggest that NGAL and NGALR expression might be served as novel prognostic factors and potential therapeutic targets in HCC.

Pancreas-sparing duodenectomy with regional lymphadenectomy for pTis and pT1 ampullary carcinoma.

BACKGROUND: The role of pancreas-sparing duodenectomy (PSD) in the treatment of ampullary carcinoma (Amp Ca) with local lymph node metastasis remains controversial. The aim of this study was to investigate the feasibility, safety, and long-term prognosis of PSD with regional lymphadenectomy in the treatment of early-stage (pTis/pT1) Amp Ca with or without regional lymph node metastasis. METHODS: Between May 2005 and November 2009, 31 consecutive patients with Amp Ca were enrolled in this study; 25 underwent PSD. A retrospective control group of 28 patients who underwent pancreatoduodenectomy (PD) for Amp Ca during the same period was established. These 2 groups were matched in terms of demographic data, tumor size, and TNM classification. RESULTS: In the PSD group, 9 patients (36%) had regional lymph node metastasis, and 23 patients (92%) had R0 resection. Patients who underwent PSD achieved favorable results in intraoperative blood loss, duration of hospital stay, and morbidity rate. The 3-year overall and disease-free survival in PSD group were 72% and 61%, respectively. There were no differences in hospital mortality and long-term survival between the 2 groups, even for patients with lymph node metastasis (N1). CONCLUSION: PSD with regional lymphadenectomy is feasible and safe in the treatment of pTis/pT1 Amp Ca with or without regional lymph node metastasis. Long-term survival and morbidity rates are also favorable. PSD can be performed as an alternative of PD in selected patients with Amp Ca.