End-to-end bile duct anastomosis and percutaneous transhepatic cholangial drainage for iatrogenic bile duct injuries / 中华肝胆外科杂志

Objective:A novel bile duct end-to-end anastomosis and percutaneous transhepatic cholangial drainage (PTCD) were designed to treat iatrogenic bile duct injuries, and the clinical efficacy and technical advantage of this combined treatment were analyzed.Methods:Clinical data from 11 patients with iatrogenic bile duct injuries treated between February 2012 to July 2021 was retrospectively analyzed. There were 4 females and 7 males, with age of (47.5±15.3) years old. The types of bile duct injuries were: Bismuth type 1 ( n=7), Bismuth type Ⅱ ( n=1), Bismuth type Ⅲ type ( n=1), combined Bismuth type 1 and type 2 ( n=1), and Bismuth type Ⅳ ( n=1). Repair operations were performed at the time of the initial surgical procedures in 8 patients. The remaining 3 patients had their repair done 2 days, 9 days and 5 months, respectively, after the initial operations. All patients underwent successful bile duct end-to-end anastomosis and PTCD without use of T-tubes. Results:All biliary injuries were successfully repaired with no operative mortalities. Two patients who underwent end-to-end anastomosis of common hepatic duct developed anastomotic bile leakage. The amount of bile leakage was small and bile leakage resolved with conservative treatment in 1 patients 3 days after surgery, and was treated successfully by percutaneous peritoneal drainage for 2 weeks in the other patient. There were no other complications, including stricture formation or cholangitis which developed in other patients. All patients’ liver functions recovered well. The percutaneous biliary drainage tube was removed 6 months after operation in 1 patient. The remaining patients had their drainage tubes removed 3 months after operation. On follow-up, all patients had no history suggestive of cholangitis, jaundice and other symptoms. The liver functions were normal on laboratory examinations. No stricture or dilatation of intrahepatic bile ducts were detected on imaging examinations. The cure rate was 100% (11/11).Conclusion:Surgical repair of biliary tract injuries should aim to preserve sphincter of Oddi function and maintain normal physiological pathway of bile excretion. PTCD helped smooth recovery of an end-to-end anastomosis, lowered severity of physical disability of patients and minimized occurrence of medical disputes.

Downregulation of GNAI3 Promotes the Pathogenesis of Methionine/Choline-Deficient Diet-Induced Nonalcoholic Fatty Liver Disease

Background/Aims@#The pathogenesis of nonalcoholic fatty liver disease (NAFLD) has not be fully elucidated, and the lack of therapeutic strategies for NAFLD is an urgent health problem. Guanine nucleotide binding protein, alpha inhibiting activity polypeptide 3 (GNAI3) participates in several biological processes, but its relationship with lipid metabolism and NAFLD has not yet been reported. We aimed to determine the function of GNAI3 in the development of NAFLD. @*Methods@#Mice were fed a methionine and choline-deficient diet to induce NAFLD. An NAFLD model in HepG2 cells was induced by free fatty acid treatment. GNAI3 levels in HepG2 cells were downregulated by shRNA. Protein levels of related proteins were evaluated by Western blotting, and mRNA levels were determined by quantitative reverse transcription polymerase chain reaction. Hematoxylin and eosin and Oil Red O staining were used to observe histological changes in liver tissue. @*Results@#The dysregulated hepatic lipid metabolism in the NAFLD mouse model was enhanced by GNAI3 knockout, which also provoked worse liver damage. In the NAFLD model in HepG2 cells, the downregulation of GNAI3 promoted cellular lipid accumulation and enhanced the changes in lipid metabolic enzyme levels. @*Conclusions@#This study demonstrates that GNAI3 participates in the development of NAFLD in both cellular and mouse models. The data indicate that GNAI3 is a potential new target for the treatment of NAFLD in humans.

Effect of acupotomy lysis on SP content in central nervous system of rats with knee osteoarthritis / 国际中医中药杂志

Objective To observe the regulatory effect of acupotomy lysis on SP level in spinal cord and tissues above spinal cord of rats with knee osteoarthritis.Methods 60 healthy SD rats were randomly divided into normal control group,model group,electro-acupuncture(EA)group,and acupotomy lysis(AL)group.Mix 4%papain solution with 0.3 mol/L cysteine solution in the ratio of 1∶1.After pausing for 0.5h,inject the mixture,20 μl each time,into the left knee joint cavities of rats in model,AL,and EA groups on the day of 1,4,7.After 4 weeks AL group was treated with acupotomy lysis and EA group with electro-acupuncture.Three weeks after treatment,take samples of spinal cord,midbrain,pituitary gland,thalamus,and hypothalamus from the swellings of rats'waists.Measure the content of SP therein separately.Results Compared with normal control group,there was a significant rise in the content of SP in spinal cord and the tissues above spinal cord of model group rats (P＜0.05,P＜0.01),and there was a significant rise in spinal cord,pituitary gland,thalamus and hypothalamus of EA group rats (P＜0.05,P＜0.01);in AL group,there was a significant rise in spinal cord,pituitary gland,thalamus,and there was no statistically difference in hypothalamus and midbrain.Compared with normal control group,there was a significant rise in spinal cord (P＜0.05)and a significant decrease in the SP contents in hypothalamus(P＜0.05,P＜0.01)in EA group.There was no statistically difference between EA group and AL group except in hypothalamus(P＜0.05).Conclusion Acupotomy lysis has positive functions in regulating SP content in centrum of rats with knee osteoarthritis,which helps easing pain.

Advancement and perspective of NF-κB in the research of acute pancreatitis / 国际外科学杂志

Acute pancreatitis is acute inflammation due to autodigestion of pancreatic tissue by trypsogen activation, can induce systemic inflammatory reaction,and deteriorate to be nonfunction and fatality. Nuclear factor kappa B seizes the coral position in the development of acute pancreatitis, regulates gene expression of inflammatory factors and immune protein. This article reviews the therapy of pancreatitis on account of NF-κB.