Artificial Downregulation of Ribosomal Protein L34 Restricts the Proliferation and Metastasis of Colorectal Cancer by Suppressing the JAK2/STAT3 Signaling Pathway

The highly conserved ribosomal protein L34 (RPL34) has been reported to play an essential role in the progression of diverse malignancies. RPL34 is aberrantly expressed in multiple cancers, although its significant in colorectal cancer (CRC) is currently unclear. Here, we demonstrated that RPL34 expression was higher in CRC tissues than in normal tissues. Upon RPL34 overexpression, the ability of proliferation, migration, invasion, and metastasis of CRC cells were significantly enhanced in vitro and in vivo. Furthermore, high expression of RPL34 accelerated cell cycle progression, activated the JAK2/STAT3 signaling pathway, and induced the epithelial-to-mesenchymal transition (EMT) program. Conversely, RPL34 silencing inhibited the CRC malignant progression. Utilizing immunoprecipitation assays, we identified the RPL34 interactor, the cullin-associated NEDD8-dissociated protein 1 (CAND1), which is a negative regulator of cullin-RING ligases. CAND1 overexpression reduced the ubiquitin level of RPL34 and stabilized RPL34 protein. CAND1 silencing in CRC cells resulted in a decrease in the ability of proliferation, migration, and invasion. CAND1 overexpression promoted CRC malignant phenotypes and induced EMT, and RPL34 knockdown rescued CAND1-induced CRC progression. In summary, our study indicates that RPL34 acts as a mediator, is stabilized by CAND1, and promotes proliferation and metastasis, in part, through the activation of the JAK2/STAT3 signaling pathway and induction of EMT in CRC.

Prognostic significance of regional lymphadenectomy in T1b gallbladder cancer: Results from 24 hospitals in China

BACKGROUND

Whether regional lymphadenectomy (RL) should be routinely performed in patients with T1b gallbladder cancer (GBC) remains a subject of debate.

AIM

To investigate whether RL can improve the prognosis of patients with T1b GBC.

METHODS

We studied a multicenter cohort of patients with T1b GBC who underwent surgery between 2008 and 2016 at 24 hospitals in 13 provinces in China. The log-rank test and Cox proportional hazards model were used to compare the overall survival (OS) of patients who underwent cholecystectomy (Ch) + RL and those who underwent Ch only. To investigate whether combined hepatectomy (Hep) improved OS in T1b patients, we studied patients who underwent Ch + RL to compare the OS of patients who underwent combined Hep and patients who did not.

RESULTS

Of the 121 patients (aged 61.9 ± 10.1 years), 77 (63.6%) underwent Ch + RL, and 44 (36.4%) underwent Ch only. Seven (9.1%) patients in the Ch + RL group had lymph node metastasis. The 5-year OS rate was significantly higher in the Ch + RL group than in the Ch group (76.3% vs 56.8%, P = 0.036). Multivariate analysis showed that Ch + RL was significantly associated with improved OS (hazard ratio: 0.51; 95% confidence interval: 0.26-0.99). Among the 77 patients who underwent Ch + RL, no survival improvement was found in patients who underwent combined Hep (5-year OS rate: 79.5% for combined Hep and 76.1% for no Hep; P = 0.50).

CONCLUSION

T1b GBC patients who underwent Ch + RL had a better prognosis than those who underwent Ch. Hep + Ch showed no improvement in prognosis in T1b GBC patients. Although recommended by both the National Comprehensive Cancer Network and Chinese Medical Association guidelines, RL was only performed in 63.6% of T1b GBC patients. Routine Ch + RL should be advised in T1b GBC.

[Efficacy of three-dimensional visualization technology in the precision diagnosis and treatment for primary liver cancer: a retrospective multicenter study of 1 665 cases in China]

Objective: To evaluate the efficacy of three-dimensional(3D) visualization technology in the precision diagnosis and treatment for primary liver cancer. Methods: A total of 1 665 patients with primary liver cancer who admitted to seven medical centers in China between January 2009 to January 2019, diagnosed and treated by 3D visualization protocol were analyzed, and their clinical data were retrospectively reviewed. There were 1 255 males(75.4%) and 410 females(24.6%), with age of (52.9±11.9) years (range: 18 to 86 years). The acquisition of high-quality CT images with submillimeter spatial resolution were conducted using a quality control system. By means of homogenization methods, 3D reconstruction and 3D visualization analysis were performed. Postoperative observation: pathology reports, microvascular invasion, perioperative complications and follow-up. SPSS 25.0 statistical software was used for statistical description and analysis of clinical data. Kaplan-Meier curve was used to calculate overall survival and disease-free survival rate. Results: (1)In the sample of 1 265 patients, 3D reconstructed models clearly displayed as follows. tumor size: ≤2 cm in 155 cases (9.31%), >2 cm to 5 cm in 551 cases (33.09%), >5 cm to 10 cm in 636 cases (38.20%), >10 cm in 323 cases (19.40%). (2) Classification of hepatic blood vessels. Hepatic artery: type Ⅰ(normal type) in 1 494 cases(89.73%),variant hepatic artery in 171 cases (10.27%), including type Ⅱ in 35 cases, type Ⅲ in 38 cases, and other types in 98 cases. Hepatic vein: type Ⅰ (normal) in 1 195 cases (71.77%),variant hepatic veins in 470 cases(28.23%), including type Ⅱ in 376 cases and type Ⅲ in 94 cases. Portal vein:normal type in 1 315 cases (78.98%), variant portal veins in 350 cases (21.02%), including type Ⅰ in 189 cases, type Ⅱin 103 cases, type Ⅲ in 50 cases, type Ⅳ in 8 cases. Hepatic artery variation coexisting with portal vein variation in 24 cases (1.44%). Hepatic vein variation coexisting with portal vein variation in 113 cases (6.79%). Three types of vascular variation in 4 cases (0.24%), including coexistence of type Ⅱ hepatic artery variation or type Ⅰ portal vein variation with type Ⅲ hepatic vein variation in 2 cases,coexistence of type Ⅲ hepatic artery variation or type Ⅲ portal vein variation with type Ⅱ hepatic vein variation in 2 cases. (3) Preoperative liver volume calculation:1 499.3 (514.4)ml (range:641.7 to 6 637.0 ml) of total liver volume, including 479.1 (460.1) ml (range:10.5 to 2 086.8 ml) for liver resection and 959.9 (460.4)ml (range:306.1 to 5 638.0 ml) for residual function. (4)Operative methods: anatomical hepatectomy in 1 458 cases (87.57%); non-anatomic hepatectomy in 207 cases (12.43%). (5)the median operation time was 285(165)minutes (range: 40 to720 minutes). (6)The median intraoperative blood loss was 200(250)ml (range:10 to 4 200 ml) and 346 cases (20.78%) had intraoperative transfusion. (7)Pathology reports: hepatocellular carcinoma in 1 371 cases (82.34%), cholangiocarcinoma in 260 cases (15.62%) and mixed hepatocellular carcinoma in 34 cases (2.04%). Microvascular invasion: M0 in 199 cases, M1 in 64 cases, and M2 in 27 cases. (8)Postoperative complications in 207 cases (12.43%), including Clavien-Dindo grade Ⅰ or Ⅱ in 57 cases, grade Ⅲ or Ⅳ in 147 cases and grade Ⅴ in 3 cases.There were 13 cases (0.78%) of liver failure and 3 cases (0.18%) of perioperative death. (9) The follow-up time was 3.0 to 96.0 months, with a median time of 21.0(17.8) years. The overall 3-year survival and disease-free survival rates were 80.0% and 56.5%, respectively. The overall 5-year survival and disease-free survival rates were 59.7% and 30.0%, respectively. Conclusion: 3D visualization technology plays an important role in realizing accurate diagnosis of anatomical location and morphology of primary liver cancer, improving the success rate of surgery and reducing the incidence of complications.

[Level and trend of cardiovascular disease mortality in China from 2002 to 2016]

Objective: To investigate the level and trend of cardiovascular disease mortality in China from 2002 to 2016. Methods: Using data of China Health Statistics Yearbook (2003-2012) and China's Health and Family Planning Statistical Yearbook (2013-2017),we calculated the age-standardized mortality rates (ASMR) in China. Joinpoint regression model was employed to estimate the annual percent change (APC) and average annual percent change (AAPC) of cardiovascular disease ASMR. Results: (1)The ASMR of cardiovascular disease were 225.65/100 thousands, 242.74/100 thousands, 214.63/100 thousands, 240.97/100 thousands, 195.24/100 thousands, 201.50/100 thousands, 208.83/100 thousands, 248.44/100 thousands, 261.38/100 thousands, 231.98/100 thousands, 210.25/100 thousands, 237.80/100 thousands, 235.21/100 thousands, 237.58/100 thousands,and 237.25/100 thousands from 2002 to 2016, and there was no significant difference in ASMR of cardiovascular disease (AAPC=0.2%, P>0.05) . The ASMR of chronic rheumatic heart disease decreased significantly (AAPC=-4.5%,P<0.05). There were no significant differences in ASMR of cerebrovascular disease, hypertensive heart disease, and ischemic heart disease (AAPC=0, P>0.05; AAPC=2.0%, P>0.05; AAPC=4.3%, P>0.05, respectively). (2) There were no significant differences in ASMR of cardiovascular disease from 2002 to 2016 in city and country (AAPC=-0.7%, P>0.05; AAPC=0.8%, P>0.05, respectively). The ASMR of chronic rheumatic heart disease decreased significantly in city and rural area (AAPC=-4.4%, P<0.05; AAPC=-4.6%, P<0.05, respectively). (3) There were no significant differences in ASMR of cardiovascular disease from 2002 to 2016 in male and female (AAPC=-0.3%,P>0.05; AAPC=-0.2%,P>0.05,respectively). The ASMR of chronic rheumatic heart disease decreased significantly in female (AAPC=-4.2%, P<0.05). The ASMR of ischemic heart disease increased significantly in male and female (AAPC=4.7%,P<0.05; AAPC=5.2%,P<0.05,respectively). (4) The ASMR of cardiovascular disease showed a significant upward trend in residents aged 15 to 34 from 2002 to 2016 (AAPC=3.1, P<0.05). There were no significant differences in ASMR of cardiovascular disease in residents aged 35 to 64 and ≥65 (AAPC=-0.1%, P>0.05; AAPC=-0.2%, P>0.05, respectively). Conclusion: The ASMR of cardiovascular disease in China remains stable during 2002 to 2016, and the ASMR of cardiovascular disease shows upward trend among young people.

Current status of surgical treatment of colorectal liver metastases

Liver metastasis (LM) is one of the major causes of death in patients with colorectal cancer (CRC). Approximately 60% of CRC patients develop LM during the course of their illness. About 85% of these patients have unresectable disease at the time of presentation. Surgical resection is currently the only curative treatment for patients with colorectal LM (CRLM). In recent years, with the help of modern multimodality therapy including systemic chemotherapy, radiation therapy, and surgery, the outcomes of CRLM treatment have significantly improved. This article summarizes the current status of surgical treatment of CRLM including evaluation of resectability, treatment for resectable LM, conversion therapy and liver transplantation for unresectable cases, liver resection for recurrent CRLM and elderly patients, and surgery for concomitant hepatic and extra-hepatic metastatic disease (EHMD). We believe that with the help of modern multimodality therapy, an aggressive oncosurgical approach should be implemented as it has the possibility of achieving a cure, even when EHMD is present in patients with CRLM.

Effect of Huaier granule on recurrence after curative resection of HCC: a multicentre, randomised clinical trial

OBJECTIVE

There is little evidence that adjuvant therapy after radical surgical resection of hepatocellular carcinoma (HCC) improves recurrence-free survival (RFS) or overall survival (OS). We conducted a multicentre, randomised, controlled, phase IV trial evaluating the benefit of an aqueous extract of Trametes robinophila Murr (Huaier granule) to address this unmet need.

DESIGN AND RESULTS

A total of 1044 patients were randomised in 2:1 ratio to receive either Huaier or no further treatment (controls) for a maximum of 96 weeks. The primary endpoint was RFS. Secondary endpoints included OS and tumour extrahepatic recurrence rate (ERR). The Huaier (n=686) and control groups (n=316) had a mean RFS of 75.5 weeks and 68.5 weeks, respectively (HR 0.67; 95% CI 0.55 to 0.81). The difference in the RFS rate between Huaier and control groups was 62.39% and 49.05% (95% CI 6.74 to 19.94; p=0.0001); this led to an OS rate in the Huaier and control groups of 95.19% and 91.46%, respectively (95% CI 0.26 to 7.21; p=0.0207). The tumour ERR between Huaier and control groups was 8.60% and 13.61% (95% CI -12.59 to -2.50; p=0.0018), respectively.

CONCLUSIONS

This is the first nationwide multicentre study, involving 39 centres and 1044 patients, to prove the effectiveness of Huaier granule as adjuvant therapy for HCC after curative liver resection. It demonstrated a significant prolongation of RFS and reduced extrahepatic recurrence in Huaier group.

TRIAL REGISTRATION

NCT01770431; Post-results.

Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China (2017 Edition)

BACKGROUND

Hepatocellular carcinoma (HCC) (about 85-90% of primary liver cancer) is particularly prevalent in China because of the high prevalence of chronic hepatitis B infection. HCC is the fourth most common malignancy and the third leading cause of tumor-related deaths in China. It poses a significant threat to the life and health of Chinese people.

SUMMARY

This guideline presents official recommendations of the National Health and Family Planning Commission of the People's Republic of China on the surveillance, diagnosis, staging, and treatment of HCC occurring in China. The guideline was written by more than 50 experts in the field of HCC in China (including liver surgeons, medical oncologists, hepatologists, interventional radiologists, and diagnostic radiologists) on the basis of recent evidence and expert opinions, balance of benefits and harms, cost-benefit strategies, and other clinical considerations.

KEY MESSAGES

The guideline presents the Chinese staging system, and recommendations regarding patients with HCC in China to ensure optimum patient outcomes.

Relationship between epithelial-to-mesenchymal transition and the inflammatory microenvironment of hepatocellular carcinoma

Epithelial-to-mesenchymal transition (EMT) is a complex process involving multiple genes, steps and stages. It refers to the disruption of tight intercellular junctions among epithelial cells under specific conditions, resulting in loss of the original polarity, order and consistency of the cells. Following EMT, the cells show interstitial cell characteristics with the capacity for adhesion and migration, while apoptosis is inhibited. This process is critically involved in embryogenesis, wound-healing, tumor invasion and metastasis. The tumor microenvironment is composed of infiltrating inflammatory cells, stromal cells and the active medium secreted by interstitial cells. Most patients with hepatocellular carcinoma (HCC) have a history of hepatitis virus infection. In such cases, major components of the tumor microenvironment include inflammatory cells, inflammatory factors and virus-encoded protein are major components. Here, we review the relationship between EMT and the inflammatory tumor microenvironment in the context of HCC. We also further elaborate the significant influence of infiltrating inflammatory cells and inflammatory mediators as well as the products expressed by the infecting virus in the tumor microenvironment on the EMT process.

Overexpression of δ-catenin is associated with a malignant phenotype and poor prognosis in colorectal cancer

Little is known regarding the expression or clinical significance of δ-catenin, a member of the catenin family, in colorectal cancer (CRC). The present study examined the expression of δ-catenin using immunohistochemistry in 110 cases of CRC, including 70 cases with complete follow-up records and 40 cases with paired lymph node metastases. In addition, δ-catenin mRNA and protein expression were compared in 30 pairs of matched CRC and normal colorectal tissues by reverse transcription quantitative polymerase chain reaction and western blot analysis. δ-Catenin was weakly expressed or absent in the cytoplasm of normal intestinal epithelial cells, whereas positive δ-catenin expression local-ized to the cytoplasm was observed in CRC cells. The rate of positive δ-catenin expression in CRC (68.18%; 75/110) was significantly higher than that in normal colorectal tissues (36.7%; 11/30; P<0.001). In addition, δ-catenin mRNA and protein expression were significantly increased in CRC tissues compared to those in their matched normal tissues (all P<0.05). The expression of δ-catenin in stage III–IV CRC was higher than that in stage I–II CRC, and the expression of δ-catenin in the tumors of patients with lymph node metastases was higher than that in patients without lymph node metastases. Kaplan-Meier survival curves demonstrated that the survival time of patients with positive δ-catenin expression was shorter than that of patients with negative δ-catenin expression (P=0.005). Furthermore, Cox multivariate analysis indicated that the tumor, nodes and metastasis stage (P=0.02) and positive δ-catenin expression (P=0.033) were independent prognostic factors in CRC. The present study therefore indicated that δ-catenin may be a suitable independent prognostic factor for CRC.

Polymyxin B protects against hepatic ischemia/reperfusion injury in a rat model of obstructive jaundice

This study was conducted in order to investigate the effects of polymyxin B (PMB) against hepatic ischemia/reperfusion (I/R) injury in rats with obstructive jaundice. Thirty-six Wistar rats (eighteen each) with induced hepatic I/R injury by biliary tract ligation and recanalization were assigned to a control group (reperfused with normal saline) and a PMB group (reperfused with PMB). Indicators involving liver function, oxidation resistance, pro-inflammatory state, and anti-apoptosis effect were determined following the instructions. Compared with normal saline, PMB reperfusion resulted in a significant improvement of liver function (increase of glutathione and reduction of aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase), oxidation resistance (decreased malondialdehyde and myeloperoxidase activity), alleviation of pro-inflammatory state (less tumor necrosis factor (TNF)-α, interleukin-1 beta (IL-1β), nuclear factor kappa B (NF-κB) mRNA, and intercellular adhesion molecule (ICAM)-1), and anti-apoptosis effect (more Bcl-2 and less Bax). PMB protects the liver from I/R injury mainly through reducing cellular oncosis and apoptosis and regulating the expression of NF-κB, TNF-α, IL-1β, and ICAM-1.

Preconditioning with glutamine protects against ischemia/reperfusion-induced hepatic injury in rats with obstructive jaundice

OBJECTIVE

To ascertain whether glutamine (Gln) pretreatment protects rats with obstructive jaundice from hepatic ischemia/reperfusion (I/R) injury and to determine the underlying molecular mechanisms.

METHODS

An obstructive jaundice rat model was developed by bile duct ligation. On the first day after the operation, all rats were randomized into two groups and received oral Gln or normal saline (NS) daily for 7 days. Then both groups underwent a 15-min liver ischemia via the Pringle maneuver. Blood samples as well as liver and intestinal tissues were harvested and measured after 1, 6 and 24 h of reperfusion.

RESULTS

The results showed that the histological morphology of the liver and intestinal tissues significantly improved in the Gln group after I/R injury compared with the NS group. Serum proteins and enzymes associated with hepatic function also significantly improved in the Gln group. The level of glutathione increased and the levels of malondialdehyde and myeloperoxidase decreased in the Gln group. The levels of interleukin-1β and tumor necrosis factor-α decreased in the Gln group. Moreover, bcl-2 protein expression was upregulated and intercellular adhesion molecule 1 and bax protein expression downregulated in the Gln group; the caspase 3 mRNA level significantly increased in the Gln group.

CONCLUSIONS

The study demonstrates that preconditioning with Gln significantly improves hepatic structure and function after I/R injury in rats with obstructive jaundice. The protective effect of Gln was mediated by the inhibition of reactive oxygen species and inflammation as well as a reduction in hepatocyte apoptosis.

Pro-apoptosis gene PUMA and cancer

The dysfunction of cell apoptosis signaling is involved in carcinogenesis. P53 up-regulated modulator of apoptosis (PUMA), a pro-apoptosis gene that has been found for a decade, encodes a protein that is one of Bcl-2 members and can induce apoptosis via the mitochondrial pathway. It is considered that mutation of the PUMA gene is not involved in carcinogenesis, because mutation of the PUMA gene has not been found in many types of tumors until now. The expression of PUMA protein is regulated transcriptionally via ER stress, p53, JNK, FOXO3a and E2F1 signaling or post-translationally by phosphorylation. Several studies have showed that the down-regulation of PUMA protein in cancer tissue is associated with carcinogenesis, lymph node metastasis and tumor prognosis, and that up-regulation of PUMA induces the inhibition of cancer cell proliferation. Increasing new findings on the precise role of PUMA in the regulation of cancer development provide new insights into the potential use of PUMA as a target for the prevention and treatment of cancer.

Diagnosis and treatment of undifferentiated embryonal sarcoma of the liver: A retrospective study of four cases

AIM: To explore the diagnosis and treatment of undifferentiated embryonal sarcoma of the liver (UESL).

METHODS: Clinical data for four patients with pathologically confirmed UESL who were treated at our hospital between 2005 and 2011 were retrospectively analyzed.

RESULTS: Three children (2 female and 1 male) and one female adult were included. Their age was 14, 14, 6 and 46 years old, respectively. Clinical presentation was typically an abdominal mass that may be accompanied by pain and/or fever. Diagnosis relies on histopathological examination and it is difficult for radiological examination to establish a definite diagnosis. Tumors were removed surgically in all four patients, and two patients received adjuvant chemotherapy.

CONCLUSION: UESL is an unusua1 malignancy of the 1iver. Whenever feasible, radica1 resection should be attempted as a part of combination modalities. Multiagent adjuvant chemotherapy and supportive therapy might improve surviva1.

Delta-catenin promotes the proliferation and invasion of colorectal cancer cells by binding to E-cadherin in a competitive manner with p120 catenin

δ-Catenin is the only member of the p120 catenin (p120ctn) subfamily whose normal pattern of expression is restricted to the brain. Similar to p120ctn, δ-catenin can bind to the juxtamembrane domain of E-cadherin. We examined the expression of δ-catenin, p120ctn, and E-cadherin using immunohistochemistry in 95 cases of colorectal cancer (CRC) and 15 normal colon tissues. Co-immunoprecipitation was used to examine whether δ-catenin competed with p120ctn to bind E-cadherin in CRC cells. The effects of δ-catenin overexpression or siRNA-mediated knockdown on the proliferation and invasive ability of CRC cells were investigated using the MTT and Matrigel invasion assays. The results showed that positive δ-catenin expression was significantly more frequent in CRC compared to normal colon tissues and associated with poor differentiation, stage III-IV disease, and lymph node metastasis in CRC (all P < 0.05). In two CRC cell lines, δ-catenin bound to E-cadherin in competition with p120ctn. Overexpression of δ-catenin promoted the proliferation and invasion of CRC cells; knockdown of δ-catenin reduced CRC cell proliferation and invasion. In conclusion, we speculate that overexpression of δ-catenin reduces the expression of E-cadherin and alters the balance between E-cadherin and p120ctn, which in turn affects the formation of intercellular adhesions and promotes invasion and metastasis in CRC.

Cerebral and renal abscess and retino-choroiditis secondary to Candida albicans in preterm infants: eight case retrospective study

OBJECTIVES

To assess the tissues and organs commonly involved and the clinical features in the invasive fungal infection (IFI) of Candida albicans in the preterm infants.

MATERIALS AND METHODS

Eight preterm infants who developed IFI with positive blood culture for Candida albicans were retrospectively studied. All infants received selected clinical and laboratory parameters evaluation, such as blood culture, cerebral magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) biochemical test, routine urine test, urine culture, renal ultrasonography, renal computer tomography (CT), and fundus examination. The re-examinations were performed after one to two months follow-up.

RESULTS

Cerebral abscesses were detected in six infants. Five cases developed renal systemic fungal infection, among which one had renal abscess. Three cases were complicated with fungal retino-choroiditis.

CONCLUSIONS

Preterm infants, especially very-low-birthweight (VLBW) and extremely-low-birth-weight (ELBW) infants are susceptible to fungi. The majority of preterm late-onset fungal infections are due to Candida albicans. The organs commonly involved in the IFI of Candida albicans are central nervous system (CNS), kidney and fundus, among which renal systemic fungal infection are prone to recur, calling for a prolonged anti-fungi treatment course.

Evaluation of surgical treatments for hepatolithiasis

Hepatolithiasis is a common and refractory disease, for which the effective treatment method is surgery for removing the lesion, depleting stones, correcting stenosis, unobstructive drainage, and preventing recurrence. There are many surgical treatments available for hepatolithiasis, including bile duct exploration, bile duct drainage, bile duct reconstruction, hepatectomy, and liver transplantation. In clinical practice, combination therapies are often performed in a large number of patients. Here we discuss the choice of surgical treatments for hepatolithiasis and evaluate their respective therapeutic effects.

Elevated muscle enzymes and muscle biopsy in idiopathic hypoparathyroidism patients

OBJECTIVE

To study idiopathic hypoparathyroidism (IHP) myopathy and its pathogenesis by histology method.

METHODS

We retrospectively analyzed the clinical data of nine IHP patients during the years 2006-2010.

RESULTS

We found that: 1) there was an inverse relationship between the decreased serum calcium level and the elevated muscle enzymes level; 2) the IHP patients had mild-to-moderate muscle cells vacuolar degeneration and focal hyaline degeneration by hematoxylin-eosin (HE) staining; 3) except for 2 patients, the others' muscles striations were undetectable by phosphotungstic acid hematoxylin staining; 4) 2 patients with extremely high level of creatine kinase and relatively longer disease duration had muscle atrophy, multiple focal muscle fiber hyaline degeneration and sarcolemma cells hyperplasia by HE staining; 5) all patients had different degree of immune complex deposition along the muscle cell membranes by immunofluorescence staining.

CONCLUSION

The patients with IHP had some histological changes in skeletal muscles but with no specificity. The changes in muscles and the elevated serum muscle enzymes were related to hypocalcemia. The severity of changes in muscles was related to the duration of hypocalcemia and not only to its degree.

Interleukin-10 suppresses hepatic TGF-β1 expression and attenuates hepatocyte apoptosis in biliary-obstructed rats

AIM: To explore the effect of interleukin-10 (IL-10) on hepatocyte apoptosis in biliary-obstructed rats.

METHODS: Male Wistar rats were divided randomly into sham operation (SO) group, obstructive jaundice (OJ) group and IL-10 group. Rats of the OJ and IL-10 groups underwent ligation and severing of the common bile duct, while mobilization of the common bile duct was performed in the SO group. The IL-10 group was intraperitoneally injected with IL-10 (4 μg/kg) daily after operation. The mRNA and protein expression of transforming growth factor-β1 (TGF-β1) in liver tissue was detected by fluorescence real-time quantitative PCR and immunohistochemical staining, respectively. Blood samples were taken to measure serum total bilirubin (TBIL), direct bilirubin (DBIL), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels, while hepatic cell apoptosis was evaluated by TUNEL method.

RESULTS: Compared to the SO group, the levels of serum ALT and AST, hepatic TGF-β1 mRNA and protein expression, and hepatic cell apoptosis index significantly increased in the OJ group 3 days after operation (ALT: 91.83 U/L ± 21.47 U/L vs 47.67 U/L ± 12.79 U/L; AST: 208.67 U/L ± 32.36 U/L vs 75.17 U/L ± 11.96 U/L; TGF-β1 mRNA: 7.48 ± 1.51 vs 1.21 ± 0.79; TGF-β1 protein: 6.11% ± 1.11% vs 1.26% ± 0.64%; apoptosis: 15.06% ± 1.17% vs 3.94% ± 0.46%; all P < 0.05), and further increased 7 d after operation (ALT: 178.83 U/L ± 46.25 U/L vs 44.50 U/L ± 9.97 U/L; AST: 461.17 U/L ± 88.48 U/L vs 76.50 U/L ± 12.39 U/L; TGF-β1 mRNA: 11.98 ± 3.05 vs 1.01 ± 0.52; TGF-β1 protein: 9.97% ± 2.84% vs 1.68% ± 0.71%; apoptosis: 23.49% ± 3.35% vs 4.31% ± 0.67%; all P < 0.05). Treatment with IL-10 significantly decreased hepatic function, hepatic TGF-β1 expression, and hepatic cell apoptosis compared to the OJ group 7 d after operation (ALT: 94.17 U/L ± 20.02 U/L vs 178.83 U/L ± 46.25 U/L; AST: 257.83 U/L ± 56.53 U/L vs 461.17 U/L ± 88.48 U/L; TGF-β1 mRNA: 7.05 ± 1.15 vs 11.98 ± 3.05; TGF-β1 protein: 7.06% ± 1.32% vs 9.97% ± 2.84%; apoptosis: 15.08% ± 1.69% vs 23.49% ± 3.35%; all P < 0.05).

CONCLUSION: IL-10 could attenuate hepatocyte apoptosis by suppressing hepatic TGF-β1 expression in biliary-obstructed rats.

Overwhelming postsplenectomy infection due to Mycoplasma pneumoniae in an asplenic cirrhotic patient: case report

Background

Mycoplasma pneumoniae infection is usually self-limited, but some fulminant cases are fatal, even when occurring in previously healthy individuals. It can also be the cause of overwhelming postsplenectomy infection (OPSI).

Case presentation

We report a case of OPSI in a 41-year-old woman with hypersplenism associated with hepatitis B cirrhosis. We detected a significant Mycoplasma pneumoniae agglutination titer, but no evidence of infection with Chlamydia pneumoniae, Legionnella spp., or any other bacterial or fungal pathogens. She eventually died despite aggressive therapy.

Conclusions

M. pneumoniae could be an underestimated cause of OPSI, and should be suspected in fulminant infectious cases in asplenic patients.

Attenuation of reperfusion-induced hepatocyte apoptosis is associated with reversed bcl-2/bax ratio in hemi-hepatic artery-preserved portal occlusion

BACKGROUND

This study aimed to examine the hepatocyte apoptosis in a hepatic blood inflow occlusion rat model without hemi-hepatic arterial control and its association with the expressions of the apoptosis-regulating genes bcl-2 and bax.

MATERIALS AND METHODS

Wistar rats were equally and randomly assigned to undergo sham operation (control group, n = 8), Pringle's maneuver (group PR, n = 32), hemi-hepatic occlusion (group HH, n = 32), or hemi-hepatic artery-preserved portal occlusion (group HP, n = 32). The hepatic blood inflow was interrupted for 30 min using a microvascular clip in the three experimental groups. The clips were removed to achieve hepatic reperfusion for up to 24 h. Blood samples and liver specimens were collected following reperfusion to perform pathologic examination, serum transferase assay, apoptosis analysis, and determination of bcl-2 and bax mRNA and protein expressions.

RESULTS

The reperfusion-related hepatocytic injuries were more severe in the PR group than in the HH and HP groups, both pathologically and biochemically. More reperfused hepatocytes became apoptotic in the PR group than in the HH and HP groups. However, the values of the HH and HP groups were comparable in cellularity, levels of serum transferases, and apoptosis rate following reperfusion. The ratios of bcl-2/bax were reversed, which was more evident in the HH and HP groups than in the PR group.

CONCLUSION

Hemi-hepatic artery-preserved portal occlusion had little effect on hepatocyte apoptosis compared with Pringle's maneuver and caused minor ischemia-reperfusion injury as shown by the reversed bcl-2/bax ratio.

Hepatic blood inflow occlusion without hemihepatic artery control in treatment of hepatocellular carcinoma

AIM: To investigate the clinical significance of hepatic blood inflow occlusion without hemihepatic artery control (BIOwHAC) in the treatment of hepatocellular carcinoma (HCC).

METHODS: Fifty-nine patients with HCC were divided into 3 groups based on the technique used for achieving hepatic vascular occlusion: group 1, vascular occlusion was achieved by the Pringle maneuver (n = 20); group 2, by hemihepatic vascular occlusion (HVO) (n = 20); and group 3, by BIOwHAC (n = 19). We compared the procedures among the three groups in term of operation time, intraoperative bleeding, postoperative liver function, postoperative complications, and length of hospital stay.

RESULTS: There were no statistically significant differences (P > 0.05) in age, sex, pathological diagnosis, preoperative Child’s disease grade, hepatic function, and tumor size among the three groups. No intraoperative complications or deaths occurrred, and there were no significant intergroup differences (P > 0.05) in intraoperative bleeding, hepatic function change 3 and 7 d after operation, the incidence of complications, and length of hospital stay. BIOwHAC and Pringle maneuver required a significantly shorter operation time than HVO; the difference in the serum alanine aminotransferase or aspartate aminotransferase levels before and 1 d after operation was more significant in the BIOwHAC and HVO groups than in the Pringle maneuver group (P < 0.05).

CONCLUSION: BIOwHAC is convenient and safe; this technique causes slight hepatic ischemia-reperfusion injury similar to HVO.

Splenectomy in patients with liver cirrhosis and portal hypertension

In patients with liver cirrhosis and portal hypertension, splenectomy allows to reduce portal vein pressure, improve liver function, reverse leukopenia and thrombocytopenia, prevent small-for-size syndrome after living donor liver transplantation, and help treat hepatocellular carcinoma and viral hepatitis. However, overwhelming postsplenectomy infection (OPSI) and portal venous thrombosis are potentially fatal complications following splenectomy. Therefore, the indications and contraindications for splenectomy should be strictly applied.

Advances in understanding the mechanisms of impaired hepatic regeneration in patients with obstructive jaundice

The regenerative capacity of the liver is extraordinary. However, it has been observed preoperatively in some patients, such as those with hilar cholangiocarcinoma, that obstructive jaundice may affect hepatocyte proliferation and even cause hepatic failure after hepatectomy. The extent of impaired hepatic regeneration caused by biliary obstruction may determine whether surgical treatment should be conducted. Nowadays, the mechanisms of impaired hepatic regeneration in patients with obstructive jaundice have been studied extensively. The possible mechanisms include restricted portal venous flow, increased hepatocyte apoptosis, and altered expression of liver regeneration-associated factors. Thus, regulation of these factors might have beneficial effects on liver regeneration after hepatectomy in patients with obstructive jaundice.

Role of Kupffer cells in hepatic fibrosis

Kupffer cells (KC), a kind of nonparenchymal cells and defenders in the liver, release various chemical mediators to induce liver injury, and play an important role in many pathologic changes of the liver. Hepatic fibrosis is the common pathologic process of varied chronic liver diseases, and it is also a "transfer station" for many chronic liver diseases lapsing to cirrhosis. As important influencing factors, cytokines secreted by KC are involved in the occurrence and progression of hepatic fibrosis. Therefore, lucubrating the role and mechanism of KC in the progression of hepatic fibrosis, and investigating the KC-related therapeutic strategies of anti-fibrosis have practical significances for the prevention and treatment of liver injury and the raise of patients' survival rates in clinical practice.

Effect of ginseng and prepared aconite injection on TXA2/PGI2 and nuclear factor-κB in rat model of hepatic ischemia-reperfusion

AIM: To explore the protective effects of ginseng and prepared aconite (Shen Fu) injection on the TXA2/PGI2 and nucleus factorκB (NF-κB) in a rat model of hepatic ischemia-reperfusion (IR).

METHODS: Twenty-four male Wistar rats weighing 200-250 g were randomly divided into Shen Fu (SF) group treated with intraperitoneal SF injection (10 mL/kg) and IR group treated with 0.9% sodium chloride solution (10 mL/kg) as control group. Hepatic ischemia was induced by Pringle's maneuver for 15 minutes, and then reperfusion was performed for one or three hours. Venous blood samples were collected three hours after reperfusion for measurement of TXB₂ and 6-keto-PGF_1α. Liver tissue samples were collected one or three hours after reperfusion, for measurement of deoxidized glutathione (GSH) and morphological and immunochemical studies.

RESULTS: Plasma TXB₂ was lower in the SF group than in the IR group after three-hour reperfusion (118.7 ± 19.1 vs 386.3 ± 282.7, P > 0.05), while 6-keto-PGF_1α was higher in the SF group than in the IR group (1081.7 ± 282.7 vs 960.0 ± 209.9, P > 0.05). The ratio of TXB₂ and 6-keto-PGF_1α (0.11 ± 0.03 vs 0.39 ± 0.24, P < 0.05) was significantly lower in the SF group. Fifteen minutes after ischemia and one hour after reperfusion, NF-κB p65 was expressed in hepatocytes and Kuffer cells. The percentage of NF-κB p65 positive cells in the SF group was significantly lower (59.33% ± 11.06% vs 75.83% ± 11.46%, P < 0.05) and GSH was slightly higher (47.59 ± 19.07 vs 37.32 ±4.71, P > 0.05) than those in the IR group. Three-hour reperfusion fifteen minutes after ischemia caused important histologic alterations in the liver. Marked structural abnormalities were observed in the IR group, such as massive hepatocyte swelling, necrosis, mitochondria edema and vacuolar changes. In the SF group, hepatic tissue injury was significantly improved.

CONCLUSION: Shen Fu injection protects hepatic tissue from ischemia-reperfusion injury by decreasing the ratio of thromboxane A₂ and prostacyclin and inhibiting the activation of NF-κB.

Effect of prostaglandin E1 on expression of interleukin-1β in hepatic ischemic reperfusion injury in rats with obstructive jaundice

AIM: To investigate the protective effect of prostaglandin E1 against hepatic ischemic reperfusion injury and effect on expression of interleukin-1β in rats with obstructive jaundice.

METHODS: Male Wistar rats were divided randomly into two groups: PG group received prostaglandin E1 (n = 18) and NS group received normal saline served as controls (n = 18). All rats underwent ligation and division of common bile duct to establish obstructive jaundice model according to Yoshidome's maneuver. After 1 wk, total liver ischemia for 15 min according to Pringle's maneuver and internal biliary drainage during hepatic reperfusion were performed. The hepatoprotective effect of prostaglandin E1 in PG group was studied throughout treatment with PGE1 by continuously pumping via portal vein from 15 min before hepatic ischemia to 60 min after reperfusion, while rats of NS group were only treated with normal saline. All rats were sacrificed at 1, 6, and 24 h after reperfusion. IL-1β expression was determined by ELISA, and glutathione (GSH) and malondialdehyde (MDA) in liver tissue homogenate, activities of alanine transaminase (ALT) and aspartate transaminase (AST) in serum, in addition to serum level of bilirubin (total and conjugated) were evaluated. Liver tissue sections were examined to observe histopathological changes.

RESULTS: Analysis of data showed that treatment with prostaglandin E1 significantly attenuated hepatic IL-1β expression (1 h: 304.1 ± 67.9 ng/L vs 362.8 ± 137.1 ng/L; 6 h: 376.8 ± 74.6 ng/L vs 618.8 ± 217.8 ng/L; 24 h: 273.0 ± 69.0 ng/L vs 373.0 ± 71.7 ng/L), and lowered serum activities of ALT (1 h: 1939 ± 1427 nkat/L vs 5596 ± 2975 nkat/L; 6 h: 3409 ± 1708 nkat/L vs 9279 ± 4404 nkat/L; 24 h: 1434 ± 274 nkat/L vs 2264 ± 630 nkat/L), AST (1 h: 21 746 ± 12 083 nkat/L vs 37  552 ± 12 382 nkat/L; 6 h: 55 039 ± 35  471 nkat/L vs 98 811 ± 11 126 nkat/L; 24 h: 9394 ± 1662 nkat/L vs 27 664 ± 15 856 nkat/L) and MDA (1 h: 0.89 ± 0.18 μmol/g vs 1.21 ± 0.24 μmol/g; 6 h: 1.08 ± 0.23 μmol/g vs 1.45 ± 0.13 μmol/g; 24 h: 1.03 ± 0.08 μmol/g vs 1.45 ± 0.26 μmol/g) levels in tissue homogenate while elevating GSH (1 h: 945.1 ± 121.2 mg/g vs 720.0 ± 80.1 mg/g; 6 h: 753.5 ± 118.6 mg/g vs 553.6 ± 140.0 mg/g; 24 h: 768.0 ± 135.9 mg/g vs 596.3 ± 36.4 mg/g, P < 0.05) levels, while there was no difference in serum bilirubin levels between PG group and NS group (P > 0.05). Additionally, histological evaluation revealed improvement of liver damage in PG group compared with NS group.

CONCLUSION: The data indicate that prostaglandin E1 administered via the portal vein reduces expression of IL-1β in hepatic tissue and protects against hepatic ischemia/reperfusion injury in rats with obstructive jaundice.

Effect of hepatic blood inflow occlusion without hemihepatic artery control during hepatic ischemia-reperfusion injury in rats

AIM: To investigate the effect of hepatic blood inflow occlusion without hemihepatic artery control during hepatic ischemia-reperfusion injury in rats.

METHODS: Ninety-six Wistar rats were randomly divided into the Pringle group (groupⅠ), hemihepatic vascular occlusion group (group Ⅱ) and hepatic blood inflow occlusion without hemihepatic artery control group (group Ⅲ). After 30 min of hepatic vascular occlusion with three methods, the liver blood flow was reperfused. After reperfusion for 1, 2, 6 and 24 hours, we measured serum AST and ALT and liver tissue (superoxide dismutase) SOD, MDA, pathology and apoptosis.

RESULTS: After each period of reperfusion, ALT, AST, MDA and apoptosis rate were significantly lower in groups Ⅱ and Ⅲ than in groupⅠ, but SOD activity was significantly higher. AST, ALT, MDA, SOD and apoptosis rate did not differ significantly between groups Ⅱ and Ⅲ.

CONCLUSION: Hepatic blood inflow occlusion without hemihepatic artery control can reduce hepatic ischemia-reperfusion injury, and the effect is similar to that of hemihepatic vascular occlusion.

Analysis of 50 cases of pancreatic schwannoma

AIM: To analyze the incidence of pancreatic schwannoma and investigate its diagnosis and treatment.

METHODS: A retrospective study of clinical data from 50 patients with pancreatic schwannoma.

RESULTS: The lesion was located in the head of pancreas in 25 patients, the body in 9 (18%), the body and tail in 6, the tail in 5, the head and body in 2, the neck in 1, and the location was not specified in 2 patients. Solid tumors were found in 18 patients, cystic tumors in 25, and the nature of the tumor was not specified in 7 patients. Forty-nine patients received operative therapy. Thirteen patients underwent a Whipple operation, 12 distal pancreatectomy, 12 local resection, 8 simple enucleation, and in 2 patients the surgical procedure was not specified. The tumor in 1 patient was unresectable. One patient underwent biopsy. One patient refused surgery. The longest follow-up was 9 years, and there have been no reports of local recurrence or metastasis.

CONCLUSION: Preoperative diagnosis of pancreatic schwannoma is difficult. Definite diagnosis depends on pathological examination. Benign tumors can be effectively treated by local excision but those with malignancy should be treated by simple enucleation. Intraoperative frozen sections are useful for determining which kind of operation should be undertaken.

Patterns of liver cell death in rats with acute bile duct obstruction

AIM: To investigate the patterns of hepatic cell death in rats with acute bile duct obstruction.

METHODS: Male Wistar rats were divided randomly into bile duct ligation (BDL) group (n = 5) and control group (n = 5). The rats in BDL group underwent ligation and division of common bile duct to set up acute bile duct obstruction model according to Yoshidome's maneuver, while the rats in the control group underwent dissociation of common bile duct only. All the animals were sacrificed for sampling on day 7. Flow cytometry was used to determine the percentages of hepatocyte apoptosis and oncosis. Hematoxylin and eosin (H&E) staining and electron microscopy were used to observe hepatocyte apoptosis, oncosis and histopathological changes. An auto analyzer was used to examine the levels of serum total bilirubin (TBIL), direct bilirubin (DBIL), alkaline phosphatase (ALP), glutamyl transpeptidase (γ-GT), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and lactate dehydrogenase (LDH).

RESULTS: The percentage of liver cell oncosis or necrosis was significantly higher in BDL group than that in the control group (oncosis: 25.41% ± 2.18% vs 6.12% ± 1.69%, P < 0.05; necrosis: 3.99% ± 1.24% vs 0.79% ± 0.29%, P < 0.05), while the percentage of apoptosis was remarkably lower in BDL group (2.79% ± 1.43% vs 5.18% ± 1.87%, P < 0.05). Moreover, the percentage of hepatic cell oncosis was higher than that of apoptosis in BDL group (25.41% ± 2.18% vs 2.79% ± 1.43%, P < 0.05). Hepatic histopathological examination showed proliferation of bile duct and fibrous connective tissue, obvious increase of hepatic cell oncosis and liver cell cord derangement in BDL group. The levels of serum TBIL, DBIL, ALP, γ-GT, AST, ALT and LDH in BDL group were all increased as compared with those in the control group (P < 0.05).

CONCLUSION: Oncosis is the dominant type of hepatic cell death in rats with acute bile duct obstruction, and the degree of hepatic injury has a close relationship with the oncosis or apoptosis of hepatic cells.

Alanyl-glutamine dipeptide inhibits hepatic ischemia-reperfusion injury in rats

AIM: To investigate the protective effect and mechanism of alanyl-glutamine dipeptide (Ala-Gln) against hepatic ischemia-reperfusion injury in rats.

METHODS: Rats were divided into group C as normal control Group (n=16) and group G as alanyl-glutamine pretreatment (n=16). Rats were intravenously infused with 0.9% saline solution in group C and Ala-Gln -enriched (2% glutamine) 0.9% saline solution in group G via central venous catheter for three days. Then all rats underwent hepatic warm ischemia for 30 min followed by different periods of reperfusion. Changes in biochemical parameters, the content of glutathione (GSH) and the activity of superoxide dismutase (SOD) in liver tissue, Bcl-2 and Bax protein expression and morphological changes of liver tissue were compared between both groups.

RESULTS: One hour after reperfusion, the levels of liver enzymes in group G were significantly lower than those in group C (P<0.05). Twenty-four hours after reperfusion, the levels of liver enzymes in both groups were markedly recovered and the levels of liver enzyme in group G were also significantly lower than those in group C (P <0.01). One and 24 h after reperfusion, GSH content in group G was significantly higher than that in group C (P <0.05). There was no statistical difference in activities of SOD between the two groups. One and 24 h after reperfusion, the positive expression rate of Bcl-2 protein was higher in group G than in group C (P <0.05) and the positive expression rate of Bax protein was lower in group G than in group C (P < 0.05). Histological and ultrastructural changes of liver tissue were inhibited in group C compared to group G.

CONCLUSION: Our results suggest that Ala-Gln pretreatment provides the rat liver with significant tolerance to warm ischemia-reperfusion injury, which may be mediated partially by enhancing GSH content and regulating the expression of Bcl-2 and Bax proteins in the liver tissue.

Parathyroid hormone regulates osterix and Runx2 mRNA expression predominantly through protein kinase A signaling in osteoblast-like cells

Runt-related transcription factor 2 (Runx2) and osterix are osteoblast-specific transcription factors essential for the development of osteoblastic cells and bone formation. PTH given intermittently has anabolic effects on bone; however, the exact role remains to be understood completely. The purpose of this study was both to investigate whether PTH regulates Runx2 as well as osterix expression and to identify the signaling used. Using RT-PCR, we confirmed that PTH (1-34) regulated Runx2 and osterix mRNA expression, in rat osteoblast-like cell line UMR 106, in a dose- and time-dependent manner. PTH in low concentrations stimulated both Runx2 and osterix mRNA expression while that in high concentrations did not. Forskolin, an adenylate cyclase activator, also enhanced Runx2 and osterix transcription, and the stimulatory effects of PTH and forskolin were blocked by the pre-treatment of the cells with H-89, a protein kinase A (PKA) inhibitor. In contrast, the protein kinase C (PKC) activator phorbol 12-myristate 13-acetate (PMA) had no effect on Runx2 transcription, but induced an increase in osterix mRNA level at the concentration of 500 nM at 12 h after treatment. Moreover, pre-treatment of the cells with calphostin C, a PKC-specific inhibitor, reduced the increase in osterix transcripts enhanced by PTH and PMA 12 h after treatment. However, these inhibitory effects were not sustained for longer terms. These observations demonstrate that PTH stimulates Runx2 and osterix expression in vitro, at least in part, at transcriptional level. Induction of Runx2 mRNA is mediated through the activation of cAMP/PKA signal transduction. In the case of osterix, although the increase in mRNA level is predominantly mediated via cAMP/PKA signaling, PKC activation might also be involved in this process.

Effects of glutamine on glutathione content and expression of Bcl-2 and Bax protein during hepatic ischemia and reperfusion injury in rats

AIM: To investigate the effect of alanyl-glutamine dipeptiven (Ala-Gln) on the content of glutathione (GSH) and the expression of Bcl-2 and Bax protein during hepatic ischemia and reperfusion injury (HIRI) in rats.

METHODS: A total of 48 Wistar rats were randomly divided into glutamine group (group G) and control group (group C), which were pretreated with Gln and normal saline, respectively. The liver was subjected to warm ischemia by Pringle method for 30 min, and then reperfused. The serum samples were colleted 1 and 24 h after the reperfusion, and the level of serum ALT was measured. The GSH content and histopathological changes were detected in the liver tissues. The expression of Bcl-2 and Bax protein in the liver tissues were detected by immunohistochemistry.

RESULTS: The level of serum ALT was significantly lower in group G than that in group C 1 and 24 h after the reperfusion (8.3 ± 2.0 mkat/L vs 13.7± 5.5 mkat/L, P < 0.05; 2.9 ± 2.5 mkat/L vs 9.1 ± 4.3 mkat/L, P < 0.01), but the GSH content was significantly higher in group G than that in group C (1216.09 ± 152.78 mg/g vs 856.68 ± 117.64 mg/g, P < 0.01; 899.73 ± 57.75 mg/g vs 800.50 ± 94.79 mg/g, P < 0.05). The histopathological changes were significantly slighter in group G than those in group C. One and twenty-four hours after the reperfusion, the positive rate of Bcl-2 protein expression was significantly higher in group G than that in group C (100.0% vs 37.5%, P < 0.05; 87.5% vs 25.0%, P < 0.05), while the positive rate of Bax protein expression was significantly lower in group G than that in group C (25.0% vs 87.5%, P < 0.05; 25.0% vs 87.5%, P < 0.05).

CONCLUSION: Ala-Gln (Gln) can protect rats against HIRI, and the mechanism may relate to the enhancement of GSH content and the regulation of Bcl-2, Bax protein expression.

Undifferentiated (embryonal) sarcoma of liver in adult: A case report

We report a case of undifferentiated (embryonal) sarcoma of the liver (UESL), which showed cystic formation in a 20-year-old man with no prior history of any hepatitis or liver cirrhosis. He was admitted with abdominal pain and a palpable epigastric mass. The physical examination findings were unremarkable except for a tenderness mass and the results of routine laboratory studies were all within normal limits. Abdominal ultrasound and computed tomography (CT) both showed a cystic mass in the left hepatic lobe. Subsequently, the patient underwent a tumor excision and another two times of hepatectomy because of tumor recurrence. Immunohistochemical study results showed that the tumor cells were positive for vimentin, alpha-1-antichymotrypsin (AACT) and desmin staining, and negative for alpha-fetoprotein (AFP), and eosinophilic hyaline globules in the cytoplasm of some giant cells were strongly positive for periodic acid-Schiff (PAS) staining. The pathological diagnosis was UESL. The patient is still alive with no tumor recurrence for four months.

Changed clinical aspects of primary liver cancer in China during the past 30 years

BACKGROUND

Primary liver cancer (PLC) is one of the most frequently seen tumors in China. Thirty years ago, patients with PLC were often detected at relatively late stage, with a palpable mass or marked clinical symptoms and poor prognosis. In the past 30 years, the diagnosis and treatment of PLC have been greatly improved with better prognosis.

METHODS

In order to study the changes of PLC during the 30 years, the clinical data of 3250 patients with PLC from 10 medical institutions of China were collected, analyzed, and compared with those of 3254 PLC patients before the 30 years.

RESULTS

In the 3250 patients aged 1-80 years, with an average age of 49.1 years, the male to female ratio (2.3:1) was lower than that before the 30 years. 73.5% of the 3250 patients sought medical advice within 3 months after the onset of the disease in contrast to 63.8% before the 30 years. Compared with those patients before the 30 years the symptoms and signs were alleviated generally. The HBsAg positive rate was 81.0%, but the HCV-Ab positive rate was 13.2%. The AFP level in 75% of patients was elevated, but in the remaining 25% was normal. 1912 patients (58.8%) were confirmed pathologically. Among them 1755 patients (91.8%) had hepatocellular carcinoma. The overall resection rate was 46.3%. Those who had early, middle, late stage carcinoma accounted for 29.9%, 51.5%, and 18.6% respectively in contrast to 0.4%, 47.0%, and 52.6% reported before the 30 years. The 1-, 3-, 5-year survival rates of the patients were 66.1%, 39.7%, and 32.5% respectively, whereas 93.5%, 70.1%, and 59.1% for the early stage patients, and 65.3%, 30.5%, and 23.5% for the middle stage patients. The half and 1-year survival rates of the late stage patients were 52.5%, and 14.7%, respectively.

CONCLUSION

Comparison with the clinical data before and after the 30 years show that PLC can be diagnosed early. More PLC patients tend to undergo resection while receiving a better conservative treatment, which ensures a prognosis.

[Studies on the synthesis and bioactivity of alpha-alkylaminobenzyl-phosphonic acids]

AIM

To search for some substituted benzyl phosphonic acids as leading compounds with inhibiting effect on osteoclast formation.

METHODS

Target compounds were prepared from aromatic aldehydes, primary amine and phosphorous acid using tetramethylenesulfone as solvent via Arbuzov type reaction. The effect on inhibiting the formation of osteoclast-like cells (OLC) of related compounds was studied by incubating the extract of rat femur marrow.

RESULTS

Ten compounds of alpha-alkylaminobenzyl phosphonic acids have been synthesized and identified by MS or 1HNMR analysis. Three (2, 8 and 9) of them were found to have notable effect on the inhibition of OLC formation (P < 0.01).

CONCLUSION

Among the present substituted benzyl phosphonic acids, the increased aromaticity and hydrophobicity (such as compound 9) can remarkably enhance the ability to inhibit OLC formation.

Historical evolution of hypothermic liver surgery

The clinical application of hypothermia dates back to the surgical treatment of blue babies (1949) and the early days of open heart surgery (1952), when generalized cooling was employed. The induction of hepatic hypothermia began with whole-body cooling in experimental models in 1953 and clinically in 1961. It was designed to minimize the ischemia-reperfusion injury associated with hepatic inflow occlusion. Body surface cooling and cooling via an extracorporeal circuit, however, were not widely accepted for hepatic surgery because of the adverse effects on the extrahepatic organs. Consequently, with the introduction of improved venovenous bypass techniques, in situ cold hepatic perfusion has been used in selected patients since 1971. In situ hypothermic hemihepatic perfusion, introduced in 1995, prevents an ischemic insult to the contralateral hepatic lobe. Topical cooling using ice slush under total or hemihepatic inflow occlusion was reported in 1993. This technique does not require cumbersome hypothermic perfusion equipment. In attempts to minimize intraoperative bleeding by vascular occlusion, the liver surgeon must consider the benefits and technical demands of hepatic hypothermia.

Heat shock protein 72 production in liver tissue after experimental total hepatic inflow occlusion

BACKGROUND

The pathogenesis of hepatic ischaemia-reperfusion injury is incompletely understood. This study examined the effects of reperfusion with congested portal blood on ischaemia-reperfusion injury of the liver following Pringle's manoeuvre, as monitored by heat shock protein (HSP) 72 production in rat liver tissue.

METHODS

Rats were randomized to three groups. In group 1 hepatic ischaemia with portal congestion was induced by Pringle's manoeuvre for 15 min; in group 2 Pringle's manoeuvre was applied for 15 min with an extracorporeal portasystemic shunt; and in group 3 the superior mesenteric vein was occluded for 15 min. The production of HSP72 in liver tissue was measured by Western blotting at 48 h after each intervention. Conventional parameters for hepatic function were examined at 1, 3 and 48 h after reperfusion.

RESULTS

There was marked HSP72 expression in group 1, but not in group 2 or 3, showing that a combination of liver ischaemia and reperfusion of congested portal blood is required to induce strong expression of HSP72 in the tissue. On the other hand, biochemical parameters were raised equally in both groups 1 and 2, reflecting a similar degree of ischaemic hepatocyte injury.

CONCLUSION

The additional stress impact of temporary portal occlusion upon ischaemia-reperfusion injury of the liver was clearly detected by in situ hepatic HSP72 production in this study.