ObjectiveTo summarize the mechanism of neutrophil extracellular traps (NETs) in hepatic ischemia-reperfusion injury (HIRI) and the research progress in targeting NETs to reduce HIRI, providing valuable reference for reducing HIRI. MethodThe related literatures at home and abroad about the role of NETs in the pathogenesis of HIRI and target NETs to alleviate HIRI were retrieved and reviewed. ResultsHIRI usually appeared in the process of liver surgery and was a common clinical problem, which occured in situations such as liver surgery, organ transplantation, liver ischemia and so on. This kind of injury would lead to tissue necrosis, inflammatory response and oxidative stress, which was a major cause of hepatic dysfunction and multiple organ failure after hepatic surgery, greatly increases the complications and mortality after hepatic surgery. NETs played a crucial role in the aseptic inflammatory response induced by hepatic ischemia/reperfusion. During hepatic ischemia-reperfusion, neutrophils promoted inflammatory cascade reactions and cytokine storms by forming NETs, exacerbating damage caused by hepatic ischemia-reperfusion. At present, some experimental and clinical studies had shown that inhibiting the formation of NETs or eliminating the formed NETs could alleviate the hepatic ischemia-reperfusion injury and improve the prognosis. ConclusionsTargeting NETs may become a new method for treating hepatic ischemia-reperfusion injury. In the future, it is foreseeable that more experiments and clinical trials will be conducted on targeted NETs for the treatment of hepatic ischemia-reperfusion injury. And gradually establish more comprehensive and effective treatment strategies, thereby providing new ways to improve the prognosis of hepatic surgery patients in clinical practice.
Objective To evaluate the clinical application value of the tauro ursodeoxycholic acid (TUDCA) for preventing the relapse of lithiasis after the gallbladder-protected lithotomy. Methods Totally 80 cholecyslithiasis patients in Chengdu General Military Hospital who met the demand of lithotomy in protecting gallbladder were divided into two groups by random permutations, with 40 patients in each. The calculus was removed by using the percutaneous ultrasonic lithotripsy in order to preserve the well-functioning gallbladder. The patients in the trial group were given TUDCA after surgery for two years, whereas the patients in the control group received the same nursing and diet therapies without medication. The thickness of gallbladder wall and the contraction function of gallbladder were checked two years after surgery, the statistics of the recurrence rate of liary calculus symptoms and cholecyslithiasis were conducted, and the comparison between those two groups was performed. Results All the operations of gallbladder-protected lithotomy were successful. There was significant difference between those two groups two years after surgery in terms of the thickness of gallbladder wall and the contraction function of gallbladder (Plt;0.05). The relapse of lithiasis was remarkably decreased in the trial group (Plt;0.05). Conclusion The application of TUDCA for patients with gallbladder-protected lithotomy can prevent the relapse of cholecyslithiasis.
Objective To observe the expression and localization of cellular homolog FLICE-like inhibitory protein (c-FLIP) in the procedure of benign biliary stricture formation and discuss the significances. Methods The method of in situ hybridization was used in anastomotic tissues from 15 dogs (experimental group) in 2, 3, 4, 5, 6 months after bile duct injury and 15 matching sham operation dogs (sham operation group) for analyzing the expression and localization of c-FLIP and calculating the average integrated optical density of each slice. Stain cells were counted under the magnification field (×400) and at least 5 fields per slice were examined. The cells stained red in the nuclei and (or) the cytoplasm were positive cells. The signals meant: Negative for cells no stained, weak positive for the cells with nuclei and (or) cytoplasm stained pink; b positive for the cells stained the bright red; while middle positive for the cells stained between the both. The image analysis software （Image pro plus 4.5） was applied in the gland tissue and interstitial tissue in each slice to calculate the average integrated optical density for the expression of c-FLIP. Results In the experimental group, there were all b positive expressions of c-FLIP in the interstitial tissue at all the time points, mainly expressed in the cytoplasm of fibroblast and very little or almost no expression in the glandular tissue. Positive expression of c-FLIP in the interstitial tissue was significantly ber than that of gland tissue (Plt;0.05); There were no significant differences among each time point in either the interstitial tissue or gland tissue (Pgt;0.05). In the sham operation group, there were all weak positive expressions of c-FLIP in the interstitial tissue and gland tissue at all the time points and was no significant difference (Pgt;0.05), no difference between each phase (Pgt;0.05). The expression of c-FLIP in the experimental group was significantly higher than that in the sham operation group in the interstitial tissue at all the time (Plt;0.05), while no significant that in the gland tissue (Pgt;0.05). Conclusion After bile duct injury, the expression of c-FLIP in anastomotic interstitial tissue is sustainable, by which the continuing obstruction effect to apoptosis may have a close relationship with the formation of biliary benign stricture.
Objective To summarize the experience of applying biliary balloon dilator to prevent rebleeding after operation for hepatolithiasis combined with hemobilia. Methods From 2003 to 2008, 11 patients were reoperated to stop from hemobilia by biliary balloon dilator’s application after operation for hepatolithiasis combined with hemobilia, and whose clinical data were collected and analyzed. Results In 11 cases, 7 were males and 4 were females. Eight cases were transferred from other hospitals. When intrahepatic duct bleeding was stopped, the biliary balloon dilator was placed at the right site under the guide of choledochoscope. Hemobilia occurred in 4 patients and biliary balloon dilator was opened to compress for 2 h, then decompress for 0.5 h alternately. In all of 4 patients, bleeding was stopped successfully, of which, 1 patient got hemobilia again 5 d after the first bleeding, and was also stopped by the same method. Conclusions After operation on hepatolithiasis combined hemobilia, rebleeding happens in some cases. Preset of biliary balloon dilator at the prebleeding site and opening it when rebleeding happens can get instant hemostasis, which may be a simple and effective treatment choice.
Objective To investigate the expressions of transforming growth factor (TGF) -α and -β1 after 90% portal branch ligation (PBL) in rats. Methods Ninety-six SD rats were randomly divided into sham operation group and portal vein branches ligation group. The weight of both ligated and unligated lobes of liver were measured on 0.5, 1, 3, 5, 7, 14, 21, and 28 d after operation. The morphological changes of the unligated liver lobes were observed by microscope. The expressions of proliferating cell nuclear antigen (PCNA), TGF-α, and TGF-β1 of the unligated liver lobes were detected by immunohistochemistry. Results After the ligation of 90% portal vein branches, hepatic lobe at the ligated side diminished progressively after ligation, whereas the lobes of the unligated side underwent compensatory regeneration. The ratio of unligated lobes weight to the whole liver increased slowly within 1 d, speeded up significantly during 1-5 d period, increased slowly on 5 d, and reached plateau phase on 7 d after operation. The expressions of PCNA protein markedly increased within 0.5-3 d (Plt;0.01), which reached the peak on 5 d and decreased slightly on 7 d after operation, but still higher than sham operation group level, and then gradually returned to the level of sham operation group lately. The expressions of TGF-α and TGF-β1 in the unligated liver lobes markedly increased on 0.5 d, and reached the peak on 3 d and 1 d respectively， and then gradually returned to the level of sham operation group in 7-28 d after operation. Conclusion Ligation of 90% portal branches can induce active regeneration of unligated liver lobes in rats, whose initiation and proliferation are involved in the expressions of TGF-α and TGF-β1 protein.