Li-Sheng Jiang

Effectiveness of chemical biliary duct embolization for chemical hepatectomy.

Background and Aims:  The high recurrence of hepatolithiasis and high operative trauma of hepatectomy necessitate new therapeutic approaches. Thus, this study was designed to (i) investigate the effectiveness of chemical biliary duct embolization (CBDE) for chemical hepatectomy; and (ii) to determine the mechanism of CBDE.

Bronchogenic cyst of the gastric fundus in a young woman

Most bronchogenic cysts (BCs) are found within the medistinum and lung [1]. Extrathoracic and subdiaphragmatic BCs are ery rare, and BCs of the stomach are even more rarely seen. A 25ear-old woman presented to our hospital with a 1-week history f epigastric pain. An upper gastrointestinal radiography revealed a harply demarcatedmass in the gastric fundus (Fig. 1a). An esophaogastroduodenoscopy revealed a 3.0 cm×2.5 cm×2.0 cm smooth ass with normal overlying mucosa in the gastric fundus (Fig. b), and simultaneously provided evidence of antral gastritis (Fig. c). Considering the uncertain diagnosis, computed tomography or ndoscopic ultrasonographywas suggested, but the patient refused ecause of financial issues. Gastrointestinal stromal tumour was onsidered preoperatively. Thus, proximal hemigastrectomy was lanned. At laparotomy, a soft mass, arising from the gastric fundus as felt and yellowmucous fluid gushed out after the correspondng stomach wall was opened. The frozen section analysis of the iopsy specimen indicated a gastric cyst but no malignant cells. ence, a wedge resection of the fundus containing the cyst was erformed. The postoperative course was uneventful and she was ischarged 7 days after surgery. Histological studies of the surgial specimen revealed a cyst lined with pseudostratified ciliated olumnar epithelium and surrounded by smooth muscle (Fig. 2), nd the final diagnosis was of a gastric bronchogenic cyst.

Epidermal Growth Factor Receptor as a Target for Anti-Proliferative Treatment of Proliferative Cholangitis in Hepatolithiasis

BACKGROUND In recent years, with a deeper understanding of pathologic changes in hepatolithiasis, more and more attention has been paid to the relationship of postoperative remnant proliferative cholangitis (PC) with stone recurrence and biliary restenosis, but effective management strategies have not yet been developed. Thus, the aim of this study was to determine whether epidermal growth factor receptor inhibitor (AG-1478) could inhibit hyperplasia and lithogenic potentiality of PC. METHODS The PC animal model was established via retrograde insertion of a 5-0 nylon thread into the common bile duct through Vaters papilla. The common bile duct in the therapeutic group received a single intraluminal administration of AG-1478, followed by weekly intraperitoneal injections of AG-1478. Subsequently, influence of EGFR inhibitor on hyperplasia, apoptosis, and lithogenic potential of PC were evaluated via histology, expression changes of EGFR, BrdU, Ki-67, terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL), Fas, mucin 5 AC, and collagen I. RESULTS EGFR inhibitor AG-1478 was effective not only in inhibiting the mRNA and protein expression of EGFR, BrdU, and Ki-67, but also in increasing Fas mRNA expression and TUNEL-positive cells, as a result leading to the inhibition of hyperplasia of the biliary epithelium, submucosal gland, and collagen fibers in the diseased bile duct. Additionally, collagen I expression and fibrous thickness of the bile duct wall was significantly reduced, thereby reducing the incidence of biliary tract stricture secondary to PC. Also of note, treatment with AG-1478 could efficiently decrease the lithogenic potential of PC via inhibition of mucin 5AC expression and mucoglycoprotein secretion, hereby facilitating prevention of stone recurrence. CONCLUSION EGFR antagonist AG-1478 had a potent anti-proliferative and anti-fibrotic effectiveness on PC and, therefore, holds promise as a candidate of PC treatment.

Infected primary retroperitoneal teratoma presenting as a subhepatic abscess in a postpartum woman

It is highly unusual for a 20-cm retroperitoneal teratoma to present as a subhepatic abscess with septic shock in a postpartum woman. We present a case of a multilocular cystic teratoma densely adherent to adjacent viscera and vessels. Because of the complexity of the case and the clinical condition of the patient, a 2-stage operation was employed for this special case. An initial emergency drainage effectively relieved symptoms of acute infection and facilitated the 2nd-stage resection of the tumor.

Effects of Epidermal Growth Factor Receptor Inhibitor Genistein on Proliferative Cholangitis in Rats

BACKGROUND Many strategies for treating hepatolithiasis neglect the therapy for associated proliferative cholangitis (PC), which is the root cause of residual and recurrent stones and biliary strictures, resulting in an unsatisfactory therapeutic outcome. Epidermal growth factor receptor (EGFR) expression is a dominant component in cell proliferation. The aim of this study was to investigate the effect of EGFR inhibitor genistein on PC in rats. METHODS The rat PC model was established by introducing a nylon thread into the bile duct. Different doses of genistein were administered directly into the bile duct. The effectiveness of genistein on PC was assessed by histology, immunohistochemistry for EGFR, and RT-PCR for EGFR mRNA. RESULTS The proliferation of biliary epithelium, and fibrous tissue, and the hyperplasia of peribiliary gland in PC were indeed suppressed by genistein, and this antiproliferative effect presented a significant dose-response relationship. The structure of biliary tissue in the high-dose group (genistein 6.0mg/kg) had approached that of the normal bile duct. Compared with the PC model, the levels of expression of EGFR mRNA and protein in the genistein-treated groups were reduced gradually with the increase of genistein dosage, and the level of expression of EGFR mRNA and protein in the high-dose group had neared that of the normal bile duct. CONCLUSIONS Direct administration of genistein into the bile duct suppressed PC in a rat model, and may provide a novel strategy towards improving the prognosis of patients with hepatolithiasis.

Clinical application prospects of gastric pacing for treating postoperative gastric motility disorders

Similar to the heartbeat, gastric peristalsis is regulated by an electrical rhythm generated by a pacemaker. Thus, electrical dysrhythmia of gastric slow waves will inevitably affect gastric peristalsis and emptying. The recurrence of postoperative gastroparesis is thereby closely related to the abnormalities of electrical dysrhythmia and ectopic pacemakers, resulting in postoperatively persistent gastric motility disorders in some severe cases, despite the use of prokinetic and antiemetic drugs. Recent studies have demonstrated that gastric pacing, analogous to pacing the human heart, is an attractive and promising therapy that is both feasible and safe. Gastric pacing has been shown to be strikingly effective in normalizing gastric dysrhythmia, increasing the activity of the gastric slow wave and thereby prompting gastric dynamia and emptying. Furthermore, the long‐term utilization of gastric pacing can (i) relieve patients from clinical symptoms, such as nausea and vomiting; (ii) release patients with severe postoperative gastroparesis from relying on prokinetic drugs and the jejunal feeding tube; (iii) return patients to normal oral nutritional intake and provide a more satisfactory nutritional status and most importantly; and (iv) give patients a better quality of life. Overall, research focused on gastric pacing has demonstrated excellent prospects for clinical application in the treatment of postoperative gastroparesis disorders, especially for those unresponsive to prokinetic drugs.

Proliferating cell nuclear antigen shRNA treatment attenuates chronic proliferative cholangitis in rats.

Background and Aim:  Chronic proliferative cholangitis (CPC) is currently considered as a pathological basis and major cause for the high recurrence rate of intrahepatic stones. Since CPC is a form of chronic proliferative disease, this study was designed to preliminarily investigate the inhibitory effect of proliferating cell nuclear antigen (PCNA) shRNA on the hyperplastic behavior and lithogenic potentiality of CPC.