BACKGROUND AND AIMS:The secretion of bile salts transported by the bile salt export pump (BSEP) is the primary driving force for the generation of bile flow; thus, it is closely related to the formation of cholesterol stones. Caveolin-1 (Cav-1), an essential player in cell signalling and endocytosis, is known to co-localize with cholesterol-rich membrane domains. This study illustrates the role of Cav-1 and BSEP in cholesterol stone formation. METHODS:Adult male C57BL/6 mice were used as an animal model. HepG2 cells were cultured under different cholesterol concentrations and BSEP, Cav-1, p-PKCα and Hax-1 expression levels were determined via Western blotting. Expression levels of BSEP and Cav-1 mRNA were detected using real-time PCR. Immunofluorescence and immunoprecipitation assays were performed to study BSEP and Hax-1 distribution. Finally, an ATPase activity assay was performed to detect BSEP transport activity under different cholesterol concentrations in cells. RESULTS:Under low-concentration stimulation with cholesterol, Cav-1 and BSEP protein and mRNA expression levels significantly increased, PKCα phosphorylation significantly decreased, BSEP binding capacity to Hax-1 weakened, and BSEP function increased. Under high-concentration stimulation with cholesterol, Cav-1 and BSEP protein and mRNA expression levels decreased, PKCα phosphorylation increased, BSEP binding capacity to Hax-1 rose, and BSEP function decreased. CONCLUSION:Cav-1 regulates the bile salt export pump on the canalicular membrane of hepatocytes via PKCα-associated signalling under cholesterol stimulation.

Objective:To explore the safety and efficacy of laparoscopic transcystic common bile duct exploration (LTCBDE) for severe choledochal obstruction in infants aged under 3 months.Methods:Clinical data, surgical approaches and postoperative care were reviewed for two young boys aged under 3 months with cholelithiasis plus severe common bile duct obstruction from December 2018 to March 2020. There were jaundice, bile-free stool and abnormal liver function. Ultrasound and magnetic resonance cholangiopancreatography (MRCP) indicated choledocholithiasis with terminal obstruction of common bile duct and bile duct dilatation. Conservative treatment failed. Operative age was 67 and 86 days and operative weight 3. 33 and 4. 65 kg respectively. LTCBDE was performed under general anesthesia. Postoperative biliary tract irrigation was performed by indwelling drainage tube and oral ursodeoxycholic, liver function, ultrasonography and cholangiography examined.Results:Both cases were successfully operated. Choledocholithiasis was cleared without a conversion into open surgery. Without intraoperative complications, postoperative regression was satisfactory. Direct bilirubin normalized and drainage tube slipped off at Week 2 post-operation. Another case reverted to normal direct bilirubin at Week 8 post-operation and biliary drainage tube was removed at Week 10 post-operation. During follow-ups, there was no recurrent choledocholithiasis, dilatation of common bile duct or obstruction at distal common bile duct.Conclusion:For cholelithiasis in very young infants with complete obstruction of common bile duct, individualized treatment should be adopted according to specific patient situation. LTCBD is both safe and feasible for infants aged under 3 months.

BackgroundAccessory breast cancer is extremely rare, especially in male patients, and only a few cases have been reported in the literature. To date, no specific guidelines regarding its diagnosis and treatment are available.ObjectivesThis study aimed to investigate the guidelines for the diagnosis and treatment of male accessory breast cancer by reviewing the available literature on this disease.MethodsThe Web of Science, Cochrane, PubMed, and CNKI databases were systematically searched (last search: 30 November 2020) to identify studies on male axillary accessory breast cancer. The following data were extracted: author names, number of patients, country, patient age, tumor location, tumor size, pathologic diagnosis, and treatment.ResultsThere were 16 studies included (6 in Chinese and 10 in English), corresponding to 16 cases of male axillary accessory breast cancer. Primary surgical resection is currently the main procedure, followed by comprehensive treatment including chemotherapy, radiotherapy, and endocrine therapy. Patient age ranged from 51–87 years, and the average age was 67.1 years. The main clinical features of the patients were pain, the portion of the skin covering the mass was either reddish or purplish, and the mass could show swelling and erosion on the surface, with purulent exudate.ConclusionsOnce male accessory breast cancer is diagnosed, we can follow the latest guidelines for the diagnosis and treatment of breast cancer. Tumor biopsy and resection seems the treatment of first choice, combined with comprehensive treatment including chemotherapy, radiotherapy, and endocrine therapy.