One of the most prominent characteristics of hepatic ischemia-reperfusion injury (HI/R) is an intense inflammatory reaction, which plays a key role in inflammatory injury induced by ischemia-reperfusion. Nucleotide-binding oligomerization domain-containing protein (NOD-), leucine-rich repeat (LRR), and pyrin domains-containing protein 3 (NLRP3) are involved in the inflammatory injury of ischemia-reperfusion as an important pattern recognition receptor for innate immunity. G protein-coupled receptor 30 (GPR30) is a newly identified as 7-transmembrane G protein-coupled receptor and can be activated by many stimulations including estrogen. The current study aims to explore whether GPR30 agonist (G1) can alleviate hepatic ischemia-reperfusion injury HI/R by inhibiting NLRP3. An induced HI/R rat model was generated, blood and liver samples were gathered and subjected to histological examination, biochemical assays, Western blot assays, and qRT-PCR. Our results indicated GPR30 agonist (G1) pretreatment or NLRP3 silencing significantly decreased the serum levels of Interleukin 1 beta (IL-1 beta), alanine aminotransferase (ALT) and aspartate aminotransferase, improved histological alterations and hepatocyte apoptosis. Moreover, G1 pretreatment or NLRP3 silencing downregulated the protein level of Caspase-1 and pro-Interleukin 1 beta (pro-IL-1 beta) while G1 pretreatment upregulated the expression of GPR30 (p < 0.05). In conclusion, the salutary effects of GPR30 agonists on HI/R are mediated at least in part through downregulating NLRP3 expression. GPR30 may be used as a therapy target of HI/R.

Hepatocellular carcinoma (HCC), the most common aggressive malignancy of liver, is the third leading cause of cancer death across the world. Laminin gamma 1 (Lamc1), encodes laminin-γ1, an extracellular matrix protein involved in various progresses such as tumor cell proliferation and metabolism. In the present study, high expression of Lamc1 and PKM2 was observed in tumor tissues of HCC patients. In vitro, down-regulation of Lamc1 inhibited proliferation of HCC cells by promoting cell death, reduced glucose consumption and lactate production, accompanied by a decrease in the expression of glucose transporter 1 (GLUT1) and lactate dehydrogenase A (LDHA), and PTEN increased, as well as PTEN S380 and AKT S473/T308 phosphorylation decreased, while Lamc1 up-regulation had the opposite effect. The effects of PKM2 were similar to that of Lamc1 and markedly counteracted the effects of Lamc1 down-regulation. In addition, Lamc1-induced increase in PKM2 expression was strongly attenuated by a PI3K inhibitor, LY294002 or a si-p110 PI3K, with a significant decrease in GLUT1 and LDHA expression, as well as decreased AKT T308 phosphorylation. Thus, we speculated that Lamc1 was implicated in the progression of HCC probably by regulating PKM2 expression through PTEN/AKT pathway.

Objective To compare the clinical efficacy of laparoscopic choledochoscope combined with U100plus laser and ERCP in the treatment of incarcerated stones of the lower common bile duct. Methods The clinical data of 54 patients with incarcerated stones of the lower common bile duct admitted to our hospital from Jan. 2014 to Dec. 2017 were retrospectively analyzed. The patients were divided into laparoscopic choledochoscope combined with U100plus laser lithotripsy group,ERCP group.Success rate of stone extraction,rate of complications and recurrence rate of stone were compared among the 2 groups. Results The difference in the success rate of stone extraction and rate of complications between the two groups was statistically significant(P<0.05).There was no significant difference in the recurrence rate of stone between the two groups(P>0.05). Conclusion Laparoscopic choledochoscope combined with U100plus laser lithotripsy in the treatment of incarcerated stones of the lower common bile duct is safe and effective. Laparoscopic choledochoscope combined with U100plus laser lithotripsy has higher success rate and fewer complications than ERCP in the treatment of incarcerated stones of the lower common bile duct.

目的 探讨术中经胆囊管胆道镜胆管探查、取石的临床价值.方法 2014-01—2018-04间,睢县人民医院共成功实施38例经胆囊管胆道镜胆管探查、取石手术,其中开腹手术26例、腹腔镜手术12例.回顾性分析患者的临床资料.结果 38例患者均成功实施手术.开腹手术时间(98.50±12.78)min,术后住院时间(7.22±1.46)d.腹腔镜手术时间(118.46±10.66)min,术后住院时间(5.48±0.24)d.均未放置T管,术中胆道镜探查及出院时彩超扫查,均未见结石遗留.腹腔镜手术后发生1例胆漏,经充分引流,4天后痊愈.术后均随访8～12个月,未发现胆道遗留结石.结论 在严格掌握适应证的前提下,经胆囊管胆道镜胆管探查、取石是安全、可行的.

目的 探讨应用腹腔镜治疗结石相关性肝内胆管细胞癌的可行性和治疗效果.方法 收集笔者医院2013年1月～2017年12月经筛选符合纳入标准的60例患者资料,30例行腹腔镜肝切除术(腹腔镜组),30例采用开腹肝切除术(开腹组);两组患者的手术方式包括左半肝切除术、肝门部区域淋巴结清扫术、胆囊切除、胆总管切开取石、胆管镜检查取石、胆管镜下激光碎石、T管引流术等,分析和对比两组手术时间、术中出血量、术中并发症、术后疼痛、术后镇痛药物应用、术后住院时间、术后切口美容效果、下床活动时间、恢复饮食时间、术后并发症、结石清除率以及肿瘤复发率等指标.结果 腹腔镜组手术时间长于开腹组(P＜0.01),其术后住院时间、术中出血量与开腹组比较,差异有统计学意义(P＜0.01),其术后止痛药使用率、术后切口美容效果、术后切口疼痛及术后并发症的发生率与开腹组比较,差异有统计学意义(P＜0.01),比开腹组更早地恢复下床活动和进食(P＜0.01),两组结石清除率及术后半年肿瘤复发率比较,差异无统计学意义(P＞0.05),且均无围术期死亡病例.结论 对于符合入选标准的病例,腹腔镜手术是安全可行的,可以达到与开腹手术同样的效果,它具有切口小、痛苦轻、恢复快、并发症少等微创手术的优势.

目的 比较平片无张力疝修补术(Lichtenstein)与腹腔镜经腹腹膜前疝修补术(TAPP)治疗成人腹股沟斜疝(斜疝)的效果.方法 选取2016年1月-2019年1月间在睢县人民医院接受手术的116例成人斜疝患者为观察对象.116例斜疝患者分为2组,平片组(对照组)和腔镜组各58例.平片组58例行Lichtenstein术,腔镜组58例行TAPP.结果 本组116例患者均为男性单侧易复性斜疝.(1)腔镜组手术时间(40.8±9.2) min,平片组手术时间(65.4±9.6)min;两组比较差异有统计学意义(P＜0.05).术后第1天视觉模拟疼痛(VAS)评分:腔镜组(3.2±0.6)分、对照组(7.2±1.4)分;下床活动时间:腔镜组(14.5±3.5)小时、对照组(24.4±3.3)小时;住院时间:腔镜组(3.4±1.3)天、对照组(6.4±1.2)天;两组比较腔镜组均少于对照组,差异均有统计学意义(P＜0.05).(2)腔镜组术后24h的超敏C反应蛋白(Hs-CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)和降钙素原(PCT)水平均较术前升高,差异有统计学意义(P＜0.05);但组间差异无统计学意义(P＞0.05).(3)术后随访6个月,均未发生术区感染、阴囊水(血)肿及排异反应等并发症.末次随访,均未见斜疝复发,差异无统计学意义(P＞0.05).结论 与Lichtenstein比较,TAPP具有手术时间短、术后疼痛轻、患者恢复快等优势;但对应激反应指标的影响差异无统计学意义.

目的 比较左肝外叶切除与胆总管探查、取石术治疗左肝内胆管结石的效果.方法 选取2014-01—2018-06间睢县人民医院收治的36左肝内胆管结石患者,依据不同术式分为2组.观察组17例实施肝左外叶切除术,对照组19例行胆总管探查、取石术.2组术中均采取胆道镜取石并在胆总管放置T管.回顾性分析其临床资料.结果 观察组近期优良率、术后残石率、胆道感染率和再手术率均优于对照组,差异有统计学意义(P<0.05).对照组手术时间、术中出血量和输血量均少于观察组,差异有统计学意义(P<0.05).结论 肝左外叶切除联合胆道镜治疗左肝内胆管结石,并发症少、残石率及复发率低,疗效肯定.但手术时间、术中出血量和输血量均较胆总管探查、取石术多,需进一步提高手术技巧和熟练程度.

Objective To investigate the effect of laparoscopic cholecystectomy(LC)combined with percutaneous transhepatic gallbladder puncture(PTGD)on acute cholecystitis with surgical contraindications and postoperative concurrent effects. Methods Using retrospective analysis, 168 patients with acute cholecystitis with severe heart/lung/renal dysfunction who were diagnosed and treated in our hospital from April 2014 to April 2017 were studied and divided into single LC according to different treatment methods. The time of operation,the amount of blood loss,and the number of intraoperative conversion to open surgery postoperative visual analogue pain(VAS)score,first postoperative anal ejection time,and hospitalization time body temperature,white blood cell count,changes in serum alkaline phosphatase,total bilirubin,and incidence of postoperative complications before and 72 hours after surgery of single LC group(emergency LC surgery) and combination group(PTGD combined with LC)were observed. Results The operation time and the laparotomy rate were higher in the combined group than in the single LC group,but the VAS score, first postoperative anal venting time,and postoperative LC hospital stay were all lower or earlier than the single LC group. The body temperature,white blood cell count,serum alkaline phosphatase and total bilirubin improvement were better than single LC group,and the incidence of postoperative complications and mortality rate were lower than that of single LC group. The above differences were statistically significant(P<0.05). Conclusion For patients with acute cholecystitis with severe heart/lung/renal function cancer,PTGD combined with LC has higher safety and clinical efficacy,and is more conducive to the recovery of postoperative patients.

Objective To explore the application value of anterior approach hepatectomy in primary hepatic carcinoma. Methods 112 patients with primary hepatocellular carcinoma treated in our hospital from October 2016 to October 2017 were analyzed retrospectively. According to the different operation methods,they were divided into control group(56 cases with traditional approach)and research group(56 cases with former into the road). The differences between the two groups of preoperative,intraoperative and postoperative indicators were compared. Results Child-Pugh, class B and C,the tumor>10cm in diameter,and the percentage of multiple tumors of research group were lower than control group(P<0.05). In the research group,the amount of blood loss,plasma volume,red blood cell volume,operation time and hospitalization time were significantly lower than those in the control group,and the difference was statistically significant(P<0.05). The incidence of postoperative complications and operative mortality were compared between the two groups,and the control group was higher than the research group,with significant difference(P<0.05). Conclusion Compared with the traditional approach of liver resection,into the road before liver resection is suitable for the multiple tumors,large size,liver function of patients with primary liver cancer,has a positive value for clinical reference and popularization.

目的 探讨晚期原发性肝癌患者应用肝动脉化疗栓塞术联合深部热疗治疗的临床效果.方法 将2015年10月～2017年10月来我院接受治疗的82例晚期原发性肝癌患者选为观察对象,依照随机数字表法分为对照组(n=41)和试验组(n=41).对照组患者给予肝动脉化疗栓塞术治疗,试验组患者在对照组基础上给予深部热疗治疗,对两组患者临床疗效、甲胎蛋白(AFP)水平、Kamofsky(KPS)评分及不良反应发生率进行统计比较.结果 试验组患者临床总有效率明显高于对照组,分别为70.7％、41.5％,差异有统计学意义(P＜0.05).两组患者治疗后AFP水平明显降低,与治疗前相比,差异有统计学意义(P＜0.05),且试验组患者明显低于对照组,差异有统计学意义(P＜0.05).两组患者治疗后KPS评分明显升高,与治疗前相比,差异有统计学意义(P＜0.05),且试验组患者明显高于对照组,差异有统计学意义(P＜0.05).两组患者胃肠道反应、肝功能损害、发热、白细胞下降发生率比较,差异无统计学意义(P＞0.05).结论 晚期原发性肝癌患者应用肝动脉化疗栓塞术联合深部热疗治疗的临床效果更加确切,不仅可以缩小肿瘤,还可以提高生活质量,是一种值得临床推广与应用的治疗方案.

目的 研究并探讨手术治疗肝细胞性肝癌的临床疗效,并分析影响肝细胞性肝癌疗效的危险因素,为完善肝细胞性肝癌手术治疗提供参考依据.方法 入组对象选择2013年1月～2017年9月期间在我院接受手术治疗且完成3年术后随访的200例肝细胞性肝癌患者,对其手术疗效进行评估.根据200例肝细胞性肝癌患者随访3年存活情况,将其分为存活组、死亡组,比较两组临床资料,对影响肝细胞性肝癌手术预后的危险因素进行单因素分析、多因素Logistic线性回归分析.结果 200例肝细胞性肝癌患者经手术治疗后,其短期客观缓解率为63.50％,术后均未发生并发症,其复发率为24.50％,3年存活率、死亡率分别为79.00％、21.00％.单因素分析中,两组在肿瘤直径、肿瘤分化程度、肿瘤间质细胞比、血管侵犯、术前甲胎蛋白水平等方面比较差异均有统计学意义(P＜0.05),而经多因素Logistic线性回归分析后发现,肿瘤直径≥5 cm、肿瘤分化程度低、肿瘤间质细胞比＜50％、血管侵犯、术前甲胎蛋白水平≥＞400 ng/mL是影响肝细胞性肝癌患者手术预后的危险因素.结论 肝细胞性肝癌患者手术治疗后的预后受到肿瘤直径、肿瘤分化程度、肿瘤间质细胞比、血管侵犯、术前甲胎蛋白水平的影响,临床上需针对相关危险因素合理调整手术方案.

目的 探讨miR-122调控LAMC1表达与肝癌细胞迁移侵袭相关性研究.方法 选取人正常肝细胞株LO2、肝癌细胞株HepG2和高转移能力肝癌细胞株SMMC-7721,构建miR-122 mimics稳定表达载体并对其进行转染,Real-Time PCR检测各组细胞株内microRNA-122含量;CCK-8法检测细胞存活率,流式细胞仪检测细胞凋亡;划痕实验检测肝癌细胞迁移侵袭能力;生物信息学预测、荧光报告载体实验Real-Time PCR检测层粘连蛋白γ1 (Recombinant laminin gamma 1,LAMC1)mRNA水平变化.结果 与对照组人正常肝细胞株LO2相比,miR-122过表达后,肝癌细胞株HepG2和高转移能力肝癌细胞株SMMC-7721细胞存活率显著降低,细胞凋亡率显著升高,LAMC 1 mRNA含量显著降低,肝癌细胞株HepG2和高转移能力肝癌细胞株SMMC-7721细胞侵袭和迁移能力显著下降,差异有统计学意义(P＜0.05).结论 上调miR-122表达可通过调控LAMC1表达抑制肝癌细胞的增殖、迁移和侵袭.

Objective To explore this effects of WWP2 interference on proliferation,apoptosis and cell cycle of hepatocellular carcinoma cell Huh7.Methods We used the experimental techniques of real-time quantitative PCR (qPCR),RNA interference and flow cytometry to investigate the role of WWP2 in the cell cycle of hepatocellular carcinoma (Huh7).Results WWP2 mRNA levels expressed significantly in hepatocellular carcinoma (HCC).Knock except cells of WWP2 will inhibited cell proliferation,the cell arrest in the G1 phase,and induce cell apptosis.Conclusion WWP2 may promote the growth of hepatocellular carcinoma cells through the regulation of apoptosis in vitro.

目的 比较不同时期使用生长抑素预防内镜逆行胆胰管造影术(ERCP)术后胰腺炎及高淀粉酶血症(PEHA)的差异.方法 选取180例胆胰疾病患者,将其按照随机数字法随机分为A、B、C三组,每组60例,A组于术前6 h持续微量泵入生长抑素3 mg,共6 h,B组于术后12 h持续微量泵入生长抑素3 mg,共12 h,C组为术前6 h持续微量泵入生长抑素3 mg,加术后12 h再持续微量泵入生长抑素3 mg,共18 h.观察各组术后24 h的血清淀粉酶水平,并评估患者ERCP术后胰腺炎和PEHA的发生率.结果 三组术后24 h淀粉酶水平、ERCP术后胰腺炎及PEHA发生率比较,差异均有统计学意义(F=33.45,χ2分别=6.76、8.87,P均<0.05),其中C组淀粉酶水平、术后胰腺炎和PEHA发生率明显低于A、B两组,差异均有统计学意义(t分别=32.02、31.80,χ2分别=6.98、4.82、8.02、6.98,P均<0.05),A、B两组淀粉酶水平、术后胰腺炎及PEHA发生率比较,差异均无统计学意义(t=1.41,χ2分别=0.29、0.04,P均>0.05).结论 ERCP术前6 h加术后12 h持续用药降低ERCP术后胰腺炎及PEHA效果最佳.

Objective To explore the clinical application of scar-hidden laparoscopic cholecystectomy.MethodsThirty-five patients with benign gallbladder disease were enrolled in this study. An incision of 10 mm was made in umbilicus for operative instruments. Another incision of 5 mm was made in the right lower abdomen in pubic hair or female striae gravidarum for 5 mm laparoscope. Another incision of 3 mm was made in the junction of the right midclavicular line and the costal margin for a grasper assisted pulling gall bladder. Dissecting the calot's triangle,clipped and cut the cystic duct and vessels,followed by dissecting gallbladder bed using an electric hook. Finally,after the gallbladder was removed out through the umbilicus,the incision in the umbilicus was closed with intradermal suturing,while the incisions in under costal margin and lower abdominal were just pulled together by adhesive plaster without suturing.ResultsAll the operations were successfully performed. Mean operative time was 45 min(35-55 min). No postoperative complications occurred. The postoperative hospital stay was 1-3 d. All patients were very satisfactory with the cosmetic results after 1-3 monthsfollow-up for scars were invisible.ConclusionScar-hidden laparoscopic cholecystectomy has the advantage of good cosmetic results,safe and feasible.

目的：探讨重组人酸性成纤维细胞生长因子（rh‐aFGF）对糖尿病患者肝内外胆管结石术后切口感染愈合过程的影响。方法：选取2010年7月－2015年12月在本院住院治疗的糖尿病及非糖尿病肝内外胆管结石术后切口感染患者120例，随机分为糖尿病患者常规治疗组（A组）30例和糖尿病患者rh‐aFGF治疗组（B组）30例，非糖尿病患者常规治疗组（C组）30例，非糖尿病患者rh‐aFGF治疗组（D组）30例；记录四组创面愈合时间，计算四组在不同时间段创面愈合率。结果：B、D组创面愈合时间较A、C组明显缩短（P＜0．001）；C组创面愈合时间明显短于A组（P＜0．05）；B、D组创面愈合时间相当（P＞0．05）；B、D组在治疗后7d、11d、14d、17d、21d的创面愈合率较A、C组高（P＜0．001）；C组创面愈合率高于A组（P＜0．05）；B、D组创面愈合率相当（P＞0．05）。结论：rh‐aFGF可促进糖尿病患者肝内外胆管结石术后切口感染创面愈合。

目的:NPRL2在肝细胞癌大小相关性.方法:收集本院手术切除的HCC组织标本56例,按肝癌大小分组:甲组≤2cm,乙组>2cm≤5cm,丙组>5cm,采用荧光定量PCR法检测NPRL2蛋白和mRNA的表达情况.结果:肝癌组织中NPRL2蛋白和NPRL2 mRNA的表达在丙组最高.结论:在肝癌中NPRL2 mRNA和蛋白水平较与肿瘤大小成正相关.

Primary liver cancer is one of the most common and aggressive human malignancies worldwide. As numerous studies have revealed that WW domain containing E3 Ub‑protein ligase 2 (WWP2) exerts cancer‑specific functions, the present study assessed the role of WWP2 in liver cancer. WWP2 was revealed to be significantly overexpressed in liver cancer tissues compared with paired normal tissues at the mRNA as well as at the protein level. Furthermore, small interfering RNA-mediated WWP2 knockdown in liver cancer cell lines was demonstrated to inhibit cell proliferation, cause cell cycle arrested in G1 phase and to induce apoptosis as revealed by a Cell Counting Kit-8 assay and flow cytometric analysis. In addition, western blot analysis revealed that WWP2 knockdown significantly increased the expression of apoptosis-associated markers caspase‑7, caspase‑8 and B-cell lymphoma 2 (Bcl-2)-associated X in liver cancer cell lines, while Bcl‑2 was significantly decreased. In conclusion, the present study suggested that WWP2 may exert important functions in the over‑proliferation and evasion of apoptosis of liver cancer, likely through regulating the expression of apoptosis-associated markers. Furthermore, WWP2 may represent a novel diagnostic marker and molecular therapeutic target for liver cancer.

The aim of the present study is to investigate the effect and mechanism of recombinant human acidic fibroblast growth factor (rhaFGF) on skin wound healing of diabetic rats. SD rats were randomly divided into three groups: control, diabetes and rhaFGF groups. Skin wound tissues of rats in the three groups were respectively arranged on days 3 and 7 after establishment of skin wound of diabetic rats. Immunohistochemistry analyses were performed to evaluate the effect of rhaFGF on expression levels of PCNA and CD34 in diabetic rats. Real-time PCR and Western blot assays were used to examine the expression levels of Bcl-2, Bax, TGF-beta, CXCL-1, CXCL-2, p-ERK1/2 and p-STAT3 in wound tissues. The results showed that rhaFGF could significantly increased expression levels of PCNA, CD34, TGF-beta, CXCL-1, CXCL-2, p-ERK1/2, p-STAT3 and the ratio of Bcl-2/Bax in wound tissues. The preliminary mechanism that rhaFGF accelerates wound healing of diabetic rats is possibly associated with the promotion of fibroblasts proliferation and angiogenesis through ERK1/2 and STAT3 pathways.

BACKGROUND:The aim of this study was to compare laparoscopic vs. laparotomic surgery for the treatment of hypersplenism with gallstones.METHODS:Forty patients were treated with splenectomy and cholecystectomy using either totally laparoscopic surgery (laparoscopic group) or laparotomy (laparotomy group). The outcomes were duration of the surgery, intraoperative bleeding volume, postoperative complications, and number of postoperative hospitalization days.RESULTS:There was no difference in the duration of the surgery between both groups. No patient experienced intraoperative complications. There were postoperative pleural effusions (N.=3) and bleeding at the puncture site (N.=1) in laparoscopic group, and postoperative pleural effusions (N.=2), incision infection (N.=2) and peritoneal effusion (N.=1) in laparotomy group. The length of postoperative hospitalization was markedly shorter in laparoscopic group. The follow-up for 3 to 15 months after the surgery demonstrated that hypersplenism was corrected in all patients. All blood markers (white blood cells, platelets, and hemoglobin) recovered to normal levels. The portal vein thrombosis occurred in 6 patients of laparoscopic group and 5 patients of laparotomy group; this was controlled by oral administration of Warfarin and enteric coated Aspirin capsules.CONCLUSIONS:Treatment efficacy is comparable between laparoscopic surgery and traditional laparotomy. Laparoscopic surgery is more advantageous because of smaller trauma, faster postoperative recovery, and minimal invasiveness.