BACKGROUND:Gallbladder cancer (GBC) remains a serious cause of cancer-related mortality across the globe. E2F5 has been identified to as a known oncogene in various cancers. However, the special functions of E2F5 have not been investigated in GBC.AIMS:To explore the regulatory functions of E2F5 and its related molecular regulatory mechanism in GBC progression.METHODS:The expression of genes were examined through qRT-PCR, western blot and IHC assay. The cell proliferation was assessed through CCK-8 and EDU assays. The cytotoxicity was tested through LDH assay. The percentage of CD8+ T cells and cell apoptosis were evaluated through flow cytometry. The binding ability was detected through luciferase reporter assay. The tumor growth was assessed through in vivo assays.RESULTS:In this study, it was demonstrated that E2F5 expression was evaluated in GBC, and resulted into poor prognosis. Bioinformatics analysis revealed E2F5 as a target for let-7d-5p, which when overexpressed, suppressed the metastasis and proliferation of GBC through the downregulation of E2F5. It was discovered that E2F5 activates JAK2/STAT3 signaling which is suppressed by let-7d-5p, implicating this pathway as one of the effectors of the oncogenic effects of ESF5 in GBC. E2F5 had been confirmed to aggravate tumor growth in vivo.CONCLUSION:E2F5 targeted by let-7d-5p facilitated cell proliferation, metastasis and immune escape in GBC through the JAK2/STAT3 pathway.

Background:The family of coiled-coil domain-containing (CCDC) proteins participates in a wide range of physiological functions and plays a pivotal role in governing the invasion and metastasis of malignant tumor cells. Nonetheless, the precise mechanism governing the interaction among the immune microenvironment, hypoxia pathway, and proliferation in hepatocellular carcinoma (HCC) remains elusive. In this study, our objective was to identify the prognostic significance of CCDC family genes in HCC.Methods:We conducted an analysis of RNA-seq data from HCC patients sourced from The Cancer Genome Atlas (TCGA) database. Our analysis involved comparing the expression profiles of 168 CCDC family genes between tumor and normal tissues to identify differentially expressed genes (DEGs). The prognostic value of these genes was verified using overall survival (OS) data from TCGA-LIHC patients, employing Univariate and multivariate Cox proportional hazards regression models and Kaplan-Meier plots. Subsequently, we constructed a prognostic signature known as the CCDC score and validated it using additional datasets (ICGC-LIRI-JP and GSE14520). Additionally, we performed functional enrichment analysis and conducted an assessment of the tumor immune microenvironment (TIME).Results:We identified 34 DEGs of the CCDC family. Among them, six DEGs (CCDC6/22/51/59/132/134) were upregulated and associated with poor prognosis. Higher CCDC score was an independent predictor of poor OS in TCGA-HCC patients (P<0.001, HR =2.37), which was validated in the ICGC-LIRI-JP (P=0.021, HR =2.15) and GSE14520 (P=0.002, HR =2.23) datasets. Functional enrichment analysis showed that hypoxia pathway genes were enriched in the high CCDC score group. Furthermore, immune microenvironment analysis demonstrated that high CCDC score was associated with a suppressed TIME caused by the extrinsic immune escape.Conclusions:The CCDC score, derived from six CCDC genes, exhibits remarkable expression levels in liver cancer and holds promise as an independent prognostic indicator. Our bioinformatics analysis revealed a high CCDC score is strongly associated with activation of the hypoxia pathway and an immunosuppressive tumor microenvironment in HCC. This profound finding may serve as a cornerstone for innovative targeted drug therapies and pave the way for further investigations into the underlying mechanisms of CCDC-related carcinogenesis in liver cancer.

Background Delayed gastric emptying (DGE) is one of the most common complications after pancreaticoduodenectomy (PD). There is currently no widely accepted procedure for PD to reduce the incidence of DGE. Our institution attempts to perform subtotal gastrectomy in patients undergoing PD to reduce DGE. Here we aimed to evaluate the effectiveness and safety of PD with subtotal gastric resection. Methods Patients who underwent PD between January 2014 and December 2021 were reviewed. They were stratified by extent of gastrectomy into a conventional PD group (PD that resected approximately 1/3 of the distal stomach) and a subtotal gastrectomy PD group (PD that resected approximately 3/4 of the distal stomach), which were compared in terms of intraoperative and postoperative parameters. Result From January 2014 to December 2021, a total of 512 patients underwent PD in the Department of Hepatobiliary Surgery, Peking University People’s Hospital. Nineteen patients were excluded from this study due to benign disease. A total of 493 patients were included, with 378 in the conventional PD group and 115 in the subtotal gastrectomy PD group. Compared with the conventional PD group, the subtotal gastrectomy PD group had a lower incidence of DGE (8.7% vs. 17.7%, p = 0.019), and a shorter hospital stay. Multivariate analysis showed that conventional PD and higher body mass index were independent risk factors for grade B/C DGE. Conclusion This study showed that, compared with conventional PD, subtotal gastrectomy PD can reduce the incidence of DGE and shorten the length of hospital stay. At the same time, subtotal gastrectomy PD is comparable to conventional PD in terms of surgical safety. Furthermore, high BMI is an independent risk factor for postoperative DGE.

Background: Tumor stemness is the stem-like phenotype of cancer cells, as a hallmark for multiple processes in the development of hepatocellular carcinoma (HCC). However, comprehensive functions of the regulators of tumor cell’s stemness in HCC remain unclear.Methods: Gene expression data and clinical information of HCC samples were downloaded from The Cancer Genome Atlas (TCGA) dataset as the training set, and three validation datasets were derived from Gene Expression Omnibus (GEO) and International Cancer Genome Consortium (ICGC). Patients were dichotomized according to median mRNA expression–based stemness index (mRNAsi) scores, and differentially expressed genes were further screened out. Functional enrichment analysis of these DEGs was performed to identify candidate extracellular matrix (ECM)–related genes in key pathways. A prognostic signature was constructed by applying least absolute shrinkage and selection operator (LASSO) to the candidate ECM genes. The Kaplan–Meier curve and receiver operating characteristic (ROC) curve were used to evaluate the prognostic value of the signature. Correlations between signatures and genomic profiles, tumor immune microenvironment, and treatment response were also explored using multiple bioinformatic methods.Results: A prognostic prediction signature was established based on 10 ECM genes, including TRAPPC4, RSU1, ILK, LAMA1, LAMB1, FLNC, ITGAV, AGRN, ARHGEF6, and LIMS2, which could effectively distinguish patients with different outcomes in the training and validation sets, showing a good prognostic prediction ability. Across different clinicopathological parameter stratifications, the ECMs signature still retains its robust efficacy in discriminating patient with different outcomes. Based on the risk score, vascular invasion, α-fetoprotein (AFP), T stage, and N stage, we further constructed a nomogram (C-index = 0.70; AUCs at 1-, 3-, and 5-year survival = 0.71, 0.75, and 0.78), which is more practical for clinical prognostic risk stratification. The infiltration abundance of macrophages M0, mast cells, and Treg cells was significantly higher in the high-risk group, which also had upregulated levels of immune checkpoints PD-1 and CTLA-4. More importantly, the ECMs signature was able to distinguish patients with superior responses to immunotherapy, transarterial chemoembolization, and sorafenib.Conclusion: In this study, we constructed an ECM signature, which is an independent prognostic biomarker for HCC patients and has a potential guiding role in treatment selection.

BACKGROUND:Due to the large number of operations, surgeons sometimes need to work overtime or even stay up late to perform pancreaticoduodenectomy. Fatigue and sleep deprivation can result in an increased error rate at work. There have been numerous studies about the effect of overtime surgery on the prognosis of patients. However, the effect of overtime work for pancreaticoduodenectomy on the prognosis of patients is unclear. This study explores the impact of overtime work for pancreaticoduodenectomy on the prognosis of patients.AIM:To explore the impact of overtime work for pancreaticoduodenectomy on the short-term prognosis of patients.METHODS:This was a single-center, retrospective cohort study. The patients who underwent pancreaticoduodenectomy between January 2017 and December 2019 were included. Patients were stratified by operative start time into the control group (surgery that started between 8:00 and 16:49) and the overtime group (surgery that started between 17:00 and 22:00) and compared intraoperative and postoperative parameters. The following parameters were compared between the overtime group and the control group: Operative time, blood loss, number of lymph nodes removed, duration of treatment in the Intensive Care Unit (ICU), and incidence of complications.RESULTS:From January 2017 to December 2019, a total of 239 patients underwent pancreaticoduodenectomy in the Department of Hepatobiliary Surgery of our institution. Four patients were excluded from this study due to lack of clinical data. A total of 235 patients were included, with 177 in the control group and 58 in the overtime group. There was no difference between the two groups in operative time, blood loss, number of lymph nodes removed, ICU length of stay, hospital length of stay, mortality during hospitalization. Compared with the control group, the overtime group had a higher incidence of pancreatic fistula (32.8% vs 15.8%, P < 0.05). Multivariate analysis showed that overtime work, higher Body Mass Index were independent risk factors for pancreatic fistula (P < 0.05).CONCLUSION:Overtime work for pancreaticoduodenectomy increases the incidence of pancreatic fistula. The effect of overtime surgery on the long-term prognosis of patients' needs to be further studied.

Objective:To explore the clinical efficacy of radical surgery after successful conversion therapy for liver cancer.Methods:We retrospectively analyzed the clinical data of 10 patients with liver cancer who underwent successful conversion therapy and subsequent radical surgery in Peking University People's Hospital from Nov 2019 to Dec 2021.Results:The median age of the 10 patients was 64 (51.25,68.50) years. The median number of conversion therapy cycles was 11 (4.75,25.00). No serious adverse reactions were found in the patients during conversion therapy. After conversion therapy, 8 patients underwent partial hepatectomy, and 2 patients underwent radiofrequency ablation. Postoperative complications occurred in 4 patients. All complications were classified as Clavien-Dindo grade Ⅰ or Ⅱ. The median follow-up time was 13 (9.75,49.75) weeks. Three patients had tumor recurrence after surgery. Among the patients with tumor recurrence, 1 patient died of liver failure.Conclusions:Conversion therapy is an effective treatment for patients with clinically unresectable liver cancer. The incidence of serious adverse reactions in conversion therapy for liver cancer is low. The radical surgery can be safely performed in patients with good general condition and liver function. Radical surgery after conversion therapy can prolong the survival time of patients for unresectable liver cancer.

目的:探讨在肝胆外科临床实习带教中应用临床路径(Clinical pathway,CP)联合案例教学法(Case-Based Learning,CBL)的效果.方法:选择在肝胆外科进行临床实习的八年制医学生34人作为研究对象,将其随机分为实验组(n=17)和对照组(n=17).对照组实施传统教学方法,实验组在此基础上加入CP联合CBL教学法.实习结束后对两组学生的出科考试成绩及问卷调查结果进行比较.结果:实验组出科考试的理论、临床实践和总成绩均明显高于对照组(P＜0.05).实验组在提高学生的疾病诊疗规范化能力和实际诊治能力方面优于对照组(P＜0.05).结论:CP联合CBL教学法有利于提高临床实习教学效果,值得进一步推广.

神经内分泌肿瘤（neuroendocrine tumor，NET）患者发生肝转移较为常见，大多数患者确诊时已不宜行肝切除。射频消融（radiofrequency ablation，RFA）广泛地应用于NET肝转移患者的治疗。RFA应用灵活，创伤相对较小，对于控制患者神经内分泌症状，减缓肿瘤进展、延长患者生存时间都有着不错的疗效。患者行RFA治疗后并发症、死亡率较低，对<3 cm的肿瘤结节疗效显著，可以与肝切除手术联合扩大肝切除手术适应证，也可以用于术后复发患者的挽救性治疗。Ki-67增殖指数、肝外疾病、术前存在临床症状、肿瘤大小、RFA治疗方式是RFA治疗预后的有效预测因素。

Objective:To compare the clinical effects of microwave ablation (MWA) and surgical resection in the treatment of small hepatocellular carcinoma(SHCC).Methods:Sixty five SHCC patients with intact clinical data, treated in the Center of Hepatobiliary Surgery, Peking University People's Hospital between Feb 2005 and Aug 2012, were enrolled in this study. Among them, 30 patients were treated by MWA, and the other 35 by hepatectomy. Follow-up was conducted from Mar 2013 to Feb 2021. The differences in long-term survival, intraoperative blood loss, operative time, postoperative complications, performance status (PS), and postoperative hospital stay were compared between the two groups.Results:The survival probability at 1, 3, 5 and 10 years was 93.2%, 82.5%, 55.6% and 41.2%, respectively, in the MWA group, and 97.1%, 82.6%, 67.2% and 48.3%, in the resection group ( P=0.347). The MWA group had less perioperative complications, less blood loss, shorter operation time, better PS score and better hospital stay than the surgical resection group (all P<0.001).There was no statistically significant difference in the survival rate between BCLC stage 0~A1 and A2~A4 patients( P=0.773, 0.536). Conclusions:Microwave ablation in the treatment of small hepatocellular carcinoma can achieve similar results as hepatectomy with less traumatic,better postoperative PS score and shorter postoperative hospital stay.

BACKGROUND:Hepatectomy is the first choice for treating neuroendocrine tumor liver metastases. However, most patients with neuroendocrine tumor liver metastases are not suitable for hepatectomy. Ablation combined with hepatectomy can be an alternative to liver resection.AIM:To explore the clinical effect of microwave ablation combined with hepatectomy for the treatment of neuroendocrine tumor liver metastases.METHODS:In this study, the data of patients who underwent microwave ablation combined with hepatectomy for the treatment of neuroendocrine tumor liver metastases from June 2015 to January 2018 were reviewed. Before the operation, the patients did not receive any treatment for liver neuroendocrine tumors. After a multidisciplinary expert group discussion, all patients were deemed unsuitable for liver resection. All patients were diagnosed with neuroendocrine tumors by pathology. The overall survival time and progression-free survival time were followed by telephone calls and outpatient visits after surgery.RESULTS:Eleven patients with neuroendocrine tumor liver metastases were treated by microwave ablation combined with hepatectomy between June 2015 and January 2018. The median number of liver metastatic nodules was 4 (range, 2 to 43). The median number of lesions resected was 1 (range, 1 to 18), and the median number of lesions ablated was 3 (range, 1 to 38). The mean operation time was 405.6 (± 39.4) min. The median intraoperative blood loss was 600 mL (range, 50 to 3000). Ten patients had a fever after surgery. The median duration of fever was 3 d (range, 0 to 21). Elevated bilirubin levels occurred in all patients after surgery. The median bilirubin on the first day after surgery was 28.5 (range, 10.7 to 98.9) µmol/L. One patient developed respiratory failure, renal insufficiency, and pneumonia after the operation. No patient died postoperatively during hospitalization. The mean overall survival time after surgery was 34.1 (± 3.7) mo, and the median progression-free survival time was 8 (range, 2 to 51) mo. One year after surgery, ten patients survived and five patients survived without progression. Three year after surgery, eight patients survived and two patients survived without progression.CONCLUSION:Microwave ablation combined with hepatectomy not only makes the patients obtain a survival rate similar to that of patients undergoing hepatectomy, but also has a low incidence of postoperative complications.

Objective Hilar cholangiocarcinoma (HC) is invariably fatal without surgical resection. The primary aim of the current study was to determine the safety of variable surgical resections for patient with HC and their survival after surgical resection. In addition, prognostic factor for the overall survival was also evaluated. Methods The study included 59 consecutive patients who were newly diagnosed with HC and underwent surgical resections with curative intend between February 2009 and February 2017. Patients were followed up at 3-6 months intervals after hospital discharge. Postoperative complications and overall survival were determined. Associations of clinicopathologic and surgeon-related factors with overall survival were evaluated through univariate analysis and Cox regression analysis. Results Of patients with Bismuth and Corlette (B & C) type Ⅲ (n=19) and Ⅳ (n=25) HC lesions, 33 (55.9%) were treated with hilar resection combined with major liver resection (MLR), while the other 11 patients with type Ⅲ and Ⅳ, and those with type Ⅰ (n=8) and Ⅱ (n=7) HC lesions were treated with hilar resection. The overall surgical mortality was 5.1% and surgical morbidity was 35.6%. There was no statistical difference in the mortality between MLR group and hilar resection group (6.1% vs. 3.8%; X2=0.703, P=0.145). The median follow-up period was 18 months (range, 1-94 months). The 1-, 3-, 5-year survival rate was 59.3%, 36.5%, and 17.7%, respectively. The overall survival after resections was 18 months. In HC patients with B & C type Ⅲ and Ⅳ lesions, the median survival was 23 months for hilar resection with MLR and 8 months for hilar resection alone; the 1-, 3-, 5-year cumulative survival rate was 63.9%, 23.3%, and 15.5%, respectively for hilar resection with MLR, and 11.1%, 0, and 0, respectively for hilar resection alone, with significant differene observed (HR, 9.902; 95% CI, 2.636-19.571, P=0.001). Four factors were independently associated with overall survival: preoperative serum Ca19-9 (HR, 7.039; 95% CI, 2.803-17.678, P<0.001), histopathologic grade (HR, 4.964; 95% CI, 1.046-23.552, P=0.044), surgical margins (P=0.031), and AJCC staging (P=0.015). Conclusions R0 resection is efficacious in surgical treatment of HC. MLR in combination with caudate lobe resection may increase the chance of R0 resection and improve survival of HC patients with B & C type Ⅲ and Ⅳ lesions. Preoperatively prepared for biliary drainage may ensure the safety of MLR in most HC patients. Novel adjuvant therapies are needed to improve the survival of HC patients with poor prognostic factors.

Objective To investigate the effect of Roux-en-Y hilar-jejunum anastomosis in surgical resection of hilar cholangiocarcinoma.Methods The clinical data of 31 patients with hilar cholangiocarcinoma admitted from Feb 2009 to Feb 2017 who underwent Roux-en-Y hilar-jejunum anastomosis after resection were retrospectively analyzed.Results According to Bismuth-Corlette classification there were 6 cases of Ⅲ a,6 cases of Ⅲ b and 19 cases of type Ⅳ.These patients all successfully underwent Roux-en-Y hilar-jejunum anastomosis,with intraoperative blood loss of 50-4 000 ml [on average of (1 146 ± 1 082) ml].The average operation time was (346 ± 118) min,and the average hilar-jejunum anastomosis time was (35 ± 13) min.The average postoperative hospital stay was (20 ± 11)days.There were 25 cases of R0 resection (80.6％).The postoperative complication rate was 25.8％(8/31).The overall median survival time was 21 months,and the 1-,3-,and 5-year survival rates were 68.8％,14.6％ and 3.6％,respectively.During the follow-up period,7 cases of reflux cholangitis,5 cases of biliary anastomotic stenosis,and 1 case of adhesive intestinal obstruction were found.Conclusion The hilar-jejunum anastomosis is simple,safe,widely applicable prcedure,which is easy to perform.

Polycyclic aromatic hydrocarbons (PAHs) are known as one of the ubiquitous environmental pollutants caused by unavoidable combustion of by-products. Despite decades of research on adverse health effects towards humans, the effects of PAHs and their hydroxylated metabolites (OH-PAHs) on UDP-glucuronosyltransferases (UGTs) remain unclear. This study aimed to investigate inhibitory effects with structure-dependence of 14 PAHs and OH-PAHs towards the activity of 7 isoforms of UGTs using in vitro recombinant UGTs-catalyzed glucuronidation of 4-methylumbelliferone (4-MU) as the probe reaction. PAHs and OH-PAHs showed inhibitory effects towards different UGT isoforms with different extents. For inhibition kinetics determination, 1-HONAP, 4-HOPHE, 9-HOPHE, and 1-HOPYR were utilized as the representative compounds, and UGT1A6, UGT1A9 and UGT2B7 were chosen as the three representative UGT isoforms. The inhibitory effects of 4-HOPHE, 9-HOPHE and 1-HOPYR on three above UGT isoforms were the same: UGT1A9>UGT1A6>UGT2B; for 1-HONAP, that is UGT1A6>UGT1A9>UGT2B. Molecular docking methods were utilized to find the activity cavity of UGT1A9 and UGT2B7 binding with 1-HONAP and 1-HOPYR. Hydrogen bonds and hydrophobic contacts were mainly contributors to their interactions. In vitro-in vivo extrapolation (IVIVE) showed that high in vivo inhibition possibility exists for the inhibition of OH-PAHs on UGTs. All the results provide a novel viewpoint for an explanation of the toxicity of PAHs and OH-PAHs.

目的 探讨老年患者胰十二指肠切除术(PD)后胃排空延迟(DGE)发生的危险因素.方法 回顾分析行PD的老年患者156例,通过单因素分析和多因素分析探讨影响DGE发生的危险因素.结果 156例老年患者中,DGE总发生率为30.8％,其中A级11例(7.1％),B级13例(8.3％),C级24例(15.4％).单因素分析结果显示手术时间(≥420 min)、术中出血量(≥1000 ml)和术后胰瘘是老年患者PD术后DGE的危险因素(P<0.001).Logistic回归分析显示手术时间(≥420 min)、术中出血量(≥1000 ml)和术后胰瘘为术后DGE的独立危险因素(P<0.05).其中术中出血量≥1000 ml(OR=3.937)和术后胰瘘(OR=8.111)是老年患者B、C级DGE的独立危险因素(P<0.01).结论 老年患者PD术后具有较高的DGE发生率,明显延长患者住院时间;术中出血较多及术后胰瘘会造成DGE尤其是B、C级DGE的发生率明显增加;术中精细操作,缩短手术时间并尽量减少出血量,有助于减少DGE的发生.

Cancer metastasis has been demonstrated as it is the culmination of a cascade of priming steps. Increasing evidence has shown that tumor-derived molecular components (TDMCs) are known as extra cellular vesicle and nonvesicle factors and serve as versatile intercellular communication vehicles which can mediate signaling in the tumor microenvironment while creating the premetastatic niche. Noncoding RNAs (ncRNAs) as one of the TDMCs have been proved in participating in the formation of the premetastatic niche. Understanding the premetastatic niche formation mechanisms through TDMCs, especially ncRNAs may open a new avenue for cancer metastasis therapeutic strategies. In this review, recent findings regarding ncRNAs function were summarized, and then the interaction with the premetastatic niche formation was studied, which highlight the potential of using ncRNAs for cancer diagnosis and therapeutic effect.

Objective To investigate the clinical efficacy and prognostic factors for combined caudate lobectomy radical resection plus broad lymph node dissection in patients of hilar cholangiocarcinoma.Methods The clinical data and follow-up results of patients with hilar cholangiocarcinoma surgically treated from Feb 2008 to Feb 2017 were retrospectively analyzed.Result The R0 resection rate[72.2％ (13/18) vs 43.9％ (18/41)],operation time [(433 ± 136) min vs (302 ± 122) min],intraoperative blood loss [(1 789 ± 1 091) ml vs (776 ± 755) ml] and postoperative complication rate [66.7％ (12/18) vs 36.6％ (15/41)]were significantly higher in the hepatic lobe combined with caudate lobe resection group than that without caudate lobe resection group (P ＜ 0.05).The median survival time of patients with enlarged lymph node dissection was longer than that of patients with regional lymph node dissection (33 months vs 13 months,P ＜0.05).Univariate and multivariate analysis showed that the preoperative serum CA199 level ＞ 1 000 U/ml,the degree of microscopic margin and tumor TNM stage were significantly correlated with the prognosis of the patients (P ＜ 0.05).Conclusion Combined with caudate lobe resection can improve R0 resection rate.Targeted lymph node dissection helps prolong survival.The degree of microscopic margin,preoperative CA199 and TNM staging are independent risk factors for the prognosis of patients with hilar cholangiocarcinoma.

目的:比较射频消融与手术切除治疗根治切除术后复发性小肝癌的疗效.方法:2015年1月～2017年12月在北京大学人民医院肝胆外科接受手术治疗的根治性切除术后复发性小肝癌患者共94例作为研究对象,进行回顾性研究,其中,射频消融手术患者50例,手术切除患者44例,对两组患者的肿瘤复发、生存情况及并发症发生率进行比较.结果:射频消融与手术组患者治疗后1年、2年、3年总生存率分别为82.0％,64.0％,52.0％和79.5％,65.9％,52.2％,两组无统计学意义(P>0.05).射频组与手术组6个月、1年、2年和3年复发率分别为20.0％(10/50)、46.0％(23/50)、62.0％(31/50)、78.0％(38/50)和13.6％(6/44)、25.0％(11/44)、40.9％(18/44)、56.8％(25/44),其中射频组的1年、2年、3年复发率均更高,具有统计学意义(P<0.05).射频组患者并发症发生率为8.0％,低于手术组的20.4％,但无统计学差异.结论:在复发性小肝癌患者治疗中,利用射频消融技术更加安全有效,治疗后患者的总生存率与手术切除相似,并发症发生率低,但在复发率方面手术切除依据占据优势,射频消融技术还需继续研究,以此提升治疗水平,并作为复发性小肝癌治疗的有效手段.

Objective To investigate the diagnosis and treatment of upper gastrointestinal hemorrhage caused by pancreatic segmental portal hypertension.Methods The clinical diagnosis and follow-up data of 13 patients with upper gastrointestinal hemorrhage caused by pancreatic segmental portal hypertension from Jan 2010 to Dec 2017 were retrospectively analyzed.Results Of the 13 patients,5 had pancreatic pseudocysts and 8 had chronic pancreatitis.All of them had a history of hematemesis or (and) tarry feces,and 2 of them had a history of hemorrhagic shock.13 patients had isolated gastric varices,and 5 of them had varicose veins in the lower esophagus.13 patients had splenomegaly and hypersplenism,and all patients underwent splenectomy.All patients were followed up,and the varicose veins were significantly improved or disappeared.During 1 year to 8 years of follow-up,there was no rebleeding.Conclusion Splenectomy cures upper gastrointestinal hemorrhage caused by rupture of the varicose veins in patients of pancreatic segmental portal hypertension.Preoperative interventional spleen artery embolization can reduce the difficulty of spleen resection.

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies. Recently, many kinds of microRNAs (miRNAs) have been found to play a significant role in development of PDAC. However, there is no investigation about expression and function of miR-7-5p in PDAC. In this study, we found that miR-7-5p was down-regulated in PDAC tissues and its low expression level indicated a poor survival rate for PDAC patients. By bioinformatic analysis, we found that miR-7-5p targeted SOX18, and there was a negative correlation between them in PDAC tissues. Then luciferase reporter and western blot assays were used to verify the binding of miR-7-5p on SOX18 3'UTR. Cell function assays demonstrated that miR-7-5p inhibited proliferation, migration and invasion of PANC-1 cells by targeting SOX18. The nude mouse tumorigenicity assay further proved that miR-7-5p targeted SOX18 to inhibit pancreatic cancer growth in vivo. In order to further understand the mechanism, we applied a transcription factor prediction tool to explore the underlying targets that transcripted by SOX18, and the result indicated that SOX18 was a transcription factor for gp130 (a subunit of IL-6 receptor), and ChIP assays was performed to prove this prediction. Furthermore, we detected the suppression of gp130/JAK2/STAT3 signaling pathway after silencing SOX18 in PANC-1 cells, which demonstrated the transcriptional activation role of SOX18 on gp130. Thus, our present study revealed that miR-7-5p targeted SOX18 to inhibit gp130/JAK2/STAT3 signaling pathway to exert its suppressing role in PDAC. (C) 2018 Elsevier Inc. All rights reserved.

Objective To investigate the complication and risk factors in elderly patients undergoing pancreaticoduodenectomy (PD).Methods From Jan 2005 to Dec 2016,358 consecutive patients undergoing PD were divided into ≥ 70 years group (98 cases) and ＜ 70 years group (260patients).Perioperative complications were compared and risk factors explored between the two groups.Results There were differences in coronary heart disease between the two groups in the preoperative medical comorbidities (P =0.008),and that of albumin,alanine aminotransferase,alkaline phosphatase and creatinine (all P ＜ 0.05).Perioperative mortality was higher in the elderly group than in the younger group (P =0.038),probably related to higher systemic complications (P =0.001).The independent risk factors influencing the postoperative medical complications were preoperative total bilirubin ≥ 171 μmol/L and intraoperative blood loss ≥ 1 000 ml.Conclusions Patients over 70 years old have a comparatively higher perioperative mortality rate after pancreaticoduodenectomy,which were probably derived from a higher postoperative vital organ dysfunction.