Compared efficacy of University of Wisconsin and histidine-tryptophan-ketoglutarate solutions in ex-situ liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis patients.

BACKGROUND: The University of Wisconsin (UW) and histidine-tryptophan-ketoglutarate (HTK) solutions are the two most frequently used liver graft preservation fluids. The present study aimed to compare their efficacy in end-stage hepatic alveolar echinococcosis patients who underwent ex-situ liver resection and autotransplantation (ELRA). METHODS: A total of 81 patients received ELRA from August 2010 to March 2018. They were allocated into UW (n = 48) and HTK groups (n = 33) based on the type of solutions used. Demographic and operational data were retrospectively analyzed. Primary outcomes included 90-day mortality, incidence of early graft loss, primary dysfunction, and postoperative complications. RESULTS: Demographic and operational characteristics were similarly distributed in the two groups. No statistically significant differences were observed with regard to 90-day mortality (12.77% vs. 12.12%) and early graft loss rate (8.51% vs. 9.09%) between the two groups. Patients in the UW and HTK groups showed a primary dysfunction rate of 27.66% and 27.27%, respectively. The UW group exhibited a higher incidence tendency of biliary complications, albeit with no statistical significance. CONCLUSIONS: This is the largest cohort study comparing the efficacy of the UW and HTK organ-preserving solutions in end-stage hepatic alveolar echinococcosis patients in ELRA settings. UW and HTK solutions presented similar efficacy and safety. A randomized clinical trial with larger scale is needed for further investigation in future clinical applications.

Soluble suppression of tumourigenicity 2 as a predictor of postoperative hepatic failure.

BACKGROUND: Posthepatectomy liver failure remains a potentially life-threatening complication after hepatectomy. Soluble suppression of tumourigenicity 2 is an injury-related biomarker. The aim of the study was to assess soluble suppression of tumourigenicity 2 elevation after hepatectomy and whether it can predict posthepatectomy liver failure. METHODS: This was a single-centre retrospective study including all patients who underwent a liver resection between 2015 and 2019. Plasma concentrations of soluble suppression of tumourigenicity 2 were measured before surgery and at postoperative days 1, 2, 5 and 7. Posthepatectomy liver failure was defined according to the International Study Group of Liver Surgery and the morbidity rate was graded according to the Clavien-Dindo classification. RESULTS: A total of 173 patients were included (75 underwent major and 98 minor resection); plasma levels of soluble suppression of tumourigenicity 2 increased from 43.42 (range 18.69-119.96) pg/ml to 2622.23 (range 1354.18-4178.27) pg/ml on postoperative day 1 (P < 0.001). Postoperative day 1 soluble suppression of tumourigenicity 2 concentration accurately predicted posthepatectomy liver failure ≥ grade B (area under curve = 0.916, P < 0.001) and its outstanding performance was not affected by underlying disease, liver pathological status and extent of resection. The cut-off value, sensitivity, specificity, positive predictive value and negative predictive value of postoperative day 1 soluble suppression of tumourigenicity 2 in predicting posthepatectomy liver failure ≥ grade B were 3700, 92%, 85%, 64% and 97% respectively. Soluble suppression of tumourigenicity 2high patients more frequently experienced posthepatectomy liver failure ≥ grade B (64.3% (n = 36) versus 2.6% (n = 3)) and Clavien-Dindo IIIa higher morbidity rate (23.2% (n = 13) versus 5.1% (n = 6)) compared with soluble suppression of tumourigenicity 2low patients. CONCLUSIONS: Soluble suppression of tumourigenicity 2 may be a reliable predictor of posthepatectomy liver failure ≥ grade B as early as postoperative day 1 for patients undergoing liver resection. Its role in controlling hepatic injury/regeneration needs further investigation. Registration number: ChiCTR-OOC-15007210 (www.chictr.org.cn/).

Laparoscopic Versus Open Roux-en-Y Choledochojejunostomy: A Single-institute Experience With Literature Review.

OBJECTIVES: The current clinical study aims to compare the clinical efficacy of open choledochojejunostomy (OCJ) and laparoscopic choledochojejunostomy (LCJ) in patients with benign and malignant biliary tract disorders. PATIENTS AND METHODS: The clinical data of 40 consecutive patients who underwent either OCJ or LCJ from January 2015 to February 2017 were retrospectively analyzed. The clinical parameters analyzed include baseline information, intraoperative characteristics, and postoperative clinical outcomes. The patients were divided into OCJ group and LCJ group based on the surgical approach performed. RESULTS: Of 40 patients during the study period, 15 underwent LCJ and the remaining 25 patients underwent OCJ. The mean operative time was slightly longer in the LCJ group (323.53±150.30 min) than the OCJ group (295.38±130.34 min) (P=0.945); intraoperative blood loss in 2 groups were similar (179.17 vs. 164.67 mL, P=0.839). Although hospital stay was significantly shorter in the LCJ group (8.33±2.1 d) compared with the OCJ group (19.24±4.2 d) (P<0.001). Biliary leakage is the most common complication after OCJ; no complication was experienced in the LCJ group. CONCLUSIONS: LCJ is a feasible and safe option for patients undergoing choledochojejunostomy.

Laparoscopy Versus Open Incarcerated Inguinal Hernia Repair in Octogenarians: Single-Center Experience With World Review.

OBJECTIVES: The clinical study is aiming to discuss the therapeutic benefit of laparoscopic hernia (LH) repair with comparing conventional open hernia (OH) repair in incarcerated hernia in octogenarians. MATERIALS AND METHODS: The clinical data of 29 octogenarian incarcerated hernia patients who underwent hernia repair from November 2013 to March 2017 were retrospectively analyzed. The variables analyzed include baseline, operation characteristics, and clinical outcomes. The patients were divided into LH and OH according to the surgical approach and their clinical parameters were compared. Descriptive statistics were calculated, and outcomes were compared using the Fisher exact test and the student t test, a P≤0.05 was considered significant. RESULTS: Of reported 18 octogenarian patients, 7 patients underwent LH, whereas the remaining 11 patients underwent OH. The median age of the patients was 86 (81 to 97). All patients in LH group and 3 patients in OH group underwent nonmesh repair. In total, 8 patients in OH group underwent mesh repair. Simultaneous intestinal resection was needed in 4 patients (2 in LH, 2 in OH) due to the necrotic bowel. No mortality was observed in all subjects. The results showed significantly shorter operation time (50±5 vs. 110±3 min; P=0.000), hospital stay (6±1 vs. 12±3 d; P=0.04). There were no noteworthy postoperative complications and during the follow-up period, no patient experienced recurrent hernia in both groups. CONCLUSIONS: LH nonmesh repair has not increased the morbidity and mortality but showed shorter hospital stay and fast recovery and no recurrence in octogenarian incarcerated hernia patients. Therefore, LH in octogenarian incarcerated hernia patients might be preferred approach in sophisticated hands with acceptable outcomes.

Expression of toll-like receptor 2, 4 and related cytokines in intraperitoneally inoculated Balb/C mice with Echinococcus multilocularis.

Immune response pattern between host and Echinococcus multilocularis (E. multilocularis) is considered as a crucial point in development of alveolar echinococcosis (AE). In this study, we are aiming to study the expression patterns of TLR2 and TLR4 with related cytokines and transcription factors in secondary E. multilocularis infected murine model. The murine model of AE was developed by using intraperitoneal inoculation of E. multilocularis protoscolexes and albendazole (E. m+ABZ group) or carboxy methyle cellulose (CMC; E. m+CMC group) administration via gastric tube was initiated in the third month and continued for one month. Mice with CMC administration served as negative controls (C+CMC group). The splenic cells and peritoneal exudates cells (PECs) were prepared and the levels of IFN-γ, IL-10, and IL-5 in splenic cells and PECs culture supernatants were detected using enzyme linked immune-sorbent assay (ELISA). Besides, the mRNA expression levels of TLR2, 4, transcription factors and cytokines were detected by using real-time fluorescent quantitative reverse-transcription polymerase chain reaction (qRT-PCR). The concentration levels of IFN-γ, IL-10, and IL-5 in PECs and splenic cell supernatants were extremely lower, however, significantly elevated after stimulated with Concanavalin A (ConA) for 36 h with higher concentrations in E. m+CMC group comparing to both E. m+ABZ and C+CMC group. The mRNA levels of TLR2, 4 and GATA3, IFN-γ, IL-10 in splenic cells were significantly increased in E. m+CMC group comparing with other groups. Simultaneously, T-bet mRNA expressions were elevated in E. m+ABZ and C+CMC group compared to E. m+CMC group. In addition, T-bet/GATA3 ratios was higher in E. m+ABZ group compared to E. m+CMC group and were higher in C+CMC group than those in E. m+CMC group. TLR2 mRNA expression in splenic cells showed a positive correlation with IL-10 concentration levels in splenic cell culture supernatants. The present study provides evidence on the possible role of TLR2 in the process of immune tolerance during E. multilocularis infection and suggests albendazole treatment might reverse the immune tolerance situation and improve parasite clearance process.