Mechanisms of JinHong Formula on treating sepsis explored by randomized controlled trial combined with network pharmacology.

ETHNOPHARMACOLOGICAL RELEVANCE: JinHong Formula (JHF) was derived from the famous Rhubarb and Moutan Decoction which was prescribed for appendicitis. It was originally recorded in the classic of "Jingui Yaolve" written by Zhang Zhongjing. It is a kind of traditional Chinese medicine, widely used in the treatment of inflammation. However, the clinical effect of JHF for sepsis and its comprehensive mechanism in sepsis remained largely unknown. RESEARCH PURPOSE: The aim of our study was to evaluate the clinical effect of JHF in the treatment of sepsis, and to explore its mechanism from the perspective of network pharmacology. RESEARCH METHODS: The single-center randomized clinical trial was conducted to assess the effect of JHF in the treatment of sepsis. Additionally, we used the Chinese herbal medicine pharmacology database and analysis platform to identify the active components and therapeutic target of JHF. Numerous well-known disease target databases have been used to screen therapeutic target proteins for sepsis. Furthermore, we have established a Protein-Protein Interaction (PPI) network and carried out Gene Onotology/Kyoto Encyclopedia of Genes and Genomes (GO/KEGG) enrichment analysis. In order to conclude which active compounds from JHF may be responsible for signaling pathway, we performed network analysis. RESEARCH RESULTS: The study included 114 patients. By comparing participants with and without JHF, the results suggested that JHF significantly reduced all-cause mortality on 28 and 60 days after intervention, and improved Sequential Organ Failure Assessment (SOFA) on 7th day after intervention as well as. JHF had an effect of anti-inflammatories and antioxidants (SOD). By using network pharmacological analysis, we identified 72 active components and 426 target genes of JHF, and successfully constructed a "JHF-compound target-sepsis" network. 116 mentioned targets revealed by GO/KEGG enrichment analysis played a significant role in the inflammatory reaction and immunoregulation via interleukin-17 (IL-17) and tumor necrosis factor (TNF) signaling pathway. Moreover, the analysis of "pathway target-active component" revealed that Sennidin A, Rheidin A, Rheidin B, Rheidin C, (E)-4-Phenyl-3-Buten-2-One, Osmanthuside H, Esculetin, and Caffeicacid were responsible for IL-17, TNF signaling pathways. CONCLUSION: JHF contains potential active substance of anti-inflammatory and antioxidant. These active compounds may come into play through IL-17 and TNF signaling pathways. For sepsis, JHF may be a promising and effective treatment strategy.

Risk factors for patient selection in ambulatory laparoscopic cholecystectomy: A Single-centre experience.

Backgrounds: Ambulatory laparoscopic cholecystectomy (LC) reduces healthcare cost and increases hospital bed capacity. Currently, there is no consensus on patient selection for ambulatory LC. Evaluation of risk factors for ambulatory discharge is essential. Materials and Methods: Consecutive patients who underwent LC in our centre throughout 2019 were collected. We evaluated the discharge fitness using the Post-Anaesthetic Discharge Scoring System at 8 h after the operation. The relations between pre-operative variables and dischargeable possibilities were analysed for screening risk factors. Furthermore, we performed a literature review to summarise all published information. Results: Six hundred and forty-one cases were included in this study. American Society of Anaesthesiologist (ASA) grading (odds ratio OR = 0.415, P = 0.001) and leucocytes (OR = 0.80, P < 0.001) significantly predicted the fitness of discharge. ASA contributed to lower activity (P = 0.002) and intake/output (P = 0.006) scores. Leucocytes influence the vital sign (P < 0.001) and pain or post-operative nausea and vomiting (PONV) (P < 0.001) scores. The prolonged operation could predict the inabilities of discharge with a cut-off value of 55 min by dropping vital signs (P = 0.011), activity (P < 0.001) and pain or PONV (P = 0.012) scores. Male sex (OR: 1.702, P = 0.010), body mass index (BMI) (OR: 1.087, P = 0.008), leucocytes (OR: 1.075, P = 0.017) and C-reactive protein (CRP) (OR: 1.018, P = 0.003) were predictors for prolonged operation (>55 min). Conclusions: We suggest that pre-operative ASA grading III and leucocytes are risk factors for the fitness of ambulatory discharge after LC and intraoperative time. Male, BMI and CRP predict complicated surgery, and they should be considered preoperatively.

Transcriptomics Reveals the ERF2-bHLH2-CML5 Module Responses to H2S and ROS in Postharvest Calcium Deficiency Apples.

Calcium deficiency usually causes accelerated quality deterioration in postharvest fruit, whereas the underlining mechanism is still unclear. Here, we report that calcium deficiency induced the development of bitter pit on the surface of apple peels compared with the healthy appearance in control apples during postharvest storage. Physiological analysis indicates that calcium-deficient peels contained higher levels of superoxide anion (O2•-), malondialdehyde (MDA), total phenol, flavonoid contents and polyphenol oxidase (PPO) activity, and reduced calcium, H2S production, anthocyanin, soluble protein content, and peroxidase (POD) activity compared with those in calcium-sufficient peels. The principal component analysis (PCA) results show that calcium content, ROS, and H2S production were the main factors between calcium-deficient and calcium-sufficient apple peels. Transcriptome data indicated that four calmodulin-like proteins (CMLs), seven AP2/ERFs, and three bHLHs transcripts were significantly differentially expressed in calcium-deficient apple peels. RT-qPCR and correlation analyses further revealed that CML5 expression was significantly positively correlated with the expression of ERF2/17, bHLH2, and H2S production related genes. In addition, transcriptional co-activation of CML5 by ERF2 and bHLH2 was demonstrated by apple transient expression assays and dual-luciferase reporter system experiments. Therefore, these findings provide a basis for studying the molecular mechanism of postharvest quality decline in calcium-deficient apples and the potential interaction between Ca2+ and endogenous H2S.

Genome-Wide Identification of Sultr Genes in Malus domestica and Low Sulfur-Induced MhSultr3;1a to Increase Cysteine-Improving Growth.

Sulfur is an essential nutrient for plant growth and development. Sulfate transporters (Sultrs) are critical for sulfate ( SO 4 2 - ) uptake from the soil by the roots in higher plants. However, knowledge about Sultrs in apples (Malus domestica) is scarce. Here, nine putative MdSultrs were identified and classified into two groups according to the their phylogenetic relationships, gene structures, and conserved motifs. Various cis-regulatory elements related to abiotic stress and plant hormone responsiveness were found in the promoter regions of MdSultrs. These MdSultrs exhibited tissue-specific expression patterns and responded to low sulfur (S), abscisic acid (ABA), indole-3-acetic acid (IAA), and methyl jasmonate (MeJA), wherein MdSultr3;1a was especially expressed in the roots and induced by low S. The uptake of SO 4 2 - in cultivated apples depends on the roots of its rootstock, and MhSultr3;1a was isolated from Malus hupehensis roots used as a rootstock. MhSultr3;1a shared 99.85% homology with MdSultr3;1a and localized on the plasma membrane and nucleus membrane. Further function characterization revealed that MhSultr3;1a complemented an SO 4 2 - transport-deficient yeast mutant and improved the growth of yeast and apple calli under low S conditions. The MhSultr3;1a-overexpressing apple calli had a higher fresh weight compared with the wild type (WT) under a low-S treatment because of the increased SO 4 2 - and cysteine (Cys) content. These results demonstrate that MhSultr3;1a may increase the content of SO 4 2 - and Cys to meet the demands of S-containing compounds and improve their growth under S-limiting conditions.

[Carbonized Apple Branches Decrease the Accumulation and Damage of Cadmium on Apple Rootstock by Reducing DTPA-Cd in Soil].

To explore the effects of carbonized apple branches on cadmium(Cd) accumulation and its damage to apple rootstock, the rootstocks of apple(Malus hupehensis Rehd.) in pots containing soil together with 0.5% and 1%(ω) carbonized apple branches were irrigated by a nutrient solution containing CdSO4. The content of DTPA-Cd(cadmium extracted by diethylenetriamine pentaacetic acid) in the potting soil, and the accumulation of Cd in the roots, stems, and leaves of apple rootstocks, were subsequently monitored. The activities of antioxidant enzymes in roots and leaves, root cell death, and the net photosynthesis rate were further analyzed. The results showed that the concentration of DTPA-Cd in the potting soil with carbonized apple branches was significantly lower than that without carbonized apple branches(Cd-only). Compared with the Cd-only treatment, the concentration of DTPA-Cd in the potting soil decreased by 17.50% and 25.55% in the treatment with 0.5% and 1%(ω) carbonized apple branches for 12 days. The Cd accumulation in roots, stems, and leaves; the accumulations of superoxide anions(·O2-), hydrogen peroxide(H2O2), and malondialdehyde(MDA) in roots and leaves; and the amount of cell death in the roots of apple rootstock treated by carbonized apple branches were significantly lower compared to the Cd-only treatment. However, the activities of superoxide dismutase(SOD), peroxidase(POD), and catalase(CAT) in the roots and leaves, and the net photosynthesis rate of apple rootstock treated by carbonized apple branches, were significantly higher than under the Cd-only treatment. Compared with the Cd-only treatment, Cd accumulation in roots decreased by 29.49% and 37.18% in the treatment with 0.5% and 1%(ω) carbonized apple branches for 12 days, and the amount of cell death decreased by 22.73% and 29.09%, respectively. Our results show that carbonized apple branches reduce the uptake and accumulation of Cd in apple rootstock by reducing the content of DTPA-Cd in the soil, thereby alleviating the damaging effect of Cd on cells and photosynthesis. Moreover, the use of 1%(ω) carbonized apple branches was more effective than 0.5%(ω).

MhNRAMP1 From Malus hupehensis Exacerbates Cell Death by Accelerating Cd Uptake in Tobacco and Apple Calli.

Excessive cadmium (Cd) damages plants by causing cell death. The present study discusses the function of natural resistance-associated macrophage protein (NRAMP) on cell death caused by Cd in Malus hupehensis. MhNRAMP1 was isolated from M. hupehensis roots, and its protein was located in the cell membrane as a transmembrane protein characterized by hydrophobicity. MhNRAMP1 expression in the roots was induced by Cd stress and calcium (Ca) deficiency. MhNRAMP1 overexpression increased Cd concentration in yeasts and enhanced their sensitivity to Cd. Phenotypic comparisons of plants under Cd stress revealed that the growth of transgenic tobacco and apple calli overexpressing MhNRAMP1 was worse than that of the wild type (WT). The Cd2+ influx of transgenic tobacco roots and apple calli was higher, and the recovery time of the Cd2+ influx to a stable state in transgenic apple calli was longer than that of the WT. Cd accumulation and the percentage of apoptotic cells in transgenic lines were higher. Correspondingly, the caspase-1-like and vacuolar processing enzyme (VPE) activities and MdVPEγ expression were higher in transgenic apple calli, but the expression levels of genes that inhibit cell death were lower than those in the WT under Cd stress. Moreover, the Cd translocation from the roots to leaves was increased after MhNRAMP1 overexpression, but the Cd translocation from the leaves to seeds was not affected. These results suggest that MhNRMAP1 exacerbated Cd-induced cell death, which was accomplished by mediating Cd2+ uptake and accumulation, as well as stimulating VPE.

Microplastic pollution around remote uninhabited coral reefs of Nansha Islands, South China Sea.

Microplastic (MP) pollution is a growing environmental problem in the global oceans. However, there is relatively little evidence of the extent of MP pollution around remote islands, such as coral reefs, in the open ocean. In this study, we conducted a large-scale investigation of MP pollution in the surface waters around the remote uninhabited coral reefs of Nansha Islands in South China Sea. Microplastics were widespread in the surface waters with an average abundance of 0.0556 ± 0.0355 items/m3, although this varied among the coral reefs. The MPs were predominantly composed of polypropylene (PP) and polyethylene (PE), and > 70% of them were <3 mm in size. Fragments and fibers comprised the most common MP types. The similarity between macro plastic and MP compositions provided evidence for the tracing of MP sources in the study area. The main pollutants (transparent PP fibers and PE fibers) around these remote coral reefs may originate from fishing gear abrasions. The plastic waste released from nearby residential islands and high-intensity fishing activities around Nansha Islands likely represented important local sources. Overall, the abundance of MPs found in the surface waters surrounding these remote coral reefs in the South China Sea was relatively low; however, these levels of MP pollution should not be disregarded given the importance of coral reef ecosystems.

Assessing the Greenhouse Gas Mitigation Potential of Harvested Wood Products Substitution in China.

Substituting harvested wood products (HWP) for greenhouse gas (GHG) intensive nonwood materials in long-lived end uses has the potential to significantly reduce GHG emissions. To determine the mitigation effects of HWP substitution, we produced China-specific wood displacement factors (DFs) by HWP end use subcategory, defined as tonnes of carbon (tC) of reduced emissions per tC contained by the HWP substituted for typical alternative nonwood materials. The weighted average DFs for substituting HWP for nonwood materials in construction and furniture production in China were estimated to be 3.48 tC/tC and 1.36 tC/tC, respectively, or 2.90 tC/tC for HWP substitution when these two sectors were combined. If annual solid HWP consumption in China increased by 10% on the basis of 2014 consumption (an increase of 25.9 million m3 of HWP) and these HWP were used to substitute for GHG-intensive materials in construction and furniture production, 18.76 Mt C of emission reduction can be achieved annually. Substituting HWP for nonwood materials in construction appeared to be more effective than in furniture manufacture in mitigating GHG emissions. Our study suggested that increasing HWP use in China, especially in the construction industry to substitute for nonwood materials can significantly contribute to China's emission reduction targets.

MhMAPK4 from Malus hupehensis Rehd. decreases cell death in tobacco roots by controlling Cd2+ uptake.

Cadmium (Cd) induces cell death in plant roots. Mitogen-activated protein kinase (MAPK) plays a role in the regulation of cell death induced by Cd in plant roots. In this study, MhMAPK4 was isolated from the roots of Malus hupehensis. Subcellular localization showed that the MhMAPK4 protein was located in the cell membrane and cytoplasm and is a transmembrane protein that is characterized by hydrophily. The expression of MhMAPK4 in the roots of M. hupehensis was up-regulated by Cd sulfate and Cd chloride. Phenotypic comparison under Cd stress showed that the growth of wild-type (WT) tobacco was lower than the transgenic lines overexpressing MhMAPK4. The fresh weight and the root length of WT also was lower than that of the transgenic tobacco. The net Cd2+ influx in the tobacco roots was decreased by the overexpression of MhMAPK4, as was root Cd accumulation. The recovery time of the Cd2+ influx to stable state in the transgenic tobacco was also shorter than the WT. The expression of iron-regulated transporter 1 (NtIRT1) and natural resistance associated macrophage protein 5 (NtNRAMP5) was relatively low in the transgenic lines under Cd stress. Cell death and apoptosis in the tobacco roots was reduced following the overexpression of MhMAPK4. The activity of vacuolar processing enzyme (VPE) and the transcript level of VPE in the transgenic tobacco was lower than that of WT under Cd stress. In addition, the electrolyte leakage and malondialdehyde and hydrogen peroxide contents in the transgenic tobacco were lower than those of WT, whereas the antioxidant enzyme activity and expression were higher. These results suggest that MhMAPK4 regulates Cd accumulation by mediating Cd2+ uptake by the roots, and controls Cd-caused cell death by adjusting VPE activity.

Feasibility research of treating advanced gastric carcinoma with laparoscopy.

PURPOSE: To determine the feasibility and safety of treating patients with advanced gastric cancer with laparoscopy. METHODS: We retrospectively analyzed 180 patients with advanced gastric carcinoma and divided them into either the laparoscopy group (96 cases) or the laparotomy group (84 cases). RESULTS: The number of lymph nodes dissected during surgery and the surgical time were similar in both groups. The incision length, total amount of bleeding during the operation, postoperative exhaust recovery time, and the length of hospital stay were significantly improved in the laparoscopy group when compared to the laparotomy group. The rate of postoperative complications was also significantly lower in the laparoscopy group. The levels of C-reactive protein (CRP) at 1, 7, and 10 days after surgery were significantly lower in the laparoscopy group. CONCLUSION: Overall, the laparoscopic radical operation for advanced gastric carcinoma demonstrated higher safety, shorter incision less bleeding, faster postoperative recovery, and lower rate of postoperative complications compared to the laparotomy group. Thus, this study has shown clear advantages for shifting to laparoscopy for the treatment of advanced gastric carcinoma.

Inhibition of CDH17 gene expression via RNA interference reduces proliferation and apoptosis of human MKN28 gastric cancer cells.

Gastric cancer is the fourth most common type of cancer and the second cause of cancer­related mortalities worldwide despite the use of multimodal therapy. Cadherins are transmembrane glycoproteins that are involved in tumorigenesis. CDH17 has been found to be over­expressed in gastric cancer and its overexpression was associated with lymph node metastasis and tumor­node­metastasis stage of the patients, yet the exact role and molecular mechanism of CDH17 in gastric cancer have not been determined. Using a lentiviral system as a delivery mediator of RNA interference, we found that inhibition of CDH17 can lead to reduce proliferation and increase apoptosis of gastric cancer cell line MKN28 in vitro and significantly diminish their tumorigenicity in vivo. Our results of the present study suggest that CDH17 may be a promising candidate for the therapeutic targeting of gastric cancer.

A new cholangiojejunostomy for multiple biliary ductal openings: A study in pigs.

BACKGROUND: To investigate the safety and feasibility of a new intrahepatic cholangiojejunostomy for multiple intrahepatic biliary ductal openings after hepatobiliary resection. MATERIALS AND METHODS: Forty-eight pigs were randomly assigned into two groups: the new intrahepatic cholangiojejunostomy group (n = 24); and the control group (n = 24) with classical hepaticojejunostomy. Six pigs in each group were sacrificed on postoperative day 7, 30, 90 and 180. The primary outcomes were postoperative mortality, morbidity, and the pathological changes in the anastomoses. The secondary outcomes were levels of aspartate transaminase, bilirubin, albumin and alkaline phosphate. RESULTS: The operations were successfully carried out. The rates of anastomotic leakage and cholangitis in the study group were 0% and 8.3% (2/24), while in the control group they were 4.2% (1/24) and 20.8% (5/24), respectively. The stenotic rates of the sectional areas of the anastomotic stomas in the study group were lower than those in the control group on postoperative day 7, 30, 90 and 180 (p < 0.001, p = 0.002, p < 0.001, and p = 0.001, respectively). Under microscopy, in the study group, the anterior wall of the stoma was everted and sunken while the posterior wall was protruded in a semicircular-disc shaped. The liver transection plane was epithelialized with mucosal covering by post-operative day 30. In the control group, however, the stoma was centripetally protruded with a relative circular stenosis. CONCLUSIONS: The new intrahepatic cholangiojejunostomy is safe, simple, and convenient for multiple biliary ductal openings.

Subadventitial cystectomy in the management of biliary fistula with liver hydatid disease.

Biliary fistulas are the most common morbidity (8.2-26%) following hydatid liver surgery. The aim of this study was to evaluate the results of subadventitial cystectomy in the treatment of liver hydatid cyst associated with a biliocystic fistula. The medical records of 153 patients who underwent subadventitial cystectomy for a liver hydatid cyst between January 2006 and December 2010 were retrospectively reviewed. Cysts were located in the right lobe anterior segment 37 (24.2%) patients, right lobe posterior segment 59 (38.6%) patients, the left lobe in 26 (17.0%) patients, and both lobes in 6 (3.9%) patients. The surgical procedures performed were closed (non-incised) subadventitial total cystectomy in 74 patients (48.4%), open (incised) subadventitial total cystectomy in 30 patients (19.6%), and subadventitial subtotal cystectomy in 49 patients (32.0%). Biliocystic communication was found in 52 patients (34.0%), and 21 patients (13.7%) were treated with T-tube drainage. Two patients had performed biliodigestive anastomosis. Biliary fistula was detected in 9 patients after subtotal subadventitial cystectomy. Biliary fistulas closed spontaneously within 10 days and 61 days respectively and the amount of drainage varying between 50 and 400ml after the procedure. Postoperative complication and recurrence rates were 19.0% and 0.7%, respectively. The mortality rate was 0%. Subadventitial cystectomy should be the surgical treatment of choice for this disease because of its feasibility and low rates of recurrence, complications of the residual cavity, and incidence of associated biliary fistula.

Isolation, characterization, and structure analysis of a vacuolar processing enzyme gene (MhVPEγ) from Malus hupehensis (Pamp) Rehd.

Vacuolar processing enzymes (VPEs) have received considerable attention recently, as they exhibit caspase-1-like cleavage activity and regulate the process of PCD. However, knowledge about their detailed characteristics and structures is relatively limited. In this study, a gamma vacuolar processing enzyme gene, MhVPEγ, has been isolated from the leaves of Malus hupehensis (Ramp) Rehd. var pinyiensis Jiang. MhVPEγ coded-translated protein sequence comprised of 494 amino acids with a signal peptide and a transmembrane helix structure at N-terminal, peptidase_C13 domain, and vacuolar sorting signal at C-terminal. Consequently, genomic walking approach was performed for the isolation of its upstream sequence. Computational analysis demonstrated several motifs of the promoter exhibiting hypothetic MeJA, ABA, and light-induced characteristics, as well as some typical domains universally discovered in promoter, such as TATA-box and CAAT-box. MhVPEγ transcript level was enhanced during wounding treatment, and WUN-motif, as one of the cis-acting regulatory elements existing in the upstream sequence perhaps regulates its expression. In silico-constructed 3D models revealed that MhCPYL successively interacts with MhVPEγ like that of "Induced Fit-Lock and Key" model, providing molecular conformation evidence that CPY is a direct substrate of VPEγ. This study is the first stride to understand the molecular mechanism of VPEγ and CPYL interactions.

Activin A induces growth arrest through a SMAD- dependent pathway in hepatic progenitor cells.

BACKGROUND: Activin A, an important member of transforming growth factor-ß superfamily, is reported to inhibit proliferation of mature hepatocyte. However, the effect of activin A on growth of hepatic progenitor cells is not fully understood. To that end, we attempted to evaluate the potential role of activin A in the regulation of hepatic progenitor cell proliferation. RESULTS: Using the 2-acetaminofluorene/partial hepatectomy model, activin A expression decreased immediately after partial hepatectomy and then increased from the 9th to 15th day post surgery, which is associated with the attenuation of oval cell proliferation. Activin A inhibited oval cell line LE6 growth via activating the SMAD signaling pathway, which manifested as the phosphorylation of SMAD2/3, the inhibition of Rb phosphorylation, the suppression of cyclinD1 and cyclinE, and the promotion of p21WAF1/Cip1 and p15INK4B expression. Treatment with activin A antagonist follistatin or blocking SMAD signaling could diminish the anti-proliferative effect of activin A. By contrast, inhibition of the MAPK pathway did not contribute to this effect. Antagonizing activin A activity by follistatin administration enhanced oval cell proliferation in the 2-acetylaminofluorene/partial hepatectomy model. CONCLUSION: Activin A, acting through the SMAD pathway, negatively regulates the proliferation of hepatic progenitor cells.

Echinococcus of the liver treated with laparoscopic subadventitial pericystectomy.

PURPOSE: Because of the new radical procedure, subadventitial pericystectomy, has succeed in treatment for the liver hydatid cysts. The aim of this report is to describe the technical details of our laparoscopic method and report the initial results. METHODS: Six patients were considered for laparoscopic subadventitial pericystectomy treatment from March 2009 and May 2011. RESULTS: A laparoscopic surgical technique was used in all cases. The total subadventitial pericystectomy was successfully performed in 2 patients (33.3%) and subtotal subadventitial pericystectomy was performed in 4 patients (66.7%). The mean operating time was 158.3 minutes (range, 90 to 270 min). Complications were observed in 2 patients postoperatively. Postoperatively the mean length of hospital stay was 6.3 days (range, 4 to 10 d). No recurrence was found after laparoscopic surgery in all the patients. The mean follow-up was 15.6 months (range, 6 to 25 mo). CONCLUSIONS: Laparoscopy subadventitial pericystectomy is effective and reliable in selected patients. It can be a useful alternative for treating hepatic hydatid disease.

[Expression of tumor necrosis factor-alpha and caspase-3 protein in monocytes adjacent to the invaded Echinococcus multilocularis in liver].

OBJECTIVE: To investigate the expression and its significance of tumor necrosis factor-alpha (TNF-alpha) and caspase-3 protein in monocytes adjacent to the invaded Echinococcus multilocularis in liver. METHODS: 40 female Kunming mice were randomly divided into experimental group (n=20) and sham operation (control) group (n=20). Mice in experimental group were infected with 20% E. multilocularis suspension (0.1 ml per mouse) through abdominal opening injection in liver and the mice in control group were injected with equal physiological saline. The mice were sacrificed at 6 months post-infection for observing the growth and metastasis of E. multilocularis. Pathological changes were observed by HE staining. The expression of TNF-alpha and caspase-3 protein in hydatid cyst and metastasis tissue were detected by immunohistochemistry staining and the apoptosis of the monocytes was measured by TUNEL. RESULTS: After 6 months post-infection, E. multilocularis were spread over the liver of the mice in experimental group. Metastasis rate of lymph nodes was 45.0% (9/20). Infiltration of monocytes was observed around E. multilocularis in liver and lymph nodes with metastasis by HE staining. Immunohistochemistry showed that the positive expression rate of TNF-alpha and caspase-3 protein in monocytes was 100% and 100%, and 95% and 100% respectively around the cyst in experimental group, while the expression rate was only 5% and 0 respectively in the liver of the control mice (P<0.01). The monocytes showed significant apoptosis by TUNEL in experimental group with a positive expression rate of 100%, with a significant difference between experiment group and the control (P<0.01). CONCLUSION: In the process of alveolar Echinococcus infection, the high expression of TNF-alpha protein might be associated with the apoptosis of monocytes, which may inhibit the host immunological function.

Treatment of complicated hepatic cystic hydatidosis with intrabiliary rupture by pericystectomy in combination with Roux-en-Y hepaticojejunostomy.

This study retrospectively reviewed 9 cases of complicated hepatic cystic hydatidosis with intrabiliary rupture who were surgically treated with pericystectomy in combination with Roux-en-Y hepaticojejunostomy in our hospital from 2004 to 2010. The clinical features, results of laboratory tests, B-mode ultrasonography and CT, post-operative recovery, days of hospital stay after the operation and post-operative complications were statistically analyzed and the patients were followed up. The subjects in our series included 7 males and 2 females, whose average age was 50.78±7.58 years. Before operation, 9 patients suffered from pain of the right upper quadrant and jaundice, which, in 4 cases (44.45%), were accompanied with fever and chills. Preoperative B-mode ultrosonography and CT showed that all the 9 patients had single hydatid cyst, with their diameter being 9.33±1.58 cm on average. The lesions involved segments V, VI in 6 cases, and segment IV in 3 cases. By WHO classification, 7 cases were classified as CE3 and 2 cases as CE4. They all had choledochectasia. The subjects underwent the surgery uneventfully. Intraoperatively, 2-4 biliary fistula orifices were found, with the average of the orifice being (0.79±0.20) cm. After the operation, one patient developed incision infection, one had pulmonary infection and one suffered from reflux cholangitis. No anastomotic leaks or peri-operative deaths took place and follow-up revealed no recurrence and implantative metastasis. We are led to conclude that pericystectomy in combination with Roux-en-Y hepaticojejunostomy can achieve satisfactory results for the treatment of complicated hepatic cystic hydatidosis with intrabiliary rupture.

[The correlation between osteopontin and metastasis of hepatic Echinococcus multilocularis infection].

OBJECTIVE: To investigate the expression and distribution of osteopontin (OPN) in Echinococcus multilocularis cyst, and explore the role of OPN in the metastasis of hepatic E. multilocularis infection. METHODS: Forty gerbils were infected with 20% E. multilocularis suspension (0.1 ml per gerbil) through abdominal opening injection in liver. Gerbils were sacrificed at 100 days postinfection for observing the growth and metastasis of hepatic echinococcus cyst. The liver, hepatic echinococcus cyst and metastasis tissue were observed on HE stain; the expression of OPN were measured by immunohistochemistry staining (SP method). RESULTS: E. multilocularis were spread over the liver and abdominal cavity. Expression of OPN was found at different degree in echinococcus cysts. The positive expression rate of OPN in echinococcus cysts was 70% (28/40). OPN was mainly distributed in the germinal layer, inflammatory cells and some liver cells. 60% (24/40) occurred thoracic lymph node metastases. The OPN expression rate in hepatic echinococcus cysts with thoracic lymph node metastases (83%, 20/24) was significantly higher than that of hepatic echinococcus cysts without thoracic lymph node metastases (50%, 8/16) (P < 0.05). The positive expression of OPN in lymph node metastases (92%, 22/24) was higher than that of hepatic echinococcus cyst (70%, 28/40) (P < 0.05). CONCLUSION: Osteopontin mainly distributes in the germinal layer of hepatic echinococcus cyst and inflammatory cells, which might be involved in metastasis of hepatic E. multilocularis infection.