Primary hepatic myelolipoma: A case report and review of the literature.

BACKGROUND: Primary hepatic myelolipoma is a rare hepatic mesenchymal tumor mixed by adipose tissue and bone marrow, and there is a lack of general guidelines related to its epidemiology and clinical management. CASE SUMMARY: A 26-year-old woman was admitted to our department complaining of a newly found tumor on her left lobe of the liver. The tumor was painless and not associated with any systemic or localized compressive symptoms. Serological tests disclosed a slight increase of gamma-glutamyl transpeptidase (70.0 U/L) and total bilirubin (19.2 µmol/L). Ultrasonography showed a mass about 5.0 cm × 5.0 cm in size that was located in the left lobe of the liver and displayed hyperechoic and well-encapsulated characteristics. Surgical resection was applied, and the following histopathological examination observed a variable proportion of myeloid tissues scattering throughout mature fibrotic adipose tissues, in which myeloid, erythroid, and megakaryocytic cells can be found in magnified view. The follow-up did not show any changes 6 mo after surgery. CONCLUSION: This case highlights an extremely rare hepatic mesenchymal tumor, the primary hepatic myelolipoma, and discloses the common characteristics behind this disease and gives clinical recommendations.

Oral microbiome and pancreatic cancer.

BACKGROUND: Microbiota profiles differ between patients with pancreatic cancer and healthy people, and understanding these differences may help in early detection of pancreatic cancer. Saliva sampling is an easy and cost-effective way to determine microbiota profiles compared to fecal and tissue sample collection. AIM: To investigate the saliva microbiome distribution in patients with pancreatic adenocarcinoma (PDAC) and the role of oral microbiota profiles in detection and risk prediction of pancreatic cancer. METHODS: We conducted a prospective study of patients with pancreatic cancer (n = 41) and healthy individuals (n = 69). Bacterial taxa were identified by 16S ribosomal ribonucleic acid gene sequencing, and a linear discriminant analysis effect size algorithm was used to identify differences in taxa. Operational taxonomic unit values of all selected taxa were converted into a normalized Z-score, and logistic regressions were used to calculate risk prediction of pancreatic cancer. RESULTS: Compared with the healthy control group, carriage of Streptococcus and Leptotrichina (z-score) was associated with a higher risk of PDAC [odds ratio (OR) = 5.344, 95% confidence interval (CI): 1.282-22.282, P = 0.021 and OR = 6.886, 95%CI: 1.423-33.337, P = 0.016, respectively]. Veillonella and Neisseria (z-score) were considered a protective microbe that decreased the risk of PDAC (OR = 0.187, 95%CI: 0.055-0.631, P = 0.007 and OR = 0.309, 95%CI: 0.100-0.952, P = 0.041, respectively). Among the patients with PDAC, patients reporting bloating have a higher abundance of Porphyromonas (P = 0.039), Fusobacterium (P = 0.024), and Alloprevotella (P = 0.041); while patients reporting jaundice had a higher amount of Prevotella (P = 0.008); patients reporting dark brown urine had a higher amount of Veillonella (P = 0.035). Patients reporting diarrhea had a lower amount of Neisseria and Campylobacter (P = 0.024 and P = 0.034), and patients reporting vomiting had decreased Alloprevotella (P = 0.036). CONCLUSION: Saliva microbiome was able to distinguish patients with pancreatic cancer and healthy individuals. Leptotrichia may be specific for patients living in Sichuan Province, southwest China. Symptomatic patients had different bacteria profiles than asymptomatic patients. Combined symptom and microbiome evaluation may help in the early detection of pancreatic cancer.

[Expression of TWEAK/Fn14 in Pancreatic Cancer].

OBJECTIVES: To investigate the effect of tumor necrosis factor -related weak inducer of apoptosis (TWEAK)/fibroblast growth factor-inducible 14 (Fn14) on the proliferation and growth of pancreatic cancer. METHODS: Human pancreatic cancer (50 cases), chronic pancreatitis (40 cases) and normal pancreatic tissues (30 cases) were collected in West China Hospital from January 2012 to December 2013. TWEAK and Fn14 expressions in these tissues were checked with hematoxylin-eosin (HE) staining and immunohistochemistry method. Relationship between TWEAK expression and clinicopathological features of pancreatic cancer was analyzed. RESULTS: TWEAK expression rate was 36% (18/50) in pancreatic cancer, higher than that in chronic pancreatitis (17.5%, 7/40) and normal pancreatic tissues (13.3%, 4/30) ( P<0.05) .Expression intensity of TWEAK in three groups was also obviously ( P<0.05). The expression rate of Fn14 was 4.0% in pancreatic cancer , 7.0% in normal pancreatic tissues , and 0% in chronic pancreatitis. TWEAK positive expression rate and high expression rate in pancreatic cancer were higher in IIB group ( P<0.05). Pathological grade was not related to TWEAK expression. CONCLUSIONS: TWEAK/Fn14 involved in the progression of pancreatic cancer. In the tissue of pancreatic cancer, TWEAK was highly expressed, and Fn14 was lowly expressed.

Early complications after interventions in patients with acute pancreatitis.

AIM: To identify the possible predictors of early complications after the initial intervention in acute necrotizing pancreatitis. METHODS: We collected the medical records of 334 patients with acute necrotizing pancreatitis who received initial intervention in our center. Complications associated with predictors were analyzed. RESULTS: The postoperative mortality rate was 16% (53/334). Up to 31% of patients were successfully treated with percutaneous catheter drainage alone. The rates of intra-abdominal bleeding, colonic fistula, and progressive infection were 15% (50/334), 20% (68/334), and 26% (87/334), respectively. Multivariate analysis indicated that Marshall score upon admission, multiple organ failure, preoperative respiratory infection, and sepsis were the predictors of postoperative progressive infection (P < 0.05). Single organ failure, systemic inflammatory response syndrome upon admission, and C-reactive protein level upon admission were the risk factors of postoperative colonic fistula (P < 0.05). Moreover, preoperative Marshall score, organ failure, sepsis, and preoperative systemic inflammatory response syndrome were the risk factors of postoperative intra-abdominal bleeding (P < 0.05). CONCLUSION: Marshall score, organ failures, preoperative respiratory infection, sepsis, preoperative systemic inflammatory response syndrome, and C-reactive protein level upon admission are associated with postoperative complications.

Effect of carboxymethylated chitosan on the biosynthesis of NGF and activation of the Wnt/ß-catenin signaling pathway in the proliferation of Schwann cells.

The proliferation of Schwann cells around injured peripheral nerves supports the process of Wallerian degeneration and is critical for axonal regeneration. In this publication, carboxymethylated chitosan (CMCS) was studied to determine its capacity (i) to induce proliferation and secretion of nerve growth factor (NGF) and (ii) to activate Wingless-type(Wnt) protein/ß-catenin signaling pathways in rat Schwann cells. CMCS was found to induce Schwann cell proliferation and NGF synthesis in Schwann cell in a dose and time dependent manner. CMCS was shown to activate factors in the Wnt/ß-catenin signaling pathway, including Dvl-1, ß-catenin, Tcf4, Lef1, C-myc, and Cyclin D1 which are active in the proliferation of Schwann cells and biosynthesis of NGF of Schwann cell. Overall, this study suggests that CMCS can promote the proliferation of cultured Schwann cells and synthesis of NGF by activating the Wnt/ß-catenin signaling pathway.

Preoperative biliary drainage in patients with hilar cholangiocarcinoma undergoing major hepatectomy.

AIM: To investigate the effect of preoperative biliary drainage (PBD) in jaundiced patients with hilar cholangiocarcinoma (HCCA) undergoing major liver resections. METHODS: An observational study was carried out by reviewing a prospectively maintained database of HCCA patients who underwent major liver resection for curative therapy from January 2002 to December 2012. Patients were divided into two groups based on whether PBD was performed: a drained group and an undrained group. Patient baseline characteristics, preoperative factors, perioperative and short-term postoperative outcomes were compared between the two groups. Risk factors for postoperative complications were also analyzed by logistic regression test with calculating OR and 95%CI. RESULTS: In total, 78 jaundiced patients with HCCA underwent major liver resection: 32 had PBD prior to operation while 46 did not have PBD. The two groups were comparable with respect to age, sex, body mass index and co-morbidities. Furthermore, there was no significant difference in the total bilirubin (TBIL) levels between the drained group and the undrained group at admission (294.2 ± 135.7 vs 254.0 ± 63.5, P = 0.126). PBD significantly improved liver function, reducing not only the bilirubin levels but also other liver enzymes. The preoperative TBIL level was significantly lower in the drained group as compared to the undrained group (108.1 ± 60.6 vs 265.7 ± 69.1, P = 0.000). The rate of overall postoperative complications (53.1% vs 58.7%, P = 0.626), reoperation rate (6.3% vs 6.5%, P = 1.000), postoperative hospital stay (16.5 vs 15.0, P = 0.221) and mortality (9.4% vs 4.3%, P = 0.673) were similar between the two groups. In addition, there was no significant difference in infectious complications (40.6% vs 23.9%, P = 0.116) and noninfectious complications (31.3% vs 47.8%, P = 0.143) between the two groups. Univariate and multivariate analyses revealed that preoperative TBIL > 170 µmol/L (OR = 13.690, 95%CI: 1.275-147.028, P = 0.031), Bismuth-Corlette classification (OR = 0.013, 95%CI: 0.001-0.166, P = 0.001) and extended liver resection (OR = 14.010, 95%CI: 1.130-173.646, P = 0.040) were independent risk factors for postoperative complications. CONCLUSION: Overall postoperative morbidity and mortality rates after major liver resection are not improved by PBD in HCCA patients with jaundice. Preoperative TBIL > 170 µmol/L, Bismuth-Corlette classification and extended liver resection are independent risk factors linked to postoperative complications.

Repairing peripheral nerve defects with tissue engineered artificial nerves in rats.

OBJECTIVE: To observe the effect of tissue engineered nerves in repairing peripheral nerve defects (about 1.5 cm in length) in rats to provide data for clinical application. METHODS: Glycerinated sciatic nerves (2 cm in length) from 10 Sprague Dawley (SD) rats (aged 4 months) were used to prepare homologous dermal acellular matrix. Other 10 neonate SD rats (aged 5-7 days) were killed by neck dislocation. After removing the epineurium, the separated sciatic nerve tracts were cut into small pieces, then digested by 2.5 g/L trypsin and 625 U/ml collagenase and cultured in Dulbecco's modified Eagle's medium (DMEM) for 3 weeks. After proliferation, the Schwann cells (SCs) were identified and prepared for use. And other 40 female adult SD rats (weighing 200 g and aged 3 months) with sciatic nerve defects of 1.5 cm in length were randomly divided into four groups: the defects of 10 rats bridged with proliferated SCs and homologous dermal acellular matrix (the tissue engineered nerve group, Group A), 10 rats with no SCs but homologous dermal acellular matrix with internal scaffolds (Group B), 10 with autologous nerves (Group C), and the other 10 with nothing (the blank control group, Group D). The general status of the rats was observed, the wet weight of triceps muscle of calf was monitored, and the histological observation of the regenerated nerves were made at 12 weeks after operation. RESULTS: The wounds of all 40 rats healed after operation and no death was found. No foot ulceration was found in Groups A, B and C, but 7 rats suffered from foot ulceration in Group D. The triceps muscles of calf were depauperated in the experimental sides in all the groups compared with the uninjured sides, which was much more obvious in Group D. The wet weight of triceps muscle of calf and nerve electrophysiologic monitoring showed no statistical difference between Group A and Group C, but statistical difference was found between Groups A and B and Groups B and D. And significant statistical difference was found between Group B and Group D. Obvious compound muscle (or motor) action potential (CMAP) could be evoked in Group A and Group C, but the evoked amplitude was very low in Group B and Group D. The axons of regenerated nerves penetrated through the whole graft in Group A and Group C, and partly penetrated through the graft in Group B, but did not penetrate in Group D. The two tips of the separated sciatic nerves of Groups A , B , and C were connected together, without formation of neuroma. But those of Group D were not connected together and neuroma formed in 6 rats. CONCLUSIONS: Tissue engineered nerves can be used for repairing long defects of the peripheral nerves of rats and ideal repairing effects can be obtained.