Objective:To investigate the therapeutic effect of Biling Weitong Granules combined with oryz-aspergillus enzyme and pancreatin tablets on patients with reflux esophagitis with functional dyspepsia.Methods:Sixty patie...Objective:To investigate the therapeutic effect of Biling Weitong Granules combined with oryz-aspergillus enzyme and pancreatin tablets on patients with reflux esophagitis with functional dyspepsia.Methods:Sixty patients diagnosed with reflux esophagitis with functional dyspepsia who were admitted to the Affiliated Hospital of Hebei University between June 2020 and June 2023 were selected and divided into two groups:the control group and the observation group,each consisting of 30 cases.The control group received oryz-aspergillus enzyme and pancreatin tablets only,while the observation group received Biling Weitong Granules in addition to the tablets.The clinical efficacy,Chinese medicine syndrome points,esophageal kinetic indexes,gastrointestinal hormone levels,and therapeutic safety of both groups were evaluated.Results:The total efficiency of the observation group reached 93.33%,significantly higher than the 73.33%of the control group(P<0.05).After treatment,patients in the observation group exhibited significantly lower scores for Chinese medicine symptoms such as early satiety,belching,abdominal distension,abdominal pain,and loss of appetite compared to the control group(P<0.05).Furthermore,the observation group showed significantly higher upper esophageal sphincter pressure,lower esophageal sphincter pressure,and distal esophageal contraction scores compared to the control group(P<0.05).Additionally,levels of gastric motility hormone,vasoactive intestinal peptide,and gastrin were significantly higher in the observation group compared to the control group(P<0.05).Throughout the treatment period,there was no significant difference in the incidence of adverse reactions between the two groups,indicating comparable safety of the two treatment modalities(P>0.05).Conclusion:The combination of Biling Weitong Granules with oryz-aspergillus enzyme and pancreatin tablets demonstrates significant efficacy in the treatment of reflux esophagitis with functional dyspepsia,with a better safety profile.This finding warrants further clinical promotion.展开更多
Objective:To analyze the effectiveness of Biling Weitong Granules(BLWTG)combined with trimethoprim and vonoprazan in treating reflux esophagitis.Methods:Sixty patients with reflux esophagitis admitted to our hospital ...Objective:To analyze the effectiveness of Biling Weitong Granules(BLWTG)combined with trimethoprim and vonoprazan in treating reflux esophagitis.Methods:Sixty patients with reflux esophagitis admitted to our hospital from March 2020 to March 2023 were selected as study subjects and randomly divided into a control group and an experimental group,with 30 cases in each group.The control group received only the combination treatment of trimethoprim and vonoprazan,while the experimental group was treated with BLWTG based on the control group.The acid reflux and heartburn symptom scores,quality-of-life scores,clinical efficacy,Chinese medicine symptom incidences,and the occurrence of adverse reactions before and after treatment in the two groups were compared.Results:After treatment,the acid reflux and heartburn symptom scores of patients in the experimental group were lower than those of the treatment control group,and the quality-of-life scores were higher than those of the treatment control group(P<0.05).The total clinical efficacy of the experimental group was 96.66%,which was significantly higher than that of the control group(73.33%,P<0.05).After treatment,the incidence of Chinese medicine symptoms,such as nausea and vomiting,abdominal distension and abdominal pain,and loss of appetite of the patients in the experimental group were significantly lower than those of the control group(P<0.05).During the treatment period,there was no significant difference in the incidence of adverse reactions between the two groups,which indicated that the safety of the two treatments was comparable(P>0.05).Conclusion:BLWTG combined with trimethoprim and vonoprazan was safe and reliable in treating reflux esophagitis,effectively relieving the symptoms and improving its clinical efficacy.This treatment is worthy of popularization.展开更多
BACKGROUND Recent research suggests that although prokinetic agents,acid suppressors,and radical treatment for Helicobacter pylori infection may be effective in patients with functional dyspepsia(FD),a large proportio...BACKGROUND Recent research suggests that although prokinetic agents,acid suppressors,and radical treatment for Helicobacter pylori infection may be effective in patients with functional dyspepsia(FD),a large proportion of patients still fail to respond to these treatments or may suffer from severe adverse reactions.Many traditional Chinese medicinal herbs can regulate the status of the entire body and have special advantages in the treatment of functional diseases.The present study was designed to verify the efficacy of Biling Weitong Granules(BLWTG),a traditional Chinese medicinal herbal compound formula,in alleviating epigastric pain syndrome(EPS)in FD patients,in an attempt to provide an effective prescription for the clinical treatment of this disease.AIM To evaluate the clinical efficacy and safety of BLWTG in treating EPS in patients with FD.METHODS In this multicenter,stratified,randomized,double-blind,placebo-controlled,parallel group clinical trial,eligible patients were randomized into the BLWTG and placebo groups who were treated for 6 wk.Efficacy indicators including the severity and frequency of EPS and the time to pain resolution and safety indicators including adverse events were observed and compared.RESULTS The baseline demographic data and clinical characteristics,such as epigastric pain symptoms,pain intensity,and frequency of attacks,were matched between the two groups before randomization.After 6 wk of treatment and after the center effect was eliminated,the epigastric pain was significantly improved in 28.33%and 85.59%of the patients in the placebo and BLWTG groups,respectively(P<0.05).At 6 wk,the resolution rate of epigastric pain was 15%and 69.49%in the placebo and BLWTG groups,respectively(P<0.05).The differences of total FD clinical score between these two groups were significant(P<0.05)at 2,4,and 6 wk(P<0.05).The scores of each item and the total score in the Functional Digestive Disorders Quality of Life Questionnaire showed significant differences between the two groups at 6 wk after both the center and interaction effects were eliminated(P<0.05).There was no significant difference in the incidence of adverse events between the two groups,and no serious adverse event was noted during the observation.CONCLUSION Compared with placebo,BLWTG markedly improved EPS in FD patients without causing serious adverse reactions.展开更多
Punicalagin has been demonstrated to exhibit anti-oxidant and anti-inflammatory properties,but whether and how it could impact hypercholesterolemia remains not fully explored.The aim of this study was to investigate t...Punicalagin has been demonstrated to exhibit anti-oxidant and anti-inflammatory properties,but whether and how it could impact hypercholesterolemia remains not fully explored.The aim of this study was to investigate the influence of punicalagin on hypercholesterolemia in mice and its related mechanisms.After 6 weeks'intervention,punicalagin significantly reduced serum total cholesterol and low-density lipoprotein cholesterol(LDL-C)levels in mice fed a high-fat high-cholesterol(HFHC)diet.Meanwhile,punicalagin supplementation lowered hepatic cholesterol level,which corresponded to the down-regulation of cholesterol synthesis genes(Fdps,Cyp51)and up-regulated bile acid synthesis genes(Cyp7a1,Cyp27a1).In addition,bile acid reabsorption was retarded in punicalagin-fed mice through down-regulating ileal apical sodium-dependent BA transporter(ASBT).Furthermore,intestinal farnesoid X receptor(FXR)-fibroblast growth factor 15(Fgf15)pathway was inhibited while hepatic FXR-small heterodimeric partner(SHP)pathway was activated in punicalagin group.Microbiota analysis and targeted metabolomics showed that punicalagin decreased the abundance of bile-salt hydrolase(BSH)-producing bacteria(Clostridiaceae and Bifidobacteriaceae)and the ratio of primary BAs to secondary BAs.In conclusion,the cholesterol-lowering effect of punicalagin partly through down-regulating cholesterol synthesis and increasing cholesterol catabolism,which could be achieved by regulating gut microbiota,altering bile acid composition and modulating FXR signaling pathway.These findings indicate the potential application of punicalagin-related products as an alternative strategy for hypercholesterolemia prevention and mitigation.展开更多
BACKGROUND Proximal bile duct injury(BDI),which often occurs after laparoscopic cholecystectomy(LC),can lead to complex biliary stricture and recurrent cholangitis.This case report presented a 39-year-old woman who ex...BACKGROUND Proximal bile duct injury(BDI),which often occurs after laparoscopic cholecystectomy(LC),can lead to complex biliary stricture and recurrent cholangitis.This case report presented a 39-year-old woman who experienced proximal BDI during LC in 2017,leading to multiple episodes of cholangitis and subsequent hepaticojejunostomy in 2018.Despite these interventions,persistent biliary complications necessitated repeated hospital admissions and antibiotic treatment.Imaging studies revealed persistent stricture at the site of hepaticojejunostomy,prompting a series of percutaneous procedures,including balloon dilatation and biliary drainage.In August 2024,she underwent biodegradable biliary stenting,which significantly improved her condition.Subsequently,she remained clinically stable for 5 months without further episodes of cholangitis and had improved liver function tests.This case highlighted the complexities of managing postinjury biliary stricture,underscored the potential of biodegradable stents as an effective treatment option,and emphasized the need for a multidisciplinary approach in managing such complications.Long-term follow-up is essential for monitoring treatment effectiveness and preventing recurrence.CASE SUMMARY A 39-year-old female had a routine LC in 2017.The patient sustained a proximal BDI during the surgery.In the months that followed,recurrent bouts of cholangitis occurred.A hepaticojejunostomy biliary reconstruction was performed in 2018.However,hepatic cholangitis persisted.In 2021 and 2022,MRCP scans revealed biliary stasis,duct dilation,and a stricture at the hepaticojejunostomy site.A subsequent percutaneous transhepatic cholangiography(PTC)confirmed these findings and led to drain placement.The treatment included internal and external biliary drain placements,repeated balloon dilations of the stricture,percutaneous transhepatic cholangioscopy to extract intrahepatic lithiasis,and insertion of a biodegradable biliary stent.Since the first PTC intervention,there have been no hospital admissions for cholangitis.Liver function tests showed improvement,and for five months following the biodegradable stenting,the condition remained stable.Long-term surveillance with regular imaging and blood work has been emphasized.The final diagnosis is recurrent biliary stricture secondary to proximal BDI.Treatment,including hepaticojejunostomy,repeated PTC with balloon dilation,and biodegradable biliary stenting,has led to complete drainage of the biliary system.Ongoing follow-up remains crucial for monitoring the patient's progress and maintaining their health.CONCLUSION This case demonstrated how strictures and recurrent cholangitis complicate the management of BDI after LC.A customized and multidisciplinary approach to control chronic biliary disease was proven effective,as shown by the patient’s good outcome.This was achieved by integrating balloon dilatation sessions,biliary drainage,stone clearing,and biodegradable stent placement.Long-term follow-up and continued monitoring remain essential to ensure patient stability and prevent further complications.展开更多
BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a ...BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a result of pancreaticobiliary reflux.Roux-en-Y choledochojejunostomy is a common surgical method for the treatment of PBM,but there are several associated complications that may occur after this operation.CASE SUMMARY The patient,a 12-year-old female,was hospitalized nearly 20 times in 2021 for recurrent acute pancreatitis.In 2022,she was diagnosed with PBM and underwent laparoscopic common bile duct resection and Roux-en-Y choledochojejunostomy in a tertiary hospital.In the first year after surgery,the patient had more than 10 recurrent acute pancreatitis episodes.After undergoing abdominal computed tomography and other examinations,she was diagnosed with“residual bile duct stones and recurrent acute pancreatitis”.On January 30,2024,the patient was admitted to our hospital due to recurrent upper abdominal pain and was cured through endoscopic retrograde cholangiopancreatography.CONCLUSION This article reports a case of a child with distal residual common bile duct stones and recurrent acute pancreatitis after Roux-en-Y choledochojejunostomy for PBM.The patient was cured through endoscopic retrograde cholangiopancreatography.展开更多
Knowledge of the etiological and pathogenetic mechanisms of the development of any disease is essential for its treatment.Because the cause of primary biliary cholangitis(PBC),a chronic,slowly progressive cholestatic ...Knowledge of the etiological and pathogenetic mechanisms of the development of any disease is essential for its treatment.Because the cause of primary biliary cholangitis(PBC),a chronic,slowly progressive cholestatic liver disease,is still unknown,treatment remains symptomatic.Knowledge of the physicochemical properties of various bile acids and the adaptive responses of cholangiocytes and hepatocytes to them has provided an important basis for the development of relatively effective drugs based on hydrophilic bile acids that can potentially slow the progression of the disease.Advances in the use of hydrophilic bile acids for the treatment of PBC are also associated with the discovery of pathogenetic mechanisms of the development of cholangiocyte damage and the appearance of the first signs of this disease.For 35 years,ursodeoxycholic acid(UDCA)has been the unique drug of choice for the treatment of patients with PBC.In recent years,the list of hydrophilic bile acids used to treat cholestatic liver diseases,including PBC,has expanded.In addition to UDCA,the use of obeticholic acid,tauroursodeoxycholic acid and norursodeoxycholic acid as drugs is discussed.The pathogenetic rationale for treatment of PBC with various bile acid drugs is discussed in this review.Emphasis is made on the mechanisms explaining the beneficial therapeutic effects and potential of each of the bile acid as a drug,based on the understanding of the pathogenesis of the initial stages of PBC.展开更多
Surgical intervention is currently the primary treatment for hepatolithiasis;how-ever,some patients still experience residual stones and high recurrence rates after surgery.Cholesterol metabolism seems to play an impo...Surgical intervention is currently the primary treatment for hepatolithiasis;how-ever,some patients still experience residual stones and high recurrence rates after surgery.Cholesterol metabolism seems to play an important role in hepatoli-thiasis pathogenesis.A high cholesterol diet is one of the significant reasons for the increasing incidence of hepatolithiasis.Therefore,regular diet and appropriate medical intervention are crucial measures to prevent hepatolithiasis and reduce recurrence rate after surgery.Reducing dietary cholesterol and drugs that increase cholesterol stone solubility are key therapeutic approaches in treating hepato-lithiasis.This article discusses the cholesterol metabolic pathways related to the pathogenesis of hepatolithiasis,as well as food intake and targeted therapeutic drugs.展开更多
BACKGROUND Bile spillage occurs more frequently in patients with incidental gallbladder carcinoma(iGBC)and may be associated with poor survival due to presumed high risk of peritoneal seeding.AIM To investigate the im...BACKGROUND Bile spillage occurs more frequently in patients with incidental gallbladder carcinoma(iGBC)and may be associated with poor survival due to presumed high risk of peritoneal seeding.AIM To investigate the impact of bile spillage during primary surgery on the survival of patients with iGBC.METHODS Medical records of patients with iGBC diagnosed between 2000 and 2019 in 27 Dutch secondary centers and 5 tertiary centers were retrospectively reviewed.Patient medical records were assessed.Predictors for overall survival(OS)were determined using multivariable Cox regression.RESULTS Of the 346 included patients with iGBC,138(39.9%)had bile spillage,which was associated with higher American Society of Anesthesiologists classification(P=0.020),cholecystitis(P<0.001),higher tumor stage(P=0.005),and non-radical resection(P<0.001).Bile spillage was associated with poor OS[hazard ratio=1.97,95%confidence interval(CI):1.48-2.63,P<0.001]with a median OS of 12 months(95%CI:7-18 months)vs 34 months(95%CI:14-55 months,P<0.001).In multivariable analysis,spillage was not an independent prognostic factor for survival(hazard ratio=1.21,95%CI:0.84-1.74,P=0.313).CONCLUSION Although bile spillage correlates with prognostic factors,it lacks independent prognostic significance for survival.Patients with an indication for additional treatment should be promptly referred to a specialized hepatopancreatobiliary center,irrespective of whether bile spillage has occurred.展开更多
BACKGROUND At present,there are few studies on the risk factors for bile leakage after laparoscopic common bile duct exploration(LCBDE)for older patients with choledocholithiasis.AIM To identify the potential risk fac...BACKGROUND At present,there are few studies on the risk factors for bile leakage after laparoscopic common bile duct exploration(LCBDE)for older patients with choledocholithiasis.AIM To identify the potential risk factors for bile leakage after LCBDE in older patients.METHODS A retrospective,single-center observational analysis was performed on patients aged≥70 years with choledocholithiasis treated by LCBDE who were admitted to our center between January 2011 and August 2022.The included patients were divided into non-bile leakage and bile leakage groups.Risk factors were determined by analyzing the observation indicators.RESULTS Seventy older patients with choledocholithiasis who underwent LCBDE were included.Univariate analysis showed that positive culture of bile bacteria was a risk factor for bile leakage after LCBDE(P<0.05).We further analyzed the bile bacteria,and univariate analysis showed that Enterococcus faecalis(E.faecalis)(P<0.05)and Pseudomonas aeruginosa(P<0.05)were associated with an increased risk of postoperative bile leakage in older patients(P<0.05).Multivariate analysis showed that E. faecalis was an independent risk factor for postoperative bile leakage in older patients (P < 0.05). Theresults of antibiotic sensitivity analysis showed that E. faecalis had 100% susceptibility to penicillin, ampicillin,linezolid, vancomycin, and furantoin.CONCLUSIONE. faecalis-associated biliary tract infection is an independent risk factor for bile leakage after LCBDE in olderpatients with choledocholithiasis. We suggest coverage with antibiotics to which E. faecalis is sensitive.展开更多
BACKGROUND Barrett esophagus(BE),a metaplastic adaptive process to gastrointestinal reflux,is associated with a higher risk of developing esophageal adenocarcinoma.However,the factors and mechanism that drive the mali...BACKGROUND Barrett esophagus(BE),a metaplastic adaptive process to gastrointestinal reflux,is associated with a higher risk of developing esophageal adenocarcinoma.However,the factors and mechanism that drive the malignant progression of BE is not well understood.AIM To investigate the role of bile acids,a component of the reflux fluid,in the malignant progression of BE.METHODS Using engineered green fluorescent protein-labeled adult tissue-resident stem cells isolated from BE clinical biopsies(BE-ASCs)as the target,we studied the effect of hydrophobic deoxycholic acid(DCA)and hydrophilic tetrahydroxylated bile acids(THBA)on cell viability by fluorescence intensity analysis,mucin production by dark density measurement,tissue structure by pathology analysis,expression of different pro-inflammatory factors gene by quantitative polymerase chain reaction and proteins by Western blot.RESULTS We found that hydrophobic DCA has cytotoxic and proinflammatory effects through activation of interleukin-1β(IL-1β)-nuclear factor kappa-B(NF-κB)inflammatory pathway on BE-ASCs.This action results in impaired cell viability,tissue intactness,reduced mucin production,and increased transition to disorganized atypical cells without intestinal features.In contrast,co-culture with hydrophilic THBA inhibited the IL-1β-NF-κB inflammatory pathway with maintenance of mature intestinal type cellular and histomorphology.CONCLUSION Our data indicates that the hydrophilic bile acid THBA can counteract the cytotoxic and proinflammatory effect of hydrophobic DCA and prevent the malignant progression of BE by inhibiting the IL-1β-NF-κB pathway.展开更多
BACKGROUND Complex hepatolithiasis has a high perioperative risk and recurrence rate.Currently,standardized treatment protocols and reliable anatomical landmarks remain undefined,posing considerable challenges for lap...BACKGROUND Complex hepatolithiasis has a high perioperative risk and recurrence rate.Currently,standardized treatment protocols and reliable anatomical landmarks remain undefined,posing considerable challenges for laparoscopic hepatectomy in these cases.Achieving complete stone clearance and addressing hilar bile duct stenosis are critical determinants of surgical efficacy in hepatolithiasis management.CASE SUMMARY We present the case of a woman with intrahepatic and extrahepatic bile duct stones and chronic cholangitis who underwent laparoscopic hepatectomy.Hepatic segments I,II,III,IV,VI,and VII of the diseased bile duct tree and bile duct cyst were resected according to the preoperative plan,plastic repair of the hilar bile duct was performed,and the repaired bile duct was anastomosed with the jejunum.The patient achieved a favorable prognosis and long-term survival.CONCLUSION Based on segmental/subsegmental diseased bile duct tree territory hepatectomy and hilar stenosis relief,laparoscopic hepatectomy for complex hepatolithiasis can be safely performed guided by double landmarks(diseased bile duct/hepatic vein).展开更多
BACKGROUND The pathogenesis of hepatic encephalopathy(HE)remains unclear,and the classical theory of ammonia toxicity lacks sufficient justification.AIM To investigate the potential of bile acids as intervention targe...BACKGROUND The pathogenesis of hepatic encephalopathy(HE)remains unclear,and the classical theory of ammonia toxicity lacks sufficient justification.AIM To investigate the potential of bile acids as intervention targets for HE.METHODS This study employed 42 wild-type male SD rats weighing 200±20 g.Using a random number table method,two rats were randomly selected to undergo common bile duct ligation(BDL).The remaining 40 rats were randomly assigned to four groups serving as controls:The vehicle+control diet(VC)group,the thioacetamide(TAA)group,the TAA+total bile acids(TAAT)group,and the TAA+cholestyramine(TAAC)group.Except for the VC group,all rats were intraperitoneally injected with 100 mg/kg TAA solution once daily for ten consecutive days to establish a HE model.Simultaneously,the TAAT and TAAC groups were administered a diet containing 0.3%bile acids(derived from BDL rats)and 2%cholestyramine,respectively,by gavage for ten days.For the BDL rat model group,the common BDL procedure was performed following the aforementioned protocol.After four weeks,laparotomy revealed swollen bile ducts at the ligation site,and bile was collected.Following successful modeling,behavioral tests,including the elevated plus maze and open field test,were conducted to assess the HE status of the rats.Peripheral blood,liver,and cerebral cortex tissue samples were collected,and the total bile acid content in the serum and cerebral cortex was measured using an enzyme cycling method.The levels of inflammatory factors in the serum and cerebral cortex were analyzed using enzyme-linked immunosorbent assay.Liver histological examination was performed using the hematoxylin-eosin double-labeling method.Reverse transcription polymerase chain reaction,western blot,immunohistochemistry,and other techniques were employed to observe the expression of microglial activation marker ionized calcium-binding adaptor molecule-1 and Takeda G protein-coupled receptor 5(TGR5)protein.RESULTS Compared to the VC group,the TAA group exhibited an exacerbation of HE in rats.The total bile acid content,proinflammatory factors[interleukin-1β(IL-1β),IL-6],and the anti-inflammatory factor IL-10 in both the serum and cerebral cortex were significantly elevated.Similarly,the expression of the TGR5 receptor in the cerebral cortex was upregulated.To investigate the impact of total bile acids on HE in rats,comparisons were made with the TAA group.In the TAAT group,the severity of HE was further aggravated,accompanied by increased total bile acid content in the serum and cerebral cortex,elevated pro-inflammatory factors(IL-1β,IL-6),reduced levels of the antiinflammatory factor IL-10,and decreased expression of the TGR5 receptor in the cerebral cortex.In the TAAC group,the severity of HE was alleviated.This group showed reductions in total bile acid content in the serum and cerebral cortex,decreased pro-inflammatory factors(IL-1β,IL-6),increased levels of the anti-inflammatory factor IL-10,and enhanced expression of the TGR5 receptor in the cerebral cortex.CONCLUSION This study demonstrated that the total bile acid content in the serum and cerebral cortex of TAA-induced liver cirrhosis rats was elevated.Furthermore,total bile acids exacerbate the progression of HE in rats.This effect may be attributed to bile acids’involvement in the development of neurological dysfunction by mediating TGR5 expression and regulating neuroinflammation.展开更多
BACKGROUND Laparoscopic cholecystectomy(LC)and laparoscopic common bile duct exploration(LCBDE)are widely used in gallbladder and biliary tract diseases.During these procedures,vessels or tissues are commonly ligated ...BACKGROUND Laparoscopic cholecystectomy(LC)and laparoscopic common bile duct exploration(LCBDE)are widely used in gallbladder and biliary tract diseases.During these procedures,vessels or tissues are commonly ligated using clips.However,postoperative migration of clips to the common bile duct(CBD)or Ttube sinus tract is an overlooked complication of laparoscopic biliary surgery.Previously,most reported cases of postoperative clip migration involved metal clips,with only a few cases involving Hem-o-lok clips and review of the literature.CASE SUMMARY This report describes two cases in which Hem-o-lok clips migrated into the CBD and the T-tube sinus tract following laparoscopic surgery.Case 1 is a 68-year-old female admitted due to abdominal discomfort,and two Hem-o-lok clips were found to have migrated into the CBD 17 months after LC and LCBDE with T-tube drainage,and were removed using a stone extraction balloon.The patient was discharged smoothly after recovery.Case 2 is a 74-year-old male who underwent LC and LCBDE with T-tube drainage and laparoscopic biliary tract basket stone extraction.Nine weeks postoperatively,following T-tube removal,a Hem-o-lok clip was found in the sinus tract,and was extracted from the T-tube sinus tract.The patient recovered smoothly postoperatively.This study also reviews the literature from 2013 to July 2024 on using Hem-o-lok clips in LC and/or LCBDE treatment of gallbladder and biliary diseases and the postoperative migration of these clips into the CBD,T-tube sinus tract,or duodenum.CONCLUSION In patients with a history of LC and/or LCBDE,clip migration should be considered as a differential diagnosis.展开更多
1.Introduction Many abdominopelvic surgeries are now performed laparoscopically rather than through open approaches.This trend continued despite reports of increased rates of unintended complications,such as bile duct...1.Introduction Many abdominopelvic surgeries are now performed laparoscopically rather than through open approaches.This trend continued despite reports of increased rates of unintended complications,such as bile duct injuries during cholecystectomy,in the early phase of laparoscopic adoption^([1,2]).展开更多
BACKGROUND Intraoperative and postoperative biliary injuries remain significant complications of laparoscopic common bile duct exploration(LCBDE).Indocyanine green(ICG)has been shown to significantly reduce injuries c...BACKGROUND Intraoperative and postoperative biliary injuries remain significant complications of laparoscopic common bile duct exploration(LCBDE).Indocyanine green(ICG)has been shown to significantly reduce injuries caused by intraoperative operational errors.We found that the J-tube can reduce postoperative strictures and injuries to the common bile duct.At this moment,we aim to analyze and compare the complications,efficacy,short-term outcomes,and feasibility of these two adjunctive tools for LCBDE.AIM To evaluate the efficacy of ICG fluorescence imaging In LCBDE and J-tube drainage for patients with common bile duct stones.METHODS We retrospectively collected the clinical case data of patients who were treated at the Hepatobiliary Surgery Department of the Third People’s Hospital of Nantong,affiliated with Nantong University,from January 2016 to January 2021 due to gallbladder stones with choledocholithiasis and who underwent LCBDE combined with a primary suture and either J-tube or T-tube drainage.The patients were divided into groups:Traditional white-light laparoscopy+T-tube group(WL+T-tube),traditional WL+J-tube group,fluorescent laparoscopy+T-tube group(ICG+T-tube)and fluorescent laparoscopy+J-tube group(ICG+J-tube).The preoperative and postoperative clinical case data,laboratory examination data,and intraoperative and postoperative complications(including postoperative bile leakage,electrolyte disturbances,biliary peritonitis,and postoperative infections)and other relevant indicators were compared.RESULTS A total of 198 patients(112 males and 86 females)were included in the study,with 74 patients in the WL+T-tube,47 in the WL+J-tube,42 in the ICG+T-tube,and 35 in the ICG+J-tube.Compared with the other groups,the ICG+J had significantly shorter operation time(114 minutes,P=0.001),less blood loss(42 mL,P=0.02),shorter postoperative hospital stays(7 days,P=0.038),and lower surgical costs(China yuan 30178,P=0.001).Furthermore,patients were subdivided into two groups based on whether a T-tube or J-tube was placed during the surgery.By the third postoperative day,the aspartate transaminase,glutamic pyruvic transaminase,total bilirubin,and direct bilirubin levels were lower in the J-tube group than in the T-tube group(P<0.001).At last,follow-up observations showed that the incidence of biliary strictures at three months postoperatively was significantly lower in the J-tube group than in the T-tube group(P=0.002).CONCLUSION ICG fluorescence imaging in laparoscopic cholecystectomy with common bile duct exploration and J-tube drainage facilitates rapid identification of biliary anatomy and variations,reducing intraoperative bile duct injury,blood loss,surgery duration,and postoperative bile duct stenosis rates,supporting its clinical adoption.展开更多
The liver is a central metabolic organ that regulates numerous physiological processes,including glucose and lipid metabolism,detoxification,and the synthesis of essential proteins and bile.Bile acids(BAs),synthesized...The liver is a central metabolic organ that regulates numerous physiological processes,including glucose and lipid metabolism,detoxification,and the synthesis of essential proteins and bile.Bile acids(BAs),synthesized from cholesterol in hepatocytes,not only facilitate the emulsification and absorption of dietary fats but also act as potent signaling molecules through receptors such as the farnesoid X receptor(FXR)and Takeda G-protein-coupled receptor 5.Metabolic dysfunction-associated steatotic liver disease(MASLD)is a leading cause of chronic liver disease globally,closely linked with obesity,insulin resis-tance,and other components of metabolic syndrome.In MASLD,the metabolism of BAs is markedly disrupted,resulting in alterations in their synthesis,compo-sition,and signaling activity.These changes contribute to hepatic steatosis,inflammation,and fibrosis,thereby exacerbating metabolic dysfunction and liver damage.The altered profiles and signaling activity of BAs in MASLD patients suggest that BAs act not only as biomarkers of disease severity,but also as active mediators of its pathogenesis.Modulators of BA signaling pathways,especially FXR agonists,are the focus of intense research for their potential to beneficially influence liver steatosis and inflammation in MASLD.Recent research has yielded promising results,indicating potential therapeutic application and the introduction of novel agents aimed at modulating BA homeostasis and function.This minireview outlines the physiological roles of BAs,seeks to advance the elucidation of the mechanisms by which their dysregulation contributes to MASLD progression,and highlights current and emerging therapeutic approa-ches.A deeper understanding of these complex interactions is essential for improving the diagnosis,prognosis and treatment of MASLD.展开更多
BACKGROUND Bile leakage is a common complication following laparoscopic common bile duct exploration(LCBDE)with primary duct closure(PDC).Identifying and analyzing the risk factors associated with bile leakage is cruc...BACKGROUND Bile leakage is a common complication following laparoscopic common bile duct exploration(LCBDE)with primary duct closure(PDC).Identifying and analyzing the risk factors associated with bile leakage is crucial for improving surgical outcomes.AIM To explore the value analysis of common risk factors for bile leakage after LCBDE and PDC,with a focus on strict adherence to indications.METHODS Clinical data of 106 cases undergoing LCBDE+PDC in the Hepatobiliary and Pancreatic Surgery Department(Division 1)of Chuzhou First People’s Hospital from April 2019 to March 2024 were collected.Retrospective and multiple factor regression analysis were conducted on common risk factors for bile leakage.The change in surgical time was analyzed using the cumulative summation(CUSUM)method,and the minimum number of cases required to complete the learning curve for PDC was obtained based on the proposed fitting curve by identifying the CUSUM maximum value.RESULTS Multifactor logistic regression analysis showed that fibrinous inflammation and direct bilirubin/indirect bilirubin were significant independent high-risk factors for postoperative bile leakage(P<0.05).The time to drain removal and length of hospital stay in cases without bile leakage were significantly shorter than in cases with bile leakage(P<0.05),with statistical significance.The CUSUM method indicated that a minimum of 51 cases were required for the surgeon to complete the learning curve(P=0.023).CONCLUSION With a good assessment of duodenal papilla sphincter function,unobstructed bile-pancreatic duct convergence,exact stone clearance,and sufficient surgical experience to complete the learning curve,PDC remains the preferred method for bile duct closure and is worthy of clinical promotion.展开更多
The gut microbiome comprises a vast community of microbes inhabiting the human alimentary canal,playing a crucial role in various physiological functions.These microbes generally live in harmony with the host;however,...The gut microbiome comprises a vast community of microbes inhabiting the human alimentary canal,playing a crucial role in various physiological functions.These microbes generally live in harmony with the host;however,when dysbiosis occurs,it can contribute to the pathogenesis of diseases,including osteoporosis.Osteoporosis,a systemic skeletal disease characterized by reduced bone mass and increased fracture risk,has attracted significant research attention concerning the role of gut microbes in its development.Advances in molecular biology have highlighted the influence of gut microbiota on osteoporosis through mechanisms involving immunoregulation,modulation of the gut-brain axis,and regulation of the intestinal barrier and nutrient absorption.These microbes can enhance bone mass by inhibiting osteoclast differentiation,inducing apoptosis,reducing bone resorption,and promoting osteoblast proliferation and maturation.Despite these promising findings,the therapeutic effectiveness of targeting gut microbes in osteoporosis requires further investigation.Notably,gut microbiota has been increasingly studied for their potential in early diagnosis,intervention,and as an adjunct therapy for osteoporosis,suggesting a growing utility in improving bone health.Further research is essential to fully elucidate the therapeutic potential and clinical application of gut microbiome modulation in the management of osteoporosis.展开更多
Bile reflux gastritis (BRG) is a gastro-intestinal condition especially characterized by the reflux of bile into the stomach, further leading to mucosal inflammation along with various other clinical manifestations. D...Bile reflux gastritis (BRG) is a gastro-intestinal condition especially characterized by the reflux of bile into the stomach, further leading to mucosal inflammation along with various other clinical manifestations. Despite its increasing recognition, BRG remains understudied, with limited understanding of its epidemiology, pathophysiology, and optimal therapeutic strategies. Present narrative review aimed to comprehensively examine the available literature on BRG, focusing on its prevalence, risk factors, pathophysiology, clinical presentation, diagnostic modalities, and available therapeutic strategies. A comprehensive literature search was conducted using PubMed, Embase, Google Scholar and Cochrane databases. Relevant studies were included based on predefined inclusion and exclusion criteria. A narrative synthesis was conducted to summarize and interpret the findings. The prevalence of BRG remains uncertain due to diagnostic challenges. Risk factors include impaired gastrointestinal motility, sphincteric dysfunction (pyloric sphincter and the lower oesophageal sphincter), biliary tract disease, and certain medications. The pathophysiology involves bile acid-induced mucosal injury, inflammation, and impaired gastric defence mechanisms. Clinical manifestations are often nonspecific. Diagnostic modalities primarily include endoscopy and bile acid reflux testing. Management strategies encompass lifestyle modifications, medical therapy, and in severe cases, surgery. BRG is a complex condition with significant clinical implications. Further research is needed to refine diagnostic criteria, elucidate pathophysiological mechanisms, and develop effective therapeutic interventions. Addressing knowledge gaps in epidemiology, risk factors, and long-term outcomes is crucial for improving patient care.展开更多
文摘Objective:To investigate the therapeutic effect of Biling Weitong Granules combined with oryz-aspergillus enzyme and pancreatin tablets on patients with reflux esophagitis with functional dyspepsia.Methods:Sixty patients diagnosed with reflux esophagitis with functional dyspepsia who were admitted to the Affiliated Hospital of Hebei University between June 2020 and June 2023 were selected and divided into two groups:the control group and the observation group,each consisting of 30 cases.The control group received oryz-aspergillus enzyme and pancreatin tablets only,while the observation group received Biling Weitong Granules in addition to the tablets.The clinical efficacy,Chinese medicine syndrome points,esophageal kinetic indexes,gastrointestinal hormone levels,and therapeutic safety of both groups were evaluated.Results:The total efficiency of the observation group reached 93.33%,significantly higher than the 73.33%of the control group(P<0.05).After treatment,patients in the observation group exhibited significantly lower scores for Chinese medicine symptoms such as early satiety,belching,abdominal distension,abdominal pain,and loss of appetite compared to the control group(P<0.05).Furthermore,the observation group showed significantly higher upper esophageal sphincter pressure,lower esophageal sphincter pressure,and distal esophageal contraction scores compared to the control group(P<0.05).Additionally,levels of gastric motility hormone,vasoactive intestinal peptide,and gastrin were significantly higher in the observation group compared to the control group(P<0.05).Throughout the treatment period,there was no significant difference in the incidence of adverse reactions between the two groups,indicating comparable safety of the two treatment modalities(P>0.05).Conclusion:The combination of Biling Weitong Granules with oryz-aspergillus enzyme and pancreatin tablets demonstrates significant efficacy in the treatment of reflux esophagitis with functional dyspepsia,with a better safety profile.This finding warrants further clinical promotion.
基金This research was funded by the Baoding Science and Technology Plan Project management(2341ZF318)。
文摘Objective:To analyze the effectiveness of Biling Weitong Granules(BLWTG)combined with trimethoprim and vonoprazan in treating reflux esophagitis.Methods:Sixty patients with reflux esophagitis admitted to our hospital from March 2020 to March 2023 were selected as study subjects and randomly divided into a control group and an experimental group,with 30 cases in each group.The control group received only the combination treatment of trimethoprim and vonoprazan,while the experimental group was treated with BLWTG based on the control group.The acid reflux and heartburn symptom scores,quality-of-life scores,clinical efficacy,Chinese medicine symptom incidences,and the occurrence of adverse reactions before and after treatment in the two groups were compared.Results:After treatment,the acid reflux and heartburn symptom scores of patients in the experimental group were lower than those of the treatment control group,and the quality-of-life scores were higher than those of the treatment control group(P<0.05).The total clinical efficacy of the experimental group was 96.66%,which was significantly higher than that of the control group(73.33%,P<0.05).After treatment,the incidence of Chinese medicine symptoms,such as nausea and vomiting,abdominal distension and abdominal pain,and loss of appetite of the patients in the experimental group were significantly lower than those of the control group(P<0.05).During the treatment period,there was no significant difference in the incidence of adverse reactions between the two groups,which indicated that the safety of the two treatments was comparable(P>0.05).Conclusion:BLWTG combined with trimethoprim and vonoprazan was safe and reliable in treating reflux esophagitis,effectively relieving the symptoms and improving its clinical efficacy.This treatment is worthy of popularization.
基金National New Drug Innovation Program,No.2017ZX09304003Special Research on Modernization of Traditional Chinese Medicine in the National Key Research and Development Program in the 13th Five-Year Plan Demonstrative Research,No.2017YFC1703703.Institutional review board statement:This study was approved by the IRB of Xiyuan Hospital of China Academy of Chinese Medical Sciences(No.2016XL011).
文摘BACKGROUND Recent research suggests that although prokinetic agents,acid suppressors,and radical treatment for Helicobacter pylori infection may be effective in patients with functional dyspepsia(FD),a large proportion of patients still fail to respond to these treatments or may suffer from severe adverse reactions.Many traditional Chinese medicinal herbs can regulate the status of the entire body and have special advantages in the treatment of functional diseases.The present study was designed to verify the efficacy of Biling Weitong Granules(BLWTG),a traditional Chinese medicinal herbal compound formula,in alleviating epigastric pain syndrome(EPS)in FD patients,in an attempt to provide an effective prescription for the clinical treatment of this disease.AIM To evaluate the clinical efficacy and safety of BLWTG in treating EPS in patients with FD.METHODS In this multicenter,stratified,randomized,double-blind,placebo-controlled,parallel group clinical trial,eligible patients were randomized into the BLWTG and placebo groups who were treated for 6 wk.Efficacy indicators including the severity and frequency of EPS and the time to pain resolution and safety indicators including adverse events were observed and compared.RESULTS The baseline demographic data and clinical characteristics,such as epigastric pain symptoms,pain intensity,and frequency of attacks,were matched between the two groups before randomization.After 6 wk of treatment and after the center effect was eliminated,the epigastric pain was significantly improved in 28.33%and 85.59%of the patients in the placebo and BLWTG groups,respectively(P<0.05).At 6 wk,the resolution rate of epigastric pain was 15%and 69.49%in the placebo and BLWTG groups,respectively(P<0.05).The differences of total FD clinical score between these two groups were significant(P<0.05)at 2,4,and 6 wk(P<0.05).The scores of each item and the total score in the Functional Digestive Disorders Quality of Life Questionnaire showed significant differences between the two groups at 6 wk after both the center and interaction effects were eliminated(P<0.05).There was no significant difference in the incidence of adverse events between the two groups,and no serious adverse event was noted during the observation.CONCLUSION Compared with placebo,BLWTG markedly improved EPS in FD patients without causing serious adverse reactions.
基金supported in part by the National Key Research and Development Program of China(2022YFD2100104)the Science and Technology Program of Shaanxi Province,China(2022JM-111)Graduate Innovation Fund of Dalian Polytechnic University。
文摘Punicalagin has been demonstrated to exhibit anti-oxidant and anti-inflammatory properties,but whether and how it could impact hypercholesterolemia remains not fully explored.The aim of this study was to investigate the influence of punicalagin on hypercholesterolemia in mice and its related mechanisms.After 6 weeks'intervention,punicalagin significantly reduced serum total cholesterol and low-density lipoprotein cholesterol(LDL-C)levels in mice fed a high-fat high-cholesterol(HFHC)diet.Meanwhile,punicalagin supplementation lowered hepatic cholesterol level,which corresponded to the down-regulation of cholesterol synthesis genes(Fdps,Cyp51)and up-regulated bile acid synthesis genes(Cyp7a1,Cyp27a1).In addition,bile acid reabsorption was retarded in punicalagin-fed mice through down-regulating ileal apical sodium-dependent BA transporter(ASBT).Furthermore,intestinal farnesoid X receptor(FXR)-fibroblast growth factor 15(Fgf15)pathway was inhibited while hepatic FXR-small heterodimeric partner(SHP)pathway was activated in punicalagin group.Microbiota analysis and targeted metabolomics showed that punicalagin decreased the abundance of bile-salt hydrolase(BSH)-producing bacteria(Clostridiaceae and Bifidobacteriaceae)and the ratio of primary BAs to secondary BAs.In conclusion,the cholesterol-lowering effect of punicalagin partly through down-regulating cholesterol synthesis and increasing cholesterol catabolism,which could be achieved by regulating gut microbiota,altering bile acid composition and modulating FXR signaling pathway.These findings indicate the potential application of punicalagin-related products as an alternative strategy for hypercholesterolemia prevention and mitigation.
文摘BACKGROUND Proximal bile duct injury(BDI),which often occurs after laparoscopic cholecystectomy(LC),can lead to complex biliary stricture and recurrent cholangitis.This case report presented a 39-year-old woman who experienced proximal BDI during LC in 2017,leading to multiple episodes of cholangitis and subsequent hepaticojejunostomy in 2018.Despite these interventions,persistent biliary complications necessitated repeated hospital admissions and antibiotic treatment.Imaging studies revealed persistent stricture at the site of hepaticojejunostomy,prompting a series of percutaneous procedures,including balloon dilatation and biliary drainage.In August 2024,she underwent biodegradable biliary stenting,which significantly improved her condition.Subsequently,she remained clinically stable for 5 months without further episodes of cholangitis and had improved liver function tests.This case highlighted the complexities of managing postinjury biliary stricture,underscored the potential of biodegradable stents as an effective treatment option,and emphasized the need for a multidisciplinary approach in managing such complications.Long-term follow-up is essential for monitoring treatment effectiveness and preventing recurrence.CASE SUMMARY A 39-year-old female had a routine LC in 2017.The patient sustained a proximal BDI during the surgery.In the months that followed,recurrent bouts of cholangitis occurred.A hepaticojejunostomy biliary reconstruction was performed in 2018.However,hepatic cholangitis persisted.In 2021 and 2022,MRCP scans revealed biliary stasis,duct dilation,and a stricture at the hepaticojejunostomy site.A subsequent percutaneous transhepatic cholangiography(PTC)confirmed these findings and led to drain placement.The treatment included internal and external biliary drain placements,repeated balloon dilations of the stricture,percutaneous transhepatic cholangioscopy to extract intrahepatic lithiasis,and insertion of a biodegradable biliary stent.Since the first PTC intervention,there have been no hospital admissions for cholangitis.Liver function tests showed improvement,and for five months following the biodegradable stenting,the condition remained stable.Long-term surveillance with regular imaging and blood work has been emphasized.The final diagnosis is recurrent biliary stricture secondary to proximal BDI.Treatment,including hepaticojejunostomy,repeated PTC with balloon dilation,and biodegradable biliary stenting,has led to complete drainage of the biliary system.Ongoing follow-up remains crucial for monitoring the patient's progress and maintaining their health.CONCLUSION This case demonstrated how strictures and recurrent cholangitis complicate the management of BDI after LC.A customized and multidisciplinary approach to control chronic biliary disease was proven effective,as shown by the patient’s good outcome.This was achieved by integrating balloon dilatation sessions,biliary drainage,stone clearing,and biodegradable stent placement.Long-term follow-up and continued monitoring remain essential to ensure patient stability and prevent further complications.
文摘BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a result of pancreaticobiliary reflux.Roux-en-Y choledochojejunostomy is a common surgical method for the treatment of PBM,but there are several associated complications that may occur after this operation.CASE SUMMARY The patient,a 12-year-old female,was hospitalized nearly 20 times in 2021 for recurrent acute pancreatitis.In 2022,she was diagnosed with PBM and underwent laparoscopic common bile duct resection and Roux-en-Y choledochojejunostomy in a tertiary hospital.In the first year after surgery,the patient had more than 10 recurrent acute pancreatitis episodes.After undergoing abdominal computed tomography and other examinations,she was diagnosed with“residual bile duct stones and recurrent acute pancreatitis”.On January 30,2024,the patient was admitted to our hospital due to recurrent upper abdominal pain and was cured through endoscopic retrograde cholangiopancreatography.CONCLUSION This article reports a case of a child with distal residual common bile duct stones and recurrent acute pancreatitis after Roux-en-Y choledochojejunostomy for PBM.The patient was cured through endoscopic retrograde cholangiopancreatography.
文摘Knowledge of the etiological and pathogenetic mechanisms of the development of any disease is essential for its treatment.Because the cause of primary biliary cholangitis(PBC),a chronic,slowly progressive cholestatic liver disease,is still unknown,treatment remains symptomatic.Knowledge of the physicochemical properties of various bile acids and the adaptive responses of cholangiocytes and hepatocytes to them has provided an important basis for the development of relatively effective drugs based on hydrophilic bile acids that can potentially slow the progression of the disease.Advances in the use of hydrophilic bile acids for the treatment of PBC are also associated with the discovery of pathogenetic mechanisms of the development of cholangiocyte damage and the appearance of the first signs of this disease.For 35 years,ursodeoxycholic acid(UDCA)has been the unique drug of choice for the treatment of patients with PBC.In recent years,the list of hydrophilic bile acids used to treat cholestatic liver diseases,including PBC,has expanded.In addition to UDCA,the use of obeticholic acid,tauroursodeoxycholic acid and norursodeoxycholic acid as drugs is discussed.The pathogenetic rationale for treatment of PBC with various bile acid drugs is discussed in this review.Emphasis is made on the mechanisms explaining the beneficial therapeutic effects and potential of each of the bile acid as a drug,based on the understanding of the pathogenesis of the initial stages of PBC.
基金Supported by Hebei Natural Science Foundation,No.H2022206539Hebei Provincial Government Funded Clinical Talents Training Project,No.ZF2023143.
文摘Surgical intervention is currently the primary treatment for hepatolithiasis;how-ever,some patients still experience residual stones and high recurrence rates after surgery.Cholesterol metabolism seems to play an important role in hepatoli-thiasis pathogenesis.A high cholesterol diet is one of the significant reasons for the increasing incidence of hepatolithiasis.Therefore,regular diet and appropriate medical intervention are crucial measures to prevent hepatolithiasis and reduce recurrence rate after surgery.Reducing dietary cholesterol and drugs that increase cholesterol stone solubility are key therapeutic approaches in treating hepato-lithiasis.This article discusses the cholesterol metabolic pathways related to the pathogenesis of hepatolithiasis,as well as food intake and targeted therapeutic drugs.
文摘BACKGROUND Bile spillage occurs more frequently in patients with incidental gallbladder carcinoma(iGBC)and may be associated with poor survival due to presumed high risk of peritoneal seeding.AIM To investigate the impact of bile spillage during primary surgery on the survival of patients with iGBC.METHODS Medical records of patients with iGBC diagnosed between 2000 and 2019 in 27 Dutch secondary centers and 5 tertiary centers were retrospectively reviewed.Patient medical records were assessed.Predictors for overall survival(OS)were determined using multivariable Cox regression.RESULTS Of the 346 included patients with iGBC,138(39.9%)had bile spillage,which was associated with higher American Society of Anesthesiologists classification(P=0.020),cholecystitis(P<0.001),higher tumor stage(P=0.005),and non-radical resection(P<0.001).Bile spillage was associated with poor OS[hazard ratio=1.97,95%confidence interval(CI):1.48-2.63,P<0.001]with a median OS of 12 months(95%CI:7-18 months)vs 34 months(95%CI:14-55 months,P<0.001).In multivariable analysis,spillage was not an independent prognostic factor for survival(hazard ratio=1.21,95%CI:0.84-1.74,P=0.313).CONCLUSION Although bile spillage correlates with prognostic factors,it lacks independent prognostic significance for survival.Patients with an indication for additional treatment should be promptly referred to a specialized hepatopancreatobiliary center,irrespective of whether bile spillage has occurred.
基金Supported by the Ke Qiao Science and Technology Plan Projects,No.2022KZ70.
文摘BACKGROUND At present,there are few studies on the risk factors for bile leakage after laparoscopic common bile duct exploration(LCBDE)for older patients with choledocholithiasis.AIM To identify the potential risk factors for bile leakage after LCBDE in older patients.METHODS A retrospective,single-center observational analysis was performed on patients aged≥70 years with choledocholithiasis treated by LCBDE who were admitted to our center between January 2011 and August 2022.The included patients were divided into non-bile leakage and bile leakage groups.Risk factors were determined by analyzing the observation indicators.RESULTS Seventy older patients with choledocholithiasis who underwent LCBDE were included.Univariate analysis showed that positive culture of bile bacteria was a risk factor for bile leakage after LCBDE(P<0.05).We further analyzed the bile bacteria,and univariate analysis showed that Enterococcus faecalis(E.faecalis)(P<0.05)and Pseudomonas aeruginosa(P<0.05)were associated with an increased risk of postoperative bile leakage in older patients(P<0.05).Multivariate analysis showed that E. faecalis was an independent risk factor for postoperative bile leakage in older patients (P < 0.05). Theresults of antibiotic sensitivity analysis showed that E. faecalis had 100% susceptibility to penicillin, ampicillin,linezolid, vancomycin, and furantoin.CONCLUSIONE. faecalis-associated biliary tract infection is an independent risk factor for bile leakage after LCBDE in olderpatients with choledocholithiasis. We suggest coverage with antibiotics to which E. faecalis is sensitive.
文摘BACKGROUND Barrett esophagus(BE),a metaplastic adaptive process to gastrointestinal reflux,is associated with a higher risk of developing esophageal adenocarcinoma.However,the factors and mechanism that drive the malignant progression of BE is not well understood.AIM To investigate the role of bile acids,a component of the reflux fluid,in the malignant progression of BE.METHODS Using engineered green fluorescent protein-labeled adult tissue-resident stem cells isolated from BE clinical biopsies(BE-ASCs)as the target,we studied the effect of hydrophobic deoxycholic acid(DCA)and hydrophilic tetrahydroxylated bile acids(THBA)on cell viability by fluorescence intensity analysis,mucin production by dark density measurement,tissue structure by pathology analysis,expression of different pro-inflammatory factors gene by quantitative polymerase chain reaction and proteins by Western blot.RESULTS We found that hydrophobic DCA has cytotoxic and proinflammatory effects through activation of interleukin-1β(IL-1β)-nuclear factor kappa-B(NF-κB)inflammatory pathway on BE-ASCs.This action results in impaired cell viability,tissue intactness,reduced mucin production,and increased transition to disorganized atypical cells without intestinal features.In contrast,co-culture with hydrophilic THBA inhibited the IL-1β-NF-κB inflammatory pathway with maintenance of mature intestinal type cellular and histomorphology.CONCLUSION Our data indicates that the hydrophilic bile acid THBA can counteract the cytotoxic and proinflammatory effect of hydrophobic DCA and prevent the malignant progression of BE by inhibiting the IL-1β-NF-κB pathway.
基金Supported by Education Project of Yunnan Province,No.2024J1628and Project of Qujing Medical College in 2024,No.2024XQ002.
文摘BACKGROUND Complex hepatolithiasis has a high perioperative risk and recurrence rate.Currently,standardized treatment protocols and reliable anatomical landmarks remain undefined,posing considerable challenges for laparoscopic hepatectomy in these cases.Achieving complete stone clearance and addressing hilar bile duct stenosis are critical determinants of surgical efficacy in hepatolithiasis management.CASE SUMMARY We present the case of a woman with intrahepatic and extrahepatic bile duct stones and chronic cholangitis who underwent laparoscopic hepatectomy.Hepatic segments I,II,III,IV,VI,and VII of the diseased bile duct tree and bile duct cyst were resected according to the preoperative plan,plastic repair of the hilar bile duct was performed,and the repaired bile duct was anastomosed with the jejunum.The patient achieved a favorable prognosis and long-term survival.CONCLUSION Based on segmental/subsegmental diseased bile duct tree territory hepatectomy and hilar stenosis relief,laparoscopic hepatectomy for complex hepatolithiasis can be safely performed guided by double landmarks(diseased bile duct/hepatic vein).
基金Supported by the National Natural Science Foundation of China,No.82200650the Key Research and Development Projects of Shanxi Province,No.202102130501014the Natural Science Foundation of Shanxi Province,No.202203021211021,No.202203021212046,and No.20210302123258.
文摘BACKGROUND The pathogenesis of hepatic encephalopathy(HE)remains unclear,and the classical theory of ammonia toxicity lacks sufficient justification.AIM To investigate the potential of bile acids as intervention targets for HE.METHODS This study employed 42 wild-type male SD rats weighing 200±20 g.Using a random number table method,two rats were randomly selected to undergo common bile duct ligation(BDL).The remaining 40 rats were randomly assigned to four groups serving as controls:The vehicle+control diet(VC)group,the thioacetamide(TAA)group,the TAA+total bile acids(TAAT)group,and the TAA+cholestyramine(TAAC)group.Except for the VC group,all rats were intraperitoneally injected with 100 mg/kg TAA solution once daily for ten consecutive days to establish a HE model.Simultaneously,the TAAT and TAAC groups were administered a diet containing 0.3%bile acids(derived from BDL rats)and 2%cholestyramine,respectively,by gavage for ten days.For the BDL rat model group,the common BDL procedure was performed following the aforementioned protocol.After four weeks,laparotomy revealed swollen bile ducts at the ligation site,and bile was collected.Following successful modeling,behavioral tests,including the elevated plus maze and open field test,were conducted to assess the HE status of the rats.Peripheral blood,liver,and cerebral cortex tissue samples were collected,and the total bile acid content in the serum and cerebral cortex was measured using an enzyme cycling method.The levels of inflammatory factors in the serum and cerebral cortex were analyzed using enzyme-linked immunosorbent assay.Liver histological examination was performed using the hematoxylin-eosin double-labeling method.Reverse transcription polymerase chain reaction,western blot,immunohistochemistry,and other techniques were employed to observe the expression of microglial activation marker ionized calcium-binding adaptor molecule-1 and Takeda G protein-coupled receptor 5(TGR5)protein.RESULTS Compared to the VC group,the TAA group exhibited an exacerbation of HE in rats.The total bile acid content,proinflammatory factors[interleukin-1β(IL-1β),IL-6],and the anti-inflammatory factor IL-10 in both the serum and cerebral cortex were significantly elevated.Similarly,the expression of the TGR5 receptor in the cerebral cortex was upregulated.To investigate the impact of total bile acids on HE in rats,comparisons were made with the TAA group.In the TAAT group,the severity of HE was further aggravated,accompanied by increased total bile acid content in the serum and cerebral cortex,elevated pro-inflammatory factors(IL-1β,IL-6),reduced levels of the antiinflammatory factor IL-10,and decreased expression of the TGR5 receptor in the cerebral cortex.In the TAAC group,the severity of HE was alleviated.This group showed reductions in total bile acid content in the serum and cerebral cortex,decreased pro-inflammatory factors(IL-1β,IL-6),increased levels of the anti-inflammatory factor IL-10,and enhanced expression of the TGR5 receptor in the cerebral cortex.CONCLUSION This study demonstrated that the total bile acid content in the serum and cerebral cortex of TAA-induced liver cirrhosis rats was elevated.Furthermore,total bile acids exacerbate the progression of HE in rats.This effect may be attributed to bile acids’involvement in the development of neurological dysfunction by mediating TGR5 expression and regulating neuroinflammation.
基金Supported by Shenzhen Science and Technology Program Project,No.JCYJ20220530145006013.
文摘BACKGROUND Laparoscopic cholecystectomy(LC)and laparoscopic common bile duct exploration(LCBDE)are widely used in gallbladder and biliary tract diseases.During these procedures,vessels or tissues are commonly ligated using clips.However,postoperative migration of clips to the common bile duct(CBD)or Ttube sinus tract is an overlooked complication of laparoscopic biliary surgery.Previously,most reported cases of postoperative clip migration involved metal clips,with only a few cases involving Hem-o-lok clips and review of the literature.CASE SUMMARY This report describes two cases in which Hem-o-lok clips migrated into the CBD and the T-tube sinus tract following laparoscopic surgery.Case 1 is a 68-year-old female admitted due to abdominal discomfort,and two Hem-o-lok clips were found to have migrated into the CBD 17 months after LC and LCBDE with T-tube drainage,and were removed using a stone extraction balloon.The patient was discharged smoothly after recovery.Case 2 is a 74-year-old male who underwent LC and LCBDE with T-tube drainage and laparoscopic biliary tract basket stone extraction.Nine weeks postoperatively,following T-tube removal,a Hem-o-lok clip was found in the sinus tract,and was extracted from the T-tube sinus tract.The patient recovered smoothly postoperatively.This study also reviews the literature from 2013 to July 2024 on using Hem-o-lok clips in LC and/or LCBDE treatment of gallbladder and biliary diseases and the postoperative migration of these clips into the CBD,T-tube sinus tract,or duodenum.CONCLUSION In patients with a history of LC and/or LCBDE,clip migration should be considered as a differential diagnosis.
文摘1.Introduction Many abdominopelvic surgeries are now performed laparoscopically rather than through open approaches.This trend continued despite reports of increased rates of unintended complications,such as bile duct injuries during cholecystectomy,in the early phase of laparoscopic adoption^([1,2]).
文摘BACKGROUND Intraoperative and postoperative biliary injuries remain significant complications of laparoscopic common bile duct exploration(LCBDE).Indocyanine green(ICG)has been shown to significantly reduce injuries caused by intraoperative operational errors.We found that the J-tube can reduce postoperative strictures and injuries to the common bile duct.At this moment,we aim to analyze and compare the complications,efficacy,short-term outcomes,and feasibility of these two adjunctive tools for LCBDE.AIM To evaluate the efficacy of ICG fluorescence imaging In LCBDE and J-tube drainage for patients with common bile duct stones.METHODS We retrospectively collected the clinical case data of patients who were treated at the Hepatobiliary Surgery Department of the Third People’s Hospital of Nantong,affiliated with Nantong University,from January 2016 to January 2021 due to gallbladder stones with choledocholithiasis and who underwent LCBDE combined with a primary suture and either J-tube or T-tube drainage.The patients were divided into groups:Traditional white-light laparoscopy+T-tube group(WL+T-tube),traditional WL+J-tube group,fluorescent laparoscopy+T-tube group(ICG+T-tube)and fluorescent laparoscopy+J-tube group(ICG+J-tube).The preoperative and postoperative clinical case data,laboratory examination data,and intraoperative and postoperative complications(including postoperative bile leakage,electrolyte disturbances,biliary peritonitis,and postoperative infections)and other relevant indicators were compared.RESULTS A total of 198 patients(112 males and 86 females)were included in the study,with 74 patients in the WL+T-tube,47 in the WL+J-tube,42 in the ICG+T-tube,and 35 in the ICG+J-tube.Compared with the other groups,the ICG+J had significantly shorter operation time(114 minutes,P=0.001),less blood loss(42 mL,P=0.02),shorter postoperative hospital stays(7 days,P=0.038),and lower surgical costs(China yuan 30178,P=0.001).Furthermore,patients were subdivided into two groups based on whether a T-tube or J-tube was placed during the surgery.By the third postoperative day,the aspartate transaminase,glutamic pyruvic transaminase,total bilirubin,and direct bilirubin levels were lower in the J-tube group than in the T-tube group(P<0.001).At last,follow-up observations showed that the incidence of biliary strictures at three months postoperatively was significantly lower in the J-tube group than in the T-tube group(P=0.002).CONCLUSION ICG fluorescence imaging in laparoscopic cholecystectomy with common bile duct exploration and J-tube drainage facilitates rapid identification of biliary anatomy and variations,reducing intraoperative bile duct injury,blood loss,surgery duration,and postoperative bile duct stenosis rates,supporting its clinical adoption.
文摘The liver is a central metabolic organ that regulates numerous physiological processes,including glucose and lipid metabolism,detoxification,and the synthesis of essential proteins and bile.Bile acids(BAs),synthesized from cholesterol in hepatocytes,not only facilitate the emulsification and absorption of dietary fats but also act as potent signaling molecules through receptors such as the farnesoid X receptor(FXR)and Takeda G-protein-coupled receptor 5.Metabolic dysfunction-associated steatotic liver disease(MASLD)is a leading cause of chronic liver disease globally,closely linked with obesity,insulin resis-tance,and other components of metabolic syndrome.In MASLD,the metabolism of BAs is markedly disrupted,resulting in alterations in their synthesis,compo-sition,and signaling activity.These changes contribute to hepatic steatosis,inflammation,and fibrosis,thereby exacerbating metabolic dysfunction and liver damage.The altered profiles and signaling activity of BAs in MASLD patients suggest that BAs act not only as biomarkers of disease severity,but also as active mediators of its pathogenesis.Modulators of BA signaling pathways,especially FXR agonists,are the focus of intense research for their potential to beneficially influence liver steatosis and inflammation in MASLD.Recent research has yielded promising results,indicating potential therapeutic application and the introduction of novel agents aimed at modulating BA homeostasis and function.This minireview outlines the physiological roles of BAs,seeks to advance the elucidation of the mechanisms by which their dysregulation contributes to MASLD progression,and highlights current and emerging therapeutic approa-ches.A deeper understanding of these complex interactions is essential for improving the diagnosis,prognosis and treatment of MASLD.
基金Supported by the Wannan Medical College Teaching Hospital Special Application for Scientific Research,No.WK2023JXYY036the Anhui Provincial Translational Clinical Medical Research Special Application,No.202204295107020062.
文摘BACKGROUND Bile leakage is a common complication following laparoscopic common bile duct exploration(LCBDE)with primary duct closure(PDC).Identifying and analyzing the risk factors associated with bile leakage is crucial for improving surgical outcomes.AIM To explore the value analysis of common risk factors for bile leakage after LCBDE and PDC,with a focus on strict adherence to indications.METHODS Clinical data of 106 cases undergoing LCBDE+PDC in the Hepatobiliary and Pancreatic Surgery Department(Division 1)of Chuzhou First People’s Hospital from April 2019 to March 2024 were collected.Retrospective and multiple factor regression analysis were conducted on common risk factors for bile leakage.The change in surgical time was analyzed using the cumulative summation(CUSUM)method,and the minimum number of cases required to complete the learning curve for PDC was obtained based on the proposed fitting curve by identifying the CUSUM maximum value.RESULTS Multifactor logistic regression analysis showed that fibrinous inflammation and direct bilirubin/indirect bilirubin were significant independent high-risk factors for postoperative bile leakage(P<0.05).The time to drain removal and length of hospital stay in cases without bile leakage were significantly shorter than in cases with bile leakage(P<0.05),with statistical significance.The CUSUM method indicated that a minimum of 51 cases were required for the surgeon to complete the learning curve(P=0.023).CONCLUSION With a good assessment of duodenal papilla sphincter function,unobstructed bile-pancreatic duct convergence,exact stone clearance,and sufficient surgical experience to complete the learning curve,PDC remains the preferred method for bile duct closure and is worthy of clinical promotion.
文摘The gut microbiome comprises a vast community of microbes inhabiting the human alimentary canal,playing a crucial role in various physiological functions.These microbes generally live in harmony with the host;however,when dysbiosis occurs,it can contribute to the pathogenesis of diseases,including osteoporosis.Osteoporosis,a systemic skeletal disease characterized by reduced bone mass and increased fracture risk,has attracted significant research attention concerning the role of gut microbes in its development.Advances in molecular biology have highlighted the influence of gut microbiota on osteoporosis through mechanisms involving immunoregulation,modulation of the gut-brain axis,and regulation of the intestinal barrier and nutrient absorption.These microbes can enhance bone mass by inhibiting osteoclast differentiation,inducing apoptosis,reducing bone resorption,and promoting osteoblast proliferation and maturation.Despite these promising findings,the therapeutic effectiveness of targeting gut microbes in osteoporosis requires further investigation.Notably,gut microbiota has been increasingly studied for their potential in early diagnosis,intervention,and as an adjunct therapy for osteoporosis,suggesting a growing utility in improving bone health.Further research is essential to fully elucidate the therapeutic potential and clinical application of gut microbiome modulation in the management of osteoporosis.
文摘Bile reflux gastritis (BRG) is a gastro-intestinal condition especially characterized by the reflux of bile into the stomach, further leading to mucosal inflammation along with various other clinical manifestations. Despite its increasing recognition, BRG remains understudied, with limited understanding of its epidemiology, pathophysiology, and optimal therapeutic strategies. Present narrative review aimed to comprehensively examine the available literature on BRG, focusing on its prevalence, risk factors, pathophysiology, clinical presentation, diagnostic modalities, and available therapeutic strategies. A comprehensive literature search was conducted using PubMed, Embase, Google Scholar and Cochrane databases. Relevant studies were included based on predefined inclusion and exclusion criteria. A narrative synthesis was conducted to summarize and interpret the findings. The prevalence of BRG remains uncertain due to diagnostic challenges. Risk factors include impaired gastrointestinal motility, sphincteric dysfunction (pyloric sphincter and the lower oesophageal sphincter), biliary tract disease, and certain medications. The pathophysiology involves bile acid-induced mucosal injury, inflammation, and impaired gastric defence mechanisms. Clinical manifestations are often nonspecific. Diagnostic modalities primarily include endoscopy and bile acid reflux testing. Management strategies encompass lifestyle modifications, medical therapy, and in severe cases, surgery. BRG is a complex condition with significant clinical implications. Further research is needed to refine diagnostic criteria, elucidate pathophysiological mechanisms, and develop effective therapeutic interventions. Addressing knowledge gaps in epidemiology, risk factors, and long-term outcomes is crucial for improving patient care.
