Effects of honey as a scolicidal agent on the hepatobiliary system

AIM： To examine the effects of 10% diluted honey, which has been shown to be scolicidal, on the liver and biliary system and determine whether it could be used as a scolicidal agent in the presence of biliary-cystic communication. METHODS： Thirty Wistar-Albino rats were divided into two groups. Honey with 10% dilution in the study group and 0.9% saline （NaCI） in the control group were injected into the common bile ducts of rats through a 3-mm duodenotomy. The animals were sacrificed 6 mo alter the procedure. Histopathological, biochemical, and radiological examinations were performed for evaluation of side effects. RESULTS： At the end of the sixth month, liver function tests were found to be normal in both groups. The tissue samples of liver and ductus choledochus of the honey group showed no histomorphologic difference from the control group. No stricture on the biliary tree was detected on the retrograde cholangiograms. CONCLUSION： According to these results, we concluded that 10% diluted honey could be used as scolicidal agent safely in the presence of biliary-cystic communication.

Determinants of Detection of Stones and Calcifications in the Hepatobiliary System on Virtual Nonenhanced Dual-energy CT

Objective To retrospectively determine the features of stones and calcifications in hepatobiliary system on virtual nonenhanced (VNE) dual-energy computed tomography (CT), and to evaluate the possibility of VNE images in diagnosis for those lesions. Methods A total of 128 gall stones and calcifications of the liver found in 110 patients were examined with triple phase abdominal CT scan from July 2007 to December 2011, in which true nonenhanced (TNE) phase and arterial phase were performed with single-energy CT (120 kVp) and portal venous phase was performed with dual-energy CT (100 kVp and 140 kVp). VNE images were generated from the portal venous phase dual-energy CT data sets by using commercially VNC software. The mean CT values for the stone, liver, bile and paraspinal muscle, mean lesion density and size in area dimension, contrast-to-noise ratio (CNR) of lesion to the liver or bile, and image noise were assessed and compared between VNE and TNE images. The effective dose and size-specific dose estimate (SSDE) were also calculated. Results The mean CT values of the lesions measured on VNE images declined significantly compared with those measured on TNE images (164.51±102.13vs. 290.72±197.80 HU,P<0.001), so did the lesion-to-liver CNR (10.80±11.82vs.18.81±17.06,P<0.001) and the lesion-to-bile CNR (17.24±14.41 vs. 21.32±17.31,P<0.001). There was no significant difference in size of lesions area between VNE and TNE images (0.69±0.88vs.0.72±0.85 cm2,P=0.062). Compared to the 128 lesions found in TNE images, VNE images showed the same density in 30 (23.4%) lesions, lighter density in 88 (68.8%) lesions, while failed to show 10 (7.8%) lesions, and showed the same size in 61 (47.7%) lesions and smaller size in 57 (44.5%)&nbsp;lesions. The CT cutoff values of lesion and size were 229.21 HU and 0.15 cm2, respectively. The total effective dose for triple phase scan protocol with TNE images was 19.51±7.03 mSv, and the SSDE was 39.84±11.10 mGy. The effective dose for dual phase scan protocol with VNE images instead of TNE images was 13.29±4.89 mSv, and the SSDE was 27.83±9.99 mGy. Compared with TNE images, the effective dose and SSDE of VNE images were down by 32.05%±3.69 % and 30.63%±2.34 %, respectively. Conclusions Although the CT values and CNR of the lesions decreased in VNE images, the lesions of which attenuation greater than 229.21 HU and size larger than 0.15 cm2could be detected with good reliability and obvious dose reduction. There was good consistency in the size of stones and calcifications in hepatobiliary system between VNE images and TNE images, which ensured the possibility of the clinical application of VNE images.

Novel mechanism of hepatobiliary system damage and immunoglobulin G4 elevation caused by Clonorchis sinensis infection

Clonorchis sinensis infection is still a major public health problem.It is estimated that more than 15 million people worldwide are infected,especially in Northeast China,Taiwan,South Korea,and North Vietnam.The detection of Clonorchis sinensis eggs in feces and bile is still the only gold standard for the diagnosis of Clonorchis sinensis infection,and new detection methods are needed to improve the detection rate.After Clonorchis sinensis invades the human body,it mainly parasitizes the hepatobiliary tract.Therefore,it is closely related to hepatobiliary diseases such as cholangitis,bile duct stones,liver fibrosis,and cholangiocarcinoma.The increase in immunoglobulin G4(IgG4)caused by Clonorchis sinensis infection is rare and there are few reports about the relevant mechanism.It may be related to the inflammatory factors interleukin(IL)-4,IL-10,and IL-13 produced by human phagocytes,T cells,B cells,and other immune cells in the process of resisting the invasion of Clonorchis sinensis.However,this finding still needs further clarification and confirmation.This article reviews the epidemiology,clinical manifestations,serology,imaging,pathogenic mechanism,and control measures of Clonorchis sinensis infection to help establish the diagnostic process for Clonorchis sinensis.We report novel mechanisms of IgG4 elevation due to Clonorchis sinensis infection to provide more experience and a theoretical basis for clinical diagnosis and treatment of this infection.

Clinical Application Value of Combined Detection of CG and TBA in Differential Diagnosis of Hepatobiliary System Diseases

Objective: To understand the clinical value of combined detection of cholyglycine CG and TBA in differential diagnosis of hepatobiliary diseases. Methods: Serum samples from 50 healthy people were collected as healthy control group. According to the latest disease diagnosis and treatment plan, 58 cases of HBV asymptomatic carrier group, 17 cases of viral hepatitis group, 49 cases of cirrhosis group, 50 cases of primary liver cancer group and 50 cases of other hepatobiliary diseases groups were collected respectively. The concentration levels of cholyglycine and total bile acid in each group were detected, and the differences among each group were compared. Results: By statistical analysis, serum CG concentration in viral hepatitis group, cirrhosis group, primary liver cancer group and other hepatobiliary diseases group was significantly higher than that in asymptomatic HEPATITIS B carriers and healthy control group, the differences were statistically significant (p 0.05). There was no significant difference in CG concentration among viral hepatitis group, liver cirrhosis group, primary liver cancer group and other hepatobiliary diseases group (p > 0.05). The serum TBA levels of asymptomatic carriers, viral hepatitis group, cirrhosis group, primary liver cancer group and other hepatobiliary system diseases group were significantly higher than those of healthy control group, the difference was statistically significant, p 0.05. Conclusion: Serum CG expression can not only detect liver lesions, but also distinguish different liver lesions. The positive rate of CG combined with TBA detection in patients with hepatobiliary diseases is significantly higher than that of single CG index detection. CG combined with TBA detection can significantly improve the sensitivity and accuracy of the diagnosis of hepatobiliary diseases, which is worthy of popularization and application.

Hepatobiliary&Pancreatic Diseases International

Copyright 2024,Hepatobiliary&Pancreatic Diseases International.All rights reserved.www.hbpdint.com.Aims and Scope.Hepatobiliary&Pancreatic Diseases International publishes peerreviewed original papers,reviews(meta-analysis,systematic review)and editorials concerned with clinical practice and research in the fields of hepatobiliary and pancreatic diseases.

Burden landscape of hepatobiliary and pancreatic cancers in Chinese young adults:30 years’overview and forecasted trends

BACKGROUND Hepatobiliary and pancreatic(HBP)cancers impose a considerable burden on young populations(aged 15 to 49 years),resulting in a substantial number of new cases and fatalities each year.In young populations,the HBP cancers shows extensive variance worldwide and the updated data in China is lacking.AIM To investigate the current status,trends,projections,and underlying risk factors of HBP cancers among young populations in China.METHODS The Global Burden of Disease Study 2019 provided data on the annual incidence,mortality,disability-adjusted life years(DALYs),age-standardized incidence rate(ASIR),mortality rate(ASMR),and DALYs rate(ASDR)of HBP cancers in young Chinese adults between 1990 and 2019.Temporal trends were assessed using estimated annual percentage change and hierarchical clustering.Sex-specific mortality and DALYs caused by various risks were analyzed across China and other regions,with future trends until 2035 projected using the Bayesian age-period-cohort model.RESULTS From 1990 to 2019,incident cases,deaths,DALYs,ASIR,ASMR,and ASDR for liver cancer(LC)in young Chinese individuals decreased,classified into'significant decrease'group.Conversely,cases of gallbladder and biliary tract cancer and pancreatic cancer rose,categorized as either'significant increase'or'minor increase'groups.The contribution of risk factors to mortality and DALYs for HBP tumors increased to varying degrees.Healthy lifestyle behaviors,such as tobacco control,weight management,alcohol moderation,and drug avoidance,could lower HBP cancers incidence.Moreover,except for LC in females,which is likely to initially decline slightly and then rise,the forecasting model predicted that the ASIR and ASMR for all HPB cancers subtypes by gender will increase among young adults.CONCLUSION HBP cancers burden among young adults in China is expected to increase until 2035,necessitating lifestyle interventions and targeted treatment strategies to mitigate the public health impact of these cancers.

Impact of fast-track surgery on perioperative care in patients undergoing hepatobiliary surgery

BACKGROUND Fast-track surgery(FTS)is a modern nursing approach that has gained popularity in the perioperative phase of surgery.AIM To investigate the impact of FTS on perioperative care for hepatobiliary surgery.METHODS A retrospective analysis was performed on 98 patients who underwent hepato-biliary surgery and were admitted to our hospital from August 2021 to October 2023.They were divided into an observation group and a control group with 49 patients in each group according to different nursing directions.The control group was treated with standard nursing and the observation group was treated with FTS concept nursing.The length of hospital stay,visual analog scale(VAS)score,wound complications,nursing satisfaction,self-rating scale(SAS)score,and SF-36 quality of life(QoL)score were compared between the two groups before and after care.RESULTS The duration of hospitalization,hospitalization cost,operation time,first im-plantation time,exhaust time,and first defecation time were shorter than the observation group(P<0.05).Additionally,the observation group showed a sig-nificant difference between the VAS and SAS scores on days 1,3,and 7(P<0.05).The complication rate in the observation group was 4.05%was significantly lower than the 18.36%in the control group,and the comparison groups were statistically significant(χ2=5.018,P=0.025).The observation group had a significantly higher level of nurse satisfaction(94.92%)than the control group(79.59%;χ2=6.078,P=0.014).Both groups showed higher QoL scores after nursing care,with higher scores in the observation group than in the control group(P=0.032).CONCLUSION FTS in patients undergoing hepatobiliary surgery can effectively improve negative mood,QoL,and nursing sa-tisfaction;reduce wound complications;and accelerate patient rehabilitation.

From strength to precision: A systematic review exploring the clinical utility of 7-Tesla magnetic resonance imaging in abdominal imaging

BACKGROUND After approval for clinical use in 2017 early investigations of ultra-high-field abdominal magnetic resonance imaging(MRI)have demonstrated the feasibility as well as diagnostic capabilities of liver,kidney,and prostate MRI at 7-Tesla.However,the elevation of the field strength to 7-Tesla not only brought advantages to abdominal MRI but also presented considerable challenges and drawbacks,primarily stemming from heightened artifacts and limitations in Specific Absorption Rate,etc.Furthermore,evidence in the literature is relatively scarce concerning human studies in comparison to phantom/animal studies which necessitates an investigation into the evidence so far in humans and summarizing all relevant evidence.AIM To offer a comprehensive overview of current literature on clinical abdominal 7T MRI that emphasizes current trends,details relevant challenges,and provides a concise set of potential solutions.METHODS This systematic review adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.A PubMed search,utilizing Medical Subject Headings terms such as"7-Tesla"and organ-specific terms,was conducted for articles published between January 1,1985,and July 25,2023.Eligibility criteria included studies exploring 7T MRI for imaging human abdominal organs,encompassing various study types(in-vivo/ex-vivo,method development,reviews/meta-analyses).Exclusion criteria involved animal studies and those lacking extractable data.Study selection involved initial identification via title/abstract,followed by a full-text review by two researchers,with discrepancies resolved through discussion.Data extraction covered publication details,study design,population,sample size,7T MRI protocol,image characteristics,endpoints,and conclusions.RESULTS The systematic review included a total of 21 studies.The distribution of clinical 7T abdominal imaging studies revealed a predominant focus on the prostate(n=8),followed by the kidney(n=6)and the hepatobiliary system(n=5).Studies on these organs,and in the pancreas,demonstrated clear advantages at 7T.However,small bowel studies showed no significant improvements compared to traditional MRI at 1.5T.The majority of studies evaluated originated from Germany(n=10),followed by the Netherlands(n=5),the United States(n=5),Austria(n=2),the United Kingdom(n=1),and Italy(n=1).CONCLUSION Further increase of abdominal clinical MRI field strength to 7T demonstrated high imaging potential,yet also limitations mainly due to the inhomogeneous radiofrequency(RF)excitation field relative to lower field strengths.Hence,further optimization of dedicated RF coil elements and pulse sequences are expected to better optimize clinical imaging at high magnetic field strength.

Management of acquired bronchobiliary fistula:A systematic literature review of 68 cases published in 30 years

AIM:To outline the appropriate diagnostic methods and therapeutic options for acquired bronchobiliary fistula(BBF).METHODS:Literature searches were performed in Medline,EMBASE,PHMC and LWW(January 1980August 2010)using the following keywords:biliobronchial fistula,bronchobiliary fistula,bronchobiliary fistula,biliarybronchial fistula,tracheobiliary fistula,hepatobronchial fistula,bronchopleural fistula,and biliptysis.Further articles were identified through crossreferencing.RESULTS:Sixtyeight cases were collected and reviewed.BBF secondary to tumors(32.3%,22/68),including primary tumors(19.1%,13/68)and hepatic metastases(13.2%,9/68),shared the largest proportion of all cases.Biliptysis was found in all patients,and other symptoms were respiratory symptoms,such as irritating cough,fever(36/68)and jaundice(20/68).Half of the patients were treated by lessinvasive methods such as endoscopic retrograde biliary drainage.Invasive approaches like surgery were used less frequently(41.7%,28/67).The outcome was good at the end of the followup period in 28 cases(range,2 wk to 72 mo),and the recovery rate was 87.7%(57/65).CONCLUSION:The clinical diagnosis of BBF can be established by sputum analysis.Careful assessment of this condition is needed before therapeutic procedure.Invasive approaches should be considered only when noninvasive methods failed.

Obstructive jaundice due to hepatobiliary cystadenoma or cystadenocarcinoma

Hepatobiliary cystadenomas (HBC) and cystadenocarci- nomas are rare cystic lesions. Most patients with these lesions are asymptomatic, but presentation with ob- structive jaundice may occur. The first patient presented with intermittent colicky pain and recurrent obstructive jaundice. Imaging studies revealed a polypoid lesion in the left hepatic duct. The second patient had recurrent jaundice and cholangitis. Endoscopic retrograde cholan- giopancreatography (ERCP) showed a cystic lesion at the confluence of the hepatic duct. In the third patient with intermittent jaundice and cholangitis, cholangioscopy re- vealed a papillomatous structure protruding into the left bile duct system. In the fourth patient with obstructive jaundice, CT-scan showed slight dilatation of the intrahe- patic bile ducts and dilatation of the common bile duct of 3 cm. ERCP showed filling of a cystic lesion. All patients underwent partial liver resection, revealing HBC in the specimen. In the fifth patient presenting with obstructive jaundice, ultrasound examination showed a hyperecho- genic cystic lesion centrally in the liver. The resection specimen revealed a hepatobiliary cystadenocarcinoma. HBC and cystadenocarcinoma may give rise to obstruc- tive jaundice. Evaluation with cross-sectional imaging techniques is useful. ERCP is a useful tool to differentiate extraductal from intraductal obstruction.

Laparoscopic vs open approach to resection of hepatocellular carcinoma in patients with known cirrhosis:Systematic review and meta-analysis

AIM: To review the currently available literature comparing laparoscopic to open resection of hepatocellular carcinoma (HCC) in patients with known liver cirrhosis.

Comparative evaluation of intragastric bile acids and hepatobiliary scintigraphy in the diagnosis of duodenogastric reflux

AIM:To assess the diagnostic value of a combination of intragastric bile acids and hepatobiliary scintigraphy in the detection of duodenogastric reflux(DGR).METHODS:The study contained 99 patients with DGR and 70 healthy volunteers who made up the control group.The diagnosis was based on the combination of several objective arguments:a long history of gastric symptoms(i.e.,nausea,epigastric pain,and/or bilious vomiting) poorly responsive to medical treatment,gastroesophageal reflux symptoms unresponsive to protonpump inhibitors,gastritis on upper gastrointestinal(GI) endoscopy and/or at histology,presence of a bilious gastric lake at > 1 upper GI endoscopy,pathologic 24-h intragastric bile monitoring with the Bilitec device.Gas-tric juice was aspirated in the GI endoscopy and total bile acid(TBA),total bilirubin(TBIL) and direct bilirubin(DBIL) were tested in the clinical laboratory.Continuous data of gastric juice were compared between each group using the independent-samples Mann-Whitney U-test and their relationship was analysed by Spearman's rank correlation test and Fisher's linear discriminant analysis.Histopathology of DGR patients and 23 patients with chronic atrophic gastritis was compared by clinical pathologists.Using the Independent-samples Mann-Whitney U-test,DGR index(DGRi) was calculated in 28 patients of DGR group and 19 persons of control group who were subjected to hepatobiliary scintigraphy.Receiver operating characteristic curve was made to determine the sensitivity and specificity of these two methods in the diagnosis of DGR.RESULTS:The group of patients with DGR showed a statistically higher prevalence of epigastric pain in comparison with control group.There was no significant difference between the histology of gastric mucosa with atrophic gastritis and duodenogastric reflux.The bile acid levels of DGR patients were significantly higher than the control values(Z:TBA:-8.916,DBIL:-3.914,TBIL:-6.197,all P < 0.001).Two of three in the DGR group have a significantly associated with each other(r:TBA/DBIL:0.362,TBA/TBIL:0.470,DBIL/TBIL:0.737,all P < 0.001).The Fisher's discriminant function is followed:Con:Y = 0.002TBA + 0.048DBIL + 0.032TBIL 0.986;Reflux:Y = 0.012TBA + 0.076DBIL + 0.089TBIL-2.614.Eighty-four point zero five percent of original grouped cases were correctly classified by this method.With respect to the DGR group,DGRi were higher than those in the control group with statistically significant differences(Z =-5.224,P < 0.001).Twenty eight patients(59.6%) were deemed to be duodenogastric reflux positive by endoscopy,as compared to 37 patients(78.7%) by hepatobiliary scintigraphy.CONCLUSION:The integrated use of intragastric bile acid examination and scintigraphy can greatly improve the sensitivity and specificity of the diagnosis of DGR.

Hepatobiliary manifestations in inflammatory bowel disease: The gut,the drugs and the liver

Abnormal liver biochemical tests are present in up to30%of patients with inflammatory bowel disease(IBD),and therefore become a diagnostic challenge.Liver and biliary tract diseases are common extraintestinal manifestations for both Crohn’s disease and ulcerative colitis(UC),and typically do not correlate with intestinal activity.Primary sclerosing cholangitis(PSC)is the most common hepatobiliary manifestation of IBD,and is more prevalent in UC.Approximately 5%of patients with UC develop PSC,with the prevalence reaching up to 90%.Cholangiocarcinoma and colon cancer risks are increased in these patients.Less common disorders include autoimmune hepatitis/PSC overlap syndrome,IgG4-associated cholangiopathy,primary biliary cirrhosis,hepatic amyloidosis,granulomatous hepatitis,cholelithiasis,portal vein thrombosis,liver abscess,and non-alcoholic fatty liver disease.Hepatitis B reactivation during immunosuppressive therapy is a major concern,with screening and vaccination being recommended in serologically negative cases for patients with IBD.Reactivation prophylaxis with entecavir or tenofovir for 6to 12 mo after the end of immunosuppressive therapy is mandatory in patients showing as hepatitis B surface antigen(HBsAg)positive,independently from viral load.HBsAg negative and anti-HBc positive patients,with or without anti-HBs,should be closely monitored,measuring alanine aminotransferase and hepatitis B virus DNA within 12 mo after the end of therapy,and should be treated if the viral load increases.On the other hand,immunosuppressive therapy does not seem to promote reactivation of hepatitis C,and hepatitis C antiviral treatment does not influence IBD natural history either.Most of the drugs used for IBD treatment may induce hepatotoxicity,although the incidence of serious adverse events is low.Abnormalities in liver biochemical tests associated with aminosalicylates are uncommon and are usually not clinically relevant.Methotrexaterelated hepatotoxicity has been described in 14%of patients with IBD,in a dose-dependent manner.Liver biopsy is not routinely recommended.Biologics-related hepatotoxicity is rare,but has been shown most frequently in patients treated with infliximab.Thiopurines have been associated with veno-occlusive disease,regenerative nodular hyperplasia,and liver peliosis.Routine liver biochemical tests are recommended,especially during the first month of treatment.All these conditions should be considered in IBD patients with clinical or biochemical features suggestive of hepatobiliary involvement.Diagnosis and management of these disorders usually involve hepatologists and gastroenterologists due to its complexity.

Hepatobiliary complications of alveolar echinococcosis: A long-term follow-up study

AIM:To determine the long-term hepatobiliary complications of alveolar echinococcosis(AE) and treatment options using interventional methods.METHODS:Included in the study were 35 patients with AE enrolled in the Echinococcus Multilocularis Data Bank of the University Hospital of Ulm.Patients underwent endoscopic intervention for treatment of hepatobiliary complications between 1979 and 2012.Patients' epidemiologic data, clinical symptoms, and indications for the intervention, the type of intervention and any additional procedures, hepatic laboratory parameters(pre- and post-intervention), medication and surgical treatment(pre- and post-intervention), as well as complications associated with the intervention and patients‘ subsequent clinical courses were analyzed.In order to compare patients with AE with and without history of intervention, data from an additional 322 patients with AE who had not experienced hepatobiliary complications and had not undergone endoscopic intervention were retrieved and analyzed.RESULTS:Included in the study were 22 male and 13 female patients whose average age at first diagnosis was 48.1 years and 52.7 years at the time of intervention.The average time elapsed between first diagnosis and onset of hepatobiliary complications was 3.7 years.The most common symptoms were jaundice, abdominal pains, and weight loss.Thenumber of interventions per patient ranged from one to ten.Endoscopic retrograde cholangiopancreatography(ERCP)was most frequently performed in combination with stent placement(82.9%),followed by percutaneous transhepatic cholangiodrainage(31.4%)and ERCP without stent placement(22.9%).In 14.3%of cases,magnetic resonance cholangiopancreatography was performed.A total of eight patients received a biliary stent.A comparison of biochemical hepatic function parameters at first diagnosis between patients who had or had not undergone intervention revealed that these were significantly elevated in six patients who had undergone intervention.Complications(cholangitis,pancreatitis)occurred in six patients during and in 12patients following the intervention.The average survival following onset of hepatobiliary complications was 8.8years.CONCLUSION:Hepatobiliary complications occur in about 10%of patients.A significant increase in hepatic transaminase concentrations facilitates the diagnosis.Interventional methods represent viable management options.

Current and future applications of in vitro magnetic resonance spectroscopy in hepatobiliary disease

Nuclear magnetic resonance spectroscopy allows the study of cellular biochemistry and metabolism, both in the whole body in vivo and at higher magnetic field strengths in vitro. Since the technique is non-invasive and non-selective, magnetic resonance spectroscopy methodologies have been widely applied in biochemistry and medicine. In vitro magnetic resonance spectroscopy studies of cells, body fluids and tissues have been used in medical biochemistry to investigate pathophysiologi- cal processes and more recently, the technique has been used by physicians to determine disease abnormalities in vivo. This highlighted topic illustrates the potential of in vitro magnetic resonance spectroscopy in studying the hepatobiliary system. The role of in vitro proton and phosphorus magnetic resonance spectroscopy in the study of malignant and non-malignant liver disease and bile composition studies are discussed, particularly with reference to correlative in vivo whole-body magnetic resonance spectroscopy applications. In summary, magnetic resonance spectroscopy techniques can provide non-invasive biochemical information on disease severity and pointers to underlying pathophysiological processes. Magnetic resonance spectroscopy holds potential promise as a screening tool for disease biomarkers, as well as assessing therapeutic response.

Role of baicalin as a potential therapeutic agent in hepatobiliary and gastrointestinal disorders:A review

Baicalin is a natural bioactive compound derived from Scutellaria baicalensis,which is extensively used in traditional Chinese medicine.A literature survey demonstrated the broad spectrum of health benefits of baicalin such as antioxidant,anticancer,anti-inflammatory,antimicrobial,cardio-protective,hepatoprotective,renal protective,and neuroprotective properties.Baicalin is hydrolyzed to its metabolite baicalein by the action of gut microbiota,which is further reconverted to baicalin via phase 2 metabolism in the liver.Many studies have suggested that baicalin exhibits therapeutic potential against several types of hepatic disorders including hepatic fibrosis,xenobiotic-induced liver injury,fatty liver disease,viral hepatitis,cholestasis,ulcerative colitis,hepatocellular and colorectal cancer.During in vitro and in vivo examinations,it has been observed that baicalin showed a protective role against liver and gut-associated abnormalities by modifying several signaling pathways such as nuclear factor-kappa B,transforming growth factor beta 1/SMAD3,sirtuin 1,p38/mitogen-activated protein kinase/Janus kinase,and calcium/calmodulin-dependent protein kinase kinaseβ/adenosine monophosphate-activated protein kinase/acetyl-coenzyme A carboxylase pathways.Furthermore,baicalin also regulates the expression of fibrotic genes such as smooth muscle actin,connective tissue growth factor,β-catenin,and inflammatory cytokines such as interferon gamma,interleukin-6(IL-6),tumor necrosis factor-alpha,and IL-1β,and attenuates the production of apoptotic proteins such as caspase-3,caspase-9 and B-cell lymphoma 2.However,due to its low solubility and poor bioavailability,widespread therapeutic applications of baicalin still remain a challenge.This review summarized the hepatic and gastrointestinal protective attributes of baicalin with an emphasis on the molecular mechanisms that regulate the interaction of baicalin with the gut microbiota.

Healing time of incision infection after hepatobiliary surgery treated by needle-free incision suture closure

AIM: To compare the effectiveness of needle-free incision suture closure with butterfly tape and traditional secondary suturing techniques in treating incision infection. METHODS: Two hundred and twenty-three patients with incision infection following hepatobiliary surgery at a tertiary hospital were randomly divided into three groups: 90 patients were closed by needle-free incision suture closure, which gradually closed the incision wound when drainage from incision infection was visibly decreased and healthy granulation tissues had grown; 79 patients were closed by butterfly bandage; another 54 patients were closed by traditional secondary suturing technique. Healing time of incision infection was calculated from the beginning of dressing change to the healing of the incision. RESULTS: Healing time in the needle-free incision suture closure group (24.2 +/- 7.2 d) was significantly shorter than that in the butterfly bandage group (33.3 +/- 11.2 d) and the traditional secondary suturing group (36.2 +/- 15.3 d) (P < 0.05). Healing time in the butterfly bandage group appeared to be slightly shorter than that in the secondary suture group, but the difference was not statistically significant (P > 0.05). CONCLUSION: Needle-free incision suture closure could gradually close the infection wound at the same time of drainage and dressing change, thereby shortening the healing time. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.

Giant hepatobiliary cystadenoma in a male with obvious convex papillate

Hepatobiliary cystadenoma that is most often found in is an uncommon lesion middle-aged women and difficult to diagnose preoperatively. Here, we report a case of giant hepatobiliary cystadenoma in a male patient with obvious convex papillate. On the basis of imaging examinations, the patient was diagnosed as hepatobiliary cystadenoma prior to operation. Left hepatectomy was performed and the patient was symptom-free during a 6-too follow-up period, suggesting that imaging examination is the major diagnostic method of hepatobiliary cystadenoma, and operation is its best treatment modality.

Extrahepatic collaterals and liver damage in embolotherapy for ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery

AIM: To evaluate the effects of extrahepatic collaterals to the liver on liver damage and patient outcome after embolotherapy for the ruptured hepatic artery pseudoa- neurysm following hepatobiliary pancreatic surgery. METHODS: We reviewed 9 patients who underwent transcatheter arterial embolization (TAE) for the ruptured hepatic artery pseudoaneurysm following major hepato- biliary pancreatic surgery between June 1992 and April 2006. We paid special attention to the extrahepatic arte- rial collaterals to the liver which may affect post-TAE liver damage and patient outcome. RESULTS: The underlying diseases were all malignan- cies, and the surgical procedures included hepatopancre- atoduodenectomy in 2 patients, hepatic resection with removal of the bile duct in 5, and pancreaticoduodenec- tomy in 2. A total of 11 pseudoaneurysm developed: 4 in the common hepatic artery, 4 in the proper hepatic artery, and 3 in the right hepatic artery. Successful he- mostasis was accomplished with the initial TAE in all patients, except for 1. Extrahepatic arterial pathways to the liver, including the right inferior phrenic artery, the jejunal branches, and the aberrant left hepatic artery, were identified in 8 of the 9 patients after the completion of TAE. The development of collaterals depended on the extent of liver mobilization during the hepatic resection, the postoperative period, the presence or absence of an aberrant left hepatic artery, and the concomitant arte- rial stenosis adjacent to the pseudoaneurysm. The liver tolerated TAE without significant consequences when at least one of the collaterals from the inferior phrenic ar-tery or the aberrant left hepatic artery was present. One patient, however, with no extrahepatic collaterals died of liver failure due to total liver necrosis 9 d after TAE. CONCLUSION: When TAE is performed on ruptured hepatic artery pseudoaneurysm, reduced collateral path- ways to the liver created by the primary surgical proce- dure and a short postoperative interval may lead to an unfavorable outcome.

Hepatobiliary scintigraphy for detecting biliary strictures after living donor liver transplantation

AIM:To investigate the diagnostic accuracy of hepatobiliary scintigraphy(HBS) in detecting biliary strictures in living donor liver transplantation(LDLT) patients.METHODS:We retrospectively reviewed 104 adult LDLT recipients of the right hepatic lobe with duct-toduct anastomosis,who underwent HBS and cholangiography.The HBS results were categorized as normal,parenchymal dysfunction,biliary obstruction,or bile leakage without re-interpretation.The presence of biliary strictures was determined by percutaneous cholangiography or endoscopic retrograde cholangiopancreatography(ERCP).RESULTS:In 89 patients with biliary strictures,HBS showed biliary obstruction in 50 and no obstruction in 39,for a sensitivity of 56.2%.Of 15 patients with no biliary strictures,HBS showed no obstruction in 11,for a specificity of 73.3%.The positive predictive value(PPV) was 92.6%(50/54) and the negative predictive value(NPV) was 22%(11/50).We also analyzed the diagnostic accuracy of the change in bile duct size.The sensitivity,NPV,specificity,and PPV were 65.2%,27.9%,80% and 95%,respectively.CONCLUSION:The absence of biliary obstruction on HBS is not reliable.Thus,when post-LDLT biliary strictures are suspected,early ERCP may be considered.