Oxidative Stress before and after Operation in Patients with Chronic Cholecystitis Containing Gallstone

To study the relationship of oxidative, antioxidative constituents and antioxidases in blood with chronic cholecystitis containing gallstone, levels of lipoperoxides (LPO), nitric oxide (NO), vitamin C(VC), vitamin E (VE) and β carotene (β CAR) in plasma as well as level of LPO, activities of superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH Px) in erythrocytes were investigated by spectrophotometric assay in 107 patients with this condition (PCg) and 100 healthy volunteers (HVs). Compared with HVs group, the average value of LPO and NO in plasma and that of LPO in erythrocytes of PCg group were significantly increased ( P <0.0001), while that of VC, VE and β CAR in plasma and the average activities of SOD, CAT and GSH Px in erythrocytes were significantly decreased ( P <0.0001). Linear regression and correlation analysis for 107 preoperative PCg showed that the value of LPO and NO in plasma and that of LPO in erythrocytes of PCg gradually increased ( P <0.0001), representing a significant linear positive correlation. The value of VC, VE and β CAR in plasma and that of SOD, CAT and GSH Px in erythrocytes of PCg gradually decreased ( P <0.0001), representing a significant linear negative correlation. Stepwise regression and correlation analysis for 107 preoperative PCg suggested that the closest correlation was observed between the course of disease and the value of NO and VC in plasma and that of SOD, GSH Px and LPO in erythrocytes, r =0.7306, F =32.1408, P <0.0001. Compared with the preoperative PCg group, the average value of LPO and NO in plasma and that of LPO in erythrocytes of the postoperative PCg group were significantly decreased ( P <0.0001). Furthermore, the average value of VC in plasma and that of SOD, CAT and GSH Px in erythrocytes of the postoperative PCg group were significantly increased ( P <0.0001), whereas no significant difference was found between their average value of VE and β CAR in plasma. These findings suggested that oxidative stress was an aggravating pathological condition in PCg group. Therefore, we recommend that in treating PCg, antioxidants such as VC, VE, β CAR should be given in order to alleviate their potential oxidative damages.

Individualized nomogram improves diagnostic accuracy of stage Ⅰ-Ⅱ gallbladder cancer in chronic cholecystitis patients with gallbladder wall thickening

BACKGROUND： Early diagnosis of gallbladder cancer（GBC） can remarkably improve the prognosis of patients. This study aimed to develop a nomogram for individualized diagnosis of stage Ⅰ-Ⅱ GBC in chronic cholecystitis patients with gallbladder wall thickening.METHODS： The nomogram was developed using logistic regression analyses based on a retrospective cohort consisting of 89 consecutive patients with stage Ⅰ-Ⅱ GBC and 1240 patients with gallbladder wall thickening treated at one biliary surgery center in Shanghai between January 2009 and December 2011. The accuracy of the nomogram was validated by discrimination, calibration and a prospective cohort treated at another center between January 2012 and December 2014（n=928）.RESULTS： Factors included in the nomogram were advanced age, hazardous alcohol consumption, long-standing diagnosed gallstones, atrophic gallbladder, gallbladder wall calcification, intraluminal polypoid lesion, higher wall thickness ratio and mucosal line disruption. The nomogram had concordance indices of 0.889 and 0.856 for the two cohorts, respectively. Internal and external calibration curves fitted well. The area under the receiver-operating characteristic curves of the nomogram was higher than that of multidetector row computed tomography in diagnosis of stage Ⅰ-Ⅱ GBC（P〈0.001）.CONCLUSION： The proposed nomogram improves individualized diagnosis of stage Ⅰ-Ⅱ GBC in chronic cholecystitis patients with gallbladder wall thickening, especially for those the imaging features alone do not allow to confirm the diagnosis.

Effective Common Chinese Herbal Medicines Used in Treating Chronic Cholecystitis with Liver-Gallbladder Dampness-Heat Syndrome: A Review of Clinical Studies in the Past 10 Years

The objective of the study is to identify the effective common Chinese herbal medicines used in treating chronic cholecystitis with liver-gallbladder dampness-heat syndrome(CCLGDHS) through reviewing relevant clinical studies published in the past 10 years. Data were collected from Science Direct and Chinese National Knowledge Infrastructure. Data screening was carried out for the abstracts and full texts of the data. The top 15 Chinese herbal medicines with the highest occurring frequency were selected, statistically analyzed, and classified by their medicinal properties, actions, and indications according to the Chinese Pharmacopoeia 2015 edition. The top 15 effective common Chinese herbal medicines comprise Chai Hu, Huang Qin, Jin Qian Cao, Bai Shao, Yin Chen, Yu Jin, Chuan Lian Zi, Yan Hu Suo, Zhi Shi, Ban Xia, Bai Zhu, Pu Gong Ying, Gan Cao, Zhi Zi, and Qing Pi. The predominant natures were cold, cool, and warm. This combination can clear stagnant heat, warm Yang, and regulate Qi dynamics. In addition, bitter, pungent, and sweet were the predominant flavors. They can clear dampness-heat, regulate Qi dynamics to relieve cramps and pain, as well as tonify the deficiency. Along with entering the liver and gallbladder meridians, these herbal medicines also entered the spleen, stomach, and lung meridians to prevent potential disease transmission. The combinatorial medicinal actions of the effective common Chinese herbal medicine highlight the importance of the holistic concept of traditional Chinese medicine when treating CCLGDHS. In addition, the inclusion of activating blood to promote blood circulation, relieving cramps and alleviating pain, and tonifying the spleen and stomach represents a new finding in the treatment principle for CCLGDHS.

Mechanism of Shugan Lidan decoction in treating chronic calculous cholecystitis

Chronic calculous cholecystitis is a common clinical medical disease,which is classified as"hypochondriac pain"in traditional Chinese medicine(TCM).It is caused by liver failure and stagnation of liver qi.Therefore,the method of Soothing the liver and promoting bile flow is often used for regulating and harmonizing qi and blood.This paper discusses its mechanism of action,and points out that Shugan Lidan decoction has great effect on the treatment of chronic calculous cholecystitis,especially in the early treatment of the disease and delaying the progress of the disease,which provides help for the clinical treatment of chronic calculous cholecystitis.

Correlation of S1P1 and ERp29 expression to progression, metastasis, and poor prognosis of gallbladder adenocarcinoma

BACKGROUND: Gallbladder cancer (GBC) is one of the most aggressive malignant neoplasms with an extremely poor prognosis. Early diagnosis significantly increases the survival rate. The present study was undertaken to evaluate the diagnostic and prognostic value of sphingosine-1-phosphate receptor 1 (S1P1) and endoplasmic reticulum protein 29 (ERp29) in benign and malignant gallbladder lesions and to develop a possible alternative treatment for GBC. METHODS: A total of 100 gallbladder adenocarcinoma, 46 peritumoral, 30 gallbladder adenomatous, 15 gallbladder polyp and 35 chronic cholecystitis tissues were included. S1P1 and ERp29 expressions were evaluated by immunohistochemistry The correlation between S1P1 and ERp29 expression and tumor pathological features and prognosis was analyzed. RESULTS: S1P1 positive rate was significantly higher in gallbladder adenocarcinomas than that in peritumoral adenomatous, polyp, and chronic cholecystitis tissues. On the contrary, ERp29 positive rate was significantly lower in adenocarcinomas than that in peritumoral, adenomatous polyp, and chronic cholecystitis tissues. Benign lesions with positive S1P1 or negative ERp29 expression showed moderate or severe atypical hyperplasia in the gallbladder epithelium The overexpression of S1P1 or non-expression of ERp29 was significantly associated with tumor differentiation, tumor mass, lymph node metastasis, and adenocarcinoma invasion Univariate Kaplan-Meier analysis showed that the elevated S1P1 (P=0.008) or absence of ERp29 (P=0.043) was closely associated with decreased survival rate. Multivariate Cox regression analysis showed that S1P1 positive (P=0.004) or ERp29 negative (P=0.029) was an independent predictor of poor prognosis in gallbladder adenocarcinoma.CONCLUSION: S1P1 overexpression or ERp29 absence is related to the carcinogenesis and progression, and may be potential biomarkers for early detection of gallbladder adenocarcinoma.