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Background: Cholangiocarcinoma, a type of malignant tumor, originates from epithelial cells of the bile duct. Perineural invasion is common path for cholangiocarcinoma metastasis, and it is highly correlated with postoperative recurrence and poor prognosis. It has been reported that muscarinic acetylcholine receptor M3 (mAChR M3) is widely expressed in digestive tract cancer, and may play an important role in the proliferation, differentiation, transformation and carcinogenesis of tumors. This study was to explore the effect of mAChR M3 on the growth of cholangiocarcinoma cells in vitro and provide a new approach to the pathogenesis and treatment of cholangiocarcinoma., Methods: Streptavidin-biotin complex immunohistochemistry was carried out to assess the expression of mAChR M3 in surgical specimens of cholangiocarcinomas (40 cases) and normal bile duct tissues (9), as well as to investigate nerve infiltration. The cholangiocarcinoma cells were treated with different concentrations of selective M-receptor agonist pilocarpine and M-receptor blocker atropine sulfate to induce changes in cell proliferation. The experimental data were analyzed by the Chi-square test., Results: The strongly-positive expression rate of mAChR M3 was much higher in poorly-differentiated (69%, 9/13) than in well- and moderately-differentiated cholangiocarcinomas (30%, 8/27) (X2=5.631, P<0.05). The strongly-positive mAChR M3 expression rate in hilar cholangiocarcinoma (50%, 14/28) was higher than that in cholangiocarcinomas from the middle and lower common bile duct (25%, 3/12) (X2=2.148, P<0.05). Cholangiocarcinomas with distant metastasis had a strongly-positive expression rate (75%, 9/12), which was much higher than those without distant metastasis (29%, 8/28) (X2=7.410, P<0.01). The absorbance value in the pilocarpine+atropine group was significantly higher than the corresponding value in the pilocarpine group., Conclusions: The expression of mAChR M3 is influenced by the extent of differentiation, distant metastasis and the site of cholangiocarcinoma. It also plays a key role in the proliferation and metastasis of cholangiocarcinoma.

Background: Many Chinese herbs, especially herbal injections, have been shown to have anti-tumor effects in recent years. However, since most reports focus on the clinical effectiveness of these herbs, their mechanisms of action are not well understood. In this study, we assessed apoptosis in the hepatocellular carcinoma (HCC) cell line HepG2 induced by an injectable extract from the seed of Coix lacryma-jobi (Semen coicis, SC), and monitored the expression of Bcl-2 and caspase-8., Methods: Injectable SC was applied to HepG2 cells at different concentrations and the cells were collected 12, 24 and 48 hours later. 5-fluorouracil was used as a positive control group, and fluorescence-activated cell-sorting cytometry was used to measure the apoptosis rate of HepG2 cells and the expression of Bcl-2 and caspase-8 proteins., Results: SC induced apoptosis in HepG2 cells in a concentration- and time-dependent manner, and the expression of caspase-8 was elevated and prolonged. However, it did not significantly influence the expression of Bcl-2., Conclusion: Injectable SC may induce apoptosis in HCC cells by regulating the expression of caspase-8.

Objective: To explore the surgical treatment and prognosis of hilar cholangiocarcinoma., Methods: This was a retrospective study of 93 cases of hilar cholangiocarcinoma that were treated surgically at our hospital from June 1999 to June 2005. Prognostic factors were also analyzed., Results: Fifty-two cases were treated with curative resection, 21 with palliative resection, and 9 with nonoperative drainage. Eleven cases underwent palliative drainage operations. The median survive time was 31 months in the curative resection group, 13.7 months in the palliative resection group, and 11 months in the nonoperative drainage group. Patient age, serum total bilirubin, clinical type of Bismuth-Corlette, tumor differentiation, and lymph node metastases were important factors for predicting the prognosis of hilar cholangiocarcinoma., Conclusions: Resection was the main treatment for hilar cholangiocarcinoma, and curative resection was the best way to obtain better prognosis. Age, preoperative serum total bilirubin, bismuth clinical type, tumor histopathological grading, and lymph node metastases were considered to have a significant effect on prognosis.

In this study, the effects of Stichopus japonicus acid mucopolysaccharide (SJAMP) on the apoptosis of the human hepatocellular carcinoma cell line HepG2 were examined. The underlying mechanism was investigated by determining the effect of SJAMP on the expression of Bcl-2 and nm23-H1 genes in HepG2 cells. In vitro cultured HepG2 cells were treated with different concentrations of SJAMP. The dimethylthiazol (MTT) assay was used to determine the inhibition of cell proliferation. Expression of Bcl-2 and nm23-H1 genes was determined by Western blot analysis. The results showed that SJAMP inhibited the proliferation of HepG2 cells in a time- and dose-dependent manner, SJAMP induced apoptosis in HepG2 cells, and SJAMP decreased the expression of Bcl-2 and increased the expression of nm23-H1. We conclude that SJAMP inhibits the proliferation of HepG2 cells by inducing apoptosis. These results provide a theoretical basis for the utilization of SJAMP as a potential antitumor component for the treatment of hepatocellular carcinoma.

Background: Many diseases can cause obstructive jaundice and then lead to a series of pathologic disorders. Thus preoperative assessment of liver function is of utmost importance. Traditional assessment is to monitor related indicators of liver function, but it is invasive and needs to be performed repeatedly. Color Doppler flow imaging (CDFI) was used to monitor blood flow of the hepatic artery and portal vein, a non-invasive method which can be used repeatedly., Methods: Twenty cases of obstructive jaundice were detected by CDFI and changes of liver function were measured after operation. The variables of hemodynamic monitoring included peak flow rate and mean blood flow in the hepatic artery proper at the peak of the contraction period; the inner diameter of blood vessels, the peak flow rate, and the congestion index, the blood flow in the main portal vein., Results: The average peak flow rate in the hepatic artery of patients with obstructive jaundice was significantly higher than that of normal people; both the inner diameter and congestive index of the portal vein were significantly larger than those of normal people. But the mean blood flow and peak flow rate in the portal vein were lower than those of normal people., Conclusions: CDFI is an ideal and non-invasive method for evaluating liver hemodynamics in obstructive jaundice. If the increase of hepatic arterial flow is more significant than the decrease of the blood flow in the portal vein, hepatic functional recovery after operation is smoother, suggesting a better prognosis. If the increase of the hepatic arterial flow is less significant than the decrease of the blood flow in the portal vein, hepatic functional recovery after operation may not be smooth, suggesting a worse prognosis.

Background: Research has revealed a shift towards Th2 in many types of malignant tumor, but the state of Th1/Th2 is not clear in patients with primary hepatic cancer (PHC). This study was designed to determine the expression of Th1- versus Th2-type cytokines in primary hepatic cancer and the adjacent liver tissue in order to provide evidence for treatment of the Th1/Th2 shift., Methods: Samples were collected from 11 patients with PHC. The gene expression of Th1/Th2 cytokines was detected by reverse transcriptase polymerase chain reaction (RT-PCR) using IFN-gamma and IL-2 as Th1-type cytokine genes, and IL-4 and IL-10 as Th2-type cytokine genes., Results: Th1-type cytokines were expressed in 7/11 PHCs and 9/11 adjacent liver tissues, while Th0 type cytokines occurred in 4/11 PHCs and 2/11 adjacent liver tissues., Conclusion: Th1-type cytokines are expressed predominantly in primary hepatic cancer and the adjacent liver tissue.

Background: The major causive factors of gallbladder carcinoma are very complex. Cholecystitis with gallstone was reported one of the most important factors. Many research revealed that cholecystitis or gallstone can give rise to epithelial hyperplasia of gallbladder mucusa or canceration secondarily. In this study, 46 patients were detected in order to find the relationship between infection of different bacteria and formation of gallbladder carcinoma., Methods: Using the common gene primer of bacteria 16S ribosomal RNA (rRNA), we detected bacterial gene fragments of gallbladder carcinoma tissues in 46 patients by polymerase chain reaction (PCR). Relative bile was also detected by PCR in 18 patients who underwent operations, including U-tube drainage (1), right or left biliary tube drainage (4), radical cholecystectomy (9), and cholecystorrhaphy (4). The tissue fragments of gallbladder carcinoma from the remaining 28 patients were paraffin slices., Results: The positive rate of bacterial DNA in gallbladder carcinoma tissue was 78.3% (36/46). The sequence of 16S ribosomal RNA gene fragments amplified by PCR was approximately 371 base pairs (bp). Multiple kinds of standard bacterial gene fragments obtained from 36 patients included Colibacillus, B.fragilis, Klebsiella, C.perfringens and Clostridium, with a positive rate of 78.3% (36/46). Among the 36 patients, 14 patients with gallbladder carcinoma received operation and their relative bile at operation was detected bacterial gene fragments with a positive rate of 77.8% (14/18). This result was close to that in gallbladder carcinoma tissues., Conclusions: Our results suggested that there might be a relationship between occurrence of gallbladder carcinoma and infection of different kinds of bacteria, especially anaerobic bacteria C.perfringens. This reminds us that the gallbladder mucosa stimulated by anaerobic and aerobic bacteria might be the principal cause for the development of carcinoma.

Objective: To detect bile anaerobic bacteria and antibiotic susceptibility in 59 patients with gallstones who had had cholecystectomy., Methods: BACT/ALERT 120 microbe detection system and SCEPTOR microbe detection system were used to detect bile anaerobic bacteria, antibiotic susceptibility., Results: The ratio of anaerobic bacteria to the patients examined was 52.5% (31/59). Obligate anaerobe bile culture showed positive results in 4 patients. B. fragilis (37.8%) was the major type of anaerobic bacteria in bile. Most (81.8%) of anaerobic bacteria were sensitive to metronidazole, and imipenem was suitable for beta-lactamase bacteria., Conclusions: Culture of anaerobic bacteria in logarithmic phase can improve the positive rate of the culture. There are some relations between anaerobic infection and gallstone formation.

Gastrointestinal fistula as a serious complication could lead to imbalance of nutrition or death. Duodenal fistula after orthotopic liver transplantation is rare and its treatment is complicated. On April 28, 200, we performed orthotopic liver transplantation for a patient at our hospital. Eight days after operation duodenal fistula developed, but cured after 13-day treatment.