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Efficacy of ursodeoxycholic acid as an adjuvant treatment to prevent acute cellular rejection after liver transplantation: a meta-analysis of randomized controlled trials

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Hepatobiliary & Pancreatic Diseases International 2014年第5期13卷 464-473页

作者： Yi-Lei Deng xian-ze xiong Nan-Sheng Cheng Department of Biliary Surgery West China HospitalSichuan University

BACKGROUND： Acute cellular rejection（ACR） after liver transplantation（LT） is one of the most common problems faced by transplant recipients in spite of advances in immunosuppressive therapy. Recently, clinical trials reported that ursodeoxycholic acid（UDCA） reduced the incidence of ACR ***, others have shown contradictory conclusion. Therefore,we performed a meta-analysis of rigorous randomized controlled trials（RCTs） to determine the efficacy of UDCA in reducing ACR after *** SOURCES： All RCTs that evaluated efficacy of UDCA as an adjuvant treatment to prevent ACR after LT were searched from PubMed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ScienceDirect databases and Web of Science（from January 1981 to March 2012）. There was no language limitation in these searches. Relevant abstracts of international meetings were also searched. References of each included study were searched ***： A total of 234 patients from four high-quality RCTs（Jadad score 4 to 5） were included in this *** use of UDCA did not decrease the incidence of ACR（RR： 0.94, 95% CI： 0.77-1.16, P0.05）, steroid-resistant rejection（RR： 0.77, 95% CI： 0.47-1.27, P0.05） and the number of patients with the multiple episodes of ACR（RR： 0.60, 95% CI：0.28-1.30, P0.05）. Different intervention programs（high-dose vs low-dose UDCA; early vs delayed UDCA treatment） also did not alter the ***： UDCA, as an adjuvant treatment, was not ableto prevent ACR and steroid-resistant rejection after LT. Further trials should be done to determine whether higher dose of UDCA will be beneficial.

关键词： ursodeoxycholic acid acute cellular rejection liver transplantation meta-analysis

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Two-stage vs single-stage management for concomitant gallstones and common bile duct stones

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World Journal of Gastroenterology 2012年第24期18卷 3156-3166页

作者： Jiong Lu Yao Cheng xian-ze xiong Yi-Xin Lin Si-Jia Wu Nan-Sheng Cheng Department of Bile Duct Surgery West China HospitalSichuan UniversityChengdu 610041Sichuan ProvinceChina

AIM:To evaluate the safety and effectiveness of twostage vs single-stage management for concomitant gallstones and common bile duct ***:Four databases,including PubMed,Embase,the Cochrane Central Register of Controlled Trials and the Science Citation Index up to September 2011,were searched to identify all randomized controlled trials(RCTs).Data were extracted from the studies by two independent *** primary outcomes were stone clearance from the common bile duct,postoperative morbidity and *** secondary outcomes were conversion to other procedures,number of procedures per patient,length of hospital stay,total operative time,hospitalization charges,patient acceptance and quality of life ***:Seven eligible RCTs [five trials(n = 621) comparing preoperative endoscopic retrograde cholangiopancreatography(ERCP)/endoscopic sphincterotomy(EST) + laparoscopic cholecystectomy(LC) with LC + laparoscopic common bile duct exploration(LCBDE);two trials(n = 166) comparing postoperative ERCP/EST + LC with LC + LCBDE],composed of 787 patients in total,were included in the final *** metaanalysis detected no statistically significant difference between the two groups in stone clearance from the common bile duct [risk ratios(RR) =-0.10,95% confidence intervals(CI):-0.24 to 0.04,P = 0.17],postoperative morbidity(RR = 0.79,95% CI:0.58 to 1.10,P = 0.16),mortality(RR = 2.19,95% CI:0.33 to 14.67,P = 0.42),conversion to other procedures(RR = 1.21,95% CI:0.54 to 2.70,P = 0.39),length of hospital stay(MD = 0.99,95% CI:-1.59 to 3.57,P = 0.45),total operative time(MD = 12.14,95% CI:-1.83 to 26.10,P = 0.09).Two-stage(LC + ERCP/EST) management clearly required more procedures per patient than single-stage(LC + LCBDE) ***:Single-stage management is equivalent to two-stage management but requires fewer ***,patient's condition,operator's expertise and local resources should be taken into account in making treatment de

关键词： Laparoscopic cholecystectomy Laparoscop-ic common bile duct exploration Endoscopic retrogradecholangiopancreatography Endoscopic sphincterotomy Gallstones Common bile duct stones Meta-analysis

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Carbon dioxide insufflation for endoscopic retrograde cholangiopancreatography:A meta-analysis and systematic review

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World Journal of Gastroenterology 2012年第39期18卷 5622-5631页

作者： Yao Cheng xian-ze xiong Si-Jia Wu Jiong Lu Yi-Xin Lin Nan-Sheng Cheng Tai-xiang Wu Department of Bile Duct Surgery West China Hospital Sichuan University Chengdu 610041 Sichuan Province China Chinese Cochrane Centre Chinese Clinical Trial Registry Chinese Evidence-Based Medicine Centre INCLEN Resource and Training Centre West China Hospital Sichuan University Chengdu 610041 Sichuan Province China

AIM:To assess the safety and efficacy of carbon dioxide (CO2) insufflation during endoscopic retrograde cholangiopancreatography (ERCP). METHODS:The Cochrane Library, Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Science Citation Index Expanded, Chinese Biomedical Literature Database, and references in relevant publications were searched up to December 2011 to identify randomized controlled trials (RCTs) comparing CO2 insufflation with air insufflation during ERCP. The trials were included in the review irrespec-tive of sample size, publication status, or language. Study selection and data extraction were performed by two independent authors. The meta-analysis was performed using Review Manager 5.1.6. A random-effects model was used to analyze various *** and subgroup analyses were performed if necessary. R ESULTS:Seven double-blind RCTs involving a total of 818 patients were identified that compared CO2 insufflation (n = 404) with air insufflation (n = 401) during ERCP. There were a total of 13 post-random- ization dropouts in four RCTs. Six RCTs had a high risk of bias and one had a low risk of bias. None of the RCTs reported any severe gas-related adverse events in either group. A meta-analysis of 5 RCTs (n = 459) indicated that patients in the CO2 insufflation group had less post-ERCP abdominal pain and distension for at least 1 h compared with patients in the air insuf-flation group. There were no significant differences in mild cardiopulmonary complications [risk ratio (RR) = 0.43, 95% CI:0.07-2.66, P = 0.36], cardiopulmonary (e.g., blood CO2 level) changes [standardized mean difference (SMD) = -0.97, 95% CI: -2.58-0.63, P = 0.23], cost analysis (mean difference = 3.14, 95% CI:-14.57-20.85, P = 0.73), and total procedure time (SMD = -0.05, 95% CI:-0.26-0.17, P = 0.67) between the two groups. C ONCLUSION:CO2 insufflation during ERCP appears to be safe and reduces post-ERCP abdominal pain and discomfort.

关键词： Systematic review Meta-analysis Carbondioxide insufflation Endoscopic retrograde cholangio-pancreatography Abdominal pain

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Prognostic value of lymphovascular invasion in Bismuth-Corlette type Ⅳ hilar cholangiocarcinoma

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World Journal of Gastroenterology 2017年第36期23卷 6685-6693页

作者： Bei Li xian-ze xiong Yong Zhou Si-Jia Wu Zhen You Jiong Lu Nan-Sheng Cheng Department of Biliary Surgery West China Hospital of Sichuan University

AIM To assess the prognostic value of lymphovascular invasion(LVI)in Bismuth-Corlette typeⅣhilar cholangiocarcinoma(HC)patients. METHODS A retrospective analysis was performed on 142consecutively recruited typeⅣHC patients undergoing radical resection with at least 5 years of *** analysis was performed by the KaplanMeier method,and the association between the clinicopathologic variables and survival was evaluated by log-rank *** analysis was adopted to identify the independent prognostic factors for overall survival(OS)and disease-free survival(DFS).Multiple logistic regression analysis was performed to determine the association between LVI and potential variables. RESULTS LVI was confirmed histopathologically in 29(20.4%)*** analysis showed that positive resection margin(HR=6.255,95%CI:3.485-11.229,Pze>30 mm(HR=1.942,95%CI:1.176-3.209,P=0.010)and LVI positivity(HR=2.799,95%CI:1.588-4.935,Pze>30 mm(HR=1.739,95%CI:1.101-2.745,P=0.018)and LVI positivity(HR=2.908,95%CI:1.712-4.938,Pze>30 *** logistic regression analysis indicated that N1 stage(HR=3.312,95%CI:1.338-8.198,P=0.026)and tumor size>30 mm(HR=3.258,95%CI:1.288-8.236,P=0.013)were associated with LVI. CONCLUSION LVI is associated with N1 stage and tumor size>30mm and adversely influences DFS and OS in typeⅣHC patients.

关键词： Bismuth-Corlette classification Diseasefree survival Lymphovascular invasion Overall survival Hilar cholangiocarcinoma

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Histological examination of frozen sections for patients with acute cholecystitis during cholecystectomy

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Hepatobiliary & Pancreatic Diseases International 2015年第3期14卷 300-304页

作者： Zhen You Wen-Jie Ma Yi-Lei Deng xian-ze xiong Anuj Shrestha Fu-Yu Li Nan-Sheng Cheng Department of Biliary Surgery West China HospitalSichuan University

BACKGROUND： Unexpected gallbladder cancer may present with acute cholecystitis-like manifestat/ons. Some authors rec- ommended that frozen section analysis should be performed during laparoscopic cholecystectomy for all cases of acute cholecystitis. Others advocate selective use of frozen section analysis based on gross examination of the specimen by the surgeon. The aim of the present study was to evaluate whether surgeons could effectively identify suspected gallbladder with macroscopic examination alone. If not, is routine frozen sec- tion analysis worth advocating？

关键词： unexpected gallbladder cancer acute cholecystitis cholecystectomy frozen section analysis

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A simple scoring system to predict early recurrence of Bismuth–Corlette type IV perihilar cholangiocarcinoma

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Gastroenterology Report 2019年第5期7卷 345-353,I0002页

作者： Ding-Zhong Peng Jiong Lu Bei Li Hai-Jie Hu Xi-Wen Ye xian-ze xiong Nan-Sheng Cheng Department of biliary surgery West China Hospital of Sichuan UniversityChengduSichuanP.R.China

Background:Early recurrence has been reported to be predictive of a poor prognosis for patients with perihilar cholangiocarcinoma(pCCA)after *** objective of our study was to construct a useful scoring system to predict early recurrence for Bismuth–Corlette type IV pCCA patients in clinic and to investigate the value of early recurrence in directing post-operative surveillance and adjuvant ***:In total,244 patients who underwent radical resection for type IV pCCA were *** on clinicopathological characteristics,perioperative details and survival outcomes were *** curves were generated using the Kaplan–Meier *** and multivariate logistic-regression models were used to identify factors associated with early ***:Twenty-one months was defined as the cutoff point to distinguish between early and late *** and multivariate analysis revealed that CA19-9 level>200 U/mL,R1 resection margin,higher N category and positive lymphovascular invasion were independent predictors of early *** scoring system was constructed *** early-recurrence rates of patients with scores of 0,1,2,3,4,and 5 were 23.9%,38.7%,60.0%,78.6%,83.4%,and 100%,*** therapy was significantly associated with higher overall survival rate for patients with early recurrence,but not for those with late *** in the early-recurrence group with scores2 had better prognoses after adjuvant ***:A simple scoring system using CA19-9 level,N category,resection margin and lymphovascular invasion status could predict early recurrence,and thus might direct post-operative surveillance and adjuvant therapy for patients with type IV pCCA.

关键词： early recurrence Bismuth–Corlette classification perihilar cholangiocarcinoma

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Organ fibrosis inhibited by blocking transforming growth factor-β signaling via peroxisome proliferator-activated receptor γ agonists

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Hepatobiliary & Pancreatic Diseases International 2012年第5期11卷 467-478页

作者： Yi-Lei Deng, xian-ze xiong, Nan-Sheng Cheng Department of General Surgery, West China Hospital,Sichuan University, Chengdu 610041, China Department of General Surgery West China Hospital Sichuan University Chengdu 610041 Chengdu China

BACKGROUND:Organ fibrosis has been viewed as one of the major medical problems, which can lead to progressive dysfunction of the liver, lung, kidney, skin, heart, and eventually death of patients. Fibrosis is initiated by a variety of pathological, physiological, biochemical, and physical factors. Regardless of their different etiologies, they all share a common pathogenetic process: excessive activation of the key profibrotic cytokine, transforming growth factor-β (TGF-β). Peroxisome proliferator-activated receptor γ (PPARγ), a ligand-activated transcription factor of the nuclear receptor superfamily, has received particular attention in recent years, because the activation of PPARγ by both natural and synthetic agonists could effectively inhibit TGF-β-induced profibrotic effects in many organs. DATA SOURCES: The English-language medical databases, PubMed, Elsevier and SpringerLink were searched for articles on PPARγ, TGF-β, and fibrosis, and related topics. RESULTS: TGF-β is recognized as a key profibrotic cytokine. Excessive activation of TGF-β increases synthesis of extracellular matrix proteins and decreases their degradation, associated with a gradual destruction of normal tissue architecture and function, whereas PPARγ agonists inhibit TGF-β signal transduction and are effective antifibrogenic agents in many organs including the liver, lung, kidney, skin and heart. CONCLUSIONS: The main antifibrotic activity of PPARγ agonists is to suppress the TGF-β signaling pathway by so-called PPARγ-dependent effect. In addition, PPARγ agonists, especially 15d-PGJ2, also exert potentially antifibrotic activity independent of PPARγ activation. TGF-β1/Smads signaling not only plays many essential roles in multiple developmental processes, butalso forms cross-talk networks with other signal pathways, and their inhibition by PPARγ agonists certainly affects the cytokine networks and causes non-suspected side-effects. Anti-TGF-β therapies with PPARγ agonists may have to be car

关键词： PPAR gamma transforming growth factor-β fibrosis

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Single-incision laparoscopic appendectomy vs conventional laparoscopic appendectomy:Systematic review and meta-analysis

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World Journal of Gastroenterology 2013年第31期19卷 5165-5173页

作者： Yu-Long Cai xian-ze xiong Si-Jia Wu Yao Cheng Jiong Lu Jie Zhang Yi-Xin Lin Nan-Sheng Cheng Department of Bile Duct Surgery West China Hospital Sichuan University

AIM: To assess the differences in clinical benefits and disadvantages of single-incision laparoscopic appendectomy(SILA) and conventional laparoscopic appendectomy(CLA).METHODS: The Cochrane Library,MEDLINE,Embase,Science Citation Index Expanded,and Chinese Biomedical Literature Database were electronically searched up through January 2013 to identify randomized controlled trails(RCTs) comparing SILA with *** was extracted from eligible studies to evaluate the pooled outcome effects for the total of 1068 *** meta-analysis was performed using Review Manager *** dichotomous data and continuous data,the risk ratio(RR) and the mean difference(MD) were calculated,respectively,with 95%CI for *** continuous outcomes with different measurement scales in different RCTs,the standardized mean difference(SMD) was calculated with 95%*** and subgroup analyses were performed when ***: Six RCTs were identified that compared SILA(n = 535) with CLA(n = 533).Five RCTs had a high risk of bias and one RCT had a low risk of *** was associated with longer operative time(MD = 5.68,95%CI: 3.91-7.46,P zed RCTs,postoperative pain was not ***: The benefit of SILA is cosmetic satisfaction,while the disadvantages of SILA are longer operative time and higher conversion rate.

关键词： Single incision Laparoscopic Appendectomy Meta-analysis Systematic review

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Effect of peroxisome proliferator-activated receptor-gamma ligand on inflammation of human gallbladder epithelial cells

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World Journal of Gastroenterology 2005年第38期11卷 6061-6065页

作者： Guang-Dong Pan Hong Wu Jiang-Wen Liu Nan-Sheng Cheng xian-ze xiong Sheng-Fu Li Suo-Fu Zhang Lu-Nan Yan Department of General Surgery West China Hospital Sichuan University Chengdu 610041Sichuan Province China Laboratory of Transplant and Immunology West ChinaHospital Sichuan University Chengdu 610041 Sichuan Province China Laboratory of Isotope West China HospitalSichuan University Chengdu 610041 Sichuan Province China

AIM： To investigate the effect of peroxisome proliferatoractivated receptor gamma （PPAR-γ） and its ligand, ciglitazone, on inflammatory regulation of human gallbladder epithelial cells （HGBECs） and to assess the effect of human epithelial growth factor （hEGF） on growth of HGBECs. METHODS： HGBECs were cultured in media containing hEGF or in hEGF-free media. HGBECs were divided into normal control group, inflammatory control group and ciglitazone group （test group）. Inflammatory control group and ciglitazone group were treated with 5 μg/L of human interleukin-1β（hIL-1β） to make inflammatory model of HGBECs. The ciglitazone group was treated with various concentrations of ciglitazone, a potent ligand of PPAR-y. Subsequently, interleukin-8 （IL-8）, IL-6, and tumor necrosis factor-α （TNF-α） concentrations in all groups were measured. The data were analyzed statistically. RESULTS： HGBECs were cultured in medium successfully. The longevity of HGBECs in groups containing hEGF was longer than that in hEGF-free groups. So was the number of HGBECs. The longest survival time of HGBEC was 25 d. The inflammatory model of HGBECs was obtained by treating with hIL-1β. The concentrations of IL-6 and IL-8 in ciglitazone group were lower than those in inflammatory conlyol group （P〈0.05）. The secretion of IL-6 in inflammatory control group was higher （350.31±37.05 μg/L） than that in normal control group （50.0±0.00 μg/L, P〈0.001）. Compared to normal control group, IL-8 concentration in inflammatory control was higher （P〈0.05）. CONCLUSION： hEGF improves the growth of HGBECs in vitro. Ciglitazone inhibits the inflammation of HGBECs in vitro and has potential therapeutic effect on cholecystitis in vivo.

关键词： PPAR-γ1 Human gallbladder epithelial cells Inflammation Effect

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Repair of a common bile duct defect with a decellularized ureteral graft

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World Journal of Gastroenterology 2016年第48期22卷 10575-10583页

作者： Yao Cheng xian-ze xiong Rong-Xing Zhou Yi-Lei Deng Yan-Wen Jin Jiong Lu Fu-Yu Li Nan-Sheng Cheng Department of Bile Duct Surgery West China Hospital Sichuan University

AIM To evaluate the feasibility of repairing a common bile duct defect with a decellularized ureteral graft in a porcine *** Eighteen pigs were randomly divided into three groups. An approximately 1 cm segment of the common bile duct was excised from all the pigs. The defect was repaired using a 2 cm long decellularized ureteral graft over a T-tube(T-tube group, n = 6) or a silicone stent(stent group, n = 6). Six pigs underwent bile duct reconstruction with a graft alone(stentless group). The surviving animals were euthanized at 3 mo. Specimens of the common bile ducts were obtained for histological *** The animals in the T-tube and stent groups survived until sacrifice. The blood test results were normal in both groups. The histology results showed a biliary epithelial layer covering the neo-bile duct. In contrast, all the animals in the stentless group died due to biliary peritonitis and cholangitis within two months post-surgery. Neither biliary epithelial cells nor accessory glands were observed at the graft sites in the stentless *** Repair of a common bile duct defect with a decellularized ureteral graft appears to be feasible. A T-tube or intraluminal stent was necessary to reduce postoperative complications.

关键词： Decellularization Stent Bile duct injury Biliary reconstruction Ureteral graft

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