BACKGROUND: Arsenic trioxide (ATO) is indicated as a broad-spectrum medicine for a variety of diseases, including cancer and cardiac disease. While the role of ATO in hepatic ischemia/reperfusion injury (HIRI) has not been reported. Thus, the purpose of this study was to identify the effects of ATO on HIRI. METHODS: In the present study, we established a 70% hepatic warm I/R injury and partial hepatectomy (30% resection) animal models in vivo and hepatocytes anoxia/reoxygenation (A/R) models in vitro with ATO pretreatment and further assessed liver function by histopathologic changes, enzyme-linked immunosorbent assay, cell counting kit-8, and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) assay. Small interfering RNA (siRNA) for extracellular signal-regulated kinase (ERK) 1/2 was transfected to evaluate the role of ERK1/2 pathway during HIRI, followed by ATO pretreatment. The dynamic process of autophagic flux and numbers of autophagosomes were detected by green fluorescent protein-monomeric red fluorescent protein-LC3 (GFP-mRFP-LC3) staining and transmission electron microscopy. RESULTS: A low dose of ATO (0.75 μmol/L in vitro and 1 mg/kg in vivo ) significantly reduced tissue necrosis, inflammatory infiltration, and hepatocyte apoptosis during the process of hepatic I/R. Meanwhile, ATO obviously promoted the ability of cell proliferation and liver regeneration. Mechanistically, in vitro  studies have shown that nontoxic concentrations of ATO can activate both ERK and phosphoinositide 3-kinase-serine/threonine kinase (PI3K-AKT) pathways and further induce autophagy. The hepatoprotective mechanism of ATO, at least in part, relies on the effects of ATO on the activation of autophagy, which is ERK-dependent. CONCLUSION Low, non-toxic doses of ATO can activate ERK/PI3K-AKT pathways and induce ERK-dependent autophagy in hepatocytes, protecting liver against I/R injury and accelerating hepatocyte regeneration after partial hepatectomy.
Animals ; Arsenic Trioxide ; Autophagy/physiology* ; Reperfusion Injury/prevention & control* ; Mice ; Male ; Proto-Oncogene Proteins c-akt/physiology* ; Arsenicals/therapeutic use* ; Oxides/therapeutic use* ; Liver/metabolism* ; Extracellular Signal-Regulated MAP Kinases/metabolism* ; Mice, Inbred C57BL

Objective:To explore whether a longitudinal integrated clerkship (LIC) model is more conducive to medical students' post competency and satisfaction with clerkships compared with the traditional block rotation clerkship.Methods:We selected 72 students who participated in graduating clerkships at The First Affiliated Hospital of Harbin Medical University from June 2018 to June 2019. They were equally divided into experimental group and control group to adopt LIC and traditional block rotation clerkship models, respectively. After completing the clerkships, the two groups were evaluated for post competency through objective testing of theoretical medical knowledge and basic clinical skills and rating of the other five competence items by the students themselves and their teachers. At the same time, a questionnaire was delivered to both groups for the degree of satisfaction with clerkships. The t-test and chi-squared test were performed using SPSS 23.0. Results:The objective tests and students' self-evaluation showed that the experimental group had significantly higher scores of theoretical medical knowledge [(8.02±1.11) vs. (7.50±0.97)], basic clinical skills [(7.63±0.90) vs. (6.93±0.73)], medical professional responsibility [(7.74±0.56) vs. (7.31±0.78)], clinical communication [(8.10±1.06) vs. (7.22±0.60)], team work [(7.84±0.62) vs. (7.11±0.69)], literature searching [(6.25±0.60) vs. (4.78±0.84)], and scientific research ability [(4.26±0.88) vs. (2.46±1.20)] compared with the control group (all P<0.05). The experimental group had significantly higher teacher-rated scores of medical professional responsibility [(8.03±0.74) vs. (6.59±0.70)], clinical communication [(7.95±0.73) vs. (6.87±0.67)], team work [(7.96±0.75) vs. (6.95±0.69)], literature searching [(4.84±0.84) vs. (3.30±0.69)], and scientific research ability [(4.53±1.03) vs. (2.70±1.05)] than the control group (all P<0.01). The scores of satisfaction were all higher in the experimental group than in the control group in terms of course arrangement satisfaction [(7.17±0.91) vs. 6.56±0.84)], teacher-student interaction satisfaction [(7.08±0.69) vs. (6.28±0.82)], self-improvement satisfaction [(7.28±0.45) vs. (6.36±0.49)], and clinical work smoothness [(7.72±0.82) vs. (6.81±0.71); all P<0.01]. Conclusion:Compared with the traditional block rotation model, the LIC model is more helpful for improving the post competency of medical students. LIC is a new clinical clerkship model that can potentially replace the traditional block rotation clerkship.

Along with the increasing quantity of patients with end-stage liver diseases year by year, as an efficacious treatment, the safety and efficacy of liver transplantation are critical issues to be considered. In addition, liver transplant techniques have become a new research hot spot. In recent years, liver transplant techniques are constantly innovating and developing with the unremitting efforts of researchers. Researchers have successively developed multiple liver transplant techniques, such as split liver transplantation, ischemia-free liver transplantation, liver xenotransplantation, domino liver transplantation, delayed total hepatectomy combined with liver resection and segment Ⅱ-Ⅲ liver transplantation, heterotopic auxiliary liver transplantation on splenic fossa and magnetic anastomosis. It has laid a foundation for expanding the donor pool, improving clinical efficacy of liver transplantation and enhancing the quality of life of liver transplant recipients. In this article, the exploration, development, innovation and improvement of liver transplant techniques were reviewed and prospected, aiming to provide reference for clinical application of liver transplantation.

High technology promotes the rapid development of the surgery. Various high and new technologies emerge to benefit patients and doctors. However, it is not surprising that there are unavoidable problems at the same time. Any situation needs to be analyzed from two aspects, which can be called the "double-edged sword" effects. Talking about and paying attention to these circumstances can promote the better application of high technology in the field of surgery.

Cholecystolithiasis is a common disease of the digestive system. In recent years, due to the changes in diet and daily living habits, the incidence of cholecystolithiasis in the world is rising gradually. Choledocholithiasis can form initially in situ, mainly due to infection and cholestasis, but also secondary to cholecystolithiasis or intrahepatic bile duct stones.Symptomatic gallstone disease in patients with laparoscopic cholecystectomy is the standard treatment.However, for patients with common bile duct calculi, traditional open surgery, laparoscopic combined choledochoscope, laparoscopic combined endoscopic and laparoscopic combined laser lithotripsy are all effective ways of treatment. But which one specific operation method is the best choice has yet to agree a consensus. In this paper, several different surgical treatment methods of common bile duct calculi are reviewed in order to provide certain reference value for clinical practice.

Hepatocellular carcinoma (HCC) is the fifth most common cancers worldwide, which ranks as the second of cancer-related death. Each year, more than half of the new and death cases occur in China. Vascular invasion is one of the important biological characteristics of HCC. HCC with portal vein tumor thrombus is closely related to the prognosis of patients, but there is no consensus on the best treatment method.Based on domestic and foreign literatures, the authors discuss the current status and progress of treatment for HCC with portal vein tumor thrombus, in order to explore the optimal treatment.

Since the concept of enhanced recovery after surgery(ERAS) has been proposed,it is valued,enriched and developed along with controversy and discussion. Although the content of ERAS involves multidisciplinary fields and is not an independent branch of surgery,surgeons,as an indispensable part,play an important role. At present,surgeons should pay more attention to post-operation complication rate,unplanned readmission rate and reoperation rate,and avoid these problems to the most extent by combining excellent surgical techniques with solid non-technical skills. As consequence,we would implement ERAS much better and be of great benefit to patients.

Since the concept of enhanced recovery after surgery(ERAS) has been proposed,it is valued,enriched and developed along with controversy and discussion. Although the content of ERAS involves multidisciplinary fields and is not an independent branch of surgery,surgeons,as an indispensable part,play an important role. At present,surgeons should pay more attention to post-operation complication rate,unplanned readmission rate and reoperation rate,and avoid these problems to the most extent by combining excellent surgical techniques with solid non-technical skills. As consequence,we would implement ERAS much better and be of great benefit to patients.

Intrahepatic cholangiocarcinoma (ICC) is the second prevalent primary liver cancer, next to hepatocellular carcinoma. Epidemiologic studies suggest the morbidity of ICC is on the rise worldwide. Owing to the complex etiology, lack of effective screening methods, the concealment of early clinical symptoms and the limited treatment strategy, it is tough to diagnose to ICC and difficult for further treatment. In recent years, with the development of medical technology and the progress of medical treatment idea, active explorations have been made on the early diagnosis and treatment strategies of ICC. The aim of this narrative review is to summarize the research status relating to diagnostic methods and treatment strategies.

Bilioenterostomy is the one of the main therapy options for extrahepatic and perihilar biliary diseases(benign and malignant tumors, congenital biliary dilatation, inflammatory stricture of bile duct reconstructive drainage of bile duct after lesion and iatrogenic injury of bile duct) resection and is a common procedure for hepatobiliary surgery. It’s necessary to take a further consideration in the choice of operation type, anastomosis method, suture and the placement of biliary stent in the bilioenterostomy for the hepatobiliary surgeon, since the incidence of postoperative complications such as anastomotic stenosis and reflux cholangitis will increase on account of the difference and inappropriateness of these choices. Currently, the development of techniques relating bilioenterostomy has become more proficient and some viewpoints have been unified. However, there are still some controversies in clinical application. It is necessary for surgeon to make the appropriate and reasonable choice on the basis of the specific circumstances in patients.