Primary hepatic carcinoma is one of the common digestive tract tumors.Surgical operation in clinic is still the most effective way to treat it so far.The caudate lobe has often been considered the forbidden zone of hepatic operation in the past due to complicated anatomy.In resent years,with the deepening of knowledge of anatomy and advanced radiological technology,many new operative approachs and operation methods have been explored to improve the situation of caudate lobectomy which is already not rare in clinic now.This article summarized the anatomy of caudate lobe and reviewed the therapy progress of the hepatic carcinomas located caudate lobe.

Objective To investigate the role of glucocorticoid-induced tumor necrosis factor ligand (GITRL) in regulating the inflammatory reaction of kupffer cells.Methods The kupffer cells and T cells of mice were isolated and divided into 6 groups after being co-cultured:control group,kupffer cells and T cells were cultured in DMEM only; lipopolysaccharide (LPS) group,kupffer cells and T cells were cultured in media with LPS (1 mg/L) ; LPS + GITRL siRNA group,kupffer cells and T cells were cultured in media as the LPS group after transfected with GITRL siRNA ; LPS + control siRNA group,kupffer cells and T cells were cultured in media as the LPS group after transfected with control siRNA; LPS + pEGFP-N1 GITRL group,kupffer cells and T cells were cultured in media as the LPS group after transfected with pEGFP-N1 GITRL plasmid; LPS + pEGFP-N1 control group,kupffer cells and T cells were cultured in media as the LPS group after transfected with control plasmid.After 24 hours of treatment,the expressions of GITRL and PDL1 of kupffer cells were detected by immunofluorescence and western blot,respectively.The proliferation and apoptosis of T cells were measured by MTF assay and Annexin V/PI flow cytometry,respectively.The expression of tumor necrosis factor (TNF-α) in the supernatant fluid was measured by ELISA.All data were analyzed using the independent t test and one-way analysis of variance.Results The transfection efficiencies of GITRL siRNA and pEGFP-N1 GITRL were 90％ and 85％,respectively.Compared with normal kupffer cells,the protein expression of GITRL of kupffer cells transfected with GITRL siRNA was significantly decreased,while the protein expression of GITRL of kupffer cells transfected with pEGFP-N1 GITRL was significantly increased (t =41.72,13.10,P ＜ 0.05).There was no significant difference in the protein expressions of GITRL between normal kupffer cells and those in the control groups (F =2.27,P ＞ 0.05).The fluorescence intensity of GITRL in the LPS group was significantly higher than that in the control group (t =49.29,P ＜ 0.05).Compared with LPS group,the activation of GITRL expression by the LPS was significantly suppressed in the LPS + GITRL siRNA group (t =9.84,P ＜ 0.05),while the expression of GITRL in the LPS + pEGFP-N1 GITRL group was significantly increased (t =5.78,P ＜ 0.05).There was no significant difference in the GITRL expression among the LPS + control siRNA group,LPS + pEGFP-N1 control group and LPS group (F =0.86,P ＞ 0.05).The expression of PDL1 in the LPS group was significantly lower than that in the control group (t =18.83,P ＜0.05).Compared with LPS group,the expression of PDL1 in the LPS + pEGFP-N1 GITRL group was significantly suppressed (t =11.79,P ＜ 0.05),while the expression of PDL1 in the LPS + GITRL siRNA group was significantly stronger (t =19.08,P ＜ 0.05).There was no significantly difference in the expression of PDL1 in the LPS + control siRNA group,LPS + pEGFP-N1 control group and LPS group (F =2.22,P ＞ 0.05).The proliferation of T cells was increased and the number of apoptotic T cell was decreased in the LPS group when compared with control group (t =49.43,40.11,P ＜ 0.05).Compared with LPS group,the proliferation and apoptosis of T cells in the LPS + pEGFP-N1 GITRL group had the same trend (t =5.77,12.64,P ＜0.05); while the proliferation of T cells was decreased and the apoptosis of T cells was increased in the LPS + GITRL siRNA group (t =17.00,49.90,P ＜ 0.05).There was no significant difference in the proliferation and apoptosis of T cells among the LPS + control siRNA group,LPS + pEGFP-N1 control group and LPS group (F =1.87,1.35,P ＞ 0.05).The expression of TNF-α was significantly higher in the LPS group than that in the control group (t =125.68,P ＜ 0.05).Compared with the LPS group,the expression of TNF-α was significantly decreased in the LPS + GITRL siRNA group (t =119.65,P ＜ 0.05),while the expression of TNF-α in the LPS + pEGFP-N1 GITRL group was significantly increased (t =147.70,P ＜ 0.05).There was no significant difference in the TNF-α expression among the LPS + control siRNA group,LPS + pEGFP-N1 control group and LPS group (F =0.14,P ＞ 0.05).Conclusion Kupffer cells suppress the expression of PDL1 by upregulating GITRL,and thus activate the proliferation of T cells and promote the inflammatory reaction.The immunologic balance may be recovered after the interference of GITRL to restrain the inflammatory reaction.

Primary gallbladder cancer is a relatively common biliarv malignant tumor but with a high mortality rate.Most patients with this disease reach an advanced stage when late onset symptoms occtur, and the prognosis tends to be poor even after radical operation.Searching for new diagnostic approaches of primary gallbladder, standardizing treatment strategy, conducting multieenter clinical trials of new drug, developing preventive measures according to different situations are significant methodls to improve the treatment effect prognosis.In this article, we reviewed the research progress of high risk factors, diagnostics, and treatment strategies of primary gallbladder cancer.

S-adenosylmethionine(SAM) is a physiologically active molecule in all the organizations and the human body fluids, and it is important to participate in a variety of biochemical reactions, the regulation of liver regeneration, liver cells differentiation and various sensitivity of the injury. The SAM affects the liver through a variety of ways. It is confirmed that the SAM and MTA can block the LPS-induced TNF-α of Kupffer cells to protect the liver. In a word, S-adenosylmethionine may be beneficial to LPS-induced liver in-jury in clinical treatment.

Objective To study the protective mechanism of S-adenosylmethionine ( SAM) underlying liver injury induced by lipopolysaccharides ( LPS). Methods One hundred BABL/c mice were randomly divided into LPS group and SAM group. Mice in LPS group were intraperitoneally injected with 10 mg/kg LPS,and the mice in SAM group were injected with 100 mg/kg SAM 2 h before receiving the same dose of LPS. The survival rate of mice in 2 groups was recorded in 24,48,72 and 120 h after LPS injection. Histopathological changes in liver of mice were examined in 0,1,3,6,12 and 24 h after LPS injection. Tumor necrosis factor-? ( TNF-?) and interleukin-10 ( IL-10) levels in serum were measured by ELISA analysis at above time points. Expression of Toll-like receptor 4 ( TLR4) and liver X receptor ? ( LXR?) in hepatic tissues was detected by immunohistochemistry and Western blotting. Results SAM increased the survival rate of mice from 50. 0% ,40. 0% ,30. 0% ,and 30. 0% before LPS injection to 80. 0% ,70. 0% ,60. 0% ,and 50. 0% after its injection ( P

0.05).However,body mass index and hemoglobin level were significantly higher in the slow coronary flow group compared with the control group(26.9?3.2 kg/m2 vs.24.9?2.9 kg/m2,P

As the biggest macrophage cells population in human body and the most important immune cells in the liver,Kupffer cells play a very important role in infection,inflammation,lipid metabolism and liver transplantation,and regulates various physiological and pathological processes.However,little is known about the role and mechanism in the tumorigenesis and tumor progression of Kupffer cells which as a kind of such important immune cells.In this paper,we summarized published researches and our experimental results about Kupffer cells,and reviewed the relationship between Kupffer cells and hepatocellular carcinoma from aspects of phagocytosis,secretary and antigen presentation.We hold that,at the early age of liver diseases,Kupffer cells inhibit tumorigenesis of hepatocellular carcinoma by its functions of phagocytosis,secretary and antigen presentation;however,when inflammation persists,Kupffer cells could induce tumorigenesis of hepatocellular carcinoma by secretary mechanism.

Objective To study the case of 76 patients with choledochoduodenal fistula ( CDF) ,and summarize the experience of mak-ing diagnosis and treatment. Methods From January 1999 to June 2012,76 patients with CDF were treated in our department and then was confirmed by endoscopic retrograde cholangiography ( ERCP) . All patients were classified based on the location of duodenal papilla in rela-tion to the orificium fistulae of CDF. Different therapies were used to certain CDF depending on the diameter of the orificium fistulae of CDF. Of the 76 CDF patients,70 patients (92%) required surgery. Results The fistula of 76 CDF patients have three types,and the formation of this classification was based on the position between the duodenal papilla and the orificium fistulae of CDF. Different therapies referred to cer-tain diameter of CDF,70 patients required surgery and 6 acquired pharmacotherapy. Of the 70 patients needing surgical intervention,clinical outcomes were excellent in 66 patients. Follow-up of these patients for 6 months to 10 years showed they did not suffer from further cholangi-tis. Conclusion The past history of biliary disease,upper abdominal pain,fever,and jaundice may lead to the disease of CDF. ERCP was the primary method for diagnosing this disease,and operative therapy was the primary treatment for most CDF patients.

Objective To explore the diagnosis and treatment for pancreatic cystic neoplasms.Methods The clinical data of 10 cases with pancrestic cystic neoplasms treated from 2004 to 2008 was reviewed and both domestic and internal pertinent literatures were summarized.Results The pancreatic cystic neoplasms mostly happened in middle-aged women.The clinical manifestations showed no specificity.Ultrasonography, CT and MRI could offer important sign for diagnosis.The rate of surgical resection was high and the prognosis was satis-factory.Conclusions The pancreatic cystic neoplasms is being muh with the development of imagings.It is dif-ficuh to distinguish the feature of the cystic neoplasms before surgery, so surgerical resection should be done for all cystic tumors found.

Intercellular adhesion molecule -1 is closely related to the occurrence,development and me mastasis of liver cancer.A variety of inflammatory cytokines and stimulus effect on the expression of Intereclluar adhesion molecule-1 through Nuclear factor-kappa B signal transduction pathways.In the stage of inflammation,hepatocirrhusis and tumor,Intercelluar adhesion molecule-1 is expressed differently,and makes different effects on different cells,to promote the occurrence and metastasis of tumor.Diagnostic significance of Intercelluar adhesion molecule1 is to diagnose hepatocellular carcinoma with AFP-negative or suspected-positive more early.What's more it can prognosticate the metastasis and prognosis of liver cancer as a biomarker.Many new treatments of liver cancer are based on the effects on Intercelluar adhesion molecule-1 in different levels producing antitumor function.