Adenosine monophosphate-activated protein kinase (AMPK) activation also can inhibit the synthesis of cholesterol and fat.Recent studies have shown that activation of AMPK can also inhibit the synthesis of bile acid and promote bile salt export pump' s generation.All of those illustrated that AMPK played an important role in regulating bile acid metabolism.This article will summarize the AMPK activation pathway,bile acid metabolism,AMPK activity in bile acid synthesis and transfer,and so on.

Pancreatic cancer is one of the malignant turnouts, the rate of early diagnosis is very low. Retrieval reliable early diagnosis marker becomes stringent requirement for improving the prognosis. Proteomics is able to un-cover and explore the tumor marker. The article describes the research progress of proteomics in the tumor markers of the pancreatic cancer tissue, juice and serum.

Objective To investigate the clinical management of Spontaneous rupture of hepatocellular carcinoma(SRHCC) . Methods This was a retrospective review of the clinical data of patients with SRHCC who underwent treated in the affiliate hospi‐tal of Luzhou medical college from January 2001 to December 2014 .Results Among 104 patients ,small hepatocellular carcinoma (<5 cm) were found in 11 cases ,and large hepatocellular carcinoma(>5 cm) in 93 cases .Thirty‐one cases which underwent surgi‐cal treatment ,were cured;44 underwent transcatheter arterial embolization (TAE) ,5 cases died of liver function failure;29 cases were treated conservatively ,11 cases died of huge bleeding ,18 cases gave up discharged .Twenty‐two small and medium‐sized SRH‐CC cases underwent hepatectomy survived 1to‐10 years ;8 huge sized SRHCC cases survived 5to‐13 months;one case who under‐went partial filling pressure hemostasis and hepatic artery ligation ,but died of tumor rupture again after 34 days .Sixteen cases un‐derwent TAE were followed up ,14 cases survived 3to‐10 moths ,the survival time of two cases were 3 years and 5 years ,respective‐ly .Conservative treatment group has not been followed up .Conclusion The tumours should be surgical resection as soon as possi‐ble in those whose lesions confined to the liver and may be removed ,systemic condition is good;TAE should be used for other pa‐tients .

Objective To evaluate the diagnostic value of the direct MR arthrography in the meniscus degeneration and tear of knee.Methods Thirty subjects undefined by MR imaging having meniscus degeneration and tear of knee underwent MR arthrography.The diagnostic accurate rates in meniscus degeneration and tear by using MR imaging and MR arthrography were evaluated according to the arthroscopy results.Results The diagnostic accurate rates of meniscus degeneration and tear were 80% and 96.7% by conventional MRI scan and MR arthrography respectively.Conclusion The direct low-feild MR arthrography can improve the diagnostic accuracy of meniscus degeneration and tear of knee.

Objective To review the clinical presentation of patients with hepatobiliary stones (HS).Method 2 359 patients with HS were divided into group A and B according to the presentation of these patients before or after 2002.Their clinical data were retrospectively analyzed.Results The age,the percentage of patients with a case history ＞ 10 years,the admission rate for relapse,the intrahepatic to extrahepatic stone ratio,the number of patients complicated with liver cirrhosis/portal hypertension,the elective operation rate,the ratio of biliary drainage operation,or the ratio of biliary drainage combined with hepatic resection in group B were 54.02 ± 13.54 years,68.99％,53.07％,73.18％,13.41％,80.80％,83.81％,44.74％,respectively.The corresponding figures for group A were 48.65 ± 14.47 years,46.25％,32.0％,62.02％,4.63％,63.92％,41.45％,19.05％,all P ＜0.01.However,the rates of biliary ascariasis,acute cholangitis of severe type (ACST),hepatic abscess,bleeding or perforation of the biliary tract,non-operative mortality,emergency operation rate and stone residual rate in group B were 6.56％,6.15％,0.84％,0,0,1.71％,5.18％,18.70％,respectively.All these were significantly lower than those in group A (12.11％,33.72％,1.95％,0.37％,0.67％,25.62％,respectively,all P ＜ 0.01).Conclusions The popularization of medical insurance and the increase in hospital admission rate,but not the actual increase in HS,led to the increase in hospitalization of patients.There was a tendency of less patients presenting with severe disease due to delay in treatment.Routine choledochoscopic stone extraction intraoperatively or postoperatively and the increased liver resection rate had decreased the residual stone rate.There should be a strict restriction on the use of choledochojejunostomy.

Objective To study the preventive effects of vitamin K2 on tumor recurrence in patients with hepatocellalar carcinoma (HCC) after radical resection. Methods The clinical data of 50 patients with HCC who received radical resection from March 2006 to March 2007 in No. 181 Hospital of PLA were analyzed retrospec-tively. All the patients were divided into 2 groups according to the random number table. Twenty-six patients in vitamin K2 group were administered with menatetrenone (45 mg per day), and the rest 24 pateints were in the control group. The accumulative and tumor-free survival rates, differences between the 2 groups, multivariate factors for prognosis were analyzed by Kaplan-Meier curve, Log-rank test and Cox regression model, respectively. Results During a period of 36 month follow-up, 10 patients died and 28 had tunor recurrence. The 1-, 2-, 3-year accumulative survival rates were 96%, 92% and 83% in vitamin K2 group, and 96%, 82% and 63% in control group (χ2 = 3.61, P > 0.05). The 1-, 2-, 3-year tumor-free survival rates were 92%, 60% and 38% in vitamin K2 group, and 75%, 42% and 12% in control group, with significant difference between the 2 groups (χ2 =5.61, P <0.05). Univariate and multivariate Cox proportional hazard analysis showed that without taking menate-trenone, the preoperative level of alpha fetoprotein (AFP) ≥800 μg/L and vascular invasion were the indepen-dent risk factors for tumor recurrence. Conclusions Vitamin K2 has a suppressive effect on tumor recurrence of HCC, while patients with AFP≥800 μg/L before operation or with vascular invasion have poor prognosis.

AIM:To investigate the effects of leptin on the expression of bile salt export pump ( BSEP) and signaling pathway in human hepatocellular carcinoma cell line HepG2.METHODS: HepG2 cells were cultured in vitro. Leptin at concentrations of 10 -8 , 10 -7 and 10 -6 mol/L was used as a stimulating factor.The protein levels of adenosine monophosphate-activated protein kinase alpha subunit (AMPKa), phosphorylated AMPKa (p-AMPKa) and BSEP in the HepG2 cells at 24 h, 48 h and 72 h were detected by Western blotting.The optimal culture time and leptin concentration were selected, and compound C at concentration of 10 μmol/L was added to this group.The protein expression of BSEP was detected by Western blotting.RESULTS:Intervention of HepG2 cells with leptin for 72 h increased the protein ex-pression of AMPKa gradually in a concentration-dependent manner, and leptin at concentration of 10 -6 mol/L induced the strongest AMPKa expression ( P<0.01 ) .Intervention of HepG2 cells with leptin for 24 h increased the phosphorylation level of AMPKa gradually in a dose-dependent manner (P<0.01).The effect of leptin on the increase in the protein ex-pression of p-AMPKa was also in a time-dependent manner ( P<0.01) .After intervention with different concentrations of leptin for 24 h, the protein expression of BSEP in the HepG2 cells was gradually increased by the stimulation of leptin in a concentration-and time-dependent manner (P<0.01).Compared with NC group, the protein expression of BSEP in 10 -6 mol/L leptin group and 10 -6 mol/L leptin+10μmol/L compound C group was increased at 72 h (P<0.01), and that in 10-6 mol/L leptin+10 μmol/L compound C group was lower than that in 10 -6 mol/L leptin group at 72 h ( P<0.01 ) . CONCLUSION:Leptin promotes the protein expression of BSEP in HepG2 cells by leptin-AMPK-BSEP signaling path-way.Leptin promotes the increases in AMPKa protein and the level of phosphorylation of AMPKa in HepG2 cells.

Objective To study treatment of massive variceal bleeding secondary to localized pancreatitis-associated portal hypertension (MVBPAPH).Methods A retrospective study on the clinical data of patients with MVBPAPH was carried out.Of 24 patients with MVBPAPH,20 had pancreatic pseudocysts.12 were operated after failure of treatment with endovascular intervention for variceal bleeding (including 10 patients with splenectomy and gastric fundus-body peripheral vessels amputation and 2 patients with pancreatic pseudocystogastrostomy).8 patients underwent partial splenic embolization and left gastroepiploic artery embolization.4 patients directly underwent splenectomy and gastric fundus-body peripheral vessels amputation for variceal bleeding.Results Left pleural effusion developed in 5 patients who underwent arterial embolization.Left pleural effusion and lung infection occurred in 2 patients who underwent operation.All patients recovered well and were discharged home.During the follow-up period of 2 to 72 months,no rebleeding occurred in these patients (including 2 patients had passed little interval melena).Gastroscopy re-examination showed that variceal veins were not found in 18 patients.Variceal veins which were detected in the remaining 6 patients were obviously less severe.Conclusion Individualized treatment should be given to patients with MVBPAPH and according to the specific type of pancreatitis and the onset time of any accompanying pseudocyst.

Objective To study the relationship between expression of G-protein-coupled bile acid receptor 1 (GPBAR1) in gallbladder mucosa and formation of lithogenic bile in patients with gallstones.Methods Gallbladder mucosa,gallbladder wall,bile and plasma were collected from 34 patients with gallstone (GS) and 15 individuals who were gallstone free (GSF).The gallbladder wall was stained with hematoxylin-eosin (HE) and immunohistochemistry to detect pathologic changes and expressions of GPBAR1,mucin 1 (MUC1) and mucin 5AC (MUC5AC).Reverse-transcription polymerase chain reaction (RT-PCR) was used to test mRNA expressions of GPBAR1,MUC1 and MUC5AC in the gallbladder mucosa.The contents of total cholesterol (TC),total bile acid (TBA),triglyceride (TG),low density lipoprotein (LDL) and high density lipoprotein (HDL) in plasma and cholesterol,TBA,phospholipid (PL) and mucin in the bile of gallbladder were measured.Results The gallbladder mucosa in all GS patients showed chronic inflammation on hematoxylin-eosin staining.The expressions of GPBAR1 and MUC5AC were more markedly increased in the GS group than in the GSFgroup (61.34±8.06 vs.43.05±7.83,P＜0.01; 52.11±9.62 vs.45.05±9.27,P＜0.05).The mRNA expressions of GPBAR1 and MUC5AC in the GS group were also more markedly increased than in the GSR group (0.87±0.07 vs.0.80±0.09,P＜0.05; 1.04±0.22 vs.0.8±0.17,P＜0.01).Serum cholesterol,as well as biliary cholesterol,cholesterol mol percentage,cholesterol saturation index and mucin in the GS group were more significantly higher than in the GSF group (5.07±1.64 vs.3.62±1.42,P＜0.01; 17.23±3.67 vs.12.47±2.31,P＜0.01; 7.47±0.65 vs.5.05±0.24,P＜0.01; 1.03±0.58 vs.0.69±0.38,P＜0.01; 92.02±20.89 vs.76.36±19.71,P＜0.05).Biliary total bile acids and bile acids mol percentage were lower in the GS group than in the GSF group (162.68±20.19 vs.180.21±26.05,P＜0.05; 71.28±1.84 vs. 73.29±0.96,P＜0.01). In the GS group,there were negative correlations between the mRNA expression of GPBAR1 and biliary TBA (γ=-0.341,P＜0.05).There were negative correlations in the GS group between the GPBAR1 expression and the level of biliary TBA (γ=- 0.403,P＜0.05),and between the GPBAR1 expression and the level of biliary total lipid (γ=-0.365,P＜0.05).Conclusions This study shows an increase in expression of GPBAR1 in gallbladder mucosa in patients with GS.It is suggested that GPBAR1 may accelerate formation of lithogenic bile by inducing re-absorption of bile acid.

Objective To investigate the natural course and treatment of adult liver hemangioma (ALH).Methods The records of ultrasonography of 2422 patients with ALH were retrospectively reviewed.Results The patients were between 16 and 69 years of age (mean age 42,9± 11.4) with a male to female ratio of 1 ∶ 1.02 (1197/1225).The prevalence rate gradually increased with age after 30 years old.The highest prevalence rate occurred between 40-69 years.ALH was most commonly 1.1-3 cm in size,located in right liver with a solitary lesion.ALHs were bigger and were seen earlier in females than males.Concurrent illness was also more common in females than males.1427 patients had 3 to 8 repeat sonographies.At a follow-up of 42.7±9.5 months,1351 patients had no change in the ultrasonographic pattern or number of haemangiomas.Increasing in size of the lesions was demonstrated in 76 patients.154 patients received operation or interventional treatment.Conclusions The prevalence rate of ALH rose with age.Female sex hormones might accelerate ALH enlargement but they did not induce the formation of ALH.Most ALH remained stable in size and in patterns.Attention should be paid to rule out other illnesses in patients with ALH and with symptoms.