Objective To investigate the effects of combined exposure to PM2.5 and a high-salt diet on hepatic inflammation and lymphangiogenesis in mice.Methods Thirty-two C57BL/6J mice were assigned randomly to control,PM2.5,high-salt(HSD),and PM2.5+HSD groups.Mice in the HSD and PM2.5+HSD groups were fed an 8%high-salt diet for 8 weeks,while mice in the other groups were fed a control diet containing 0.4%salt.Mice in the PM2.5 and PM2.5+HSD groups were treated with PM2.5 by tracheal instillation(twice per week),and mice in the other groups were instilled with equal volumes of saline(twice per week).All mice were sacrificed after the last PM2.5 exposure.Tumor necrosis factor-α(TNF-α)and interleukin(IL)-6 levels in the liver tissues of the mice were determined and lymphatic vessel endothelial hyaluronan receptor-1(LYVE1)expression in the liver tissues was visualized by immunofluorescence staining.Protein expression levels of the lymphangiogenesis markers PROX1 and LYVE1,and the lymphangiogenesis regulatory proteins vascular endothelial growth factor(VEGF)receptor(VEGFR)3 and VEGF-C in liver tissue were measured by Western blot.Results TNF-α and IL-6 levels and protein expression levels of PROX1,LYVE1,VEGFR-3,and VEGF-C in liver tissues were increased in the HSD group compared with the control group(P＜0.05),and in the PM2.5+HSD group compared with the HSD group(P＜0.05).Moreover,there were significant interaction effects between PM2.5 and a high-salt diet on these above indicators.Conclusions Combined exposure to PM2.5 and a high-salt diet aggravated hepatic inflammation and may increase hepatic lymphangiogenesis by upregulating VEGFR-3 and VEGF-C in liver of mice.

Objective To study the effect of fine particulate matter(particulate matter 2.5,PM2.5)exposure on hepatic lymphangiogenesis in C57BL/6J mice and metabolic-associated fatty liver disease(MAFLD)model mice,and to provide a novel target for prevention and treatment of PM2.5-induced liver injury.Methods Forty male C57BL/6J mice were randomly divided into a control group,PM2.5 group,MAFLD group,and PM2.5-MAFLD group.Mice in the MAFLD and PM2.5-MAFLD groups were fed high-fat diet for 12 weeks,and mice in the other groups were fed normal chow diet.From weeks 13 to 16,mice in the PM2.5 and PM2.5-MAFLD groups were exposed to PM2.5 by tracheal instillation(twice per week),and mice in the other groups were instilled with saline at the same time.All animals were euthanized 24 h after the last PM2.5 instillation.Serum alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were measured,and the expression of LYVE1 in liver tissues was visualized using immunofluorescence staining.Hepatic oxidative stress markers levels(4-HNE and GSH/GSSG)were measured.The protein expression levels of lymphangiogenesis markers(PROX1 and LYVE1),lymphangiogenesis regulatory protein VEGF-C,and the lymphatic junctional function marker VE-cadherin in liver tissue were determined using Western Blot.Results PM2.5 exposure significantly increased the levels of serum AST and ALT,markedly decreased the protein expression of PROX1 and LYVE1,increased the protein expression of VEGF-C and VE-cadherin in the liver,increased the level of 4-HNE,and decreased the T-GSH/GSSG ratio in livers of mice in the MAFLD group(P＜0.05).However,PM2.5 exposure did not affect the levels of serum AST and ALT,protein expression of PROX1,LYVE1,or VEGF-C;level of 4-HNE;or T-GSH/GSSG ratio in the livers of the C57BL/6J mice(P＞0.05).Conclusions PM2.5 exposure obviously aggravated hepatic oxidative injury and reduced hepatic lymphangiogenesis by reducing the VEGF-C concentration in the livers of MAFLD model mice.

Objective To investigate the effects of combined exposure to PM2.5 and a high-salt diet on hepatic inflammation and lymphangiogenesis in mice.Methods Thirty-two C57BL/6J mice were assigned randomly to control,PM2.5,high-salt(HSD),and PM2.5+HSD groups.Mice in the HSD and PM2.5+HSD groups were fed an 8%high-salt diet for 8 weeks,while mice in the other groups were fed a control diet containing 0.4%salt.Mice in the PM2.5 and PM2.5+HSD groups were treated with PM2.5 by tracheal instillation(twice per week),and mice in the other groups were instilled with equal volumes of saline(twice per week).All mice were sacrificed after the last PM2.5 exposure.Tumor necrosis factor-α(TNF-α)and interleukin(IL)-6 levels in the liver tissues of the mice were determined and lymphatic vessel endothelial hyaluronan receptor-1(LYVE1)expression in the liver tissues was visualized by immunofluorescence staining.Protein expression levels of the lymphangiogenesis markers PROX1 and LYVE1,and the lymphangiogenesis regulatory proteins vascular endothelial growth factor(VEGF)receptor(VEGFR)3 and VEGF-C in liver tissue were measured by Western blot.Results TNF-α and IL-6 levels and protein expression levels of PROX1,LYVE1,VEGFR-3,and VEGF-C in liver tissues were increased in the HSD group compared with the control group(P＜0.05),and in the PM2.5+HSD group compared with the HSD group(P＜0.05).Moreover,there were significant interaction effects between PM2.5 and a high-salt diet on these above indicators.Conclusions Combined exposure to PM2.5 and a high-salt diet aggravated hepatic inflammation and may increase hepatic lymphangiogenesis by upregulating VEGFR-3 and VEGF-C in liver of mice.

Objective:To examine a new technique of robot-assisted nephroureterectomy without robot reldocking or patient repositioning.Methods:Patients diagnosed as upper tract urothelial carcinoma treated with this modality between November 2015 and January 2019 at Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine were included in this analysis. Data collection including patient demographics, operative procedure and postoperative morbidities were conducted by retrospective charts review, after receiving the institutional review board′s approval. There were 35 males and 27 females with a median age of 70 years (range: 30 to 91 years) underwent single docking robot-assisted nephroureterectomy without repositioning. Among the 62 cases, 37 patients had pelvic carcinoma while 25 patients had ureteral carcinoma (with proximal portion 12 cases, middle portion 5 cases and distal portion 8 cases). The patient was placed in a 60 to 80-degree, modified flank position with a 15-degree Trendelenburg tilt. The contralateral arm was positioned perpendicular to the torso on an arm board while the ipsilateral arm was taped to the patient′s side with ample padding. The robot cart was then docked at a 90-degree angle, perpendicular to the patient. A “W”-shape, three robotic-arm configurations was used for port placement.Results:The surgical procedures were performed successfully in all the 62 patients. The operation time was (171.6±54.7) minutes (range: 60 to 370 minutes). The estimated blood loss during the operation was 50(50) ml (range: 20 to 400 ml) with 4 patients had transfusion. No perioperative death was encountered. Eleven patients had post-operative complications (Clavien-Dindo grade 2) including 3 cases of hemorrhage and 8 cases of chylous leakage. All cases were regularly followed up with a median time of 37 months (range: 17 to 55 months). There were 8, 30, 19, 4 and 1 case followed up for 48, 36, 24, 18 and less than 18 months, respectively. Three patients had reginal recurrences and 11 cases of distant metastasis occurred, with 5 patients died for cancer. The survival rate within 24 months was estimated as 75.4%(43/57).Conclusion:Robot-assisted nephroureterectomy without robot redocking or patient repositioning could be safely reproduced, with surgical outcomes comparable to other established techniques.

Objective:To examine a new technique of robot-assisted nephroureterectomy without robot reldocking or patient repositioning.Methods:Patients diagnosed as upper tract urothelial carcinoma treated with this modality between November 2015 and January 2019 at Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine were included in this analysis. Data collection including patient demographics, operative procedure and postoperative morbidities were conducted by retrospective charts review, after receiving the institutional review board′s approval. There were 35 males and 27 females with a median age of 70 years (range: 30 to 91 years) underwent single docking robot-assisted nephroureterectomy without repositioning. Among the 62 cases, 37 patients had pelvic carcinoma while 25 patients had ureteral carcinoma (with proximal portion 12 cases, middle portion 5 cases and distal portion 8 cases). The patient was placed in a 60 to 80-degree, modified flank position with a 15-degree Trendelenburg tilt. The contralateral arm was positioned perpendicular to the torso on an arm board while the ipsilateral arm was taped to the patient′s side with ample padding. The robot cart was then docked at a 90-degree angle, perpendicular to the patient. A “W”-shape, three robotic-arm configurations was used for port placement.Results:The surgical procedures were performed successfully in all the 62 patients. The operation time was (171.6±54.7) minutes (range: 60 to 370 minutes). The estimated blood loss during the operation was 50(50) ml (range: 20 to 400 ml) with 4 patients had transfusion. No perioperative death was encountered. Eleven patients had post-operative complications (Clavien-Dindo grade 2) including 3 cases of hemorrhage and 8 cases of chylous leakage. All cases were regularly followed up with a median time of 37 months (range: 17 to 55 months). There were 8, 30, 19, 4 and 1 case followed up for 48, 36, 24, 18 and less than 18 months, respectively. Three patients had reginal recurrences and 11 cases of distant metastasis occurred, with 5 patients died for cancer. The survival rate within 24 months was estimated as 75.4%(43/57).Conclusion:Robot-assisted nephroureterectomy without robot redocking or patient repositioning could be safely reproduced, with surgical outcomes comparable to other established techniques.

Portal hypertension-related esophagogastric variceal bleeding (EVB) is deadly. Therefore, multidisciplinary management involving hepatologists, digestive endoscopy, radiological intervention, and/or surgery is necessary. Digestive endoscopy is the core of the multidisciplinary approach to the overall management of portal hypertension. It plays an important role in the early warning, emergency treatment, and the prevention of the initial and re-bleeding of portal hypertension accompanied by esophagogastric varices. In addition, gastroscopy with endoscopic ultrasound scanning can enhance the management capabilities of ectopic varices.

Objective To investigate the application of ultrasound and blood indicators in diagnosis of early liver cirrhosis (S4) for patients with chronic hepatitis B (CHB).Methods Data of blood and ultrasound examinations of 631 patients with CHB who received liver biopsy in the Sixth People' s Hospital of Shenyang during April 2002 and March 2011 were collected.Logistic regression analysis was performed to determine the factors independently correlated with early liver cirrhosis,and the diagnostic model was established using these indicators.The diagnostic value of the established model was assessed by using area under receiver operating characteristic curve (AUROC) and compared with FIB-4 index,aspartate aminotransferase (AST)/platelet (PLT) ratio index (APRI) and S index.Results Logistic regression analysis indicated that age,PLT,albumin globulin ratio (A/G) and splenic square area (SPS) in ultrasound findings were independently correlated to early liver cirrhosis (Wald =10056,46.236,3.751 and 10.669,P ＜0.01).AUROC of the model based on the above factors in diagnosing early liver cirrhosis was 0.908,which was higher than those of FIB-1 index,APRI index and S index (Z =8.322,4.334 and 4.087,P ＜ 0.05).Taking 0.063 as cut-off value,the sensitivity,specificity,positive predict value and negative predict value of the established model in diagnosis of early liver cirrhosis were 90.1％,77.8％,50.0％ and 97.1％,respectively.Taking ＜0.060 and ≥0.110 as the cut-off values to exclude,and diagnose early liver cirrhosis,69.7％ (440/631) patients could avoid liver biopsy.Conclusion The model based on age,PLT,A/G and SPS can effectively predict early liver cirrhosis,and can reduce liver biopsy.

Objective To preliminarily evaluate efficacy and safety of endoscopic embolization with Glubran-2 glue for gastric varices in liver cirrhosis. Methods Forty-nine patients with cirrhosis gastric varices,admitted to Beijing You′an Hospital from January 2011 to December 2012,underwent endoscopic embolization with Glubran-2 glue under gastroscopy. Of the 49 cases,40 were males and 9 females with age of 34-82(55 ± 11)years. Of these patients,19 were at Child-Pugh class A,23 class B,and 7 class C. Of the 49 patients,22(44. 9%)had isolated gastric varices(IGV)and 27 patients(55. 1%)had gastro-esophaged varices( GOV ). The methods were as follows:50% glucose was prefilled in injection syringe and,after injecting Glubran-2 glue at the location of gastric varices,the left Glubran-2 glue in injection syringe was injected into the varicose vein via the 50% glucose. The Glubran-2 glue was given by way of one spot or multiple spot and each spot needed Glubran-2 glue 1. 0-3. 0 ml. The endoscopic embolization completed at one time as possible. The situation of varicose veins disappearing was observed under gastroscopy at months 1,3,6 after treatment. Safety evaluation index included postoperative burning sensation below the xiphoid,ectopic embolism,fever,blood routine test before operation and at 3 days after operation,and liver and renal functions before operation and at months 1,3,6 after operation. Results The total dose of Glubran-2 glue for IGV patients was 2. 0-12. 0 ml every patient with an average dose of (4. 7 ± 2. 6)ml and for GOV patients was 1. 0-9. 0 ml with an average dose of(4. 2 ± 2. 1)ml. Of the 49 patient,varicose veins of 45 patients(91. 8%)disappeared and varicose veins of 4 patients(8. 2%) improved;extrusions of glue was seen in 18 patients(36. 7%)at one month,30 patients(61. 3%)at 3 month,and 1 patient(2. 0%)at 6 months after treatment. All the patients experienced burning sensation below the xiphoid after glue injection. Three patients presented with fever after operation but their temperature did not exceed 38 ℃. No patient developed ectopic embolism. Nine patients(18. 4%)deve-loped errhysis due to local ulcer because of extrusions of glue and massive haemorrhage did not occur. There were no obvious differences in blood routine test and liver and renal functions before and after treatment. Conclusion Endoscopic embolization with Glubran-2 glue is effective and safe for treatment of gastric varices in liver cirrhosis patients.

Objective To preliminarily evaluate efficacy and safety of endoscopic embolization with Glubran-2 glue for gastric varices in liver cirrhosis. Methods Forty-nine patients with cirrhosis gastric varices,admitted to Beijing You′an Hospital from January 2011 to December 2012,underwent endoscopic embolization with Glubran-2 glue under gastroscopy. Of the 49 cases,40 were males and 9 females with age of 34-82(55 ± 11)years. Of these patients,19 were at Child-Pugh class A,23 class B,and 7 class C. Of the 49 patients,22(44. 9%)had isolated gastric varices(IGV)and 27 patients(55. 1%)had gastro-esophaged varices( GOV ). The methods were as follows:50% glucose was prefilled in injection syringe and,after injecting Glubran-2 glue at the location of gastric varices,the left Glubran-2 glue in injection syringe was injected into the varicose vein via the 50% glucose. The Glubran-2 glue was given by way of one spot or multiple spot and each spot needed Glubran-2 glue 1. 0-3. 0 ml. The endoscopic embolization completed at one time as possible. The situation of varicose veins disappearing was observed under gastroscopy at months 1,3,6 after treatment. Safety evaluation index included postoperative burning sensation below the xiphoid,ectopic embolism,fever,blood routine test before operation and at 3 days after operation,and liver and renal functions before operation and at months 1,3,6 after operation. Results The total dose of Glubran-2 glue for IGV patients was 2. 0-12. 0 ml every patient with an average dose of (4. 7 ± 2. 6)ml and for GOV patients was 1. 0-9. 0 ml with an average dose of(4. 2 ± 2. 1)ml. Of the 49 patient,varicose veins of 45 patients(91. 8%)disappeared and varicose veins of 4 patients(8. 2%) improved;extrusions of glue was seen in 18 patients(36. 7%)at one month,30 patients(61. 3%)at 3 month,and 1 patient(2. 0%)at 6 months after treatment. All the patients experienced burning sensation below the xiphoid after glue injection. Three patients presented with fever after operation but their temperature did not exceed 38 ℃. No patient developed ectopic embolism. Nine patients(18. 4%)deve-loped errhysis due to local ulcer because of extrusions of glue and massive haemorrhage did not occur. There were no obvious differences in blood routine test and liver and renal functions before and after treatment. Conclusion Endoscopic embolization with Glubran-2 glue is effective and safe for treatment of gastric varices in liver cirrhosis patients.