Macrophages induce natural killer cell dysfunction via KIR2DL1 during Echinococcus multilocularis infection

Purpose: To investigate the mechanism by which natural killer (NK) cells are compromised by infection with Echinococcus multilocularis in patients with alveolar echinococcosis (AE). Methods: NK cells from AE patients and healthy individuals were measured by flow cytometry and quantitative real-time polymerase chain reaction (PCR) to identify the frequency of different types of NK cells and assess their function. E. multilocularis cyst fluid (EMF) was applied to human monocytic leukaemia cells (THP-1 cells) to assess its effect on their differentiation. In a co-culture system with NK and EMF-THP-1 cells, the function of NK cells were analyzed by enzyme-linked immunosorbent assay (ELISA) with or without antibody against KIR2DL1. Results: Blood from AE patients had fewer CD56low NK cells (p < 0.01) with decreased production of IFN-γ and granzyme B due to the elevated expression of KIR2DL1 (p < 0.001). Treatment of THP-1 cells with EMF induced a tolerogenic phenotype upon activation. Incubation of these EMF-THP-1 cells with NK cells isolated from AE patients significantly impaired the cytotoxic function of NK cells, but this effect was largely blocked by an anti-KIR2DL1 antibody (p < 0.001). Conclusion: E. multilocularis modulates infection macrophages to induce NK cell dysfunction via interaction with KIR2DL1. These results provide a new insight into the mechanisms of parasitic infection-induced dysfunction of NK cells, and may be helpful for the development of therapeutic strategies for the treatment of alveolar echinococcosis

Diagnosis and treatment modalities of hilar biliary duct stricture in hepatic cystic echinococcosis after endocystectomy

Aim: Hilar biliary duct stricture may occur in hepatic cystic echinococcosis (CE) patients after endocystectomy. This study aimed to explore diagnosis and treatment modalities. Methods: Clinical data of 26 hepatic CE patients undergoing endocystectomy who developed postoperative hilar biliary duct stricture were retrospectively analyzed and were classified into three types: type A, type B, and type C. Postoperative complications and survival time were successfully followed up. Results: Imaging showed biliary duct stenosis, atrophy of ipsilateral hepatic lobe, reactive hyperplasia, hepatic hilum calcification, and dilation or discontinuity of intrahepatic biliary duct. All patients received partial hepatectomy to resect residual cyst cavity and atrophic liver tissue, and anastomosis of hepatic duct with jejunum or common bile duct exploration was applied to handle hilar biliary duct stricture. Twenty-five patients were successfully followed up. Among type A patients, one patient died of organ failure, and upper gastrointestinal bleeding and liver abscess occurred in one patient. Moreover, calculus of intrahepatic duct was found in one type B and type C patient. Conclusion: Long-term biliary fistula, infection of residual cavity or obstructive jaundice in hepatic CE patients after endocystectomy are possible indicators of hilar bile duct stricture. Individualized and comprehensive treatment measures, especially effective treatment of residual cavity and biliary fistula, are optimal to avoid serious hilar bile duct stricture

Cause and prevention of pleural effusion after liver resection

Liver resection is the main method of treatment of hepatic space-occupying lesion, and pleural effusion is one of the common complications. With the technological development in recent years, this paper analyzes the pleural effusion after liver resection from the aspects of hypoproteinemia, diaphragm defects, inflammatory response, portopulmonary shunt, and hepatitis B immune complex deposition, summarizes the causes of pleural effusion after liver resection and its preventive measures, and explores the effective ways to reduce the incidence of pleural effusion after liver resection, with the purpose of providing guidance for future clinical practice

Reference Genes Selection of Gymnosporangium yamadae during the Interaction with Apple Leaves

Apple rust disease caused by Gymnosporangium yamadae is the one of the major threats to the development of the apple industry in China, but the pathogenic molecular mechanism of the disease remains unclear. It is imperative to screen out appropriate reference genes during the interaction between G. yamadae and apple leaves to analyze the gene expression patterns during the pathogenesis of G. yamadae. ACT, EF1, EF2, GAPDH, 40S, 60S, α-TUB, β-TUB and UBCE3 were selected as candidate reference genes based on the transcriptomic dataset of G. yamadae. The expression levels were tested by real-time quantitative PCR during time-course infection of apple leaves and the expression stabilities were evaluated by △Ct method as well as by three software (NormFinder, geNorm and BestKeeper) and one web-based analysis software (RefFinder). The expression stability of the candidate reference genes was further validated by using the effector candidate gene Cluster-3395.48660 as the target gene in RT-qPCR. According to the results by △Ct and BestKeeper, 40S, EF2 and EF1 were the most stable reference genes, while EF1, EF2 and GAPDH were the most stable reference genes based on the NormFinder analysis result. The geNorm recommended the most stable genes EF1, EF2 and α-TUB as reference genes. Comprehensive analysis results of the RefFinder indicated EF1, EF2 and α-TUB were the most suitable genes. Based on these results, EF1, EF2 and α-TUB were considered as reference genes for analyzing the gene expression profiles of Cluster-3395.48660 in different infection stages, and the results were consistent with the transcriptome data. All the results suggest that the combination of EF1, EF2 and α-TUB proved to be acceptable reference genes during the interaction between G. yamadae and apple leaves

Laparoscopic hepatectomy for the treatment of hepatic alveolar echinococcosis

Background: At present, laparoscopy is relatively mature as a minimally invasive technique, but there are few reports on this approach for the radical treatment of hepatic alveolar echinococcosis (AE). In this study, we aimed to evaluate the safety and feasibility of laparoscopic hepatectomy (LH) for AE treatment. Results: A retrospective review of medical records obtained from 13 patients diagnosed with AE between January 2018 and December 2019 and treated with laparoscopic hepatectomy was conducted at the First Affiliated Hospital of Xinjiang Medical University. All patients (n = 13) underwent hepatic resection using laparoscopy and none were transferred to open surgery. The average duration of surgery was 285 min (145–580 min). Intraoperative bleeding was 305 mL (20–2000 mL). The mean duration of postoperative catheterization was 6.9 days (3–21 days), and postoperative hospital stay was 7.2 days (4–14 days). No complication of Clavien-Dindo grade III or above occurred, except for the second patient with acute liver failure post-surgically. No recurrences or deaths were observed at 9–30 months of follow-up. Conclusions: Laparoscopic hepatectomy appears to be safe and effective in selected AE patients. The advantages of this technique for AE treatment need to be further compared with the classical open approach

Laparoscopic approach for total cystectomy in treating hepatic cystic echinococcosis

Background: The laparoscopic approach has been proposed for treating hepatic cystic echinococcosis (HCE) and has already been used in clinical practice, mostly for non-radical operations. In this study, we aimed to evaluate the feasibility of total cystectomy of HCE under laparoscopy (LS). Results: A retrospective review of the medical records obtained from 22 patients diagnosed with HCE between June 2009 and June 2013 and treated with an LS approach was conducted in the First Affiliated Hospital of Xinjiang Medical University. A total of 15 patients underwent total cystectomy of HCE using LS. The average time of surgery was 174 min (160–210 min). Intraoperative bleeding was 103 mL (80–200 mL). The mean duration of hospitalization was 7 days (6–15 days). Seven patients were transferred to open surgery (OS). For these patients, the average duration of surgery was 177 min (150–230 min). Intraoperative bleeding was 237 mL (160–350 mL), and the mean duration of hospitalization was 10 days (8–15 days). The most frequent postoperative complications were hydrops in the surgical area (two cases in LS and three cases in OS), and temporary bile leakage (one patient in the LS group). Recurrence was not seen in any cases in either group with a follow-up of 6–12 months. Conclusions: Total cystectomy of HCE appears to be safe and effective in selected patients with unique, small-sized, superficially located cysts. To establish precise recommendations about the technique and its indications, prospective studies are necessary

Laparoscopic approach for total cystectomy in treating hepatic cystic echinococcosis

Background: The laparoscopic approach has been proposed for treating hepatic cystic echinococcosis (HCE) and has already been used in clinical practice, mostly for non-radical operations. In this study, we aimed to evaluate the feasibility of total cystectomy of HCE under laparoscopy (LS). Results: A retrospective review of the medical records obtained from 22 patients diagnosed with HCE between June 2009 and June 2013 and treated with an LS approach was conducted in the First Affiliated Hospital of Xinjiang Medical University. A total of 15 patients underwent total cystectomy of HCE using LS. The average time of surgery was 174 min (160–210 min). Intraoperative bleeding was 103 mL (80–200 mL). The mean duration of hospitalization was 7 days (6–15 days). Seven patients were transferred to open surgery (OS). For these patients, the average duration of surgery was 177 min (150–230 min). Intraoperative bleeding was 237 mL (160–350 mL), and the mean duration of hospitalization was 10 days (8–15 days). The most frequent postoperative complications were hydrops in the surgical area (two cases in LS and three cases in OS), and temporary bile leakage (one patient in the LS group). Recurrence was not seen in any cases in either group with a follow-up of 6–12 months. Conclusions: Total cystectomy of HCE appears to be safe and effective in selected patients with unique, small-sized, superficially located cysts. To establish precise recommendations about the technique and its indications, prospective studies are necessary

Collateral circulation caused by end-stage hepatic alveolar echinococcosis

Abstract Background Hepatic alveolar echinococcosis (HAE), as a benign parasitic disease with malignant infiltrative activity, grows slowly in the liver, allowing sufficient time for collateral vessels to emerge in the process of vascular occlusion. Methods The portal vein (PV), hepatic vein and hepatic artery were observed by enhanced CT and the inferior vena cava (IVC) by angiography, respectively. Analysis of the anatomical characteristics of the collateral vessels helped to look into the pattern and characteristics of vascular collateralization caused by this specific etiology. Results 33, 5, 12 and 1 patients were included in the formation of collateral vessels in PV, hepatic vein, IVC and hepatic artery, respectively. PV collateral vessels were divided into two categories according to different pathways: type I: portal -portal venous pathway (13 cases) and type II: type I incorporates a portal-systemic circulation pathway (20 cases). Hepatic vein (HV) collateral vessels fell into short hepatic veins. The patients with IVC collateral presented with both vertebral and lumbar venous varices. Hepatic artery collateral vessels emanating from the celiac trunk maintains blood supply to the healthy side of the liver. Conclusions Due to its special biological nature, HAE exhibited unique collateral vessels that were rarely seen in other diseases. An in-depth study would be of great help to improve our understanding related to the process of collateral vessel formation due to intrahepatic lesions and its comorbidity, in addition to providing new ideas for the surgical treatment of end-stage HAE

Spleen-preserving surgery is effective for the treatment of spleen cystic echinococcosis

Objective: This study evaluated two surgical procedures, total splenectomy and spleen-preserving surgery, for the treatment of spleen cystic echinococcosis (CE). Methods: A total of 21 patients who underwent surgery for removal of spleen CE were evaluated retrospectively. Patients were divided into two groups, those who received a total splenectomy (n = 7) and those who underwent spleen-preserving surgery (n = 14). Results: Total splenectomy surgery took 127.1 ± 11.1 min and spleen-preserving surgery took 104.3 ± 25.3 min (p < 0.05). The length of hospital stay was the same for both patient groups (10.6 days on average). No patient suffered from recurrence during follow-up and all of the patients made a good recovery. No patient developed post-splenectomy sepsis or serious infectious complications. No patient suffered recurrence. Conclusions: The spleen-saving approach is likely an effective method for the removal of CE spleen cysts given that it is a quick procedure and preserves the function of the spleen. Total splenectomy procedures may be performed particularly for larger, centrally located cysts