An antimalarial medication, artesunate (Art), has exhibited promising anticancer effects with excellent tolerability in various types of cancer, suggesting that it has the potential to be used in combination with sorafenib (Sora) in hepatocellular carcinoma (HCC) treatment. To determine the potency of this combination, the present study attempted to quantitatively measure the dose-effect relationship of each drug alone and in combination in liver cancer cells in vitro using Calcusyn software. Cell growth inhibition was determined using the CyQUANT proliferation assay in two liver cancer cell lines, HepG2 and Huh7. Drug combination and reduction indices and isobologram plots were used to assess drug interactions. Cell apoptosis was evaluated by measurements of the proportion of cells in the sub G0/G1 phase of the cell cycle, and determination of protein expression levels of cleaved poly ADP ribose polymerase and caspase-9. Additionally, a cell migration assay was conducted using Essen ImageLock plates with an IncuCyte Zoom imaging system. The results of the present study revealed that the inhibitory effect of Sora on cell growth was synergistically enhanced by the combination with Art in HepG2 and Huh7 cells. The combination index and dose reduction index were specific to each cell line. Furthermore, combination at a fixed ratio presented mutual enhancement with respect to apoptosis induction and suppression of in vitro liver cancer cell migration. Therefore, considering the low toxicity and well-defined clinical characteristics of Art, combination of Sora and Art may present an attractive therapeutic option in the development of clinical trials for HCC treatment.

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Introduction:There are many studies for the increased incidence for choledocholithiasis and common bile duct (CBD) dilatation after gastrectomy. However, there are few reports about the dilatation of CBD according to the type of anastomosis in patients undergoing gastrectomy for gastric cancer. We compared the changes of CBD diameter after gastrectomy with various anastomosis. The aim of this study was to evaluate the degree of CBD dilation in patients who underwent subtotal gastrectomy with various anastomosis using 1-year follow-up abdominal computed tomography (CT) scan. Methods: From January 2012 to December 2015, 395 patients who underwent subtotal total gastrectomy for gastric cancer and had no gallstones were enrolled. We measured CBD diameter in the pancreas head by analyzing preoperative, 6-, and 12-month follow-up abdomen-pelvis enhanced CT (A-P CT) scans. Results: The CBD was dilated slightly from 4.1 mm at baseline to 5.1 mm at 6 months and 6.1 mm at 12 months after gastrectomy. The number of cases of CBD dilatation of more than 7 mm at 6 months and at 12 months after cholecystectomy were 11 (24.4%) and 9 (29.0%), respectively. Seven cases at 6 months and 5 cases at 12 months showed bile duct dilation of more than 3 mm compared to baseline. There were no cases having bile duct dilation of more than 10 mm. Conclusions: The diameter of CBD was significantly increased after subtotal or total gastrectomy. In addition, the degree of dilation of CBD was higher after not only Billroth-II with Braun anastomosis but Roux-en Y anastomosis compared.

Introduction: Hemorrhagic cholecystitis is a rare disease with high morbidity and mortality, especially in patients with cirrhosis. Here, we described a case of perforated hemorrhagic cholecystitis in a patient with alcoholic liver disease. Methods: A 47-year-old male with a history of alcoholic abuse was presented to the hospital with severe right upper quadrant abdominal pain. He has never been diagnosed with a specific underlying disease. In the emergency room, the initial hemoglobin level was 11 g/dL, but decreased to 8.4 g/dL after 6 hours. On physical examination, there was a palpable mass with tenderness in the right upper quadrant area. On abdomino-pelvis computed tomography, it showed highly attenuated, homogenous materials in the gallbladder, and a diffuse gallbladder wall thickening with edematous change. Results: We performed laparoscopic cholecystectomy that revealed a gallbladder filled with large blood clots and hemoperitoneum. Conclusions: Although hemorrhagic cholecystitis is a rare entity of acute cholecystitis, it should be considered in high risks patients, such as trauma, malignancy, the use of anticoagulation and higher bleeding tendency in dialysis patient. Therefore, early diagnosis of this potentially fatal complication is important to facilitate urgent surgical management.