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The downstaging of hepatocellular carcinoma (HCC) has been confirmed to benefit liver transplantation (LT) patients whose tumors are beyond the transplantation criteria. Milan criteria (MC), a tumor size and number-based assessment, is currently used as the endpoint in these patients. However, many studies believe that tumor biological behavior should be added to the evaluation criteria for downstaging efficacy. Hence, this study aimed to explore the feasibility of Hangzhou criteria (HC), which introduced tumor grading and alpha-fetoprotein in addition to tumor size and number, as an endpoint of downstaging.We performed a multicenter and retrospective study of 206 patients accepted locoregional therapy (LRT) as downstaging/bridge treatment prior to LT in three centers of China.Recipients were divided into four groups: failed downstaging to the HC (group A, n = 46), successful downstaging to the HC (group B, n = 30), remained within the HC all the time (group C, n = 113), and tumor progressed (group D, n = 17). The 3-year HCC recurrence probabilities of groups B and C were not significantly different (10.3% vs. 11.6%, P = 0.87). The HCC recurrent rate was significantly higher in group A (52.3%) compared with that in group B/C (P 0.05). Seven patients (7/76, 9.2%) whose tumor exceeded the the HC were successfully downstaged to the MC, and 39.5% (30/76) to the the HC. In group B, 23 patients remained beyond the MC and their survivals were as well as those of patients within the MC.Compared to the MC, HC downstaging criteria can give more HCC patients access to LT and furthermore, the outcome of these patients is the same as those matching MC downstaging criteria. Hangzhou downstaging criteria therefore is applicable in clinical practice.

To evaluate aesthetic outcomes in patients with bilateral trapezius hypertrophy treated by botulinum toxin type A (BTxA) injection for aesthetic reconstruction of the upper trapezius. From May 2015 to May 2016, 30 women with a short neck shape resulting from bilateral trapezius hypertrophy were treated with botulinum toxin type A (BTxA) injection at the most affected area of the upper trapezius. Pre- and postoperative values of SACDF (irregularly shaped area of the four points A, C, D, and F) and SACDE (irregularly shaped area of the four points A, C, D, and E), responses to patients’ and doctors’ Global Aesthetic Improvement Scale (GAIS) questionnaires for neck aesthetic assessment, as well as reported adverse events, were recorded and analyzed. Duration of follow-up ranged from 4 to 12 months. Subjects experienced non-severe adverse events and complete recovery after a single BTxA injection. In patients’ GAIS questionnaires, “very much improved” accounted for 53%, “much improved” accounted for 13%, and “improved” accounted for 27%. In doctors’ GAIS questionnaires, “very much improved” accounted for 27%, “much improved” accounted for 33%, “improved” accounted for 33%, and “no change” accounted for 7%. The overall degree of improvement was high. Statistically significant differences were observed with respect to the “very much improved” response to GAIS questionnaires between patients and doctors (P = 0.035). A single injection of BTxA for aesthetic reconstruction of the upper trapezius is safe and effective in patients with bilateral trapezius hypertrophy. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Objective: This study aims to explore the effects of microRNA-27a (miR-27a) on the proliferation and invasiveness of colon cancer cells through the Secreted Frizzled-related protein 1 (SFRP1) and the Wnt/β-catenin signaling pathway. Methods: Colon cancer tissues and adjacent normal tissues from 125 colon cancer patients, together with the HCEpic, HCT-116, HT-29, SW480 and SW620 cell lines, were prepared for this study. The transfected HCT-116 cells were divided into the miR-27a mimics, miR-27a-NC, anti-miR-27a, blank, Lv-SFRP1, Lv-NC, and miR-27a mimics + Lv-SFRP1 groups. RT-qPCR was performed to detect the expressions of miR-27a and SFRP1 mRNA. A dual-luciferase reporter assay was conducted to examine the effect of miR-27a on SFRP1. Western blotting was used to measure the expressions of the SFRP1, β-catenin, GSK-3β, p-β-catenin, p-GSK-3β, c-Myc and cyclin D1 proteins. MTT, soft agar clone formation and Transwell chamber assays were performed to detect cell proliferation and invasion. Results: Compared with normal tissues and cells, colon cancer tissues and cells demonstrated significantly higher expression of miR-27a, but lower expressions of SFRP1 mRNA and protein. MiR-27a negatively regulated the expression of SFRP1 mRNA. SFRP1 was also found to be a target gene of miR-27a. In the miR-27a mimic group, the proliferation and invasiveness of colon cancer cells were significantly increased, while the expressions of GSK-3 β and p-β-catenin were remarkably down-regulated; in contrast, the expressions of p-GSK-3β, -catenin, c-Myc and cyclin D1 were up-regulated. While the proliferation and invasiveness of colon cancer cells in the anti-miR-27a and Lv-SFRP1 groups were decreased, the expressions of GSK-3β and p-β-catenin were elevated, and the expressions of p-GSK-3β, β-catenin, c-Myc and cyclin D1 were decreased. Conclusion: These findings indicated that miR-27a could promote the proliferation and invasiveness of colon cancer cells by targeting SFRP1 through the Wnt/β-catenin signaling pathway.

Portal vein tumor thrombosis (PVTT) is regarded as a contraindication for liver transplantation (LT) in hepatocellular carcinoma (HCC). However, some of these patients may have a favorable prognosis after LT. In this study, we evaluated the biological behavior of HCC with PVTT using tumor biomarker (alpha-fetoprotein, AFP) andSeventy-five HCC-PVTT liver recipients transplanted during February 2016 and June 2018 were analyzed. Different pre-transplant prognostic factors were identified by univariate and multivariate analyses. PVTT status was identified following Vp classification (Vp1-Vp4).Three-year recurrence-free survival and overall survival rates were 40% and 65.4% in Vp2-Vp3 PVTT patients, 21.4% and 30.6% in Vp4 PVTT patients (P 0.05). Total tumor diameter8 cm, pre-transplant AFP level1000 ng/mL and intrahepatic tumor maximal standard uptake value (SUVmax-tumor5) were independent risk factors for HCC recurrence and overall survival after LT in Vp2-3 PVTT patients. Low risk patients were defined as total tumor diameter ≤8 cm; or if total tumor diameter more than 8 cm, with both pre-transplant AFP level less than 1000 ng/mL and intrahepatic tumor SUVmax less than 5, simultaneously. Twenty-two Vp2-3 PVTT HCC patients (46.8%) were identified as low risk patients, and their 3-year recurrence-free and overall survival rates were 67.6% and 95.2%, respectively.Patients with segmental or lobar PVTT and biologically favorable tumors defined by AFP and

Background: Approximately 50% hepatocellular carcinoma (HCC) patients die within 5-year after surgical resection. The present staging systems do not fully allow to accurately predict the HCC prognosis and recurrence. This study aimed to identify clinicopathological characteristics and molecular markers to establish classifiers to predict the 5-year overall survival (OS) and the 3-year recurrence in HCC patients post-operatively. Methods: In this retrospective multicenter study, we enrolled 647 patients, underwent surgical resection for HCC and divided the patients into one training (406 patients from the Institution I) and two validation cohorts (136 and 105 patients from Institutions I and II). Clinicopathologic characteristics and tumor protein expression of 29 biomarkers on tumorigenesis, development and invasiveness by immunohistochemical (IHC) analysis were used to develop and validate a prognostic and a recurrent classifier after a five-year follow-up. The classifiers were developed using the maximum relevance minimum redundancy algorithm jointly with the multivariable regression method. The classifiers were further validated by an internal validation from the Institution I, and an independent validation from the Institution II. Findings: The prognostic classifier integrated three clinicopathologic characteristics of age, tumor number, tumor diameter; and seven immunomarkers, including BAX, CD34, CEA, E-cadherin, MMP-9, S100A9, and TYSY, while the recurrent classifier was composed of five clinicopathologic characteristics of age, tumor location, tumor number, tumor diameter, AFP levels; and six immunomarkers, CD34, E-Cadherin, HRas, PCNA, p53 and S100A9. The prognostic classifier distinguished HCC patients into high- and low-probability survival groups with significant differences in 5-year OS rate in all three cohorts (training cohort: 57.36% vs. 22.97%; P

The Milan criteria are widely accepted among many centers. However, patients with hepatocellular carcinoma beyond the Milan criteria might still benefit from liver transplantation (LT) when tumor itself is not aggressive. [In order to determine its role in candidate selection for LT, we therefore retrospectively analyzed 103 recipients with preoperative positron emission tomography (PET) findings.Positive PET findings (PETCertain patients with hepatocellular carcinoma and negative PET findings, who have exceeded the Milan criteria, are also eligible candidates for LT. Preoperative PET/CT imaging is an important marker, which should be incorporated in extended candidate selection criteria for LT.

Cholangitis, bacteremia, and pyogenic liver abscess (PLA) can be often caused by intrahepatic bile ducts stone (IBDS), which is endemic to South-East Asia. The association between IBDS and cholangiocarcinoma has been well recognized. Concomitant cholangiocarcinoma in the PLA related to IBDS is often missed.A case-control study consisting of 64 patients with PLA related to IBDS and 256 control patients with PLA not related to IBDS was used to investigate clinical features of PLA and incidence of concomitant cholangiocarcinoma in patients with PLA related to IBDS.The main imaging manifestations of PLA related to IBDS was cystic-solid lesions and solid lesions. Of seven patients (10.9%) with pathology-proven cholangiocarcinoma in the same area of PLA related to IBDS among 64 patients, only two patients were initially diagnosed as having concomitant cholangiocarcinoma by biopsy, and other five patients diagnosed as acute inflammatory lesion. Within 60 days after onset, the infection-related death rate and recurrence rate in patients with PLA related to IBDS were 12.9% and 20.3%, respectively, whereas in patients with PLA not related to IBDS were 3.9% and 3.1%, respectively. Only 25% of patients with PLA related to IBDS underwent surgery after admission. The main pathogens in PLA patients related to IBDS were Escherichia coli and extended-spectrum beta-lactamase-producing Enterobacteriaceae.The imaging manifestations of PLA related to IBDS often present cystic-solid or solid lesions. PLA related to IBDS is characterized by high rate of recurrence and infection-related death, difficulty in diagnosis of concomitant cholangicarcinoma.

The long noncoding RNA HOTAIR has been reported as a poor prognostic biomarker in patients with breast cancer. The aim of the present study is to examine the expression pattern of HOTAIR in hepatocellular carcinoma (HCC) and its clinical significance as well as its biological role in tumor progression.We examined the expression of HOTAIR in 110 HCC samples using real-time reverse transcription-polymerase chain reaction and analyzed its correlation with clinical parameters and prognosis in 60 HCC patients that have undergone liver transplantation (LT). Suppression of HOTAIR using siRNA was performed to explore its roles in tumor progression.The expression level of HOTAIR in cancer tissues was higher than in adjacent noncancerous tissues. High expression level of HOTAIR was an independent prognostic factor for predicting HCC recurrence in LT patients (P = .001, hazard ratio, 3.564). Furthermore, in patients exceeding the Milan criteria, those with a high expression level of HOTAIR revealed a significantly shorter recurrence-free survival. Moreover, siRNA suppression of HOTAIR in a liver cancer cell line reduced cell viability and cell invasion, sensitized TNF-α induced apoptosis, and increased the chemotherapeutic sensitivity of cancer cells to cisplatin and doxorubicin.The high expression level of HOTAIR in HCC could be a candidate biomarker for predicting tumor recurrence in HCC patients who have undergone liver transplant therapy and might be a potential therapeutic target.

The aim of the study was to evaluate the efficacy of transcatheter arterial chemoembolization (TACE) in treating patients with liver metastases from pancreatic cancer, and explore the prognostic risk factors.Three of the 27 patients were totally recovered, and 12 were partially alleviated. The total efficacy rate was 55.6% (15/27). The median survival time was 13.6 months, and the 0.5-, 1-, 2-, 3-, and 5-year survival rates were 70.4% (19/27), 48.1% (13/27), 22.2% (6/27), 14.8 (4/27), 11.1% (3/27), respectively. None of the groups showed any severe complications. Univariate analysis showed that pathological type, concomitant therapies for liver metastasis, vascular supply, CA199 levels and extrahepatic metastasis were related to prognosis (P0.05). Multivariate analysis indicated that pancreatic cancer pathology and extrahepatic metastasis were independent risk factors influencing patients' prognosis (χ2 = 13.182, 17.989, P0.05).The clinical records of 27 patients with lliver metastases from pancreatic cancer diagnosed at the First Affiliated Hospital of Zhejiang University between May 2009 and May 2015 were retrospectively analyzed. The short-term and long-term efficacy and toxic side effects of TACE were observed. The prognostic risk factors were analyzed using Cox (proportional hazards) regression model.TACE is an effective therapy for treating liver metastases from pancreatic malignancy. Pathological type and extrahepatic metastasis of pancreatic tumor are independent risk factors for patients' prognosis. The prognosis of patients with liver metastasis from pancreatic neuroendocrine neoplasm is superior to that of extrahepatic metastasis.

We selected 42 early-stage primary biliary cirrhosis (PBC) patients and 30 healthy controls (HC). Metagenomic sequencing of the 16S rRNA gene was used to characterize the fecal microbiome. UPLC-MS/MS assaying of small molecules was used to characterize the metabolomes of the serum, urine and feces. Liquid chip assaying of serum cytokines was used to characterize the immune profiles. The gut of PBC patients were depleted of some potentially beneficial bacteria, such as Acidobacteria, Lachnobacterium sp., Bacteroides eggerthii and Ruminococcus bromii, but were enriched in some bacterial taxa containing opportunistic pathogens, such as γ-Proteobacteria, Enterobacteriaceae, Neisseriaceae, Spirochaetaceae, Veillonella, Streptococcus, Klebsiella, Actinobacillus pleuropneumoniae, Anaeroglobus geminatus, Enterobacter asburiae, Haemophilus parainfluenzae, Megasphaera micronuciformis and Paraprevotella clara. Several altered gut bacterial taxa exhibited potential interactions with PBC through their associations with altered metabolism, immunity and liver function indicators, such as those of Klebsiella with IL-2A and Neisseriaceae with urinary indoleacrylate. Many gut bacteria, such as some members of Bacteroides, were altered in their associations with the immunity and metabolism of PBC patients, although their relative abundances were unchanged. Consequently, the gut microbiome is altered and may be critical for the onset or development of PBC by interacting with metabolism and immunity.

The aim of the study is to validate a new classification of pancreatic fistula (PF) and to document risk factors for PF.A retrospective study was performed on 100 patients who underwent pancreaticoduodenectomy (PD) within a 2-year period. PF was diagnosed according to the criteria developed by an International Study Group on Pancreatic Fistula (ISGPF). Sixteen pre- and intraoperative risk factors for PF were analyzed.Of 100 patients 32 developed PF; grade A in 21 patients, grade B in 10, and grade C in 1. Four risk factors including pathological diagnosis, concomitant surgery, diameter of pancreatic duct, and texture of the remnant pancreas were found to be significantly associated with PF by univariate analysis. Texture of the remnant pancreas and concomitant surgery were demonstrated to be independent risk factors by multivariate logistic regression. If a PF occurred, advanced age was found to be a risk factor for PF grade B by univariate analysis, but age was not an independent risk factor by multivariate logistic regression.The status of the remnant pancreas is identified asa substantial risk factor for PF after PD. When soft remnant pancreas is encountered, more careful handling is required in an attempt to minimize the rate of PF. This study confirms that the ISGPF classification of PF is useful.

The aim of our study was to determine the outcomes of liver transplant recipients receiving either lamivudine (LAM) monotherapy or LAM combined with low-dose intramuscular (IM) hepatitis B Immunoglobulin (HBIG) therapy. We performed a retrospective review of the medical records of patients that had had liver transplantation in a single center for HBV-related liver diseases from December 1999 to June 2004. A total of 165 patients received LAM monotherapy (51 patients) or combined prophylaxis (114 patients) post-liver transplantation (LT) with a mean follow-up of 20.13 months. Hepatitis B relapsed in 21 patients of the hepatitis B surface antigen (HBsAg) carriers who received LAM monotherapy, with a 1- and 2-yr actuarial risk of 27.4% and 39.7%. Recurrence occurred in 16 patients of 114 patients receiving the combined prophylaxis, with a 1- and 2-yr recurrence rate of 13.5% and 15.2% (P = 0.024). A total of 25 cases (67.6%) with YMDD mutants were detected in all the 37 patients, 14 cases (66.7%) in the monotherapy group and 11 cases (68.8%) in the combination group. In conclusion, LAM and low-dose intramuscular HBIG treatment demonstrates a better result than LAM monotherapy, as prophylaxis against post-LT reinfection of the graft, but the safety and efficacy as a substitution for high-dose intravenous HBIG with LAM needs to be investigated further.

To evaluate the clinical value of PVE (portal vein embolism) prior to surgery in primary liver cancer (PLC) patients and the effect of liver cirrhosis on liver lobe hyperplasia after PVE.13 patients with primary liver cancer non-suitable for curative hepatectomy underwent k sequential transcatheter arterial chemoembolization (TACE) (1-3 times) and percutaneous selective portal vein embolization (PVE) when the remnant liver volumes were predicted to be insufficient. All patients were divided into non-cirrhosis (n = 7) and cirrhosis group (n = 6). Left liver remnant volumes were assessed by computed tomography (CT) before and after PVE. Right liver resection was performed when the remnant liver volume was sufficient.All patients underwent TACE treatment was successful. The frequency of TACE was 1-3. PVE was all successfully performed at weeks 2-4 after final TACE, all PVE patients subsequently underwent hepatic lobectomy. Left liver volume increased from (457.0 ± 121.0) cm(3) pre-PVE to (633.6 ± 120.2)cm(3) post-PVE. Hepatic lobe volume increased (44.4 ± 39.7)%. Statistical difference existed in left hepatic lobe volume before and weeks 4-6 after PVE (P = 0.000). The mean volume of left liver, calculated before and 4-6 weeks after PVE, increased from (442.0 ± 96.8) to (652.3 ± 115.8) cm(3) in non-cirrhotic group and from (474.5 ± 152.4) to (611.7 ± 132.3) cm(3) in cirrhotic group. Hepatic lobe volume increased (54.5 ± 50.7)% and (32.7 ± 19.9)% respectively. Statistical differences were both detected in left hepatic lobe volume before and 4-6 weeks after PVE (P = 0.011, P = 0.003). However, no significant inter-group difference existed at Weeks 4-6 weeks (P = 0.295) . Liver function damage was minimal after PVE and no serious complications occurred.Sequential transcatheter arterial chemoembolization, TACE and percutaneous selective PVE before surgery may cause remnant liver compensatory hypertrophy and increase the resection rate of primary liver cancer. Liver cirrhosis has no significant effect on liver lobe hyperplasia after PVE.

The significance of neoangiogenesis in the metastasis of nasopharyngeal carcinoma (NPC) was investigated to clarify the role neovascularity in the prognosis of NPC and the probability of antiangiogenesis preventing NPC from distant metastasis. A group of 52 patients presenting with metastatic NPC were selected and strictly paired one-to-one, in sex, age, T stage, and N stage, with another 52 patients with non-metastatic NPC, who had survived for a long time after therapy. The tumor tissues of all 104 patients were retrieved for computer-assisted, immunohistochemical analysis of tumor vasculature. Counts of the microvessels and the relative area of all microvessels per image were significantly higher in metastatic NPC than they were in curable, non-metastatic NPC, while the average area of the microvessels and their average perimeter of in metastatic NPC were smaller than in non-metastatic disease. No significant difference in any microvessel parameter was found among the various types of metastasis. The alterations of microvessel parameters were significantly linked to the metastasis of NPC. Evaluation of neovascularity by computer image analysis may be helpful in estimating the prognosis of NPC and in determining the indicators for aggressive multimodal treatments.

Recurrence of hepatitis B-related hepatocellular carcinoma (HCC) after curative resection is the leading factor influencing the prognosis of the disease. Therefore, further improvement of long-term survival may depend on the prevention and treatment of the recurrent tumor. The aim of this research was to investigate the role of antiviral therapy and postoperative transcatheter arterial chemoembolization (TACE) in the prevention and treatment of hepatitis B-related HCC recurrence.One hundred and twenty patients who underwent curative resection of hepatitis B-related HCC between January 2005 and June 2008 at our hospital were enrolled. Patients were divided into four groups according to the post-operative adjuvant therapy they received, i.e., control, antiviral therapy group, TACE group, and combined group. The disease-free survival (DFS) and the 12-, 24-, 36-month cumulative recurrence rates were studied.There was no significant difference between isolated postoperative antiviral therapy group and control in terms of disease-free survival (P = 0.283), while it was significantly higher in the TACE group compared to control (P = 0.019). In all patients, however, viral prophylactic therapy combined with/without TACE brought a favorable result compared to those only with/without TACE (P0.001). Similarly, no matter combined with or without antiviral treatment, postoperative TACE prolonged DFS (P = 0.015). Naturally, a combination of viral prophylactic therapy on the baseline TACE significantly benefited patients' postoperative DFS (P = 0.047) and vice verse (P = 0.002). The 24-month cumulative recurrence rates of combined group were significantly lower than that of isolated control group and antiviral therapy (P0.001 and P = 0.011 respectively). However, 36-month recurrence rate was significantly different in the control group compared to the TACE group and combined group (P = 0.040 and 0.002 respectively); same as the antiviral group compared to the combined group (P = 0.034).Post-operative TACE prevents early recurrence while antiviral therapy prevents late recurrence of HCC. Combination of antiviral therapy and TACE are suggested for prevention in HCC patients with high risk of recurrence.

Salvage liver transplantation (SLT), or liver transplantation after liver resection (LR), has been performed after primary LR for many years. However, the true outcomes and risks of SLT versus primary liver transplantation (PLT) remain unclear. We performed a systematic review and meta-analysis to evaluate the survival rate of SLT recipients and the incidence of postoperative complications. Among 2799 screened references, 7 eligible studies were identified. The results of the meta-analysis indicated no statistically significant differences in the overall survival rates of SLT and PLT: the pooled relative risk (RR) was 0.99 [95% confidence interval (CI) = 0.90-1.09, P = 0.87] at 1 year, 0.97 (95% CI = 0.83-1.13, P = 0.68) at 3 years, and 0.96 (95% CI = 0.81-1.13, P = 0.61) at 5 years. As for postoperative complications, there were no statistically significant differences in the incidence of sepsis and biliary complications between SLT and PLT, but there was a significantly higher incidence of bleeding with SLT (RR = 2.84, 95% CI = 1.57-5.13, P = 0.001). In conclusion, the overall survival associated with SLT is similar to that associated with PLT. Because of the limited organ donor pool, SLT might be an acceptable therapy for patients undergoing primary LR for hepatocellular carcinoma.

Recepteur d'originenantais (RON) is a receptor tyrosine kinase (RTK) that belongs to the MET proto-oncogene family. The aim of this study was to investigate the expression of RON receptor tyrosine kinase in human non-small cell lung cancer (NSCLC) and its relationship with clinical pathology of NSCLC and prognosis.RON protein expression by immunohistochemistry (IHC) in 96 NSCLC specimens was evaluated and compared with the clinical pathology and prognosis, and 20 para-neoplastic tissues were included as controls. RON mRNA and protein expression in 25 fresh tissue samples of lung cancer and 10 normal lung tissues were also analyzed by reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting.The rate of positive RON expression differed significantly between NSCLC tissues (55.2%, 53/96) and para-neoplastic tissues (5%, 1/20) (P0.001). RON protein expression was not found to be associated with gender or age. However, RON expression positively correlated with clinical TNM stage (P = 0.004), histological types (P = 0.001), lymph node metastasis (P = 0.012) and differentiation (P = 0.035). RT-PCR and Western blotting analysis also confirmed that the expression of RON mRNA and protein was significantly increased in the NSCLC tissues versus normal tissues. In addition, RON expression was associated with a poor prognosis for patients with NSCLC (P = 0.045).The expression of RON protein and mRNA is significant in human NSCLC and low in para-neoplastic and normal tissues. Elevated RON expression may contribute to the occurrence, progression and metastasis of NSCLC, inferring that it could be useful as a new prognostic indicator for patients with NSCLC.

Classical angiomyolipomas are benign tumors composed of various tissues, including fat, abnormal blood vessels and smooth muscle cells. The present study reports a male patient affected by mediastinal angiomyolipomas with massive chylous pleural effusion. The tumors were characterized with histological and immunohistochemical methods.

Differentiating surgical jaundice from non-surgical jaundice is of vital importance after liver transplantation (LT) and endoscopic retrograde cholangiopancreatography (ERCP) is not effective for all anastomotic stricture (AS) cases. In the present study, we aim to determine the optimal indication of ERCP treatment for AS after LT.Twenty-eight jaundice patients who underwent successful ERCP treatments for post-transplant AS were classified into two groups: AS with intrahepatic biliary dilation (group 1, n=22) and AS without intrahepatic biliary dilation (group 2, n=6). The outcomes of the two groups were evaluated.The median time intervals from LT to the occurrence of AS were 38 days and 434 days for group 1 and group 2, respectively. The median total bilirubin significantly decreased from 142umol/L to 49umol/L (p0.05) two weeks after ERCP treatment in group 1. Fourteen patients (63.6%) were cured and for the other 8 the treatment proved effective in group 1. But total bilirubin was not improved after the ERCP treatment in group 2 (p0.05).Therapeutic ERCP is not effective in AS without intrahepatic biliary dilation after LT.

Copy number variation (CNV) in gene was a novel type of genetic diversity in human that affect the pathogenesis, progress, and prognosis of disease. The aim of this study was to determine the associations between CNV in CCL3L1 gene and the rejection risk in liver-transplant recipients. The 266 Han-Chinese patients and 135 volunteers were enrolled in this study. Genomic DNA and mRNA samples were obtained from the whole peripheral blood; a quantitative real-time PCR-based assay was carried out to determine the copy number of CCL3L1, and real-time PCR was carried out to calculate the CCL3L1/CCL3 mRNA ratio. The CNV distributions in patients and health controls had no significant differences. Copy number in acute rejection group (AR) shifted to higher number compared with non-acute rejection group (4.74±1.87 vs. 3.88±2.13, p=0.017). Moreover, patients with higher CCL3L1 copies (≥3 copies) had a significantly higher rejection risk than patients lower copies CCL3L1 (OR=3.85, 95% CI, 1.14-13.04; p=0.021). No association was found between CNV and rejection grades. In conclusion, liver transplant recipients with high copy number of CCL3L1 gene had a significant higher risk of AR. CNV might be a novel genetic diversity that correlated with allograft rejection.

This study sought to investigate the associations between polymorphisms in the chemokine receptor 5 gene and acute rejection in liver transplant.A total of 266 patients who underwent a liver transplant between January 2006 and March 2009 were enrolled in this study. Genomic DNA was extracted from whole blood, and chemokine receptor 5Δ32 was detected by polymerase chain reaction. Eight nucleotide polymorphism loci in the chemokine receptor 5 gene were detected by Applied Biosystems SNaPShot and TaqMan technologies.Chemokine receptor 5Δ32 mutation was not detected in all the individuals from China. There was no significant association between the single nucleotide polymorphism in chemokine receptor 5 gene and acute rejection.Single nucleotide polymorphisms in a single gene of the chemokine receptor 5 might not play a role in acute rejection after liver transplant.

Hepaticocutaneous jejunostomy offers the advantage of permanent percutaneous access to the biliary tract in patients with complex biliary problems. The long-term value, however, has not been assessed. In 41 patients who underwent this procedure for intrahepatic stones, there was no hospital mortality, and the postoperative morbidity rate was 10%. The presence of the cutaneous stoma facilitated postoperative flexible choledochoscopy for dilatation of biliary strictures and extraction of residual stones. On follow-up, symptoms recurred in 12 patients (29%) at a median time of 27 months (range: 1 to 97 months). Reconstruction of the cutaneous stoma and flexible choledochoscopy via the jejunal loop helped to resolve the acute cholangitis (n = 4) and to eradicate recurrent stones in all cases. Hepaticocutaneous jejunostomy was also beneficial in the management of three patients who experienced further recurrence of symptoms. There was no major difficulty in reconstructing the cutaneous stoma and in performing choledochoscopy via the jejunal loop. The overall complication rate related to the cutaneous stoma was 15%. Repeat laparotomy for recurrent disease was required in only one patient who underwent a second bilio-enteric anastomosis for a nondilatable left duct stricture. We conclude that hepaticocutaneous jejunostomy is a valuable procedure in the management of hepatolithiasis.

The 2009 H1N1 influenza A virus was first identified in April 2009 and rapidly evolved into a pandemic. Recipients of solid-organ transplants have a higher risk for severe infection because of immunosuppression. There are limited reports of 2009 H1N1 influenza in liver transplant recipients, especially in China.We present a case of a 48-year-old male liver transplant recipient with 2009 H1N1 influenza A virus. He received therapy for acute rejection after transplantation and was confirmed with H1N1 virus infection.The patient was started on oseltamivir (75 mg, orally twice daily) and had a benign hospital course, with defervescence and resolution of symptoms within 72 hours. The follow-up chest radiograph after discharge was normal.The 2009 H1N1 influenza in this hospitalized transplant recipient was relatively mild, and prolonged viral shedding was not noted. Oseltamivir can be a valid measure in immunocompromised individuals.

To investigate the loss of heterozygosity (LOH) at mitofusin-2 (Mfn2) gene in hepatocellular carcinoma (HCC) and its clinicopathological significance.Four high polymorphic microsatellite markers flanking Mfn2 were selected for LOH analysis in 29 cases of HCC.The frequencies of LOH on D1S2667, D1S2740, D1S434 and D1S228 were 21%, 23%, 21% and 22%, respectively. LOH at Mfn2 was closely correlated with tumor size, age, capsule, differentiation and t HBV infection (P0.05), not with gender, thrombosis, cirrhosis and serum AFP levels (P0.05).LOH at Mfn2 gene in HCC is associated with the clinicopathological features of patients.

The aim of this study was to investigate the possible effect of somatostatin on the liver function of recipients undergoing living donor liver transplantation.Forty recipients were randomized into group A (n = 20) and group B (n = 20). Recipients in group A received no somatostatin whereas somatostatin was administrated for recipients in group B perioperatively. Liver function, the plasma concentration of endothelin-1 and nitric oxide, the intragraft expressions of endothelin-1 and inducible nitric oxide syntheses at 2 hours after declamping of the portal vein were compared between the two groups.Compared to group A, alanine transaminase values in group B were significantly reduced at 2 hours after portal vein declamping, at the end of the operation and postoperation day 1 (P0.05), whereas aspartate aminotransferase values in group B decreased at 30 minutes after portal vein clamping, at 2 hours after portal vein declamping and at the end of the operation (P0.05). Total bilirubin values in group B were reduced significantly at 2 hours after portal vein declamping and at the end of the operation when compared to group A (P0.05). Intragraft expression of endothelin-1 was significantly downregulated at 2 hours after declamping of the portal vein accompanied with a reduction of plasma concentration of endothelin-1 in the peripheral blood (P0.05).Somatostatin had a protective effect on liver function during the early phase after declamping of portal vein for recipients undergoing living donor liver transplantation, and the possible mechanism might be partially attributed to the downregulation of endothelin-1.

Rupture of hepatocellular carcinoma (HCC) following transcatheter arterial chemoembolization (TACE) is a rare and life-threatening complication. The purpose of the present study was to evaluate the utility of emergency embolization for treatment of ruptured HCC following TACE.Five patients developed rupture of tumor after TACE in 1005 patients of HCC from October 2007 to February 2010, and were studied retrospectively. Emergency selective arterial embolization was performed in all 5 patients because of intractable hemorrhage in the peritoneal cavity or around the liver that could not be controlled by conservative method. The mean hemoglobin level before embolization was 75.6 g/L +/- 20.7 (mean +/- standard deviation).Hepatic angiography did not revealed extravasation of contrast from the tumor in all 5 patients with rupture of HCC following TACE. After selective embolization of feeding arteries of the liver tumor, intraperitoneal bleeding from HCC was stopped immediately in all patients. The mean hemoglobin level after embolization in 48 hours was 102.6 g/L +/- 3.5. No severe complication related to emergency embolization was found after treatment.Emergency arterial embolization is effective for hemostasis of ruptured HCC following TACE in patients with hemodynamically unstable condition.

To investigate the indication and effect of the application of Ligasure vessel sealing instrument in laparoscopic hepatectomy for liver cancer.Eleven patients with liver cancer undergoing laparoscopic hepatectomy were analyzed for the tumor size and location, operation time, volume of intraoperative bleeding, postoperative hospital stay and short-term clinical outcomes.All the operations were performed successfully in the 11 cases. All the tumors were less than 7 cm in diameter, locating at the segments II, III, V, VI and VII. The mean operation time was 91 min (80-126 min), and the intraoperative blood loss averaged 82 ml (20-200 ml). The average postoperative hospital stay of the patients was 8 days (7-9 days). No complications were observed in these cases.Ligasure vessel sealing instrument in laparoscopic hepatectomy is applicable in cases of perimeter liver cancer. This instrument can decrease the operation time, reduce the intraoperative blood loss and postoperative hospital stay with good safety and minimal invasiveness.

Acute kidney injury (AKI) is a common complication in the early period after liver transplantation (LT), posing an enormous obstacle to treatment efficiency and patient survival. However, the exact influencing factors of AKI are still unclear and a predictive model is desperately required in the clinic.Data of 102 consecutive LTs were reviewed. A model for predicting AKI was established and further validated in a prospective study of 44 patients receiving LT.The incidence of AKI was 32.4%. AKI patients showed a significantly lower survival rate than non-AKI patients. Multivariate analysis demonstrated the independent influencing factors of AKI were preoperative serum creatinine1.2 mg/dl, intraoperative urine outputor=60 ml/h, intraoperative hypotension status, and intraoperative use of noradrenaline. A model was then established and showed a sensitivity of 75.0%, a specificity of 93.8%, and an accuracy of 88.6% in predicting AKI.High preoperative serum creatinine, low intraoperative urine output, and intraoperative hypotension contribute to the development of AKI, and intraoperative use of noradrenaline serves as a protective factor. The predictive model could potentially facilitate early prediction and surveillance of AKI.

Sarcomatoid carcinoma of the gallbladder is rare and its characteristics are poorly understood. This study aimed to understand the behavior and prognosis of sarcomatoid carcinoma of the gallbladder as well as its clinical manifestations and survival rate of patients after radical or palliative surgery, and to review the reported data worldwide and our 10 patients.From 2004 to 2009, ten patients were pathologically diagnosed with sarcomatoid carcinoma of the gallbladder and underwent operation at our center. These characteristics, clinical presentations, tumor-node-metastasis (TNM) staging, surgical modes, and prognosis were reviewed, retrospectively. We collected the data of 46 patients reported in the English-language literature worldwide and analyzed the survival with ours. The survival rate was estimated using the Kaplan-Meier method, and was compared using the log-rank test.The median age of the 10 patients was 67 years (inter-quartile range 59-74 years), and the size of tumor inter-quartile ranged from 3.1 to 7.9 cm. In this series, 9 patients received radical surgery, and one undewent palliative surgery. There was no surgical mortality, and one patient underwent a second operation because of liver metastasis. The median survival time of the patients was 9 months (inter-quartile range 6-12 months), with 3 patients still being alive until follow-up; however, two patients had tumor recurrence. The data from the 56 patients (10 patients in our series and 46 reported elsewhere) statistically indicated that the median age was 66 years (inter-quartile range 61-74.5 years) and the overall median survival was 5.5 months (inter-quartile range 2.5-10 months). The survival time in the patients undergoing radical surgery (n=42) was significantly longer than that in the patients undergoing palliative surgery (n=14)(P=0.031).The survival of the patients with sarcomatoid carcinoma of the gallbladder is poor. Some patients may die shortly after the surgery because of recurrence or metastasis. However, radical surgery is still necessary if possible.

Although the low central venous pressure (LCVP) technique is used to decrease blood loss during liver resection, its efficacy and safety during transplant procedures are still debatable. Our study aimed to assess the effects of this technique and its clinical safety for recipients undergoing liver transplantation.Eighty-six adult patients were randomly divided into a LCVP group and a control group. In the LCVP group, CVP was maintained below 5 mmHg or 40% lower than baseline during the preanhepatic phase by limiting infusion volume, manipulating the patient's posture, and administration of somatostatin and nitroglycerine. Recipients in the control group received standard care. Hemodynamics, blood loss, liver function, and renal function of the two groups were compared perioperatively.A lower CVP was maintained in the LCVP group during the preanhepatic phase, resulting in a significant decrease in blood loss (1922 +/- 1429 vs. 3111 +/- 1833 ml, P0.05) and transfusion volume (1200 +/- 800 vs. 2400 +/- 1200 ml, P0.05) intraoperatively. Compared with the control group, the LCVP group had a significantly lower mean arterial pressure at 2 h after the start of the operation (74 +/- 11 vs. 84 +/- 14 mmHg, P0.05), a lower lactate value at the end of the operation (5.9 +/- 3.0 vs. 7.2 +/- 3.0 mmol/l, P0.05), and a better preservation of liver function after the declamping of the portal vein. There were no significant differences in perioperative renal function and postoperative complications between the groups.The LCVP technique during the preanhepatic phase reduced intraoperative blood loss, protected liver function, and had no detrimental effects on renal function in LT.

Pneumonia caused by multidrug-resistant (MDR) Gram-negative bacilli is associated with a higher mortality rate. The appropriate empiric therapy is based on the understanding of local etiology and MDR pattern. This study was to evaluate the spectrum of Gram-negative bacilli, MDR rate, risk factors and mortality in 475 liver transplantation (LT) recipients. In the first six months after LT, the incidence of bacterial pneumonia was 21.3% (101/475). The overall infectious incidence during the first post-transplant month was 80.2%. The most frequent pneumonia isolates were Enterobacteriaceae, Acinetobacter baumannii, Pseudomonas aeruginosa and Staphylococcus aureus. Gram-negative bacilli accounted for 69.6% of all pneumonia pathogens. Of the main 124 Gram-negative bacilli isolates, MDR rate was 58.9%. Four risk factors for post-LT pneumonia caused by MDR Gram-negative bacilli were LT candidates with grade II-IV encephalopathy (OR 2.275, 95%CI 1.249-4.124, p = 0.006), prolonged duration of endotracheal intubation (OR 8.224, 95%CI 4.276-15.815, p = 0.013), tracheostomy (OR 4.929, 95%CI 1.099-18.308, p = 0.027) and post-LT episode(s) of reoperations (OR 10.597, 95%CI 3.726-30.134, p0.001). MDR Gram-negative bacterial pneumonia-related mortality was significantly higher than that because of antibiotic-susceptible bacilli (45.6% vs. 11.4%, p = 0.010). Our data suggest that pneumonia caused by MDR Gram-negative bacilli after LT is common, and associated with the severity of underlying disease, prolonged mechanical ventilation and upper abdominal surgery.

Hepatic artery (HA) reconstruction is one of the key steps for living donor liver transplantation (LDLT). The incidence of HA thrombosis has been reduced by the introduction of microsurgical techniques under a high resolution microscope or loupe.We report our experience in 101 cases of HA reconstruction in LDLTs using the graft-artery-unclamp and posterior-wall-first technique. The reconstructions were completed by either a plastic surgeon or a transplant surgeon.The rate of HA thrombosis was 2% (2/101). The risk factors for failed procedures appeared to be reduced by participation of the transplant surgeon compared with the plastic surgeon. For a graft with duplicate arteries, we considered no branches should be discarded even with a positive clamping test.HA reconstruction without clamping the graft artery is a feasible and simplified technique, which can be mastered by transplant surgeons with considerable microsurgical training.

The discrepancy between available livers and requests for transplantation has forced many centers to use marginal donors in order to expand the donor pool. Many previous studies have demonstrated controversial results of the application of steatotic liver grafts. The aim of the present study was to summarize our experience and evaluate the value of steatotic liver grafts.The clinical and follow-up data of 24 adult patients receiving moderately steatotic liver grafts (30%-60%) from May 2003 to June 2005 (group 1) were analyzed. After matching for age, gender, model for end-stage liver diseases score and cold ischemia time, another 24 patients receiving liver grafts with steatosis less than 30% were chosen as the control group (group 2). The patient and graft outcomes were compared between the two groups.No difference of liver and kidney functions in the first post-transplant week was found between the two groups (P0.05). Neither the incidence of early allograft dysfunction and acute kidney injury nor the patient survival rates (3 months, 6 months and 1 year) showed differences between groups 1 and 2 (P0.05).Moderately steatotic liver grafts provide adequate function in the first phase after transplantation and can be used for transplantation.

To study the clinical features and treatment of recurrent hepatocellular carcinoma after liver transplantation.Clinical data of 95 patients with recurrent hepatocellular carcinoma (HCC) after liver transplantation from January 2003 to November 2005 were analyzed retrospectively.During follow-up, 42 patients (43.2%) were diagnosed HCC recurrence. The predominant sites of recurrence were liver graft (32 cases), lung (21 cases), bone (7 cases). Tumor size, tumor distribution, liver cirrhosis, pre-transplant AFP level, tumor differentiation, macrovascular invasion were considered risk factors of both post-transplant survival and HCC recurrence in univariate analysis. Tumor distribution, tumor differentiation, macrovascular invasion were considered independent risk factors of both overall post-transplant survival and HCC recurrence in multivariate analysis. Intervention therapy and internal radiation of recurrent HCC could delay tumor progression and resection of recurrent HCC in selected patients can significantly prolong post-recurrence survival.Carefully selection of HCC patients as candidates for liver transplantation can significantly reduce HCC recurrence. At the present stage, surgical resection of recurrent HCC is the best treatment method in selected patients.

Diabetes mellitus (DM) is a frequent and serious complication in patients with liver diseases. We aimed to assess the prevalence and consequences of post-transplant DM (PTDM) in Chinese patients with HBV-related liver diseases and to determine the possible risk factors.Altogether 165 patients with HBV infection and undergoing cadaveric related liver transplantation (LT) were enrolled. The clinical data of patients with (PTDM group) and without PTDM (non-PTDM group) were compared.Of the 165 patients, 28 had DM and 12 had impaired fasting glucose (IFG) before LT. Patients with pre-transplant DM or IFG had a survival rate similar to that of the others. Forty patients (24.2%) developed PTDM with a mean time of 36+/-17 days (range 2-300 days) after LT. Of those, 32 developed PTDM within 3 months post-LT and 29 needed insulin treatment. Pre-transplant hepatic encephalopathy and tacrolimus application were found more frequently in the PTDM group than in the non-PTDM group. The plasma tacrolimus levels were notably higher at 1 and 3 months post-LT in the PTDM group than those in the non-PTDM group. Compared to the non-PTDM group, the PTDM group showed remarkably poorer survival and tumor-free survival in patients with hepatocellular carcinoma, and significantly higher incidence of sepsis, fungal infection, chronic kidney diseases and biliary complications after LT.Pre-transplant DM did not affect the patient survival after LT. Since PTDM is common, it has a negative impact on outcome and may contribute to tumor recurrence. Pre-transplant hepatic encephalopathy, a tacrolimus-based regimen, and high levels of tacrolimus are clearly associated with the occurrence of PTDM.

Posttransplantation lymphoproliferative disorder (PTLD) involving the central nervous system (CNS) is a rare and serious complication associated with solid organ transplantation. We treated a case of PTLD with CNS involvement in a liver transplant recipient and reviewed the literature.The clinicopathological features of a 53-year-old man were retrospectively analyzed.Metastasis of the hepatoma was preoperatively considered on the basis of clinical findings. Craniotomy was performed and PTLD was diagnosed pathologically. The patient was treated with antiviral agents, radiation therapy, and chemotherapy; the immunosuppressive medication was reduced. The patient is still alive after follow-up for 14 months.Definitive diagnosis of PTLD is only established on the basis of histopathologic evaluation of the tissue. Although there are several ways to manage PTLD with CNS involvement, the prognosis is still poor.

Introduction Liver transplantation (LT) has been the treatment of choice for patients with hepatocellular carcinoma (HCC). This study was designed to summarize our experience in LT for HCC patients and establish a new set of criteria for patient selection and prognosis prediction. Materials and methods Data of 195 patients with HCC were retrospectively analyzed and various clinical and pathological factors for survival and tumor-free survival were examined by univariate and multivariate analyses. Results Macrovascular invasion, preoperative serum alpha fetoprotein (AFP) level, tumor size, multifocality, histopathologic grading, distribution, and cirrhosis background were significant factors for survival and tumor-free survival by univariate analysis. Multivariate analysis identified macrovascular invasion, tumor size, preoperative AFP level, and histopathologic grading were prognostic factors independently associated with patient survival or tumor-free survival (RR=1.688-2.779, P=0.000-0.034). Based on the prognostic stratification of different risk groups of patients without macrovascular invasion, Hangzhou criteria was established, containing one of the two following items: (a) Total tumor diameter less than or equal to 8 cm; (b) total tumor diameter more than 8 cm, with histopathologic grade I or II and preoperative AFP level less than or equal to 400 ng/mL, simultaneously. The difference between survival curves of patients fulfilling Milan criteria (n=72) and patients fulfilling Hangzhou criteria (n=99) did not achieve statistical significance (5-year survival rates: 78.3% vs. 72.3%, P>0.05). Of the patients exceeding Milan criteria (n=123), those who fulfilled Hangzhou criteria (n=26) also had better prognosis than the others (n=97) (P=0.000). Conclusion The results of this study show a reliable and feasible candidates selection and prognostic criteria of LT in HCC patients.

Invasive fungal infections are an important cause of posttransplant mortality in solid-organ recipients. The current trend is that the incidence of invasive candidiasis decreases significantly and invasive aspergillosis occurs later in the liver posttransplant recipients. The understanding of epidemiology and its evolving trends in the particular locality is beneficial to prophylactic and empiric treatment for transplant recipients.A retrospective analysis was made of recorded data on the epidemiology, risk factors, and mortality of invasive fungal infections in 352 liver transplant recipients.Forty-two (11.9%) patients suffered from invasive fungal infection. Candida species infections (53.3%) were the most common, followed by Aspergillus species (40.0%). There were 21 patients with a superficial fungal infection. The median time to onset of first invasive fungal infection was 13 days, first invasive Candida infection 9 days, and first invasive Aspergillus infection 21 days. Fifteen deaths were related to invasive fungal infection, 10 to Aspergillus infection, and 5 to Candida infection. Invasive Candida species infections were associated with encephalopathy (P = 0.009) and postoperative bacterial infection (P = 0.0003) as demonstrated by multivariate analysis. Three independent risk factors of invasive Aspergillus infection were posttransplant laparotomy (P = 0.004), renal dysfunction (P = 0.005) and hemodialysis (P = 0.001).The leading etiologic species of invasive fungal infections are Candida and Aspergillus, which frequently occur in the first posttransplant month. Encephalopathy and postoperative bacterial infection predispose to invasive Candida infection. Posttransplant laparotomy and poor perioperative clinical status contribute to invasive Aspergillus infection. More studies are needed to determine the effect of prophylactic antifungal therapy in high risk patients.

Various techniques are used to repair circular defects in special positions on the face. Simple closure will yield unsatisfactory results because of skin tension. As an ideal method of reconstruction, various flaps are used to provide a versatile and safe alternative. The authors applied double opposing-rhomboid flaps, which provided for closure of a circular skin defect without alteration to the original shapes of the vital structures and resulted in an imperceptible scar. With careful designing, 21 patients with circular defects caused by skin tumor excisions to special facial positions have attained effective functional and aesthetic results using this method since 2004.

To study the expression of Polo-like kinase 1 (PLK1) and E-cadherin in the tissues of hepatocellular carcinoma, and to discuss the relationship between them and clinical-pathological features, and to evaluate their prognostic value of hepatocellular carcinoma after liver transplantation.mRNA and protein expression of PLK1, E-cadherin were detected by RT-PCR and immunohistochemistry method respectively, the correlations of them with clinical-pathological data, tumor free time, recurrence rate were compared and analyzed.The mRNA expression was observed in 90.0% for PLK1 and 96.0% for E-cadherin, and higher in cancerous' tissues than paracancerous' of all cases for PLK1 but no trend for E-cadherin. The positive and decreased expression rate for PLK1 and E-cadherin was observed in 60.0% and 50.0% respectively, the positive PLK1 expression was correlated with preoperative serum alpha-fetoprotein (AFP) only (chi2 = 4.433, P = 0.035), while E-cadherin expression was associated with none of the clinical-pathological features. There was a correlation between the positive PLK1 and decreased E-cadherin expression (chi2 = 5.333, P = 0.021). PLK1 (P = 0.006), E-cadherin (P = 0.019) and larger tumor (P = 0.019), portal vein tumor thrombi (P = 0.030), Edmondson grading (P = 0.019), preoperative serum AFP (P = 0.020) were all correlated with recurrence rate under Kaplan-Meier analysis, while only PLK1 (RR = 3.104, P = 0.009) had significant difference under Cox regression analysis.The positive PLK1 expression and the decreased E-cadherin expression indicate higher recurrence rate of HCC after liver transplantation, and PLK1 is a independent risk factor.

The feasibility and immediate outcome of laparoscopic fenestration for patients with congenital liver cysts have been generally recognized. The aim of the present study was to assess the long-term results after laparoscopic fenestration.A retrospective study was performed on 44 patients with congenital liver cysts who had undergone laparoscopic fenestration between June 1998 and December 2004. Among them, 30 were women and 14 men, aged 57 years on average (range 18-76 years). While 14 patients had solitary cysts, 20 had multiple cysts, and 10 had polycystic liver disease. The results of laparoscopic fenestration, including mortality, morbidity, mean postoperative hospital stay, and recurrences of cysts were evaluated.There was no perioperative death and the morbidity rate was 11% (5/44). All complications were treated conservatively. The mean postoperative hospital stay was 4 days. A mean follow-up of 57 months showed that the rates of cyst recurrence and symptom recurrence were 9% and 4.5%, respectively.Laparoscopic fenestration as a feasible and safe treatment procedure for patients with congenital liver cysts can yield very good long-term results.

The incidence of extrahepatic cholangiocarcinoma increases in recent years. But the diagnosis and treatment are still troublesome to surgeons. This study was designed to explore the value of surgical approach in the treatment of extrahepatic cholangiocarcinoma.We retrospectively analyzed the clinical data of 135 patients with extrahepatic cholangiocarcinoma who had been treated in our hospital from January 1992 to December 2006.The ratio of extrahepatic cholangiocarcinoma to biliary duct diseases was 1.81%. The rates of total resection and radical resection were 70.75% (75/106) and 56.60% (60/106), respectively. The overall 1-, 3-, 5-year survival rates were 46.93%, 37.33% and 18.75%, respectively. The 1-, 3-, 5-year survival rates were better in the radical resection group (74.94%, 55.74% and 41.27%, respectively) than in the palliative resection group (42.86%, 26.79% and 26.79%, respectively) (P0.05). The survival rates of patients who had undergone palliative resection were higher than those of patients who had been subjected to palliative drainage or non-operation: 1-, 3-, 5-year survival rates were 42.86%, 26.79%, 26.79% vs. 23.33%, 6.67%, 0 or 17.86%, 0, 0 (P0.05). While the survival rates were not significantly different between palliative drainage and non-operation (P0.05). Multivariate analysis revealed that the histopathological grades, TNM stages and modalities were key factors influencing the outcome.The outcome of the patients with extrahepatic cholangiocarcinoma is still not optimistic. Radical resection is the first choice for the treatment of tumors.

To evaluate clinical and pathological features of post-transplant lymphoproliferative disorders (PTLD) and its significance in diagnosis.Six cases of PTLD were studied by light microscope, immunohistochemistry, in-situ hybridization, and gene rearrangement analysis. The clinical and follow-up information were also reviewed.Among the 6 cases, 3 with monomorphic PTLD were renal transplant recipients, and died 4, 2, and 1 months after diagnosis. 2 were liver transplant recipients, 1 of whom with monomorphic PTLD died 5 months after diagnosis, the other one was diagnosed as early lesion of PTLD and the post-bone marrow transplant case was classified as polymorphic PTLD who survived for 12 months after diagnosis of PTLD. EBER 1/2 DNA was demonstrated in 4 cases.PTLD is a lymphoproliferative disease with distinctive morphologic and clinical characteristics after organ transplantation. The prognosis of PTLD correlates with the pathological subtypes and clinical stage.

Although the use of hepatitis B immunoglobulin (HBIG) may lead to a significant reduction in recurrent hepatitis B virus (HBV) infection and improve the survival of patients who have undergone liver transplantation (LT) for hepatitis B-related diseases, the recurrence of the disease still remains at a lower level. Different clinical curative effects were observed in patients with the same HBV-related diseases and the same therapy. This study was undertaken to investigate whether the efficacy of HBIG is associated with FCGR3A gene polymorphisms in Chinese liver transplant patients.Altogether 77 patients who had received liver transplantation for hepatitis B-related diseases with more than one-year survival after surgery were studied. The recurrence of HBV was characterized by the appearance of HBsAg in serum after the operation. The FCGR3A genotyping was performed using genomic DNA sequencing (ABI 3037). Single nucleotide polymorphism at nucleotide 559 was detected by Polyphred.Of the 77 patients, 14 were complicated with HBV recurrence post-transplant. The FCGR3A at nucleotide 559 TT was observed in 35 (45.5%) subjects, whereas TG in 31 (40.3%) and GG in 11 (14.3%). In the 559G carrier group (n = 42, 54.5%), the risk of HBV recurrence was 9.5%, and 1- and 2-year recurrence-free survival rates were 95.2% and 88.7%, respectively. In the 559G noncarrier group (n = 35, 45.5%), the risk of HBV recurrence was 28.6%, and 1- and 2-year recurrence-free survival rates were 74.3% and 69.3%, respectively. The risk of HBV recurrence and the recurrence-free survival rate were both statistically different between the 559G carrier and noncarrier groups (P0.05).A single nucleotide polymorphism (T/G) at position 559 of the FCGR3A gene was found in Chinese patients. The efficacy of HBIG in prophylaxis of HBV recurrence after LT is associated with the gene polymorphism, so detecting FCGR3A genotypes can be a clinical reference of the HBIG administration.

E-cadherin is an epithelial cell adhesion molecule, and decreased E-cadherin expression in liver cancer is associated with poor prognosis. A -160 C--A polymorphism in the promoter region of E-cadherin has been reported to decrease gene transcription. This allelic variation may be a potential genetic marker for identifying those individuals at higher risk for invasive/metastatic disease.The effect of E-cadherin gene polymorphism on risk of tumor recurrence was studied in 93 patients with hepatocellular carcinoma (HCC) after liver transplantation, and determined whether this polymorphism is a biomarker for the risk of tumor recurrence.The genotype frequencies in the patients with recurrence were C/C: 0.667, C/A: 0.311, and A/A: 0.022, and in the patients without recurrence C/C: 0.604, C/A: 0.271 and A/A: 0.125. No significant difference was found between the two groups (P=0.171). Between -160 C--A polymorphism and the clinicopathological data, there were no statistically significant differences in the distribution of the parameters as to age, gender, portal vein tumor thrombi, preoperative alpha-fetoprotein level, tumor size, or histopathological grading (P0.05).The results of this study show no association exists between the E-cadherin genotype and the risk of tumor recurrence in Chinese patients with HCC.

To investigate the prevalence and associated risk factors of bacterial translocation (BT) in patients with cirrhosis after liver transplantation and analyze the effect of BT on bacterial infection after the surgery.Mesenteric lymph nodes (MLN), portal vein blood, and peripheral blood were collected during the liver transplantation for microbiological culture from 78 patients with cirrhosis. And meanwhile, all related clinical data were analyzed to investigate the risk factors of BT and its relationship with post-liver transplantation infections.BT was occurred in 8 of 78 cirrhotic patients (10.3%) and positive-rate of MLN culture was 5/8. Gram-negative aerobic bacillus was the main causative bacterium of BT (5/9), followed by Gram-positive aerobic enterococcus (22.2%, 2/9). Total bilirubin level in patients with BT was significantly higher than that in patients without BT.It suggests that hyperbilirubinemia is the only risk factor for BT, and BT is associated with an increased infectious rate after liver transplantation.

To investigate the effects of tacrolimus-based immunosuppression regimens after orthotopic liver transplantation and search a reasonable regimen of combination therapy and suitable blood concentration of tacrolimus.Ninety-four adult recipients of cadaveric livers were randomly divided into 3 groups to undergo different tacrolimus-based immunosuppression regimens: dual (tacrolimus + glucocorticoid), triple [tacrolimus + mycophenolate mofetil (MMF) + glucocorticoid]; quadruple [tacrolimus + MMF + glucocorticoid in addition of induction treatment by daclizumab]. The efficacy and safety of the 3 groups 6 months after the transplantation were compared.The frequencies of acute rejection were 25.9%, 11.1%, and 7.5% for the dual, triple, and quadruple therapy groups, that of the quadruple therapy group being significantly lower than that of the dual therapy group (P = 0.038). There were no significant differences in the rates Three months after transplantation, the levels of ALT and total cholesterol of the dual therapy groups were significantly higher than those of the quadruple therapy group (P(ALT) = 0.011, P(Tch) = 0.002). Within the first month post-operatively the concentration of tacrolimus of the triple therapy group could be controlled at the level 8 ng x ml(-1)-13 ng x ml(-1).Quadruple tacrolimus-based immunosuppression regimen is the most effective and safest, followed by the triple therapy and dual therapy. Low-dose tacrolimus combination therapy provides an effective protection to the liver graft with mild drug toxicity to the patient.

Solid-pseudopapillary tumor (SPT) of the pancreas is a rare exocrine pancreatic tumor. Despite the increasing recognition of the tumor in recent years, its pathogenesis and apparent therapeutic algorithm remain unclear. This study was designed to define the clinical, imaging, and pathologic features and to improve the diagnosis and treatment of this rare disease.The clinical, imaging, and pathologic findings of 9 SPT patients managed in our hospital between 2001 and 2005 were retrospectively analyzed, and related literatures were reviewed.In the 9 patients aged from 14 to 68 years, 8 were female and 1 male. The mean age of these patients at diagnosis was 30 years. Initially, 8 patients complained of vague abdominal pain and one patient had pancreatic mass detected incidentally by abdominal CT. The levels of blood and urine amylase and tumor markers were all within the normal range. B-US, CT and MRI demonstrated that tumors were well encapsulated and contained some degree of internal hemorrhage or cystic degeneration. The mean transverse diameter of these tumors was 5.4 cm (range, 2-10.5 cm). The tumors were located at the head (2 patients), body (2), body and tail junction (4), and tail (1) of the pancreas. Surgical procedures included pancreaticoduodenectomy, distal pancreatectomy, distal pancreatectomy with splenectomy, and enucleation. Histological examination showed solidified cystic areas and papillary protrusions. Two malignant tumors demonstrated retroperitoneal metastases and vascular invasion. Follow-up for 2.5 years on average showed that one patient died of tumor recurrence at 10 months and the rest were alive.SPT exhibits unique clinical and pathologic features and is readily diagnosed by its characteristic imaging and histological appearance. Surgical resection of the primary tumor and metastases is the treatment of choice.