Search

To investigate the effect of electroacupuncture (EA) on intestinal Toll-like receptor 4 (TLR4) and nuclear factor-kappa B (NF-κB) in obese rats, so as to explore the mechanism of action of acupuncture in losing weight.A total of 50 male Wistar rats were randomly divided into control and model groups. High-fat feed was used to establish a rat model of obesity, and after modeling, the 24 rats were randomly divided into model group, TLR4 inhibitor group, and EA group, with 8 rats in each group. The rats in the EA group were given EA at "Guanyuan" (CV4), "Zhongwan "(CV12), "Zusanli" (ST36), and" Fenglong" (ST40), 10 minutes each time, 3 times a week, and those in the TLR4 inhibitor group were given intraperitoneal injection of TAK-242 three times a week; the course of treatment was 8 weeks for both groups. Body weight and blood glucose were measured every two weeks. Co-immunoprecipitation was used to observe the interaction between TLR4 and NF-κB p65 in the intestinal tissue; electrophoretic mobility shift assay was used to measure the activity of NF-κB p65; Western blot was used to measure the protein expression of TLR4, phosphorylated nuclear factor of kappa light polypeptide gene enhancer in B-cells inhibitor alpha (p-IκBα), and NF-κB p65; quantitative real-time PCR was used to measure the mRNA expression of TLR4, NF-κB p65, and IκBα.Compared with the control group, the model group had significant increases in body weight, blood glucose, and protein and mRNA expression of TLR4 and NF-κB p65 (EA can effectively regulate intestinal TLR4, inhibit the interaction between TLR4 and NF-κB p65, and reduce the activity of NF-κB p65, which may be a potential mechanism of EA in reducing body weight and blood glucose in obese rats.

Cholangiocarcinoma (CCA) is one of the most difficult cancers to treat and lacks an established standard chemotherapy regimen. This study evaluated the effects of different combinations of gemcitabine, sorafenib, and S-1 on CCA cells to identify the optimal drug combination. A fractional factorial design method was applied in drug combination experiments to determine the optimal combination of these three drugs (gemcitabine=1.4 mmol/l, sorafenib=0.03 mmol/l, S-1=0.185 mmol/l). We constructed a mathematical model with a small number of runs (Y=1.14-0.377A-23.0B-1.81C+0.084A+109B+6.06C+3.83AB+0.175AC-40.4BC) to predict the efficacy of combinations of the drugs. The optimal combination can significantly inhibit the AKT/mTOR pathway, and thus CCA cell proliferation, and can induce cell apoptosis. In vivo, this combination (gemcitabine=1.4 mmol/l, sorafenib=0.03 mmol/l, S-1=0.185 mmol/l) can significantly inhibit tumor growth. The present study showed that the mathematical model was reliable and could predict the efficacy of the different drug combinations. The optimal combination of these drugs may aid the development of a promising standard chemotherapy regimen for CCA.

Although the combination of cisplatin and gemcitabine (GEM) is considered the standard first-line chemotherapy against unresectable hilar cholangiocarcinoma (HC), its efficacy is discouraging. The present randomized open-label clinical trial aimed to evaluate the efficacy and safety of the GEM plus S-1 (GEM-S-1) combination against unresectable HC. Twenty-five patients per group were randomly assigned to receive GEM, S-1 or GEM-S-1. Neutropenia (56%) and leukopenia (40%) were the most common chemotherapy-related toxicities in the GEM-S-1 group. Median overall survival (OS) in the GEM-S-1, GEM and S-1 groups was 11, 10 and 6 months, respectively. GEM plus S-1 significantly improved OS compared to S-1 monotherapy (OR=0.68; 95%CI, 0.50–0.90; P=0.008). Median progression-free survival (PFS) times in the GEM-S-1, GEM and S-1 groups were 4.90, 3.70 and 1.60 months, respectively. GEM plus S-1 significantly improved PFS compared to S-1 monotherapy (OR=0.50; 95%CI, 0.27–0.91; P=0.024). Response rates were 36%, 24% and 8% in the GEM-S-1, GEM and S-1 groups, respectively. A statistically significant difference was found in response rates between the gemcitabine-S-1 and S-1 groups (36% vs 8%, P=0.017). Patients with CA19-9

Potted Citrus. junos cv. Ziyang Xiangcheng seedlings were used to study the effects of selenium (Se) valence states (Se以盆栽香橙为试材,分析不同施用浓度Se

Heme oxygenase-1 has been identified to protect allograft from ischemia/reperfusion and immunologic rejection. Activity of heme oxygenase-1 is regulated by a guanine-thymine dinucleotide length polymorphism in the heme oxygenase-1 gene promoter. In this study, we aimed to explore the impact of the heme oxygenase-1 gene promoter polymorphism of donors and recipients on the orthotopic liver graft function after transplantation. Sixty recipients and their accompanying donors of orthotopic liver allografts were included retrospectively in this study. Heme oxygenase-1 gene promoter polymorphism was assessed using genomic DNA isolated from cryopreserved splenocytes or peripheral blood mononuclear cells and analyzed by genetic analyzer. Small allele of the donor heme oxygenase-1 gene polymorphism significantly prolonged the graft survival (p = 0.017). Recipients of allografts from a class of small-allele carrier had significantly lower serum total bilirubin compared with recipients of a nonclass small-allele donor liver (p

CNC machining center spindle early mechanical failure has hidden and complex features. In this paper, PeakVue technology early detection of potential and subtle abnormal spindle vibration signal, to solve the problem of weak signal difficult to detect. In order to quickly and accurately determine the motorized spindle potential mechanical failure, this paper PSO global search capability and fast optimization speed and fuzzy neural network(FNN) fault-tolerant ability, self-adaptable characteristics of a method is proposed. The method combines fuzzy logic, RBF neural networks and FNN, spindle in order to predict an early mechanical failure of CNC machining center. In order to optimize the parameters of fuzzy neural network structure, velocity updating formula and inertia weight of PSO has been improved, so as to establish an improved PSO optimized fuzzy neural network CNC machining center spindle early failure prediction method. The results show that: the method of early mechanical failure of the spindle has higher prediction accuracy and generalization ability stronger.

Little is known about the role of antiviral therapy for patients with hepatitis B who underwent curative hepatectomy for hepatocellular carcinoma (HCC). The aim of this study was to assess whether antiviral therapy after hepatectomy improves the prognosis of HCC in preoperatively antiviral-free patients.This was a retrospective study of postoperative antiviral treatment in patients (n=87) who underwent curative hepatectomy for HCC. Clinicopathological features and disease-free survival (DFS) were assessed. Patients were followed up to monitor HCC recurrence (median of 31 months).In patients with HCC up to 3 cm (n=36), antiviral therapy reduced serum alanine transminase levels after 6 months of treatment (-26.3%, P0.01). Among these patients, there was a significant prolongation of DFS in patients who received antiviral therapy after hepatectomy compared with those who did not (P=0.006). However, in patients with HCC greater than 3 cm (n=51), antiviral therapy did not decrease alanine transminase levels (+32.8%, P0.01). In these patients, antiviral therapy had no effect on DFS (P0.05). Using multivariate analysis, postoperative antiviral therapy was found to be an independent prognostic factor that was associated with a better DFS in patients with HCC up to 3 cm (odds ratio=0.220, 95% confidence interval: 0.120-0.434, P=0.008).Antiviral therapy improved the prognosis of hepatitis B virus-related HCC up to 3 cm. Antiviral therapy should be considered a standard postoperative adjuvant therapy of hepatitis B virus-related HCC.

Infective factors cause the perpetuation of inflammation as a result of the permanent exposure of the immune system to exogenous or endogenous products of virus or bacteria. Mesenchymal stem cells (MSCs) can be exposed to this infective environment, which may change the characteristics and therapeutic potency of these MSCs. MSCs have the ability to repair damaged and inflamed tissues and regulate immune responses. In this study, we demonstrated that MSCs express functional Toll-like receptors (TLR) 3 and 4, the Toll-like receptor families that recognize the signals of viral and bacterial mimics, respectively. The specific stimulations did not affect the self-renewal and apoptosis capabilities of MSCs but instead promoted their differentiation into the adipocytes and osteoblasts with the TLR3 ligand. The reverse of these results were obtained with the TLR4 ligand. The migration of the MSCs to stimulate either of the two specific ligands was inhibited at different times, whereas the immunogenicity and immunosuppressive properties of the MSCs were not weakened unlike in the MSCs group. These results suggest that TLR3 and TLR4 stimulation affect the characterization of MSCs.

Current treatment of intrahepatic cholangiocarcinoma (ICC) remains ineffective because knowledge of ICC carcinogenesis is unclear. Increasing evidence suggests that microRNAs (miRNAs), including miRNA-191, play an important role in tumorigenesis, but expression and biological functions of miRNA-191 in ICC remain to be established. This study aimed to investigate the functions and underlying mechanisms of miRNA-191 in ICC. ICC miRNA profiles were generated in 5 pairs of ICC and matched to normal bile duct tissues by next-generation sequencing technology; ICC miRNA profiles were verified in 18 pairs of ICC tissues and normal bile duct tissues by quantitative reverse transcription PCR (qRT-PCR). The miR-191-associated mechanisms in ICC were investigated in vitro and in vivo and clinical outcomes associated with miR-191 were correlated in 84 patients. Our results showed miR-191 expression was significantly increased in ICC compared with the adjacent normal bile duct tissues (p

Based on the function structure tree ,the spot failure data of CNC grinding machine were analyzed and found out that of the all failure positions in the subsystem of the CNC machine was High-frequency Motor Built-in Spindle an high failure frequent and main criticality failure position . By further in detail analysis found out that the main failure cause of the CNC grinding machine was burning out of components. It was defined the main direction to improve the reliability of this CNC grinding machine and put forward the corresponding improvement measures. It can offer a theory basis for the reliability design and analysis of CNC machine tool .

The aim of this study was to investigate the differences in portal hemodynamics between whole liver transplantation and living donor liver transplantation (LDLT). Twenty patients who underwent LDLT (the L group) and 42 patients who underwent whole liver transplantation (the W group) were enrolled, and colored Doppler ultrasonography was performed preoperatively and on postoperative days (PODs) 1, 3, 5, 7, 30, and 90. The changes in the portal blood flow velocity (PBV) and portal blood flow volume (PBF) were monitored. The graft and spleen sizes were measured with angiographic computed tomography, and upper endoscopy was used to measure esophageal varices on PODs 14, 30, and 90. Although the portal venous pressure (PVP) decreased after graft implantation, it was higher in the L group with a smaller graft size ratio (25.7 ± 5.1 cm H2O for the L group and 18.5 ± 4.6 cm H2O for the W group, P < 0.05). PBF and PBV increased in both the W and L groups on POD 1 after transplantation; however, the PBF and PBV peaks were significantly higher in the W group. The postoperative PVP and graft volume were greatly related to PBF on POD 1. Grafts in the L group regenerated rapidly after the operation, and the volume increased from 704 ± 115 to 1524 ± 281 mL as early as 1 month after transplantation. A rapid improvement in splenomegaly was observed in both groups. An improvement in esophageal varices was observed in the W group on POD 14 after transplantation, whereas no change was observed in the L group. The portal venous flow in patients with portal hypertension showed a high perfusion state after LDLT, but in contrast to whole liver transplantation, the PVP elevation after LDLT postponed the closing time of the collateral circulation and affected the recovery from splenomegaly. Liver Transpl 16:1236-1241, 2010. © 2010 AASLD.

Background: While benign duodenal tumours are rare compared with malignant tumours, they comprise a wide variety of pathologies. Despite their diagnostic challenge, the optimal management of benign duodenal tumours remains undefined. We aimed to review the diagnosis and surgical treatment of benign duodenal tumours. Methods: Records of all patients with post-operative pathological diagnosis of benign duodenal tumour were retrieved. Information on clinical presentations, diagnostic methods, tumour locations, surgical approaches, pathological results and patient outcomes were analysed. Results: The operative spectrum included local resection in 8 cases, segmental duodenectomy in 1 case, subtotal gastrectomy in 1 case, papilla resection with sphincteroplasty in 3 cases and pancreaticoduodenectomy in 5 cases. The post-operative pathology results indicated 5 cases of adenoma, 2 cases of tubular adenoma, 2 cases of villous adenoma, 2 cases of tubulovillous adenoma, 2 cases of hamartoma and 1 case each of hamartomatous polyp, Brunner's adenoma, adenomyoma, fibromatosis and ectopic pancreas. Post-operatively, one patient died of unrelated disease, one case was lost in follow-up and the remaining patients survived recurrence-free with a good quality of life. Conclusion: The presentation of benign duodenal tumours is non-specific, with upper abdominal discomfort and upper gastrointestinal bleeding as common symptoms. Surgical resection is the preferable therapeutic choice with satisfactory prognosis.

The aim of this study was to investigate the changes in splanchnic hemodynamics after LDLT and their relationship with graft regeneration. Eighteen patients with LDLT December 2006 and June 2008 were enrolled, and color Doppler ultrasonography was performed preoperatively and on postoperative days (PODs) 1, 3, 5, 7, 30, and 90 after transplantation. The changes in the portal blood flow mean velocity (PBV) and portal blood flow volume (PBF) were monitored, and their effects on hepatic function were observed simultaneously. Graft sizes were measured on PODs 7, 30, and 90 after the operation. The regeneration rates of grafts were calculated. PBF increased in the recipient group from 1081.17 +/- 277.50 to 2171.44 +/- 613.15 mL/minute, and PBV increased from 15.01 +/- 5.67 to 56.00 +/- 22.11 cm/s; they were both significantly higher than those in the donor group (P0.01). On POD 1, serum aspartic aminotransferase, alanine aminotransferase, and total bilirubin all peaked; however, these indices in patients with PBF/graft weight (GW)300 mL/minute . 100 g were significantly higher than those in patients with PBF/GW300 mL/minute . 100 g. Livers in the recipient group regenerated rapidly. The graft regeneration rate reached 119.40% +/- 28.21% as early as 1 month post-transplantation. PBF and PBV on PODs 1 and 3 were greatly related to liver regeneration at 30 days. The portal venous flow in patients with portal hypertension after LDLT showed a high perfusion state, which could promote graft regeneration, but PBF/GW after the operation should be controlled below 300 mL/minute . 100 g in order to protect grafts from hyperperfusion injury.

An independent association between acute renal failure (ARF) and intra-abdominal hypertension (IAH) after liver transplantation has not been established previously. The aim of this retrospective study was to understand the role of IAH as an independent risk factor for ARF in the early postoperative period. This study involved 62 subjects who underwent liver transplantation. Intra-abdominal pressure (IAP) was measured in the first three days after surgery by using the urinary bladder technique. An IAP of at least 20 mmHg per day was defined as IAH. Clinical parameters between group IAH and group NO-IAH were compared in terms of the incidence of ARF, blood creatinine levels, blood urea nitrogen (BUN) levels, urine volume per hour and glomerular filtration gradient (GFG). Hemodynamic variations were recorded in the first three postoperative days between group ARF and group NO-ARF. The perioperative suspected risk factors of ARF were determined for statistical evaluation using correlation coefficients and logistic regression analysis. In group IAH, 45.8% patients developed ARF as against 7.9% in group NO-IAH; GFG was significantly lower at 0-72 h after surgery; and blood creatinine levels, BUN levels, urine volume per hour were significantly different at 24-72 h after surgery compared with group NO-IAH. The patients with ARF were not significantly different from those without ARF in terms of central venous pressure, pulmonary artery pressure and mean arterial pressure (MAP) in the first three postoperative days despite a significant increase in heart rate at 24-72h after operation. Postoperative IAH, intraoperative MAP and intraoperative blood transfusion volume of more than 15 U were found to be independent risk factors for ARF. IAH impaired renal function and was an independent risk factor for ARF after liver transplantation. Routine measurement should be taken to monitor IAP every eight hours postoperatively.

OBJECTIVE The influence of surgical approaches on patients with gastric cancer with portal hypertension is unknown. The aim of the study was to investigate the outcomes in such patients who had undergone curative surgery for gastric cancer. PATIENTS AND METHODS The clinical data of 60 patients with portal hypertension undergoing curative surgery for gastric cancer or simultaneous surgery for portal hypertension were retrospectively analyzed. RESULTS Radical gastrectomy alone had no tremendous impact on postoperative liver function, but simultaneous surgery for portal hypertension affected patients' liver function dramatically (P

We hypothesized that the combination of APACHE II and Model for End-Stage Liver Disease systems would work satisfactorily in patients admitted to intensive care unit after living-donor liver transplant.Data were retrospectively collected from the database of our surgical team. The study included 38 patients (hepatitis B virus cirrhosis, 47.4%; hepatocellular carcinoma, 28.9%; other diseases, 23.7%). Laboratory values were obtained. Vital signs, Glasgow Coma scale scores, and urine output were abstracted. Variables included age, sex, acute physiology score, APACHE II score, APACHE II-predicted intensive care unit and hospital mortality, predicted length of intensive care unit, and hospital stay. Patients' actual length of intensive care unit and hospital stays, intensive care unit and hospital discharge status, and discharge location were recorded. Standardized mortality ratios were calculated. Discrimination and calibration of APACHE II were assessed. All patients were divided into 3 groups: Model for End-Stage Liver Disease score:25, 18 to 25, and18. Predicted hospital mortality was calculated and compared.Mean APACHE II scores of survivors and non-survivors were 13.03 and 23.67. Mean risk of death was 7.05% and 25.07%. APACHE II scores and risk of death between survivors and non-survivors was significantly different (P.001). The cutoff value of APACHE II score and Model for End-Stage Liver Disease score in the receiving operating characteristic curve was 20 and 25. Patients with APACHE II scores greater than 20 or Model for End-Stage Liver Disease scores greater than 25 had higher predicted hospital mortality after living-donor liver transplant.The modified APACHE II model provides an accurate prognosis of patients receiving a living-donor liver transplant. The combined application of Model for End-Stage Liver Disease score and APACHE II score can improve the predictive accuracy.

The induced expression of heme oxygenase-1 (HO-1) in donor islets improves allograft survival. Cobalt protoporphyrin (CoPP) could significantly enhance the expression of HO-1 mRNA and protein in rat islet safely. Our work was to study how to protect pancreatic islet xenograft by CoPP-induction.Islet xenografts treated with CoPP-induction and CoPP + Zinc protoporphyrin (ZnPP) in vitro and in vivo were randomly transplanted into murine subrenal capsule; then the graft survival time was compared by blood glucose level and pathological examination and meanwhile the interferon γ (IFN-γ), tumor necrosis factor α (TNF-α), interleukin 10 (IL-10) and IL-1β level in serum and their mRNA and HO-1 mRNA and protein expression were examined.Islets with CoPP-induction under low- and high-glucose stimulation exhibited much higher insulin secretion compared with other three groups. CoPP-induction could increase higher expression of HO-1 (mRNA: 3.33- and 76.09-fold in vitro and in vivo; protein: 2.85- and 58.72-fold). The normoglycemia time in induction groups ((14.63 ± 1.19) and (16.88 ± 1.64) days) was significantly longer. The pathological examination showed less lymphocyte infiltration in induction groups. The IL-10 level and its mRNA in induction groups were significantly higher.The HO-1 induced by CoPP would significantly improve function, prolong normoglycemia time and reduce lymphocyte infiltration. Meanwhile CoPP-induction in vivo had more beneficial effects than in vitro. Its mechanism could be related to immune-modulation of IL-10.

While benign duodenal tumours are rare compared with malignant tumours, they comprise a wide variety of pathologies. Despite their diagnostic challenge, the optimal management of benign duodenal tumours remains undefined. We aimed to review the diagnosis and surgical treatment of benign duodenal tumours.Records of all patients with post-operative pathological diagnosis of benign duodenal tumour were retrieved. Information on clinical presentations, diagnostic methods, tumour locations, surgical approaches, pathological results and patient outcomes were analysed.The operative spectrum included local resection in 8 cases, segmental duodenectomy in 1 case, subtotal gastrectomy in 1 case, papilla resection with sphincteroplasty in 3 cases and pancreaticoduodenectomy in 5 cases. The post-operative pathology results indicated 5 cases of adenoma, 2 cases of tubular adenoma, 2 cases of villous adenoma, 2 cases of tubulovillous adenoma, 2 cases of hamartoma and 1 case each of hamartomatous polyp, Brunner's adenoma, adenomyoma, fibromatosis and ectopic pancreas. Post-operatively, one patient died of unrelated disease, one case was lost in follow-up and the remaining patients survived recurrence-free with a good quality of life.The presentation of benign duodenal tumours is non-specific, with upper abdominal discomfort and upper gastrointestinal bleeding as common symptoms. Surgical resection is the preferable therapeutic choice with satisfactory prognosis.

To retrospectively analyze the surgical outcome of portal hypertension and explore the risk-factors of long-term survival after operation.The data of 149 patients (male 119, female 30, aged from 19 to 73 years old) with portal hypertension treated surgically from January 1996 to October 2007 was collected. Among these patients, there were 110 patients for Child A and 39 patients for Child B according to Child-Pugh classification. According to different surgical modality, all patients were divided into devascularization group (n = 85) and shunting group (n = 64).The follow-up rate was 78.8% and the average follow-up time was (46.3 +/- 30.4) months. The overall survival rates of 1-, 3-, 5- and 10-years were 95.6%, 88.7%, 83.4% and 65.1% respectively. Meanwhile the survival rates of 1-, 3-, 5- and 10-years in devascularization group and in shunting group were 95.4%, 87.7%, 80.6%, 56.3% and 95.8%, 90.1%, 86.8%, 72.6% respectively. There was no significant difference in survival rate between these two groups (P0.05). Child-Pugh classification has been the most important risk-factor that could influence long-term survival after operation by analysis of COX regression and it showed that the long-term survival time in Child A was longer than in Child B. The re-hemorrhage rates of 1-, 3- and 5-years in shunting group would be much better than in devascularization group. The rate of postoperative encephalopathy in devascularization group and shunting group was 6.9% and 6.1% respectively and there was no significant difference (P0.05). The portal venous pressure and flow of portal vein decreased significantly after shunting operation (P0.05).The mainly sole risk-factor of long-term survival for portal hypertension has been the classification of Child-Pugh, not surgical procedure. The individualized proximal splenorenal shunt is much better than devascularization in controlling variceal hemorrhage.

To summarize the experience on diagnosis and treatment of multiple endocrine neoplasia type 1 (MEN-1) related pancreatic endocrine tumors (PET).From January 2004 to December 2007, there were 10 patients of MEN-1 related PET were treated in Shanghai Jiaotong University School of Medicine Affiliated Ruijin Hospital. There were 2 males and 8 females, aged from 11- to 49-years-old. They were diagnosed by laboratory tests, imaging examinations and genes sequencing. Drug therapy, surgery and follow-up were applied on the patients.There were 9 patients having insulinomas including 2 cases of multiple insulinomas and 1 case presenting an insulinoma, multiple nonfunctional PET and malignant duodenum gastrinoma with liver metastasis. The other patient was diagnosed as glucagonoma clinically. Five cases had family history and MEN-1 gene mutation was detected in 9 patients. Seven patients accepted nine operations. Twelve insulinomas, four nonfunctional PET and one duodenum gastrinoma were found in the operations. All patients were followed up from 1 month to 11 years, and 9 patients with good conditions and 1 patient died.Well recognizing PET and MEN-1, early diagnosing MEN-1 related PET, appropriately surgical intervention will prove patients' life quality and will help for prolonging patients' survival time.

To evaluate current selection criteria for patients undergoing liver transplantation (LT) in response to hepatocellular carcinoma (HCC), and to analyze the prognostic factors for successful transplantation.We evaluated the outcome of 1,078 consecutive patients with HCC from the Shanghai Multi-Center Collaborative LT Group who underwent LT over a 6-year period. Clinicopathologic data for these patients were evaluated. The prognostic significance was assessed using Kaplan-Meier survival estimates and log-rank tests. Multivariate study with Cox's proportional hazard model was used to evaluate the prognosis-relative aspects.We determined that expansion of Milan criteria to include: a solitary lesionor = 9 cm in diameter, no more than three lesions with the largestor = 5 cm, a total tumor diameteror = 9 cm without macrovascular invasion, lymph node invasion and extrahepatic metastasis (referred to as the "Shanghai criteria"), resulted in overall survival (OS) and disease-free survival (DFS) rates that were similar to the Milan criteria. Multivariate analysis using the Cox proportional hazards regression model showed that the Child-Pugh-Turcotte classification (P = 0.010, 0.000), tumor differentiation (P = 0.001, 0.000), tumor size (P = 0.000, 0.000) and number (P = 0.014, 0.016), macrovascular invasion (P = 0.022, 0.000) and alpha-fetoprotein (AFP) levels (P = 0.031, 0.003) were independent predictors of OS and DFS, while post-LT chemotherapy (OS, P = 0.000) and tumor encapsulation (DFS, P = 0.038) were independent predictors of OS or DFS.Shanghai criteria expanded the current criteria while maintaining similar survival.

To study the regularity of splanchnic hemodynamic changes after orthotopic liver transplantation (OLT) for patients with portal hypertension. At the same time, effect of such changes on splenomegaly, hypersplenism, collateral circulation and the postoperative liver function was discussed.Between June 2002 and October 2005, 173 liver transplantations were performed. In 38 patients with portal hypertension undergoing OLT, the following parameters were measured before surgery and subsequently at 1, 3, 5, 7 days, 1, 6 months and 1, 2, 3 years after operation by using Color Doppler sonography: portal blood flow mean velocity (PBV), portal blood flow volume (PBF), hepatic artery resistance indexes (HA-RI) and spleen size. The same parameters were measured in 8 patients with acute liver failure and 20 healthy controls. Meanwhile to observe liver function and varicose vein of esophagus.In cirrhotics, PBV and PBF increased immediately after transplantation [from (13.7 +/- 4.2) cm/s to (58.4 +/- 25.2) cm/s and from (958 +/- 445) ml/min to (3024 +/- 1207) ml/min respectively, P0.05]. HA-RI also augmented [from (0.65 +/- 0.11) to (0.74 +/- 0.12), P0.05]. PBV returned to normal values after 6 months, PBF returned to normal value after 2 years. Spleen size decreased significantly, but splenomegaly persisted after 3 years. In addition the esophagogastric varix ameliorated significantly.Abnormal splanchnic hemodynamic changes for patients with portal hypertension still will long-term exist after OLT, but does not effect recovery of hypersplenism, esophagogastric varix and liver function.

To evaluate the effect of the small intestinal mesenteric lymphoid tissues stimulating mixed lymphocyte reaction with dendritic cells (DC) and peripheral blood monocyte cells (PBMC), and observe the changes of the MHC molecular expression on DC.DC, PBMC and mixed lymphocyte were separated to culture from SD rats. Lymphoid tissue suspension was adopted from small intestinal mesentery of Wistar rats. In the mixed lymphocyte reaction (MLR), the cellular proliferation of small intestinal mesenteric lymphoid tissue antigen act on DC and PBMC was detected with cell counting of CCK-8 assay, the same assay used in small intestinal mesenteric lymphoid tissue antigen and ovalbumin (OVA) acting on DC. FACS analysis was performed after lymphoid tissue suspension stimulating DC to observe the MHC molecular expression.In the lymphoid tissue suspension, 91% of the cells was lymphocyte, others including granulocyte, plasmocyte, epithelium. The effect of stimulating mixed lymphocyte proliferation were higher in DC groups than in PBMC groups with the small intestinal mesenteric lymphoid tissue (P0.05). In the proportion of DC and mixed lymphocyteor= 1:100 groups, the mixed lymphocyte proliferation were higher in the small intestinal mesenteric lymphoid tissues groups than in the OVA groups (P0.05). After stimulated by the small intestinal mesenteric lymphoid tissue, DC expressed higher MHC-I and -II molecules than control groups.The small intestinal mesenteric lymphoid tissue has high antigenicity; the antigen presenting ability of DC was much stronger than granulocytes; DC expresses high MHC-I and MHC-II molecules after stimulated by mixed lymphoid tissue suspension.

To investigate the characteristic and management of postoperative infection in abdominal cluster transplantation.Preliminary experience of two cases of abdominal cluster transplantation including small intestine was reviewed.Combination of five immunosuppressive agents based on tacrolimus was used. Severe Gram-negative bacillus infections occurred. The majority of invasive fungal infections was due to Candida species. Cytomegalovirus (CMV) infection increased monocytes and caused eosinopenia and an inversion of the CD4(+) to CD8(+) cell ratio in recipient I, and human CMV matrix proteins pp71 (CMV-pp71) was detected and identified in bile by PCR. Microabscesses in liver transplant biopsies were presented.Infectious complications after cluster transplantation were complicated. Strategies to optimize the immunity suppression protocol and early diagnosis and treatment will be important to reduce infection after abdominal cluster transplantation.

The past several decades have witnessed increasingly successful rates of liver transplantation. However, retransplantation remains the only choice for patients with irreversible graft failure after primary transplantation. This article aimed to summarize our clinical experience in liver retransplantation.From June 2002 to December 2005, a total of 185 cases of liver transplantation including 8 cases of retransplantation were performed in our hospital. The clinical data were analyzed retrospectively.The rate of liver retransplantation was 4.32%. Retransplantation was indicated for the following reasons: biliary complication (3 cases), chronic rejection (2), hepatic artery thrombosis (1), uncontrollable acute rejection (1) and hepatitis B recurrence (1). The mean model of end-stage liver disease (MELD) scores before primary transplantation and retransplantation were 15.6 and 23.9, respectively (P0.05). The MELD score reflected the severity of liver disease more precisely than the Child classification. The mean interval between the first and second transplantation was 316 days (78-725 days). The first three patients, with mean interval of 101 days, died of severe infection combined with multiple organ failure after retransplantation. The patients who underwent retransplantation more than six months after the first transplant had better outcomes. The one-year survival rate for retransplantation in our group was 62.5%.Liver retransplantation is the only means of saving the patient with hepatic allograft failure. Understanding of the indications for retransplantation, careful selection of operation timing, excellent surgical skills and meticulous postoperative management all contribute to the success of each case of retransplantation.

To investigate the pharmacokinetics of mycophenolic acid (MPA), an active metabolite of mycophenolate mofetil (MMF) in Chinese adult liver transplant patients.Thirty-eight liver transplant patients (male 30, female 8) receiving MMF 1.0 g, twice daily in accordance with the recommended regimen were included in this study. Plasma MPA concentrations were measured by high performance liquid chromatography at 0.5, 1, 1.5, 2, 4, 6, 8, 10 and 12 h after the administration of a single dose. Pharmacokinetic parameters were calculated with 3P97 software.The plasma MPA concentration-time curve was characterized with an early sharp peak reached at 0.5 - 6.0 h after oral administration. And in some patients there was a small second peak due to enterohepatic circulation of mycophenolic acid glucuronide (MPAG), which underwent deglucuronidation and re-absorption as MPA at 4 to 12 h postdose. The mean peak plasma concentration (C(max)) and area under concentration-time curve (AUC(0-12 h)) were (12 +/- 7) microg x mL(-1) and (44 +/- 16) microg x h x mL(-1), respectively. However, a large variability of pharmacokinetic parameters existed in these patients.In view of the inter-individual variability of MMF pharmacokinetics, plasma MPA concentration should be monitored routinely after MMF administration for individual patient.

This study aimed to: (i) define the clinical pharmacokinetics of mycophenolic acid (MPA) in Chinese liver transplant recipients; and (ii) develop a regression model best fitted for the prediction of MPA area under the plasma concentration-time curve from 0 to 12 hours (AUC(12)) by abbreviated sampling strategy.Forty liver transplant patients received mycophenolate mofetil 1g as a single dose twice daily in combination with tacrolimus. MPA concentrations were determined by high-performance liquid chromatography before dose (C(0)) and at 0.5 (C(0.5)), 1 (C(1)), 1.5 (C(1.5)), 2 (C(2)), 4 (C(4)), 6 (C(6)), 8 (C(8)), 10 (C(10)) and 12 (C(12)) hours after administration on days 7 and 14. A total of 72 pharmacokinetic profiles were obtained. MPA AUC(12) was calculated with 3P97 software. The trough concentrations (C(0)) of tacrolimus and hepatic function were also measured simultaneously. Multiple linear regression analysis was used to establish the models for estimated MPA AUC(12). The agreement between predicted MPA AUC(12) and observed MPA AUC(12) was investigated by Bland-Altman analysis.The pattern of MPA concentrations during the 12-hour interval on day 7 was very similar to that on day 14. In the total of 72 profiles, the mean maximum plasma concentration (C(max)) and time to reach C(max) (t(max)) were 9.79 +/- 5.26 mg/L and 1.43 +/- 0.78 hours, respectively. The mean MPA AUC(12) was 46.50 +/- 17.42 mg . h/L (range 17.99-98.73 mg . h/L). Correlation between MPA C(0) and MPA AUC(12) was poor (r(2) = 0.300, p = 0.0001). The best model for prediction of MPA AUC(12) was by using 1, 2, 6 and 8 hour timepoint MPA concentrations (r(2) = 0.921, p = 0.0001). The regression equation for estimated MPA AUC(12) was 5.503 + 0.919 . C(1) + 1.871 . C(2) + 3.176 . C(6) + 3.664 . C(8). This model had minimal mean prediction error (1.24 +/- 11.19%) and minimal mean absolute prediction error (8.24 +/- 7.61%). Sixty-three of 72 (88%) estimated MPA AUC(12) were within 15% of MPA AUC(12). Bland-Altman analysis also revealed the best agreement of this model compared with the others and a mean error of +/-9.89 mg . h/mL.This study showed the wide variability in MPA AUC(12) in Chinese liver transplant recipients. Single timepoint MPA concentration during the 12-hour dosing interval cannot reflect MPA AUC(12). MPA AUC(12) could be predicted accurately using 1, 2, 6 and 8 hour timepoint MPA concentrations by abbreviated sampling strategy.

To create the clinical degree of the superior mesenteric vein (SMV) involvement in pancreas uncinate process carcinoma (PUPC) and its clinical significance to be discussed.According to the contiguous relationship between the SMV and the PUPC, the clinical degree of SMV involvement in PUPC are as followings four grades, 1 grade, the grade of clear boundary. 2 grade, the grade of fuzzy boundary. 3 grade, the grade of dissolved boundary. 4 grade, the grade of SMV infringed. The coherence between the type under the CT scan (Tx) and the type under the inoperative judgement (Sx) were analyzed with Kappa-test.There is a significant difference between the grade of SMV involvement and the surgery. The resection rate is 100% in 1st grade, 97.4% in 2nd grade, 65.8% in 3rd grade and 21.7% in 4th grade. There is coherent in the degree judgement between the CT scan and the inoperative inspection (U = 15.96, P0.01).There is clinical significance to establish the degree of SMV involvement in PUPC. It is helpful for clinician to accurately know its anatomic characteristic and decide more reasonable surgical strategy.

Multivisceral transplantation (MTX, or cluster transplantation) is defined as the transplantation of three or more abdominal organs en bloc, namely the liver together with the pancreatoduodenal complex, the stomach as well as the small bowel with/without the right hemicolon. Up to May 1999, only 72 cases were reported to the Intestinal Transplant Registry. Organ cluster transplantation may carry with complex hemodynamic alterations. Based on our experience in two cases of abdominal cluster transplantation, we describe the technical details of multivisceral transplantation and the management of hemodynamic changes.A Swan-Ganz catheter was placed to assist in monitoring the patients' hemodynamic status. After the transplantation, the 2 patients were closely observed in the intensive care unit in terms of vital signs;disseminated intravascular coagulation (DIC) including activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen (Fg) and D-dimer, and arterial blood gas; and quantity and characteristics of drainage. Additionally, intra-abdominal hemorrhage was supervised by bedside B-ultrasonography or enhanced computed tomography (CT) examination. Whole blood viscosity was monitored 2 weeks after transplantation. The blood flow of the hepatic artery and portal vein and arterial resistant index were assessed routinely by Doppler ultrasonography.Hemodynamic changes were observed during perioperation. Liver and renal function recovered within one week after transplantation. Enteral feedings and oral intake were gradually increased with a reciprocal decrease in parenteral nutrition. Despite systemic antibiotics were given according to the results of frequent cultures, patient 1 died from cytomegalovirus (CMV) infection 4 months after transplantation and patient 2 died of a systemic sepsis 2 months after the operation.Many factors contribute to the success of multivisceral transplantation. In order to maintain hemodynamics stable during perioperation, preoperative coagulatory function should be corrected, and stable circulation, serum electrocyte balance, and normal body temperature should be kept during the operation in addition to the treatment of intra-abdominal hemorrhage and making up for the loss of body fluid. However, complications, infection and rejection are barriers for the improvement of graft survival.

The role of aggressive surgery for end-stage gallbladder carcinoma is controversial. This retrospective study was designed to evaluate the outcome of surgical treatment for Nevin stage IV and V gallbladder carcinoma at a single institution.A retrospective analysis was made on 70 patients with Nevin stage IV and V gallbladder carcinoma undergoing surgical treatment from January 1993 to June 2004.There were 22 cases of stage IV and 48 of stage V. Cholecystectomy was performed in 37 cases with a resection rate of 53%, 9 cases received radical resection, 13 extended radical resection, and 15 palliative resection. The curative resection rate was 31% and the morbidity rate was 36%. Postoperative 1-, 3-, 5-year survival rates of curative and palliative resection were 69%, 33%, 8% and 27%, 13%, 0, respectively (P0.01). The 1- and 3-year survival rates of patients undergoing exploratory laparotomy only were 3% and 0, respectively.Nevin stage IV and V gallbladder carcinoma should be treated by aggressive surgery. Curative resection is promising in the improvement of long-term survival rate.

The number of split liver transplantations (SLT) has increased in the last 5 years. Regeneration after the loss of hepatic tissue is a fundamental response to liver injury. Because partial-liver grafts may not be an optimal size for recipients,the purpose of this study was to investigate the regeneration of graft liver after SLT.Four recipients have undergone SLT at our hospital since 2002. The graft liver volume (GLV) in the postoperative day (POD) was measured by computed tomography (CT) and the serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TB), prealbumin (PA) and albumin (ALB) were monitored. The GLV at different postoperative times was compared to the recipient's standard liver volume (SLV) and the liver volume regeneration ratio (LVRR) was calculated. In order to compare SLV in recipient 2, we measured the total liver volume including the graft and the residual native liver as the GLV.The GLV/SLV at POD120 and POD360 of recipient 1 was measured 114% (1159.32 cm(3)/1016.95 cm(3)), 97% (986.44 cm(3)/1016.95 cm(3)) with the LVRR being -11.0%, -24.3%, respectively. For recipient 2, it was measured 96% (927.32 cm(3)/965.96 cm(3)) and 100% (968.98 cm(3)/965.96 cm(3)), with the LVRR being 24.4%, 30.0%, respectively. The initial graft volume of segment II, III was 265.36 cm(3) and increased to 335.24 cm(3) and 360.56 cm(3) at POD120 and POD360, respectively, with the LVRR being 26.3% and 35.9%, respectively. The GLV/SLV at POD60 of recipient 3 was 86% (893.04 cm(3)/1038.42 cm(3)) and the LVRR was 12.0%. For recipient 4, it was 90% (567.48 cm(3)/630.54 cm(3)) whereas the LVRR was 20.0%. The serum levels of ALT, AST and TB in all recipients declined gradually and returned to normal while the serum levels of PA and ALB increased to normal. The serum levels of ALT and AST peaked within 3 days after SLT. The neurological symptoms of Wilson's disease in recipient 2 were improved markedly. The levels of serum copper and copper-protein decreased to 30 mg/L, 120 mg/L at POD120 and the Kayser-Fleischer rings began to obliterate.The size of the transplanted liver after SLT tends to converge to the standard liver volume with time and it is adequate clinically for SLT to meet the need of the body's metabolic demands. The functional recovery of the graft liver occurs earlier than the morphological restoration.

Background and Objective Since being named and reclassified by WHO in 1996, solid-pseudopapillary tumor (SPT) of pancreas has been recognized as a special entitative disease that is different from pancreatic cancer and should be recognized and treated more accurately in the surgical process. The clinic characteristics and surgical strategy on 25 cases of SPT of pancreas from the authors’ center are discussed. Methods The clinical pathology and the surgical methods of 25 SPTs were retrospectively studied. The analyses were performed by the statistical software package SAS6.12. Results No tumor recurrences were found in all patients. There was significant difference between operative types in radical resection and the tumor position of the pancreas (P = 0.0011). The judgment on the tumor’s boundary could directly affect the adoptable operative types (P = 0.0099). Conclusions As a uniquely entitative disease, SPT is a kind of uncommon neoplasm with low-grade malignancy with a strong rate of occurrence in women. Surgical resection is most favorable in the treatment of SPT, which has excellent prognosis. The course of SPT, the possible malignant cells by the frozen section biopsy, and the tumor’s boundary are important for operators to decide an operative scheme. SPT that has infiltrated contiguous vessels, organs, even with local liver metastasis should not be regarded as operative contraindication. The choice of the local tumor resection, the part of pancreas resection or radical resection depends on the judgment of the tumor’s boundary, whereas operative types in radical resection depend on the tumor position of the pancreas.

Solid-pseudopapillary tumors (SPTs) of the pancreas have been reported as rare lesions with "low malignant potential" occurring mainly in young women. This study was designed to define the clinicopathological characteristics and the effect of surgical intervention.A retrospective clinical analysis was made of 21 patients with solid-pseudopapillary tumor of the pancreas admitted from June 1994 to December 2004.Abdominal pain as the major complaint was found in 13 patients, and palpable abdominal mass in 7. Imaging examination showed the abdominal mass clearly, but diagnosis was not defined. In 12 patients, tumors were located in the pancreatic head and in 9 patients, in the pancreatic tail. The average diameter of the tumor was 9.5 cm (range, 3-20 cm). One patient had liver metastasis. The diagnosis of the tumor was proved pathologically during operation in 14 patients, and other 3 patients who had been diagnosed as having insulinoma and other malignant tumors were confirmed by paraffin section and enzyme labeling after operation. Eighteen patients (85.7%) were followed up with a median period of 24 months, 1-60 months without tumor recurrence.Huge pancreatic masses of the pancreas in young women are suggestive of solid-pseudopapillary tumors. Aggressive surgical therapy can result in good prognosis in these patients.

To study the roles of granzyme B and perforin in diagnosing acute rejection after liver transplantation, and the relationship between their activity index (AI) and Banff's histological grading criteria.Liver biopsies were processed as for routine surgical specimens and labeled with granzyme B and perforin monoclonal antibodies. The number of positive cells/mm(2) was determined as activity index (AI) by IPP image analysis software. Histologic findings were used as the "gold standard" in diagnosing acute rejection.Of 41 liver biopsy samples studied, acute rejection was noted in 21 cases, the remaining 20 cases showed no evidence of rejection. The AI of granzyme B and perforin in the acute rejection group was significantly higher than that in the non-acute rejection group (0.001). In the acute rejection group, the AI in moderate to severe acute rejection was higher than that in mild to indeterminate acute rejection (0.001). Compared with the "golden" histologic criteria, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of granzyme B in diagnosing acute rejection were 90.0%, 95.2%, 94.7%, 90.9% and 92.7% respectively. The values of these parameters for perforin were also above 80%.Granzyme B and perforin are key markers of activated immune cells in acute rejection and highly expressed during acute liver rejection episodes. As ancillary investigations, these parameters demonstrated high sensitivity and specificity in diagnosing acute rejection in allograft post-transplant liver biopsies.

To develop a clinically relevant porcine model of acute hepatic failure (AHF).Twenty-two healthy pigs were randomly divided into 5 groups: group I (n = 3, intraportally administered with normal saline), group II [n = 5, intraportally administered with 1 microg/kg of lipopolysaccharide (LPS)], group III [n = 5, intraportally administered with 0.5 g/kg of D-galactosamine (D-Gal)], group IV (n = 6, intraportally administered with 0.5 g/kg of D-Gal plus 1 microg/kg LPS), and group V [n = 3, intraportally administered with 0.5 g/kg of D-Gal plus 1 microg/kg LPS and then receiving auxiliary partial orthotopic liver transplantation (APOLT)], Blood samples were collected to examine the arpartate transaminase (AST), total bilirubin, lactic acid, blood ammonia, prothrombin time (PT), blood sugar, and creatine at different time points. Autopsy was performed on the dead animals. Eight days after the APOLT laparotomy was performed again on the surviving pigs to take specimens of the original and transplanted liver to undergo pathological examination.All the pigs in the groups I and II survived with minimal changes in liver function tests. Two of the 5 pigs in the group III died (40%), 5 pigs in the group IV (5/6, 83%) died within 120 h, with a significant increase in aspartate transaminase 48 h after (4912 U/L +/- 759 U/L). In comparison with those of the group 1 and 2, the TBIL, blood ammonia, lactic acid, and PT 48 h after of the group 4 were all significantly higher and the blood sugar was significantly lower (all P0.05). Reversal of AHF in the pigs in the group V following APOLT was observed and the liver function returned near to normal level on the 7th postoperative day and regeneration of the native liver was confirmed histologically.The porcine model of AHF induced by a combination of D-gal (0.5 g/kg) and LPS (1 microg/kg) will be of much use in the development of APOLT for AHF.

AIM: To introduce the American Pittsburgh’s method of rapid liver procurement under the condition of brain death and factors influencing the quality of donor liver. METHODS: To analyze 32 cases of allograft liver procurement retrospectively and observe the clinical outcome of orthotopic liver transplantation. RESULTS: Average age of donors was 38.24 ± 12.78 years, with a male:female ratio of 23:9. The causes of brain death included 21 cases of trauma (65.63%) and nine cases of cerebrovascular accident (28.13%). Fourteen grafts (43.75%) had hepatic arterial anomalies, seven cases only right hepatic arterial anomalies (21.88%), five cases only left hepatic arterial anomalies (15.63%) and two cases of both right and left hepatic arterial anomalies (6.25%) among them. Eight cases (57.14%) of hepatic arterial anomalies required arterial reconstruction prior to transplantation. Of the 32 grafts evaluated for early function, 27 (84.38%) functioned well, whereas three (9.38%) functioned poorly and two (6.25%) failed to function at all. Only one recipient died after transplantation and thirty-one recipients recovered. Four recipients needed retransplantation. The variables associated with less than optimal function of the graft consisted of donor age (35.6 ± 12.9 years vs 54.1 ± 4.3 years, P < 0.05), duration of donor’s stay in the intensive care unit (ICU) (3.5 ± 2.4 d vs 7.4 ± 2.1 d, P < 0.005), abnormal graft appearance (19.0% vs 100%, P < 0.05), and such recipient problems as vascular thromboses during or immediately following transplantation (89.3% vs 50.0%, P < 0.005). CONCLUSION: During liver procurement, complete heparization, perfusion in situ with localized low temperature and standard technique procedures are the basis ensuring the quality of the graft. The hepatic arterial anomalies should be taken care of to avoid injury. The donor age, duration of donor’s staying in ICU, abnormal graft appearance and recipient problem are important factors influencing the quality of the liver graft.

Since being reclassified by WHO in 1996, solid pseudopapillary tumour (SPT) of pancreas has been recognized as the internationally accepted name. Clinicians are lacking in knowledge of this rare disease so the misdiagnosis and inappropriate therapy are hard to avoid. The clinic data on 22 patients were summarized to study the misdiagnosis and treatment of a sample of SPTs.Twenty-two female patients with SPT were studied retrospectively and divided into two groups, the misdiagnosed group and the correctly diagnosed one. The analyses were performed with Fisher test with accurate probability for categorical data, and Kruskal-Wallis test for ranked data.The rate of misdiagnosis in this sample was 45.5%. The misdiagnosed SPTs were apt to be the incomplete capsule ones (P = 0.020), which resulted in obvious difficulties during operation (P = 0.024). In the misdiagnosed SPT group, the medical expenses increased significantly (P = 0.042), and the number of days in hospital greater than in correctly diagnosed group (P = 0.041).Although SPT has low malignancy with excellent prognosis after surgical treatment in most patients, the misdiagnosis of SPT increases the social and economic burdens on patients. It is important to analyse the causes of misdiagnosis.

Resection of the superior mesenteric-portal vein (SMPV) during pancreatoduodenectomy is disputed. Although the morbidity and mortality of patients after this operation are acceptable, survival is limited. In this study, we evaluated the morbidity, mortality and survival of patients with ductal adenocarcinoma of the pancreas who had undergone pancreatectomy with en bloc portal vein resection.A total of 32 patients with ductal adenocarcinoma of the pancreas who had undergone pancreatectomy with SMPV resection between 1999 and 2003 were retrospectively analyzed. In addition, they were categorized into two groups according to the invasion of the wall of the portal vein: group A (n=12),extended compression of the wall of the portal vein by surrounding carcinoma without true invasion and group B (n=20), true invasion including intramural and transmural invasion.The morbidity of the 32 patients was 31.25%. There was no operative death, and the overall 1-,3-year survival rates were 59% and 16%, respectively. The mean survival time of patients with microscopically positive margin was only 5.6 months as compared with 20 months in patients with microscopically negative margin. No differences in tumor size, margin positivity, nodal positivity, and 1-, 3-year survival rates were observed between the two groups.If selected carefully, pancreatectomy combined with SMPV resection can be performed safely, without increase in the morbidity and mortality. SMPV resection should be performed only when a margin-negative resection is expected to be achieved. SMPV invasion is not associated with histologic parameters suggesting a poor prognosis.

To investigate the expression of perforin and granzyme B in rejection response following liver transplantation, and evaluate their roles to be used as predictive markers of rejection.The expression of perforin and granzyme B in liver biopsies obtained from liver allograft recipients was determined by immunohistochemistry. Biopsies were classified into two groups-no evidence of rejection and rejection-according to Histopathologic criteria. The relationship between the perforin/granzume B expression and acute rejection was analyzed.From 19 patients, thirty-five liver biopsies were obtained after liver transplantation. Among them, nineteen samples were diagnosed as rejection response. The frequencies of perforin and granzyme B expression in rejection group were 100% (19/19) and 94.7% (18/19), respectively. While those in no rejection group were 25.0% (4/16) and 12.5 (2/16), respectively. In most rejected samples, perforin and granzyme B were expressed simultaneously. Only three samples showed perforin expression alone, while no samples demonstrated granzyme B expression alone. There was a close relationship between perforin/granzyme B expression and liver allograft rejection.Perforin and granzyme B expression seemed to be related to the development of acute rejection following liver transplantation, and might be served as sensitive and reliable markers in diagnosing acute rejection in early stage.

To assess transjugular intrahepatic portosystemic shunt (TIPSS) as an effective bridge between the control of variceal bleeding or refractory ascites and orthotopic liver transplantation (OLTx) and to examine whether TIPSS influences the operative procedures of OLTx.Five patients treated by TIPSS prior to OLTx were retrospectively reviewed.The patients were followed up for 2-7 months (average 4.2 months) after transplantation. Transplantation was performed at a mean of 9.6 months (range 0.2-24.7) after TIPSS insertion. In four patients, stents were predominantly intrahepatic and they did not interfere with OLTx. In one patient, the stent extended into the portal vein, requiring removal during OLTx by division of the stent with the recipient portal vein. All patients are alive and none has portal vein thrombosis. No difference was observed in operation time, blood transfusion, and the length of hospital stay.TIPSS is an effective bridge to OLTx for the control of variceal hemorrhage or refractory ascites. Our results suggest that TIPSS does not increase surgical morbidity or mortality, but optimal TIPSS placement within the liver is emphasized to facilitate subsequent OLTx.

To assess individualized therapeutic protocol for patients with portal hypertension on the basis of accumulated knowledge about the mechanism of portal hypertension.Patients data on shunt and other surgical procedures from Ruijin Hospital, Shanghai, China and the published papers.The direction of blood flow of the collateral vessels in the gastro-splenic region is an important factor in deciding surgical strategy because there is a close relationship between surgical risk and the classification of liver function. Clinically it is confirmed that each patient needs an individualized surgical procedure and that prophylactic operation is suitable for patients with splenomegaly, splenism associated with serious esophageal varices and hemorrhagic tendency under endoscopy but acceptable liver function. The shunt diameter (SD) (SD = 0.67 x PVD) is determined in our patients according to individualized hemodynamics. The rehemorrhagic rate after shunt being higher than that in others may be related to lesioned gastric mucosa caused by portal hypertension or bleeding and temporary melena. This finding is good for prevention of hepatic encephalopathy. The life quality and labor ability of patients will be improved because of hepatopetal flow in the portal vein. With strict indications for reoperation, selective operation is performed as soon as possible when hemorrhage is controlled conservatively and liver function improved. Once the patient with cirrhosis associated with portal hypertension is scheduled for liver transplantation, treatment of hemorrhage should aim to keep the patient in good condition and to avoid the protocol that may be disadvantageous to liver transplantation in the future.Surgical procedures for patients with portal hypertension should follow the principle of individualization. To obtain the best outcome, the choice of reasonable surgical procedure is expected.