Objective To study the changes of serum liver functions in recurrent hepatitis C ~after liver transplantation.Methods The clinical data of 50 cases of recurrent hepatitis C (~simultaneously negative for serum HBV DNA) after liver transplantation were collected. The relationship between liver function parameters with the HCV RNA genotype, inflammation histological activity, fibrosis stage, steatosis grade and rejection was evaluated. Results ALT, AST and ?-GT were increased in recurrent hepatitis C. Among them, ?-GT was obviously elevated along with the ~aggravation of histological activity (P

Objective To study the diagnosis and treatment of portal vein complications after orthotopic liver transplantation. Methods The clinical data of 173 patients receiving orthotopic liver transplantation in our hospital from 2002 to 2005 were retrospectively analyzed. Results The incidence of portal vein complications was 3.5% (6 cases). The incidence of portal vein stenosis was 1.2% and that of portal vein thrombosis was 2. 3%. Three cases had previously been treated for portal hypertension and three cases had had a history of portal vein thrombosis before liver transplantation. All the complicated patients recovered and were discharged after successful treatment. There was no complication related mortality. Conclusions A history of previous treatment for portal hypertension, portal vein thrombosis is a risk factor predisposing the patients to portal vein complications after orthotopic liver transplantation. Color Doppler sonography is a sensitive and specific method for monitoring the portal vein complications following orthotopic liver transplantation. The angiography of portal vein is essential for diagnosis of the complications. Thrombolysis treatment is unsatisfactory for advanced stage portal vein thrombosis. Balloon dilation and stenting are both a safe and effective management modality for simple portal vein stenosis.

ObjectiveTo explore the effect of CQI on the teaching of physical diagnostics.MethodsThe theory and practice of CQI are discussed in accordance with specific conditions of the teaching of physical diagnostics.ResultsThe level of the teaching of physical diagnostics can be raised by applying CQI.ConclusionThere will be broad prospects in the application of CQI to quality teaching of physical diagnostics.

There were some limitations existed in current teaching mode of diagnostics,including simple evaluation methods,mechanical internship for body sign,tedious internship for laboratory diagnosis and unsustainable interest-stimulating.Interest teaching was proposed in the teaching reform and some concert measures were implemented including interesting inquiry,interesting skill examination,interesting teaching of laboratory diagnostics,simulated case discussion,interesting training of centesis as well as interesting clinical involvement and interesting medical community activities.The interesting teaching contributed to the improvement of students'comprehensive analysis ability,practical ability,adaptability,humanistic quality,English communication ability and doctor-patient communication,which is of grate importance.

Objective To verify the diagnosis of the bacterial infections and to identify the pathogens, by PCR detection and bacterial endotoxin limulus test. Methods This study enrolled 50 patients receiving liver al-lografts from October 2005 to October 2007 in Ruijin Hospital. Peripheral blood samples were taken on DO, D1, D7 and D14. After preparation of the samples, PCR detection, bacterial endotoxin limulus test were performed. Results The sensitivity, specificity, and accuracy in the diagnosis was 66.7% ,95.0%, and 78.0% for the PCR, and 84.2%,83.9%,and 84.0% for limulus test respectively. It took 3 hours on average for the accomplishment of all these tests. Conclusions Positive PCR test plus negative limulus test suggest G+ infection, which may need the drugs targeting on G+ bacteria;positive PCR test plus positive limulus test, suggest G-infection or mixed infection, which may need drugs against the G-bacteria;negative PCR test, suggests the lack of severe infection. PCR test and limulus test were both remarkably faster than traditional cultural methods in diagnosis.

Humans ; Liver ; cytology ; metabolism ; Liver Diseases ; metabolism ; pathology ; therapy ; Receptors, Angiotensin ; metabolism ; Receptors, Cell Surface ; metabolism ; Receptors, Endothelin ; metabolism ; Receptors, Vasopressin ; metabolism

Objective To compare the two liver volume measurements using multi-slice spiral CT (MSCT)for clinical reference.Methods Twenty-four patients with hepatic disease awaiting orthotopic liver transplantation underwent muhiphase MSCT of the upper abdomen.Liver volumes using two measurements(manual volume measurement and semi-automated volume measurement)before transplantation were compared with the actual liver volume(ALV)measured during transplantation by means of water displacement.Both measurements were timed.Correlation coefficient.one way ANOVA and Bland-Altman tests were used for statistical analysis.Results The mean liver volume estimated with the manual method and the semi-automated method were(1360±157)cm3 and(1345±152)cm3.respectively.The actual liver volume was(1307±153)cm3.There was no significant diffierence between the volumes measured using the three methods(F=0.032,P＞0.05).For all the patients,there Was significant correlation between liver volume measured by MSCT and the actual liver volume.There was a good correlation between the liver volume measured by manual method and the actual liver volume(r=0.976,P＜0.05),so did the correlation between the liver volume measured by semi-automated method and the actual liver volume (r=0.987,P＜0.05).And the semi-automated method took much shorter time[(9.2±1.8)min]compared with the manual method [(23.2±5.8)min ].Conclusion Semi-automated method provided acceptable measurements for liver volume.

BACKGROUND: Presently, there is not an optimal cryopreservation protocol of the microcapsules, which has restrained the application of the microcapsules. OBJECTIVE: To investigate the characteristics of ice crystal and the morphology of alginate-chitosan-alginate (ACA) microcapsules cryopreserved at different solutions and different cooling rates, and to explore the optimal cryopreservationprotocol for ACA microcapsules. DESIGN, TIME AND SETTING: An observational study was performed at the Laboratory of Cryomicroecope in Shanghai University of Science and Technology (China) from February to April in 2008. MATERIALS: The high-voltage pulsing microcapsule shaping device was used to prepare ACA microcapsules.METHODS: The ACA microcapsules were preserved at different cooling rates (1 ℃/minute, 10 ℃/minute, 30 ℃/minute and 100 ℃/minute) by the cryomicroscopy system and then rawarmed at 50 ℃/minute. The protocols were repeated after the supplement of 10% dimethyl sulphoxide. MAIN OUTCOME MEASURES: The growth of ice crystals and the morphology of ACA microcapsules were checked at different cooling rates and in different solutions. The changes of forms and the rates of damage were checked after the microcapsules were rewarmed.RESULTS: The ice crystals grew into big crystals at the freezing process when the cooling rate was low than 10 ℃/minute and cryoprotector was not used. The growth of ice crystals would result in the distortion of microcapsules. It also could reduce the cryodamage of the microcapsules. The size of the ice crystals would grow down when raising the cooling rate and using thecryoprotector. The post-thaw ACA microcapsules were intact when dimethyl sulphoxide was used at a concentration of 10% and the cooling rate was higher than 30 ℃/minute (P ＜ 0.05). CONCLUSION: Mechanical damage occurs mainly during the growing of ice crystals at the time of microcapsules cryopreservation process. The growth of the ice could be restrained effectively by raising the cooling rate and using the cryoprotector.

Objective To investigate the risk factors of pancreatic fistula after pancreaticoduodenectomy.Methods The clinical data of 310 patients who received pancreaticoduodenectomy at the Ruijin Hospital of Shanghai Jiaotong University from January 2005 to May 2013 were retrospectively analyzed.The risk factors associated with the interoperative pancreatic fistula were analyzed.The univariate and multivariate analysis were done using the Pearson chi-square test and non-conditional Logistic regression model.Results A total of 134 patients had postoperative complications,including 103 (33.23％) with pancreatic fistula,among them 40 patients developed additional complications.The results of univariate analysis showed that preoperative levels of hemoglobin,total bilirubin,diameter of the pancreatic duct and postoperative level of albumin were risk factors of pancreatic fistula after pancreaticoduodenectomy (x2 ＝ 4.543,6.087,6.265,5.311,P ＜ 0.05).The results of multivariate analysis showed that preoperative level of total bilirubin equal to or above 34.2 μmol/L,the diameter of the pancreatic duct under 3 mm and the level of postoperative albumin under 28 g/L were the independent risk factors of pancreatic fistula (OR =1.806,1.936,1.780; 95％ confidence interval:1.107-2.948,1.170-3.206,1.002-3.165,P ＜ 0.05).Conclusion Preoperative jaundice (the level of total bilirubin ≥ 34.2 umol/L),pancreatic duct diameter ＜ 3 mm and postoperative malnutrition (albumin ＜ 28 g/L) indicate a higher incidence of postoperative pancreatic fistula.

Objective To evaluate the surgical treatment of Nevin′s stage Ⅳ and Ⅴ gallbladder carcinoma. Methods A retrospective analysis was made on 62 cases of Nevin′s stage Ⅳ and Ⅴ gallbladder carcinoma patients undergoing surgical treatment from Jan. 1993 to Dec. 2002. Results There were 17 cases of stage Ⅳ and 45 of stage Ⅴ. Cholecystectomy was performed in 32 cases with a resection rate of 52%, 7 cases received radical resection, 10 extended radical resection and 15 palliative resection. The total surgical morbidity rate was 35.3%. Postoperative 1-, 3-, 5-year survival rate of radical and palliative resection were 61%, 31%, 11% and 27%, 13%, 0 respectively (P