Objective: To study the surgical strategy of portal vein organized thrombosis ( PVOT ) during liver transplantation ( LT ) . Methods: The clinical data of 41 patients with PVOT performed LT from January 2005 to June 2006 ( 359 cases ) in our institute was retrospectively analyzed . The reconstruction of portal vein ( PV ) were removing thrombosis in 22 cases , throm- boendovenectomy in 10 cases , PV to splanchnic varicose vein in 8 cases , cavoportal hemitranspo- sition in 1 case . Results: 1 case died of multiple organ failure , 1 case died of hepatic artery bleeding . Retransplantation and portosystemic shunt vein ligation were performed in 1 case 14 days after LT because of its insufficient PV flow 2 cases were found anastomotic stenosis and they were cured by balloon angioplasty and stent placement via hepatic vein . Other patients were followed up 6 to 20 months , all of them had normal PV flow . Conclusion: Thromboen- dovenectomy or removing thrombosis is applicable to manage PVOT during LT .

Aging changes in acetylcholinesterase positive (AChE-P) neurons of the globus pallidus were investigated histochemically and morphometrically in young (3 months old) and old (24 months old) Spragur-Dawley male rats. The number of the positive neurons in the old group is decreased by 11.8％ in comparison with the young group. The total process length of the AChE-P neurons in the young rat is approximately 1.4 times as that in the old rat. The length of about 8.6％ of the positive neurons in the old group, however, exceeds the average length of AChE-P cellls in the young group (232.1 ?m). In the old rat, the gray value of AChE-P neurons of the globus pallidus is notably higher than that in the young rat, but the value of nearly 6.8％ of the positive cells in 24-month-old rat is inferior to the average value in 3-month-old rat (117.8). The transverse dimensions of AChE-P cell bodies in the old group are increased by 9.2％ as compared to those in the young group. Morphological observations show that most of AChE-P neurons in the old rat globus pallidus represent a typical degenerative alterations, while a substantial number of the positive neurons in the old animal are characterized by enlarged bodies, strong histochemical reaction as well as dense processes and their branches. The above findings indicate that, in the old rat, a decline of AChE histochemical reactivity and the morphological degeneraton of AChE-P neurons with the advanced age do not occur synchronously in all the AChE-P neurons of the globus pallidus. Therefore, it is suggested that there probably exist a compensative mechanism in senescence of the globus pallidus.

Objective:To investigate the renal injury of portal hypertensive rat after one hour of occlusion of portal vein and inferior vena cava.Methods:Healthy male Wistar rats were taken randomly as normal control、portal hypertensive control and trial group.The recoverable portal hypertensive model was induced firstly.Three weeks later ,15 model rats were taken randomly as portal hypertensive control group,others had another operation and were divided randomly into 0,6h,12h,24h,48h,72h,7d group according to different reperfusion time after 1 hour of occlusion of portal vein and inferior vena cava.At the corresponding time points after reperfusion,the examinations below were done:serum ALT,TBIL,BUN,Cr concentrations;mor-phological changes of liver and kidney,the ultrastructure of renal tissue.Results:Serum and Cr in trail group reached their peak value 12~24 hours after reperfusion,then decreased gradually,and returned to normal 72 hours after reperfusion.The main injury of kidney was located in proximal tubular epithelial cell ,it peaked at 12 hours and 24 hours after reperfusion,the sporadic karyopyknosis and karyorrhexis could be seen,but the basement membrane preserved well.48 hours later,the restoration could be seen.7 days later it restored obviously.Conclusion:There are obvious injury in tubular epithelial cell in the portal hypertensive rat after 1 hour of occlusion of portal vein and inferior vena cava.But the injury of kidney is reversible.

Objective To investigate the relationship between renal vascular resistance index( RI) and serum Apelin level in type 2 diabetic mellitus ( T2DM )?Methods Seventeen cases newly diagnosed T2DM patients with RI increased but without microalbuminuraia in Minhang Hospital Affiliated to Fudan University from December 2011 to December 2014 were selected as observation group,17 newly diagnosed T2DM patients with RI normal during the same period were selected as control group?Fasting plasma glucose(FPG),glycosylated hemoglobin A1C(HbAlC),blood lipids and fasting insulin(FINS),hepatic functional and renal function were tested in all the subjects?Serum Apelin level was detected by enzyme?linked immunosorbent assay?Results Compared with control group,serum Apelin level was significantly higher in observation group((179?2±122?4)μg/L vs?(56?7±50?6) μg/L,t=3?814,P<0?05)?Partial correlation analysis showed that the RI was positive correlated with Apelin ( r= 0?364, P= 0?040 )?Conclusion The serum Apelin levels elevated in newly diagnosed T2DM patients with RI increased, and RI is positively correlated with Apelin, which indicate that Apelin play an important role in the pathophysiology of early renal damage in patients with TsDM.

Objective To analyse our clinical experience in pediatric living donor liver transplantation (PLDLT).Methods The clinical data of 45 patients who underwent PLDLT in our hospital from April 2005 to April 2014 were retrospectively studied and their preoperative,intraoperative and postoperative data were analyzed.Results All donors recovered well.The graft to recipient weight ratio (GRWR) ranged from 1.0％ ～ 6.4％ (2.5％ ± 1.2％).Size reduction of graft were performed in 2 patients.An interposition venous conduit from the confluence of the native right and left portal vein (PV) to the graft PV was carried out in 1 patient,venous grafts for revascularization of the tributaries of the middle hepatic vein from segment Ⅴ and Ⅷ were used in 3 patients,and a venous patch for revascularization of the left hepatic vein was used in 2 patients.Hepatic artery re-reconstruction was performed in 3 patients after hypoperfusion was detected on intraoperative Doppler ultrasound.The postoperative complications included acute rejection (n =2),vascular complications (n =7),biliary complications (n =11),and infectious complications (n =27).The 1-,2-and 5-year survival rates were all 84.4％.Seven of 45 recipients died within one year post transplantation,with 3 patients who died of vascular complications,and 4 patients who died of infection.The differences in age [(50.8 ± 49.8) months vs (12.6 ± 14.9) months],body weight [(16.2 ± 10.5) kg vs (7.3 ± 1.7) kg],serum total bilirubin [(177.0 ± 126.5) μmol/L vs (301.9 ± 110.6)μmol/L],Pediatric end-stage liver disease (PELD) score (16.1 ± 12.1 vs 26.2 ± 11.3) and GRWR (2.2％ ± 0.8％ vs 4.2％ ± 1.6％) between the survival and the dead groups were significant (P ＜ 0.05).Conclusions PLDLT is an effective method to treat children with end-stage liver disease.Using a multidisciplinary approach in the preoperative management,excellent surgical techniques,and proper postoperative management are extremely helpful to improve postoperative survival rate.

Objective To investigate the characteristics of infection and risk factors after pediatric living donor liver transplantation (PLDLT).Method Form April 2005 to April 2014 the clinical data of 45 cases of PLDLT in General Hospital of Chinese People's Armed Police Forces were retrospectively investigated,and the difference between the patients after PLDLT with infection and those without infection was analyzed.Result Eighty-four infections occurred in 27 (60.0％) of 45 patients,including 25 cases of bacterial infections,14 cases of viral infections,and 3 cases of candida albicans infections.Most infections occurring within 3 months after PLDLT have been found to be caused by bacteria,viruses and fungi.The trough level of tacrolimus (Tac) was in target therapeutic window in 16/20 infected patients and more than 10 ng/mL in 4/20 infected patients within 3 months after PLDLT,and there were 12/16 infected patients with the trough level of Tac of more than 10 ng/mL 3 months post-PLDLT,with the difference being significant (P＜0.05).Multivariate analysis revealed that post-transplant infection was significantly related with the factors as weight＜10 kg,age ＜12 months,biliary intestinal anastomosis,pediatric end-stage liver disease (PELD) score,ChildPugh score,total bilirubin,blood loss per kg body weight and graft to recipient weight ratio (GRWR).Logistic regression analysis suggested that PELD score was independent risk factor of infection after PLDLT.Conclusion The infection after PLDLT has their special characteristics.The proper irnmunosuppressive protocol and control of above risk factors are helpful to decrease the incidence of infection after PLDLT.

Objective To investigate the safety and efficacy of radiofrequency ablation (RFA) combined with extracting blood from hemangiomas guided with CEUS for treating hepatic cavernous hemangiomas (HCH).Methods Data of 55 patients with 77 lesions of HCH underwent CEUS guided RFA combined with extracting blood from hemangiomas during January 2010 to December 2016 were retrospectively analyzed.Conventional ultrasound and CEUS were performed before therapy,in order to obtain the size and blood supply information of lesions,also performed immediately after treatment and 3 months later to calculate the volume of hemangiomas and the rate of hemangiomas after the treatment,as well as the rate of non-blood supply 3 months after the treatment.Then statistical analysis was done.Results The mean operation time was (31.53±15.89)min,and the blood extracting from hemangiomas was (135.36± 68.13)ml.There was positive correlation between the volume of hemangiomas before treatment and the blood extracting from hemangiomas (r=0.722,P＜0.05).No serious complication occurred among 55 cases,while mild complications happened in 9 cases (9/55,16.36 ％).The volume of hemangiomas decreased immediately and 3 months after treatment (both P＜0.05),and the rate of hemangiomas reducing was (48.76±32.58) ％ and (22.37±35.73) ％,respectively.The rate of non-blood supply 3 months after treatment was 96.10％ (74/77).Conclusion CEUS-guided RFA combined with extracting blood from hemangiomas is an effective and safe method,which has potential to become a first-line therapy.

Objective TostudythevalueofordinarycolorDopplerflowimaging(CDFI)inthe diagnosis of hepatic artery thrombosis (HAT)in early stage after pediatric liver transplantation (PLT).Methods Clinicaldataof55childrenundergoingPLTintheGeneralHospitalofChinesePeople'sArmed Police Forces from April 2005 to May 2014 were analyzed retrospectively. Conventional hemodynamic monitoring was performed in all cases in the early stage after operation by CDFI. No intrahepatic arterial blood flow signal was observed by CDFI multi-angle examination and HAT was suspected. Computed tomography angiography (CTA)and surgical exploration were performed in the suspected HAT patients. The sensitivity and specificityofordinaryCDFIindiagnosingHATwerecalculatedbyChissstatisticalsoftware.Results Among the 55 PLT recipients,3 cases were suspected as HAT by CDFI,including 2 cases of HAT in the main hepatic artery,1 cases of HAT in the right hepatic artery. All cases were confirmed by CTA or surgical exploration.The incidence of HAT was 5% (3/55 ). The sensitivity and the specificity of CDFI in diagnosing HAT after PLTwereboth1.0,andfalsepositiveratewas0.Conclusions OrdinaryCDFIisthepreferredandmain method for hemodynamic examination after PLT. The experienced sonographer for transplantation can improve the accuracy in diagnosing HAT.