Objective　To determine the changes of serum IL-10 level in perioperative period in patients with hepatocellular carcinoma (HCC) and discuss its significance. Methods　The serum IL-10 level was determined with ELISA in 30 patients with HCC and 30 healthy volunteers. Results　The serum IL-10 level was significantly higher in the perioperative period in patients with HCC than in the healthy volunteers. In the patients with HCC, the level was higher before than after the operation. Meanwhile, it was markedly higher in patients with poorly differentiated tumor or the tumor with a diameter over 5 cm than in those with well-differentiated tumor or the tumor with a diameter less than 5 cm (P<0.01). Conclusion　HCC cells might produce IL-10 that may participate in immune response of HCC. Furthermore, IL-10 might be a factor that can reflect the differentiation grade, assess the prognosis and predict recurrence of HCC.

Objective To sum up the clinical experience of liver retransplantation (ReTx).Methods All recipients were male. The average age was 50 years old (43-55). The indications included primary nonfunction (PNF) (1 case), acute rejection (1 case), chronic rejection and biliary infection (1 cases) and ischemic type billiary lesion and biliary infection (2 cases). The blood types of recipients and donors were identical. All donors were heart arrest. The immunosuppressive protocols included Zenapax and methylpredinisone (MP) and FK506. MMF was added if necessary.Results Three patients were cured. Two patients died at 8th and 10th day. One died of serious infection and failure of multiple organs and another died of heart failure. Complications included multiple organ infection (1 case) and biliary infection (1 case) and wound infection (1 case).Conclusion Liver retransplantation is an effective treatment for graft failure after liver transplantation. Proper indication and optimum operation time, intensive perioperative supervision and proper treatment were very important for improved effect of liver retransplantation.

Objective To describe depression in liver transplant(LT)recipients and explore their coping styles.Methods One hundred transplant recipients were divided into three groups according to the time after LT:one to six months after the operation(group1),six months to one year(group2)and one to three years after the operation(group3).A self-rating depression scale(SDS)was used to measure their depression levels,and a Medical Coping Modes questionnaire(MCMQ)Was used to investigate their coping styles.The results were compared with those from a general population,and the relevance of depression symptoms and coping styles was analysed. Results The average SDS score of all the LT recipients was 41.03±7.14(42.90±7.18 for group 1.40.71±7.97 for group 2 and 39.69±6.00 for group 3).The average depression scores of the three groups were all significantly higher than in the normal population,but there was no statistically significant difference among the three groups.The depression scores were negatively correlated with the confrontation aspect of coping style,while positively correlated with avoidance and resignation.Conclusion LT recipients tend to be depressed,and the level of depression is strongly related with their coping styles.

Objective To investigate immune status changes in liver transplant patients suffering from early developed sepsis.Methods In this study 19 patients undergoing liver transplantation for severe hepatitis from Oct 2008 to Jul 2009 were enrolled.Immune status was compared between patients of severe hepatitis and 20 healthy volunteers.According to whether early sepsis developed or not,patients were divided into sepsis group (HSS) and non-sepsis group (HSNS).T lymphocyte subgroups of the peripheral blood were compared between post-transplant and pre-transplant in these two groups on different stages.Results Comparing to volunteers,T％ and IFN-γ/IL-4 of severe hepatitis patients significantly decreased,CD4 + CD25 + Foxp3 + Treg( ％ ),Foxp3 mRNA and IL-10 significantly increased.Early sepsis developed in 9 patients.Compared with pre-transplant levels,T％ in both groups significantly decreased on the first day post transplant.T％ in HSNS group increased to the level of pretransplant while T％ of HSS group remained at the low level.Treg％ ( t =3.265,P =0.004 ) and Foxp3 mRNA ( t =2.750,P =0.013 ) of HSNS group on day 14 decreased significantly lower than that before transplantation.Those two parameters of HSS group even increased slightly.IFN-γ/IL-4 in HSNS group increased significantly on day 3 (t =2.261,P =0.036),while there was no change in HSS group.The concentration of IL-10 in both groups significantly decreased,and the level in HSNS group remained at a low level,while that in HSS group increased on day 14.Conclusions Patients with severe hepatitis have weakened immune status.The imbalance of immune status recovers gradually since 7-14 days after transplantation in patients uncomplicated with sepsis.However,the immune status of receipients complicated with sepsis fails to improve.

Objective To investigate in vitro anti-hydatid efficacy on Echinococcus granulosus protoscolex(EgPSC) by using albendazole sulfoxide(ASOX) and its two enantiomeric antipodes, L-ASOX and D-ASOX.Methods Eg protoscoleces were divided into eight groups and cultured in the DMEM culture media under two concentrations(50 ?g/ml and 100 ?g/ml) of ASOX, L-ASOX and D-ASOX respectively.The appropriate controls included(i) a culture containing an equal amount of DMSO and(ii) a culture medium alone.The mortality of EgPSC in each group was daily counted until 100% EgPSC death in some groups.Results Significant difference of EgPSC mortality was found among the three drugs with various concentrations compared to control group(P0.05), but between ASOX group and L-ASOX group(P

AIM: To investigate the effect of ischemic preconditioning(IPC) on expression of nitric oxide synthase(NOS) in rat smallfor-size liver graft and its significance.METHODS: Sixty SD rats were randomly divided into 3 groups(n=10 pairs/group): nonwarm ischemia group(NWI);warm ischemic group(WI);and ischemic preconditioning group(IPC).The models of rat small-for-size liver transplantation were set up by two-cuff technique.Expression of eNOS mRNA and iNOS mRNA in hepatic tissue were detected by fluorescence-quantitating-PCR.RESULTS: Heptic expression of eNOS mRNA post-IPC was higher than that pre-IPC(P0.05).It was higher in IPC group than that in NWI and WI group(P

ObjectiveTo investigate the choice of graft,and transfusion and immunosuppressant regimen of a RhD negative recipient in liver transplantation.MethodsOne RhD negative patient with hepatocellular carcinoma who received a liver graft from a RhD positive donor was retrospectively studied,and related references were reviewed.During the operation,the patient received five units of RhD negative/O RBC,3000 ml positive/O plasma and 30 units cryoprecipitate.Tacrolimus and prednisone were used to prevent rejection,and prednisone was withdrawn 30d post transplant.Results The patient's liver function recovered smoothly,without any acute rejection or hemolytic reaction.Anti-D antibody was not detected.The patient suffered from cancer recurrence 9 months and died of brain metastasis 13 months after transplantation.ConclusionsA RhD negative recipient can receive a graft from a RhD positive donor in liver transplantation.The selection of RBC and platelet from RhD negative or positive donors should be based on the result of anti-D antibody test.Plasma and cryoprecipitate can be transfused regardless of Rh type.Enhanced immunosuppressant regimen was unnecessary for these patients.

ObjectiveTo establish a prognostic score model based on preoperative neutrophillymphocyte ratio (NLR) to predict recurrence of hepatocellular carcinoma (HCC) following liver transplantation.MethodsThe clinical data of 76 HCC patients undergoing liver transplantation were retrospectively analyzed.An NLR≥2.5 was considered to be elevated.A preoperative recurrence score was established by using three preoperative factors which significantly increased the risk of tumour recurrence after liver transplantation on multivariate analysis,namely,vascular invasion,tumour number＞3,and NLR≥2.5.We then evaluated the scoring system in predicting tumour recurrence of HCC after liver transplantation.ResultsArea under the receiver operating characteristic curve of preoperative recurrence score was 0.758,with scores of 2 and 3 having hazard ratios of 10.038 and 59.773,respectively.All ten patients with a score of 3 developed tumour recurrence in less than 6 months.The 1-,3- and 5-year tumour-free survival rates for patients with a score of 0,1 and 2 were 95.0％,78.4％,and 78.4％ vs.76.9％,66.9％,and 63.2％ vs.51.9％,8.7％,and 8.7％,respectively.Of 55 patients who had no gross vascular invasion,5 patients with both tumour number＞3 and NLR≥2.5 developed recurrence in less than 31 months.ConclusionsPatients with both preoperative NLR≥2.5 and tumour number more than 3 were at a high risk of tumour recurrence after liver transplantation for HCC.The preoperative recurrence score model strongly correlated with tumour recurrence,and may aid in the selection of patients with HCC for liver transplantation.

ObjectiveTo study the role of micafungin in the treatment of invasive fungal infection after liver transplantation.MethodsWe retrospectively studied the clinical data of 32 patients who developed invasive fungal infection after liver transplantation treated in our center between December 2008 and June 2010.The therapeutic effect,adverse effect,and the blood concentration/dose ratio of tacrolimus (tacrolimus concentration per dose.kg-1) before and after micafungin treatment were analysed.ResultsThe curative rate was 93.7％.There were no obvious toxicity and sideeffect.The blood concentration/dose ratio in the triazoles treatment group [(1031± 634.2) ng·ml-1/mg · kg-1] was markably higher than the micafungin treatment group [(172.6±39.45) ng·ml-1/mg · kg-1] and the control group (ceasing antifungal agents) [(183.8±47.08) ng· ml-1/mg · kg-1] (P＜0.05).However,there was no significant difference in the blood concentration/dose ratio between the micafungin treatment group and the control group (P＞0.05).ConclusionsMicafungin did not significantly affect the blood concentration/dose ratio of tacrolimus,and effectively treated invasive fungal infection in patients after liver transplantation.

To demonstrate the possibility of radiotherapy for echinococcosis of rats and to explore its mechanism of action, the effects of different doses of 6 MV X-ray radiotherapy on the activity of Echinococcus granulosus in rats were investigated. After being irradiated by 10, 20, 30 and 40Gy of 6 MV X-ray, a lot of examinations were carried out, such as examination of the ultrastructure of the Echinococcus granulosus cysts in rat with electron microscope, the total amount of proteins and Ca2+ ion in hydatid cyst fluid(HCF) .The potassium-pyroantimonate(PPA) cytochemical method was used to demonstrate whether the blocked calcium channels would be one reason for radiotherapy on Echinococcus granulosus cysts in rat. It was found that the ultrastructures of E.granulosus cysts showed different extents of alterations or damages with abnormal changes and destruction in tissues or cells of cysts. The total protein amount in HCF was increased, while Ca2+ ions in HCF were reduced obviously in the treated groups of rats , especially in high dose groups. With PPA, some electron-dense precipitates were observed on the mitochondria and endocytoplasmic reticulum in the treated groups. It is evident that the structure of cysts of Echinococcus granulosus in rat can be damaged by radiotherapy with certain extent of the quantity-efficiency relationship.