Gastroesophageal varices hemorrhage is a common complication of portal hypertension. Drug and endoscopic therapy have become the basic treatments for varices. Transjugular intrahepatic portal venous shunt is recommended for the management of refractory or recurrent variceal hemorrhage. Liver transplantation will be considered when variceal hemorrhage becomes fatal and traditional therapies are with high risk, contraindicated, or have unsatisfactory results. Patients who received traditional treatments can achieve short-term efficacy and even stabilize the disease for a long time. However, if these treatments lead to complications such as portal vein thrombosis and hepatorenal syndrome, it may increase the risk of liver transplantation complications and affect the patient’s prognosis. Elevated portal venous pressure has a variety of adverse effects on systemic circulation, which can cause hepatopulmonary syndrome, portal pulmonary hypertension, refractory ascites, etc. In these cases, liver transplantation should be performed as early as possible. Conventional treatments are unsatisfactory. In addition, frailty may be worsened after traditional treatment, which will significantly increase the risk of liver transplantation. With the increase of model for end-stage liver disease, the requirement for donor liver volume will also has been increased, which will also affect the implementation of living donor liver transplantation. Some patients with portal hypertension may have poor quality of life and it may also become a clinical indication for liver transplantation. These liver transplant-related issues should be evaluated when administering traditional therapies. Traditional therapies aimed at improving the patient's condition, delaying or controlling complications should not interfere with the consequent implementation of liver transplantation. Improving the long-term overall survival rate and quality of life of patients with portal hypertension is the ultimate standard of all treatments.

OBJECTIVE: To study the constituents of the subaerial of Saussuare deltoidea (DC.)C. B. Clarke. METHODS: The constituents were separated by column chromatography on silica gel and the structures were elucidated by spectroscopic means. RESULTS: Eight constituents were identified to be Luteolin(Ⅰ), Quercetin(Ⅱ), Quercetin 3 0 ? L rhamnopyranoside(Ⅲ), rutin(Ⅳ), Lupeol acetate(Ⅴ), Lupeol(Ⅵ), ? sitosterol (Ⅶ), and Daucosterol(Ⅷ).CONCLUSION: Compounds Ⅰ Ⅷ were obtained from S.deltoidea for the first time.

0.05). Conclusion Combined inplantation of different types of DES is safe and does not increase the incidence of MACE.

BACKGROUND: Results from clinical trials suggested that clopidogrel and ticlopidine had side effects of granulopenia, and aspirin could inhibit endothelial progenitor cell proliferation. There is no report of effects of these drugs on human bone marrow mesenchymal stem cells (hBMSCs) in stem cell transplantation. OBJECTIVE: To investigate the effects of antiplatelet drugs including clopidogrel, ticlopidine and aspirin on hBMSC proliferation and secretion. DESIGN, TIME AND SETTING: The cytology in vitro observation was performed at the Laboratory of Toxicology, Shanghai Municipal Center for Disease Control and Prevention from March to December 2006.MATERIALS: The second passage of hBMSCs was kindly donated from Shanghai Tissue Engineering Research & Development Center, Shanghai Ninth People's Hospital. Clopidogrel (Lot number J20040006) and ticlopidine (Lot number H19980186) were obtained from Hangzhou Sanofi-Synthelabo Minsheng Pharmaceutical CO., Ltd. Aspirin (Lot number 20050059) was obtained from Bayer Vital GmbH. METHODS: The standard culture medium consisted of DMEM-LG, 10% heat-inactivated FBS, 100 U/mL penicillin and 100 μg/mL streptomycin. After being cultured in vitro expanded out to passage 6, hBMSCs were treated with antiplatelet drugs of different concentrations and compared with control group. MAIN OUTCOME MEASURES: Cell proliferation was assessed by 3- (4, 5-dimethylthiazol -2-yl)-2,5-diphenyltetrazolium bromide (MTT) colorimetric assay, level of vascular endothelial growth factor (VEGF) of culture medium was detected by enzyme-linked immunoadsordent assay (ELISA), and surface antigens of hBMSCs were analyzed by the flow cytometry. RESULTS: A570 values of hBMSCs treated by clopidogrel or ticlopidine of 0.02,0.1,0.4,2,10,40 μmol/L were higher than control group (P < 0.01), while A570 values of aspirin group of 60, 600, 2 000 μmol/L were lower than control group(P < 0.05). Antiplatelet drugs had no obvious effect on cell surface antigens(CD34, CD105, CD106)expressed by hBMSCs. Treated by high dose clopidogrel or ticlopidine (40 μmol/L), VEGF level from hMSCs was lower than that of control group(P < 0.01), but VEGF level of low dose (0.02 μmol/L) ticlopidine group was higher than control group(P < 0.01), and there was no significantly difference of VEGF level among low dose clopidogrel group (0.02 μmol/L), aspirin group (5, 2 000 μmol/L), and control group(P > 0.05). CONCLUSION: Clopidogrel and ticlopidine improve proliferation of hBMSCs, but aspirin inhibits proliferation of hBMSCs. High dose of clopidogrel and ticlopidine suppress VEGF secretion of hBMSCs, while low dose of ticlopidine promote it. Antiplatelet drugs have no obvious effect on hBMSCs differentiation.

Purpose　The aim is to obtain the cDNA sequence of encoding extramembrane human FL gene with high level expression in E.coli. Methods　The primers were designed based on the known FL cDNA sequence. The total RNA was isolated from fetal liver cells , and then RT-PCR was performed. The fragment was cloned into pUC-18T vector, and further sequenced by automatic sequence analyzer. The gene was inserted into GST fusion expression vector between BamH Ⅰ and EcoR Ⅰ sites. The recombinant plasmid was transformed into E.coli strain DH5 α and induced with 1mmol/L IPTG.Results　The 546bp DNA fragment was amplified by RT-PCR method from fetal liver cells and its sequence was identical to the published sequence encoding human FL. The expressed fusion protein, with molecular weight of about 22kD, was about 10% of the total bacteria protein by SDS-PAGE and densitometry analysis.Conclusion　cDNA was cloned successfully. This study provided a basis for the further fundamental research and clinical application of FL.

Objective To explore the efficacy of liver retransplantation for hepatocellular carcinoma (HCC) patients with or without HCC recurrence.Method 131 cases of retransplantation performed between 2003 and 2012 were analyzed retrospectively.Their first and second liver transplantations were both performed in our hospital.Diagnoses of their primary diseases before transplantations were confirmed pathologically after the first transplantation.Patients were divided into two groups in terms of benign causes and HCC.Results Sixty cases were fallen into benign disease group and 65 cases into HCC group.The proportions of main causes of retransplantation were similar between two groups.The graft survival rate of early retransplantation (retransplantation performed within 30 days after the first transplantation) and late retransplantation (retransplantation performed beyond 30 days after the first transplantation) was calculated and compared respectively due a great difference in survival rate between the two phrases.The deaths of HCC patients with HCC recurrence before retransplantation were more than those without HCC recurrence (P＜0.01) and benign disease group.The 5-year cumulated survival rate was close between HCC patients without recurrence before retransplantation (51.0％) and benign disease group (51.8％).Conclusion The retransplantation after HCC recurrence has an unacceptable prognosis.The survival rate was similar between patients without HCC recurrence and patients with benign diseases.HCC patients without recurrence should not be restrained from retransplantation just for the HCC history.

Objective To evaluate the effect of carbon fiber couch on dose distribution of radiotherapy planning and verification pass rate.Methods Establishing the carbon fiber treatment couch model in Pinnacle8.0m Treatment Planning system (TPS),and then this model was used to correct dose calculations of oblique fields in the treatment plans of 10 cases of nasopharyngeal carcinoma,10 cases of breast cancer and 10 cases of lung cancer and evaluate the effect of carbon fiber couch on the whole dose distribution of the plans.Then these plans were measured by three-dimensional dose verification equipment Delta4 to confirm the improvement extent of Gamma pass rate after considering the carbon fiber treatment couch.Results For the majority of plans,when the carbon fiber couch was taken into consideration,the target doses was significantly reduced (4772 cGy-7266 cGy vs.4859 cGy-7347 cGy,P=0.000-0.002) and the relative deviation of D95 was 1％ to 3％.Measurement results of Delta4 showed that Gamma pass rate (3 mm/3％ criteria) increased in all plans (96.4％-98.8％ vs.93.4％-97.3％,P =0.000),some of that were up to 5 percentage when the couch model was applied.Conclusions Target doses will be overestimated if the treatment couch is ignored in TPS measurement.,However it should arouse enough attention when the disease with smaller doses corresponding gradient.

Objective To investigate the development status of tumor radiotherapy in Guangxi Zhuang autonomous region in order to provide reference for the decision-making of the competent administrative departments for public health.Methods A questionnaire survey was conducted by the aid of on-site inspection and telephone or Email investigation among the medical institutions in Guangxi to know the current status of radiotherapy units and settings,human resources,allocation of radiotherapy facilities,and standardization of medical practices.Results Up to the end of August 2014,radiotherapy was carried out in 39 hospitals,with other 5 hospitals under preparation for construction.Among these 40 hospitals were three-dimensional conformal radiotherapy in 38,intensity modulated radiation therapy (IMRT) in 23,and image guided radiation therapy (IGRT) in 5.There were 48 linear accelerators,15 afterloading therapy apparatus,and 4 γ-knife or X-knife in Guangxi.There were 647 professional personnel (except nurses),including 322 radiation oncologists,100 radiotherapy physicists,213 radiotherapy technologists and 12 professional engineers.There were 2 000 to 2 500 hospital beds and 20 000 cancer patients had received radiotherapy in 2013.1 600 to 2 000 people received treatment on average every day.Conclusions The present radiotherapy resources in Guangxi are insufficient and the input to radiotherapy equipment is deficient,with low proportion of cancer patients treated with radiotherapy.Because of the uneven radiotherapy quality among different hospitals,the reasonable planned development and unified diagnostic and treatment practices are required to improve radiotherapy level in Guangxi.For shortage of medical staff and high-quality physical and technical personnel,the improvements are needed by fostering and introduction of personnel.Compared with developed regions in China,the introduction of new technology is largely needed.

Objective To investigate the characteristics of liver function recovery in steatotic liver graft transplantations.Method From August 1st 2013 to July 20th 2014,a prospective clinical cohort study of liver transplantations was performed in Tianjin First Central Hospital.Multiple linear regression analyses were made for related factors with the degree of donor liver steatosis and the average total bilirubin (TBil) levels on the post-operative day 6 to 8,week 4,and month 3 and 6,respectively.Result Of 82 cases used for analysis,there were 28 cases of mild steatotic grafts and 54 cases of non steatotic grafts.The multiple linear regression analysis revealed the average TBil level on the post-operative day 6 to 8 was the only one index related with the degree of graft steatosis.By the same means,recipient age,the aspartate aminotransferase (AST) level on the post-operative day 1,the average AST level on the post-operative day 2 to 3,and the degree of graft steatosis were associated with the average TBil level on the post-operative day 6 to 8.The AST level on the postoperative day 1,the average AST level on the post-operative day 2 to 3,and the degree of graft steatosis were associated with the average TBil level on the post-operative week 4.But only the AST level on the post-operative day 1 and the average AST level on the post-operative day 2 to 3 were associated with the average TBil level on the 3th and the 6th month post-operation.Conclusion Mild steatotic liver graft can result in increased TBIL level within perioperative period,but the graft function is not affected by it.The average AST level on the post-operative day 2 to 3 can effectively predict the prognosis of the graft.Objective Methods Results Conclusion

Objective To investigate the prognosis of liver retransplantation in patients with transplanted liver function failure caused by viral hepatitis recurrence.Methods From January 20th 2003 to November 20th 2012,the clinical data of 215 patients with liver retransplantation were retrospectively analyzed.The survival of transplanted liver of 18 cases with liver retransplantation because of hepatitis recurrence (eight cases of hepatitis C and 10 cases of hepatitis B) was compared with that of 115 cases with liver retransplantation for biliary complications.The dysfunction of transplanted liver after first transplantation and the survival after second liver retransplantation of patients with hepatitis C recurrence were compared with those of patients with hepatitis B recurrence.The prognosis analysis was compared by survival curves made by Kaplan-Meier method.Results Biliary complications were the most common reason in 215 patients with second liver retransplantation and which accounted for 115 cases (53.5 ％).Eighteen cases were hepatitis recurrence (8.4 ％).There was no significant difference in survival rate of the second transplanted liver between patients with hepatitis recurrence and biliary complication (P =0.543).The dysfunction of transplanted liver occurred at early stage (in three months) after first liver transplantation in part of patients with hepatitis C recurrence.The dysfunction of transplanted liver almost all occurred two years after first liver transplantation in patients with hepatitis B recurrence.Among eight patients with hepatitis C recurrence,the second transplanted liver of five cases survived more than one year.All the second transplanted liver of 10 patients with hepatitis B recurrence survived more than one year.There was no significant difference between them (P =0.060).Conclusions The prognosis of liver retransplantation in patients with hepatitis recurrence is similar with that of patients with biliary complications.The prognosis of liver retransplantation in patients with hepatitis B recurrence is good.