Objective To explore the influence of cirrhotic portal hypertension and its complications on liver transplantation. Methods The literatures of the recent years on influence of hepatic cirrhotic portal hypertension on liver transplantation were reviewed. Results Splenomegaly, hypersplenism, portal vein thrombosis, portosystemic shunt and collateral flow in cirrhotic patients will increase the difficulty of liver transplantation and lead to more postoperative complications. Appropriate handling of these conditions can achieve a higher success rate of liver transplantation. Conclusion Correct management of end-stage cirrhotic portal hypertension and its complications can expand the indications of liver transplantation and improve long-term survival rates.

Objective To investigate indications of thoracoscopic resection of esophageal carcinomas. Methods A total of 75 patients with esophageal carcinomas underwent video-assisted thoracoscopic surgery (VATS) from July 1997 to July 2003. The dissection of the esophagus and radical resection of lymph nodes were performed using a right-sided VATS approach. Then the stomach was dissociated through an upper-abdominal incision and was pulled up for esophago-gastric anastomosis in the left neck. Results A conversion to open surgery was required in 3 patients, in 2 of whom the tumors had enroded into the hilum and the posterior wall of the heart, and in 1 of whom the azygous vein was ruptured. The operation time was 160~220 min, with the intrathoracic operation time accounting for 60~90 min. The postoperative blood loss was 300~400 ml. No surgery-related deaths were noted. Postoperative complications included 1 case of volvulus of stomach, 2 cases of anastomotic leakage, 1 case of anastomotic stenosis, and 1 case of chylothorax. Follow-up checkups in 60 patients for 3 months ~ 7 years (mean, 4 years) found 2 cases of supraclavicular lymph node metastasis and 1 case of abdominal lymph node metastasis. The 1-, 3- and 5-year survival rates were 85.0% (51/60), 51.7% (31/60) and 40.0% (24/60), respectively. Conclusions Video-assisted thoracoscopic resection of esophageal carcinomas is feasibly suited to patients with localized lesions at phaseⅠ or Ⅱ.

Objective To explore the effect of fatty liver on graft survival, especially with reference to macrovesicular and microvesicular steatosis and to evaluate the relationship between histological grading and inflammation activity. Methods Different degrees of rat fatty liver model were established by feeding rats a diet consisting of 79% standard diet, 20% lard and 1% cholesterol. By modified two cuff vascular anastomoses and end to end suture for bile duct, rat orthotopic liver transplantation was performed to evaluate the relationship between donor histological grading and survival rate. Results Low survival rate of macrosteatosis (grade Ⅲ) was found. Most rats died of liver failure in early days after transplantation. Pathological findings showed frequent hepatic necrosis. There was no significant difference between macrosteatosia(gradeⅠ) and the normal group. After transplantation, almost all of the fat was cleared by the end of the fourth week. Diminished steatosis and liver regeneration were found in macrosteatosis (gradeⅡ), while microsteatotic donors had higher survival rate than the other groups except the normal group. Conclusion Macrovesicular steatosis(grade Ⅲ) affects graft survival and these steatotic livers should not be used as donors. However, steatotic livers with mild macrovesicular steatosis (grade Ⅰ) and microvesicular steatosis(grade Ⅲ) do not influence recipient survival, so these livers can be used safely for liver transplantation. The ischemic damage should be considered when using livers of macrovesicular steatosis(gradeⅡ). Donors with numbering score more than 2.7 are correlated with the poor survival.

Objective To observe the survival time, pathological change and liver regeneration in different kinds of reduced size liver transplantation in steatotic rats. Methods Rat models of different kinds of reduced size orthotopic liver transplantation were performed by modified two cuff vascular anastomoses and end to end suture for bile duct to observe the recipient body weight, graft weight, recipient original liver weight, histological and pathological and electron microscopic findings in comparison with those of the whole rat liver transplantation. Results One week survival rate of the whole liver transplantation, 70% reduced size liver transplantation(ROLT), 60% ROLT and 50% ROLT group (grade Ⅰsteatotic donor) was 91.67%, 75%, 75% and 25%, respectively, and 2 week survival rate was 83.33%, 75%, 58.33% and 0, respectively. In grade Ⅱ steatotic donor, 1 week survival rate of the whole liver transplantation and 70% ROLT was 83.33% and 25%. As to donor livers with microvesicular steatosis, 1 week survival rate of the whole liver, 70% ROLT, 60%ROLT and 50% ROLT was 83.33%, 75%, 75% and 33.33% and the 2 week survival rate was 75%, 66.67% 66.67% and 0. The survival rates of 50% ROLT in grade Ⅰ steatotic donor and livers mainly with microvesicular steatosis were significantly different from those in other groups. The 1 week survival rate of 70% ROLT was very poor in steatotic donors in grade Ⅱ. Pathological findings after operation included liver regeneration and mild lymphocyte infiltration in portal space, the amelioration of the steatosis in some cases and dilation of the central vein and sinusoids. Conclusion To obtain long term survival of reduced size liver transplantation using steatotic donors, the GRBW should be over (2.28?0.12)(the ratio of graft to recipient liver weight over 60%). Steatotic livers in grade Ⅱ should not be used as donors in ROLT. The steatosis can be ameliorated after operation.

The mechanisms of rHu-EPO attenuating the apoptosis after myocardial infarction in rats were studied. Thirty-two rats were divided into three groups: sham operation group (Sham), acute myocardial infarction group (MI) and rHu-EPO-treated group (MI+ EPO). Acute myocardial infarction model was made by ligating the anterior descending coronary artery. rHu-EPO was administered i. p. in MI+EPO group at the dose of 5 000 IU/kg body weight immediately after the ligation. Each rat in MI+EPO group received the same dose of rHu-EPO daily the next 6 days. On the 14th day all rats underwent hemodynamic measurements and then killed. The samples were examined with HE stain, immunohistochemistry technique (bcl-2, bax) and TUNEL dyeing. The results showed that hemodynamic function in MI+ EPO group was much better than in MI group. The number of the cells positive for bax and TUNEL in MI+ EPO group was less than that in MI group. The number of the cells positive for bcl-2 in MI+ EPO group was more than that in MI group. These findings suggested that rHu-EPO could treat myocardial infarction by preventing apoptosis and attenuating post-infarction deterioration in hemodynamic function.

Objective To evaluate contrast-enhanced ultrasound (CEUS) for the diagnosis and follow-up of hepatocellular carcinoma ( HCC) patients after percutaneous radiofrequence ablation ( RFA). Methods The data of 46 HCC cases were reviewed in our study. Results of contrast enhanced computed tomography (CT) , ultrasound contrast agent sonography and grey ultrasound were compared with each other pre- and after percutaneous radiofrequence ablation. Results Contrast agent ultrasound imaging had the same value with CT in preoperative diagnosis of HCC, with postive likelihood ratio of 1.26 and 1.31, respectively,sensitivity of 97% and 91% and specificity of 23% and 31% respectively. For grey ultrasound the positive likelihood ratio was 0.99, sensitivity and specificity was 76% and 23% respectively. The sensitivity and specificity of contrast-enhanced ultrasound after percutaneous radiofrequence ablation was 60% and 90% respectively, and the postive likelihood ratio and negative likelihood ratio was 6. 18 and 0. 44 respectively. The difference was significant while compared with CT (P = 0. 012). All cases were followed-up from 1 to 9 months, and all were alive with recurrence found by contrast-enhanced ultrasound in 3 cases. Conclusions Contrast agent ultrasound imaging is sensitive and effective in the diagnosis of HCC and follow-up after percutaneous radiofrequence ablation.

Objective To investigate the value of bone mineral density and bone resorption markers around the mini-screw implant in the orthodontic treatment.Methods 178 orthodontic patients were prospectively collected.According to the organization condition around the mini-screw implant loaded,all patients were assigned into stable group (n =160) and loose group (n =18).The levels of interleukin-1 β (IL-1 β) and matrix metalloproteinase-9 of the liquid around the mini-screw implant were detected at 1,2 and 3 months after loading.Moreover,the bone miner al density around the mini-screw implant before and after loading were studied as well.Results Compared with the stable group,the loose groups at 1,2 and 3 months after loading got significantly higher levels of IL-1β [(35.48 ± 4.39)pg/mL vs.(29.48 ±3.92)pg/mL,t =3.348,P =0.004;(41.45 ±5.39)pg/mL vs.(26.29 ±4.12)pg/mL,t =6.493,P =0.000;(54.39 ± 12.82) pg/mL vs.(23.58 ± 3.62) pg/mL,t =11.589,P =0.000].Compared with the stable group,the loose group at 1,2 and 3 months after loading got significantly higher levels of MMP-9[(5.68 ± 3.54) ng/mL vs.(1.74 ± 0.88) ng/mL,t =8.496,P =0.000;(6.84 ± 2.82) ng/mL vs.(1.25 ± 0.62) ng/mL,t =9.835,P =0.000;(9.84 ± 4.39) ng/mL vs.(1.21 ± 0.58) ng/mL,t =12.548,P =0.000].Compared with the sta ble group,the loose group got significantly lower levels of bone mineral density of maxillary bones around the miniscrew implant before and at 3 months after loading[(620.48 ±67.82) HU vs.(694.39 ±84.58)HU,t =2.459,P =0.015;(597.39 ± 58.93) HU vs.(693.59 ± 83.29) HU,t =2.909,P =0.008].Conclusion The decrease of bone mineral density around the mini-screw implant is related to the loosening of the mini-screw implant,and IL-1 β and MMP-9 of the surrounding fluid can reflect the peripheral inflammation.

Objective To investigate the value of diffusion-weighted magnetic resonance imaging in the differential diagnosis of primary gallbladder cancer with liver invasion and primary hepatocellular carcinoma (HCC) with gallbladder invasion. Methods From January 2009 to October 2010, 11 patients with primary gallbladder cancer and 19 patients with primary HCC were admitted to the PLA General Hospital. The clinical data of the 30 patients were retrospectively analyzed. All patients underwent diffusion-weighted magnetic resonance imaging with b value of 800 s/mm2, and the receiver operating curve (ROC) was drawn. The apparent diffusion coefficient (ADC) values of the patients with gallbladder cancer and HCC were compared by independent sample t test. Results Thirty tumors were detected in the 30 patients. All tumors showed high signal on DWI, slightly low signal on T1 WI and slightly high signal on T2 WI. The foci of 11 patients with primary gallbladder cancer were at the gallbladder fossa, and 10 of them had liver involvement. The mean ADC value of the 11 patients was (0.89 ±0. 14)mm2/s. Of the 19 patients with primary HCC, the foci of 15 patients were at the right lobe of liver, and 4were at the left lobe. The mean ADC value of the 19 patients was (1.04 ±0.18)mm2/s. There was a significant difference in the ADC value between patients with primary gallbladder cancer and those with primary HCC ( t =2.425, P＜0. 05). The area under the ROC was 0. 756 (95% confidence interval: 0.577-0. 935), and the sensitivity and specificity were 68.4% and 81.8%, respectively, when the threshold value was 0.96 mm2/s.Conclusion The ADC value of patients with primary gallbladder cancer is lower than those with primary HCC when the b value is 800 s/mm2, which is helpful in the differential diagnosis of primary gallbladder cancer and primary HCC.

ObjectiveTo share the experience of arterial plasty and reconstruction of variant arteries in living donor liver transplantation. MethodsFrom September 2006 to May 2010, 73 living donor liver grafts (64 cases using the right lobe,9 cases using left lobe) were used in patients with end-stage liver disease. The hepatic arteries were evaluated preoperatively with computed tomography and magnetic resonance angiography. Back-table arterial plasty was performed under a microscope or a loupe according to arterial variation. We described technical points based on anatomic variations. There were 13 (17. 8 ％) liver grafts with anatomic hepatic arterial variations and all of these cases were subjected to back-table reconstruction with interrupted 8-0 or 9-0 nonabsorbable nylon monofilament sutures according to the diameter of artery. ResultsIn 3 cases, the associate right hepatic arteries that were arisen from superior esenteric arteris (SMA) were reconstructed to cystic arteries. In 2 cases with the associate right hepatic arteries arisen from the abdominal trunk, the right hepatic arteries and associate right hepatic arteries of donors were anastomosed with right hepatic arteries and left hepatic arteries in recipients respectively. In 2 donors, hepatic arteries had branches, which were reconstructed. All of the arterial plasty were conducted on a back table. No arterial thrombosis was found during a postoperative follow-up period of 6 months. ConclusionLive donor liver transplantation using the right lobe with hepatic artery variation can be performed safely, but there is a potential operative risk of severe complication after transplantation. Tominimize operative difficulties and complications, back-table reconstruction should be applied and proper treatment is given according to individual situations to ensure a safe and satisfactory outcome

Objective To explore the effect of reduced glutathione and venous systemic oxygen perfusion on apoptosis and ultrastructure of hepatocytes in rat steatotic liver grafts. Methods Before liver transplantation grade Ⅱ steatotic liver model was established by a diet consisting of 79% standard diet,20% lard and 1% cholesterol for 6 weeks. In pretreatment group, the donor received intraperitoneal injection of reduced glutathione at a dosage of 500 mg/kg/body weight 3 times a day for 2 days, and intrahepatic venous oxygen perfusion for 6 hours while kept in cold preservation. Results Preconditioning measures in steatotic liver grafts significantly decreased the hepatocytes necrosis (38?10)% vs (17?6)%, P