Donation after cardiac death (DCD) means organ harvest and donation cannot be carried on until the requirement of death criteria using cardiopulmonary arrest is reached.Great success has been achieved since DCD was promoted widely in China.However,some problems were encountered during the implementation of DCD and there also exists many ethical controversies.The ethical principles of informed consent and no harm mentioned inDonation after Cardiac Death Work Instructions of China should be strictly adhered to,while justice,fairness and openness must be ensured in organ allocation.Appropriate compensation should be given to DCD donor and his family,and the utilization of DCD should be further improved.All of these ethical principles will help to promote the healthy development of organ donation and transplantation in China.

Gastroesophageal variceal bleeding is one of the major causes of death for patients with portal hypertension.The treatment of portal hypertension has evolved from surgery being the only option to the wide range of options currently available,including endoscopic sclerotherapy of varietals ligation,interventional radiology and surgery.Given the shortage of liver transplantation donors,devascularization would be one of the major treatments for portal hypertension for a considerable time.Based on the clinical experience of the People's Hospital of Peking University,we think that peraesophagogastric devascularization without splenectomy is a better option for the treatment of portal hypertension,with less operation time,less intraoperative blood loss and fewer postoperative complications,and better short-and long-term hemostatic effect.

Pancreatic neuroendocrine tumor (pNET)is a rare type of pancreatic tumors.The incidence of pNET shows a gradually increas-ing trend in recent years.The most common organ of distant metastases is the liver.Surgical resection is still the optimal treatment for resect-able,well -differentiated liver metastases with no evidence of extrahepatic spread.For unresectable patients,a combination of multiple mo-dalities,such as transarterial chemoembolization,radiofrequency ablation,systemic chemotherapy,and molecular targeted therapy,can pro-long the survival time of patients.Liver transplantation should be strictly evaluated on an individual basis.

Liver transplantation is the only curative treatment for cirrhotic portal hypertension, especially for the patients with end-stage liver failure. In the era of liver transplantation, when drugs, endoscopy and interventional treatments fail, surgery (not including liver transplantation) is an irreplaceable treatment option for esophagogastric variceal bleeding, which should be individualized, in order not to increase the risk and difficulty of liver transplantation in the future.

ObjectiveTo manage the early immunosuppressant-associated hypertention in liver transplantation patients. MethodsFifty-six liver transplantations were performed from May 2000 to May 2002, their clinical feature (data of blood pressure and treatment) were analysed. ResultThe incidence of hypertension after liver transplantation was 70% in 2 weeks, 66% in one month. The incidence in cyclosporine group and FK506 group was 73% (31/40) and 33%(3/9) respectively(P

Objective To investigate the effect of Shenfu injection on ischemia reperfusion injury of rat liver graft. Methods Male SD rats were used as isogeneic orthotopic liver transplantation. Sixty rats were randomly divided into two groups(30 in each). The recipient received Shenfu injection intravenously immediately before the removal of the liver in SF group and normal saline of the same volume in control group. At 3、6 and 24h after the reperfusion blood and hepatic tissue were sampled for examination. Results The levels of superoxide dismutase (SOD) and nitric oxide (NO) in SF group significantly increased compared with those in control group(P

Objective To investigate the relationship of the nutritional status with liver function and clinical outcomes of liver cancer patients treated with surgery.Methods Altogether 112 hospitalized patients undergoing surgical treatments for liver cancer were enrolled from October 2011 to October 2013.Their general clinical data were collected,including creatinine-height index (CHI),arm circumference,grip strenghth,albumin,prealbumin,and transferrin.The nutritional status was assessed using Patient-Generated Subjective Global Assessment (PG-SGA).The liver function was assessed with Child-Pugh classification.Postoperative infectious complications and the hospital stays were recorded to assess the clinical outcomes.The correlation between nutritional status and liver function,and that between nutritional status and clinical outcomes were analyzed.Results Among the 112 patients,70 (62.5％) were in normal nutritional status,34 (30.4％) were with moderate malnutrition,and 8 (7.1％) were with severe malnutrition according to PG-SGA scores.PG-SGA assessment showed strong consistence with CHI nutritional assessment (κ =0.760,P =0.000),and moderate consistence with arm circumference assessment (κ =0.564,P =0.000),and grip strength assessment (κ =0.523,P =0.000).The live function classified by Child-Pugh was found highly correlated with PG-SGA assessment (rs =0.829,P =0.000).Postoperative infectious complications and hospital stays were both positively correlated with PG-SGA assessment (r =0.349,P =0.000 ; r =0.624,P =0.000).Conclusions PD-SGA combining with CHI can be used for the nutritional status assessment of liver cancer patients undergoing surgical treatments.The nutritional status of the patients has positive correlation with live function,infectious complications,and postoperative hospital stays.

Objective To investigate the application of structured triglyceride (STG) in malignant obstructive jaundice (MOJ) patients after pancreaticoduodenectomy.Methods The records of 21 MOJ patients received pancreaticoduodenectomy in our hospital were retrospectively analyzed.The patients received parenteral nutrition on the first postoperative day, of whom 7 were given STG (STG group) and 14 were given medium and long chain triglyceride (MCT/LCT group).The changes of liver function, lipid profile, albumin, and postoperative complications were compared between the two groups.Results The triglyceride levels in the STG group on the 3rd and 7th postoperative days were significantly lower than those in the MCT/LCT group [3rd day:(1.85 ±0.90) mmol/L vs.(2.18 ±1.41) mmol/L;7th day: (1.62 ±0.78) mmol/L vs.(2.46± 1.62) mmol/L;both P =0.042];the level of high-density lipoprotein on the 7th postoperative day was significantly higher than that in the MCT/LCT group [(0.67 ±0.64) mmol/L vs.(0.45 ±0.15) mmol/L, P =0.046].The albumin in the STG group returned to normal on the 3rd postoperative day, which was significantly higher than that in the MCT/LCT group [(35.50 ±2.91) g/L vs.(30.66 ±5.08) g/L, P =0.048].There were no significant differences in terms of liver function, length of hospital stay, wound healing, systemic inflammatory response syndrome, and infection between the two groups.Conclusions Parenteral nutrition with structured triglyceride after pancreaticoduodenectomy in MOJ patients is tolerable and safe.STG has less influence on lipid metabolism than MCT/LCT does, and can increase albumin level rapidly.

The effects of spindle afferents activated by stretching gastrocnemius on the nociceptive responses of WDR neurons were recorded extracellularly with microelectrode and observed in paralyzed rats. The results indicated that in 51/80, the spindle afferent activity activated by stretching can inhibit nociceptive responses of neurons. 16 out of 80 neurons no effects can be observed, in 13/80 the effects of spindle afferent activity can excite the nociceptive responses of WDR neurons. Among 51 units, which have inhibitory effects induced by stretching muscle, the inhibitory effects induced by instance and bilateral stretching are stronger than that induced by continuous and unilateral stretching. These results suggested that spindle afferent activity is possesaed of analgesic effects.

Objective To investigate the role of recombinant adenovirus Ad-PD-L1 on immunotolerance induction in mouse pancreatic islet transplantation. Methods Full-length mouse PD-L1 cDNA linked with an internal ribosome entry site (IRES)-GFP cassette was subcloned into pShuttle-GFP-CMV( - ) shuttle plasmid. The product was cut by certain restriction endonuclease and ligate with pAdxsi vector. The adenovirus bone plasmid was transformed into DH5α competent bacteria. The positive clone was identified by restriction endonuclease digestion and further confirmed by sequencing. After linearization, the recombined adenovirus DNA was transfected into 293 cells by liposome for package and amplification, which was purified by CsC1 density gradient centrifugation. Streptozocin was injected i.p. into C57BL/6 (H-2b) mouse to induce diabetic model recipient. Recipients were randomly divided into three groups, Group A was the control. Group B and group C were injected of Ad-EGFP and Ad-PD-L1 through tail vein respectively 1 day before islet transplantation. 300 to 400 islets of DBA/2 (H-2d) were transplanted into the renal subcapsular space of the diabetic model recipient. The level of blood sugar and the graft survival time were monitored. Results Recombinant adenovirns Ad-PD-L1 have high efficiency expression of PD-L1 in recipient mouse. The survival time of grafts of Ad-PD-L1 group (27.63 ± 3. 51 ) d was significantly longer than that of the control ( 7. 85 ± 0. 33 ) d and Ad-EGFP group ( 7. 67 ± 0. 59 ) d ( P < 0. 01 ). Mixed lymphocyte response showed a specific decrease reaction of recipient lymphocyte toward donor lymphocytes. Conclusion Recombinant adenovirus Ad-PD-L1 was successfully constructed. In mouse pancreatic islet transplantation, it can suppresses the activation of recipient T lymphocyte through PD-1/PD-L1 co-stimulatory pathway, and significantly prolong the survival time of grafts.