Objective To discuss the long-term effect of orthotopic liver transplantation to patients with hepatic myelopathy. Methods The clinical data of 2 patients with hepatic myelopathy undergoing liver transplantation were analyzed retrospectively. The condition of recovery of muscle strength of the patient's double lower limbs was carefully observed both pre-and post operatively. Results The patient's clinical symptoms were well improved and liver function recovered to normal. Hepatic myelopathy was controlled. The follow-up duration of 2 cases was 18 and 43 months respectively. The muscle strength of lower limbs was recovered from 1 degree to 3 and 4 degree respectively. Conclusion Liver transplantation can effectively control the development of hepatic myelopathy and it is obviously useful for recovery of double lower limbs.

Objective To explore the evidences of the humoral factor involved in the liver allograft rejection, and to explore better monitoring methods and therapy of the humoral liver rejection. Methods After the humoral liver rejection, liver puncture biopsies were performed. Immunohistochemical examinations of C4d, CD20+ B lymphocytes and CD138+ plasma cells were performed to judge whether humoral factor was involved in liver rejection. The dosage of tacrolimus was increased first when rejection was identified. The patients with severe liver function damage were treated with methyllprednisolone, and the steroid-insensitive cases were treated with antithymocyte globulins (ATG) and rapamycin. Results 25 biopsies were performed in 16 patients. Humoral rejection was diagnosed for 15 times in 10 patients, cellular rejection was diagnosed for 6 times in 4 patients, and the both kinds of rejection occurred in the last 2 patients. The effect of methylprednisolone was obviously lower in the humoral rejection cases (29.4%, 5/17) than that of the cellular rejection cases (7/8). Steroid-insensitive humoral rejections were diagnosed in 12 biopsies from 7 patients receiving liver transplantation. One patient was cured with ATG and 5 patients were cured with addition of rapamycin. The case whose blood type was AB receiving a liver transplant from the donor of O blood type died of liver function failure even after an extensive treatment. Conclusions Humoral immune factors maybe involved in some acute and chronic liver allograft rejection. ATG and rapamycin are more effective for the patients with humoral liver rejection.

Objective To evaluate the application of artificial liver support system (ALSS) in severe hepatitis patients before liver transplantation. Methods Double lumen catheters were inserted into the femoralvein to construct the blood conduit in patients receiving ALSS. The blood purification apparatus was applied for plasma replacement and blood perfusion with PIS separator and HA hemoperfusion apparatus. The plasma replacement capacity was 3000ml-4000ml (average 3200 ml) with albumin 20g. The average dosages of both heparin and protamine were 25 mg. The separation speed was 26 ml/min. The replacement blood flow was 100-150 ml/min, and the average treatment time was 120 min. Results The liver function markers, including TB, DB, ALT, AST and NH 3, were improved in patients with ALSS. Conclusion ALSS could correct the imbalance of homeostasis of the patients, eliminate the toxic substances effectively and provide valuable support for liver transplantation.

Objective To explore causative factors, and prevention and treatment of nonanastomotic biliary stricture (NABS) after orthotopic liver transplantation. Methods The donor’s liver together with celiac artery and its branches were havvested rapidly without injury to reduce heat ischemia time and artery loss, then the bilinary duct was flushed to clean out residual bile. During operation, when the portal vein was opened, the hepatic artery of the donor liver was flushed with heparin saline. Post-operatively, acute or chronic rejection and cytomegalovirus infection should be prevented. When NABS occurred, it was treated with bilinary balloon dilatation. Results Of 36 patients with liver transplantation, 4 patients (11.1%, 4/36) were found to suffer from NABS. Two patients were cured, in one patient it was improved after dilatation, and one patient died. Conclusion NABS is mainly related to artery loss, cold/warm ischemia injury, ischemia/reperfusion injury, bile toxicity injury, immune injury and cytomegalovirus infection etc. Biliary balloon dilatation is the major treatment for NABS. Retransplantation is necessary for some severe cases.

Objective To explore a new therapeutic method to intractable rejection after liver transplantation.Methods Low dose prograft and rapamycin were given to 2 patients with intractable acute rejection and 2 patients with intractable chronic rejection confirmed by biopsy after liver transplantation, which had no response to normal treatment. The blood concentration of prograft was controlled in 3～5 ?g/L and rapamycin in 6～12 ?g/L. Rapamycin was withdrawn and prograft was increased to normal dose while the rejections were rectified.Results Four allograft rejections were all reversed in the end with this method. In the course of this therapy, one of the 4 patients had CMV pneumonia and cured with antiviral therapy. One had diabetes and another's diabetes got more critical. The blood glucose recovered to the primary level after the withdrawal of rapamycin.Conclusion The intractable acute and chronic rejection which has no response to normal treatment can be reversed by combined use of low dose prograft and rapamycin.

Objective To study the education of medical mycology for undergraduates of medical laboratory specialty and provide a basis for teaching reformation.Method Setting of mycology related courses of medical mycology for undergraduates in 5 medical schools and 85 inspection and technical personnel's detection of fungi in 81 hospitals were investigated through consultation and questionnaire survey.Results More than 140 class hours for medical mycology were arranged in 5 schools,but as to medical mycology,22 class hours in 1 school and less than 10 class hours in 4 schools,the minimum class hours were 5.Although various numbers of Candida and filamentous fungi could be isolated in hospitals investigated,more than half laboratory workers could not identify penicillium,thermally dimorphic fungi,Zygomycetes and Dematiaceous fungi.Conclusion Education on medical mycology for medical laboratory specialty undergraduates is insufficient and the corresponding teaching lacks such content as medically important pathogenic fungi detection methods and identification characteristics.The hospital technical personnel's fungal identification ability cannot meet the situation of increasing fungal infection involved in clinical medicine,so it is necessary to carry out teaching reformation of medical mycology for undergraduates in laboratory medicine,including adding class hours,increasing course contents and so on.

Objective To explore the roles of B lymphocyte and plasma cell in liver allograft re-jection to find the evidences of humoral factor participating in the rejection. Methods Immunohisto-chemical inspection of C4d, CD20+ B lymphocytes and CD138+ plasma cells were performed in 34 liver biopsy specimens from 25 patients with hepatic injury and their preoperative specimens. Then we ob-served the variances of the above parameters in the liver biopsy specimens and the differences of them with different hepatic injuries. We further observed the relation of the presence of CD20+ B lympho-cytes and CD138+ plasma cells to C4d positivity. Meanwhile, we compared the difficulties of clinical therapy with different presences of CD20+ B lymphocytes and CD138+ plasma cells in the liver biopsy specimens. Results The positive ratios of CD20+B lymphocytes and CD138+ plasma cells were signif-icantly higher in the acute rejection group than in the non-rejection group(P<0. 05 and P<0. 01).The positive ratios of CD20+ B lymphocytes were markedly higher in the chronic rejection group than in the non-rejection group(P<0. 05). There was no difference in CD138+ plasma cells between the 2 groups. The degrees of hepatic injury could not influence the positive ratioes of CD138+ plasma, but the positive ratioes of CD20+ B lymphocytes in the heavy hepatic injury groups was higher than in the slight hepatic injury groups(P<0. 05). CD20+ B lymphocytes and CD138+ plasma cells presented fol-lowing C4d(P<0. 01 and P<0. 05). The effective power of steroid in the all-positive group was obvi-ously lower than in the all-negative group(P<0. 05). Conclusion Humoral immune may participate in some liver allograft rejection. It would be more favorable for observing and prewarning the humoral re-jection by finding CD20, CD138 and C4d by immunohistochemical staining in liver biopsy specimens with hepatic injury after liver transplantation. It would be helpful for choosing the therapeutic regi-mens of liver allograft rejection.

Objective To investigate the expression of IL-23 and IL-23 mRNA in allograft and peripheral blood of mice receiving skin transplantation under different immune states. Methods Mice skin allograft models were established and divided into 3 groups: synergeneic transplant group (BALB/c→BALB/c), allogeneic transplant group (C57BL/6→BALB/c), donor spleen cells infusion group (C57BL/6→BALB/c). Peripheral blood plasma concentration of IL-23 was measured by ELISA. RT-PCR was used to detect the expression of IL-23 mRNA in the skin allograft. Results There was no significant difference in the IL-23 and IL-23 mRNA expression among all three groups one day after skin transplantation (P＞0. 05). On the day 3, 5, and 7 after skin transplantation, there was significant difference in the IL-23 and IL-23 mRNA expression levels between synergeneic transplant group, donor spleen cells infusion group and allogeneic transplant group (P ＜ 0. 01 ), but there was no significant difference between synergeneic transplant group and donor spleen cells infusion group (P＞0. 05). Conclusion The high expression levels of IL-23 and IL-23 mRNA were detected when early acute rejection took place in recipient mice. IL-23 could serve as a predictable and prognostic marker for the acute rejection. Infusion of donor spleen cells can significantly prolong the allograft survival.

BACKGROUND:Previous studies have reported the cause and treatment of biliary complication. However, how to improve operative technique for preventing the complication is rarely reported.
OBJECTIVE:To explore the effect of operational skil s during liver transplantation on biliary complications.
METHODS:Biliary complications in 475 patients who underwent liver transplantation were retrospectively analyzed. The relationship between operational skil s and biliary complications after liver transplantation was observed. The potential risk factors about operative technique were summarized. Some preventive interventions for biliary complications were suggested.
RESULTS AND CONCLUSION:Biliary complication was diagnosed in 36 (7.6%) of 475 patients who underwent liver transplantation. They were nonanastomotic biliary stricture (n=19, 4.0%), anastomotic biliary stricture (n=7, 1.5%), biliary leakage (n=3, 0.6%), twisted common biliary duct (n=3, 0.6%), residual common duct stone (n=1, 0.2%), and neoformative common duct stone (n=3, 0.6%). There was no difference in the incidence of nonanastomotic biliary stricture among the three biliary anastomotic styles. The possibility of anastomotic biliary stricture in placing T-drainage tube group was lower than the other two groups according to clinical data. Nevertheless, there was no statistical difference between these three groups. Infusing UW into the liver from cranial mesenteric vein and douching the biliary duct immediately while taking the donor could decrease the incidence of biliary complication after liver transplantation (P=0.013 and P=0.018, OR=0.26 and OR=0.28), the later factor could also decrease the incidence of nonanastomotic biliary stricture (P=0.001, OR=0.09). Meanwhile, some operational skil s also decrease the incidence of biliary complications, such as protecting the artery around the biliary duct, and elevating the liver when suturing the common biliary duct.

BACKGROUND: Hepatic myelopathy results from liver disease, which lacks of effective cure method. Liver transplantation has attempted to cure this disease; however, the long-term therapeutic effect is rarely reported. OBJECTIVE: To explore the long-term therapeutic effect of liver transplantation in patients with hepatic myelopathy. METHODS: The clinical data of 2 patients with hepatic myelopathy, who underwent orthotopic liver transplantation, in August 2002 and November 2004, at the 309 Hospital of Chinese PLA, were analyzed retrospectively. The time of follow-up was 18 and 43 months, respectively. The muscle strength of double lower limbs in 2 patients was assessed prior to and after operation. RESULTS AND CONCLUSION: Two patients recovered well at 4 weeks after transplantation, the clinical symptom and physical signs of patients were improved obviously, the blood routine examination and other biochemical index were normal,and the function of transplanted kidney was normal. Two patients discharged at 6 weeks after transplantation. Patient 1 could stand for a long time at months 6 after transplantation, walked slowly with the supporter after 12 months and without the supporter at 43 months. The muscular strength of two lower limbs was grade 4. And the liver function was normal. Patients 2 could move his lower limbs in bed at months 6 after transplantation, walked with the supporter at 18 months. The muscular strength of two lower limbs was grade 3. The liver function was normal. It demonstrated that liver transplantation is beneficial to control hepatic myelopathy and recover muscular strength of two lower limbs. It is a newly developed, effective curing method for treating hepatic myelopathy. However, the numbers were small with short time observation, thus, the long-term therapeutic effect still need to be explored.