Objective To judge the prognosis of adult recipients after first liver transplantation by stepwise discriminant analysis,and screen out the main influencing factors.Methods The clinical data of 221 patients who received liver transplantation at the Nanfang Hospital of Southern Medical University were retrospectively analyzed.A total of 218 patients who met the criteria were divided into the training samples (188 patients admitted from August 2004 to June 2010) and checking samples (30 patients admitted from July 2010 to February 2011),and then all patients were re-divided into dead group (survival time ≤ 90 days,34 patients) and surviving group (survival time ＞ 90 days,184 patients).Factors which had significant difference after the univariate analysis was further analyzed by the stepwise discriminant analysis method.All data were analyzed by the t test,rank sum test,chi-square test or Fisher exact probability test.Results The ages of the recipients in the dead group and the living group were (54 ± 11)years and (51 ± 11)years,respectively,with no significant difference between the 2 groups (t =-1.681,P ＞ 0.05).The preoperative levels of hemoglobin in the dead group and the living group were 106.7 g/L and 119.2 g/L,respectively,with a significant difference between the 2 groups (t =2.809,P ＜ 0.05).There were significant differences in the levels of serum creatinine,urea nitrogen,albumin,total bilirubin,indirect bilirubin,Na+,prothrombin time,activated partial thromboplastin time,international normalized ratio,fibrinogen,prothrombin activity,platelet,nutrition risk index,model for end-stage liver disease score,number of patients with preoperative hepatic encephalopathy (HE),preoperative hepatorenal syndrome (HRS),preoperative digestive tract bleeding,preoperative infection,preoperative diabetes,Child-Turcotte-Pugh score,cardiac function classification and anesthesia risk rating operation time,anhepatic time,volume of intraoperative blood transfusion,volume of peritoneal effusion ; intraoperative urine output,between the 2 groups (Z =-2.277,-2.595,-3.290,-3.486,-2.562,-2.577,-3.670,-3.882,-3.625,-3.557,-3.837,-1.974,-3.693,-3.815,x2 =19.632,9.756,28.143,Z =-4.175,-3.905,-4.865,-3.564,-5.822,P ＜ 0.05).Preoperative HE,preoperative HRS,duration of operation,intraoperative blood transfusion and intraoperative volume of urine were the independent influencing factors of early prognosis after liver transplantation.The standardized partial regression coefficients were 0.146,0.188,0.257,0.181,-0.340,89.9％ (169/188) of the training samples and 90.0％ (27/30) of the checking samples were correctly classified.Conclusion Based on factors including HRS,HE,intraoperative blood transfusion,intraoperative volume of urine and duration of operation,the early prognosis can be judged in adult recipients after first liver transplantation.

Objectives To evaluate the predictive value of the revised model for end-stage liver disease in the clinical early stage after liver transplantation.Methods The clinical data of 218 patients were retrospectively analyzed.After calculating the MELD score,ReFit MELD score and ReFit MELDNa score before transplantation,we compared the predictive accuracies of these scoring systems using the area under curve (AUC) of the receiver operating characteristic.The groups were categorized with the cut-offs of the MELD,ReFit MELD and ReFit MELDNa,and the early-stage complications and mortality in the different groups were analyzed.Results The AUC for the MELD,ReFit MELD and ReFit MELDNa were 0.737 (95％CI 0.621～0.854),0.727 (95％CI 0.663～0.785) and 0.735 (95％CI 0.671～0.792),respectively.There was no statistical difference is the AUC among the MELD,ReFit MELD and ReFit MELDNa.Elevated scores in the 3 models predicted higher rates of pulmonary infection,abdominal infection and acute renal dysfunction,as well as a higher mortality.Conclusions The ReFit MELD score and ReFit MELDNa score were relatively useful predictors of short-term survival rates after liver transplantation.The predictive accuracy was similar to the MELD score.Values of the score above the cutoff values indicated higher rates of complication and poorer prognosis.

Objective To investigate and evaluate the clinical value of full endoscopic transnasal transphenoidal approach for the surgery of pituitary adenomas.Methods Seventy-two patients,who underwent full endoscopic transnasal transphenoidal approach for the surgery of pituitary adenomas,were selected from the Medical Center of Pituitary Adenomas of our hospital from January 2009 to March 2012.To retrospectively investigate pre- and post-operation symptoms,hormone levels,images information,operation information,complications,following-up information and so on.Results Among the 72 consecutive patients,there were 22 nonfunctioning adenomas,twenty-four prolactin secreting adenomas,seven somatotropin secreting adenomas,five adrenocorticotropic hormone secreting adenomas,one thyrotropin secreting adenomas,and 13 multi-secreting adenomas.The tumor removal was total in 56(77.8％),subtotal 13(18.0％),and partial 3(4.2％).Five cases had CSF leaks,and 6 diabetes insipidus.After 3-24 months of follow-up,the levels of increasing-hormone declined to normal levels in most patients.Conclusion Full endoscopic transnasal transphenoidal approach for the surgery of pituitary adenomas is a kind of technique which is safe,minimally invasive,having less complications and fast recovery.However,it is necessary for surgeons to accept systematic and specialized training,and own advanced equipments.

OBJECTIVETo investigate the approaches to diagnosis, treatment and prevention of the biliary complications after orthotopic liver transplantation (OLT).

METHODSThe clinical data were collected from 258 adult patients receiving orthotopic liver transplantation between August, 2004 and December, 2011, among whom 56 patients with biliary complications were identified to analyze the diagnosis and treatment of the complications.

RESULTSThe incidence of biliary complication was 22.13% in the 258 recipients of secondary liver transplantation. Of the 56 patients with biliary complication, 32 (57.14%) had biliary stricture and 24 (42.86%) had bile leakage; 36 (64.29%) patients presented a simple type of biliary complication and 20 (35.71%) had a composite type, including bile leakage, biliary obstruction, biliary calculi, biliary tract infections, biliary sludge formation, and biliary tract bleeding. Thirty-one patients (55.36%) underwent routine endoscopic retrograde cholangiopancreato- graphy (ERCP), percutaneous transhepatic cholangiography (PTC) and other endoscopic or interventional treatments, and 23 (74.19%) were cured or showed improvement, while 3 died due to multiple organ dysfunction syndrome (MODS).

CONCLUSIONAppropriate surgical approaches and skills in bile duct anastomosis are crucial to reduce the incidence of biliary complications following liver transplantation. Non-surgical treatment (including ERCP) is the primary option, followed by surgical bile duct exploration, for the management of biliary complications; liver retransplantation is the most effective life-saving means for patients with liver graft non-function. But still, prevention of biliary complications is of pivotal importance to improve the outcome of liver transplantation.

Adult ; Bile Ducts ; Biliary Tract Diseases ; epidemiology ; Cholangiography ; Endoscopy ; Humans ; Incidence ; Liver ; Liver Transplantation ; adverse effects ; Postoperative Complications ; Reoperation ; Retrospective Studies

No data were available on the acute oral toxicity, short-term oral toxicity of vegetable carbon in animals. This study was designed to evaluate the safety of two commercially available dietary bamboo charcoal powders (BCP1 and BCP2). The size distribution of the two powders was determined by a Mastersizer 2000 laser particle size analyzer prior to the in vivo safety studies. For the acute toxicity study, a single dose of 11.24 g/kg body weight of BCP1 and BCP2 was given once orally to healthy Sprague-Dawley (SD) rats. Mortality and clinical symptoms were observed and recorded for the first 30 min after treatment, at 4 h post-administration, and then at least once daily for 14 days after administration. In the repeated dose 28-day oral toxicity study, BCP1 and BCP2 were administered orally at doses of 2.81, 5.62, and 11.24 g/kg body weight for 28 days to SD rats. Animals were sacrificed and organs and blood samples were analyzed. Results showed that both BCP1 and BCP2 were micro-sized and various in size. In the acute toxicity and the repeated dose 28-day oral toxicity studies, BCP caused neither mortality nor visible signs of toxicity in rats. No significant differences were found in the relative organ weights or in biochemical parameters in BCP treated groups compared to a control group. No treatment-related histological changes were observed in the organs of these animals. Based on these data, it is concluded that the median lethal dose (LD50) of BCP for both male and female rats is more than 11.24 g/kg body weight and the no-observed-adverse-effect level (NOAEL) is >11.24 g/kg body weight for 28 days.
Animals ; Bambusa ; chemistry ; Diet ; Female ; Male ; Powders ; Rats ; Rats, Sprague-Dawley ; Toxicity Tests, Acute