Objective To evaluate the clinical effect of integrated traditional and western medicine in the treatment of serious ulcerative colitis. Methods Salicylate and cortical hormone were given to patients in acute phase, supplemented by oral administration of herbal medicine and retention enema of Kushenhuaihua concoction. During the period of remission, the patients were treated mainly with Jianpiling supplemented with salicylate for at least half a year. Results In 55 patients receiving conservative treatment, 35(63.6%) recovered completely, 18(32.7%) showed effective result, only 1 patient died and another showed ineffective result (1.8%). Five patients underwent surgical treatment, among them 4 were completely relieved. Long-term follow-up showed that in 67.4% of patients the symptoms were completely relieved, and in 2.3% of patients malignant degeneration occurred, 4.7% of the patients died, and 6.9% of the patients underwent operative treatment. Conclusion The effects of integrated traditional and western medicine treatment in patients with serious ulcerative colitis is superior to western medicine aloner as evidenced by a decrease in mortality and necessity of operation.

Objective To analyze the outcomes of renal transplantation from donation after citizen death (DCD) in our single center.Method We retrospectively investigated the recipient outcomes of renal allografts from DCD.Between November 2010 and 31st December 2014,our institution performed 242 renal transplants from DCD.Outcome variables (survival of recipients/allografts and adverse events) and characteristics of marginal donor transplants were analyzed.Result There were 139 males and 44 females in the enrolled 183 donors,and the range of age was from 2 days to 68 years.183 donors included 102 cases of donation after brain death (category Ⅰ),22 cases of donation after circulatory death (category Ⅱ) and 59 cases of donation after brain death followed by circulatory death (category Ⅲ).Utilizing these renal allografts,we performed 242 kidney transplantations including 237 single kidney transplants and 5 pediatric en bloc kidney transplants.The age of recipients ranged from 12 to 64 years.The data indicated that the 1-year recipient/allograft survival rate was 93.8％ and 90.5％,respectively.The rate of delayed graft function (DGF) was 33.1 ％,higher than that from executed prisoners allografts (23.6％,P＜0.05).However,the rate of 1-year acute rejection,interstitial pneumonia and the other adverse events (urinary fistula,ureteral obstruction and cardiac and cerebral vascular accident,etc.) was similar to that from executed prisoners allografts.In addition,good results from pediatric and elder donor renal transplantation were shown in our data,even though the discard rate of elder donor kidney was high.Conclusion By comprehensive evaluation,strictly screening donors and enhancing the rnanagenent of donors,the long-term survival of recipients may be prolonged and the incidence of DGF and primary graft non-function (PNF) may be decreased.The marginal donors from pediatric and elder DCD donors could be utilized in clinical transplantation safely and effectively as long as reasonable evaluation was carried out.

Objective: To investigate the surgical techniques for establishing the rat model of orthotopic liver transplantation.Methods: On the basis of the double-cuff technique of Kamada,we improved the techniques for the separation and perfusion of the donor liver,the shearing and anastomosis of the superior and inferior caval veins,and the anastomosis of the bile duct.Results: Of the 40 rats that underwent orthotopic liver transplantation,80% survived longer than 24 hours and 70% over 7 days.Conclusion: With extreme patience and carefulness,the operator can successfully establish the rat model of orthotopic liver transplantation by shortening the anhepatic phase with skillful surgical techniques.

Objective To study the expression of interleukin (IL-17A) in primary liver cancer (PHC) tissue and its clinical significance.Methods Reverse transcription polymerase chain reaction (RT-PCR) and immunohistochemistry was performed respectively to detect the expression of IL-17A mRNA and CD34 in tumor tissues from 37 patients with PHC.Murine H22 cells cultured in vitro were exposed to IL-17A at different dosages (0.1,0.5,1.0,5.0,10,50,100,500,1000 ng/ml) and the cell proliferation was assayed by MTT.IL-17A was administered to the mice transplanted with H22 cancer cells via caudal vein and the tumor volume was measured by vernier caliper.Immunohistochemistry was used to detect the CD31 expression in H22 cancer tissues.Results IL-17A mRNA was detected in 26 of the 37 samples of primary liver cancer.The microvessel densities in IL-17A-positive samples and IL-17A-negative samples were 66.6 ± 2.5 and 26.7--2.5,respectively.The difference between two groups was significant (P＜0.01).The proliferation of H22 cells exposed to various dosages of IL-17A was not different (P＞0.05).The volume of murine tumor tissue in animals treated with IL-17A was (843.6± 90.9) mm3 and in untreated animals was (198.7±24.4) mm3 (P＜0.01).The microvessel density in treated group and control group was 71.9± 6.8 and 33.3 ± 2.9,respectively (P＜0.01).Conclusions The expression of IL-17A could be detected in a considerable proportion of primary liver cancers and correlated with angiogenesis.Exogenous IL-17A could not accelerate H22 cell proliferation in vitro but in vivo probably via enhancing angiogenesis.

Objective To investigate the effective regimen and security to treat the hepatitis C virus (HCV) recurrence after orthotopic liver transplantation (OLT).Methods The clinical data of 9 cases of HCV related end-stage hepatopathy after liver transplantation were retrospectively analyzed.Five patients with recurrent HCV after OLT were selected for treatment,and all of them were given pygylated interferon αα-2a and ribavirin.The treatment course was 48 weeks.The changes in hemoglobin,white blood cells,transaminase,and HCV RNA copies were observed before and after treatment.The early viral response (EVR),sustained viral response (SVR) and adverse reactions were assessed.Results Three cases out of 5 cases of HCV recurrence after OLT obtained EVR within 12 weeks,all of them obtained SVR after the treatment,and the function of the transplanted liver returned to normal; In one case,HCV RNA was declined by less than 102 copies after 12 weeks of treatment,and the treatment was terminated; In one case,HCV RNA was declined by greater than 102 copies after 12 weeks of treatment,and at 24th week,HCV RNA was still positive and the treatment was terminated,but HCV RNA remained at a low level at 48th week.Side effects occurred in all 5 cases after antiviral treatment,and alleviated after symptomatic treatment.Conclusion To treat the recurrence of HCV timely after OLT by pygylated interferon (in combination with ribavirin was safe,and the majority of patients could achieved sustained virological response.

Objective To investigate the diagnostic value of barium stury of small bowel obstruction due to various bowel diseases.Methods Barium meal study and enteroclysis (small bowel enema)were performed in 23 patients with incomplete small bowel obstruction due to small bowel diseases confirmed by operation.The imaging data were retrospectively analysed.Results Of the 23 patients,14 cases were malignancy,9 cases were benignant.Conclusion Both barium meal study and enteroclysis( small bowel enema) with air-barium double-contrast technique are of diagnostic value in incomplete small bowel obstruction due to small bowel diseases.

CD46 is not only identified as a complement regulatory protein which protects host cells from complement attack, but also a new co-stimulatory molecule for human T cells. CD3/CD46 co-stimulation can induce a T-regulatory 1 cell (Tr1)-specific cytokine phenotype in human CD4(+) T cells. However, the role of CD46 as a co-stimulatory molecule in the modulation of the acquired immunity, such as transplant immunology, remains unclear. In this study, CD4(+) T cells were isolated from human CD46-transgenic C57BL/6 mice by magnetic-activated cell sorting, and further induced by anti-CD3, anti-CD28 and anti-CD46 antibodies respectively, and anti-CD3/anti-CD28 antibodies, anti-CD3/anti-CD46 antibodies, or the monoclonal antibody panel against CD3/CD28/CD46. The levels of interleukin-2 (IL-2), gamma-interferon (gamma-IFN), interleukin-10 (IL-10) and transforming growth factor-beta (TGF-beta) were detected in the supernatants of different groups. Suppression of allogeneic T cell proliferation were assessed by using mixed lymphocyte reaction (MLR) assay, in which monoclonal antibodies against CD46 were added to the culture. The results showed that CD3/CD28, CD3/CD46 and CD3/CD28/CD46 co-stimulation could significantly induce stronger proliferation of T cells than CD3 stimulation (P<0.05), and CD3/CD28/CD46 co-stimulation significantly increased the proliferation of T cells when compared with CD3/CD28 or CD3/CD46 co-stimulation (P<0.05 for each). IL-2 and gamma-IFN levels were much higher in CD3/CD28 co-stimulation group than in CD3, CD28, CD46 and CD3/CD46 groups (P<0.05 for each). IL-10 and TGF-beta levels were dramatically increased in CD3/CD46 co-stimulation group as compared with those in the CD3, CD28, CD46 and CD3/CD28 groups (P<0.05 for each). CD3/CD46 co-stimulation significantly inhibited the T cell proliferation and allogenic immune responses through the secretion of IL-10 and TGF-beta in MLR (P<0.05). These results suggested that CD3/CD46 can induce Tr1 cells to modulate allogenic immune responses, and it may become a novel target for the development of new therapeutic approach for T-cell-mediated diseases. CD46 plays an important role in regulating the T cell-mediated immune responses by bridging innate and acquired immunity.

Objective To investigate the immunosuppressive regimen of cyclosporine A(CsA) reduced or withdrawn in the HBV-DNA positive kidney transplanted patients. Methods The program of 64 kidney transplanted patients with HBV-DNA positive from Jan,2004 to Dec,2007 were analyzed, the patients were divided into 3 groups ①CsA + MMF group(A group) ;②FK506 + MMF group(B group) ;③low dose of CsA + SRL group(C group). All the patients received entecavir to resist HBV replication and were followed up for acute rejection incidence,liverfunc- tion and HBV-DNA test for 6 months. Results There was no significant difference in 3 groups about acute rejection incidence rate. Liver dysfunction took place in 12 patients of A group (80%) ,8 patients(53%) in A group HBV-DNA became negative; 5 patients (20%) in B group appeared the liver dysfunction, HBV-DNA became negative in 18 patients(75%). 4 patients in C group(16%) appeared liver dysfunction sHBV-DNA was negative in 18 patients (72%) of C group. Conclusion It was safe and efficient for the immunosuppressive regimen of cyclosporin A re-duced or withdrawn in the HBV-DNA positive kidney transplanted patients,not increasing the incidence of acute re-jection and aggratating the liver injury.

Objective To investigate anatomic feature of variant right hepatic artery originating from the gastroduodenal artery.Methods We studied the anatomy of hepatic artery in 70 patients by 64-slice CT scans.If the right hepatic artery originated from the gastroduodenal artery,its relation to duodenum,common bile duct and portal vein was further investigated.Results Normal hepatic artery was found in 40 patients (57.1％).Variant hepatic artery can't be categorized to classic types in 8 patients (11.4％),among them 6 patients (8.6％) were with replaced (5 patients) or accessory (one patient) right hepatic artery arising from gastroduodenal artery.With the distance between original point of the right hepatic artery and that of the gastroduodenal artery growing further anatomic course of the variant right hepatic artery is more similar to that of the right hepatic artery originating from the superior mesenteric artery.Conclusions The variation of right hepatic artery originating from the gastroduodenal artery was not uncommon.This specific variant hepatic artery can exert impact on biliary blood supply,avoiding injury decreases the incidence of serious biliary complications in general surgery.

Objective To discuss the improvement of surgical techniques and adjustment of immunosuppressive regimen for combined liver and intestinal transplantation.Method A male patient with liver dysfunction and short bowel syndrome underwent the combined liver and intestinal transplantation.Ostomy of graft was performed instead of intestinal anastomosis during the operation.The anastomosis of graft and autologous intestine was performed 8 months after transplantation.Hospital and follow-up data of the patients were analyzed retrospectively.Result The functions of liver and small bowel recovered smoothly after operation.Slight rejection occurred one month after operation with normal function of intestine but dysfunction of liver.In the first month after operation, abdominal infection was controlled by intraperitoneal drainage with open surgery.Immunosuppression protocol was administrated with alemtuzumab for induction plus maintenance treatment with tacrolimus, and mycophenolate mofetil was added because of renal dysfunction 2 years after transplantation.The patient was followed up for nearly 3 years with good quality of life without rejection and infection.Conclusion Combined liver and intestinal transplantation could improve patient's life quality and extend the survival time through the improvement of surgical techniques and individual immunosuppressive regimen.