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 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 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.

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 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.

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.

We report a case of reversible hepatofugal portal flow after auxiliary partial orthotopic liver transplantation (APOLT) from a living donor in this study. On postoperative day 6, continuous hepatofugal portal flow was observed in the grafted liver without portal thrombosis and obstruction of the hepatic vein. Based on histological findings, acute rejection was the suspected cause. The normal portal venous flow was restored after steroid pulse and antithymocyte globulin (ATG) therapies. The patient was discharged on the 30th postoperative day. It was concluded that hepatofugal flow after liver transplantation is a sign of serious acute rejection, and can be successfully treated by anti-rejection therapy.

Objective To investigate the clinical characteristics and strategies of early stage antibody-mediated rejection after renal transplantation.Method The clinical data of early stage AMR of 3 cases of renal transplantation,and 1 case of pancreas transplantation after renal transplantation were retrospectively analyzed.(1) The case 1 was diagnosed as having early severe acute AMR.Serum creatinine was increased,urine volume rapidly reduced,the blood flow of transplanted kidney reduced on the postoperative day 8;the positive rate of panel reactive antibody (PRA) class Ⅰ and Ⅱ was 74.6％,and 2.7％ respectively on the postoperative day 12.Biopsy showed widely ischemia and local bleeding in transplanted kidney and DSA showed anti-B62 mean fluorescence intensity (MFI) increased to 6800 on the postoperative day 14.(2) The case 2 was diagnosed as having early mild acute AMR.The positive rate of PRA class [and Ⅱ was 65.6％ and 78.9％ respectively.DSA Ⅰ was positive,anti A11 MFI was 3059,and DSA Ⅱ was negative on the postoperative day 13.Biopsy showed mild ischemia reperfusion injury in transplanted kidney on the postoperative day 21.(3) The case 3 was diagnosed as having early severe chronic AMR,and the recipient received pancreas transplantation 1 year after kidney transplantation.Eight months after pancreas transplantation,DSA for pancreas donor was detectable,anti A2 MFI was 7514,anti B46 MFI was 3 159 and anti DQ7 MFI was 1 503.(4) The case 4 was diagnosed as having early mixed rejection.Serum creatinine was elevated on the postoperative day 8;PRA testing showed that the positive rate of class Ⅰ and Ⅱ was 3％ and 70％ respectively,DSA was positive,and anti DR16 MFI was 15 170 on the postoperative day 14;transplanted kidney biopsy showed acute mixed rejection on the postoperative day 16.Result Case 1 and case 3 were not diagnosed and treated in time and graft loss developed.Case 2 and case 4 were functionally recovered after combined treatment of plasmapheresis,IVIG and bortezomib.Conclusion Diagnosis of antibody-mediated rejection is based on transplant graft dysfunction,positive DSA and graft biopsy.Early diagnosis,early treatment and combined therapy can improve the curative rate of AMR.