The low-density lipoprotein (LDL) receptor level and endocrine function were studied in 30 cases of non-familial hypercholesterolemia. The results showed that endocrine dysfunction may play a role in the pathogenesis of hyper-cholesterolemia, for example, the elevation of insulin and growth hormone level, the abnormal ratio of estrogen and testosterone. In addition, the increase of TXB2 and 6-ketone prostacyclihe may make the blood hypercoagulative, raise the incidence of myocardial infarction and cerebral thrombosis. Except the physiologic compensation the LDL receptor level in non-familial hypercholesterolemia may also be regulated by insulin and estrogen.

CD4+CD25+FoxP3+Treg may regulate the immune responses and induce tolerance to alloantigen in vivo in organ transplantation. A high expression of CD4+CD25+FoxP3+Treg may be a possible indicator of acute allograft rejection. The patients with renal transplantation showing a high expression of CD4+CD25+FoxP3+Treg might be more prone to the development of acute allograft rejection,and the detection of its expression may contribute to predict allograft acceptance or rejection. It seems plausible that the imbalance between effector T cells and Treg might reflect an immune state. Additional experimentation and clinical studies are needed to investigate the long-term impact of development and function of Treg cells on immunosuppression in allogeneic renal transplantation.

Recent advances in transplantation tolerance were comprehensively reviewed. The contents included the mechanisms and methods of induction and maintenance of transplantation tolerance. Some experimental protocols were introduced including mixed chimerism of allogeneic bone marrow, blockade of co-stimulation signal and transgene technology for transplantation tolerance induction. The problems and the future of clinical transplantation tolerance were objectively evaluated here.

The development status and specific problems of liver transplantation in China were analyzed, and the strategies to resolve these problems were discussed in this study. "Hepatitis B related diseases", including cirrhosis and hepatic cancer, were the main indications for liver transplantation in China. Recurrence of hepatitis B and hepatic cancer was found to significantly affect the long term survival of the recipients of liver transplantation. Severe hepatitis and fulminating liver failure were the main causes of death in the perioperative periods of liver transplantation. Nonanastomotic biliary stricture (NABS) and acute rejection often occurred. Lamivudine and anti-Hepatitis B immunoglobulin(HBIg) could effectively protect the recipients from hepatitis B recurrence. The indication of liver transplantation for the patients with the hepatic cancer should be observed strictively, and measures should be taken before and during the operation to prevent the recurrence of the cancer. In the patients with severe hepatitis and fulminating liver failure, therapy to support the liver function should be emphasized and the artificial liver support system (ALSS) should be administered. The prognosis of NABS was found to be poor, and biliary duct dilatation with balloon catheter might be an effective treatment for NABS, but retransplantation was necessary for some of the patients. The rate of biopsy of the liver graft, the quality of the biopsy and the level of pathological diagnosis should be greatly enhanced.

AIM:Anti-hepatis B immunoglobulin in combination with lamivudine is efficient to prevent chronic hepatitis B virus (HBV) reinfection following liver transplantation. However, long-term usage of lamivudine can result in YMDD variation and lead to medicine resistance even HBV relapse. In this study, we investigated etiological factors and prevention and treatment protocol of HBV recurrence and YMDD variation after liver transplantation. METHODS:A computer-based online search of Pubmed database from January 2002 to January 2008 and Chinese Journal Full-text Database from January 2003 and December 2007 was undertaken to identify articles about HBV recurrence and YMDD variation after liver transplantation. The collected articles were firstly selected and the references of each article were looked up. Only articles that involved in HBV recurrence and YMDD variation after liver transplantation were included. The articles published in authoritative journals in recent 5 years were accepted in priority. Repetitive articles and Meta analysis were excluded. RESULTS:HBV recurrence after liver transplantation is associated with hepatitis B DNA loading dose, invasion of hepatitis B into non-liver tissues, immunosuppressive therapy and viral genovariation. The major prevention and treatment protocol of HBV reinfection after liver transplantation is the combination of anti-hepatis B immunoglobulin and lamivudine, which is economical and efficient. However, long-term administration of lamivudine induces YMDD variation in hepatitis B DNA polymerase, leading to drug resistance even HBV recurrence. Now adefovir dipivoxil is regarded as an effective remedy for YMDD variation. CONCLUSION:Virus variation and HBV recurrence can influence prognosis of HBV-related end-stage diseases after liver transplantation. Prevention and cure approaches are developing. It is important to find an economic, safe, convenient and effective therapeutic regimen. In addition, individualized treatment and the evaluation of risk and advantage should be emphasized.

ObjectiveTo introduce an improved implantation for urethral stents in patients with infra-sacral neurogenic voiding dysfunction and to evaluate its outcome.MethodsTwelve patients with infrasacral neurogenic voiding dysfunction were treated by implantation of urethral stent according to an improved method.The following objective parameters were used to evaluate the outcome:voiding diary,urine residue volume(URV),renal hydronephrosis and urodynamic tests.ResultsThese parameters were improved significantly after implantation:detrusor leak point pressure,voiding pressure and URV decreased,voiding volume and urine flow increased.The main complications were incontinence,difficult voiding and hematuria,but these were transient and disappeared during a week.ConclusionsThis procedure is effective with fewer complications,protects the function of upper urinary tract and improves the life quality of the patients with infra-sacral neurogenic voiding dysfunction.

BACKGROUND: Mesenchymal stem cells (MSCs) from adult bone marrow can alter alloimmune response in vitro and vivo. Their potentiality is great in solid organ transplantation.OBJECTIVE: To develop MSC antirejection therapy and identify behind mechanishm of MSCs immunomodulation ability. METHODS: We searched Pubmed (1994-Mar.2009) with the key words of "mesenchymal stem cells, solid organ transplantation, tolerance, immunosuppression, animal model". RESULTS AND CONCLUSION: Totally 262 English articles about influence and mechanism of action of adult bone marrow mesenchymal stem cells on solid organ transplantation were collected. The 49 suitable articles were included without earlier publication time, repeated and analogous study. Human mesenchymal stem cells did not express MHC2 Ⅱ antigen and T cell costimulatory molecules B7. Coculture with allogenic T lymphocytes could not induce T cell proliferation, but inhibited mixed lymphocyte reaction and mitogenstimulated T cell proliferation. Inhibitory effects of mesenchymal stem cells on T cell proliferation were not limited by major histocompatibility complex. Mesenchymal stem cells no matter from donors or recipients had similar immunoloregulation effects. Allogene mesenchymal stem cells could cause immunereaction in vivo, no complete immune privilege. The in vivo effects of mesenchymal stem cells will strongly depend on their localization and migration pattern after injection. Therefore, MSCs are interesting candidate cells for tolerance induction in clinical organ transplantation.

Stem cells under the controlled condition may directionally differentiate into function cells in organism,formed various types of the organization and the organ.This article narrated the concept and classification of stem cells and regeneration medicine,discussed the application of stem cells to diabetes,myocardial cell damage disease,and neurotrosis disease,analyzed and summarized the problems of stem cells and regeneration medicine.The analysis processing material demonstrated that stem cells have been widely applied to clinical trials addressing cardiovascular system disease,nervous system disease,skeleton muscle related disease,diabetes and so on.This has obtained preliminary curative effect and has demonstrated the widespread clinical practice prospect.

Objectives To investigate the surgical technique and some other related problems of simultaneous heptorenal transplantation. Methods Combined liver-kidney transplantation was performed in one patient with huge polycystic liver, bilateral kidney, and another with liver cirrhosis after hepatitis B complicated with hepatic carcinoma and uremia due to chronic nephritis. Donors' organs were infused in situ with UW solution and rapidly harvested. Orthctopic or piggyback liver tranlsplantation was carried out and the kidney was transplanted with conventional method respectively. The patients received an immunosuppression therapy including simulect (CD25 antibody), FK506 or CsA, Mycophenolate mofitil (MMF), and Predinision. Results Both transplanted organs rapidly functioned well after the operation. One patient recovered well but suffered from ALI (acute lung injury) on the 2nd postoperative day and ARDS on the 11th postoporative day. There were no acute rejection or recurrence of the primary diseases in both cases. Conclusions Simultaneous hepatorenal transplantation is one of the treatment methods for end stage liver and kidney diseases. Skillful operative technique, comprehensive perioperative monitoring and appropriate management are all important factors for obtaining a successful result. It requires more shillful techniques than single organ transplantation.

Objective To investigate the safety and effectiveness of the application of an immunosuppressing primed total lymphoid irradiation (TLI) of the recipient in kidney transplantation of living donor kidney graft. Methods 5 recipients, 3 males and 2 females with the average age of 27, underwent the primed regimen of TLI. As to 6 HLA-A, B, DR antigens of donors and recipients, 4 HLA antigen mismatches were found in one case, 3 mismatches in two cases, and 1 mismatch in two cases. The donor grafts were procured by the technique of hand-assisted transperitoneal laparoscopic living donor nephrectomy (HLDN). The primed regimen of TLI was carried out 5 days before the operation in a dosage 90 cGy/d. The intra- and postoperative immunosuppressant protocols for these cases were similar to that for the other cases, but the doses were reduced slightly. WBC, total T cell, CD4~+ and CD8~+ T cell subsets and Th1/Th2 immune deviation were examined in recipients periodically. The function of the grafted kidney, acute rejection frequency, and side effects of TLI were also observed. Results In the recipients undergone TLI, the total WBC and T cell, CD4~+ and CD8~+ subsets were reduced to a base value at 1-2 weeks post-transplantation and did not restore to the pre-transplantation levels until the investigation was ended. A particular phenomenon showing that in TLI based regimen T cells were shifted from Th1 to Th2 cells was observed. No side effects of TLI, such as infection, were found during the observation. Transplanted kidneys functioned normally and no rejection episodes were observed up to the end of the study. The immunosuppressant doses for those 5 cases were lower than that of conventional protocol. Conclusions TLI based non-myeloablative primed regimen is a safe and effective method for immunosuppression without serious side effects, and it can markedly alleviate kidney transplant rejection and reduce the dosage of immunosuppressive drugs.