Objective To explore the effect of hepatectomy or cholangiolithotomy on patients with hepatocholangic stones. Methods The clinical data of surgical treatment of 316 patients with hepatocholangic stones combined with bile duct stricture was retrospectively analyzed. The patients were divided into two groups:172 patients chiefly underwent hepatectomy,and the other 144 patients chiefly underwent cholangiolithotomy. Results The ratio of residual stones and reoperation in the hepatectomy group was significantly lower than those in the cholangiolithotomy group (P

Objective To assess the impact of a single hemodialysis on the left ventricular systolic function of uremia patients with 3-dimensional ultrasound speckle tracking imaging (3D-STI).Methods Thirty-seven clinically stable outpatients with uremia undergoing hemodialysis were studied.The echocardiographic examinations were obtained in 30 minutes before and after homodialysis.Twenty nine normal subjects with age and sex matched were selected as control groups.Conventional ultrasound was recorded and then left ventricular mass index(LVMI) was calculated.The peak systolic mitral annular velocity S' was recorded by tissue Doppler imaging.3D-STI imaging were recorded from standard left ventricular apical 4-chamber views before and after a single hemodialysis.Left ventricular end diastolic volume (LVEDV),left ventricular end systolic volume (LVESV),left ventricular ejection fraction (LVEF),and left ventricular global longitudinal peak systolic strain (LVGLS),left ventricular global radial peak systolic strain (LVGRS),left ventricular global circumferential peak systolic strain (LVGCS),left ventricular global area peak systolic strain (LVGAS) were measured.The indicators of conventional ultrasound and 3D-STI were compared between the pre-hemodialysis group and the normal control group,and also between pre-and post-hemodialysis groups.Results ①Compared with the control group,the left ventricular end-diastolic diameter (LVDD),interventrieular septal thickness at diastole (IVSD),left ventricular posterior wall thickness at diastole(LVWPD),left atrial diameter(LAD) in the group before a single hemodialysis were significantly higher (P ＜0.05 for all).Meanwhile,the S' was significantly lower (P ＞0.05) and LVMI was significantly higher in the pre-hemodialysis group than the control group(P ＜ 0.05).The LVDD,LAD,left atrial volume index(LAVI) were significantly lower in the post-hemodialysis group than that in the pre-hemodialysis group(P ＜0.05 for all).②Results of 3D-STI showed that the LVEF,LVGLS,LVGCS,LVGRS,LVGAS was significantly lower,however LVEDV,LVESV were higher in the pre-hemodialysis group compared with the control group (P ＜ 0.05 for all).After a single hemodialysis,LVEDV,LVESV,LVGLS were significantly lower than before(P ＜0.05 for all),but LVEF,LVGRS,LVGCS,LVGAS were not significantly changed (P ＞ 0.05 for all).Conclusions After a single hemodialysis,the whole systolic function of the left ventricular was not changed.but the left ventricular global longitudinal peak systolic strain was significantly lower.The parameter of LVGLS was sensitive to the change of preload and was volume-load dependent.The preload of the patients should be sufficiently considered when the LVGLS are measured in the patients with uremia undergoing hemodialysis.

BACKGROUND: Axial-flow blood pump is a main pump for ventricle assistance. Previous researches demonstrate that poor hemocompatibility of blood pump is an important factor for hemolysis and thrombus.OBJ ECTTVE: To design an axial-flow blood pump based on previous kinds of blood pumps through changing whole appearance and impeller shape of the pump by using Computer-Aided Design CAD) and Computational Fluid Dynamics (CFD), and manufacture it successfully.DESIGN: Rationality of theoretical design was verified by practical tests.SETTTNG: Beijing Anzhen Hospital of Capital University of Medical Sciences Department of Biomedical Engineering,Beijing Institute of Heart, lung and Blood Vessel Diseases; the Faurteenth Institute of China-Aerospace Science and Industry Corporation.MATERIALS: Body of blood pump and impeller were titanium alligation, and shaft bearing was ceramic. Test in vitro was accorded to artificial ventricular assist device which was provided by Department of Biomedical Engineering, Beijing Anzhen Hospital of Capital University of Medical Sciences. Experimental goats were provided by Experimental Animal Center, Beijing Anzhen Hospital of Capital University of Medical Sciences.METHODS: Since the beginning of 2005, a model of axial flow blood pump was designed in the 14th Institute of China-Aerospace Science and Industry Corporation base on decreasing shearing force and circulating dead bands. In the process, CAD and CFD were used to generate the geometrical data document of pump's structure, which included the figures of pump's body, shape and number of impeller's vanes, the structure and position of the guide vanes, and the size of impeller's screw-pitch. And then, NC machine tool was used for shaping. Finally, axial-flow blood pump was fixed on artificial ventricular assist device which was provided by Department of Biomedical Engineering, Beijing Anzhen Hospital of Capital University of Medical Sciences. The pump's hemodynamic output was 5 L/min and the average pressure was 13.3 kPa under the mixture of glycerin and water and fresh anticoagulation goat blood. The samples were collected at every one half hour during pumps being pumping for 4 hours. According to testing pressure output of blood pump, normalized index of hemolysis (NIH) was used to reflect content of free hemoglobin in plasma, observe thrombogenesis in pump and verify pump's hemodynamic output and vascular damaging degree.RESULTS: Shaped axial-flow blood pump included body, impeller, guide vanes, ceramic shaft bearing, export and import. The volume was 63 mL. Experimental results in vitro indicated that when the rotation speed of blood pump was 10 000 r/min, its pressure and flow output were 21.01 kPa and 6.0 L/min. The hemodynamic output might satisfy for left ventricular assistance. Surface temperature did not change obviously during successive rotation. The calculation indicated that most parts in blood pump showed a streaming flow. The mean NIH was (0.047±0.017) g/100 L, which was less than that of previous pumps; while, thrombogenesis was not observed in blood pump.CONCLUSTON: Axial-flow blood pump designed by using CAD and CFD can not only satisfy for the hemodynamics of a left ventricular assistant devices, but also the blood damage is milder than previous pumps. Therefore, axial-flow blood pump improves blood compatibility.

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.

ObjectiveTo determine the correlation of human leukocyte antigen-G (HLA-G)expression with CMV active infection after kidney transplantation. MethodsA total of 215 first-time kidney transplantation recipients in one transplantation center were divided into CMV ( + ) group and CMV ( - ) group according to whether they had active CMV infection. mhla-g1 expression on leukocytes was analyzed by flow cytometry. The concentrations of soluble HLA-G5 were detected by using ELISA. The sHLA-G5 cutoff levels by ROC curve was employed to predict the active CMV infection. The expression of sHLA-G5 mRNA and protein in leukocytes was analyzed by using RTPCR and Western blotting respectively. Immunohistochemical staining was used to detect the HLA-G expression in kidney biopsies of 12 cases. ResultsThe expression of mHLA-G1 in peripheral blood was low in both CMV ( + ) group and CMV ( - ) group. Also when CMV-PP65 was positive, there was no significant change in mHLA-G1. In CMV ( + ) group, the proportion of CD14+ mHLA-G1 +cells[(45. 53 ± 17.32)％]in peripheral blood was increased as compared with that in CMV (-)group[(10. 22 ± 5.78)％]. The expression of sHLA-G5 was increased significantly in CMV ( + )group. The optimal cutoff value of sHLA-G5 predicting the active CMV infection was 202. 9 μg/L,with high diagnostic accuracy. HLA-G was positive in the kidney tissue of 10 patients out of 12 patients with active CMV infection. Both RT-PCR and Western blot analysis showed that sHLA-G5 was significantly higher in CMV ( + ) group than that in CMV ( - ) group. ConclusionROC curve analysis of sHLA-G5 with the cutoff value of 202. 9 μg/L can be used to predict the active CMV infection. The HLA-G levels in peripheral blood were significantly increased and HLA-G expression in the tubular epithelial cells of the graft could be a protection mechanism of the kidney function.

Objective To study the correlation of HLA-G levels with acute rejection and CMV active infection post-kidney transplantation.Methods A total of 132 initial kidney transplantation recipients were divided into kidney function stable group (F),acute rejection group (AR),CMV group according to whether they had active CMV infection and acute rejection.Forty-one healthy donors served as control group (H).HLA-G levels and mRNA expression were analyzed by using flow cytometry,ELISA,RT-PCR and Western blotting.Immunohistochemical staining was used to detect the HLA-G expression in kidney biopsies.Results The expression levels of mHLA-G1 were low in all 4 groups pre-transplantation.Only CMV group had significantly more CD14+ mHLA-G1+ cells post-transplantation (P＜0.05).sHLA-G5 levels were higher in F group than in H group (P＜0.05),but there was no significant difference among other groups pre-transplantation (P＞0.05).sHLA-G5 levels were increased significantly in CMV group as compared with F group (P＜0.05),and those in F group were higher than in H and AR groups (P＜0.05).Renal tissue biopsies from 21 renal transplantation recipients with AR indicated that HLA-G5 was expressed negatively in 17 patients,positively in 3 patients and 1 weakly positively.HLA-G was positive in the kidney tissue of 9 patients out of 9 patients with active CMV infection.In total 132 recipients,AR incidence was significantly lower in CMV ( + ) group (7.1 ％,2/28) than that in CMV ( - ) group (24.0 ％,25/104).Conclusion The sHLA-G5 may contribute to predict AR and CMV active infection; AR and CMV active infection may be correlation with immune balance in kidney transplantation recipients.

Objective To measure the cytokines levels in peripheral blood from kidney transplantation recipients by using cytometric bead array and to analyze their change and the clinical significance in pre- and post- kidney transplantation, inducting with basiliximab and graft rejection. Methods A total of 72 renal transplantation recipients were divided into two groups, kidney function stable group(n =53) and acute rejection group (n = 19). And they were also grouped by induction with basiliximab or not,32 in basiliximab group and 40 in without basilixmab group. The levels of IFN-γ, TNF-α, IL-10, IL-5,IL-4, IL-2 were measured by cytometric bead array in peripheral blood of 72 kidney transplantation recipients and 30 healthy donors at differential time. The data was analyzed according to the following grouping:donors and recipients, kidney function stable group and acute rejection group post transplantation and with or without basiliximab group. Results The levels of TNF-α, IL-10, IL-5, IL-4, IL-2 in recipients before transplantation were ( 1.65 ±0. 10) ,(2. 55 ±0. 19) ,( 1.88 ±0. 14) ,(1.85 ±0. 12) ,(2. 12 ±0. 09) ng/L,respectively. While they were (3.04 ±0. 17), (3.33 ±0. 26), (4.03 ±0.25), (2.73 ±0. 16), (4.03 ±0. 26) ng/L respectively in healthy donors. There was statistical significance between the two groups ( t =6. 890, 2. 375, 7. 851,3.955,7.153, P<0. 01, <0. 05, <0.01, <0.01, <0.01). While the level of IFN-γ in recipients before transplantation was (2. 50 ±0. 18) ng/L,compared with (3. 00 ±0. 24) ng/L in healthy donors. There was no statistical significance between the two groups( t = 1. 625, P > 0. 05 ). The levels of IFN-γ and IL-10 in kidney function stable group were (2. 71 ± 0. 11 ) ng/L and (3.91 ± 0. 52) ng/L,while they were ( 3.30 ± 0. 36 ) ng/L and ( 12. 01 ± 5.35 ) ng/L in acute rejection group. There were statistical dirrerences between the two groups ( t = 5. 061, 11. 465, P < 0. 01, < 0. 05 ). Before induction with basiliximab, the levels of IFN-γ, TNF-α, IL-10 in recipients were (2.90 ±0. 21 ), ( 1.67 ±0. 12),(2. 45 ± 0. 16) ng/L respectively. But they were ( 2. 78 ± 0. 17 ), ( 1.58 ± 0. 07 ), ( 2. 77 ± 0. 24 ) ng/L respectively after induction with basiliximab, which showed significantly different ( t = 5. 605, 6.011,4. 126, P <0. 01, <0. 01, <0. 05). Four weeks after kidney transplantation in recipients with basiliximab,the levels of IFN-γ, IL-10, IL-4 were (2. 90 ± 0. 31 ), (9. 08 ± 0. 16), (2. 73 ± 0. 11 ) ng/L. While they were (3.28 ±0. 11 ), (4. 17 ±0. 21 ), (2. 11 ±0. 20) ng/L respectively in recipients without basiliximab induction, which were significantly different from those with basiliximab induction (t = 4. 268,4. 263,3.762, P <0. 01, <0. 01, < 0. 05 ). Conclusions Six kinds of cytokines can be measured by cytometric bead array simultaneously and accurately. The data suggests that the detection of multiple cytokines in kidney transplantation recipients by cytometric bead array can provide more guidance for clinical diagnosis and therapy.

Objective To evaluate the efficacy and security of splenic artery ligation for severe hypersplenism during liver transplantation.Method Thirty-two liver transplant patients with preoperative hypersplenism were selected,including 17 cases (ligation group) treated by splenic artery ligation during liver transplantation,and rest 15 patients as non-ligation group.The fluctuation of white blood cells,platelets and volume of spleen were compared between these two groups.At the same time,splenic infarction,postoperative infection,recurrent gastrointestinal bleeding,splenic artery steal syndrome and other complications were observed in these two groups.Result All recipients were followed up for over 6 months.One recipient in ligation group died of multiple organ dysfunction caused by delayed recovery of liver donor with the survival rate being 94.1％ (16/17).The survival rate in non-ligation group was 93.3 ％ (14/15) (one recipient died of respiratory failure caused by pulmonary infection).There was no statistically significant difference in survival rate between these two groups (P＞0.05).Splenic necrosis wasn't detected in the ligation group.The splenic volume in ligation group was significantly less than that in non-ligation group (P＜0.01).The products of splenic maximum length and wide diameter shrunk 33.17-± 8.26 cm2 and 22.47 ± 7.25 cm2 in ligation group and non-ligation group,respectively.The platelet counts of ligation group were significantly greater than those of non-ligation group in all the observation points within 6 postoperative months (P＜0.01).The white blood cell counts of ligation group were greater than those of non-ligation group at the first week postoperatively (P＜0.01),whereas,there was no statistically significant difference between these two groups from then on (P＞0.05).The infection incidence of ligation group was lower than that of non-ligation group within 6 postoperative months (P ＜0.05).Statistically significant differences in recurrent gastrointestinal bleeding and splenic artery steal syndrome weren't found between these two groups (P＞0.05).Conclusion Splenic artery ligation in liver transplantation is safe and effective.It can rapidly increase the counts of platelet and white blood cell in the earlier postoperative time,which is beneficial to patient's recovery.Besides,it adds no correlative complication.

Objective To study the effects of tacrolimus(Tac) concentrations on the number of NK cells and receptor expression in peripheral blood of renal transplantation receptors.Methods A total of 60 first-time kidney transplantation recipients in our institute from Dec.2007 to July 2009 were followed up.Tac maintenance immunosuppressive therapy was given to all recipients.The recipients were divided into low-concentration Tac group (6.84 + 1.72μg/L,n =30) and highconcentration Tac group ( 11.88 + 2.59 μg/L,n =30) according to concentrations of Tac.Twenty healthy volunteers served as controls.Before and 6 months after operation,concentrations of Tac were analyzed by using micro particle immunoassay chemiluminescent method.NK cells and their receptors (CD85j,CD158d,CD94 and NKG2D) were detected by using flow cytometry.The concentrations of soluble HLA-G5 were detected by using ELISA.Results The number of NK cells in lowconcentration Tac group and high-concentration of Tac group preoperatively was significantly reduced as compared with control group (P ＜ 0.05 ). The percentage and number of NK cells in low concentration Tac group and high-concentration Tac group at 6th month after operation were significantly reduced as compared with control group (P＜0.05).The number of NK cells in lowconcentration Tac group was significantly greater than in high-concentration Tac group (P＜ 0.05).There was no significant differende in the expression of CD85j,CD158,CD94 and NKG2D before operation between two groups(P＞0.05).The expression of CD85j and CD158d in two groups was increased,but that of CD94 and NKG2D was decreased at 6th month post-transplantation as comapred with that preoperation.In low-concentration Tac group,the expression of CD85j and CD158d was increased as compared with that in high-concentration Tac group (P＜0.05 ).Spearman correlation analysis revealed that the CD85j and CD158d expression had a positive correlation with sHLA-G5(P＜0.01 ),but the NKG2D had a negative correlation with sHLA-G5(P＜0.01 ).Conclusion There was correlation between the concentrations of Tac and NK cells count and NK receptors. Low concentrations of Tac can safely and effectively protect kidney function.The number of NK cells andtheir inhibitor receptors are increased in the recipients with low concentration of Tac.

BACKGROUND:Cytotoxic T lymphocyte-associated antigen 4 is a newly discovered costimulatory molecule. It has been studied more in tumor and autoimmune diseases, less in the field of kidney transplantation.
OBJECTIVE:To explore the role of cytotoxic T lymphocyte-associated antigen 4 in acute rejection after renal transplantation.
METHODS:Fifty patients undergoing renal transplantation were divided into acute rejection group (20 cases) and stable graft function group (30 cases). Another 30 healthy persons served as control group. Blood samples were extracted from the peripheral blood. Cytotoxic T lymphocyte-associated antigen 4 was detected by enzyme linked immunosorbent assay and flow cytometry.
RESULTS AND CONCLUSION:The expression of cytotoxic T lymphocyte-associated antigen 4 in the serum showed significant differences in the acute rejection group, stable graft function group and healthy control group (F=70.008 1, P=0.000 0), but showed no difference in peripheral blood lymphocytes of three groups (F=1.865 6, P=0.161 7). Compared with the healthy control group, the expression levels of cytotoxic T lymphocyte-associated antigen 4 in peripheral blood lymphocytes of acute rejection group and stable graft function group were significantly decreased (P=0.000 0). In addition, the acute rejection group had a lower cytotoxic T lymphocyte-associated antigen 4 expression than the stable graft function group (P=0.000 0). In renal transplant rejection, the expression of cytotoxic T lymphocyte-associated antigen 4 in serum was reduced, showing some correlation with acute rejection after renal transplnatation. Cytotoxic T lymphocyte-associated antigen 4 might be involved in the rejection.