Fifteen journals related with liver diseases were selected from Chinese science and technology journal citation reports ( core ) ( CJCR ) during 2004 - 2009.Eleven important quantitative indicators including total cited frequency and impact factor were analyzed.At the same time,the dynamic evaluation model was also used to evaluate the academic influence of the 15 kinds of liver diseases journals.There were 5 kinds of trends:always arising,spiral arising,stabilizing after adjusting,vibrating highly and adjusting.The academic influence of liver diseases journals was rather high,but there were some problems including low academic influence,low ratio of funded papers and international papers and poor paper quality.

Objective To evaluate the treatment and prevention measure for intrahepatie diffuse biliary stricture after orthotopic liver transplantation. Methods The clinical data of 21 patients with intrahepatic diffuse biliary stricture after orthotopic liver transplantation from January 2002 to December 2007 in Beijing Center for Organ Transplantation were retrospectively analyzed. A prospective clinic study was launched in order to prevent microthrombosis in the microcireulation of bile duct during warm and cold iscbemia in non-heart-beating donor since January 2006. Urokinase perfusion of the artery system was conducted during graft harvesting and reperfusion at the end of graft trimming to reduce the incidence of intrahepatic diffuse biliary stricture. Results Among 21 patients with intrahepatie diffuse and mixed type biliary stricture, 16 patients underwent liver retransplantation, and the other 5 patients died of primary graft failure while waiting for retransplantation. The incidence of intrahepatic diffuse biiiary stricture was 5.9% in non-urokinase perfusion group. On the contrary, the incidence rate of intrahepatie diffuse biliary stricture was 1.4% in urokinase perfusian group (x2 = 5.98, P < 0. 05). Conclusions Liver retransplantation is effective for refractory biliary stricture in liver transplant recipients. The incidence of intrahepatic diffuse biliary stricture is reduced in non-heart-beating donor by using urokinase perfusian.

OBJECTIVE To analyze the characteristic of vancomycin-resistant Enterococcus(VRE) infection after orthotopic liver transplantation, and provide a basis to improve prophylaxis and therapy. METHODS A retrospective survey in 136 patients who underwent orthotopic liver transplantation was carried out to define the incidence, clinical feature and therapeutic outcome of VRE infection. RESULTS Eleven patients were infected by VRE in this study and the incidence of infection by VRE was 8.1% following liver transplantation. Totally 31 of the VRE isolates were isolated, including 26 Enterococcus faecium strains and 5 E. faecalis strains. Sites of VRE infection included abdomen(n=4), blood(n=2), and respiratory tract(n=2). In the other 3 patients, VRE was cultured from multiple sites. Among 11 patients with VRE infection, 4 were sensitive to teicoplanin, and 7 resistant to teicoplanin. So 4 patients received antibiotics with teicoplanin and 7 patients with linezolid. In this study, 10 patients were cured and 1 patient died of sepsis. CONCLUSIONS VRE has become an nosocomial pathogen of increasing importance in liver transplantation patients. The risk factor of VRE infection should be paid attention. Infection prophylaxis of VRE should be emphasized.

Objective To summarize the experience of emergency orthotopic liver transplantation (EOLT) in fulminant hepatic failure (FHF).Methods The clinical date of 4 cases of FHF successfully subject to EOLT were retrospectively analyzed.Results Four patients’ consciousness completely recovered in 12 to 48 h after operation, no surgical complication occurred; Acute rejection postoperatively occurred in 2 patients and reversed after treatment. Now 4 patients were survived for 38, 17, 11, 7 months respectively with good liver function, and 3 of them went to work again.Conclusion EOLT is an effective means to cure FHF. Choosing appropriate perioperative management and (operative) timing is essential to improve the successful rate of EOLT.

Objective To discuss the feature of transient intrahepatic cholestasis in early stage of orthotopic liver transplantation. Methods Based on the review of early (within 1 month) postoperative hyperbilirubinemia in consecutive 200 patients undergoing liver transplantation, we summarized the occurrence, development and outcome of early postoperative intrahepatic cholestasis. Results Early transient intrahepatic cholestasis was identified in 112 patients. The characteristic of early intrahepatic cholestasis is that DBIL and?-GT increasingly elevated from the second or third day postoperatively, with a peak on the 7 - 14th d, then descended to normal level on approximately 21 -28th day. The average peak level of DBIL and?-GT were( 157. 32?82. 08)?mol/L and (172?80) IU/L respectively. During the period of DBIL and?-GT ascending, AST and ALT kept descending, and within 1 week it could fall to normal level. Acute rejection, drug toxicosis and bile duct obstruction were excluded. Conclusions Postoperative early transient intrahepatic cholestasis associated with ischemia-reperfusion injury has its special clinical process and most patients recover themselves without the need for special therapy.

Medical science has both the characteristics of natural science and humanities.Modem medical education pays more attention to the close association between professional education and humanistic education.How to handle the relationship between infectious disease and humanistic education has become more and more important.In current study,integrating humanistic education in clinical infectious disease teaching not only improved infectious disease teaching effect but also established good medical ethics and increased the comprehensively quality.

Objective To study the clinical characteristics which are related to malignancy in pancreatic intraductal papillary mucinous neoplasm (IPMN) with an aim to provide evidence for clinical practice.Methods Using PubMed,all pancreatic IPMN related articles with positive pathologic results before July 30th,2011 were studied.A pooled analysis was carried out on the morphological features of the disease.The analysis included gender,diameter of main pancreatic duct,diameter of cystic lesion,mural nodules and histological types (benign/malignant) of the neoplasm.Results 98 articles (including 1902 cases) were collected and analyzed.1025 cases were benign (53.89％) and 877 cases (46.11 ％) were malignant.Morphologically,there were a correlation between main pancreatic duct dilatation (≥5 mm),cystic lesion of large size (≥30 mm),presence of mural nodules and malignancy.The OR (95％ CI) were 5.591 (3.657-8.548),3.633 (2.626-5.027) and 4.983 (3.872-6.412) respectively.Conclusions A main pancreatic duct dilatation (≥5 mm),cystic lesions of large size (≥30 mm) and presence of mural nodules prompt the tumor to be malignant.In clinical work,the management of pancreatic IPMN should be made prudently based on comprehensive analysis of clinical features and the patient's status and intent.

Objective To investigate the relationship between the immunohistochemical types and the pathological types of pancreatic intraductal papillary mucinous neoplasms (IPMN).Methods Literatures on the diagnosis and treatment of pancreatic IPMN published before June 30,2011 in the PubMed database were retrieved.The literatures adopted were scored by the case reports quality assessment list.The correlation analysis between the immunohistochemical types and the gender,pathological types,characteristics of benign or malignant tumor and morphological types were analyzed.All data were analyzed using the Pearson chi-square test or multiple regression analysis.Results Thirteen literatures were adopted,the scores were 31-45 (full mark:50),and the mean score was 37.The clinical data of 826 pancreatic IPMN patients who were comfirmed by pathological examination were collected,and there were 4 immunohistochemical types:(1) The gastric type (363 patients).Of the 271 patients who underwent gender analysis,there were 195 males and 76 females,with the median age of 65.6 years.Of the 225 patients who underwent pathological types analysis,there were 146 cases of adenoma,34 cases of borderline tumor,24 cases of carcinoma in situ,21 cases of invasive carcinoma,the benign tumor was accounted for 86.68％ (293/338).Of the 215 patients who underwent morphological type analysis,there were 34 cases of main pancreatic duct type,151 cases of branch duct type and 30 cases of mixed type.(2) The intestinal type (327 patients).Of the 269 patients who underwent gender analysis,there were 184 males and 85 females,with the median age of 64.5 years.Of the 262 patients who underwent pathological types analysis,there were 28 cases of adenoma,43 cases of borderline tumor,91 cases of carcinoma in situ,100 cases of invasive carcinoma,the benign tumor was accounted for 29.21％ (85/291).Of the 151 patients who underwent morphological type analysis,there were 63 cases of main pancreatic duct type,54 cases of branch duct type and 34 cases of mixed type.(3) The pancreatobiliary type (92 patients).Of the 78 patients who underwent gender analysis,there were 41 males and 37 females,with the median age of 69.2 years.Of the 81 patients who underwent pathological types analysis,there were 4 cases of adenoma,1 case of borderline tumor,21 cases of carcinoma in situ,55 cases of invasive carcinoma,the benign tumor was accounted for 5.75％ (5/87).Of the 34 patients who underwent morphological type analysis,there were 7 cases of main pancreatic duct type,18 cases of branch duct type and 9 cases of mixed type.(4) The oncocytic type (44 patients).Of the 37 patients who underwent gender analysis,there were 24 males and 13 females,with the median age of 60.3 years.Of the 33 patients who underwent pathological types analysis,there were 18 cases of carcinoma in situ,15 cases of invasive carcinoma,and all of them were with malignant tumors.Of the 36 patients who underwent morphological type analysis,there were 9 cases of main pancreatic duct type,16 cases of branch duct type and 11 cases of mixed type.The immunohistochemical type of pancreatic IPMN was correlated with gender,pathological type and characteristics of maglignant or benign tumors (x2=10.626,281.839,333.212,r =0.097,0.569,0.625,P ＜ 0.05).The result of the chi-square test between the immunohistochemical types and the morphological types was statistically significant (x2 =50.732,P ＜ 0.05),but there was no correlation between them (r =0.010,P ＞ 0.05).Conclusion The immunohistochemical type of pancreatic IPMN is correlated with gender,pathological type and the characteristics of maglignant or benign tumors,which provide references for the diagnosis and prognosis evaluation of pancreatic IPMN.

Objective To investigate the expression of peripheral blood (PB) CD4+ CD25+ Foxp3+ regulatory T cells (Tregs) in patients with benign end-stage liver disease after liver transplantation and the relationship between levels of PB Tregs and acute rejection. Methods A prospective analysis was performed on 55 consecutive patients who underwent liver transplantation.Fourteen out of 55 cases suffered from acute rejection after liver transplantation were defined as rejection group,while the rest patients were classified into no acute rejection group. PB was obtained from liver transplant patients at different time points longitudinally: pre-transplant, post-transplant within one year and acute rejection. The circulating CD4+ CD25+ Foxp3+ Tregs in PB were measured by flow cytometry. Blood samples were drawn during acute rejection, at the same time, liver biopsies were performed. The circulating CD4+ CD25+ Foxp3+ Tregs were compared between two groups.Results There was no difference between two groups in levels of circulating CD4+ CD25+ Foxp3 + Tregs cells pre-transplant. However, the levels of circulating CD4+ CD25+ Foxp3+ Tregs in rejection group were decreased significantly as compared with no-rejection group (2. 23 % ± 0. 54 % vs. 2. 99 % ±0. 86 %,P＜0.01). The frequency of CD4+ CD25+ Foxp3+ T cells was negatively correlated with rejection activity index (RAI) (r = - 0. 80, P＜0. 01 ). Conclusion Monitoring PB CD4+ CD25+ Foxp3+ Tregs levels may be helpful in evaluating the immune state and act as a more sensitive marker for acute rejection diagnosis in the patients following liver transplantation.

ObjectiveTo analyse the clinical characteristics of pancreatic intraductal papillary mucinous neoplasm (IPMN) which coexists with extrapancreatic malignancy (EPM),with an aim to provide strategies for clinical diagnosis and treatment.MethodsThe PubMed was used to search for the pancreatic IPMN related articles with positive pathologic results.A pooled analysis was then performed.The ratio ofpancreatic IPMNs coexisting with EPMs and the locations (or the type) of EPMs were analyzed.ResultsAfter a strict process of screening,18 articles met the pre-determined standardsand were accepted.Of the 1327 patients,363 had coexisting EPMs (27.35％).There were 392 EPMs in these 363 patients.The EPMs occurred in almost all the systems of the body,especially in the digestive tract and its related organs,which accounted for 63.06％ of the EPMs. Conclusions There is a tendency for patients with pancreatic IPMN to have coexisting EPM. More than half of these EPMs are malignant tumors in the digestive system. When pancreatic IPMN is diagnosed,the clinician should be aware of the possible coexistence of an EPM and should look for the possibility of a new EPM developing in a patient after treatment of pancreatic IPMN.