According to professor DONG Ting-yao,s understanding,syndrome differentiation characteristic,principle of treatment and so on to the young child spleen gastric disease,the paper lifted the clinical application of rising jin and activating spleen,harmonizing ying and noruishing stomach,dispersing stagnated liver-qi and regulating spleen,strengthening earth to generate metal,clearing spleen and dissipating hygrosis,invigorating spleen and benefiting qi.Professor DONG Ting-yang cured various kinds of disease through regulating spleen and stomach.

Donation after cardiac death (DCD) means organ harvest and donation cannot be carried on until the requirement of death criteria using cardiopulmonary arrest is reached.Great success has been achieved since DCD was promoted widely in China.However,some problems were encountered during the implementation of DCD and there also exists many ethical controversies.The ethical principles of informed consent and no harm mentioned inDonation after Cardiac Death Work Instructions of China should be strictly adhered to,while justice,fairness and openness must be ensured in organ allocation.Appropriate compensation should be given to DCD donor and his family,and the utilization of DCD should be further improved.All of these ethical principles will help to promote the healthy development of organ donation and transplantation in China.

Objective To establish an animal model of hepatic inflow occlusion with meso-caval shunt in Bama swines so as to evaluate the tolerance limit of normothermic hepatic inflow occlusion.Methods Eighteen Bama swines were divided into group A in which the hepatic blood inflow was occluded for 90 min and group B in which the hepatic blood inflow was blocked for 100 min.The animal survival rate,the changes of liver function and histopathology were observed.Results The animal survival rate was significantly higher in group A than group B(100% vs 44.4%,P

Objective To investigate the application of structured triglyceride (STG) in malignant obstructive jaundice (MOJ) patients after pancreaticoduodenectomy.Methods The records of 21 MOJ patients received pancreaticoduodenectomy in our hospital were retrospectively analyzed.The patients received parenteral nutrition on the first postoperative day, of whom 7 were given STG (STG group) and 14 were given medium and long chain triglyceride (MCT/LCT group).The changes of liver function, lipid profile, albumin, and postoperative complications were compared between the two groups.Results The triglyceride levels in the STG group on the 3rd and 7th postoperative days were significantly lower than those in the MCT/LCT group [3rd day:(1.85 ±0.90) mmol/L vs.(2.18 ±1.41) mmol/L;7th day: (1.62 ±0.78) mmol/L vs.(2.46± 1.62) mmol/L;both P =0.042];the level of high-density lipoprotein on the 7th postoperative day was significantly higher than that in the MCT/LCT group [(0.67 ±0.64) mmol/L vs.(0.45 ±0.15) mmol/L, P =0.046].The albumin in the STG group returned to normal on the 3rd postoperative day, which was significantly higher than that in the MCT/LCT group [(35.50 ±2.91) g/L vs.(30.66 ±5.08) g/L, P =0.048].There were no significant differences in terms of liver function, length of hospital stay, wound healing, systemic inflammatory response syndrome, and infection between the two groups.Conclusions Parenteral nutrition with structured triglyceride after pancreaticoduodenectomy in MOJ patients is tolerable and safe.STG has less influence on lipid metabolism than MCT/LCT does, and can increase albumin level rapidly.

Objective To optimize the condition of converting murine naive CD4+ CD25-T cells ( effector T cells,Teffs) to CD4-CD8-double negative regulatory T cells ( DN Tregs) in vitro.Methods Naive Teffs from C57BL/6 mouse were isolated with magnetic activated cell sorting( MACS)and co-cultured with DBA/2 mature dendritic cells (mDCs) with different doses of recombinant murine interleukin-2 (IL-2).The percentage of converted DN Tregs was examined by flow cytometry after 6 days.Purified DN Tregs were co-cultured with CFSE labeled Teffs.The proliferation rate of Teffs were evaluated by flow cytometry.Results Without IL-2,the percentage of CD4-CD8-T cells was 6.21％ ± 2.03％.With IL-2,the percentage was 14.77％ ± 2.15％ ( 25 ng/ml),21.29％ ± 2.68％ (50 ng/ml),43.45％ ±4.45％ (75 ng/ml),and 28.59％ ±3.05％ ( 100 ng/ml) respectively.The IL-2 concentration of 75 ng/ml signilicantly enhanced the conversion of Teffs to DN Tregs ( separately t =10.700,8.288,6.158,3.932,all P ＜ 0.05).Highly purified DN Trega significantly suppress the proliferation of Teffs in vitro.Conclusions Teffs are converted to DN Trega in vitro with the LPS-activated allogeneic mDCs and that 75 ng/ml of IL-2 is the optimal concentration for the conversion of Teffs to DN Trogs in vitro.

Objective To evaluate the clinical application of Helix water-jet dissector in complex hepatectomy. Methods Clinical data were retrospectively analyzed in 47 patients who received complex hepatectomy using Helix water-jet dissector for the parenchymal division. It was evaluated for the intraoperative blood loss, operation time, postoperative hepatic function and complications in these patients.Results Forty seven patients including 10 cases of hepatic giant cavernous hemangioma, 34 cases of hepatocellular carcinoma, and 3 cases of miscellaneous liver tumors. Among these patients, caudate lobe resection was performed in 6 cases, hepatic segment Ⅵ + Ⅷ resection in 19 cases, segment Ⅳ + Ⅴ + Ⅷresection in 9 cases, segment Ⅷ resection in 5 cases and right hepatic trisegmentectomy in 8 cases. The operation time was (240 ±85) min, intraoperative blood loss was (950 +650) ml, 13 out of 47patients (27.7%) received heterologous packed red blood cell (PRBC) transfusion for more than 2 units per case.Length of stay in hospital was ( 12. 5 ±4. 7) days. Post-operative complications included ascites in 6 cases,hydrothorax in 4 cases, atelectasis in 2 cases and pulmonary infection in 4 cases. No severe complications and death occurred in this group. Conclusion Water-jet dissector may increase operation accuracy,decrease massive blood loss and postoperative complications, therefore, it should be widely used in complex hepatectomy.

Objective To investigate the protective effects of 17β-estradiol on ischemia reperfusion injury in rat liver transplantation. Methods The rats were divided into three groups: male to male group(MG), female to female group (FG), and male to male group which were given 17β-estradiol 4000 μg/kg 24 hours before liver transplantation intraperitoneally (M + EG). Then transplantation was performed. At 6 hours after portal vein reperfusion, blood samples were obtained to determine the levels of alanine aminotransferase(ALT), aspartate aminotransferase (AST), and nitric oxide(NO). The expression of endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) in liver were observed by immunohistochemistry. Results ALT and AST levels in the M+EG group were lower than those in MG and FG (561. 69 U/L vs 730. 78 U/L and 678. 82 U/L; 726. 44 U/L vs 914. 21 U/L and 861. 86 U/L). The NO level (63. 54 μmol/L) was much higher than those in the MG and FG groups. The expression of eNOS in the M+EG group was higher than those in MG and FG, while the expression of iNOS in M+EG were lower than those in MG. and FG. Conclusion 17β-estradiol can attenuate ischemia reperfusion injury in rat liver transplantation by improving the balance of eNOS and iNOS.

Objective To evaluate the feasibility of OX40L gene silence in dentritic cells by RNAi through lentiviral vector, so that to explore the influence of CD4 + CD25 + T regulatory cells by blocking OX40/OX40L costimulation signals. Methods Serial plasmids were constructed, consisting of lentiviral vector framework, containing different OX40L siRNA sequences. The most effective packaged one by 293T cells to be the operating siRNA vector named OX4OL-RNAi-LV was chosen. The negative comparing vector was NC-GFP-LV. DCs isolated from C57BL/6 mice by magnetic selecting system were cultured in vitro and divided into 3 groups. Experimental group and negative control group were transfected with OX40L-RNAi-LV and NC-GFP-LV, respectively, and the blank control group was given the same volume culture solution. The MOI was 25. The status of transfection and GFP expression was monitored by GFP fluorescence. 6 days later, CD86 positive DCs were isolated and were co-cultured with CD4 + CD25 + T regulatory cells isolated from na(y)ve BALB/C. 6 days later, the proliferation and apoptosis of Tregs were evaluated by flow cytometry.Results The most effective siRNA sequence targeted the C,CTCATACAAGAATGAGTA episode of OX40L gene. The suppressive ratio of the OX40L protein expression was 73.1%. While the MOI was 25, the DCs transfected ratio by lentiviral vectors was at the level of 86. 4%. After co-cultured for 6 days, the CD4+CD25 +T regulatory cells of experimental group have a higher proliferation index (respectively, 38.3% vs.24.5 % ,22. 9%, F = 95.40, P = 0. 000) and lower apoptosis percentage ( respectively, 8.7 % vs. 20. 1%,19.8%, F=244.22,P=0. 000) than negative group and blank group. Conclusions The OX40L siRNA lentiviral vetor was constructed. This vector could effectively transfect DCs and block OX40/OX40L pathway, so to promote CD4 + CD25 + T regulatory cells proliferation in vitro.

Objective To explore the clinical effect of embolectomy through incision of right atrium and inferior vena cava under normothermia cardiopulmonary bypass with beating heart + partial hepatectomy for hepatocellular carcinoma (HCC) combined with tumor thrombus in right atrium and inferior vena cava.Methods The retrospective and descriptive study was conducted.The clinical data of 1 patient with HCC combined with tumor thrombus in right atrium and inferior vena cava who were admitted to the Peking University People's Hospital in December 2014 were collected.The patient underwent embolectomy through incision of right atrium and inferior vena cava under normothermia cardiopulmonary bypass with beating heart + partial hepatectomy.Observation indicators:(1) intra-and post-operative situations:intraoperative findings,operation time,cardiopulmonary bypass time,volume of intraoperative blood loss,intraoperative blood transfusion,postoperative complication and duration of hospital stay;(2) postoperative pathological examination;(3) follow-up situation:survival of patient and tumor recurrence or metastasis.Follow-up using outpatient examination was performed to detect survival of patient and tumor recurrence or metastasis up to September 2016.Results (1) Intra-and post-operative situations size of tumor thrombus in right atrium,operation time,cardiopulmonary bypass time,volume of intraoperative blood loss,volumes of intraoperative red blood cell and blood plasma transfusions were 3.0 cm × 4.0 cm,630 minutes,85 minutes,4 000 mL,1 820 mL and 2 200 mL,respectively.The abnormal and transient liver and renal functions in early stage after surgery recovered quickly to the normal level.Patient with pleura1 effusion and pulmonary infection received active treatment,and then ventilator treatment was stopped at 5 days postoperatively and closed thoracic drainage-tube was removed at 15 days postoperatively.There was no occurrence of hemorrhage,bile leakage and wound infection.Patient was discharged from hospital at 25 days postoperatively.(2) Postoperative pathological examination:tumor with unclear boundary and gray-white section located in the right posterior lobe of the liver.Tumor thrombus in right atrium and inferior vena cava was gray-white,with a rough texture and size of 4.0 cm × 4.0 cm × 2.0 cm.Immunohistochemical staining dectection showed that liver cells,glypican 3 and CD34 were positive and alpha-fetoprotein was negative,with a positive index of Ki-67 of 15％.The moderate-differentiated HCC was confirmed by pathologic examination.(3) Follow-up situation:patient had a smooth recovery after discharge,without obvious discomfort.Hepatic arterial-venous fistula was confirmed at 45 days postoperatively by hepatic arterial angiography.Patient underwent preventive infusion chemotherapy with oxaliplatin and gemcitabine,and right hepatic arterial embolization with gelatin sponge.During the follow-up,patient received regular reexaminations of abdominal computed tomography and chest X-ray,without tumor thrombus in inferior vena cava and tumor recurrence.Conclusion Embolectomy through incision of right atrium and inferior vena cava under normothermia cardiopulmonary bypass with beating heart and partial hepatectomy are safe and feasible for patient with HCC combined with tumor thrombus in right atrium and inferior vena cava.

Objective To investigate the precautionary effect of fibrin glue on postoperative bleeding and bile leakage when used in partial hepatic resection.Methods House-hold rabbit partial hepatectomy model was prepared and 40 rabbits were divided into sham operation(SO) group(n=10),control group(n=10) and protocol group(n=20) randomly.The SO rabbits received laparotomy only,while both the control and protocol group received partial hepatectomy.Fibrin glue was used in the protocol group following electric coagulation therapy while the control group received electric coagulation therapy only.The animals' diet,weight and adverse effects were observed then,and the celiac drainage volume,levels of hemoglobin(Hg),WBC and TBil in celiac outflow and ALT,AST,LDH and TBil in rabbit serum were checked on schedule after operation.Results The average blood loss volume and operation time in the protocol group were(16.0?2.7) ml and(23.7?2.9) min respectively,which were lower than those in the control group((20.8?3.5) ml and(27.3?2.9) min(P