ObjectiveTo evaluate the changes of portal vein pressure by (PVP) radionuclide imaging in cirrhotic patients undergoing portacaval shunt or esophageal transection-splenectomy.MethodThe radionuclide imaging was used to calculate portal pressure perioperatively in 15 shunt and 20 esophageal transection-splenectomy patients of portal hypertension.Results were compared with direct portal vein manometry.ResultPVP by manometry in portal hypertension patients 〔(37?4)?cm?H 2O〕 was very close to that calculated by preoperative imaging 〔(36?4)?cm?H 2O〕r=0.81,P

Objective To investigate the clinical efficacy of liver transplantation for liver cirrhosis and portal hypertension.Methods The clinical data of 181 patients with liver cirrhosis and portal hypertension who were admitted to the People's Hospital of Peking University from January 2000 to January 2012 were retrospectively analyzed.The efficacy of liver transplantation for liver cirrhosis and portal hypertension was investigated.The indications of liver transplantation included repeated upper gastrointestinal hemorrhage,failure of medication,surgical treatment and interventional therapy,and portal hypertension combined with hepatic functional decompensation.Orthotropic liver transplantation or piggyback liver transplantation was selected according to the condition of the patients.The pressures of the portal vein were detected before and after the transplantation of the liver graft by the manometer tube.The incidence of postoperative complications was detected.Patients were followed up regularly till December 2012.The varices and rebleeding of the esophageal veins and the survival of the patients were monitored.The survival rates was calculated using the Kaplan-Meier method,and the measurement data were analyzed using the t test.Results Of the 181 patients,65 received orthotropic liver transplantation,and 116 received piggyback liver transplantation.The operation time,volume of blood loss and anhepatic phase were (485 ± 97) minutes,(4 380 ± 1 993) mL and (56 ± 24) minutes,respectively.T tube was placed in 157 patients.The portal vein pressure was detected in 102 patients.The portal vein pressures before and after liver transplantation were (32 ± 11) cmH2O (1 cmH2O =0.098 kPa) and (21 ± 6) cmH2O,respectively.There was significant difference in the portal vein pressure before and after liver transplantation (t =2.412,P ＜ 0.05).Severe infection was detected in 23 patients,acute renal failure in 20 patients,severe abdominal bleeding in 6 patients,vascular complications in 5 patients and primary graft non-function in 2 patients after liver transplantation.A total of 181 patients were followed up for 6-131 months.One hundred and thirty-eight patients received endoscopy or upper gastrointestinal imaging at 1 year after liver transplantation.The varices were disappeared in 112 patients and alleviated in 26 patients,with the overall alleviation rate of 85.71％ (138/161).Four patients were complicated with upper gastrointestinal rebleeding within 1 year after liver transplantation,and the rebleeding rate was 3.70％ (4/108).The condition of 3 patients was alleviated by haemostatics and endoscopic treatment,and 1 patient died of liver failure caused by rebleeding.The 1-month,1-,5-year survival rates were 86.8％,84.9％ and 77.4％,respectively.Twenty-three patients died.Fifteen patients died of multi-organ dysfunction syndrome,5 died of vascular complications (2 died of hepatic artery thrombosis,2 died of portal vein thrombosis and 1 died of anastomotic stricture of vena cava),2 died of primary graft non-function,and 1 died of respiratory complications.Conclusion Liver transplantation is an efficient method for the treatment of liver cirrhosis and portal hypertension with the advantages of low rebleeding rate and ideal efficacy of reducing portal vein pressure.

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 application of helix hydro-jet in laparoscopic hepatectomy (LH).Methods Clinical data of 18 patients who underwent laparoscopic hepatectomy by helix hydro-jet were analyzed retrospectively.Results There were 18 cases including 9 cases of hepatic cavernous hemangioma,5 cases of primary hepatocellular carcinoma,2 cases of hepatic focal nodular hyperplasia,1 case of hepatic metastasis from colon carcinoma and 1 case of biliary cystadenoma in left liver.In 17 out of 18 patients laparoscopic hepatectomy was successfully completed by using helix hydro-jet.Only 1 patient was converted to open hepatectomy during operation due to uncontrollable hemorrhage from the branch of left hepatic vein.Partial hepatectomy was performed in 14 cases and hepatic left lateral hepatectomy was performed in 3 cases.Average intraoperative blood loss was 230 ml and average operation time was 170 minutes.No postoperative hemorrhage and hepatic function failure was observed.Postoperative bile leakage was observed in 1 patient,which was cured by drainage.Asymptomatic pleural effusions was found in 2 patients,necessitating no special intervention.The average hospital stay after the surgery was 5.6 days.5 patients with hepatocellular carcinoma were followed up for an average of 17 months and the patient converted to open hepatectomy suffered from tumor recurrence 13 month postoperatively.No implantation metastasis was observed on the trocar sites.Conclusions Laparoscopic hepatectomy by helix hydro-jet device can provide excellent visualization of vessels and bile ducts,which can assure the safe margin of hepatic neoplasm.No severe complications were observed.Laparoscopic hepatectomy by helix hydro-jet is a safe and feasible technique.

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 analyze clinical features,surgical treatment efficacy and prognostic factors of bone metastasis patients after liver transplantation for hepatocellular carcinoma.Methods A retrospective clinical data of 20 bone metastasis patients after liver transplantation for hepatocellular carcinoma from July 2000 to January 2010 were received.The effect of surgery aimed at bone metastasis was evaluated.Univariate and multivariate prognostic risk factors were analyzed.Results The median survival time of these patients was 7.5 months and 1-year survival rate was only 20％.Surgical treatment could relieve pain and promote patients' peformance status significantly.Univariate and multivariate analysis found that tumor microvascular invasion within the removed recipient liver was the only prognostic risk factor.Conclusions Patients of bone metastasis after liver transplantation for HCC had poor prognosis.Surgical treatment helps improve patient's quality of life.Tumor microvascular invasion is the risk factor of surgical prognosis.

ObjectiveTo investigate the incidence of de novo malignancies in liver transplantation recipients.MethodsWe retrospectively assessed data of 475 patients undergoing liver transplantation from May 2000 to December 2008. ResultsAmong the 475 recipients followed-up for 6 months at minimum,5 patients developed de novo malignancy and the total incidence rate was 1.1％.The median elapsed time from transplant to the diagnosis of de novo malignancy was 14 months (range 6 to 72).The patients were all males,including one of rectal cancer which was cured by radical resection,2 of hepatocellular carcinoma who died 6 and 14 months respectively after the diagnosis,1 of neuroendocrine carcinoma of the lung dying after 16 months,1 of Bukitt lymphoma who died within 2 months.Conclusions De novo malignancy is an uncommon event in liver transplantation recipients,but the outome is very poor.

Objective:To investigate the outcome of liver transplantation(LT) for end stage liver disease with portal vein thrombosis(PVT) in different processes.Methods: Data from 308 patients who underwent LT from July 2004 to February 2008 were retrospectively assessed.The processes of varies grades of PVT during LT were analyzed and estimated for whether the outcome of LT was different between patients with or without PVT.Results: There were 46 patients with PVT,including 11 of grade 1,14 of grade 2,18 of grade 3 and 3 of grade 4.LT performed in grade 1 and 2 PVT patients without special intervention.LT was performed in 16 patients with grade 3 PVT after simple thrombectomy or thrombus-extraction.The other 2 patients with grade 3 PVT received the donor superior mesenteric vein to act as a bridge between the donor portal vein and host superior mesenteric vein.Two cases with grade 4 PVT received a cavo-portal hemitransposition,and the other one anastomosis between graft portal vein and varicose coronary vein.The postoperative 1-year survival rates of patients without PVT and patients with PVT were 91.6%(240/262),80.5%(211/262)vs 86.9%(40/46),76.1%(35/46),respectively.The patients with PVT had a recurrence rate of 4.3%(2/46).Conclusion: Most patients suffering from end stage liver disease with PVT can be successfully treated by LT.However,the result of the patients with diffused PVT undergoing LT is relatively poor.

Objective To discuss the clinical presentation and management of pancreatic arteriovenous malformation.Methods The data pool for the analysis was collected from pancreatic arteriovenous malformation cases encountered by our hospital and sporadic case reports in the literature.Results A total of 95 cases were collected,including 83 males (87.37％) and 12 females (12.63％).The most common presenting symptom was epigastric pain (45.26％),followed by melena (17.89％),epigastric pain accompanied melena (14.74％) and haematemesis (8.42％).The most commonly associated complications were gastrointestinal bleeding (48.42％),pancreatitis (23.16％),duodenal ulcer (16.84％),portal hypertension (11.58％),pseudocyst (4.21％) and hemobilia (3.16％).Most cases were of singular lesion,located in the pancreatic head (61.05 ％) in 58 cases and in the pancreatic body-tail (20％) in 19 cases.Surgery (51.58％) was the most common treatment for pancreatic arteriovenous malformation cases,followed by transarterial embolization (17.89％),a combination of surgery and transarterial embolization (7.37％) and radiotherapy (4.21％).Watchful conservation was adopted in 20％ cases.Conclusions Pancreatic arteriovenous malformation occurs most commonly in males.Epigastric pain and gastrointestinal bleeding are the main clinical presentations.Surgical resection is indicated in symptomatic patients.

Objective To study the risk factors of hepatitis B virus re-infection after liver transplantation. Methods We retrospectively analyze the data of 285 patients who underwent liver transplantation for hepatitis B related diseases basing on data collected during a follow-up of at least 6 months. Results The postoperative follow-up ranges from 6 to 59 months of all the 285 cases after liver transplantation. There were 10 patients diagnosed as hepatitis B virus re-infection after liver transplantation leading to a 3.5% re-infection rate. There were 9 patients being diagnosed as HCC recurrence before HBV re-infection was identified. Patients with HCC recurrence suffered from higher HBV re-infection rate than other patients, and HBsAg and HBcAg was detected in one of the 13 metastatic HCC specimens.Conclusions HBIg combined with nucleotide analogue can effectively prevent HBV re-infention. HCCrecurrence is an important risk factor to HBV re-infection after liver transplantation.