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.

Tumorous cells are characterized by distinctive metabolic reprogramming and living conditions. Understanding drug metabolizing features in tumor cells will not only favor the estimation of metabolic rate, elimination half life and the assessment of potency, but also facilitate the optimal design of anti-tumor drugs/prodrugs. This article reviewed the expression and activity features of major drug metabolizing enzymes (DMEs) in solid tumorous tissues, such as liver, intestine, breast and lung, and the difference from the correspondingly normal tissues, exemplified by the metabolic properties of some classic antitumor-agents in tumorous tissues. In combination with the data retrieved in vitro tumor cell lines, we discussed the similarities and differences of DMEs expression and function between tumor tissues (in vivo) and tumor cells (in vitro), and proposed the possible factors that cause the differences.

One of the most promising antimalarial drugs which are widely used throughout the world is the artemisinin (ARS)and its derivatives,e.g.,artemether,arteether,and artesunate.Their true potential lies in broader anti-disease applications.The mechanism of action of these compounds appears to involve the endoperoxide bridge to produce carbon-centred free radicals.Large clinical studies did not show serious side effects,however,there is a paucity of large-scale clinical trials suitable to detect rare but significant toxicity.Therefore,a final and definitive statement on the safety of artemisinins still cannot be made.In contrast,animal experiments at high doses shown considerable toxicity upon application of artemisinins.In the present review,the authors give a comprehensive overview on toxicity studies in cell culture and in animals (mice,rats,rabbits,dogs,and monkeys)as well as on toxicity reported in human clinical trials.The authors emphasize the current knowledge on neurotoxicity,embryotoxicity, genotoxicity,hemato-and immunotoxicity and cardiotoxicity.Rapid elimination of artemisinins after oral intake represents a relatively safe route of administration compared to delayed drug release after intra-muscular (im ) injection. There are drug-related differences, i.e., intramuscular application of artemether or arteether,but not to artesunate,which is safe and gives good profiles after im administra-tion in severe malaria.It might also be important in determining dose limitations for treatment of other diseases such as cancer.Questions about dosing regimens,safety of long-term use and possible inter-actions with existing therapies and toxicities that might be related to the treatment of tumors should be answered by appropriate clinical and preclinical studies.

Objective To evaluate intraperitoneal Composix Kugel prosthetic patch repair of vental hernia. MethodsThe clinical data of 10 cases were reviewed for the surgical procedures and perioperative management in the use of this technique. ResultsMean operation time was 62 min(ranging grom 43 to 80 min). There was no postoperative wound hematoma and infection except for 1 case with seroma. Follow up of 2 to 19 months found no hernia recurrence. Conclusion Intraperitoneal Composix Kugel patch repair of vental hernia has the advantages of short operative time, minimal invasiveness and rapid convalescence.

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.

ObjectiveTo study the diagnosis and treatment of primary retroperitoneal tumor ( PRT) and the key for preventing and treating of recurrent retroperitoneal tumor (PRT).MethodsThe clinical data of 42 patients with PRT operated on from 1990 to 2000 were retrospectively analyzed.ResultTumors were benign in 19 patients and malignant in 23. Of the 19 patients with benign tumor, 15 underwent complete resection with incidental organ resection in 3 cases, palliative resection in 1 case, and complete resection of recurrent tumor in one. Of the 23 malignant tumors, complete resection was performed in 9 cases, complete resection with incidental organs resection in 11 cases, biopsy only in 3 cases. There was no operative death.ConclusionPreoperative imaging results are gists on which the resectability is judged, and complete resection is the only hope of cure. Surgical resection is the therapy of choice for postoperative recurrent PRT.

ObjectiveTo investigate the causes and management of postsplenectomy continuous fever in portal hypertensive patients. MethodThe clinical data of 329 portal hypertension patients with liver cirrhosis undergoing splenectomy from 1992 to 2001 were reviewed. Among those, 72 patients suffered from a fever higher than 38.5℃ for more than 2 weeks postoperatively. ResultThe most common cause was portal or splenic vein thrombosis and hematocele or hydrops and infection in splenic recess. Portal or splenic vein thrombosis was related to the surgical modality adopted and liver function. ConclusionPortal system thrombosis and hematocele, hydrops, or infection in the splenic recess were among the most common causes leading to postoperative long-term fever in these patients. Active anticoagulant use, effective drainage, antibiotic therapy and judicious application of surgical modality will help to reduce the rate of postoperative fever.

Objective: To observe the effect of the combination of acupuncture and medication on orthostatic hypotension after incomplete cervical spinal cord injury. Methods: Ninety-two patients with orthostatic hypotension after incomplete cervical spinal cord injury were divided into two groups according to the random number table method, with 46 cases in each group. The control group was treated with oral midodrine hydrochloride on the basis of conventional treatment, and the observation group was treated with acupuncture in addition to the intervention used in the control group. Both groups were treated for 4 weeks. The changes in supine and orthostatic blood pressures, motor and sensory scores, quadriplegic function index score, clinical efficacy, and safety evaluation were observed. Results: During the treatment, 2 cases dropped out in the observation group, and 3 cases dropped out in the control group. After 4 weeks of treatment, the clinical efficacy of the observation group was better than that of the control group (P<0.05). After treatment, the supine systolic blood pressure and diastolic blood pressure in the two groups had no significant changes (P>0.05), while the orthostatic systolic blood pressure and diastolic blood pressure, the motor and sensory scores, and the quadriplegic function index score were significantly higher than those before treatment (P<0.05), and the scores in the observation group were higher than those in the control group (P<0.05). Adverse reactions were mild in both groups. Conclusion: The combination of acupuncture and medication can significantly improve the orthostatic blood pressure, motor and sensory function and daily living ability of patients with orthostatic hypotension after incomplete cervical spinal cord injury, and it is safe and reliable.

Objective To evaluate the diagnostic procedures and treatment choice of primary malignant tumor of the duodenum.Methods The clinical data of 170 cases with primary malignant tumor of the duodenum at Peking University People's Hospital from 1996 to 2015 were analyzed retrospectively.Results Tumors located in the first,second,third and fourth parts in 14 cases (8.2％),144 cases (84.7％),9 cases (5.3％),and 3 cases (1.8％) respectively,and among them,tumors within papillary area accounted for 62.4％ (106 cases).The main clinical presentations included jaundice,upper abdominal pain,abdominal distention,nausea and vomiting.Among the 170 cases,125 cases obtained accurate tumor stages,with 34 cases on stage Ⅰ (27.2％),45 cases on stage Ⅱ (36.0％),30 cases on stage Ⅲ (24.0％),16 cases on stage Ⅳ (12.8％).The accuracy rate of ultrasound and CT in preoperative diagnosis was 27.6％,and 72.3％ respectively.The pathological type of 144 cases (84.7％) was adenocarcinoma.The postoperative 1-,3-and 5-year survival rate was 69.1％,48.6％ and 33.9％.Conclusions Most primary malignant duodenal tumors are located in papillary region,necessitating radical pancreaticoduodenecomy,early diagnosis remains the key for longterm survival.

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.