Pancreatic neuroendocrine tumor (pNET)is a rare type of pancreatic tumors.The incidence of pNET shows a gradually increas-ing trend in recent years.The most common organ of distant metastases is the liver.Surgical resection is still the optimal treatment for resect-able,well -differentiated liver metastases with no evidence of extrahepatic spread.For unresectable patients,a combination of multiple mo-dalities,such as transarterial chemoembolization,radiofrequency ablation,systemic chemotherapy,and molecular targeted therapy,can pro-long the survival time of patients.Liver transplantation should be strictly evaluated on an individual basis.

Objective To investigate the relationship of the nutritional status with liver function and clinical outcomes of liver cancer patients treated with surgery.Methods Altogether 112 hospitalized patients undergoing surgical treatments for liver cancer were enrolled from October 2011 to October 2013.Their general clinical data were collected,including creatinine-height index (CHI),arm circumference,grip strenghth,albumin,prealbumin,and transferrin.The nutritional status was assessed using Patient-Generated Subjective Global Assessment (PG-SGA).The liver function was assessed with Child-Pugh classification.Postoperative infectious complications and the hospital stays were recorded to assess the clinical outcomes.The correlation between nutritional status and liver function,and that between nutritional status and clinical outcomes were analyzed.Results Among the 112 patients,70 (62.5％) were in normal nutritional status,34 (30.4％) were with moderate malnutrition,and 8 (7.1％) were with severe malnutrition according to PG-SGA scores.PG-SGA assessment showed strong consistence with CHI nutritional assessment (κ =0.760,P =0.000),and moderate consistence with arm circumference assessment (κ =0.564,P =0.000),and grip strength assessment (κ =0.523,P =0.000).The live function classified by Child-Pugh was found highly correlated with PG-SGA assessment (rs =0.829,P =0.000).Postoperative infectious complications and hospital stays were both positively correlated with PG-SGA assessment (r =0.349,P =0.000 ; r =0.624,P =0.000).Conclusions PD-SGA combining with CHI can be used for the nutritional status assessment of liver cancer patients undergoing surgical treatments.The nutritional status of the patients has positive correlation with live function,infectious complications,and postoperative hospital stays.

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.

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 investigate the diagnosis and treatment of bladder dysfunction after radical resection of rectal carcinoma.Methods One hundred and sixty-five patients with bladder dysfunction after radical resection of rectal carcinoma were observed by urodynamic study.The results included maximum urinary flow rate,postvoid residual,urine volume,pressure of detrusor,maximum urethral closure pressure.These patients were treated by different methods.Results Bladder with underactive detrusor were 116 patients,109 patients returned to normal voiding after 3 months,7 patients were performed with suprapubic cystostomy.Detrusor overactivity were 42 patients,insufficiency of urethral sphincter were 7 patients,all symptoms of them improved after treatment.Conclusion Patients with bladder dysfunction after radical resection of rectal carcinoma should do check to clear etiology,according to the results to take the appropriate means to treatment.

Objective To observe the efficacy of Sorafenib in preventing and treating tumor recurrence after liver transplantation for patients with primary hepatic carcinoma beyond Milan criteria.Methods From March 2008 to June 2010,30 patients of liver transplantation with primary hepatic carcinoma exceeding Milan criteria were randomized into 2 groups,each group of 15 cases.Beginning one month posttransplantatoin patients in the experimental group received oral administration of Sorafenib (400 mg bid),while those in the control group received Capecitabine ( 1500 mg bid) for 14 days every 4 weeks.Drug was withdrawn in patients without recurrence in 18 months after transplantation,recurrent patients maintained the original dose until they were not suitable for the medication.Results The 1 year recurrence rate in experimental group was 53.3％,that in control group was 86.6％ ( x2 =3.968,P ＜ 0.05).The 1 year survival rate in experimental group was 93.3％,that in the control group was 46.6％( x2 =7.777,P ＜ 0.05 ).The mean survival time of patients in experimental group was (24.6 ± 1.7 ) months (7 - 28 months),that in the control group was ( 16.4 ± 2.7 ) months ( 5 - 34 months ) ( x2 =7.154,P ＜ 0.05).Most adverse reactions in both groups were of grade Ⅰ - Ⅱ.The incidence of diarrhea and handfoot syndrome in experimental group is higher than that in control group.Conclusions Using Sorafenib for patients with primary hepatic carcinoma exceeding Milan criteria after liver transplantation may reduce carcinoma recurrence rate,and prolong patients' survival time.

ObjectiveTo observe the efficacy of using sorafenib in preventing and treating tumor recurrence after liver transplantation for patients with primary hepatic carcinoma exceeding Milan criteria.MethodsFrom March 2008 to June 2010,30 patients of liver transplantation with primary hepatic carcinoma exceeding Milan criteria were randomized into 2 groups,each group of 15 cases.The experimental group received oral administration of sorafenib (400 mg bid) ; the control group received capecitabine (1500 mg bid) for 14 days every 4 weeks.The patient without recurrence in 18 months after transplantation stoped taking the medication.The recurrent patients maintained the original dose until they were not suitable for the medication.Patients with serious adverse reactions must reduce the dose or stop the medication.ResultsThe 1 year recurrence rate of experimental group was 53.3％,the control group was 86.6％,the difference between 2 groups was statistically significant (x2 =3.968,P＜0.05).The 1 year survival rate of experimental group was 93.3％,the control group was 46.6％,the difference between 2 groups was statistically significant (x2 =7.777,P＜0.05).The mean survival time of experimental group was (28.3±2.5)months (7～36 months),the control group was (17.9±3.5)months (5 ～ 41 months),the experimental group patients' survival time was longer than the control group,the differences was statistically significant (x2=5.702,P＜0.05 ).Most adverse reactions in 2 groups were grade Ⅰ - Ⅱ.The incidence of diarrhea and hand-foot syndrome in experimental group was higher than in control group.ConclusionUsing sorafenib for patients with primary hepatic carcinoma exceeding Milan criteria after liver transplantation probably may reduce or delay the process of carcinoma recurrence,can prolong the survival time of those patients,and side effects can be tolerated.

Objective To investigate the clinical effectiveness of oral ganciclovir on prevention and treatment of cytomegalovirus (CMV) infections after liver transplantation.Method We tested archival peripheral blood of 69 kidney recipients for CYP3A5 genotyping by polymerase chain reaction sequence-specific primer.The dose,blood concentrations and dose-normalized blood concentrations of tacrolimus were measured at 1 st and 2nd month after the renal transplantation.Result pp65 antigen of CMV was negative in all the patients before liver transplantation.In 72 patients subject to acyclovir,9 cases (12.5％) were infected by CMV.By using oral ganciclovir to prevent CMV infection after 1iver transplantation in 376 patients,pp65 antigen of CMV was detected in 17 patients (4.5％).Fifteen patients received intravenous ganciclovir for treatment of CMV infection or CMV pneumonia,and 6 patients (40％) suffered from granulocytopenia because of the use of intravenous ganciclovir.Forty-six patients (12.2％) suffered from granulocytopenia because of the use of oral ganciclovir.Conclusion Oral ganciclovir is a safe and effective drug for prevention and treatment of CMV infection.

Objective To explore the effects of infusion per unit of weight on pulmonary edema and acute respiratory distress syndrome (ARDS).Methods The clinical data of 70 patients with cirrhosis who had accepted liver transplantation were retrospectively collected,including the age,height,weight,BMI,preoperative liver function,indexes during liver transplantation and the postoperative intake and output records in the first 5 days,and the emerging postoperative pulmonary complications (EPPCs) in the first 2 weeks were screened.The relationship between clinical data and new pulmonary edema and ARDS was analyzed.Results The incidence rate of NPPCs was 82.9 ％,in which the incidence rate of pleural effusion,atelectasis,pulmonary edema,ARDS and pulmonary infection was 60.0％,14.7％,8.6％,31.4％ and 10％ respectively.In the pulmonary edema group (n =6),the preoperative Child-Pugh score (9.3 ± 1.6),the total volume (2 667 ± 1 164) ml and the volume of unit weight (39.4 ± 19.0) ml/kg of plasma transfusion,the total volume (1 417 ± 376) ml of artificial colloid during operation,and the input of unit weight (53.2 ± 9.3 ml/kg) on the 3rd day after operation were significantly different from those (7.6 ± 1.9,1 753 ± 1 040 ml,24.2 ± 15.7 ml/ kg,2 347 ± 1 088 ml,and 44.6 ± 10.1 ml/kg) in the group (n =64) without pulmonary edema.Their P values in the order were 0.028,0.046,0.029,0.046,and 0.046.In the ARDS group (n =22),the plasma transfusion volume per unit of weight during operation (31.3 ± 20.4 ml/kg),the total balance volume equaled with the difference of input and output (1 504 ± 894 ml) and the balance volume per unit of weight (22.1 ± 13.1 ml/kg) on the first postoperative day and the total input volume per unit of weight on the third postoperative day (49.0 ± 10.1 ml/kg) were significantly distinguished with those (22.7 ± 13.4 ml/kg,910 ± 684 ml,12.7 ± 9.9 ml/kg,and 43.6 ± 9.9 ml/kg) in the group (n =48) without ARDS.The P values in the order were 0.045,0.003,0.001 and 0.042 respectively.Conclusion The incidence rate of NPPCs in the patients with cirrhosis receiving the liver transplantation is relatively higher.In order to reduce the risk of NPPCs,based on the hemodynamic stability during operation,the artificial colloids should be appropriately increased and excessive plasma transfusion reduced.In addition,the redundant input should be limited according to the weigh,in the first and third postoperative days.

Objective To investigate the relationship between the expression of MAGE-1,SSX-1,and CTp11 mRNA in the peripheral blood of patients with hepatocellular carcinoma (HCC) receiving orthotopic liver transplantation (OLT) and the prognosis of these patients. [WT5”HZ]Methods The expression of the three genes in the peripheral blood mononuclear cells (PBMCs) was detected by nested RT-PCR,and a follow-up was carried out in 26 patients. Results Before OLT,the positive rate of MAGE-1,SSX-1 and CTp11 transcripts was 40.0% (14/35),37.1% (13 /34),and 31.4% (11/35),respectively in the PBMC samples of HCC patients;Sixty percent (21/35) of the PBMC samples were positive for at least one of the three gene transcripts. The follow-up of 26 patients showed that,the tumor recurrence/metastasis rate after OLT (75.0%) in 16 patients with positive preoperative PBMC samples of at least one gene transcripts was significantly higher than that of the other 10 patients who was negative preoperatively for gene transcripts (30.0%)( P = 0.043).Postoperative tumor recurrence or metastasis developed in 15 out of 20(75%) patients with persistently perioperative positive MAGE-1,SSX-1 and /or CTp11 transcripts in PBMC samples or swithing from negative to positive perioperatively,in contrast to no recurrence nor metastasis in the other 6 patients with the gene transcripts switching from positive to negative postoperatively,or negative perioperatively ( P =0.002). [WT5”HZ]Conclusions MAGE-1,SSX-1 and CTp11 transcripts may act as combined tumor-specific makers to detect tumor cells in the peripheral circulation of HCC patients,and the detection is valuable for selecting OLT candidates and predicting the postoperative prognosis.