Objective To investigate the safety and efficacy of sirolimus-based immunosuppression therapy in liver transplantation. Methods Immunosuppression in 12 patients after liver transplantation was converted from calcineurin Inhibitor (CNI) to sirolimus for at least one month. Safety evaluations consisted of regular measurements of serum creatinine and liver enzymes to assay the restoration of CNI related nephrotoxicity and hepatoxicity. Efficacy analysis was performed by biopsy to evaluate the rejection incidence. Results The patients were followed up for a mean of 37 months after liver transplantation. Immunosuppression therapy was converted after a mean of 11 months. The average sirolimus conversion therapy period was 14 months. Among 12 patients experiencing sirolimus conversion therapy, 6 did not develop rejection on biopsy. Among 7 patients with CNI-related nephrotoxicity, 5 showed the restoration of serum creatinine to normal but1 developed albuminuria. All four patients with mild liver dysfunction did not improve. Conclusion The conversion from CNI to sirolimus is treatable based on liver biopsy in some selected liver transplant recipients,

This paper is about the clinical trials of preoperative concurrent chemoradiotherapy for advanced adenocarcinoma of the stomach or gastroesophageal junction reported in recent years. The radiation dose of most trials is 45 Gy. Chemotherapy drugs such as 5-fluorouracil, cisplatin and taxol are concurrently used as sensitizers. A number of trials have induction chemotherapy prior to chemoradiotherpy. The validity is evaluated by R0 resection rate, pathological complete response rate and overall survival rate. The safety is assessed by the adverse reaction, treatment related mortality, and its effect on postoperative complications and mortality. The results showed that preoperative chemoradiotherapy can significantly improve the R0 resection rate and benefit the prognosis of the patients. Meanwhile, the security and impact on operations of preoperative chemoradiotherapy is controllable. The recent researches are mostly in phase II, and more randomized controlled studies are needed. To fully accept the preoperative chemoradiotherapy as a standard treatment, more evidence and long-term efficacy index are indispensible.

Objective To study the safety and efficacy of surgical treatment for hilar cholangiocarcinoma (HC).Methods We retrospectively analyzed the clinical data of 56 patients with HC who underwent resection at the Beijing YouAn Hospital,Capital Medical University,from January 2010 to July 2015.The patients were divided into two groups according to the types of operations:the minor hepatectomy group (n =12) and the major hepatectomy group (n =44).The postoperative complications,mortality and long-term survival rates were compared and the clinical data were analyzed using uni-and multivariate analyses to examine the significant factors of survival.Results (1) The morbidity rates of the two groups were 33.3％ and 63.6％,respectively,with the latter group being significantly higher than the former group;(2) The 1-and 3-year overall survival rates were 60％ and 15％ in the minor liver resection group and 64％ and 15％ in the major resection group,and there was no significant difference between the two groups (P ＞ 0.05).The median survival was 16 months;(3) The median survival of R0 resection was significantly longer than the R1/R2 resection group (22 months vs 10 months,P ＜0.05);(4) Age,preoperative CA19-9 level,vascular invasion,surgical margin,tumor differentiation and nodular metastasis were significantly correlated with prognosis on univariate analysis.Multivariate analysis showed surgical margin and tumor differentiation to be significant prognostic factors.Conclusions RO resection obviously prolonged survival of HC patients,and histopathology negative surgical margin should be emphasized.With R0 resection,minor liver resection significantly reduced postoperative complications and mortality in selected patients.

Hilar cholangiocarcinoma (HCC) resection is a difficult and complicated surgery with high complication risk because of the special anatomic position.The detailed preoperative assessment is very important.Ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) can provide important information on the tumor location, vascular invasion and distant metastasis, which is necessary for the resection.Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) can be used to determine the tumor location and size, and achieve bile drainage.Magnetic resonance Cholangiopancreatolography (MRCP) as a noninvasive examination with fewer complications has comparable accuracy in identifying tumor extent with PTC and ERCP.The ultimate goal of surgical treatment is R0 resection.Preoperative resectablility evaluation mainly depends on the bile duct involvement, hilar vessels invasion, extent of hepatic lobe atrophy, lymphatic metastasis and nerve plexus infiltration.HCC radical resection often demands extended liver resection and accurate assessment of the residual liver function is very important for clinical strategy.Preoperative biliary drainage could be conducted in patients with cholangitis, long-term refractory jaundice (direct bilirubin level ＞ 200 μmol/L), poor nutrition status and residual liver volume ＜40％ of the total liver volume.Portal vein embolization decreases the long-term complications for HCC patients with enlarged liver resection.Portal vein embolization can be considered when residual liver volume ＜ 30％ ～40％.

Cirrhotic portal hypertension can lead to changes in the cardiovascular system,including hyperdynamic circulation,increased cardiac output,increased splanchnic blood flow,increased heart rate,peripheral vasodilatation,decreased resistance,and a drop in blood pressure.This hemodynamic disorder not only plays an important role in the maintenance of portal hypertension,but also causes retention of sodium and water,ascites,hepatorenal syndrome,and hepatopulmonary syndrome.Recently,there is an increased interest in clinical research reports that suggest treatments for cirrhotic portal hypertension.Therapies involve internal medicine,interventional treatment,and surgery for preventing and controlling upper gastrointestinal hemorrhage,splenomegaly,hypersplenism,and other symptoms.Various treatments had some positive effects on the hyperdynamic circulatory state of the cardiovascular system.

Objective:To study the eExecutive fFunctions Characteristics of Cchildren with Aattention dDeficit hHyperactivity Ddisorder in Cclock Ddrawing Ttest. Methods: 60 ADHD children and 60 normal children awere tested by CDT. Then analyze the data to detect the difference of Executive Functions of two growps. Results:ADHD group geot significant lower scores than control group on both time total score (data) and clock face structure score. (3.23?1.40/4.15?0.78,11.2?1.48/11.90?0.76,t=7.742、5.073,P0.05). Conclusions: the lower score in CDT showed that ADHD child have some weaknesses in planning , in attention regulating and in working memory. The core of these weaknesses is failing of execute function.

ObsjectiveTo investigate the clinical data,and to summarize the clinical experience of diagnosis and treatment of graft-versus-host-disease (GVHD) after liver transplantation.Methods 4 of 480 recipients undergone liver transplantation developed GVHD from Apr.2005 to Sep.2011.The 4 recipients'clinical courses and laboratory tests were recorded.ResultsThe diagnosis of GVHD depended on clinical syndrome involved skin rash,bone marrow depression and diarrhea.Skin biopsy and STR-PCR were matched.Among them,2 with successful treatment have been surviving for 7 and 24 months,and 2 died from infection.One recipient had the donor T lymphocyte microchimerism detected by STR-PCR.ConclusionsGVHD after liver transplantation can cause high mortality due to bone marrow depression.A reasonable treatment can be to reduce immunosuppressant and glucocorticoids and IVIG.

Objective To explore the value of the Accordion severity grading system (ASGS) in predicting short-term outcomes after orthotopic liver transplantation for severe hepatitis by classifying post-surgery complications.Methods The clinical documents of 159 patients were retrospectively analyzed who underwent orthotopic liver transplantation for severe hepatitis between Aug.1,2004 to Sept.1,2014 at our center.Complications were categorized according to the ASGS:grade 1 (mild),grade 2 (moderate),grade 3-5 (severe),and grade 6 (death).Outcome measures included ventilator support time,the length of ICU stay,postoperative recovery time.Spearman rank correlation analysis was used to test the correlation between the different grades with these outcome measures.1-year survival trends of different grade complication groups were demonstrated by Kaplan-Meier method and compared by Log-rank test.Results In total,43 (27.0％) patients had a grade 2 complication;41 (25.8％) grade 3;31 (19.5％) grade 4;9 (5.7％) grade 5;and 35 (22.0％) grade 6.There was no grade 1 patient.There was a significant correlation between the complication grades and the ventilator support time,the length of ICU stay and postoperative inpatient time (P＜0.01).With the increase of the complication grades,the outcome measures were even worse.Severe grade complication group had a longer ventilator support time,the length of ICU stay and postoperative inpatient time than the moderate grade complication group (P＜0.01).There was a significant downward trend in 1-year survival with the increase of the complication grade (P＜0.01).Conclusion The ASGS is helpful to assess risks and predict short-term outcomes after liver transplantation for severe hepatitis.Higher Accordion grades are correlated with even worse short-term outcomes.

Objective: To investigate the relation between ser um hyaluronic acid (HA) concentration and cryopreservation-reperfusion injury. Methods: The animals were randomly assigned to 3 groups: (1 ) group A: the control; (2) group B: liver allografts were stored in lactated R inger's solution (0℃) for 2 h before implantation; (3) group C:liver allografts were stored in lactated Ringer's solution (0℃) for 4 h before implantation. Th e serum sample and liver specimen were taken up at 2 h and 4 h after transplanta tion to detect the concentration of HA, AST and LDH, and to get pathologic obser vation. Results: Serum HA increased earlier and decreased more s hortly than AST and LDH after transplantation in group A. Serum HA increased sig nificantly in group B and C, much higher than that in group A(P<0.01). The i njury of vascular endothelium and the disorder of hepatic sinuses and hepatic lo b ules were observed in group B and C. In the specimen of 4 h in group C, evident infiltration of inflammatory cell was present. Conclusion: Cryopreservation leads to injury of endothelial cell and reperfusion aggravat es this injury. The serum HA concentration indicates the degree of cold ischemia -reperfusion injury.

Objective To evaluate the parallactic unsharpness caused by flat panel detector in digital radiography using different incident angle of central ray. Methods R-1 square-wave phantom was exposed by Kodak DR3000 system with X-ray tube angled 0°, 10°, 20°, 30°, and 40° respectively. Then,presampled modulation transfer function (MTF) was calculated for each case above. Subsequently,experimental data were processed and Wilcoxon signed ranks test were performed by statistic software SPSS 10. 0, in which P ＜ 0. 05 was considered as statistically significant difference. Results The presampled MTF curves of incident angle of 0°-40° degree, were presented orderly from top to bottom, especially the incident angle of 40° was obviously the lowest. The incident angle of 0° was considered as a control group and other groups were compared against it. There was no statistically significant difference for MTF of incident angle of 10°( Z = - 1. 893 ,P = 0. 058 ), while there were significant difference for MTF of incident angle of 20°, 30°, and 40° ( Z = - 2. 547, - 2. 666, - 2. 666, P ＜ 0. 05 ). Conclusions For flat panel detector in digital radiography, the bigger the incident angle of central ray, the larger the parallactic unsharpness. In addition, this effect has less influence on structures of low spatial frequency than those of high spatial frequency.