Objective To investigate the effect of a modified cuff insertion technique named “portal vein branch-sling” (PBS) method for portal vein (PV) anastomoses in rat liver transplantation.MethodsA total of 60 cases of orthotopic liver transplantation (OLT) using 2-cuff technique in rats were performed in our transplantation center.The PBS technique and conventional methods were used respectively in study and control groups.Time for PV anastomoses,anhepatic phase (AP) and surgery of recipients,successful rate for PV cuff insertion and operation were statistically compared between the different groups.Results35 cases of OLT using PBS technique in rats were assessed.The successful rate of PV cuff insertion was 94.3％,and the time of PV anastomoses using the modified PBS cuff insertion technique was only 1.9 ± 0.7min.The successful rate of operation was 80％with a 21.8±2.2min AP.The study group showed significant differences (P＜0.05) compared with conventional group.The survival rate in the first week was 85.8％ with no statistical difference (P＞0.05).ConclusionsThe modified PBS cuff insertion technique for PV anastomoses of OLT has advantages in speed,safety and stabilization,and should be considered as one of the best available PV anastomosis technique for OLT in rats.

ObjectiveTo identify the proteins presented variation during ischemia/reperfusion injury (I/RI) in liver transplantation (LT).MethodsAt Mar.2009,a total of nine liver sample tissues,three samples obtained from each donor liver at three different time points,were studied.The time points were as follows:(1) the time point immediately after donor liver was harvested (T1) ; (2) the time point just before the anastomosis of hepatic artery and potal vein (T2),during this time period the donor liver was kept in ice cold and transported,then back-table prepared,during time from T1 to T2,ischemia injury occurred; (3) the time after donor reconnected to the recipient (T3),during which the donor liver was subjected to reperfusion injury.The three time points represent normal control,ischemia injury,and reperfusion injury respectively.By using method of 2DE-MALDI-TOF and mass-spectrum,the differential expression of these protein at T1,T2,and T3 time point were compared.ResultsFrom the 1580 proteins that were isolated,19 ischemia/reperfusion injury (I/RI)-related proteins that varied markedly from time point T1 to T2 and from time point T2 to T3 were identified.They were metabolic enzyme,molecular chaperone,redoxase,cytoskeleton protein,signal transduction protein,and binding protein,respectively.The character of each protein was further analized based on their functions.ConclusionsFor the first time,we detected the protein related to I/RI during LT.We obtained independent proteomics information of ischemia injury,and reperfusion injury,respectively.Further functional analyses of these proteins may improve the understanding of the critical biological processes during I/RI.Medicine intervention on the I/RI-related proteins may result in improved survival of the recipients.

Objective To assess the effects of liposomal prostaglandin E1 (Lipo PGE1) on hepatic arterial and portal vein inflow early after orthotopic liver transplantation (OLT).Methods Fifty-six patients were divided randomly into two groups who received a primary liver transplant: normal control group and PGE1-treated group. Lipo PGE1 was infused by 20??g/d from day 1 to 14 after OLT in the PGE1-treated group. Measurements of hepatic arterial and portal vein inflow were taken on post-operative day 1, 3, 5, 7, 9 and 14 by color Doppler image (CDI).Results In control and PGE1-treated groups, hepatic artery velocity (HAV) was gradually increased during postoperative 2 weeks, but portal vein flow volume (PVFV) showed a decreased trend. HAV in PGE1-treated group was higher than normal control group during postoperative 5 days, but there was no significant difference in PVFV between two groups.Conclusion Lipo PGE1 can improve hepatic arterial inflow early after OLT, but not significantly influence portal vein inflow.

Objective To study the clinical feature and treatment of cytomegalovirus(CMV) pneumonia in the orthotopic liver transplantation(OLT) recipients.Methods The clinical data of 451 patients after OLT in our hospital from Oct.2003 to June 2005 were retrospectively analyzed.The prevention,clinical feature and treatment of CMV pneumonia were discussed.Results Seven patients((1.66 %)) developed CMV pneumonia after OLT.The symptoms presented much earlier than signs.All patients had high fever,and followed with cough,polypnea,dyspnea one week later.Blood-gas analysis showed hypoxemia.CMV pp65 antigen detection was helpful for early diagnosis.All the infected patients received ganciclovir and foscarnet treatment.At the same time,immunosuppressive drugs were withdrawn and complex treatment including high dose immunoglobulin,low does thymulin and broad-spectrum antibiotec were given.Six patients((85.7 %)) were cured.Conclusions The early onset of CMV pneumonia is not specific but still regular.CMV pp65 antigen detection is specific and sensitive.Ganciclovir and foscarnet treatment is effective and complex therapy necessary for CMV pneumonia.

Twenty six patients with liver cancer who received liver transplantation were enrolled in the study. The patients were assessed by SF-36 scale and QOL-LC V2.0 scale before and 0 -6, 7 - 12, > 12 months after the liver transplantation. Scores in physical function domain and social function domain decreased significantly in the early stage post LT (0 -6 month post-LT). While in later stage ( >7 months post-LT), the scores showed no significant difference or even higher than that of pre-LT. In psychological function domain, no significant difference was found pre- and post-LT. The scores were improved significantly in later stage post-LT than pre-LT and early stage post-LT.

Objective To evaluate the association of the size of thyroid nodules and accuracy of fineneedle aspiration cytology in diagnose of thyroid nodules.Methods 691 thyroid nodules in 630 patients pathologically confirmed were retrospectively analyzed in our hospital.All imaging data of preoperative ultrasound-guided FNAC were collected in our review.Yields of FNAC were divided into six levels according to the classification criteria of the Bethesda system(level Ⅰ,insufficient material or nondiagnosed;level Ⅱ,benign ; level Ⅲ,atypical hyperplasia; level Ⅳ,follicular neoplasm ; level Ⅴ,suspicious for malignancy; level Ⅵ,malignant),＞level Ⅳ was the malignant cytologic criteria for diagnosis of thyroid nodules.According to the maximal diameter of thyroid nodules,the nodules were divided into group A(L≤0.5 cm),group B(0.5 cm＜L＜1.0 cm) and group C(L≥1.0 cm).Postoperative pathologic results were taken as the gold standard.Results Of 691 nodules,there were 176(25.47％),298(43.13％) and 217(31.40％) in group A,group B and group C respectively.Among the three groups,accuracy of ultrasound-guided FNAC in group B (90.94 ％) was higher than in group A(80.11％) and group C(83.41 ％),with statistically significant(P ＜0.05).There was not statistically different between group A and group C(P ＞0.05).The specificity,positive predictive value and negative predictive value were not statistically different among three groups(P ＞0.05).Conclusions The size of thyroid nodules was partly associated with accuracy of ultrasound-guided FNAC.

AIM: To investigate the antiproliferation effects of oridonin on hepatocellular carcinoma BEL-7402 cells and its mechanisms of action. METHODS: BEL-7402 cells in culture medium were treated with different concentrations of oridonin. The inhibitory rate of the cells was measured by MTT assay. Cell apoptotic rate was detected by flow cytometry (FCM). Morphology of cell apoptosis was observed by Hoechst 33258 stain. Reverse transcriptase polymerase chain reaction (RT-PCR) and PCR-enzyme-linked immunosorbent assay (ELISA) were used to detect hTERT mRNA expression and telomerase activity before and after apoptosis. RESULTS: Oridonin could inhibit the growth of BEL-7402 cells and cause apoptosis significantly. The suppression was in both time-dependent and dose-dependent manner. Marked morphological changes in cell apoptosis including condensation of chromatin and nuclear fragmentation were observed clearly by Hoechst 33258 stain especially after the cells were treated 48-60 h by oridonin. The expression of hTERT mRNA as well as activity of telomerase decreased concurrently by treatment with oridonin in BEL-7402 cells. CONCLUSION: Oridonin has apparent antiproliferation and apoptosis-inducing effects on BEL-7402 cells in vitro, downregulation of the hTERT mRNA expression and decreasing the telomerase activity of BEL-7402 cells may be one of its important anti-hepatocellular carcinoma mechanisms.

AIM: To investigate the effect of ischemic preconditioning(IPC) on expression of nitric oxide synthase(NOS) in rat smallfor-size liver graft and its significance.METHODS: Sixty SD rats were randomly divided into 3 groups(n=10 pairs/group): nonwarm ischemia group(NWI);warm ischemic group(WI);and ischemic preconditioning group(IPC).The models of rat small-for-size liver transplantation were set up by two-cuff technique.Expression of eNOS mRNA and iNOS mRNA in hepatic tissue were detected by fluorescence-quantitating-PCR.RESULTS: Heptic expression of eNOS mRNA post-IPC was higher than that pre-IPC(P0.05).It was higher in IPC group than that in NWI and WI group(P

0.05 ). Conclusion Individual immunosuppression regime can prolong the survival of the recipients with high risk factors and is proved to be more safe and reliable.

Objective To evaluate the efficacy and indications of salvage liver transplantation for patients with recurrent hepatecellular carcinoma(HCC)after liver resection.MethodsThe clinical data of 35 HCC patients who received salvage liver transplantation after liver resection at the Third Affiliated Hospital of Sun Yatsen University from October 2003 to March 2006 were retrospectively analyzed.All patients were divided into the salvage liver transplantation(SLT)group(n = 19)and extended SLT group(n = 16).Perioperative condition,postoperative complications and prognosis of the 2 groups were compared.The survival rate was analyzed and compared by the Kaplan-Meier method and Log-rank test,respectively.Results The anhepatic phase,ischaemic time,operation time,intraoperative blood loss,packed red blood cell transfusion,fresh frozen plasms transfusion,mobidity and retransplantation rate were(32 ± 9)minutes,(8.0 ± 2.1)hours,(7.6 ± 1.5)hours,2300 ml,8 U,23 U,6/19 and 2/19 in the SLT group,and(34 ± 7)minutes,(7.4 ± 2.3)hours,(7.4 ± 2.0)hours,2750 ml,12 U,20 U,4/16,1/16 in the extended SLT group,respectively,with no significant difference between the 2 groups(t=0.726,-0.804,-0.366,Z=-0.348,-0.549,-0.149,x2 =0.184,0.203,P＞0.05).The perioperative mortality,tumor recurrence rate were 0 and 2/19 in the SLT group,and 4/16 and 9/16 in the extended SLT group,with significant differences between the 2 groups(x2 = 5.363,8.426,P ＜ 0.05).The 1-,3-,5-year cumulative survival rates were 100%,84% and 84% in the SLT group,and 75%,33% and 33% in the extended SLT group.The 1-,3-,5-year tumor-free survival rates were 100%,89% and 89% in the SLT group,and 48%,29% and 19% in the extended SLT group.There were significant differences in the cumulative and tumor-free survival rates between the2 groups(x2 =11.58,19.31,P＜0.05).Conclusions The efficacy of SLT is satisfactory in the treatment of recurrent HCC.The optimal indication for SLT is Milan criteria.