Pediatric liver transplantation has long been developed in the western world.Currently,favorable outcomes after liver transplantation have been achieved in pediatric recipients and the postoperative 5-year survival rate reached 80％ in western transplantation centers.In the mainland China,pediatric liver transplantation started quite recently and there is still a big gap compared with western centers.In addition,there is unbalanced development between adult and pediatric recipients due to surgical difficulties and undesirable outcomes following pediatric liver transplantation.The operation methods of pediatric liver transplantation include whole liver transplantation,reduced-size liver transplantation,living donor liver transplantation and split liver transplantation.Perioperative complications of pediatric liver transplantation mainly include portal vein thrombosis,hepatic artery thrombosis,intra-abdominal bleeding,infections,rejection,bile leakage and biliary strictures.While the long-term complications are infections,post-transplantation lymphoproliferative disorders,acute and chronic rejections caused by poor compliance with immunosuppressive therapy.Perioperative complications have been reduced recently thanks to improvement of surgical techniques.With the highly-prolonged survival period,long-term postoperative complications have been playing a significant role in recipients' survival rates.Management of long-term follow-up and compliance has been the next focus of pediatric liver transplantation.

Cholangiocarcinoma (CCA) is a malignant neoplasm derived from cholangiocytes. The incidence of CCA is only lower than that of hepatocellular carcinoma and ranked the second in liver malignant cancers. The prognosis of CCA patients is poor and most patients will die within a few months after diagnosis. CCA is related to various risk factors, including primary sclerosing cholangitis, cirrhosis, certain chemical agents and liver fluke. Establishment of proper animal models of CCA can not only be helpful for understanding the mechanisms of incidence and development, but also lay a solid foundation for developing novel treatment strategies. Common animal models of CCA include carcinogen-induced models, implantation models, operation models, and genetically engineered models.

AIM: To examine whether reactive oxygen species (ROS) is involved in the neuroprotection by mitochondrial ATP- sensitive potassium channel (mitoKATp) in rat hippocampal slices during hypoxia. METHODS: The technique of elec-trophysiology was used, and the latency to hypoxic depolarization (HD) and the amplitude of population spike (PS) in the stratum pyramidale of the CA1 region were measured. RESULTS: Pretreatment of the slices with diazoxide (DIA, a mitoKATP opener, at concentration of 300 ?mol/L) , prolonged the latency to HD, delayed the onset of PS disappearance and improved the recovery of PS after reoxygenation. The effects induced by DIA were attenuated by 5 - hydroxydecanoic acid (a mitoKATP blocker, at concentration of 200 ?mol/L). Pretreatment with N - 2 - mercaptopropionyl glycine (MPG, a ROS scavenger, at concentration of 500 ?mol/L), also abrogated the effects induced by DIA, while treatment of MPG alone had no effect on PS and HD. CONCLUSION: ROS participates in neuroprotection offered by mitoKATp opener during hypoxia.

Objective To investigate the clinical and pathological features of children malignant lymphoma.Method A retrospective study was carried out to analyse the clinical,laboratory and pathological data in 65 patients with malignant lymphoma.Results In the chidren malignant lymphoma,the incidence of nonHodgkin′s lymphoma(NHL) was more than that of Hodgkin′s disease(HL),the ratio of NHL to HL was 2.25∶1.The peak incidence of age was among 6 to 9 years old,the ratio of male to female is about(3.5∶1.)NHL of our children was mostly consised of lymphoblastic lymphoma,anaplastic large-cell lymphoma,diffuse large B-cell lymphoma and Burkitt′s lymphoma.The clinical manifestations were predominantly presented with peripheral nodes intumescing,mediastinal tumeur,abdominal tumeur,bone marrow infiltration.In patients with Hodgkin′s disease,mixed cellularity was the most common pathological category,and cervical painless lymphadenectasis was usually the initial signs in most patients,sometimes accompanied with infiltration of celiac lymph nodes,spleen and bone marrow.Conclusions NHL of our children differs from that of adult in the clinical feature and pathology,while HL of our patients is similar to adults.Since the prognosis of the malignant lymphoma is determined by its pathology,immunohistochemistry plays an important role in the diagnosis and differential diagnosis.J Appl Clin Pediatr,2006,21(3):160-161

The Risk-sharing agreements have achieved remarkable success in improving patients'access to drugs, lowering the uncertainty of the drugs cost-effectiveness, financial risk control and other aspects of medical in-surance fund , so they have attracted widespread attention by the concerned governments and insurers .This paper sys-tematically reviewed the patient access schemes in UK from several aspects , including the origin of the program , clas-sification , application processes and the implementation effects as well .The results of the research indicated that Chi-na has basically met the conditions for implementation of the risk-sharing agreements .In order to gradually promote the risk-sharing agreements implementation , this paper suggests that China should clarify the main root of risk-sharing agreements implementation , establish risk-sharing agreements standardization process and strengthen the application of health technology assessment in health resources allocation to improve the Chinese medicines bargaining system more scientifically and efficiently .

Background:Acute hepatic failure( AHF)is a common pathophysiological process of end-stage liver disease with complex etiology,difficulty in diagnosis and high mortality rate. Aims:To investigate the protective effect of nicotinamide on AHF in mice. Methods:AHF model in mice was established by intraperitoneal injection with D-galactosamine 700 mg/kg and lipopolysaccharide 10 μg/kg. Fifty-four mice were divided into blank control group,nicotinamide control group, AHF model group and low,moderate,high dose(400,800,1 000 mg/kg)nicotinamide groups,levels of ALT,AST, TNF-α and IL-6 were determined,HE staining was used to examine hepatic histological injury,liver cell apoptosis was measured by TUNEL assay,and protein expression of Caspase-3 was detected by Western blotting. Another 40 mice were divided into AHF model group,saline group and low,moderate,high dose(400,800,1 000 mg/kg)nicotinamide groups,mortality rate was observed dynamically. Results:Compared with blank control group and nicotinamide control group,levels of ALT and AST were significantly increased(P<0. 05),infiltration of inflammatory cells and necrosis of cells and levels of TNF-α and IL-6 were significantly increased( P <0. 05 ),and apoptosis of liver cells and protein expression of Caspase-3 were significantly increased in AHF model group(P <0. 05). In groups pretreated with low, moderate and high dose nicotinamide,all the above-mentioned indices were significantly improved in a dose-dependent manner(P<0. 05). Survival rate in low,moderate,high dose nicotinamide groups was significantly higher than that in AHF model group(37. 5%,62. 5%,100% vs. 0%,P all <0. 05). Conclusions:Nicotinamide could protect mice from AHF via inhibiting inflammatory response and hepatocyte apoptosis,thereby increase the survival rate.

Objective The purpose of this study was to investigate the effect of pinacidil, an ATP-sensitive K + channel opener in protecting myocardium of immature rabbit heart from ischemia-reperfusion injury.Methods Fifty-two rabbits of 3-4 weeks old, weighing 350-450g were anesthetized with intraperitoneal pentobarbital sodium(50mg/kg). Hearts were excised and connected to modified Langendorff perfusion system and passively perfused with Krebs-Henseleit buffer(KHB) at 76 cmH 2O. Hearts were made globally ischemic for 30 min by aortic crossclamping and then reperfused for 30min. During ischemia the hearts received 20-25 ml cardioplegic solution of diferent constituents every 15 min. There were four groups with 13 hearts in each group based on the diferent constituents of cardioplegic solution: group Ⅰ(control, no cardioplegic solution); group Ⅱ(KHB+K + 16mmol/l); group Ⅲ(KHB+K +16mmol/L+pinacidil 50?mol/L); group Ⅳ (KHB+K +16mmol/L+glibenclamide 10?mol/L). Left ventricle developed pressure (LVDP), left ventricle diastolic pressure (LVEDP),?dp/dtmax, coronary flow (CF), and the levels of CK, LDH and AST in coronary sirnus veneous effluent and by myocardial ultrastructural changes. Myocardial ultrastructure was examined before and after ischemia.Results Before myocardial ischemia, there were no significant differences in the above mentioned parameters among four groups. Group Ⅲ was the best in terms of postischemic recovery of LVDP, LVEDP,?dp/dtmax and CF. The changes in CK,LDH,AST levels and myocardial ultrastructure were the least in group Ⅲ.Conclusions Pinacidil can afford best myocardial protection against ischemia-reperfusion injury in immature rabbit hearts.

Objective To evaluate the training benefits of computer simulation compared with conventional training modalities for minimally invasive surgery. Methods Seventeen junior surgeons and twenty - four medical students were randomized into four groups . They practiced with either a conventional laparo-scopic training model or a Virtual reality(VR) simulator for one hour. After the practice session, each participant performed running sutures with a conventional laparoscopic training model for half an hour. The number of completed stitches and the average accuracy of each stitch were measured to assess the skills acquired in practice. Results Regardless of the kind of training, junior surgeons performed better than medical students, especially in suture speed. Both medical students and junior surgeons trained with VR tended to have better scores than those who underwent training with a conventional laparoscopic training model. Conclusion Virtual reality training could make a major contribution to training in laparoscopic surgery but further studies will be needed to confirm these preliminary findings.

AIM: To investigate whether calcium activated potassium channel(KCa) and mitochondrial permeability transition pore(mPTP) contribute to cardioprotective effect elicited by anoxic postconditioning.METHODS: The isolated perfused hearts of male Sprague-Dawley rats were subjected to 30 min global anoxic followed by 120 min reoxygenation.Formazan content of myocardium was measured at 490 nm spectrophotometrically,and the level of lactate dehydrogenase(LDH) in the coronary effluent was detected.The absorbance of isolated heart mitochondria at 520 nm was determined.RESULTS: Anoxic postconditioning increased formazan content,reduced LDH release,improved the hemodynamic parameters of the left ventricular developed pressure,maximal rise/fall rate of left ventricular pressure,left ventricular end-diastolic pressure and rate pressure product and attenuated the decrease of coronary flow during reperfusion.Pretreatment with paxilline(1 ?mol/L) inhibited the effect of anoxic postconditioning.The opening of mPTP was suppressed in the mitochondria isolated from A/R hearts treated with anoxic postconditioning.CONCLUSION: The findings indicate that in the isolated rat heart,anoxic postconditioning protects myocardium against anoxic/reoxygenation injury via inhibiting KCa and the mPTP opening.