20 yrs in Yuhang is high.We should further screen for MS among adults older than 40 yrs and make some effective measures against MS in the high-risk population.

Classical piggyback liver transplantation (CPBLT) is an advanced technique based on standard orthotopic liver transplantation (SOLT),which has more advantages compared to the SOLT.However,there are still some problems with CPBLT to be solved,such as complicated surgical procedures,postoperative hepatic venous outflow obstruction and thrombosis.Recently,in order to solve these problems,modifications have been made,being named ameliorated piggyback liver transplantation (APBLT).The APBLT solved above-mentioned problems,and expanded the application of PBLT.Therefore,this article describes the technique of these ameliorations,and discusses their individual characteristics.

Objective To investigate the effects of simultaneous hepatic artery and portal revaseularization on the expression of TNF-α during bile duet ischemia-reperfusion injury in rats liver transplantation.Methods Male Spragne-Dawley rats were used to establish an autologous orthotopic liver transphmtation model.Model rats were random divided two groups,simultaneous revascularization group(sroup P)and portal vein revascularization group(group N).The animals were separately killed at the 2nd hour,6th hour and 24th hour after reperfusion.Plasma samples were collected for ALT,AST,GGT,AKP,TBiL and DBiL test.Bile duct tissues were collected to detect the histolosical changes,MPO activit,and the expression of TNF-α mRNA.Results The serum levels of GGT in group P was significantly lower than that in group N at the 6th hour and 24th hour after reperfusion(P＜0.05).And the serum levels of AKP,TBiL and DBiL and the morphological scores of bile duct in group P were significantly lower than that in group N at the 24th hour after reperfusion(P＜0.05).The activity of MPO in group N was significantly higher than that in group P at the 6th hour after reperfusion(P＜0.05).Compared with group N,the expression of TNF-αmBNA was reduced significantly in group P at the 2nd hour and 6th hour after reperfusion(P＜0.05).Conclusion Simultaneaus hepatic artery and portal revascularization can alleviate I/R induced bile duct injury of rat liver grafts,and the protective mechanism may be asseciated with inhibition the expression of TNF-α and decrease of neutrophil infiltration.

Objective To investigate the relationship between wound suture and incision complications in acute gastrointesti -nal tract incision .Methods Patients with abdominal surgery ( acute digestive tract perforation , and acute intestinal obstruction ) were divided into two groups .The differences between two suture methods were compared with the indicators such as operative time , incision complications, and hospital stay, etc.Results There were no significant differences between two groups (12.5%vs 20%) in incision complications ( P >0.05 );while there were differences in the postoperative hospital stay between two groups .The hospital stay of the intradermalsubcutaneoussuturegroup(13.54±7.32)dweresignificantlyshorterthanthatoftraditionalgroup(18.11±11.67)d(P<0.05 ) .Conclusions Wound intradermal subcutaneous suture was superior to traditional suture in acute gastrointestinal tract inci -sion.No significant difference was found between two groups in incision complications , but wound intradermal subcutaneous suture had significantly shorter postoperative hospital stay .

Objectives To investigate the results of liver transplantation using steatosis liver donors in order to provide a scientific basis for the use of marginal donors.Methods From 2002 to 2011,80 of 407 were steatosis liver donors.There were 69 males and 11 females.Their age ranged from 20-54 years old.Sixteen donor livers with severe fatty liver and reperfusion injury were not used.The remaining 64 livers were divided into a S1 group (mild steatosis,n=22),a S2 group (moderate steatosis,n=25),and a S3 group (severe steatosis,n=17).A S0 group was used as a control (randomly selected fat-free liver,n=80).Results The occurrence rates of delayed graft function (DGF) in the S0,S1,S2,S3 groups were 5％,9.1％,20％,29.41％,respectively.Primary nonfunctioning occurred in 2 cases of the S3 group,which represented a 11.76％ of the S3 group (2/17),and 3.12％ of the total 64 cases (2/64).Conclusions Although the incidence rate of DGF was higher in the steatosis liver donor groups than the S0 group,there was no correlation in the mortality rate of the S1-S3 group within one year of transplantation.Attentions should be paid to the treatment of complications after steatosis liver transplantation.By minimizing ischemia-reperfusion injury,improving microcirculation,strengthening routine therapy and reducing the amount of immunosuppression,the same results could be achieved using steatosis donor liver and normal liver for transplantation.

Vascular complications after liver transplantation can seriously threaten the survival of patients.In the preoperative assessment and postoperative monitoring of patients' vascular conditions,although the digital subtraction angiography (DSA) is the golden standard for vascular lesion diagnosis,but not the first choice due to traumatic lesions.In some clinical circumstances,DSA can only be used when Doppler ultrasound,spiral CT,and MRI are not applicable,and in most cases DSA is used for treatment rather than diagnosis.This article reviewed the current interventional treatment of vascular complications to stress the important role of DSA in diagnosis and treatment of related complications after liver transplantation.

China donation after citizens' death (CDCD) has already entered a new historical era,and the donation after brain death plus cardiac death (DBCD),which refers to the transition from brain death to cardiac death,is most widely used.The various pathological and physiological changes have an influence on donor organs,which could not be ignored.So the research on the effects of donor brain death for CDCD liver transplantation will be of great significance.Here we discussed the CDCD initiation and its classification,and the necessity and application of establishing a donation after brain death (DBD) animal model to clarify the relationship between DBD and CDCD liver transplantation and thus to enlighten future studies.

Liver transplantation,a unique effective treatment for end-stage liver diseases,has already been applied in clinical practice for more than half a century.But the shortage of donor liver source has been the bottleneck limiting its development.How to determine the tiny minority donor liver quality to guarantee the prognosis of transplant patients becomes a hot focus for current research.Brain death causes patho-physiological changes of body organs,including liver.How to carry out related pathological and serologic tests to determine the safety of the donor liver is a very important issue.In this paper,the articles published in recent years were overviewed and analyzed to summarize the evaluation index of donating organ quality.We hope this paper may benefit the treatment through ensuring an effective evaluation on the donor liver in the future.

Objective To explore the cause and treatment strategy of chronic graft rejection characteristic of jaundice in patients with liver transplantation. MethodsPrimary disease, immunosuppressive protocol were reviewed in nine cases surviving more than 1 year after liver transplantation. The pathology examination, choledochoscopy and ultrasound examination were performed. The dosage of immunosuppressive agent was adjusted. Four cases underwent operation. Results Chronic rejection was well controlled in 6 out of the 9 cases with total bilirubin level decreased from 200 ?mol/L to less than 100 ?mol/L. Bile flocculus and bile slush became less obvious or disappeared after flushing and dilataltion of the common bile duct. Three cases died in spite of aggressive therapy. ConclusionsInsufficient immunosuppressive strength is one of the most important causes for chronic rejection. Immunological injury results in hepatocellular damage, bile slush, inflamed thick bile duct.

Hypoxia-inducible factors 1α (HIF-1α) is the key cellular oxygen-sensitive transcription factors that could activate diverse pathways in regulating cellular metabolism,angiogenesis,proliferation and migration,enabling a cell to generate adaptive responses to a low oxygen or hypoxic environment.HIF-1 α has been shown to play an important role in the pathogenesis of multiple liver diseases.This review explores the impact of HIF1α on liver ischemia-reperfusion injury and liver transplantation as well as its mechanism.