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,

Objective To observe the changes of lung and kidney aquaporin-1 expression in Lung-Qi deficiency model rats and to investigate and compare the effects of endothlin(ET)on the expression of lung and kidney aquaporin-1.It provide expremental basis to the theory of mutual relationship of lung and kidney.Method Twenty healthy rats were divided into the model group and the control group.Sample blood was taken and ET was measured by radioimmunoassay.The method of Western blot was used to observe the expression of aquaporin-1 in lung and kidney.Result The expression of aquaporin-1 in kidney was higher in model group than in the control group,while the expression of aquaporin-1 in lung was on the contrary.Compared with the control group,ET in the plasma was higher in the model group(P

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 analysis the efficacy and safety of endovascular graft exclusion for patients with Stanford type B aortic dissection.Methods The clinical data of 46 patients with Stanford type B aortic dissection who received endovascular graft exclusion were analyzed retrospectively.The stents were inserted from the femoral artery to exclude the tear of dissection,and all operation were peformed under digital subtraction angiography (DSA).The operative technique,outcome and complications were observed.Results The stents were successfully performed in all patients.The length of stay in hospital time after operation was 5-20 (12.9 ± 3.4) d.Endo-leak occurred in 2 patients and relieved after re-expanding.Followed up for 2 d to 5.1 years,average 36 months,1 patient got lacunar infarction and 1 patient died after leaving hospital 2 d.The others were free from the serious complications such as aortic dissection and paraplegia.Conclusion Endovascular graft exclusion is safe and effective for the treatment of Stanford type B aortic dissection in hospital and mid-term,and can significantly improve the survival rate and quality of life.

Objective To investigate the application value of fusion indocyanine green fluorescence imaging (FIGFI) in the laparoscopic anatomical liver resection (ALR).Methods The retrospective crosssectional study was conducted.The clinical data of 21 patients who underwent laparoscopic ALR using FIGFI in the Chinese People's Liberation Army General Hospital between December 2015 and February 2017 were collected.Indocyanine green (ICG) staining included positive staining and negative staining.Observation indicators:(1) intraoperative situations:surgical procedures,extent of liver resection,methods and results of ICG staining,operation time,volume of intraoperative blood loss,cases with blood transfusion;(2) postoperative situations:postoperative complications,duration of postoperative hospital stay,postoperative pathological examination;(3) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect the patients' survival and tumor recurrence or metastasis up to March 2017.Measurement data with normal distribution were represented as average (range).Results (1) Intraoperative situations:of 21 patients,20 underwent successful laparoscopic ALR and 1 had conversion to open surgery.The positive and negative stainings of ICG were respectively applied to 5 and 16 patients.Seventeen patients had successful staining and 4 had failed staining.Average operation time,average volume of intraoperative blood loss and cases with blood transfusion were respectively 268 minutes (range,120-360 minutes),388 mL (range,100-800 mL) and 3.(2) Postoperative situations:5 patients had postoperative complications,including 3 with Clavien-Dindo classification Ⅰ and 2 with Clavien-Dindo classification Ⅱ.Average duration of postoperative hospital stay of 21 patients was 9.3 days (range,6.0-14.0 days).Sixteen patients with malignant tumor had negative surgical margins.(3) Follow-up situations:all the 21 patients were followed up for 1.0-14.0 months,with a median time of 3.3 months.During follow-up,all the patients survived,and 1 patient had tumor recurrence.Conclusion The FIGFI is safe and feasible in the laparoscopic ALR,with a good short-term outcome.

Objective To study the therapeutic effect of continuous renal replacement therapy (CRRT) in renal failure after liver transplantation.Methods Renal function in 82 patients who underwent CRRT in the perioperative period of liver transplantation were retrospectively analyzed.Results There were significant differences in ALT,TB,BUN and Cr before and after the treatment (P ＜ 0.05).The differences were significant in glutamic-pyruvic transaminase (ALT),creatinine phosphate kinase (CPK) and C reactive protein (CPR) before and after the treatment (P ＜0.05).There were significant improvements in K+,Na+,Cl-,HCO3-and CVP before and after the treatment (P ＜ 0.05),while the differences were not significant in other biochemical parameters (P ＞ 0.05).This research also looked at the effect of timing of CRRT on renal function recovery.Based on the RIFLE classification of AKI,the ratio of renal function recovery in RIFLE-Ⅰ was significantly higher than RIFLE-F (P ＜ 0.05).Conclusion CRRT treatment significantly improved the prognosis of patients with acute renal failure after liver transplantation.

ObjectiveTo summarize and investigate the incidence,reason,diagnosis and treatment of postoperative early cardiac arrhythmia after orthotopic liver transplantation(OLT).Method A retrospective study was made for the incidence,dignosis and treatment of cardiac arrhythmia (two weeks after OLT) following OLT from June 2004 to January 2012 in the Beijing You-An Hospital.ResultsIn 500 patients who received OLT,Cardiac arrhythmia developed in 82 patients (16.4％).Among these cardiac arrhythmia,35(7.0 ％) were sick sinus syndrome (including severe sinus bradycardia ),18 (3.6 ％ ) were paroxysmal supraventricular tachycardia,21(4.2 ％) were atrial fibrillation,8(1.6 ％,including 2 patients with torsades de pointes) were ventricular tachycardia and 4 (0.8 ％ )were cardiac arrest.Mortality rate after OLT relate to cardiac arrhythmia was 0.4％ (2 patients).Cardiac arrhythmia was mainly correlated with four factors:(1)whether patient had heart disease before OLT or not(x2 =15.82,P＜0.01),(2)Prolonged QT interval in patients with end-stage liver disease before OLT(x2 =11.00,P＜0.01).ConclusionsCardiac arrhythmia was common complication after OLT,and it can lead to death of recipients.Careful evaluation to recipients before OLT,controlling fluid load after OLT,keeping the balance of the electrolyte,acidity and alkalescence,giving intensive monitor to patients with heart disease before OLT and prolonged QT interval are the key factor to reduce incidence and mortality of cardiac arrhythmia.Application of medication and cardiac pacemaker can prevent cardiovascular accident after OLT.

Objective To investigate the effect of Solitaire stent combined with coils on endovascular embolization of intracranial wide-necked aneurysms.Methods Twenty-six cases with intracranial wide-necked aneurysms from June 2009 to December 2011 in the NO.264 Hospital of the Chinese People's Liberation Army were treated with Solitaire stent-assisted coils,and anticoagulation and antiplatelet therapy were done among peri operation period.The effect of endovascular embolization was evaluated after 3 months cerebral angiography.Results A total of 27 solitaire stent were used in the 26 patients,one of which used 2 stents.The stents were successfully put in place,and the placement effect were satisfaction.The immediate angiography showed that 24 cases were dense embolism,2 cases of subtotal embolization.Stent were placed at right position.Twenty-three patients were followed with DSA for 3 months,and no aneurysm evidence of recurrence was found.Conclusion Solitaire stent-assisted coil embolization of intracranial wide-necked aneurysms is simple to perform and embolism rate is high and the recurrence rate is low.

Hilar cholangiocarcinoma (HCC) is a rare tumor with a poor prognosis.With the development of high definition imaging technology,improvement of surgical instruments,optimization of perioperative surgical strategies and accumulation of surgical experiences,the radical resection rate of HCC is significantly improved.Operation is the main method of treatment for HCC,and radical resection is important for a long-term survival of HCC patients.The clinical data of 66 patients with HCC who were admitted to the Beijing Youan Hospital from April 2004 to April 2012 were retrospectively analyzed.The key points in surgical procedure and prognosis of patients were investigated.

Objective To explore the impact and significance of hypoxia preconditioning on the expression of cytochrome C and caspase 3 protein in rats after hepatic resection.Methods A hepatectomy model was used to study the ischemia reperfusion injury in hepatic resection.Sprague-Dawley rats were randomly divided into the following three groups:normal control (NC) group,hepatic resection(HR) group,and hypoxia preconditioning (HP) group,there were twenty four rats in each group.HP Group was given an 10％ oxygen-mixed gas for 90 minutes before the operation.At 1,6,12 and 24 hours after the operation,the rats were killed and the following tests were conducted:(1) Liver tissue was sampled to observe the expression of cytochrome C and caspase 3 protein; (2) blood was drawn to conduct a chemical examination; (3) Liver tissue and morphology was observed by transmission electron microscopy.Results The serum levels of ALT and AST in HP group were significantly lower than that of HR group (P＜0.05) at 1,6,12 and 24 hours after the hepatic resection.In each time,liver function of the HP group was significantly better than the HR group; The expression of cytochrome C and caspase 3 protein was decreased significantly in HP group at each measurement point.Hepatic cells in HR group showed typical apoptosis signs under transmission electron microscopy (TEM),but no apoptosis was found in HP group.Conclusion HP has marked inhibition to apoptosis by down-regulating the expression of Cyt C and Caspase-3protein and protection to chondrosomes after a hepatic resection.