Objective To investigate serum leptin and adiponectin levels and their relationship in elderly coronary artery disease (CAD).Methods A total of 88 subjects aged 55 yeas or older were enrolled in which coronary angiograms were performed.The subjects were divided into CAD group (52 patients) and control group (36 patients) by angiography.Serum concentrations of leptin and adiponectin were evaluated by ELISA system.Results Serum concentrations of leptin were significantly increased in CAD group compared with that in control group [(9.38 ±3.51) μg/L vs.(7.27 ±3.25) μg/L,P ＜0.05].On the contrary,serum concentrations of adiponectin were significantly decreased in CAD group compared with that in control group [(11.08 ±3.87) mg/L vs.(13.34 ±4.94) mg/L,P＜0.05].Logistic regression analysis revealed that only serum leptin was the independent risk factor for CAD.Serum adiponectin concentrations had a negative relationship with leptin concentrations (r =-0.320,P =0.002).Conclusion Lower serum adiponectin levels are related to higher serum leptin concentrations.Elevated serum leptin but not decreased serum adiponectin is the independent risk factor for CAD.

Objective To investigate the prevention of gram-positive cocci infection by oral administration of vaBeomvcin after liver transplantation. Methods Eighty patients who underwent liver transplantation from September 2005 to September 2006 were divided into vaneomycin group and control group.All the patients were intravenously infused with piperacillin + tazobatam to prevent infection after liver transplantation.Patients in vancomycin group were given vancomycin orally in the first 7 days after liver transplantation and vancomycin concentration in the blood were measured at the same time.Infection and stool cocci and bacilli ratio of the patients in the 2 groups were observed.Results Seven patients in vancomycin group and 15 patients in control group(including 3 and 10 patients infected with methicillin resistant staphylococcus aureus in each group)were infected with grampositive cocci,respectively,with statistical difference(x2=4.501,P＜0.05).Three patients in vancomycin group and 10 patients in control group presented with imbalance of gastrointestinal flora,with statistical difference (x2=4.501,P＜0.05).No statistical difference was found in the patients infected with gram-negative bacilli or fungi between the 2 groups(x2=0.065,0.251,P＞0.05).The vancomycin concentration was 0 in the blood of patients who simply took vancomycin.Conclusions It is safe and effective to take vancomycin orally to prevent gram-positive cocci infection and imbalance of gastrointestinal flora after liver transplantation.

Objective To investigate the effects of recombinant human thioredox ( rhTrx) on primary cultured hepatocytes. Methods The cDNA coding hTrx was amplified by using RT-PCR. The objective protein was expressed in E. Coli. The activity of purified rhTrx protein was determined by IgM and insulin disulfide reduction assay. DNA synthesis was determined by 3H-TdR mixing assay to realize the proliferating roles of rhTrx in murine primary cultured hepatocytes. Cell viability was assessed by lactate dehydrogenase ( LDH) releasing assay. Results The cloning hTrx open reading frames cDNA was confirmed by sequence analysis. The soluble recombinant hTrx are expressed efficiently in the prokaryotic expression system. The recovery ratio was 23. 20% of total bacteria protein with a purity of the expressive protein of 96. 30%. The rhTrx had stronger IgM and insulin reduced activity compared with the controls (P

Objective To explore the relationship between hepatitis B virus (HBV) concentration and hepatocellular carcinoma (HCC) recurrence in HCC patients undergoing orthotopic liver transplantation (OLT). Methods 148 HCC patients associated with HBV infection undergoing OLT were enrolled in the study.Survival analysis was performed using the Kaplan-Meier method.Cox multiple regression analysis was performed to determine the parameters predicting HCC recurrence. Results Survival rates at 1,3 and 5 years were 86%,72% and 72%,respectively,and disease-free survival rate were 79%,71% and 54%,respectively.In this series 43 patients suffered from HCC recurrence.The recurrence rate was 29.1%(43/148),with the mean recurrence time being (13.16 ± 14.17) months (1 ～ 54 months).Exceeding Milan criteria (HR = 9.89; 95% CI 2.30 ～ 42.52; P = 0.002) and pretransplant HBV DNA level ＞ 5log10copies/ml (HR = 2.26; 95% CI 1.01 ～ 5.04; P = 0.047) were significant independent predictors for posttransplant HCC recurrence. Conclusion High HBV DNA load before transplantation is statistically associated with recurrence of HCC after liver transplantation.

Objective To summarize our experience in hepatic artery reconstruction in adult-to-adult right lobe living donor liver transplantation(LDLT).Methods A retrospective analysis was made for 17 cases undergoing LDLT in our center from May 2007 to Oct 2008.Results All the 17 right lobe graft of the liver was supplied by single right hepatic artery and the mean diameter of right hepatic artery was 3.1 mm.The hepatic artery for segment 4 was mainly originated from left hepatic artery(12/17,70.1%).The recipient right or left hepatic artery was used in 14 cases of reconstruction,proper hepatic artery was used in 2 cases,and gastroduodenal artery was used in one case.Anastomosis was performed with interrupted 8-0 prolene and 12-16 stitches were made on the posterior wall first and then the anterior wall to avoid turning over the vessel.The mean anastomosis time was(51±26) minutes and all hepatic arteries were patent immediately after anastomosis.Hepatic arterial complications including hepatic artery thrombosis (HAT)did not occur after LDLT.Conclusions Detailed evaluation and careful protection of the hepatic artery of segment 4 are the key to successful reconstruction of hepatic artery in LDLT.Anastomosis was performed without flipping the artery wall helped to reduce the difficulty of operation remarkably and with a good result.

Objective To evaluate surgical indications and method for regional pancreatoduodenectomy combined with blood vessel reconstruction. Methods Forty-four patients underwent pancreatoduodenectomy combined with superior mesenteric vein and portal vein(smv-pv) resection and reconstruction between April 1994 and March 2001.Among them superior mesenteric artery (SMA) and hepatic artery (HA) were reconstructed in 4 and 2 cases, respectively. Partial resection of the anterior wall of the inferior vena cava was performed in one case for tumor invasion. Results The overall mortality was 7.1%,with no complications. The resected endothelium or margins of the blood vessel and pancreas were microscopically tumor free in all cases. Histological specimen examinations demonstrated adenocarcinoma of pancreas head in 43 cases, neuroendocrine adenocarcinoma was diagnosed in one case. Patients were followed-up from 3～87 months with 2 cases lost after PV/SMV for pancreatoduodectomy. Six patients have survived more than 5 yearsand 21 cases more than 3 years. Conclusion Regional pancreatoduodenectomy combined with reconstructionof blood vessel could increase tumor resection rate in properly selected patients and could be performed safely without increased morbidity and mortality.

ObjectiveTo investigate the etiology of epileptic seizures after orthotopic liver transplantation and preventive measures.MethodClinical data of 83 patients receiving orthotopic liver transplantation from May 1998 to December 2001 were retrospectively studied.ResultsSix cases suffered seizures with an incidence of 7.23%.The interval between transplantation and clinical diagnosis of seizures ranged from 4 to 15 days with a meadian time of 9.3?1.2 days. Tonic-clonic seizure was the most common type of seizures. Three patients had a previous history of seizure. Computed tomographic(CT) scan revealed strokes in 2 patients. Seizure related mortality was 3.61% in this group of 83 cases.ConclusionSeizures are not infrequent neurological complication after liver transplantation and it may indicate an underlying CNS lesions. Cyclosporine and tacrolimus neurotoxicity, metabolic abnormalities and pneumonia are factors contributing to the onset of seizures. Proper mangement and comprehensive therapy may improve the prognosis.

Objective To investigate the occurrence and treatment of lamivudine resistance in immunocompromised chronic hepatitis B liver transplantation recipient. Methods From Oct 2003 to Mar 2005, 157 chronic hepatitis B liver recipients were analyzed retrospectively to investigate the occurrence and treatment of lamivudine resistant chronic hepatitis B. Results Ten (6. 37% ) cases developed resistance to lamivudine within 1 year after liver transplantation. These patients were treated subsequently with Adefovir dipivoxil or Entecavir. The mean reduction in HBV DNA levels at weeks 12,24,48 was(3. 85?0. 79)、(3. 27?0.84)、(3. 19?0.58) and 3,4,5 cases achieved HBV DNA

0.05). Compared with BHD group,HCC group had better liver function as assessed by Child-Pugh scores. Postoperatively, the period of artificial respiration was shorter in HCC group(P0.05). Elderly HCC patients meeting Milan criteria(n=12) had 1-,2-y overall and disease-free survival equivalent to patients exceeding Milan criteria (n=19).Conclusions Liver transplantation is safe and feasible in elderly patients. The prognosis of elderly patients with HCC after LT is comparable to those with benign hepatic disease. Milan criteria for selecting HCC patients for LT may be too restrictive and could be expanded in the elderly over sixty years of age.

Objective To investigate the indications, complications and survival results of combined liver-kidney transplantation. Methods From Oct 2003 to Dec 2008, the clinical data of 13 patients who underwent combined liver-kidney transplantation (CLKTs) were retrosptiverly analyzed in our institution. The perioperative mortality rate, complications and the result of follow-up were analyzed.Results The perioperative mortality rate (within 30 days) was 30.8% (4/13). Postoperative complications included intrabdominal bleeding in 4 patients ( 30. 8% ); pulmonary infection in 7 patients (53.8%); acute renal rejection in one (7. 7% ). Survivors were followed up from 4.4 to 60 months, with the median time of 40 months. Eight patients have survived more than 1 year; six patients have survived more than 2 years; five of them have survived for more than 3 years; and three of them have survived for more than 4 years, with one surviving for more than 5 years. One patient had undergone liver transplantation ( case 2 ) and two patients had had kidney transplantations ( case 3 and case 4 ) before this CLKTs.Postoperatively case 4 died of pulmonary infection and multiple organ failure at day 29, while case 2 and case 4 survived respectively 40 m, 48 m after CLKTs. Conclusions CLKTs is an effective therapy for end-stage liver and kidney disease. CLKTs for patients with irreversible liver and renal insufficiency after initial liver transplantation or kidney transplantation was feasible.