Objective To study the change of intestinal permeability in patients with acute pancreatitis (AP) to investigate the indication of early operation in AP patients. Methods Serum concentrations of glutamine, endotoxin and urine lactulose/mannito (L/M) ratio were measured and compared at different time in 18 AP patients received non-operative treatment and 7 underwent operation . Results Serum concentrations of glutamine, endotoxin and urine lactulose mannito (L/M) ratio were significantly higher in operation treatment AP patients than those in non-operation treatment AP patients. Conclusion In the early course of AP, continued increased intestinal permeability and serum concentration of endotoxin is the indications of operation.

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Lymphocyte function associated antigen-1 (LFA-1) is a member of integrin family, that plays an important role in the adhesion of lymphocytes with other cells and matrix. To investigate the role of LFA-1 in collagen-induced arthritis (CIA), the incidence of CIA, histological and radiological assessments in the LFA-1 deficient (LFA-1~ -/- ) mice and control mice were examined. LFA-1~ -/- mice and control mice were immunized with 100?g collagen type II(CII) emulsified with an equal volume of Freund’s complete adjuvant (CFA), followed by the booster injection of the same amount of CII in CFA on day 21. Then, clinical, histological and radiological assessments were done. It showed that 57% control mice developed arthritis and apparently changed in the histological and radiological assessment, whereas the all of LFA-1~ -/- mice had the normal histological and radiographic response and none developed arthritis. These results suggeste that LFA-1 is indispensable for the onset of CIA.

Objective To explore the effect of different cold ischemia (CI)times on the patterns of intra-graft T cell activation gene-3 (TCA-3) expression early after isogeneic half liver transplantation (PLT)in mice. Methods The models of C57BL/6 full-size(FS) and PLT were established.The CI time was 1,4 and 8 h.Specimen were collected at 4 and 24 h post-reperfusion.Ribonuclease protection assays (RPA)was used to evaluate serial mRNA expression of the TCA-3 chemokine in all mice.Histopathology was used to examine cold ischemia injury in the liver grafts. Results A total of 45 control and 30 PLTs were performed.The survival rate at 7 day after control and PLT was 100％.Quantitative analysis demonstrated the levels of TCA-3 mRNA expression were low at 4 h after reperfusion in control group with 1,4,8 h CI.The levels of TCA-3 significandy increased at 4 h after reperfusion in PLT group with CI of 1,4,8 h and the difference between the two groups was statistically significant ( F =7.41,P ＜ 0.05 ). TCA-3 mRNA expression significantly decreased at 24 h after reperfusion in two groups. But the difference was not statistically significant ( P ＞ 0.05 ). Histopathology showed severer cold ischemia injury in PLT grafts compared with control grafts. Conclusions The expression of TCA-3 significandy increased early after PLT and played an important role in cold ischemia injury.TCA-3 could be used as the early therapeutic target for reducing ischemia injury in PLT grafts.

BACKGROUND: Tumor recurrence in liver transplant recipients greatly affects prognosis of liver transplantation with hepatocellular carcinoma (HCC). How to prevent tumor recurrence has aroused increasing attention. Arsenious acid chemotherapy is considered effective on treating moderate or advanced liver cancer, but its utilization following liver transplantation remains few. OBJECTIVE: To explore the role of arsenious acid on tumor recurrence in liver transplant patients with primary HCC extending Milan criteria. RESULTS AND CONCLUSION: All patients were routinely followed up for 3-32 months. Thirty recipients were presented with tumor recurrence, 16 in the chemotherapy group and 14 in the non-chemotherapy group. Tumor recurred in lung, liver graft and bones in most cases. The total recurrence rate was similar in these two groups, but chemotherapy could delay recurrence after transplantation (P=0.026). There was no significance in 6-month, 1-year survival rate between two groups, but the 2-year survival in the chemotherapy group was higher (P=0.037); 6-month tumor-free survival rates in the two groups had no significance, 1-year and 2-year tumor-free in the chemotherapy group were significantly higher than those in the non-chemotherapy group (P=0.030, 0.023). Intravenous arsenious acid chemotherapy can delay tumor recurrence and prolong survival in liver transplant patients with HCC extending Milan criteria.

Objective To observe the effects of exogenous interleukin (IL)-6 on survival time and regeneration of liver grafts in an orthotopic liver transplantation model in IL-6 knockout (KO) mice.Methods A model of liver transplantation in C57BL/6 wild type (WT) and IL-6 KO mice with C57BL/6 background was established. Grafts were preserved at 4 ℃ in UW solution before transplantation.Study was divided into 4 groups:IL-6 KO→IL-6 KO control group,IL-6 KO→C57BL/6 WT group,IL-6 KO→IL-6 KO+ rIL-6 group,and IL-6 KO→C57BL/6 WT+ rIL-6 group.Recipient animals were injected subcutaneously with human recombinant IL-6 (1 mg/kg body weight) 1 h before transplantation.Survival of liver grafts after transplantation was followed up.Hepatocyte replication with BrdU uptake after liver transplantation was examined by irnmunohistochemistry.Results A total of 48 liver transplantations were performed.Cold ischemic time was 50 min.The survival time of liver grafts in the control group was 2.2 days,and that was 1.9 days,＞17.6 days and ＞20.4 days in IL-6 KO→C57BL/6 WT group,IL-6 KO+ rIL-6 group and C57BL/6 WT+ rIL-6 group respectively with the the difference being statistically significant among the latter three groups (P＜0.01 ).The liver grafts transplanted in control group recipients showed patchy areas of necrosis and hepatocyte ballooning.Slight increase in BrdU uptake was found at 48 h post-transplantation.Minimal injury and no necrosis were observed in IL-6 treated groups.Mild increase of BrdU uptake was demonstrated at 48 h after liver transplantation. Conclusion Exogenous recombinant IL-6 appears to significantly prolong the survival time of IL-6 KO liver grafts after liver transplantation and enhance the regenerative response after liver transplantation in IL-6 KO mice.

Objective To explore the causes and management of intra-abdominal hemorrhage after orthotopic liver transplantation (OLT). Methods Clinical data of 638 OLT patients were analyzed retrospectively from January 2004 to December 2008 in the First Affiliated Hospital of Sun Yat-Sen University. The diagnosis and treatment of postoperative intra-abdominal hemorrhage after OLT were reviewed. Results Among the 638 patients, 53 suffered from posttransplant intra-abdominal hemorrhage,the morbidity was 8. 3% (53/638). Thirty-one cases suffering from bleeding on raw surfaces or around the liver due to impairment of coagulation function were treated by non-surgery methods, 22 cases who suffered from active postoperative intra-abdominal hemorrhage due to surgical factors underwent laparotomy and bleeding control operation after failure of anti-shock treatments such as hemostatic drugs, blood reperfusion.Among the 53 patients who suffered from intra-abdominal hemorrhage, 12 patients died, and the main causes were serious infections and multiple organ dysfunction syndrome. The mortality associated with intraabdominal hemorrhage was 22. 6%. Conclusions Intra-abdominal hemorrhage at different locations were found after OLT, and the fatal rate is quite high. Timely and appropriate treatments especially laparotomy may improve the prosnosis of these patients.

Objective To evaluate the impact of steatotic hepatic grafts on postoperative early liver function and prognosis.Methods Clinical data of 35 cases receiving steatotic liver grafts in our hospital were retrospectively analyzed.The donor liver grafts were divided into 3 groups based on the degree of fatty infiltration(＜20%group,20%～40%group,≥40%group).Results were compared with that from control normal grafts(41 cases).Liver function parameters including AST,ALT,TB,PT on the day of surgery and 1,2,3,7 days later were monitored among the 4 groups,as well as the incidence of delayed nonfunction (DNF),and 3 and 6 months patient survival rate.Analysis of the correlation between degree of donor steatosis and liver function after operation was carried out.Resuits There was significant difference in postoperative ALT、AST、TB、PT level between≥40%group and 20%～40%group,and between 20%～40%and group＜20%group.There was no significant difference among the groups in DNF occurrence rate and 3 month.6 month patient survival rate.Correlation analysis suggested that the degree of donor steatosis was positively correlated with the damage of liver function.Conclusions Grafts with≤20% steatosis was safe,whereas≥20% especially ≥40% steatosis carries a high risk of posttransplant liver dysfunction even delayed nonfunction.

Objective To investigate the diagnosis,and management of aspergillosis infection in orthotopic liver transplant recipients.Methods The clinical data of 776 cases of orthotopic liver transplantation patients from 2000 to 2006 were collected and analyzed retrospectively.Results Aspergillosis infection occurred in 13 patients(1.68%),among those there were pulmonary aspergillus infection in 7 cases,hepatic aspergillus infection in 2,cerebral aspergillosis in one and multi-organ aspergillosis in 3.Liposomal amphotericin B was the main therapy especially for cases at early stage.7 patients died of aspergillosis and the aspergillosis-related mortality was 53.8%.Conclusion Early diagnosis and management remain the key for the prevention and cure for aspergillus infection and decreasing mortality.The use of anti-fungal therapy should follow the principle of eliminating the local infection,adjusting immunosuppressive regimen and use of sensitive anti-fungal drugs.Anti-fungal drugs should be started early,with sufficient dosage and long-term.