Objective To investigate the factors in association with colorectal disorders in adult recipients of liver allograft. Methods A retrospective cohort study was carried out with clinical, microbiological and management data regarding diarrhea in 218 adult recipients of liver allograft from Jan. 2003 to Dec. 2006. Results Of the 218 patients, 68(31.2%) of them, who did not history of ulcerative colitis, were found to have diarrhea after orthotopic liver transplantation. Among these 68 patients, diarrhea was probably caused by administration of immunosuppressive agents in 35 cases (51.4%), in 12 cases (17.6%) diarrhea was antibiotics associated, and in 5 cases (7.4%) it was due to intraperitoneal infection. The other pathogenic factors included fungal infection in 3 cases (4.4%), cytomegalovirus infection in 3 cases (4.4%), Roux-en-Y choledochojejunostomy in 8 cases (11.8%) and some other unknown problem related in 2 cases (2.9%). Diarrhea occurred soon after transplantation in most cases. Of the 68 patients, the symptom of diarrhea occurred in the first 2 months in 45 cases (66.2%), and in the next 4 months in 23 cases (33.8%), i.e. the symptoms occurred 5-180 days after transplantation. Conclusion Immunosuppressive agents, antibiotics, fungal infection and cytomegalovirus infection are the top four common causes of diarrhea after orthotopic liver transplantation. The outcome is good with appropriate conservative management.

OBJECTIVEThis study was performed to determine the feasibility of digital virtual positioning of braces in clinical applications.

METHODSWe determined the positions of brackets in 28 teeth of 15 cases according to positioning methods that use bracket height or root information. Final status was generated by OrthoRx software. Treatment results were assessed with American board of orthodontics objective grading system (ABO-OGS).

RESULTSThe deduction points in the marginal ridge height were significantly decreased after treatment using the two methods (P<0.05). However, no statistically significant difference was found in the deduction points in the marginal ridge height between the two methods (P>0.05). No improvement was found in the deduction points in root parallelism with both methods. No statistical significance was found in the deduction points in root parallelism before and after treatments using both methods. The deduction points in alignment and the three scoring components were significantly decreased after treatment using the two positioning methods. In addition, statistically significant differences were found in the deduction points in alignment between two methods (P<0.05).

CONCLUSIONBy using OrthoRx software, we achieved effective therapeutic treatment in reconstructing three-dimensional digital modes using two different bracket-positioning methods. The positioning method that used root information is more accurate compared with the bracket height positioning method. This study provides an experimental basis for bracket accuracy in the mouth.

ObjectiveTo share the experience of arterial plasty and reconstruction of variant arteries in living donor liver transplantation. MethodsFrom September 2006 to May 2010, 73 living donor liver grafts (64 cases using the right lobe,9 cases using left lobe) were used in patients with end-stage liver disease. The hepatic arteries were evaluated preoperatively with computed tomography and magnetic resonance angiography. Back-table arterial plasty was performed under a microscope or a loupe according to arterial variation. We described technical points based on anatomic variations. There were 13 (17. 8 ％) liver grafts with anatomic hepatic arterial variations and all of these cases were subjected to back-table reconstruction with interrupted 8-0 or 9-0 nonabsorbable nylon monofilament sutures according to the diameter of artery. ResultsIn 3 cases, the associate right hepatic arteries that were arisen from superior esenteric arteris (SMA) were reconstructed to cystic arteries. In 2 cases with the associate right hepatic arteries arisen from the abdominal trunk, the right hepatic arteries and associate right hepatic arteries of donors were anastomosed with right hepatic arteries and left hepatic arteries in recipients respectively. In 2 donors, hepatic arteries had branches, which were reconstructed. All of the arterial plasty were conducted on a back table. No arterial thrombosis was found during a postoperative follow-up period of 6 months. ConclusionLive donor liver transplantation using the right lobe with hepatic artery variation can be performed safely, but there is a potential operative risk of severe complication after transplantation. Tominimize operative difficulties and complications, back-table reconstruction should be applied and proper treatment is given according to individual situations to ensure a safe and satisfactory outcome

Objective To assess the feasibility,safety and advantages of robotic-assisted precise hepatectomy.Methods Between April and July 2009,13 consecutive patients underwent robotic-assisted hepatectomy for hepatic diseases.The clinical data were analyzed retrospectively.Results All 13 Da Vinci surgical systemassisted precise hepatectomies were successfully performed without conversion to laparotomy.Major hepatectomies were performed in 9 patients,left lateral segmentectomies in 4 patients.All the Da Vinci surgical system-assisted hepatectomies were performed anatomically with hilum dissection.Prior to the parenchymal transaction,vascular control of the portal vessels was carried out whenever possible.The mean operative time was 338 minutes(range,150-720 minutes).The mean blood loss was 208 ml(range,50-800 ml).No patient required blood transfusion,and no mortality,transient bile leakage was observed in patients with hilar cholangiocarcinoma.The mean postoperative stay was 7 days(range,2-13 days).Conclusions These preliminary results show that Da Vinci surgical system-assisted precise hepatectomy is safe and feasible with potential benefits of a minimally invasive approach.Da Vinci surgical system may broaden the indications for laparoscopic hepatactomy,and it enables surgeons to perform precise laparoscopic hepatectomy which required hilum dissection,hepatocaval dissection,endoscopic suturing and microanastamosis.

Objective To investigate the clinical value of computer-assisted operation planning system for precise hepatectomy.Methods The clinical data of 45 patients who had undergone precise hepatectomy at General Hospital of PLA from November 2006 to November 2009 were retrospectively analyzed.The 3-dimensional imaging of liver was constructed by computer-assisted operation planning system,and the anatomic relationship between hepatic vasculature and tumor Was analyzed.Volume of hepatic segments,total liver volume,tumor volume,predicted resection volume and the remnant liver volume were calculated before operation.Virtual liver resection was performed in order to select the best operative procedure.The predicted resection volume Was compared with the hepatic segment resected.All data were analyzed by t test,Pearson rank correlation analysis and chi-square test.Results The predicted resection volume calculated based on the 2-dimensional imaging was similar to that calculated based on the 3-dimensional imaging(t=2.125,P>0.05).The three-grade branches of the hepatic artery,portal vein and hepatic vein were clearly shown in the computer-assisted operation planning system.The anatomic relationship between tumor and adjacent vessels was quantitatively analyzed.There was a positive correlation between the predicted resection volume and the resected liver volume(r=0.999,P<0.05),and the error rate Was 5.1%.All patients received anatomical hepatectomy,and the incidence of postoperative complications was 20%(9/45).No liver failure or perioperative mortality was observed.Conclusion Computer-assisted operation planning system may facilitate and promote precise hepatectomy.

Objective To summarize the initial experience in adult-to-adult living donor liver transplantation(ALDLT),so as to improve the efficacy of ALDLT.Methods The clinical data of 31 adult patients who undelwent ALDLT from June 2006 to February 2008 were retrospectively analyzed.Results Of all the patients,8 was with decompensated cirrhosis,7 with acute liver failure,12 with hepatocellular carcinoma,2 with purpura of liver,1 with hilar cholangiocarcinoma,and 1 with Wilson disease.The liver grafts included 25 right lobes with middle hepatic vein(MHV),3 right lobes without MHV,1 right lobe with MHV+left lateral lobe,1 right lobe with MHV+left lobe.The remaining 1 patient underwent auxiliary partial orthotopic liver transplantation with left lobe graft.Six post-transplantation complications occurred in 5 donors. Eleven post-transplantation complications occurred in 9 recipients,including 4 biliary complications,3 vascular complications,3 infection complications and 1 delayed healing of the incision.After ALDLT,2 recipients died of pulmonary infection and 1 of multiple aspergillus infection. Conclusions ALDLT has become an effective method to expand the source of liver grafts.Rational donor and recipient assessment,surgical procedure and postoperative management are key to ALDLT.

Objective To research the Annexin V-nanoscale ultrasound contrast agents'preparation, ultrasound imaging and the ability to binding apoptosis cells of tumor in vitro.Methods The nanoscale bubble (Nanobubbles,NBs ) packaged the octaflouropropane (C3 F8 ) gas was prepared by thin film hydration.The Annexin V-Nanobubbles (AVNBs ) solutions was acquired through conjugating the biotinylated-Annexin V to the surface of the NBs by biotin-streptavidin bridging chemistry.The size and zeta potential of AVNBs were measured by NanoPlus-3 zeta/nano particle analyzer.The shift in size distribution of AVNBs bubbles was analyzed for the stability,after it was stored at 4 ℃ for different time. AVNB's shape were measured by scanning electron microscopy.The AVNBs bubble was measured using an ultrasound system for echogenicity in vitro,and SonoVue was for control.Finally,the ability of AVNBs binding with apoptosis cells of tumor in vitro was determine via the fluorescence microscope.Results AVNBs has a size distribution of (640.2±32.1 )nm,and a mean zeta potential of (-23.30 ±5.71 )mV.Its size remained relatively constant and appeared to show less size variation within the 24 h analysis period. AVNBs solutions were visible milky white and slightly suspension liquid with the naked eye.Under scanning electron microscopy,AVNBs were uniform hollow sperical cavitation bubble with small size and larger dispersibility in solution.The AVNBs and SonoVue solution had the same higher grayscale signal intensity by ultrasonic imaging.The AVNBs binded well with apoptosis cells of tumor in vitro,and the rate of binding was (97.55 ± 1 .30 )%.Conclusions The AVNBs particles prepared by method of thin film hydration have a nanoscale size,good stability and echogenicity.It can be targeted binding with the apoptosis cells of tumor in vitro.

Objective:The present study aimed to conduct a clinical analysis of nosocomial infections in hospitalized cancer pa-tients and propose effective precautionary measures. Methods:We retrospectively analyzed 56,430 cases of discharges from the Cancer Institute and Hospital of Tianjin Medical University between January and December 2012. Results:Among 825 cases, the rate of noso-comial infections was 1.46%;46.42%of the patients aged>60 years. The highest infection rate was observed in the Medical Depart-ment of Stomach Cancer. The highest composing rate was recorded in the Department of Hepatobiliary Cancer. The major pathogenic bacteria were Gram-negative bacilli;fungal infections were relatively rare. The most vulnerable body parts were the abdomen and diges-tive tract, which were mainly infected by pathogenic Escherichia coli. Conclusion:Healthcare workers should consider the importance of influencing factors and take precautionary measures to reduce the rate of nosocomial infections in cancer patients.

Objective To explore the value of superior vena cava (SVC) Doppler spectrum in evaluation of the therapeutic effects of intermittent hypobaric hypoxia (HBHO)-induced pulmonary hypertension (PH) in rats and establish a new method for assessing pulmonary hypertension.Methods Fifty male SD rats were included.Forty of them were developed HBHO-PH and randomly divided into four groups with different manipulations:beraprost treatment group,sildenafil treatment group,placebo group and model group,with 10 rats in each group.The rest of 10 rats served as controls.Cardiac structure,pulmonary peak velocity (PAVmax),tricuspid peak velocity (TVEmax) and SVC Doppler ultrasound were performed in all rats before and after treatment for 2 weeks.Pulmonary arterial pressure was determined by the right heart catheterization.The relationship of the parameters with the pulmonary arterial pressure was analyzed.HE staining was done in lung tissues.Results Right heart catheterization showed that pulmonary artery systolic pressure (PASP) of the treatment groups were lower than that of the model group,the difference was significant(P ＜0.01).Pulmonary artery pressure decreased in varying degrees both after placed in a normal environment and after 2 weeks of treatment.PASP of the beraprost treatment group and the sildenafil treatment group decreased significantly and showed no statistical significant difference with the control group.In contrast,PASP of the placebo group was significant higher than that of control group(P ＜ 0.05).No statistically significant difference was found between the non-placebo treatment groups in PASP.Compared with the control group,the right ventricle/body weight ratio of the model group was statistically significant increased in all other groups(P ＜0.01).Right SVC AR/S ratio was well correlated with PASP (r =0.603,P =0.001).Right SVC AR/S ratio was statistically significant lower in treatment groups compared with the model group (P ＜0.01).All groups except the control group demonstrated various degrees of pulmonary arterial wall thickening.Conclusions The right SVC spectrum of AR/S correlates well with PASP and can be used to evaluate the pharmacological therapeutic effect of rats with HBHO-PH,in particular with moderate to severe PH.

OBJECTIVE To explore the treatment measure of pulmonary infection after liver transplantation.METHODS The clinical data of 78 cases of pulmonary infection after liver transplantation in our hospital were analyzed retrospectively.RESULTS The incidence of pulmonary infection in this group of patients was 48.8%.The mean onset time of the first pulmonary infection after operation was(9.56?5.53)days after surgery.Forty four patients were diagnosed as right pneumonia,14 as left pneumonia,and 20 bilateral pneumonia.Long operation time,mechanical ventilatory time,abdominal bleeding,intraoperative total fluid perfusion and renal dysfunction after liver transplantation were risk factors of pulmonary infection.87.2% Of these patients improved,and 12.8% died.CONCLUSIONS The mortality of pulmonary infection after liver transplantation is high.Bacteria and fungi are the major pathogens.The key of prevention and cure of pulmonary infection after liver transplantation wis included of cutting down operation time,lessening abdominal bleeding,controlling intraoperative fluid perfusion,extubating as soon as possible,protecting renal dysfunction and raising pathogeny to check.