Objective To investigate a safe method for donor's hepatectomy in living donor liver transplantation (LDLT).Methods Of the 14 patients with endstage liver diseases undergoing LDLT successfully since Jan. 1995, 2 cases were subjected to extensive left lateral hepatetomy,10 to extensive left hepatetomy including middel hepatic vein and 2 to right hepatetomy. Results Bile leakge occurred only in one patients after removal of the T tube. All patients received a period of 1 month to 5 years. No complain was found. The function of the liver in all patients was normal. Conclusion The operative risk of donor hepatetomy is minimal if it is performed by experienced liver surgeons.

BACKGROUND: Recently,liver transplantation technique has been developed rapidly,and prevention of ischemia/reperfusion injury and protection of liver regeneration have become a research focus.Ischemic preconditioning(IPC)is an effective method for protecting liver ischemic injury.However,the mechanism remains controversial.OBJECTIVE: To investigate the mechanism of IPC on hepatic injury and regeneration after reduced-size rat liver transplantation.METHODS: Animals were randomly divided into 3 groups.Rat reduced-size liver transplantation model was established in liver transplantation group.IPC+liver transplantation group underwent first porta hepatis blocking for 10 minutes before liver graft reperfusion,followed by reperfusion for 15 minutes.The ligament around the liver was dissociated in the sham-surgery group.The samples were collected 0.5,2,6 and 24 hours post-operation.The hepatic injury was examined by the serum alanine aminotransferase(ALT)and hepatic tissue histopathology analysis of grafts.Semi-quantitative immunohistochemistry and westernblotting were used to examine the redox factor-1(Ref-1)protein expression.The hepatic regeneration of the grafts was examined by the expression of proliferating cell nuclear antigen(PCNA)in hepatic cells.RESULTS AND CONCLUSION: Compared with liver transplantation group,the ALT values at 6 and 24 hours after operation in IPC group decreased significantly(P < 0.05; P < 0.01).Pathological analysis indicated that there were lots of inflammation cells around the portal veins,the serious sinus hepaticus dilation and damage of hepatic tissue in liver transplantation group.However,the tissue injury observed in IPC group was comparatively slight.Semi-quantitative immunohistochemistry revealed that Ref-1 protein was more abundant in IPC grafts tissue compared to liver transplantation group.These observations were supported by westernblotting studies where Ref-1 protein was shown to be over-expressed in IPC specimens at 24 hours after reduced-size liver transplantation(P < 0.05).In addition,the number of PCNA-positive cells in IPC group was more than liver transplantation group at 2,6 and 24 hours after operation(P < 0.05).IPC improves hepatic regeneration and relieves grafts injury in earlier period after reduced-size rat liver transplantation,which is associated with the over-expression of Ref-1protein.

Objective To investigate the value of retention rate of indocyanine green at fifteen minutes(ICGR15)during hemihepatectomy for evaluation of residual liver reserve function in patients with primary liver carcinoma.Methods During hemihepatectomy,ICGR15 was tested in 44 patients after the hepatic artery and portal vein of resected side were ligated.Child-Pugh score,Child-Pugh classification,and MELD score before operation were tested.After operation,the liver function condition was estimated.Results The incidence of liver dysfunction was significantly lower in ICGR150.05).ICGR15 and MELD score in normal liver function group were statistical lower than those in mild insufficiency of liver function group and severe insufficiency of liver function group(P

Objective To detect the spreading scope of rectal cancer to mesorectum by RT PCR using carcinoembryonic antigen (CEA) mRNA as a marker and to investigate the excision scope of mesorectum in resection of rectal cancer. Methods Forty specimens from 40 rectal cancer patients who underwent curative operation was employed to detect the metastatic deposits scattered in the mesorectum by RT PCR using CEA as a marker. Results Nine of 40 (22.5%) specimens contained metastatic deposits scattered in the mesorectum. The metastasis was just within the range of 4cm mesorectum under the verge of tumor. The tumor spreading to mesorectum is correlated with Dukes stages,the infiltrated depth of bowel wall, tumor differentiation and tumor type( P 0.05). Conclusion The excision of mesorectum should be within the range of 5cm under the verge of tumor in surgical management of rectal cancer.

Objective To study the expression and significance of miR-26a in intrahepatic cholangiocarcinoma.Methods The expression of miR-26a in 46 intrahepatic cholangiocarcinoma(ICC) tissues and peritumoral tissues was detected by quantitative real time polymerase chain reaction (qRT PCR).The intrahepatic eholangiocarcinoma cell line HCCC-9810 and RBE were transfected with miR 26a mimics and miR 26a inhibitors,respectively,by lipofectamine 2000.The growth curves were constructed by the CCK 8 method.The migration and invasion ability was demonstrated by wound healing and transwell assay.The cell cycle was analyzed by flow cytometry.The potential mechanism was illustrated by Western blotting.Results For the 46 ICC tissues and peritumoral tissues,miR 26a levels were significantly higher in the tumor tissues than in the peritumoral tissues (P＜0.05).Vascular invasion,TNM Ⅲ～Ⅳ stage and lymph node metastasis were significantly associated with high miR 26a expression levels (P＜0.05),but gender,age,tumor amounts,tumor encapsulation,tumor diameter and tumor differentiation showed no significant association (P＞0.05).Enhanced cell proliferation,migration and invasion ability,accelerated G0/G1 phase to S phase transition,activated AKT by PTEN suppression were observed in HCCC-9810 cells with up regulation of miR-26a.Conversely,cell proliferation,migration and invasion ability was inhibited,G0/G1 phase was blocked and AKT was restrained by PTEN increase wkh down regulation of miR-26a in RBE cells.PTEN mRNA in versely correlated with the miR-26a level (r=-0.8272,P＜0.01).Patients with a high miR-26a expression had significantly poorer overall survival (P＜0.05).A high miR 26a exprcssion,multiple tumors and lymph node metastasis were independent prognostic factors of overall survival (P＜0.01).Conclusion Overexpression of miR-26a in intrahepatic cholangiocarcinoma correlated with clinicopath ological features and overall survival,and it potentially promoted tumor proliferation and metastasis through the PTEN/AKT pathway.

Objective To evaluate living-related liver transplantation (LRLT) for the treatment of Wilson′s disease. MethodsBetween Jan. 2001 and Oct. 2003,LRLT was performed in 20 patients (mean age 11.1 years) of late staged Wilson′s disease. Among them emergency transplantation was performed in 3 patients. Donor livers were all from patient′s parents. ResultsSurgery was successful in all donors and recipients, liver function test and serum ceruloplasmin reached normal level one month after transplantation. One patient died of severe rejection. Discharged patients were followed up from 2～33 months (mean 18.9 months). [WT5”HZ]ConclusionsLiving related liver transplantation is an effective treatment for Wilson′s disease complicated with hepatic dysfunction.

The effectiveness of liver autotransplantation for patients with partial hepatic alveolar echinococcosis was analyzed. We retrospectively studied 6 patients with hepatic alveolar echinococcosis who underwent liver autotransplantation in our hospital from 2008 to 2010. We also summarized the surgical indications of liver autotransplantation for hepatic alveolar echinococcosis and our experience in the management of postoperative complications of liver autotransplantation. Of 6 patients, 5 achieved good curative results, and one died of multiple organ failure caused by portal vein thrombosis. Main complications included postoperative bleeding, bile leak and small-for-size liver graft syndrome. Liver autotransplantation offers a new approach to cure hepatic alveolar echinococcosis with non-resectable lesions. It could be the most effective method to cure intractable hepatic alveolar echinococcosis if correct handling in operation and proper prevention of complications are performed. But the long-term outcomes are still needed to be confirmed in longer follow-up.

OBJECTIVE: To investigate the self-management behaviors of patients with type 2 diabetes mellitus (DM) in a community and to explore the relationship between self-management behaviors and the glycemic control. METHODS: A total of 211 type 2 DM patients in a community were selected by stratified random sampling. Patients were grouped according to the scores of self-management behaviors. The fasting plasma glucose (FPG), 2 h postprandial plasma glucose (2hPG) and glycated hemoglobin (HbA1C) level were tested. The differences between groups and relationship between self-management behaviors and glycemic control were analyzed. RESULTS: Self-management behaviors of most patients were not effective, and 2hPG and HbA1C were affected by different levels of the self-management behaviors (P<0.05). The self-management behaviors were negatively related to FPG (r=-0.277, P=0.015), 2hPG (r=-0.453, P=0.001), and HbA1C (r=-0.435, P=0.001). Glycemic control of the patients whose course of disease was over 5 years was significantly different due to different self-management behaviors. FPG level of the patients was positively related to alimentary control. The 2hPG level of the patients was positively related to alimentary control, medication persistence, and blood glucose self-monitoring. The HbA1C level of the patients was positively related to alimentary control and medication persistence. The times the patients received DM education, the way to use insulin, and the disease course of the patients were important factors to affect self-management behaviors of type 2 DM in the community. CONCLUSION Self-management behaviors of type 2 DM patients in the community are not effective. Satisfactory self-management behaviors, specially the control of 2hPG and HbA1C are beneficial to glycemic control. We can improve the self-management behaviors in type 2 DM patients by paying attention to the disease course, the treatment method, and the contents and effect of DM education.
Adult ; Aged ; Aged, 80 and over ; Attitude to Health ; Blood Glucose ; metabolism ; Blood Glucose Self-Monitoring ; statistics & numerical data ; China ; Community Networks ; Diabetes Mellitus, Type 2 ; blood ; psychology ; therapy ; Diet, Diabetic ; methods ; psychology ; Female ; Glycated Hemoglobin A ; analysis ; Humans ; Male ; Middle Aged ; Patient Education as Topic ; Self Care ; methods ; psychology ; Surveys and Questionnaires ; Young Adult

Objective To synthesize 11 C-methyldopamine (MDA) and to explore its feasibility as an agent for cardiac sympathetic nerve imaging.Methods 11 C-MDA was synthesized by direct N-methylation method and purified by semi-preparation reverse HPLC.Thirty Kunming mice were divided into five groups by random number table.The mice were respectively sacrificed at 2,5,10,20 and 30 min after injection of 7.4 MBq 11C-MDA.The lung,liver,spleen,kidney,stomach,intestine,brain,muscle,bone tissues and blood of mice were removed and weighed before radioactive γ-counting.The ％ID/g was calculated.Six Chinese mini-swine were divided into normal group (n=3) and inhibition group (n =3) for myocardial imaging.Mini-swine of inhibition group were injected with 10 mg/kg imipramine hydrochloride at 30 min before 11C-MDA (370 MBq) injection.The data were analyzed with SPSS 15.0 software.Results The synthesis of 11 C-MDA took 45 min with radiochemical yields of (20±3)％.The solution of11 C-MDA was colorless and the pH value was 6.5.The radiochemical purity was more than 98％ and the specific activity was 50 GBq/mmol.The myocardial uptake reached the peak value of (8.78± 1.18) ％ID/g at 2 min after injection of 11 C-MDA in mice.11C-MDA was mainly metabolized through liver and kidney.PET/CT imaging showed that 11 C-MDA was highly uptaken in swine myocardium and could be blocked by imipramine hydrochloride.Conclusions 11C-MDA can be synthesized by a simple and economic method.The high uptake rate of 11 C-MDA in the heart suggests it may be a potential agent for cardiac nerve imaging.

Objective To evaluate 11C-MDA,a cardiac sympathetic nerve presynaptic molecular probe,in acute myocardial ischemia (AMI) and to compare with 13N-Ammonia myocardial perfusion imaging.Methods Twelve Bama miniature pigs were used to establish AMI models.11C-MDA and 13N-Ammonia PET/CT were performed before and after model establishment.The defect fraction,ratio of defect to normal region,defect volume of 11C-MDA and 13N-Ammonia PET/CT were calculated.Paired-t test and twosample t test were used.Results Eight models were established successfully and 4 pigs died.The defect fractions on 11C-MDA and 13N-Ammonia myocardial imaging were significantly different (13.4±3.3 vs 7.4±1.0,18.8±4.4 vs 4.8±1.0,10.5±4.2 vs 4.4±0.9;t values:4.901,8.864,4.030,all P＜0.001) at the first,third and sixth month post-model establishment.The ratios of defect to normal region on 11C-MDA and 13N-Ammonia PET/CT myocardial images were significantly different (0.47±0.14 vs 0.59±0.10,0.43±0.13 vs 0.61±0.09;t values:-2.166,-3.415,both P＜0.05) at the first and third month post-model establishment.The defect volumes on 11C-MDA and 13N-Ammonia PET/CT were significantly different ((4.20±0.34) vs (2.55±0.11) cm3,(10.66±0.71) vs (2.46±0.12) cm3,(5.95±0.50) vs (2.44±0.11) cm3;t values:12.925,32.149,19.440,all P＜0.001) at the first,third and sixth month post-model establishment.Conclusions Myocardial ischemia-reperfusion and cardiac sympathetic restoration might occur at different times.The recovery of myocardial ischemia-reperfusion is earlier than that of the cardiac sympathetic nerve.