5 cases of orthotopic live transplantation (OLTX) were performed in unresectable hepatic cellular carcinoma(3),Wilson's disease(1)and hepatitis B(1).The donor livers were harvested by the technique of rapid multiple organ harvesting,flushed and preserved with UW solution.The veno-venous bypass was introduced during the anhepatic phase in the operation.The double or triple-drug immunosuppressive regimen was used and three episodes of acute rejection were controlled in two patients.One patient died of CMV infection and another,of upper gastrointestinal hemorrhage on the 92nd and 58th postoperative day respectively.The other three are still alive for 35,150 and 210 days.

Objective To investigate the relationship between the intercellular adhesion molecule-1(ICAM-1) and lymphocyte function associated with antigen-1( LFA-1) and acute rejection of liver transplantation in rats. Methods SD rats and Wistar rats were randomly divided into normal control group, isograft group, and allograft group. Liver biopsies from the recipients were obtained on the day 2,4, and 7 postoperatively to examine the expression level of ICAM-1 and LFA-1 in liver grafts. Samples were firstly stained with specific monoclonal antibodies using immunohistochemistry stain and then applied to image semiquantitive analysis. Results The expression levels of ICAM-1 and LFA-1 in allograft group were obviously higher than those in both isograft group and normal group. Moreover, the expression levels of ICAM-1 and LFA-1 were correlated positively with the degree of acute liver rejection. Conclusions Detecting the expressions of ICAM-1 and LFA-1 in liver graft tissue may be helpful to the diagnosis of acute rejection after liver transplantation.

【Objective】To investigate the relationship between the expression of lymphocyte function-associated antigen-1 (LFA-1) on peripheral lymphocytes and acute rejection after orthotopic liver transplantation (OLTx) in rat.【Methods】Adult male rats were divided into 2 groups.In the non-rejection group,40 SD rats were used as both donors and recipients.In the rejection group,20 Wistar rats were used as donors and 20 SD rats as recipients.Blood samples were collected through the tail vein 1 day before transplantation and on days 1、3、5、7 after OLTx.The expression of LFA-1 (CD11a) on peripheral lymphocytes was analyzed by using indirect immunofluorescent marker-flow cytometry.【Results】The expression level of LFA-1 on peripheral lymphocytes in recipient rats after orthotopic liver transplantation was markedly lower than that before operation (P<0.01);The expression level of LFA-1 on peripheral lymphocytes in rats with acute liver rejection was significantly higher than that in the non-rejection group (P<0.01).【Conclusion】Monitoring the expression level of LFA-1 on peripheral lymphocytes may be helpful to the diagnosis of acute graft rejection.

Objective To investigate the quality of life and its influencing factors in hver transplantation recipients in order to supply scientific reference for improving their life quality.Methods 33 patients with terminal liver diseases waiting for liver transplantation(the pre-operation group)and 102 patients 2 weeks after liver transplantation and outpatients for follow-up visits(the post-operation group)were conducted with SF-36,self-rating anxiety scale,self-rating depression scale,and social support questionnaire.Results Except for the scores of physiological function,emotional role,social function in SF-36.differences of scores of other factors were evident between the preand post-operation groups.Life quality of patients over 1 year after operation was better than those within 1 year. The influencing factors of QOL were subjective support and anxiety.Conclusions After liver transplantation,the patients' QOL evidently improves.Life quality of patients over 1 year after operation was better than those within 1 year.Patients' QOL is positively related to subjective support,negatively related to anxiety.

It has been shown, however, that in terms of immune function, a transitional stage of dendritic cell maturation exists between immature myeloid dendritic cells (imDCs) and mature dendritic cells (DCs), which were named semimature dendritic cells (smDCs). Therefore, the theory that DCs can be classified as imDCs and mDCs has been challenged because of finding smDCs. SmDCs and imDCs are regarded as tolerogenic dendritc cells while what concrete mechanism taken by smDCs and imDCs in transplantation immunity has yet to know. The authors analyzed the important roles and the advanced molecular mechanism of smDCs and imDCs in transplantation immunity in order to update and widen understand underlying tolerogenic dendritic cells.

BACKGROUND: During the embryonic stage, E-cadherin expression plays a critical role in the formation of hepatic tissue.OBJECTIVE: E-cadherin gene was transfected into mouse embryonic stem cells (ESCs) to observe its effects on adhesive capacity of differentiated cells.DESIGN, TIME AND SETTING: A cytological in vitro observation was performed at the Laboratory of Surgery, First Hospital Affiliated to Sun Yat-sen University between December 2007 and December 2008.MATERIALS: BALB/c mice at gestational 13 days, of clean grade, were provided by Laboratory Animal Center, Sun Yat-sen University. BALB/c mouse ESCs were preserved by professor Huang Bing from the Department of Ophthalmology, Sun Yat-sen University. CMV promoter-containing eukaryotic expression plasmid pEGFP-N1 was gifted by doctor Lu Zhi-yue from Medical College, Sun Yat-sen University.METHODS: Total RNA was extracted from BALB/c mouse fresh hepatic tissue and synthesized into cDNA by reverse transcription (RT). The synthesized cDNA was used as a template to perform a polymerase chain reaction (PCR) that amplifies a targeted fragment. Following double enzyme digestion, pEGFP-E-cadherin plasmids were reconstructed and transfected into mouse ESCs. In vitro differentiation of transfected mouse ESCs was performed.MAIN OUTCOME MEASURES: Detection of E-cadherin expression in the differentiation system using RT-PCR and immunocytochemistry and observation of adhesive capacity of differentiated cells.RESULTS: E-cadherin gene-transfected ESCs could stably express E-cadherin during differentiational 1-17 days, while non-transfected ESCs expressed a decreasing amount of E-cadherin. The adhesive capacity of differentiated cells that stably expressed E-cadherin was markedly enhanced. Compact cell connection and multi-layer growth state remained at 19 days. While non-transfected ESCs gradually changed from embryoid bodies into noncohesive cell populations.CONCLUSION: Differentiating E-cadherin ESCs exhibit markedly enhanced adhesive capacity and maintain multi-layer growth state.

BACKGROUND:E-cadhedn plays an important role in development of liver tissue in the embryonic stage.Therefore,it is importance for investigating the feasibility of dynamic expression of E-cadherin in embryonic stern cell differentiation to in vitro development of liver tissue.OBJECTIVE:To observe the dynamic expression of E-cadherin in embryonic stem cell differentiation and the effect on cell adhesion.DESIGN,TIME AND SETTING:An in vitro cytological observation was performed at Surgical Laboratory of the First Affiliated Hospital of Sun Yat-sen University from December 2007 to December 2008.MATERIALS:Embryonic stem cells of BALB/c mice were obtained from Professor Huang (Department of Ophthalmology,Sun Yat-sen University).Twenty 13-day-old pregnant BALB/c mice of clean grade were provided by the Experimental Animal Centar of Sun Yat-sen University.METHODS:Following trypsinization,embryonic stem cells were suspend-incubated in DMEM culture medium containing fetal bovine serum,2-mercaptoethanol,HEPES,penicillin,and streptomycin.Embryoid body was formed 5 days after normal development and incubated in the culture plate at day 6.Liver tissue which was obtained from 13-day-old pregnant BALB/c mice was prepared for fetal liver cells which were frozen-sectioned as the controls.MAIN OUTCOME MEASURES:E-cadherin expression was detected using reverse transcriptase-polymerase chain reaction (RT-PCR) and immunocytochemistry st varying time points of 1,5,9,13,and 17 days in stages of initial differentiation of embryonic stem cells,formation of embryoid body,and formation of differentiated clusters.Additionally,the effect of E-cadherin expression on cell adhesion was also detected.RESULTS:RT-PCR showed that E-cadherin mRNA expression was not observed at day 1 but peaked at day 5;gradually,the expression was decreased until the expression was stopped at day 17.E-cadherin mRNA expression was strong in fetal liver cells in the control group.Immunocytochemistry showed a similar outcome.Morphologically,embryonic stem cells developed from unicells into compact three-embryonic layer embryoid body and into incompact cell population.CONCLUSION:E-cadherin expression correlates with differentiated cell adhesion;additionally,the lost expression in an in vitro environment may be an important cause for unable regularization of differentiated cells.

Objective To evaluate the effect of single injection of low dose zoledronic acid on bone resorption.Methods332 menopausal patients with bone deficiency treated in our hospital were selected.The patients were treated with zoledronic acid 1mg (1mg group), 2.5mg treatment group (2.5mg group), 5mg treatment group (5 mg group) and placebo treatment group (control group), each group of 83 patients.The patients of 1mg group, 2.5mg group and 5 mg group were treated with 1mg, 2.5mg and 5mg zoledronic acid alone.The patients in the control group were given intravenous infusion of placebo.Evaluated the lumbar spine (L1-L4) and total hip bone mineral density (BMD) and bone metabolic markers at baseline, 6, 12, 18, and 24 months in the four groups.The bone metabolic criteria included t β-Cterminal-telopeptide of type I collagen (β-CTX) and procollagen type-I N-terminal propeptide (P1NP).ResultsThe Lumbar spine BMD and the Total hip BMD were significantly higher in 1mg group than baseline value and Simultaneous valueand in the control group (P<0.05), The difference were statistically significant (all P<0.05).The values at 8 and 24 months decreased gradually.The value was significantly lower (P<0.05) compared with the control group, There were no statistically significant difference compared with the simultaneous value in control group.The lumbar BMD and the total hip BMD in 2.5mg and 5mg groups were significantly lower than the baseline values during the whole trial period (all P<0.05).The trend of β-CTX and P1NP was similar to that of BMD in each group.ConclusionIntravenous injection of 1 mg and 2.5 mg of zoledronic acid produces anti-bone resorption that can last for at least 1 year.After one year of treatment, The effect of single injection of 2.5 mg of zoledronic acid on bone is similar to that of single injection of 5 mg zoledronic acid.1 mg zoledronic acid produced by anti-bone resorption can last for 12 months, and then slowly disappear.

Objective　To report the experience in diagnosis and treatment of inferior vena cava stenosis (IVCS) after orthotopic liver transplantation (OLT). Methods　The clnical data of 3 patients with IVCS out of 51 OLT patients were analysed retrospectively. Results　The incidence of IVCS after OLT was 5.8% (3/51) in our hospital. In the 3 cases, IVCS of the posteriorhepatic IVC segment occurred within the first postoperative month. IVCS was identified by color duplex ultrasonography and confirmed by angiography. Percutaenous transluminal angioplasty (PTA) or metallic stent replacement were used in the 3 cases resulting in restoration of normal venous flow and elimination of legs edema. The first patient died of cerebral hemorrhage 14 days after transplantation during anti-coagulative therapy. The other two recovered smoothly with good liver function, abdominal ultrasonography demonstrated patency of the IVC. The 2 cases were alive for 18 and 4 months respectively. Conclusions　The venacavographic balloon angioplasty and metallic stent replacement are safe and useful for post-OLT IVCS. The short-term result is excellent.

Objective To evaluate the efficacy of liver grafts with warm ischemia and with different cold preservation time in liver transplantation.Methods The clinical data of 154 patients who received liver transplantation at the First Affiliated Hospital of Sun Yat-sen University from January 2006 to December 2007 were retrospectively analyzed.The warm ischemia time of the liver grafts obtained from the non-heart-beating donors was within 10 minutes.According to cold perservation time of the liver grafts,patients were divided into 3 groups:the cold preservation time of the liver grafts was within 8 hours,8-12 hours and above 12 hours in group I(n=58),group Ⅱ(n=62)and group Ⅲ(n=34),respectively.The peak level of alanine aminotransferase(ALT),primary graft dysfunction(PGD)after liver transplantation,acute rejection response,biliary complications,vessel complications,perioperative infections and the survival of liver grafts and recipients among the 3 groups were analyzed via chi-square test,t test and variance analysis.Results No PGD was detected in the 3 groups after liver transplantation.All patients were followed up for 8-32 months.The peak level of ALT,incidence of infection and biliary complication,survival of liver grafts and recipients were(482±357)U/L,12%(7/58),12%(7/58),86%(50/58)and 88%(51/58)in group Ⅰ,and were(1274±608)U/L,29%(10/34),26%(9/34),68%(23/34)and 71%(24/34)in group Ⅲ,with significant difference between the 2 groups(t=5.23,X~2=4.28,6.77,4.51,4.28,P<0.05).The peak level of ALT in group Ⅱ was(953±424)U/L,which was significant higher than(482±357)U/L in group Ⅰ(t=4.76,P＜0.05).Conclusions Liver grafts with a warm ischemia time shorter than 10 minutes could tolerate the injury caused by cold preservation with the maximum time of 12 hours.The incidences of biliary complications and postoperative infections are significantly increased and the survivals of liver grafts and recipients are decreased when the cold preservation time exceeds 12 hours.