In recent 20 years,liver transplantation has been rapidly developed in China,and the number of cases and patient outcomes have continued to improve.However,many problems emerged,such as mismatch of donor source and unbalanced distribution system,the research achievements lacking of innovation and core competitiveness,and clinical study level lags behind.In order to solve the problems mentioned above,the First Affiliated Hospital of Nanjing Medical University has carried out a series of work,such as expanding the donor pool,improving clinical technologies,and strengthening basic researches.

Objective To review the regulation of liver regeneration factors.Methods The literatures about liver regeneration related regulators in recent years were reviewed.Results With further advancement of researches on regulators of liver regeneration in recent years,there were more therapies for treatment of liver-related diseases.Regulators play important roles in the process of liver regeneration,as one of which,cell growth factor plays an essential role in liver cell proliferation,such as the proper expression of TNF-? and IL-6 promoting liver cell proliferation,HGF,TGF-?,EGF,ALR,FS,and others motivating liver cell proliferation,while TGF-? and IL-1 physically terminating liver cell proliferation.Conclusion By strengthening the studies on liver regeneration regulators,new methods may appear for treating liver-related diseases.

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Objective To explore the application value of superior mesenteric vein-caval-right atrium Y shape shunt (abbr.SMV-CV-RA Y shape shunt) as a new approach for treatment of mixed pattern Budd-Chiari syndrome (B-CS).Methods The clinical data of 101 cases of mixed pattern B-CS patients were evaluated for the curative effect.Of the 101 patients,62 were treated with superior ruesenteric vein-caval-right atrium Y shape shunt,26 with splenic vein-caval shunt and 13 with superior mesenteric vein-caval shunt using artificial vascular graft.Results Compared with the plastocyte count of patients receiving splenic vein-caval shunt and superior mesenteric vein-caval shunt,the plastocyte count of 62 cases undergoing SMV-CV-RA shunt increased obviously after operation (P＜0.05).The portal vein pressure of patients with SMV-CV-RA shunt decreased significantly (P＜0.05),but the pressure of patients in splenic vein-caval shunt group and superior mesenteric vein-caval shunt group deceased slightly (P＞0.05).The incidence of hepatic encephalopathy in one year after operation was not significantly different among the 3 groups (P＞0.05).The incidence was 3.2%(2/62),0% (0/26),0% (0/13),respectively.The recanalization rate of artificial vascular graft was 95.2%(59/62),69.2%(18/25),38.4%(5/13),respectively in SMV-CV-RA shunt group,splenic vein-caval shunt group and superior mesenteric vein-caval shunt group.The recanalization rate of artificial vascular graft in SMV-CV-RA shunt group was increased significantly (P＜0.05).Conclusion Compared with splenic vein-caval shunt and superior mesenteric vein-caval shunt,the SMV-CV-RA Y shape shunt can get satisfactory effeet in curing massive hemorrhage of gastrointestinal tract for cutting down the pressure of portal vein and inferior vena.Otherwise,the shunt could eliminate hypersplenia of patients.The splenic vein-caval shunt and superior mesenteric vein-caval shunt are not effective in curing the mixed pattern B-CS.

Objective To study the effects of peroxisome proliferators-activated receptor (PPAR) ? on the growth of human hepatocellular carcinoma cells and explore the roles of phosphatase and tensin homologue deleted on chromosome ten (PTEN) and phospho-Akt in this process. Methods SMMC-7721 cells were treated with 15-d-PGJ2 or pioglitazone, which were two kinds of PPAR? ligands, at different concentrations. The viability of SMMC-7721 cells was evaluated by MTT assay. The cell cycle was analyzed by flow cytometry. PTEN mRNA level was determined by RT-PCR. The protein expressions of PTEN and pAkt were measured by Western blot analysis. Results It was demonstrated through MTT assay that both 15-d-PGJ2 and pioglitazone had an inhibitory effect on the growth of SMMC-7721 cells in a time- and dose- dependent manner. According to flow cytometry detection, more cells were arrested in G0/G1 phase. Increased expression of PTEN mRNA was detected in 15-d-PGJ2 or pioglitazone-treated cells through RT-PCR. Increased expression of PTEN protein and decreased expression of pAkt were confirmed by Western blot analysis. Conclusion The ligands of PPAR? could inhibit SMMC-7721 cells proliferation in a time- and dose- dependent manner. The upregulation of PTEN may be involved in the underlying mechanism.

Objective To evaluate the effect of cold ischemia on the expression of tumor necrosis factor alpha (TNF-?) and interleukin-10 (IL-10) and hepatic regeneration in liver grafts.Methods Partial liver transplantation model in rats was developed. The rats were divided into 3 groups: control group receiving 50 % liver resection,experimental group 1 receiving partial liver transplantation 30 min after cold ischemia and experimental group 2 receiving partial liver transplantation 10 hr after cold ischemia. The expression of the proliferative cell nuclear antigen (PCNA),TNF-? and IL-10 in liver tissues obtained on the postoperative day 1,2 and 4 in rats was detected by using immunohistochemical method. Correlation analysis was performed on the liver proliferation and regeneration,and the expression of TNF-? and IL-10.Results The survival rate in control group,experimental group 1 and experimental group 2 was 100 % , 79 % and 29 % respectively. In the experimental group 2,the expression of PCNA,TNF-? was significantly decreased,while the expression of IL-10 increased as compared with that in experimental group 1 (both P

Objective To evaluate the effects of rHGF on liver regeneration after partial transplantation.Methods The partial orthotopic liver transplanted model was established in SD rats with two-cuff technique. In experimental group, immediate after operation, 500 ?g/kg rHGF was administered intravenously twice a day. Same vehicle of saline was administered as control. The rats were (killed) randomly on the day 1, 2, 4 and 7 after operation. The serum levels of albumin and alanine (aminotransferase) were detected. Each liver was removed and weighed. The expression of Ki-67 antigen was detected by using immunohistochemistry assay. The regeneration response of hepatocytes was evaluated by flow cytometry.Results The wet weigh in rHGF group was significantly larger than that in control group 1, 2 days after transplantation. The serum level of alanine aminotransferase was (lower) and that of albumin was higher in rHGF group than in control group 4, 7 days after operation. The proliferating index and Ki-67 labeling index of graft in rHGF group were higher than in control group.Conclusion rHGF can promote the regeneration of hepatocytes after partial transplantation.

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.

ObjectiveTo observe the killing effect on hepatocellular carcinoma(HCC) cell lines by growth response-1(Egr-1) promoter activated herps simplex virus thymidine kinase (tk). MethodsPlasmid pET was constructed by fusing of Egr-1 promoter to the upstream of tk gene and transfect human hepatocellular carcinoma cell lines SMMC-7721(SMMC/ET) with lipofectamine as a delivery system. The cloned cells, after selected with G418, and exposure to ?-radiation by a 60Co source, were added with prodrug GCV. The viability of cell lines was observed. ResultsAfter irradiation, transfected cell lines (0.07?0.03) was killed by prodrug GCV at higher percentage compared with control group(0.88?0.12)(P

Objective To study the relationship between expressions of E-cadherin and syndecan-1 in hepatocellular carcinoma(HCC) and the invasive characters of HCC. Methods The expression of E-cadherin and syndecan-1 were observed in 47 HCC cases using immunohischemistry. Results Most HCC cases showed decreased expression of E-cadherin and syndecan-1 (55%, 60%). Their expressions decreased more significantly in HCC larger than 3*!cm in diameter than in HCC less than 3*!cm (P