AIM:To investigate the levels and clinical significance of microRNA-133a/b (miR-133a/b) and multidrug resistance-associated protein 1 ( MRP1 ) in peripheral blood of the patients with drug-refractory epilepsy. METHODS:Prediction of the miRNAs targeting transcriptional regulation of MRP1 was conducted by bioinformatics analy-sis.The plasmids containing wild type and mutant 3’UTR of MRP1 reporter gene were constructed.Dual luciferase report-er gene assay was used to verify this prediction.In addition, the peripheral blood samples of the epilepsy patients (37 cases were drug-refractory, the other 58 cases were nonresistant) were collected.The levels of miR-133a/b and MRP1 were measured by real-time PCR and ELISA.RESULTS:Through TargetScan database, it was predicted that miR-133a/b tran-scriptionally regulated MRP1.The results of dual luciferase report gene assay suggested that luciferase activity in experi-mental group with miR-133a/b mimics, pMIR-MRP1 and pRLTK plasmids were down-regulated by 76.9% and 64.1%compared with that in control group with scramble mimic, pMIR-MRP1 and pRLTK plasmids.The luciferase activity was up-regulated by 3.62 times and 2.04 times in mutation group with miR-133a/b mimics, pMIR-mut-MRP1 and pRLTK plasmids compared with experimental group.Before administration, the serum levels of miR-133a/b in the epilepsy patients without drug resistance was 2.18 times and 1.74 times higher than than in the epilepsy patients with drug resistance ( P<0.05), respectively, while MRP1 expression level was 3.72 times higher in the epilepsy patients with drug resistance than those in the epilepsy patients without drug resistance.After administration, the levels of miR-133a/b in the epilepsy pa-tients without drug resistance were 2.76 times and 2.95 times higher than those in the epilepsy patients with drug resistance (P<0.05), respectively, while the serum level of MRP1 in the epilepsy patients with drug resistance was 4.99 times higher than that in the epileptic patients without drug resistance (P<0.01).CONCLUSION:miR-133a/b transcriptio-nally regulates MRP1.There are lower expression levels of miR-133a/b and higher expression level of MRP1 in the epilep-sy patients with drug resistance compared with those in the epilepsy patients without drug resistance.miR-133a/b and MRP1 may be a diagnostic indicator for determining refractory epilepsy.

Objective To review the advances in overcoming multidrug resistance of tumors caused by mdr1 gene. Methods Different ways of overcoming multidrug resistance of tumors caused by mdr1 gene in the literatures were reviewed. Results One of the important reasons causing multidrug resistance was due to the overexpression of mdr1 gene and its product P-glycoprotein. There were two ways to overcome multidrug resistance of tumors through mdr1 genes mRNA and its product P-glycoprotein effectively.Conclusion The clinical test of the unitary way to overcome multidrug resistance of tumors is unsatisfactory, combining different ways to overcome multidrug resistance of tumors will be the hot spot of tumors research in the future.

Objective To report the diagnosis and treatment of hilar cholangiocarcinoma.Methods The relevant information about the hispathological feature, transfer ways, clinical manifestation, laboratory examination, imaging feature, immunohistochemical examination and treatment ways were gathered from previous original articles, and checking the latest issues of appropriate journals.Results The clinical manifestation, laboratory examination, and imaging feature of hilar cholangiocarcinoma were due to the neoplasm obstructing bile duct and sequent infection of bile duct. The diagnosis was depanded on the combining clinical manifestation, laboratory examination and imaging feature. The value of immunohistochemical examination was not clear. Radical surgery was the best treatment of unique curing the neoplasm. By-pass surgery was used in the late phase patients to solve the obstruction of bile and digest duct. The effect of unique chemical treatment was not perfect. It did’t generally propose the treatment of orthotopic liver transplantation.Conclusion The perfect prognosis of hilar cholangiocarcinoma is depended on early diagnosis and redical surgery.

Objective To investigate the etiology and management of early postoperative hyperbilirubinemia after liver transplantation. Methods The etiology and dynamic alteration of early postoperative hyperbilirubinemia in 50 liver transplants were retrospectively analyzed by a comparative trial of clinical manifestation with serial liver biopsy. Results The total serum bilirubin (TB) level profile presented like a invert "S" curve. At the first week, second week and 4th week after liver transplantation the serum TB levels were in average ( 127.19? 113.15)? ( 135.45? 124.6) and ( 73.1? 49.52)??mol/L respectively. Three months later, the serum TB level approximated to normal TB level ( 29.8? 37.56)??mol/L. The dynamic alternations of total serum bilirubin level were incorporated with the morphological improvement under microscopy of liver allograft following liver transplantation. The initial hyperbilirubinemia of reciepient before liver transplantation (10 cases, 20?%), preservation injury (containing 44 cases of ischemic reperfusion injury, 88?%), acute cellular rejection (13 cases, 26?%) and bile duct leakage (4 cases, 8?%) were 4 essential causes responsible for the early postoperative hyperbilirubinemia. The total serum bilirubin level profile was not characteristic of each catergory. Those 4 casuses mentioned above presented either independently or concomitantly in concrete case. No primary hepatic failure (PHF) occurred and curability of hyperbilirubinemia was about 100?% in our series. Furthermore, the perioperative survival rate of the recipients and liver allograft was 90.6?% and 1-year accumulative survival rate was about 80?%.Conclusions The hyperbilirubinemia is common clinical manifestion within 3 months after liver transplantation. Preservative injury, acute rejection, preoperative hyperbilirubinemina and bile duct leakage are four essential causes. The comprehensive management targeted to etiology can usually achieve a good outcome for the reciepients with hyperbilirubinemia.

Objective To investigate the effect of liver transplantation on extensive intrahepatic duct stones with biliary cirrhosis and unresectable intrahepatic alveolar echinococcosis.Methods Orthotopic liver transplantation was performed on 2 patients with extensive intrahepatic stones with biliary cirrhosis and 4 cases of unresectable alveolar echinococcosis. The pre- and intraoperative condition and postoperative complications were evaluated. All patients were regularly followed up. Results Two patients with intrahepatic stones have survived for more than 2 years after the transplantation. Three of 4 patients with alveolar echinococcosis have survived for 9, 15 months and 2 years respectively, up to now. Another one died of heart failure at the postoperative 3rd month. All survivors have recovered well their normal life and work. Conclusion Liver transplantation could be regarded as effective therapeutic means for extensive intrahepa- tic stones and unresectable alveolar echinococcosis.

Objective To explore the therapeutic effect of liver transplantation on hepatic alveolar echinococcosis (HAE) in late stage.Methods Five HAE cases in late stage failed to be treated by hepatic lobectomy underwent liver transplantation, in which 4 cases were performed under veno-venous bypass and 1 without bypass. Three cases were subjected to veno-venous bypass prior to mobilization of the liver. The end-to-end anastomosis was made between the hepatic artery and hepatic artery, and between the bile duct and bile duct. Two cases received placement of T tube in the bile duct. The mean duration of surgery was 8.3 h. Results One patient was reoperated because of the T tube falling off on the postoperative day 10, and one because of the bile leakage. Four patients recovered completely in the postoperative period, one died of multiple organ failure (MOF) and septi-caemia caused by pneumonia, acute rejection and embolism of the liver artery. Four patients were followed up for 21 months to 37 months, showing a good quality of their life. Conclusion Liver transplantation can be applied in treatment of hepatic alveolar echinococcosis in end stage, and can ensure a better clinical result.

Objective To investigate the technique of b iliary reconstruction and treatment of biliary complications in orthotopic liver transplantation (OLT). Methods From Feb. 1999 to Jan. 2003, OLT was performed in 103 patients with end-stage l iver disease. OLT was performed with standard techniques with or without a veno -venous bypass. Reconstructions of biliary tract were performed using choledoc hocholedochostomy (CDC) or Roux-en-Y choledochoje- junostomy (RCDJ). CDC was carried out in 94 cases, with T tube (CDCT) in 62 cases and without T tube (CDCO ) in 32 cases respectively. Among the 32 cases without T tube, 11 had a small tu be placed in the common bile duct through the recipient cystic duct. RCDJ was pe rformed in 9 cases without internal stent. Diagnosis of the biliary complication s after OLT was based on the clinical manifestations, ultrasound findings, MRCP and ERCP. All the patients were followed up regularly after discharge for 12 to 48 months. Results The overall incidence of biliary complications in 103 patients after OLT was 7 .8% (8/103). Of the 62 cases of CDCT posttransplant, biliary complications occ urred in 6 cases ( 9.6% ), including 4 cases of bile leaks following OLT and 2 cases of bile leaks following T-tube removed. Of the 32 patients subject to CD CO, 1 ( 3.1% ) had stricture of anastomosis. Of the 9 cases subject to RCDJ, one patient was complicated with bile leaks at the anasto mosis. Two cases of the bile leaks were drained reoperatively, and others were k ept adequate drained. The patient with stricture of CDCO was cured by balloon di latation and stent placed endoscopically. No death associated with biliary compl ications occurred. Conclusions Bile leaks and stricture of anatomosis are the common biliary complications afte r OLT. Good blood supply to biliary tract and surgical technique are the keys to prevent biliary complications after OLT. The timely endoscopical and radiologic al technique is a valuable nonoperative precedure for diagnosis and treatment of biliary complicat ions.

Objective To investigate the modifications of surgical technique in adult-to-adult living donor liver transplantation (A-A LDLT) using right lobe liver grafts.Methods From Jan.2002 to Aug.2005,16 patients underwent living donor liver transplantation using right lobe grafts.During operation,a modification,designed to improve the reconstruction of right hepatic vein,the reconstruction of the tributaries of the middle hepatic vein by interpositing a vein graft,and the anastomosis of the hepatic arteries and bile ducts,was done.Results In these series,there were no donor severe complication and death.The graft and recipient weight ratio(GRWR) was between(0.72%) and(1.24%),among these,9 cases

Objective To investigate the common reasons,prophylaxes and treatment of postoperative complications in orthotopic liver transplantation (OLT).Method Seventy two patients who underwent OLT during recent three years were collected and analyzed retrospectively.Results OLT was performed on 50 cases with benign diseases including terminal liver cirrhosis 34;and 22 cases with and malignant diseases including hepato cellular carcinoma 19 cases.Fifty four complications were occurred postoperatively,including secondary abdominal cavity bleeding (4 cases ),severe infection of ascites (2 cases),stress gastric ulcer with bleeding and perforation (1 cases),biliary leak (6 cases),pulmonary infection (21 cases),and enteric fungal infection (5 cases).There were no primary dysfunction of liver and vascular complications.Follow up 2-41 months, without biliary complications and chronic liver dysfunction occurred 6 cases death postoperative,6 cases death on follow-up period.Total surrival rate is 83.33%, 32 cases alive more than 1 year,the longest surrival cases is 41 months postoperative.Conclusions It is suggested that the cases with cirrhosis are main indication for liver transplantation.The patients with liver cirrhosis always combinated of liverdisfunction,coagulopaphy,malnutrition and poor immune functions and we should pay attention to replace that of coagulation factors,antibiotics using and nutrition support perioperatively.Good surgical technique is the key point for preventing vascular complications.

Objective To explore the surgical reconstructive procedures of adult-to-adult living donor liver transplantation (LDLT).Methods Two patients with end-stage liver disease were successfully subjected to adult-to-adult LDLT using dual grafts in our division. One patient’s donors were left lobe and left lobe from his two old sisters, respectively. The other graft was right lobe from his 56 years-old mother and left lobe separated from a cadaveric organ donor.Results Both recipients and three donors display good graft function and normal triangular shape regeneration of their liver grafts after liver transplantation. There was neither mortality nor serious complications in the donors. Conclusion The critical issue of LDLT is donor morbidity. Dual grafts from two living donors can help to alleviate the problem of small-for-size grafts and yet secure the safety of the donor. But the complicated surgical techniques give a great challenge for liver transplant surgeons.