Objective To investigate the role of peroxynitrite in induction of apoptosis in non-heart-beating donor (NHBD) liver grafts. Methods Rat livers were harvested and perfused via the portal vein with 60 ml of cold 4℃ HTK solution from heart beating donors (HB) or 60 min after car-diac arrest from NHBD. A third group consisted of NHBD livers which were perfused with HTK con-taining 7500 IU of superoxide dismutase (SOD) (n=6, resp.). After cold storage for 24 h, the func-tional integrity of the liver was evaluated by isolated reperfusion with Krebs-Henseleit Buffer in a re-circulating system at 37℃ for 45 min. Results Compared to the NHBD livers, HB and SOD groups were characterized by a significantly reduced hepatic enzyme leakage(P<0. 05) as well as decreased portal venous pressure(P<0.01). Bile production upon reperfusion was increased significantly (P< 0.01). Prominent decreasing nitrite oxide(NO) (P<0.05), nitrotyrosine(P<0.01, P<0.05) and apoptosis(P<0.05) in effluent perfusate was encountered. Slight nitrotyrosine staining was concen-trated on the endothelial cells. Conclusion Peroxynitrite may play a fundamental role in the apoptosis caused by enhanced oxygen free radical production in NHBD livers.

More and more studies suggest that endocrine-metabolic diseases and liver diseases influence each other. Endocrine-metabolic diseases may lead to abnormal liver function, and liver diseases are found also to cause disturbance of endocrine-metabolic system.

Objective To sum up the harvesting and trimming (bench surgery) experience of simultaneous pancreas-kidney (SPK) transplantation.Methods Retrospectively analysis of the methods of harvesting and skill of trimming in 19 cases of SPK transplantation was made.Results No injury of allograft occurred. Exogenous insulin was discontinued within 9 day after operation in 18 patients, and their fasting blood sugar was normal, and urine sugar was negative or(+). Serum creatinine and urea nitrogen became normal at 2-4 d postoperatively. Three transplanted kidney and 2 transplanted pancreas had acute rejection (AR), and all the AR were disappeared after anti-rejection therapy. The SPK grafts in 1 patient was excised on 11 d postoperatively due to accelerated rejection. Conclusions The skill of procurement and bench surgery trimming of allograft in one of the key factors for successful SPK.

Objective To evaluate the diagnosis and treatment of vipoma based on our experience on 4 cases.Method Clinical manifestations,laboratory examination,imaging features,surgical findings,and pathology of 4 patients with vipoma admitted in our hospital from 1991 were discussed.Results Watery diarrhea and hypokalemia were the main clinical manifestations.Hepatic metastasis OCCurred in two patients.Tumor located in the head of the pancreas in one case.Two tumors were shown in the pancreatic body and one tumor was in the pancreatic tail.Resection of tumor and hepatic metastatic lesions with repeat resection of metastases Was performed in 1 patient.Resection of the pancreatic body and tail was done in one patient.Pancreatoduodenectomy Was performed in one patient.Laparotomy only was done in one patient because of invasion of the superior mesenteric vein and duodenum.Conclusion Typical symptoms play an important role in the diagnosis of vipoma.Hepatic metastasis is common.Surgery is the most effective means for treatment.

The microinjection of brain nuclei and potassium iontophresis induced tail flick were used to investigate the effect of injecting oxytocin (OT) or anti-oxytocin serum (AOTS) into locus ceruleus (LC) on the pain threshold (PT) and morphine analgesia. The result showed that OT injection into LC could enhance PT, while ATOS injection could reduce PT. The OT injection could strengthen morphine analgesia, but AOTS injection could antagonize this action. These results suggest that the OT analgesia and OT-enhanced morphine analgesia were related with the locus ceruleus.

BACKGROUND:The use of donor rat of cardiac death inevitably experiences warm ischemia injury, so the length of warm ischemia time plays a significant role on the number and function of pancreatic islet obtained. OBJECTIVE:To investigate the effect of Exendin-4 on pancreatic islet function of donor rats with cardiac death at different heat ischemia time. METHODS:Islet cells from Wistar rats were cultured in vitro and randomly divided into three groups according to the experimental conditions:0, 30, 45 min heat ischemia groups. Each group was further assigned into two subgroups, control group was cultured for 24 hours while experimental group wad cultured with 10 nmol/L Exendin-4 for 24 hours. The number of isolated pancreatic islets was calculated with diphenylthiocarbazone staining, and the purity of the extracted islets was adjusted. The viability of the islets was examined by AO/EB staining, and insulin secretion index assay was used to detect the function of the islets. RESULTS AND CONCLUSION:With the time of heat ischemia increasing, the number, purity, viability and function of islet cells obtained were decreased. After the cells in heat ischemia 0, 30, 45 min groups were cultured with 10 nmol/L Exendin-4 for 24 hours, the number, purity and viability of isolated and purified islets were increased compared to the group without added Exendin-4. There was significant difference between experimental group and control group in 30-minute and 45-minute ischemia groups (P<0.05). Exendin-4 can protect pancreatic islet cells in donor rats with cardiac death at different heat ischemia times, reduce the apoptosis, and improve islet survival and functions. The use of Exendin-4 can be an effective pretreatment method at early ischemia phase of islet transplantation.

Objective To observe the influence of warm ischemia time on acquisition of rat pancreatic islets and islet function.Method Male Wistar rats were used.After heart beats stopped,the pancreases in four groups of rats were harvested,and warm ischemia time was 0,15,30 and 45 min separately.The pancrease was preserved in UW at 4℃C for 8 h,and subjected to injection of collagenase solutions.After islets were acquired,the purity,survival rate and islet activity were tested,and statistical analysis was performed.Result The number of islets obtained in 0 min group,15 min group,30 min group and 45 min group was (433 ± 41),(396 ± 38),(350 ± 31) and (66 ± 17)IEQ/one,islet viability was 94％,88％,77％ and 25％,and purity was 88％,78％,60％ and 32％,and insulin release index was 2.38 ± 0.23,2.25 ± 0.18,2.19-± 0.18 and 1.25 ± 0.12,respectively.There was no significant difference in islet number,purity,survival rate and activity 15 min group and 30 min group between 15 min group or 30 min group and 0 min group (P＞0.05).There was significant difference between 45 min group and 0 min group in islet number,purity,survival rate and activity (P＜0.05).The survival rate and purity in 45 min group were lower than the clinical standards for islet transplantation (survival rate ＞ 75％,and purity ＞ 50％).Conclusion Warm ischemia time of 15 min in non-heart-beating brain death(NHBD) rats had no effect on islet isolation and purification.Warm ischemia time within 30 min showed no significant influence on islets of NHBD rats,which can be used in islet transplantation.Warm ischemia time at 45 min showed significant influence on islets of NHBD rats,which can't be used in islet transplantation.

Objective To discuss the treatment of half hallux toenail flap transplantation for reconstruction of the distal segment finger defect. Methods Based on using the first plantar/dorsal metatarsal artery, or toe artery as pedicle to cut off partial toenail together with toe abdomen flap or partial toenail to repair 64 cases which include 69 fingers with distal segment complete and partial defect,the distal skin avulsion,skin tube in postoperative plastic,replantation failure and so on.Depending on the size of the donor foot wound use the first dorsal metatarsal artery,second toe artery,the perforating branch of peroneal artery or plantar metatarsal artery flap to cover the wound, and then observe the appearance of the finger and foot donor site after operation. Results The finger pulp was full and elastic,nail bed of the toe was well healing,nail groove which originated from the reconstructed nail fold was shallow,the appearance wos realistic,all feelings were recover,two-point discrimination was 4 to 5 millimeter,the donor toe was plump like the original one in appearance,patients were all satisfied with the reconstructed finger and the toe shape,after a follow-up from 3 month to 4 years. Conclusion Half hallux toenail flap transplantation is an effective way to repair the distal segment finger defect.

Objective To observe the short-term efficacy and safety of sequential administration of erlotinib and chemotherapy in unselected, chemonaive patients with advanced non-small-cell lung cancer (NSCLC). Methods Previously-untreated patients (n=23) with stage Ⅲ_B/Ⅳ NSCLC and ECOG PS of 0/1 received erlotinib (150 mg/d) on days 15-28 of a 4-week cycle that included gemcitabine (1250 mg/m~2, days 1 and 8), and either cisplatin (75 mg/m~2, day 1) or carboplatin (AUC=5, day 1). The primary end points were tumor response rate and safety. Results 23 patients received a total of 95 cycles of treatment, and all were evaluable for efficacy and toxicity. The overall response rate was 30.4%, 0 case achieved complete responses (CR), 7 cases (30.4%) achieved partial responses (PR), 14 cases (60.9 %) achieved stable disease (SD), 2 cases (8.7 %) achieved progression disease (PD). The disease control rate was 91.3 %. The sequential administration of erlotinib following gemcitabine/platinum chemotherapy was well tolerated. The major grade 3 treatment-related adverse events were eutropenia (13.4%), rash (8.7%), nausea (8.7%) and thrombocytopenia (8.7%). No treatment-related interstitial lung disease. Conclusion equential administration of erlotinib following gemcitabine/platinum chemotherapy was effective, and the toxicity was tolerable. This treatment strategy warrants further investigation.

Objective Islet transplantation has been an effective method for diabetes mellitus. The quality of donor pancreas is important for successful islet isolation. In this study, we evaluated expanded criteria donor usability based on the warm ischemic time, fatty pancreas and perfusion injury. Methods The marginal pancreases include those from cardiac death donor, fatty pancreas and edema pancreas from perfusion injury. Islets were isolated and purified using a modified University of Minnesota method. Islet yield and purity was determined by Dithizone (DTZ) staining and microscopic examination. Islet viability was assessed by AO/EB staining, and islet function was assessed by static glucose stimulation test. Results In the cardiac death donor group, the islet quality, viability, and in vitro function were similar when the warm ischemic time within 15 min. The quality and viability was decreased when the warm ischemic time beyond 30 min, but the function remained well. With 45 min warm ischemic time, insulin release index was decreased significantly. The islet quality, viability, and in vitro function from severe obesity group and severe edema group were decreased obviously. Conclusion Donor factors play a vital role in pancreas transplant outcomes. We concluded that pancreas severe obesity, severe edema and pancreas from cardiac donors (warm ischemic time ＞30 min) are unsuitable for islet isolation.