Objective: To compare post-orthotopic liver transplantation(OLT) survival rates between patients with recurrent HCC after partial hepatectomy and those with de novo OLT for HCC, and to screen for the risk factors associated with post-OLT mortality. Methods: From July 2003 to August 2005, 77 consecutive HCC patients underwent OLT, including 15 patients with recurrent HCC after partial hepatectomy for tumor resection (the rescue OLT group) and 62 patients with de novo OLT for HCC (the de novo OLT group); the post-operation survival rates were compared between the 2 groups. Thirty-three demographic, clinical, histological, laboratory and intra- and post-operative variables were analyzed. Cox proportional hazards regression model were used to screen for the factors associated with the survival rate. Results: The median age of the patients was 48.6 years and the median follow-up period was 20 months. Three patients(20.0%) in the rescue OLT group and 15 patients (24.2%) in the de novo OLT group died during follow-up(P=0.73). The 30 day-mortality of OLT was 6.7% for the rescue OLT group vs. 1.6% for the de novo OLT group(P=0.27). Cox proportional hazards model showed that the presence of pre-OLT hyperbilirubinemia, requirement of post-OLT transfusion, size of the largest tumor, tumor macroembolism and family history of HCC were significantly associated with a higher hazard for mortality. Conclusion: No significant difference is found in the survival rates between OLT as de novo therapy and OLT as a rescue therapy for patients with HCC. Pre-OLT hyperbilirubinemia, post-OLT requirement of transfusion, size of the largest tumor, tumor macroembolism, and family history of HCC are associated with a poor survival outcome.

Objective To study the platelet antibody screening and crossing match by surface plasmon resonance(SPR) ,and to find a new way for platelet compatibility testing .Methods The corresponding universal platelet antigen was fixed on the SPR chip surface by the amino coupling method .Platelet antibody positive and negative control serum were analysed by SPR micro-ar-ray ,the stability ,sensitivity and specificity of this technique were discussed ,and compared with MAIPA assay .Finally we used the SPR technology to cross match for ten cases of the platelet antibody positive patients before infusion ,and to evaluate the effect of platelet infusion .Results For the SPR technology ,the stability ,sensitivity and specificity of platelet antibody detection were all better ,106 cases of the repeated platelet transfusion samples were tested by SPR assay and MAIPA method ,there was no signifi-cant difference between them(chi-square=0 .333 ,P>0 .05) ,the total consistency was 97 .2% .The 10 cases of platelet antibody positive patients were crossed match before platelet transfusion by SPR technology ,the good results of 8 cases of them were found by the clinical tracking evaluation ,1 h CCI>7 .5 ,24 h CCI>4 .5 .Conclusion SPR technology for screening platelet antibody mat-ches with MAIPA method in basic quality ,but SPR assay is simple ,rapid ,reliable and intuitive ,label free ,which can satisfy the re-quirements for clinical rapid detection of platelet antibody screening and crossing match .

Objective To study the prevention and treatment of chylous leakage after Whipple operation.Methods Clinical data of 381 patients underwent Whipple operation from Jan 2010 to march 2013 were retrospectively analyzed.Results Among 381 patients,23 patients had chylous leakage,the incidence was 6.04％.While in 89 patients,in which intraoperative precautionary physical ligation or mattress suturing of the lymphatic vessels were undertaken,no chyle leakage occurred ; Most of chyle leakage occurred in malignant tumor after radical resection(21 patients),most chylous leakage was found 5-8 days after surgery,with daily volume of 260-450 ml.All patients of chylous leakage were cured by conservative treatment.Conclusions Chylous leakage are common in PD.Intraoperative preventive measures such as lymphatic duct ligation or safe suturing can effectively prevent chyle leakage.Conservative therapy heals most chylous leakage after Whipple operation.

OBJECTIVETo assess the long-term clinical effectiveness of Chinese herbal medicines for benefiting qi and activating blood circulation (CHMBQABC) plus routine Western medical intervention in treating unstable angina (UA) patients of qi deficiency blood stasis syndrome (QDBSS) after percutaneous coronary intervention (PCI) based on Markov model.

METHODSA Markov model was established based on prognosis and sequelae of UA patients after PCI treated by CHMBQABC plus routine Western medical intervention or by routine Western medical intervention. According to the transition probabilities of 40 Markov cycles and quality-adjusted life years (QALYs) averagely gained, we assessed the therapeutic advantage of CHMBQABC plus routine Western medical intervention.

RESULTSBy the prediction of Markov model for 20 years, the transition probabilities of revascularization, non-fatal myocardial infarction, non-fatal stroke, and all-cause death in the CHMBQABC plus routine Western medical intervention group was 56.65%, 6.53%, 5.16%, and 31.66%, respectively, and the QALYs averagely gained was 12.95; while the transition probabilities of revascularization, non-fatal myocardial infarction, non-fatal stroke, and all-cause death in the Western medical intervention group was 55.31%, 6.87%, 5.25%, and 32.57%, respectively, and the QALYs averagely gained was 12.84. Compared with the Western medical intervention group, the QALYs averagely gained was 0.11 in the CHMBQABC plus routine Western medical intervention group.

CONCLUSIONBased on predicted results of the Markov model, CHMBQABC plus routine Western medical intervention got better efficacy in treating UA patients after PCI, indicating CHMBQABC plus routine Western medical intervention could improve the long-term clinical effectiveness for UA patients of QDBSS after PCI.

Aged ; Angina, Unstable ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Markov Chains ; Middle Aged ; Models, Theoretical ; Phytotherapy ; Treatment Outcome

Objective To investigate the application value of double-layer continuous suture in pancreatic jejunum anastomosis of pancreatoduodenectomy (PD).Methods A retrospective analysis of 114 consecutive patients (67 men and 47 women) who underwent PD from June 2012 to July 2013 were conducted. There were 79 patients who were treated by double-layer continuous suture technique and 35 patients by double-layer interrupted suture technique .The incidence of pancreatic fistula and other complications after PD with two different suture techniques were compared .Results The operation time of double-layer continuous suture group and double-layer interrupted suture group is respectively ( 284 ±5 ) and ( 288 ±7 ) mins, the intraoperative bleeding volume is respectively (236 ±29) and (282 ±49) ml, the differences between two groups were no statistical significance .The postoperative fasting time in two group was respectively (7.8 ± 0.5) and (9.7 ±0.5) days, the length of hospital stay time was respectively (14.0 ±1.0) and (17.2 ± 10.0) days, the incidence of postoperative pancreatic fistula ( POPF) was respectively 17.1%(6/35) and 39.2%(317/9 ), the differences between two groups were statistically significant (all P<0.05).Grade A POPF was found in 4 patients ( 11.4%) from the double-layer continuous suture group and in 5 patients (6.3%) from the double-layer interrupted suture group.Grade B POPF was identified only in 1 patients (2.9%) from the double-layer continuous suture group and in 23 patients (29.1%) from the double-layer interrupted suture group .The presence of Grade C POPF was only documented in 1 patient from the double-layer continuous suture group and in 3 patients from the interrupted suture group .Conclusions Continuous suture can be safely used in the duct-to-mucosa pancreatojejunostomy .The double-layer continuous suture can be more effective in reducing pancreatic fistula , improving the feeding time , and reducing the length of hospital stay, and it is worthy of clinical popularization and application .

Objective To study the changes of the peripheral blood regulatory B cells and related cytokines in children patients with chronic idiopathic thrombocytopenic purpura (CITP),and to analyze their correlations with effective Th cells,and to discuss their roles in the pathogenesis of CITP.Methods The peripheral blood mononuclear cells (PBMC)were separated in 30 cases of CITP,then percentages of Th1 ,Th17,Th22 and Breg cells were detected by the flow cytometry(FCM).IFN-γ,IL-17,IL-22 and IL-10 levels in culture supernatant were measured by the ELISA method.Results Compared with the control group,the proportions of the peripheral blood Th1 ,Th17,Th22 subsets in CITP children were increased[(18.4±4.7)% vs.(10.82±4.4)%;(2.42±1.02 )% vs.(1 .23±0.42)%;(0.79±0.24)% vs.(0.26±0.11)%],the proportion of Breg cells was reduced significantly,the differ-ences had statistical significance[(0.83±0.21)% vs.(1 .89±0.12)%,P <0.05].In CITP children,the IFN-γ,IL-17,IL-22 levels in culture supernatant were higher than those in the control group[(278.2±121.2)pg/mL vs.(181.8 ±82.2)pg/mL;(214.8 ± 100.5)pg/mL vs.(161 .4±67.8)pg/mL;(122.16±22.2)pg/mL vs.(90.8±31.1)pg/mL],but the IL-10 level was lower than that in the healthy control group[(27.4±12.6)pg/mL vs.(46.1±16.2)pg/mL),differences between them had statistical signifi-cance(P <0.05).Besides,there was a positive correlation between the proportion of Breg cells and cytokine IL-10 level(r=0.617, P <0.05 ),however,there was a negative correlation between the proportion of Breg cells with Th1 ,Th17 and Th22 cells (P <0.05),between IL-10 level with IFN-γ,IL-17 and IL-22 levels(P <0.05).Conclusion The downregulation of Breg cells proportion may participate in the immune disorder mechanism of effective Th cells in CITP children,which can provide a new idea for the im-munoregulation therapy in CITP children.

The gene of beta-glucuronidase from Thermotoga maritima was cloned into the plasmid pHsh, and expressed in Escherichia coli JM109. The recombinant protein was purified to homogeneity by a simple step, heat treatment. The recombinant enzyme had a molecular mass of 65.9 kD. The optimal activity of beta-glucuronidase was found at pH 5.0 and 80 degrees C. The purified enzyme was stable over a pH range from 5.8 to 8.2 and had a half life of 2 h at 80 degrees C. The kinetic experiments at 80 degrees C with p-nitrophenyl-beta- glucuronide as substrate gave a K(m) and V(max) of 0.18 mmol/L and 312 u per mg of protein. The purified enzyme could transform glycyrrhizin to glycyrrhetinic acid.
Cloning, Molecular ; Enzyme Stability ; Escherichia coli ; enzymology ; genetics ; Glucuronidase ; biosynthesis ; genetics ; metabolism ; Glycyrrhetinic Acid ; metabolism ; Glycyrrhizic Acid ; metabolism ; Hot Temperature ; Kinetics ; Recombinant Proteins ; biosynthesis ; genetics ; metabolism ; Thermotoga maritima ; enzymology ; genetics

Ataxia Telangiectasia Mutated Proteins ; Breast ; metabolism ; pathology ; Breast Neoplasms ; metabolism ; pathology ; Carcinoma, Ductal, Breast ; metabolism ; pathology ; Carcinoma, Intraductal, Noninfiltrating ; metabolism ; pathology ; Cell Cycle Proteins ; metabolism ; Checkpoint Kinase 2 ; DNA-Binding Proteins ; metabolism ; Female ; Humans ; Lymphatic Metastasis ; Neoplasm Grading ; Protein-Serine-Threonine Kinases ; metabolism ; Tumor Burden ; Tumor Suppressor Protein p53 ; metabolism ; Tumor Suppressor Proteins ; metabolism

Objective To investigate the utility of plasma procalcitonin (PCT) as an early predictor for postoperative complications in patients who underwent elective pancreaticoduodenectomy (PD).Methods Clinical data of 87 patients who underwent elective PD in Changhai Hospital from March.1, 2016 to Dec.31, 2016 were collected.The general data, postoperative recovery, serum PCT level and white blood cell (WBC) count before, 1 d, 3 d and 5 d after PD were recorded.ROC curve was drawn and AUC was calculated to determine the cutoff value, sensitivity and specificity.Patients were divided into complication group (n=42) and noncomplication group (n=45) based on the occurrence of post-operative complications, and the comparisons between the two groups were performed.Results There were no significant differences on the age, gender, diabetes, obstructive jaundice, laboratory tests including PCT, operative time, blood loss volume during surgery and tumor type between the two groups, which were comparable.Complication group had longer hospitalization than noncomplication group (24 d vs 15 d,P<0.001), and the differences were statistically significant.In complication group, 18 patients had pancreatic fistula, 13 had peritoneal infection, 7 had gastric empty dysfunction, 8 had bleeding, 2 had bile fistula and 2 had incision infection after PD.The postoperative plasma PCT level in patients with gastric empty dysfunction, bleeding, bile fistula and incision infection was not statistically different from those in noncomplication group (all P>0.05), but the plasma PCT level in patients with pancreatic fistula and peritoneal infection on 3 d and 5 d after PD was significantly higher than those in noncomplication group, and the difference was statistically significant (all P<0.05).The combination of plasma PCT and WBC on 3 d and 5 d after PD was superior to PCT or WBC alone in predicting pancreatic fistula (sensitivity 88.9%, 72.7%;specificity 68.5%, 78.2%) and abdominal infection (sensitivity 100%, 100%;specificity 45.9%, 44.4%).Conclusions Plasma PCT could predict the occurrence of abdominal infection and pancreatic fistula after PD.The combination of PCT and WBC might be more valuable in predicting abdominal infection and pancreatic fistula.

OBJECTIVETo evaluate the skin irritation and sensitization potential of the swine acellular dermal matrix treated with hyaluronic acid (SADM-HA).

METHODS(1) Skin irritation test. Twelve New Zealand rabbits were divided into SADM-HA group, allogeneic skin group, and (human) xeno-skin group according to the random number table, with 4 rabbits in each group. Four test sites were designed on the back of each rabbit. Two test sites of each rabbit in the three groups were covered with SADM-HA, allogeneic skin, and xeno-skin, respectively. Another test site was covered with gauze containing 200 g/L sodium dodecyl sulfate solution as positive control. The last test site was covered with gauze containing normal saline as negative control. The primary irritation index and cumulative irritation index of each material were calculated. (2) Skin closed-patch test. Sixty guinea pigs were used. Fifty-four guinea pigs were divided into SADM-HA group, allogeneic skin group, and (human) xeno-skin group according to the random number table, with 18 guinea pigs in each group. Twelve guinea pigs in each of the three groups were correspondingly induced and stimulated by SADM-HA, allogeneic skin, and xeno-skin, with 6 guinea pigs in each group treated with ethanol-soaked gauze to serve as negative control. The remaining 6 guinea pigs were treated with gauze containing 25% α-hexylcinnamaldehyde ethanol solution as positive control. The rating scales of Magnusson and Kligman were used to grade the condition of skin after being treated with above-mentioned materials to evaluate skin sensitivity to them at post stimulation hour 24 and 48. Data were processed with the non-parametric test of independent samples.

RESULTS(1) In the skin irritation test, the primary irritation indexes of the three dressings in SADM-HA group, allogeneic skin group, and xeno-skin group were respectively -0.04, 0.13, and 0.08. The cumulative irritation indexes of the three dressings in SADM-HA group, allogeneic skin group, and xeno-skin group were respectively 0.27, 0.10, and 0.25, which were close to those of negative control within the three groups. The skin irritation of each of the three materials was negligible. (2) In the skin closed-patch test, all scores of the three dressings in SADM-HA group, allogeneic skin group, and xeno-skin group were between 0 and 1. The scores of SADM-HA group and allogeneic skin group were close to those of negative control within the two groups (with U values respectively 188.00 and 90.00, P values both above 0.05). The differences were statistically significant between each material of the three groups and positive control (with U values respectively 19.00, 59.00, 21.50, P values all below 0.01).

CONCLUSIONSThe SADM-HA is safe and reliable without skin irritation and sensitization, and it has encouraging prospect in clinical application.

Acellular Dermis ; adverse effects ; Animals ; Guinea Pigs ; Hyaluronic Acid ; adverse effects ; Rabbits ; Skin ; Skin Irritancy Tests ; Skin Transplantation ; methods ; Swine