Objective:To explore the protective effect of hypothermia plus extracorporeal membrane oxygenation(ECMO)on kidney in brain-dead kidney transplant donors.Methods:From July 2017 to July 2018 at Institute of Transplantation Medicine, Hospital No. 923 of PLA, 29 patients with circulatory dysfunction brain death donors fulfilling the organ donation criteria were randomly divided into sub-hypothermia group according to the treatment of extracorporeal membrane oxygenation(body temperature 34.0~35.0℃, 15 cases)and normal temperature group(36.5~37.5℃, 14 cases). Hemodynamic profiles and renal function changes were compared between two groups during ECMO.And renal complications of two groups were followed up.Results:The hemodynamic parameters of two groups remained stable during ECMO period.Heart rate of 5 MO-organs was lower in hypothermia group than that in normal temperature group( P<0.05). Systolic and diastolic pressures before ECMO 3 h-organ acquisition were higher than normal temperature group( P<0.05). No significant difference existed between PaO 2 and normal temperature groups( P>0.05). Donor serum creatinine(SCr)and blood urea nitrogen(BUN)were lower in hypothermia group than in normal temperature group( P<0.05). The postoperative recipient levels of BUN were lower in mild hypothermia group than those in normothermia group( P<0.05)and no significant difference between SCr and normal temperature groups( P>0.05). The postoperative hospital stay was(16.52±3.59)days in mild hypothermia group. And it was lower than that in normal temperature group( P<0.05). Delayed renal function was lower than normal temperature group(3.45% and 21.43%, P<0.05). Conclusions:Mild hypothermia plus ECMO can reduce hemodynamic fluctuations in circulatory unstable donors after brain death, improve renal function and lower the incidence of delayed functional recovery after renal transplantation.

Objective:To evaluate the efficacy and safety of continuous infusion of low-dose intravenous (Ⅳ) heparin during perioperative period of simultaneous pancreas-kidney (SPK) transplantation for donation after citizen death (DCD) donor to prevent pancreatic thrombosis post-transplantation.Methods:From January 2015 to August 2019, 46 DCD donors undergoing SPK were divided into retrospective cohort groups 1 ( n=27) and 2 ( n=19). Group 1 received aspirin enteric-coated tablets only at Day 1 post-SPK. In Group 2, 5-7 days of continuous infusion of heparin 260 IU per hour at Day 1 post-SPK was followed by a daily intake of aspirin enteric-coated tablets of 100 mg. Incidence of thrombus, recovery of graft function and adverse reactions of anticoagulant therapy were observed. Results:Thrombosis occurred in (5.3%, 1/19 vs 14.8%, 4/27) in heparin and non-heparin groups. Thrombosis and graft loss were significantly lower in heparin group than those in non-heparin group ( P<0.05). Conclusions:Continuous infusion of low-dose heparin vein is effective and safe in preventing thrombosis after SPK transplantation.

Organ shortage is one of the important factors restricting the development of human organ transplantation. The identification and referral of potential donors determine the total scale of organ donation. Whether potential donors can be identified and referred is the most important reason for the difference of organ donation rates in different regions. This paper interprets the chapter of the identification and referral of potential donors in the Guide to the Quality and Safety of Organs for Transplantation (6th edition) issued by European Union in order to provide reference for the staff of organ procurement organization and related medical personnel in China and improve the organ donation rate in China.

Objective:To assess the anatomic relationship of inferior mesenteric artery (IMA)/inferior mesenteric vein (IMV) with ureter by contrast-enhanced abdominal pelvic CT, in order to provide guidance for vascular management and ureteral protection in laparoscopic rectal surgery.Methods:A retrospective cohort study was conducted. Image data of contrast-enhanced abdominal pelvic CT at Department of Medical Radiography of Peking University First Hospital in November 2018 were enrolled. Exclusion criteria: (1) previous history of abdominal or pelvic surgery; (2) scoliosis deformities; (3) missing images; (4) minors; (5) inferior mesenteric vascular disease or tumor involvement resulting in suboptimal imaging; (6) poor image quality. Finally, contrast-enhanced abdominal pelvic CT data of 249 cases were collected, including 120 males and 129 females with mean age of (60.1±13.4) years. Multi-planar reconstruction (MPR) and maximum intensity projection (MIP) were used to evaluate the anatomic relationship of IMA/IMV with ureter. IMA root location, IMA length, branch types of IMA, distance between major branches, distance between IMA/IMV and ureter at the level of root of IMA, left colic artery (LCA) root, abdominal aortic bifurcation, and sacral promontory were measured and association between IMA/IMV and ureter site was summarized.Results:The distance from IMA root to the aortic bifurcation and sacral promontory was (42.0±8.5) mm and (101.8±14.0) mm, respectively. The length of IMA was (38.5±10.7) mm. The proportion of IMA roots locating at levels of the 2nd, 3rd, and 4th lumbar vertebra was 3.2% (8/249), 79.5% (198/249), and 17.3% (43/249), respectively. The higher the level of the lumbar vertebra, the longer the IMA [length of IMA originating from the 2nd, 3rd, 4th lumbar vertebra level: (42.4±10.9) mm, (39.5±10.4) mm, (33.0±10.9) mm, respectively; F=7.48, P<0.001]. In 111 cases (44.6%), LCA arose independently from IMA (type 1), and the distance between LCA and the first branch of sigmoid artery (SA) was (15.0±7.4) mm; in 56 cases (22.5%), LCA and SA had a common trunk (type 2), with a length of (11.0±8.5) mm; in 78 cases (31.3%), LCA branched with SA at the same point (type 3); LCA was absent in 4 cases (1.6%)(type 4). The length of IMA in LCA-deficient type 4 was (54.8±18.0) mm, which was longer than (38.2±10.5) mm in LCA-presence type (type 1, type 2 and type 3) and the difference was statistically significant ( t=-3.11, P=0.002). The distance between the ureter and IMA was the longest at the level of IMA root [(35.7±8.1) mm], was the shortest at the level of the aortic bifurcation [(22.4±6.4) mm], and the distance between the ureter and IMA in different planes was significantly different ( F=185.70, P<0.001). The distance between the ureter and IMV was the longest at the level of the sacral promontory [(21.1±9.0) mm], was the shortest at the level of LCA root [(12.0±5.7) mm], whose difference was also statistically significant ( F=87.66, P<0.001). Conclusions:CT post-processing techniques including MPR and MIP can efficiently and accurately assess the branch types of IMA and anatomical relationship between IMA/IMV and ureter, and provide insights into laparoscopic rectal surgery for surgeons. IMA/IMV and ureter depart farthest at the level of IMA root. Artery first and plane second strategy in the middle approach of laparoscopic rectal surgery is considerable and feasible.

Objective:To assess the anatomic relationship of inferior mesenteric artery (IMA)/inferior mesenteric vein (IMV) with ureter by contrast-enhanced abdominal pelvic CT, in order to provide guidance for vascular management and ureteral protection in laparoscopic rectal surgery.Methods:A retrospective cohort study was conducted. Image data of contrast-enhanced abdominal pelvic CT at Department of Medical Radiography of Peking University First Hospital in November 2018 were enrolled. Exclusion criteria: (1) previous history of abdominal or pelvic surgery; (2) scoliosis deformities; (3) missing images; (4) minors; (5) inferior mesenteric vascular disease or tumor involvement resulting in suboptimal imaging; (6) poor image quality. Finally, contrast-enhanced abdominal pelvic CT data of 249 cases were collected, including 120 males and 129 females with mean age of (60.1±13.4) years. Multi-planar reconstruction (MPR) and maximum intensity projection (MIP) were used to evaluate the anatomic relationship of IMA/IMV with ureter. IMA root location, IMA length, branch types of IMA, distance between major branches, distance between IMA/IMV and ureter at the level of root of IMA, left colic artery (LCA) root, abdominal aortic bifurcation, and sacral promontory were measured and association between IMA/IMV and ureter site was summarized.Results:The distance from IMA root to the aortic bifurcation and sacral promontory was (42.0±8.5) mm and (101.8±14.0) mm, respectively. The length of IMA was (38.5±10.7) mm. The proportion of IMA roots locating at levels of the 2nd, 3rd, and 4th lumbar vertebra was 3.2% (8/249), 79.5% (198/249), and 17.3% (43/249), respectively. The higher the level of the lumbar vertebra, the longer the IMA [length of IMA originating from the 2nd, 3rd, 4th lumbar vertebra level: (42.4±10.9) mm, (39.5±10.4) mm, (33.0±10.9) mm, respectively; F=7.48, P<0.001]. In 111 cases (44.6%), LCA arose independently from IMA (type 1), and the distance between LCA and the first branch of sigmoid artery (SA) was (15.0±7.4) mm; in 56 cases (22.5%), LCA and SA had a common trunk (type 2), with a length of (11.0±8.5) mm; in 78 cases (31.3%), LCA branched with SA at the same point (type 3); LCA was absent in 4 cases (1.6%)(type 4). The length of IMA in LCA-deficient type 4 was (54.8±18.0) mm, which was longer than (38.2±10.5) mm in LCA-presence type (type 1, type 2 and type 3) and the difference was statistically significant ( t=-3.11, P=0.002). The distance between the ureter and IMA was the longest at the level of IMA root [(35.7±8.1) mm], was the shortest at the level of the aortic bifurcation [(22.4±6.4) mm], and the distance between the ureter and IMA in different planes was significantly different ( F=185.70, P<0.001). The distance between the ureter and IMV was the longest at the level of the sacral promontory [(21.1±9.0) mm], was the shortest at the level of LCA root [(12.0±5.7) mm], whose difference was also statistically significant ( F=87.66, P<0.001). Conclusions:CT post-processing techniques including MPR and MIP can efficiently and accurately assess the branch types of IMA and anatomical relationship between IMA/IMV and ureter, and provide insights into laparoscopic rectal surgery for surgeons. IMA/IMV and ureter depart farthest at the level of IMA root. Artery first and plane second strategy in the middle approach of laparoscopic rectal surgery is considerable and feasible.

Objective To evaluate the efficacy of sirolimus (SRL) after liver transplantation for hepatocellular carcinoma (HCC).Methods The information up to January 2018 was retrieved from Cochrane library,Pubmed,EMbase,CBM,CNKI,VIP.Collected publications were all about casecontrol study of SRL versus calcineurin inhibitors (CNIs) after liver transplantation for HCC.After evaluating the literatures' quality and extracting the data,RevMan 5.3 was used to analyze the data of each study.Results A total of 13 articles including 4181 patients were enrolled.There was no significant difference between SRL and CNIs in 3 and 5 year diseasefree survival (RR=1.13,95％CI:0.97-1.31,P=0.11;RR=1.07,95%CI:0.92-1.24,P=0.37),however,the 1-,3-and 5-year overall survival rate and 1-year disease-free survival rate in SRL were significantly higher than CNIs (RR=1.09,95％CI.:1.03-1.15,P=0.005;RR=1.08,95％CI:1.02-1.14,P =0.006;RR =1.11,95％CI:1.00-1.23,P =0.05;RR=1.14,95％CI:1.05-1.24,P =0.001).Conclusion There was no significant difference between SRL and CNIs in 3-and 5-year disease-free survival,but the 1-,3-and 5-year overall rate and 1-year disease-free survival rate in SRL was significantly higher than in CNIs.

Objective By analyzing the perioperative management in our hospital to explore the clinical effect and safety of single kidney transplantation from deceased juveniles' donors.Methods We retrospectively analyze 86 cases of kidney transplantations from deceased juveniles' donors in our hospital from 2007 December to 2015 August.Results The success rate of the operations was 100％.The postoperative complications occurred as fellows:7 cases of acute rejection (8.14％);10 cases of drug intoxication (11.62％);21 cases of DGF (24.44％),4 cases of leakage of urine (4.65％),7 cases of lung infection (8.14％).Two cases (2.32％) died after the operation because of serious lung infection,and by corresponding treatment 47 cases recovered after 2-4 weeks.The creatinine level in 37 cases without any complications was 131.88 ± 44.20 μmol/L during discharge.Conclusion With strict selection,the organ from a deceased juvenile donor is safe and practicable.

Objective: To study the oxidative damage of di- (2-ethylhexyl) phthalate (DEHP) on MCF-7 cells, and to investigate the effects of 3β-hydroxysteroid dehydrogenase (3β-HSD) gene silence or overexpression on DEHP-induced oxidative damage. Methods: MCF-7 cells, 3β-HSD gene silencing cells and 3β-HSD gene overexpression cells were treated with different doses of DEHP (0,0.05,0.1,0.2,0.4,0.8 mmol/L) for 24h, then intracellular oxidative damage index such as MDA, SOD, GSH, GSH-PX were detected, DNA repair gene hOGG1, hMTH1 mRNA expression were tested by Q-PCR, hOGG1, hMTH1 protein expression were detected by western blot. Results: After MCF-7 cells were treated by DEHP, MDA levels increased; SOD activity, GSH content, GSH-PX activity decreased, hOGG1 and hMTH1 mRNA expression levels increased, hOGG1 and hMTH1 protein expression levels increased, the differences were statistically significant when compared with control (P<0.05 or P<0.01) . In 3β-HSD gene silencing cells which were treated by DEHP, when compared with the same dose group of MCF-7 cells, MDA content increased, SOD activity, GSH content, GSH-PX activity decreased, hOGG1 and hMTH1 mRNA expression levels decreased, hOGG1 and hMTH1 protein expression levels decreased, the difference were statistically significant (P<0.05 or P<0.01) . In 3β-HSD gene overexpression cells which were treated by DEHP, when compared with the same dose group of MCF-7 cells, MDA content decreased; SOD activity, GSH content, GSH-PX activity increased, of hOGG1 and hMTH1 mRNA expression levels increased, hOGG1 and hMTH1 protein expression levels increased, the difference were statistically significant (P<0.05 or P<0.01) . Conclusion DEHP could cause oxidative damage in MCF-7 cells, induce the changes of related genes and proteins, 3β-HSD plays an antioxidant role in the process of DEHP ox-idative damage.

Objective To observe the clinical effect of the maintenance for the liver and kidney function by extra corporeal membrane oxygenation (ECMO) in brain death donor with severe hemodynamic instability.Methods Ninety-nine brain death donors maintained by ECMO were followed up.The criteria for using the ECMO to protect the organ function were as follow:cardiopulmonary resuscitation history (cardiac compression ＞ 20 min);mean arterial pressure (MAP),for Adult ＜60-70 mmHg,for child ＜50-60 mmHg,and for infant ＜40-50 mmHg;cardiac index ＜2 L/(m2 ·min) (3 h);Large doses of vasoactive drugs,for doparnine 20μg/(kg·min),for (norepinephrine) epinephrine 1.0 μg/(kg· min) (3 h),and for oliguria ＜0.5 mL/(kg · h);blood biochemical indexes,moderate,severe impairment on acute hepatic and renal function;others,ST-T significant changes in electrocardiogram,and difficult to correct the metabolic acidosis (3 h).The organs were evaluated during their retrieval and as well their evolution after transplantation was evaluated.Results ECMO allowed for the maintenance of hemodynamic stability before organ procurement.A total of 99 cases receiving ECMO maintenance were collected,equal to100 ％ of the total donation cases (100％).198 kidneys,and 99 livers were procured from these donors meanwhile 15 kidneys and 42 livers respectively were discarded as theywere shown in a macroscopic evaluation.177 of the procured kidneys were transplanted.DGF of kidney transplantation was observed in 20.9％of the cases.Acute rejection incidence was 12.99％.Transplanted kidneys and recipient survival rate was 96.1％/99.3％ for one year,94.7％/97.8％ for 3 years,and 93.6/97.8％ for 4 years,respectively.There was no significant difference in patient or graft survival between the group with ECMO and the group without ECMO.Conclusion ECMO in the brain dead donors with severe circulatory dysfunction allows to avoid organ donors loss and obtain good quality kidneys and livers with excellent graft survival after transplantation.

BACKGROUND:Delayed graft function (DGF) occurs frequently in kidney transplants from donation after cardiac death if creatinine level is high in kidney recipients. OBJECTIVE:To analyze the clinical effects of renal transplantation with kidneys from donors dying of cardiac death in organophosphate poisoning. METHODS:Data were col ected from kidney transplants from two donors dying of cardiac death in organophosphate poisoning. After some donor maintenance, donor organ were obtained and perfused with impulse type machine. Recipients were treated with intervention of immunity induction, anti-rejection drugs and infection prevention drugs during and after renal transplantation. Pathological data of donor kidney zero needle biopsy, DGF after kidney transplantation, complication rate (such as acute rejection), renal al ograft recovery situation, the survival rate of recipients and kidney transplants were col ected and analyzed. RESULTS AND CONCLUSION:Needle biopsy results from four donor kidneys showed that glomerular morphology was normal, but there were edema and degeneration in kidney tubules in some degree. Donor DGF rate was 75%(3/4), acute rejection rate was 0%(0/4), perioperative period donor kidney and recipient survival rate were 100%(4/4). Al recipients showed a good result of transplanted kidney, their creatinine and urea nitrogen were at low level, and had no proteinuria. One recipient died of severe pulmonary infection 4 months after surgery. For some organophosphate poisoning donors dying of cardiac death, donor kidney quality can be improved by suitable donor maintenance and high-quality donor kidney preservation using machine perfusion. Kidney transplants from donors dying of cardiac death in organophosphate poisoning who receive the maintenance of organ function may be a promising candidate for renal transplantation due to a severe lack of kidney donor sources.