Abstract:

Objective:To investigate the clinical features and outcome of liver transplantation for benign end-stage liver disease in recipients over sixty years of age. 
Methods:From June 2002 to January 2008, the clinical data of patients with benign liver disease who underwent liver transplantation in our department were analysed retrospectively. The aged group consisted of patients ≥60 years (n=19) and the adult group consisted of patients aged between 18 years to 59 years (n=88). Preoperative laboratory indexes and complications, variables of intra-operation, postoperative complications and 2-year survival rate were compared between the two groups. 
Results:Preoperative diabetes mellitus and the level of serum creatinine, intensive care unit (ICU) length of stay and postoperative deep fungal infection in the aged group were significantly higher than those in adult group (P＜0.05). There was no statistically significant difference in 2-year survival rate between the two groups (P＞0.05). 
Conclusions:Compared with adult group，aged group has higher incidence of diabetes mellitus, lower renal function reserve preoperatively, and postoperative deep fungal infection. Moreover，with close monitoring of patients in the perioperative period，effective support of vital organs and judicious use of immunosuppressants, the prognosis of elderly patients with benign hepatic disease after liver transplant is comparable to adult recipients.

Abstract:

Objective:To investigate the clinical characteristics, diagnosis and treatment of acute appendicitis after orthotopic liver transplantation (OLT) in adult. 
Methods:The clinical data of 4 liver transplant recipients with acute appendicitis after transplantation and 4 patients with misdiagnosed appendicitis from Jan 2000  to Dec 2007 were studied retrospectively.
Results:The incidence rate of acute appendicitis after OLT was 0.49%（4/817）in our single center. The 4 patients complained of right lower quadrant abdominal pain and fever on the 8th, 13th, 11th and 9th day post-transplantion, respectively. Tenderness in right lower abdomen and rebound tenderness were presented, and white blood cells counts was elevated. Appendicetomy was perfomed in 2 cases on the 1st day and in 2 cases on the 2nd day of the onset of symptoms. No appendicular perforation was found during the operation. The patients recovered and well during followed up for 84m, 62m, 40m and 29m, respectively. The other 4 misdiagnosed patients were diagnosed with duodenal diverticulum perforation in 1 case, jejunum perforation in 1 case and bile leakage in 2 cases after exploratory laparotomy.
Conclusions:The incidence rate of acute appendictis after OLT is low, and should be differentiaed from other surgical complications, such as gastrointestinal perforation and bile leakage. Appendicetomy should be performed as early as possible in patients with definite diagnosis.

Abstract:

Objective:To investigate the expression of high mobility group box-1 protein, (HMGB1) mRNA in the peripheral blood after liver transplantation and the relationship between HMGB1 and early sepsis after transplantation.
Methods:The clinical and laberatory data of 17 patients underwent liver transplantation for hepatic failure were prospectively enrolled into this study. HMGB1 mRNA of peripheral blood was detected at 30 min before transplantation and on 1, 3, 7, 14 d after transplantation by reverse transcription-polymerase chain reaction (RT-PCR). Patients were divided into 2 groups according to whether development of early sepsis or not. HMGB1 mRNA expression was compared between the 2 groups.
Results:The study included 14 males and 3 females, with mean age of (45.3±9.0) years (range, 31-65 years). Eight patients developed early sepsis. The mean time of diagnosis of sepsis was 5.5d（4-10 d）. HMGB1 mRNA expression in non-sepsis group was significantly elevated on 1 d after transplantation compared to that of pre-transplantation［（3.50±1.20） vs.（1.80±0.59), P=0.036］, and reached to the peak on 3 d after transplantation （7.85±3.00，P＜0.001）. Then it began to decrease and come down to the level of pre-transplantation（2.62±1.11，P=0.301）. After transplantation, HMGB1 mRNA expression in sepsis group elevated significantly on 1d ［（7.31±2.27) vs. (1.92±0.64)，P=0.002］, and maintained at high level on 14 d which was still significant higher than that of pre-transplantation（12.45±5.58, P＜0.001）. The expression of HMGB1 mRNA of sepsis group was significant higher than that of non-sepsis group after transplantation（P＜0.001）.
Conclusions:Dynamic mornitoring expression of HMGB1 may help to predict the development of early sepsis.

Abstract:

Objective:To investigate the effect  of hypoxia preconditioning(HP) on intrahepatic cholangiocytes of autogenic liver graft and its mechanism.
Methods:The models of autogenic liver transplantation were constructed,including group A (autogenic liver transplantation), group B(hypoxic preconditioning before transplantation), and group C (sham operation).Blood samples were collected 24 huors after operation for examination of the serum total bilirubin(TBIL), direct bilirubin (DBIL)and alkaline phosphatase(ALP). Immunohistochemical method was used to detect the expression of vascular endothelial growth factor(VEGF)and proliferation rate of cholangiocytes. The pathological changes were observed by light microscope.
Results:(1)Compared with group C,the TBIL,DBIL,ALP was increased in group A and B,but  increased more obviously in group A.(2)VEGF was detected in all groups,but in group B the expression was most obvious. As compared with group C, proliferation rate of cholangiocytes was higher in group A and B, but the proliferating cell nuclear antigen index (PI) was the highest in group B.(3) Compared with group B,the damage, inflammatory cell infiltrate and the absence of the cell arrange were more severe in group A.
Conclusions:HP has protective effect on cholangiocytes of autogenic liver graft,and its mechanism may relate with the over expression of VEGF on cholangiocytes induced by HP.

Abstract:

Objective:To investigate the relationship between ischemic preconditioning (IP) and acute rejection (AR) after allogenic orthotopic liver transplantation (OLT) in rats.
Methods:By using random digits table,the rats were divided into Sham group (group A), similar gene OLT group (group B), OLT with ischemia reperfusion (IR) group (group C, D), and ischemic OLT with IR and with or without IP group(group E, F).  The rats were killed at 1，3，5 and 7 day after the models and sham operation were constructed respectively. Plasma samples were assessed for the severity of IR injury (IRI). The liver tissue was paraffin-embedded to examine the liver histological changes (HE), and rejection was classificed by rejection activity index of Banff. Apoptosis was measured by TUNEL, and the protein and mRNA expression of Fas, perforin and granzyme B were detected by using immunohistochemistry and real-time PCR.
Results:The severity of acute rejection in hepatic tissue of groups C-F was paralleled with the degree of IRI.No rejection occurred in group A and B. The extent of disease and degree IRI and the classification of rejection activity index were lower in group E than in group  C, and group F than group D (P＜0.05). The mRNA and protein expression levels of Fas, perforin and granzyme B in group C were higher than group  E (P＜0.05),  and group  D were higher than group F (P＜0.05) at 1，3，5 and 7 days after graft reperfusion.
Conclusions: IP relieved the severity of IRI and the classification of acute rejection of the same cold and warm ischemia time, which is correlated with modulation of apoptosis and modulation of mRNA and protein expression of Fas, perforin and granzyme B. 

Abstract:

Objective:To investigate the effect of ischemic preconditioning of the small intestine on intestinal mucosal barrier and liver graft in rats.
Methods:SD rats were randomly assigned into the following study groups: group S (sham operation group, n=8), group A (orthotropic liver transplantation group, n=20), group B (ischemic preconditioning on the recipient rat′s small intestine, n=20). At postgraft 1 h, each 8 rats were obtained from groups A and B. The MDA and MPO of the intestine,as well the serum SOD and NO and liver function were determined. The morphological changes of liver lobules and the epithelial basement membrane and mucosa of small intestine were observed by microscopy.
Results:The one-day-survival between in groups A and B was not significant. The one-week-survival in group B  was significantly increased than that in group A. MPO and MDA in group A was significantly higher than in group B and group S; SOD and NO in group A were higher than those in group B and group S. The mucosal wet weight, villus height and villus wide in group A were significantly lower than those in  group B and group S.The lesions of hepatic cells and intestine unber microscope were milder in group B than that in group A.
Conclusions:Ischemic preconditioning of the recipient rat small intestine has early protective effect on liver graft.

Abstract:

Objective:To investigate the effect of Bmi1 on proliferation of rat adult hepatic stem cells.
Methods:Bmi1 siRNA was transfected into rat adult hepatic stem cells OC3. Then the expression of Bmi1 in OC3 was detected by real time PCR; the proliferative capability was detected by CCK8; and the cell cycle was detected by flow cytometry 24 h after transfection.
Results:The decreased expression of Bmi1 was associated with decreased viability of OC3 cells ［inhibition ratio: （20.35±0.132）%］ and the number of cells with S phase［（24.48±0.96）%］ was decreased significantly.
Conclusions:Knockdown of Bmi1 can inhibit the proliferative capability of rat hepatic stem cells.

Abstract:

Objective:To investigate the effect of PMN migration between myeloid cells TLR4 and LSEC TLR4 in hepatic ischemia/reperfusion(I/R) injury in mice. 
Methods:TLR4 wild-type mice (C3H/HeN) and TLR4 mutant mice(C3H/HeJ) were the research subjects, bone marrow cells of the donor mice were injected into the irradiated recipient ones, and  four chimeric models were established as follows:class A, myeloid cells TLR4+/+ ［recipient (R) HeN］and  LSECTLR4+/+［donor (D) HeN］; class B,myeloid cells TLR4+/+ (R, HeN) and LSECTLR4-/- (D, HeN); class C,myeloid cellsTLR4-/- (R, HeN) and LSECTLR4+/+ (D, HeN); class D,myeloid cellsTLR4-/- (R, HeN) and LSECTLR4-/- (D, HeN). Each mouse of the four chimeric models underwent hepatic I/R injury.Finally,inflammatory protein extracted from liver tissue and PMN isolated from peripheral blood were placed into separate wells of Transwell,and PMN migration was recorded by calculating the numbers of PMN.C3a was used as a positive control and buffer as a negative control.
Results:Compared with class C(67.10±6.89), there was statistical increase of PMN migrating numbers in class A(148.95±11.04)(P＜0.05). Compared with class D(63.15±8.86), class B (142.65±8.67)had statistical increase of PMN migrating numbers(P＜0.05).While there was no significant difference between class A and class B(P＞0.05), and class C and class D had no significant difference (P＞0.05)as well.
Conclusions:Myeloid cells TLR4,not endothelial cell TLR4,play a leading role of PMN migration in hepatic I/R injury.

Abstract:

Objective:To explore the protective mechanisms of terlipressin on small-for-size livers in the early phase after major hepatectomy.
Methods:The rat model of major hepatectomy(90%) with Pringle maneuver for 30 minutes was used for the study. A total of 60 rats were randomly categorized into 2 groups: Thirty rats in group T(Terlipressin group) and 30 in group C(control group). Five observation time points of 30min, 2h, 4h, 6h and 24h posthepatectomy after reperfusion were designed. A total of 10 subgroups, which were named T1/2, T2, T4, T6,T24 and C1/2, C2, C4, C6, C24 in terms of different time points and groups, were studied. Every subgroup consisted of 6 rats. Samples were collected from every subgroup. Blood samples were obtained for alanine transaminase, aspartate transaminase and total bilirubin  determination. Fresh frozen specimens of remnant liver were collected for RT-PCR detection of intrahepatic A20 and iNOS expression at mRNA levels. Paraffin sections of remnant liver were used for HE staining and then observed for morphological changes microscopically. Intracellular expression of endothelin-1(ET-1), A20 and iNOS were detected by histochemical staining. In situ cell death by TUNEL was also used for detection of apoptosis.
Results:AST, ALT and TBil reached their peak levels at 24 hours after reperfusion in each group.The above 3 parameters were significantly reduced in subgroup T6 and T24 compared to subgroup C6 and C24 (all P＜0.01). RT-PCR showed that except the time point of 30min after reperfusion, A20 expression was upregulated at all of the other time points in group Ts, overexpression was observed in subgroup T2 compared to group C（P＜0.05）. The expression of iNOS was down-regulated in group Ts as detected by RT-PCR; and on the contrary, it was upregulated in group Cs, overexpression was observed in sub group C2 compared to group T2 （P＜0.05）. Microscopic observation showed that the morphological changes of remnant liver in group T at every time point was markedly milder than that in group C. The apoptosis index in subgroup C6 was significantly higher than that in subgroup T6（P＜0.05）. Histochemical staining showed that A20 expression was stronger at subgroup T2,T4 and T6 compared to subgroup C2,C4 and C6.There was no marked difference of A20 expression at 24h after reperfusion in both groups. ET-1  was markedly down-regulated in subgroup T24 compared to C24（P＜0.05）. The iNOS expression was down-regulated in subgroup T24 compared to subgroup C24（P＜0.05）.
Conclusions:Terlipressin can effectively improve small-for-size liver function in the early posthepatectomy phase after reperfusion. It can also inhibit the early inflammatory response. Hepatocyte apoptosis is attenuated by terlipressin. Terlipressin is also supposed to ameliorate sinusoidal mechanical injury and hence, to help stabilize microcirculatory homeostasis.

Abstract:

Objective:To evaluate the treatment effect of transplantation of  frozen hepatocytes on cirrhosis and acute hepatic failure of rats.
Methods:The isolated  hepatocytes were harvested by in situ perfusion and frozen by programme freezing. A cirrhosis and acute hepatic failure (HF) model of rats was established, then the rats were divided into three groups: group I (control group);  group II (cirrhosis group) and group III (HF group), the latter 2 group were subdivided into two groups (group IIa,IIb, and group IIIa, IIIb) according to without or with transplantation of frozen hepatocyte into portal vein. Portal venous pressure, liver function and pathology results were observed before and after the hepatocyte transplantation, and data were analyzed by statistical methods.
Results:The recovery of frozen hepatocyte was 50 to 70 percent. In the cirrhosis group, 7 days after the transplantation (group IIa), portal venous pressure, liver function and pathology results showed no significant changes comparing with group IIa. Compared with non-transplantation group (group IIIa),  in group IIIb (hepatocyte transplantation for acute hepatic failure) after 7 days of transplantion, the  ALT level was lower, while the total protein and albumin were significantly improved(P＜0.05).
Conclusions:Frozen hepatocyte transplantation is conducive to the recovery of liver function in rats with acute hepatic failure, while it has no significant effect in the rats with cirrhosis.

Abstract:

Objective:To investigate the effect of SH2-B on proliferation and cell cycle of colon caner HT-29 cells.
Methods:Screening of the SH2-B low expression colon cancer cell line (HT-29) by immunofluorescence assay was done. pcDNA3.1-SH2-B was transfected into HT-29 cells using LipofecTAMINE 2000. After gene transfection, SH2-B expression was detected by Western-blotting,  cell proliferation was measured by MTT assay, and cell cycle was analyzed by flow cytometer.
Results: Immunofluorescence assay results showed that SH2-B lowly expressed in HT-29 cells.  after being transfected with pcDNA3.1-SH2-B,  SH2-B expression dramatically increased in HT-29 cells, and HT-29 cells proliferation was significantly enhanced (P＜0.05). Cell cycle analysis showed that S stage cells were significantly increased in the SH2-B transfected group (39.4±2.31) % compared with the blank control group (18.6±4.25)% and vector control group (11.1±2.39)% (P＜0.05).
Conclusions:SH2-B may enhance colon cancer HT-29 cell proliferation and promote cell cycle.

Abstract:

Objective:To study the expressive levels of PSCA, OCT-4,CD24 and CD44v6 of rectal cancer and peritumoral tissues and their clinicopathological significances.
Methods:EnVisionTM immunohistochemistry for assaying the expressive levels of prostate stem cell antigen (PSCA) OCT-4,CD24 and CD44v6 was used in the conventional paraffin-embedded sections from surgical resected specimens of rectal carcinoma (n=50) and peritumoral tissues (n=20).
Results:The positive rates of PSCA, OCT-4,CD24 and CD44v6 were significantly higher in rectal carcinoma than those in peritumoral tissues (all P＜ 0.01) The positive expressive cases of PSCA, OCT-4,CD24 and/orCD44v6 in peritumoral tissues showed atypical-hyperplasia of epithelium. The positive rates of PSCA, OCT-4,CD24 and CD44v6 were significantly lower in patients without  cancer invasion of serous layer,the maximal diameter of mass≤5 cm, non-metastasis of lymph node and Dukes stage A+B than patients with cancer invasion of serous layer,the maximal diameter >5cm, metastasis of lymph node and Dukes stage C+D(P＜0.05 or P＜0.01) High consistences were found among the expressive levels of PSCA,OCT-4,CD24,and CD44v6 in rectal cancer tissues(P＜0.01).
Conclusions:The expressive levels of PSCA, OCT-4,CD24 and CD44v6 could be important markers of cancer stem cells for reflecting the carcinogenesis, progression，biological behaviors and prognosis of rectal cancer.

Abstract:

Objective:To evaluate the effect of application of combined hemihepatic inflow and hepatic veins occlusion in major liver resection.
Methods:The clinical data of 46 cases of large hepatic carcinoma who underwent liver resection were surveyed retrospectively. The hepatic pedicle of affected side and hepatic veins were dissected and controlled initially, then hepatectomy was performed under the condition of vascular exclusion of the affected side of liver.
Results:All the 46 cases suffered from hepatocellular carcinoma. The average size of the tumors was 8.3 cm (6-15 cm) in diameter. One main hepatic vein was invaded by tumor in 20 cases and 2 main hepatic veins were invaded by tumor in 14 cases. Among the 46 hepatectomies, right hemihepatectomy was performed in 16, right posterior lobe hepatectomy in 14, and left hemihepatectomy in 16 cases. The mean occlusion time of the hemihepatic pedicle was 30 min(10-45 min), and occlusion time of the hepatic veins was 20 min(10-30 min). The average blood loss was 540 ml(300-1 500 mL). Postoperative complications occurred in 14 cases, and all recovered after treatment. There was no mortality in this series.
Conclusions:Combined hemihepatic inflow and hepatic veins occlusion in major hepatectomy is a safe, effective and practical vascular exclusion method which can effectively reduce the blood loss and the incidence of the liver function failure.

Abstract:

Objective:To investigate the application of selective hepatopetal blood occlusion techniques  in anatomic hepatectomy.
Methods:We retrospectively reviewed the clinical data of 259 patients with hepatolithiasis or liver tumor undergoing anatomic hepatectomy under selective hepatopetal blood occlusion from January 2006 to December 2009.
Results:Totally, 183 cases with hepatolithiasis and 76 cases with liver tumor underwent anatomic hepatectomy under selective hepatopetal blood occlusion. The average intra-operation blood loss was 210 mL（120-1 600 mL）; post-operation incidence of complications and the rate of residual stones was 10.9% and 4.2%, respectively. Thre was no operative death in this series. The intrahepatic recurrence and metastasis rate of liver tumor was 23.6% and the median recurrence was 16.3 months.
Conclusions:The use of a appropriate selective hepatopetal blood occlusion during anatomic hepatectomy for hepatolithiasis and liver tumors is an effective measure to reduce surgical complications and improve outcome.

Abstract:

Objective:To evaluate the clinical values of selective hemihepatic vascular occlusion in hepatectomy for large hepatocellular carcinomas.
Methods:Forty patients with large hepatocellular carcinomas who underwent hepatectomy with selective hepatic inflow and outflow occlusion of tumor-bearing liver were retrospectively analyzed.
Results:All the 40 patients underwent hepatectomy successfully. The blood losts during the operation was 100-800 mL (average 360 mL). The operation time was 90-150 min(average 116 min). Intraoperative blood transfusion was not performed in twenty-five patients. All patients recovered completely and were discharged without liver function failure or other severe complications. There was no perioperative death.
Conclusions:Selective  hemihepatic vascular occlusion in hepatectomy for large hepatocellular carcinomas is a safe and effective method with advantages of controlling hemorrhage,  decreasing liver damage and gut barrier injury, avoiding air embolism and preventing metastasis.

Abstract:

Objective:To evaluate the value of clinical application of modified liver hanging maneuver method via  anterior approach in right hepatectomy.
Methods:Firstly, a retrohepatic tunnel was developed, then the liver was elevated with single or double suspension slings, and right hepatectomy was performed with liver hanging maneuver method via anterior approach.
Results:Ten cases included 5 cases of liver cancer, 2 cases of hepatic hemangioma, 2 cases of intrahepatic stones, and 1 case of severe liver injury. All the operations were carried out successfully without surgery-related complications.
Conclusions:The liver hanging maneuver is a safe and reliable method for right hepatectomy. This method is recommended for right hepatectomy in both benign and malignant hepatic lesions and severe liver injury.

Abstract:

Objective:To study the rational  treatment of spontaneous rupture of hepatocellular carcinoma(SRHCC).
Methods:The clinical data of 46 patients with SRHCC treated by 3 operation strategies during five and a half years were retrospectively analyzed.
Results:Compared with non-SRHCC matched selective operation group(group B), emergency hepatectomy (group A) had more complications and high mortality,but the long-term survival was not significantly different(P＞0.05). Compared with non-SRHCC matched selective operation group (group),second stage hepatectomy (group C)had similar rate of complications and mortality,but the long-term survival was worse(P＜0.05). Compared with group C,group A had more complications and higher mortality, but the long-term survival rate was better(P＜0.05).
Conclusions: The patients with SRHCC should be managed individually. Emergency hepatectomy is safe and effect, it can be recommended in selected patients.

Abstract:

Objective: To set up CEAP system for the diagnosis of portal hypertention.
Methods:Based on CEAP system from American Venous Forum, the clinical and pathologic classification of Budd-Chiari syndrome from Xu, the clinical and pathologic data of 251 cases of portal hypertension were analyzed retrospectively.
Results:According to the results of imaging examination ［(Doppler ultrasound, percutaneous splenoportography, selective angiography of mesenteric artery, multi-slice spiral CT (MSCT) three dimensional (3D) reconstruction］, clinical and pathological data, CEAP system for the diagnosis of portal hypertention was defined as follows: Clinical manifestation (C) including mild and severe types; Etiology (E) (congenital, primary, secondary); Anatomy (A) consists of liver, inferior vena cava, hepatic veins, and portal vein system; Pathophysiology (P) could have liver fibrosis/cirrhosis, obstruction, thrombosis, intrahepatic collateral circulation and tumors.
Conclusions:CEAP system for correct diagnosis, classification as well as the individual treatment is of great practical importance, and could be wide application.

Abstract:

Objective:To evaluate the effect of early endoscopic treatment for patients with severe acute biliary pancreatitis.
Methods:Ninety patients with severe acute biliary pancreatitis were divided into three groups: Thirty patients underwent early endoscopic treatment (group A), 30 patients underwent expectant treatment (group B) and 30 patients receive surgical treatment (group C), respectively.  complications and safety were evaluated.
Results:The symptoms and signs disappeared in all 30 cases after early endoscopic treatment. All the 30 patients (100%) of endoscopic treatment (group A) were cured which significantly better than the other groups(group B 83.3% and group C 93.3%, respectively).
Conclusions:Early endoscopic treatment relieves the orifice obstruction of biliary and pancreatic ducts, decreases the pressure of biliary and pancreatic ducts, it is safe, mini-invasive and highly effective for the treatment of severe acute biliary pancreatitis.

Abstract:

Objective:To investigate the diagnosis and treatment of pregnancy-associated pancreatitis (PAP).
Methods:A retrospective review of medical records of pregnant women suffered from PAP admitted to Xiangya Hospital between 2002 and 2009.
Results:Sixteen patients presenting with 18 episodes of acute pancreatitis were identified. Most attacks occurred in the third trimester (15/18). Five patients were classified as SAP by APACHE II system. Six patients had hypertriglyceridemia, 1 patient caused by gall stone, the others had “undetermined” etiologies. Elevating of amylase was appeared in 14 patients (77.8%, 14/18). B type ultrasonography (BUS) was taken as the most effective method for diagnosis of pancreatitis, the accuracy diagnastic rate was 66.7% of BUS in this study. All the patients were accepted conservative treatment after admission. Operation was performed in one patient. Pregnancy was terminated in 13 patients. Three fetal were loss (18.8%) and there were no maternal death occurred.
Conclusions:Pancreatitis attacks pregnancy women in second and third trimester mostly. Hypertriglyceridemia was the frequency cause of pregnancy-associated pancreatitis in this group. Conservative treatment was the first choice of treatment. The safety of maternal should have to be considerated firstly during treatment. Terminating pregnancy in the proper time, as well as treating maternal and fetal by cooperation of doctors of separate department may help increase the prognosis of this disease.