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A widening gap between demand and availability of donor livers for transplantation has stimulated the use of extended-criteria donor(ECD)livers, including donation after circulatory death liver grafts.However, these types of donor livers carry an elevated risk of developing such postoperative complication as ischemic type biliary lesions(ITBL).Although the pathogenesis of ITBL has remained elusive, severity of histological bile duct injury(BDI)at the time of transplantation has been identified as a strong predictor of the development of ITBL post-transplantation.In recent years, significant advances have been achieved in the field of liver machine perfusion.Normothermic machine perfusion(NMP)is primarily utilized for determining the quality of ECD organs.To evaluate the extent of biliary injury during NMP, some reliable criteria of BDI are required.This review focused upon different approaches of assessing damage to biliary tree and current understandings of potential effects of NMP on biliary system and biliary injury.Also it offered an overview of novel biomarkers and emerging therapeutic strategies.
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Objective:To investigate gender differences in arterial velocity pulse index(AVI), which is an indicator of vascular stiffness, across various age groups.Additionally, the study will also examine the risk factors associated with AVI.Methods:This cross-sectional study enrolled 4311 patients with an average age of 57.8±12.8 years at Jiading Branch of Shanghai First People's Hospital between August 2020 and September 2021.Patients were divided into three groups based on age: young(<45 years old, n=755), middle-aged(45-59 years old, n=1260), and elderly(≥60 years old, n=2 296). The AVI of the subject was obtained using the cuff oscillation wave method.The subject's AVI was acquired using the cuff oscillation wave.High AVI, indicating arteriosclerosis, was defined as AVI≥33.The subjects were then divided into two groups: the high AVI group(122 cases)and the normal AVI group(4 189 cases).Results:The ankle-brachial index(AVI)was found to be 12.8±3.7, 17.5±5.7, and 19.8±6.5 in the young, middle-aged, and elderly groups, respectively.The study revealed that AVI increased with age( Ftrend=767.819, P<0.01). Additionally, the incidence of high AVI in middle-aged women was found to be(2.8% or 20/722), which was higher than that in men 0.9%(5/538)in the same age group.This difference was statistically significant( χ2=5.371, P<0.05). The results of the multivariate logistic regression analysis indicate that being overweight, having a higher height, and a pulse rate greater than 80 BPM are protective factors in preventing a high incidence of AVI.The odds ratios( OR)with 95% confidence intervals( CI)for these factors were 0.468(0.317-0.690), 0.926(0.895-0.958), and 0.143(1.026-2.432), respectively, all with a P-value less than 0.01.On the other hand, old age, systolic blood pressure of 140 mmHg or higher, and diastolic blood pressure of 90 mmHg or higher were identified as risk factors for AVI.The ORs with 95% CIs for these factors were 2.119(1.322-3.396), 6.652(4.136-10.699), and 1.580(1.026-2.432), respectively, all with a P- value less than 0.05l. Conclusions:Arterial stiffness, as measured by the ankle-brachial index(ABI), tends to increase with age.In middle-aged subjects, women have a higher incidence of high ABI than men.Independent risk factors for high ABI include age and increased blood pressure, while factors such as overweight and height may affect the measured value of ABI.
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Objective:To explore the role of internal stenting for preventing biliary anastomotic complications during complex duct-to-duct biliary reconstruction of orthotopic liver transplantation.Methods:From December 1, 2018 to April 30, 2020, intraductal stent was placed in 6 cases of complex biliary tract reconstruction during liver transplantation. Postoperative prognosis, recovery of bilirubin and biliary enzymes, management of intraductal stent and occurrence of postoperative biliary complications were observed.Results:All of them recovered and were discharged smoothly and bilirubin and biliary enzymes normalized before discharge. The average peak values of total bilirubin, alkaline phosphatase, total bile acid and γ-glutamyl transpeptidase were 83.8±56.4 μmol/L, 151.5±76.3 U/L, 301.7±177.0 U/L and 98.4±80.9 μmol/L and the average turning points of total bilirubin, alkaline phosphatase, total bile acid and γ-glutamyl transpeptidase 2.3±1.0, 3.0±1.1, 3.8±1.2 and 1.8±0.8 days; average time of complete recovery of total bilirubin, alkaline phosphatase, total bile acid and γ-glutamyl transpeptidase 7.7±5.1, 5.0±4.9, 23.5±7.6 and 3.8±2.4 days respectively. Intraductal stent was removed by gastroduodenoscopy ( n=3) and slipped off ( n=3). Except for one case of asymptomatic anastomotic stricture at 1 year post-operation, no biliary complications occurred during follow-ups. Conclusions:The placement of intraductal stent during complex biliary reconstruction of liver transplantation can effectively promote the recovery of postoperative liver function, enhance the quality-of-life of patients, effectively avoid the occurrence of biliary anastomotic complications and ensure the safety of patients.
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The shortage of donor liver is the main factor that restricts the development of liver transplantation and the curative effect of liver transplantation for hepatocellular carcinoma (HCC). Previous studies have focused on the selection criteria of recipient, downstaging therapy, immuno-suppressive therapy, etc. In recent years, it has been found that the selection of donor liver significantly inluence tumor recurrence after liver transplantation. The author discusses the main types of clinical liver donors, criteria of liver transplantation for HCC, selection of donor liver in liver transplantation for HCC within indications, selection of donor liver in liver transplantation for HCC beyond indications, and the influences of donor liver selection on the prognosis of liver transplantation for HCC.
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Objective:To explore the clinical evaluation outcomes of COVID-19 risk assessment scale on organ donation and procurement during the pandemic of novel coronavirus pneumonia (NCP) and reduce the incidence of donor-derived infection and medical staff infection.Methods:From January 20 to February 29 in 2020, the organ procurement team adopted the COVID-19 risk assessment scale for evaluating 8 potential donors. They were classified into the levels of high/low/uncertain risk by analyzing the risk levels of donation hospitals, clinical characteristics and exposure history. The coordinators, organ evaluators and ward medical staff adopted essential protective measures. The infection status of 2019-nCoV in the above mentioned staff was examined and graft function in the corresponding recipients were observed.Results:Based upon the COVID-19 risk assessment results, the risk level was high (n=8), low (n=5) and uncertain (n=2) and underwent organ procurement. A total of 19 grafts including liver, kidney, pancreas and heart were harvested and successfully utilized for organ transplantation. During the observation period of 14 days, there was no suspected or confirmed infection of 2019-nCoV among coordinators and medical staff. No graft dysfunction or acute rejection was observed during a follow-up period of 4 to 30 days. No recipient was suspected or confirmed to be infected with 2019-nCoV and 6 of them were negative for 2019-nCoV nucleic acid testing after organ transplantation.Conclusions:During the COVID-19 pandemic, it is safe to proceed with donor organ evaluations and procurements according to the result with the COVID-19 risk assessment scale. Low-risk donor organ donation may be carried out, uncertain risk donor organ donation should be performed cautiously and high-risk donations discouraged.
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Liver transplantation is the only effective treatment for portal hypertension (PHT) and end-stage liver disease.However,great therapeutic needs are far from satisfaction due to extreme shortage of donated livers.Good timing and indicator selection for PHT liver transplantation,and appropriate management of complications before or during on the waiting list,can avoid unnecessary liver transplantation and decrease the mortality rate of patients on waiting list.There are some particularities and issues worthy of attention.Understanding these particularities and handling these issues properly are extremely important to increase the success rate of PHT liver transplantation,enhance the recovery after surgery,and decrease the operative mortality.
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Objective To analyze the specific IgE test results and the distribution of allergens in patients with allergic diseases in Shenzhen area .Methods Western blot was used to detect inhaled and food specific IgE in 2154 patients with allergic diseases ,and the types and distribution of allergens were analyzed .Results The total positive rate of allergen specific IgE was 48 .88％ .More than 20％ of the patients were allergic to more than two allergens .The most common allergies were dust mites ,freshwater fish and sea fish .The posi-tive rate of IgE in male allergens was higher than that in females ,and the difference was statistically signifi-cant (P<0 .05) .The positive rate of allergen specific IgE in different age groups was statistically significant (P<0 .001) .The positive rate of dust mites increased year by year before the age of 18 ,and then decreased year after year .The positive rate of chicken protein and milk showed a significant downward trend after 7 years old .The positive rate of allergen IgE in patients with different diseases was statistically significant (P<0 .001) .The positive rate of dust mite combination in rhinitis patients was the highest ,49 .94％ .Conclu-sion The main allergen of allergic diseases in Shenzhen area is dust mites combination ,freshwater fish com-bination and sea fish combination .The main food allergen of children is egg and milk .The main allergen of a-dult is dust mites combination and fish ,and the patients with rhinitis are high sensitized people of dust mites combination .
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Aim To explore the anti-proliferation effects of curcumin trinicotinate ( CurTn ) on vascular smooth muscle cell ( VSMC ) and its mechanism. Methods The cells were cultured in DMEM supple-mented with 10% fetal bovine serum. MTT assay was used to examine cell proliferation. FCM was used to observe cell cycle. The expressions of PCNA, Cy-clinD1 and p-ERK1/2 were analyzed using Western blot. Results CurTn could inhibit the proliferation of VSMC and showed a certain amount-time relationship. What’ s more, CurTn could increase the G1 phase pro-portion of cell, decrease the S phase proportion and the expression level of PCNA protein. It was also found that CurTn significantly inhibit the protein expression of p-ERK1/2 and Cyclin D1 . Conclusion CurTn may inhibit the proliferation of VSMC via downregulating the expression of CyclinD1 and p-ERK1/2 .
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Objective To study the application method and effect of perioperative enteral nutrition support in patients with gastrointestinal cancer.Methods 82 patients with gastrointestinal tumor were randomly divided into two groups.41 cases in the control group were given intravenous nutrition.41 patients in the study group were given enteral nutrition support 7d before operation,outage on the day of surgery,postoperation consistently given enteral nutrition support for 7d.The preoperative nutritional status,immune index,postoperative complications,the length of time and hospitalization expenses were compared between the two groups.Results Preoperative 1d,7d,the ALB,TRF,TP, PAB levels in the study group had no statistically significant differences compared with admission (all P >0.05).7d after operation,the TRF,PAB of the study group were (1.71 ±0.17)g/L,(174.67 ±22.81)mg/L,which of the con-trol group were (1.46 ±1.46)g/L,(142.73 ±27.32)mg/L,the differences were statistically significant (t =2.662, 2.917,all P <0.05).3d,7d after operation,the CRP,IL -6 and TNF - levels in the two groups increased signifi-cantly,compared with preoperation the differences were statistically significant (P <0.05).3d,7d after operation,the team CRP levels of the study group were (121.5 ±15.6)mg/L,(55.17 ±7.62)mg/L respectively,IL -6 levels were (81.42 ±13.56)pg/L,(56.14 ±9.73)pg/L and TNF -levels were (67.25 ±17.23)pg/L,(63.23 ±11.80)pg/L;In the control group,3d,7d after operation,CRP levels were (161.3 ±20.7)mg/L,(99.26 ±20.74)mg/L,IL -6 levels were (103.62 ±21.54)pg/L,(77.43 ±18.26)pg/L,the TNF -levels were (79.01 ±16.9)pg/L,(68.25 ± 12.48)pg/L,the differences between the two groups were statistically significant (P <0.05).The incidence rate of complications of the study group was 2.44%,which of the control group was 12.20% (χ2 =2.717,P <0.05 ). Conclusion Gastrointestinal tumor patients with malnutrition,perioperative enteral nutrition support can promote the synthesis of protein metabolism,relieve excessive postoperative systemic inflammatory reaction,reduce the risk of surgery.
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Objective To investigate the application and clinical value of donation after citizens death (DCD) in salvage liver transplantation (SLT).Method The clinical data of 12 recipients who underwent SLT from DCD of 12 donors at the Guangzhou General Hospital of Guangzhou Military Area from October 2010 to December 2013 were retrospectively analyzed.Of the donors,there was one case of type of China-Ⅰ,2 cases of the type of China-Ⅱ and 9 cases of the type of China-Ⅲ.Extracorporeal membrane oxygenation (ECMO) was applied to donation after brain and cardiac death to avoid warm ischemia.Of the recipients,6 met the Milan criteria,3 UCSF(The University of California,San Francisco) criteria and 3 Hangzhou criteria respectively.Orthotopic liver transplantation was performed on recipients.Eleven recipients received end-to-end anastomosis of the bile duct and followed up regularly.Result Liver transplantation was successfully performed on all recipients.No mortality during operation,no recovering delay and non-function of the transplanted liver occurred.Postoperative complications occurred in 4 cases,2 patients died,and 2 patients recovered and discharged after the second surgery.Ten recipients had a long-term survival.Two cases of hepatocellular carcinoma (HCC) recurrence were still alive after active treatment.The longest survival time was 42 months.All of them had no long-term complications such as biliary stricture.Conclusion The role and status of SLT in the treatment of HCC has become increasingly,and there will be more and more use of DCD donor in SLT.To ensure the DCD donors safely and effectively applied in SLT,we should grasp the characteristics of SLT,choose the appropriate DCD donor according to recipients,and rationally use the ECMO to protect the graft quality.
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Objective To explore the leaves water extract on the liver human hepatocellular carcinoma xenografts and protein expression of Bcl-2 and HSP70 .Methods From cell morphology and DNA agarose gel electrophoresis the observation leaves water extract the characteristics of the material role in human hepatoma cells ,further use of immunocytochemistry agent Western blotting analysis method oncogene Bcl-2 and tumor suppressor genes HSP70expression .Results After the processing of the the 60 mg/mL leaves water extract of liver cancer cells after 12 h ,liver cells showed severe shrinkage ,pyknosis ,highlight the cell plasma mem-brane ,immunohistochemistry and Western blotting analysis showed that during the experiment along with the oncogene Bcl-2 ex-pression weakened(P<0 .05) ,while the expression of tumor suppressor genes HSP70 had no obvious change(P<0 .05) .Conclusion Water extract of the leaves can be induced in vitro human liver cancer cell apoptosis ,and the apoptotic process may be followed by the oncogene Bcl-2 ,tumor suppressor gene expression of HSP70 relationship .
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Objective To summarize the clinical experiences in liver transplantation from donation after cardiac death donors. Methods The clinical data of 20 recipients who underwent liver transplantation from donation after cardiac death of 20 donors at the Guangzhou General Hospital of Guangzhou Military Area from July 2006 to May 2011 were retrospectively analyzed.Extracorporeal membrane oxygenation (ECMO) was applied to donors with brain and cardiac death to avoid warm ischemia.Donors in type Ⅲ according to the Maastricht classification did not receive ECMO.Liver grafts were obtained 5 minutes after the stop of heartbeat of the donors.Orthotopic liver transplantation was performed on recipients.Seventeen recipients received end-to-end bile duct anastomosis and 3 received cholangioenterostomy.All the recipients were followed up regularly.The survival curve was drawn by Kaplan-Meier method.Results Of the 20 donors,2 ( 10％ ) were in the type of Maastricht Ⅲ and 18 (90％) were donation after brain and cardiac death donors.Liver transplantation was successfully performed on all recipients,and the mean operation time,duration of anhepatic phase,mean volume of blood loss and duration of postoperative intensive care unit stay were (6.2 ± 2.7 ) hours,( 54 ± 13 ) minutes,( 2305 ± 1311 ) ml and (44 ±35) hours,respectively.There was no mortality during operation,and no recovering delay and non-function of the transplanted liver occurred.One recipient died of sepsis and 1 died of pulmonary infection at 1 month after operation,the other 18 recipients all survived.The longest survival time was 58 months.Conclusions Donation after cardiac death is the main source of liver grafts in China currently,and donation after brain and cardiac death is the main type.Establishment of rational flow-sheets of the donation after cardiac death and liver transplantation,rational application of ECMO for protecting the liver grafts are helpful for the work of organ donation after brain and cardiac death.
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At present,there are some problems about teaching acupuncture and massage elective course in colleges of western medicine,which are caused by student's specialty,thinking mode and the teaching material of elective course.To improve the quality of the teaching in acupuncture and massage,it is necessary to reorientate the teaching intention,adjust the course plan.
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Objective To investigate the treatment of common bile duct or common hepatic duct transverse injures(CBDTI) in cholecystectomy.Methods From January 1993 to March 2008,3362 patients received cholecystectomy in our hospital,among them 5 developed CBDTI.We reviewed the clinic feature,management,and outcomes of these patients. Results Of the 5 patients,2 had common hepatic duct transverse injuries and 3 showed common bile transverse injuries.One of the five received postenterobiliary drainage and the other four underwent choledoch end-to-end anastomosis.No biliary leakage was found after the operation.One patient developed biliary stenosis and cholangitis after the end-to-end anastomosis and thus received postenterobiliary drainage.This case was followed up for 15 years,during which no abdominal pain,fever or jaundice occurred.The patient who underwent postenterobiliary drainage showed symptoms of cholangitis for 3 times whithin 2 months after the treatment;therefore,conservative therapy was carried out.Afterwards,the patient was cured and showed no abdominal pain,fever or jaundice during a 5-year follow-up.The other 3 patients who received end-to-end anastomosis were followed up for 1,2,or 4 years,no complications were noticed during the period.Conclusions Based on personal experience and the type of injury,surgeons may chose choledoch end-to-end anastomosis or postenterobiliary drainage to treat CBDTI.
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Objective To explore difficulties and countermeasures of laparoscopic cholecystectomy (LC) for treating huge gallstones. Methods Fifty-six cases of huge gallstones with a diameter of 2.0~5.3 cm (3.4?0.6 cm) were reviewed in respect of their clinical features and operative difficulties and countermeasures during laparoscopic cholecystectomy. Results The laparoscopic cholecystectomy was completed smoothly in 54 cases, with an operation time of 30~130 min (94.3?40.7 min). Conversions to open surgery were required in 2 cases because of acute suppurative cholecystitis. Moderate-to-severe adhesion was found in 41 cases (73%). White bile or absence of bile secretion was found in 23 cases (41%). There were 2 cases (4%) of small bile duct injuries in the gallbladder bed, 15 cases (27%) of liver tissue injures in the gallbladder bed, and 19 cases (34%) of intraoperative gallbladder leakage. No major bile duct injury or massive hemorrhage occurred. The postoperative hospitalization time was 3.6?1.5 days. Follow-up observations for 6~12 months (mean, 11 months) found that the symptoms disappeared and no complications were noted. Conclusions The difficulties during LC for huge gallstones lie in the thickening of the gallbladder wall that causes injuries of the liver tissue and small bile ducts in the gallbladder bed. Careful dissection and reservation of part of the gallbladder wall are effective methods to lower the incidence of complications.
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Objective To discuss the prevention and treatment of bile duct injures io the gallbladder bed during laparoscopic cholecystectomy(LC).Methods A retrospective analysis was made on clinical features,treatment,and curative effects of 15 cases of bile duct injures in the gallbladder bed out of 2 032 cases of LC from January 1997 to December 2004.Results There were 5 cases of acute attack of chronic calculous cholecystitis and 10 cases of chronic atrophic calculous cholecystitis.The location of injury was at the branches of the right hepatic ducts in 8 cases and at aberrant bile ducts in 7 cases.The injury was treated with titanium clipping in 8 cases,primary suture in 5 cases,and open surgery of bile duct repair in 2 cases because the injury was relativly large and the site of injury was near the trunk of the right hepatic duct.Postoperatively,bile leakage happened in 1 case and was cured by drainage for 5 days.Follow-up surveys for 6~36 months (mean,23 months) showed free of symptoms and no jaundice or cholangitis.Conclusions Surgical dissection closely near the gallbladder wall when mobilizing the gallbladder is the key to preventing bile duct injuries in the gallbladder bed during laparoscopic cholecystectomy.Prompt detection and proper management of the injury have satisfactory curative effects.
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Objective To investigate the laparoscopic treatment for giant intraabdominal cysts with postoperative lower body edema. Methods Five cases of giant intraabdominal cysts were given an aspiration of 1 500 ~ 2 000 ml (mean, 1 800 ml) of fluid. The aspiration was performed percutaneously in 2 cases of hepatic cyst, and under direct vision through a 1.5~2.5 cm incision around the umbilics in 3 cases of lower intraabdominal cyst. After aspiration the cysts were excised (3 cases) or fenestrated (2 cases) laparoscopically. Postoperative lower body edema was treated with diuretics either orally (2 cases) or intravenously (3 cases). Results Symptoms completely disappeared after operation in 4 cases and were significantly improved in 1 case of polycystic liver. Follow-up for 3~12 months found no recurrence. The lower body edema subsided in 5~7 days after operation. Conclusions Aspiration of cystic fluid before laparoscopic operation and postoperative administration of diuretics could get good results for patients with giant intraabdominal cysts.
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Objective To evaluate the value of vascular intervention in the diagnosis and management of hemobilia. Methods With Seldinger's technique ,digital subtraction angiography of superior mesenteric artery and hepatic arteriography were performed on 3 patients with hemobilia, two of whom manifested hemobilia after the operation of liver trauma and one of whom did after the operation of command bile duct stones . Arteriography showed the bleeding vascular branch, the false aneurysm and the arteriovenous fistula. And then a small catheter was put into the bleeding focus. The bleeding branch arteries were selectively embolized with embolus of n-butyl cyanoacrylate (NBCA),PVA granule,spring wire loop and gelatin sponge. Results Two cases showed diffuse bleeding focus and another showed a local bleeding focus. Two cases had expression of false aneurysm and one showed expression of ateriovenous fistula. The artery branches of the bleeding focus were successfully embolizated and the hemobilia stopped immediately. Conclusions Vascular intervention is an effective method for the diagnosis and management of hemobilia.
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Objective To investigate laparoscopic treatment of hepatic cysts in the right posterior lobe.Methods A four-port laparoscopic fenestration and drainage was performed in 35 patients with symptomatic hepatic cysts in the right posterior lobe(the lesion was located at the segment Ⅳ in 21 patients and at the segment Ⅶ in 14 patients) from January 1998 to December 2005.For cysts located at the superior segment of the right posterior lobe,the operation was performed through the suprahepatic approach. The liver was pressed along the anterior and inferior direction by using a pair of traction tongs for the exposure of hepatic cysts.Then the cyst was fenestrated and filled with pedicled greater omentum.For cysts located at the inferior segment of the right posterior lobe,the operation was conducted through the infrahepatic approach.The hepatocolic ligament,right triangular ligament,and connective tissues between the liver and the kidney were opened by using a harmonic scalpel.The liver was lifted with the traction tongs,and the cyst was fenestrated and filled with greater omentum.Results Laparoscopic fenestration and drainage was accomplished in all the 35 patients,without conversions to open surgery.The suprahepatic approach was adopted in 15 patients and the infrahepatic approach,in 20 patients.The operation time was 30～95 min(mean,46 min).No surgery related complications occurred.Pathological examinations in the 35 patients showed congenital cysts of liver.After operation,patients' symptoms all disappeared.The postoperative hospitalization time was 2～5 days (mean,3.8 days).All the 35 patients were followed for 6～36 months(mean,34 months).The cyst did not completely disappeared but significantly subsided in 2 patients(suprahepatic approach),without remarkable symptoms.The cysts were not obviously enlarged within 6 months.Conclusions Laparoscopic fenestration and drainage via suprahepatic or infrahepatic approach is an effective treatment for hepatic cysts in the right posterior lobe.
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Objective To investigate the diagnosis and treatment of latent perforation of peptic ulcer (LPPU) during laparoscopic cholecystectomy (LC). Methods A retrospective analysis was made on clinical data of 13 cases of LPPU diagnosed during LC from January 1994 to November 2005. Results All the 13 cases were misdiagnosed before the LC and clarified as having LPPU during the LC. Three cases of anterior duodenal bulbar perforation (0.4~0.5 cm in size) were laparoscopically repaired, whereas conversions to open repair were performed in 5 cases of duodenal perforation (0.5~1 cm in size) and 5 cases of gastric perforation (0.6~1 cm in size) because of severe adhesion or difficult performance. No surgical complications occurred. Twelve cases were followed for 6~36 months (mean, 27 months). The symptoms disappeared and gastroscopy showed healed ulcer. No recurrence of perforation was found. Conclusions Underestimation of LPPU leads to misdiagnosis, and preoperative gastrosopy can prevent it. For small perforation, laparoscopic repair and abdominal drainage can be employed. But in most cases, a conversion to open surgery is required. It is necessary to give regular internal medicine for peptic ulcer after operation.