ABSTRACT
Objective To review the development of adult and pediatric liver transplantation in Tianjin First Center Hospital, and to enhance academic exchanges, improve technological innovation, and jointly promote the progress and maturity in the field of liver transplantation. Methods The development of liver transplantation in Tianjin First Center Hospital was analyzed. The clinical data of adult and pediatric liver transplantation from September 1998 to September 2018 were collected. The important events and technological innovation achievements of liver transplantation during the 20 years were summarized. Results The first clinical liver transplantation was attempted in Tianjin First Central Hospital in April 1980. The first long-term survival adult liver transplantation in China was completed in 1994 (11 years survival after the operation). The specialized team of liver transplantation was formally established in September 1998. The 20-year clinical exploration and progress reflected the characteristics of era changes and technological innovation during the rapid development of liver transplantation in China. Our center performed liver re-transplantation in January 1999, reduced-size pediatric liver transplantation in August 2000. In May 2001, we organized the formulation for the preventive and treatment plan for hepatitis B recurrence after liver transplantation. We performed combined liver and kidney transplantation in July 2002, split liver transplantation (SLT) in April 2004, the first domino liver transplantation (DLT) in August 2005. Pediatric living donor liver transplantation (LDLT) was initiated in October 2006, adult LDLT was carried out in August 2007. In September 2007, the first living donor combined liver and kidney transplantation from the same donor in Asia was performed. The first domino+living donor double grafts liver transplantation in the world was performed in January 2009. In March 2011, we performed laparoscopically assisted right hepatic lobe liver transplantation (LDLT) with middle hepatic vein. In May 2014, living donor laparoscopic left lateral lobe procurement was successfully established. In April 2016, simultaneous liver, pancreas and kidney multi-organ transplantation was completed. Domino donor-auxiliary liver transplantation was performed in February 2017. In December 2017, extracorporeal membrane oxygenation (ECMO)-supported liver transplantation in a patient with severe pulmonary hypertension was successfully completed. Liver transplantation combined with partial splenectomy was established in April 2018. Cross-domino liver transplantation (hypersensitive kidney transplantation with auxiliary liver transplantation+pediatric liver transplantation) was performed in May 2018. During the 20 years, the team has performed or assisted other centers in Beijing, Shanghai, Guangzhou and Shenzhen to carry out more than 10 000 cases of liver transplantations. A total of 7 043 cases of various types of liver transplantation were performed in the single center of the hospital (6 005 adult liver transplantations and 1 038 pediatric liver transplantations). Concerning adult liver transplantation, the cumulative 1-year, 3-year and 5-year survival rate from September 1998 to March 2003 were 83.1%, 73.0% and 69.0%, from April 2003 to March 2009 were 85.3%, 76.2% and 72.1% and from April 2009 to September 2018 were 87.5%, 79.2% and 75.1%, respectively. The cumulative 1-year, 3-year and 5-year survival rate for pediatric liver transplantation were 93.5%, 92.2% and 90.2%, respectively. The nucleoside (acid) analogue combined with low dose hepatitis B immunoglobulin (HBIG) was developed to prevent the recurrence of hepatitis B after liver transplantation, this plan has reduced the recurrence rate of hepatitis B and the 5-year re-infection rate of hepatitis B virus (HBV) after liver transplantation significantly. The risk assessment system for tumor recurrence after liver transplantation was established and individual treatment method was established based on this assessment system. Continuous exploration and improvement of liver transplantation for liver cancer, liver re-transplantation, liver transplantation with portal vein thrombosis, SLT, DLT and multi-organ combined transplantation have significantly improved the clinical efficacy of patients and the post-operative survival rate. Conclusions The liver transplantation team of Tianjin First Center Hospital has carried out a scientific and technological exploration on the key problems and technical difficulties of clinical liver transplantation. This work strongly has initiated and promoted the rapid development of liver transplantation in China. The restrictive barrier of hepatitis B recurrence after liver transplantation has been overcome. The risk prevention and control system of tumor recurrence after liver transplantation has been established. A series of innovative achievements that can be popularized have been achieved in the field of complex liver transplantation and expansion of donor liver source. The iterative progress and sustainable development of liver transplantation have been realized.
ABSTRACT
Objective To explore the feasibility of three-dimensional (3D) laparoscopic technique in treating Hirschsprung's disease in infants. Methods 13 cases of Hirschsprung's infants diagnosed by lower gastrointestinal radiography and rectal mucosa biopsy in the third affiliated hospital of zhengzhou university during the period from July 2015 to March 2017 were collected. All of them were treated by laparoscopic 3D technique. Results The 13 case of surgeries were all accomplished successfully, and no case was transferred to laparotomy. After operation, the symptom of abdominal distention disappeared, no difficult defecation, no anastomotic fistula. And routine anal dilatation 2 weeks after operation of anal. Follow-up for 6 to 24 months, there was no abdominal distension, fecal incontinence, anal stenosis and other complications. Conclusions 3D laparoscopic technique has the advantages of high resolution and three-dimensional, which is safe and feasible for the treatment of infant's Hirschprung's disease.
ABSTRACT
Esophageal and gastric varices are common complications of liver cirrhosis and are seen in 50% of patients with liver cirrhosis. The annual incidence rate of esophagogastric variceal bleeding is 5%-15%, and even if the recommended treatment is used, the 6-week mortality rate is still as high as 15%-20%. Spontaneous bacterial peritonitis (SBP) is a common complication of end-stage liver disease and has an incidence rate of 10%-30% in patients with severe liver damage. SBP refers to the bacterial infection of the peritoneum and/or ascites that occurs in the absence of any inflammation in adjacent tissues (e.g., intestinal perforation and intestinal abscess). Hepatic encephalopathy (HE) is the clinical syndrome manifesting as cognitive impairment in patients with chronic liver disease, and its pathogenesis has not yet been fully elucidated and may be associated with ammonia poisoning theory, γ-aminobutyric acid and endogenous benzodiazepine complex receptor theory, and inflammatory pathway theory. This article introduces the advances in the treatment of upper gastrointestinal bleeding in patients with liver cirrhosis, SBP, and HE in 2016.
ABSTRACT
With the rising detection rate of strains with extensive drug resistance clinically, there is an increasingly urgent need of novel anti-microbial agents. More and more researchers put emphasis on bacteriophage therapy and have made great progress in this field. A large number of studies showed that some bacteriophages could produce enzymes which killed the host bacteria by degrading polysaccharides in their extracellular polymeric substances (EPS). This review introduces the classification of phage polysaccharide depolymerases and their action mode, the methods to determine whether the phage produces depolymerases, and their applications in anti-bacterial treatment, biofilm degradation and bacterial capsule typing.
ABSTRACT
Objective:To explore the effect of different separation and purification technology on the physical and chemical proper-ties of water extract of ophiopogonin. Methods:The water extraction process of total ophiopogon saponins was optimized by an orthogo-nal test. The macroporous resin adsorption and membrane separation technology were adopted to purify the ophiopogonin water extract. The physical and chemical parameters, such as electrical conductivity, pH value, viscosity and turbidity, and the contents of total sap-onins, proteins, tannins and polysaccharides were determined. Results:The optimum water extraction technology of total saponins was as follows:6-fold amount of water was added, boiling 3 times with 90 min for each time. The electrical conductivity, pH value and vis-cosity of different purified liquid of total saponins had no significant differences, while the contents of total saponins and the three kinds of macromolecules showed significant differences. Conclusion: The content of macromolecules can be used as the reference index of purification process of total saponins water extract. Compared with macroporous resin separation, membrane separation technology is more suitable for the separation and purification of total saponins water extract.
ABSTRACT
To optimize the water extraction process for glycyrrhiza. Methods: HPLC was used to determine the con-tents of glycyrrhizic acid and liquiritin. The comprehensive index included the contents of glycyrrhizic acid and liquiritin and the yield of dry extract. The water amount and the extraction time were selected as the independent variables, and the comprehensive index was set as the dependent variable. Design-expert 8. 06 software was used to fit multivariate linear or quadratic multinomial models for the experimental values. Response surface methodology was used to optimize the water extraction process. The prediction was carried out through comparing the observed and predicted values. Results:The regression coefficient of binomial fitting complex model was as high as 0. 979 7. The optimum conditions of extraction process were as follows:12-fold amount of water, extracting 3 times with 90 min for each time. The deviation between the observed and predicted values was -1. 72%. Conclusion: Central composite design-response surface methodology is convenient and highly predictive in optimizing the water extraction process for glycyrrhiza, which can be applied in the further membrane separation and purification.
ABSTRACT
Objective To evaluate the diagnosis and therapy of intestinal obstruction caused by multiple jejunal diverticula.Methods Clinical data of intestinal obstruction caused by multiple jejunal diverticula in 18 cases admitted from Jan 2001 to Aug 2012 were analyzed retrospectively.Results All patients experienced the symptoms of abdominal pain and abdominal distension,5 cases experienced nausea and vomit,2 cases had a fever.Plain abdominal X-ray series demonstrated distension of small bowel and multiple air-fluid levels,5 cases with anemia,the average value of hemoglobin was (9.5 ± 1.0) g/L,B-ultrasonography revealed bowel dilatation in 7 out of 15 cases,9 cases underwent abdominal computed tomography and all had positive sign of small bowel distension and multiple air-fluid levels,mesenteric volvulus was suspected in 1 case.All patients underwent laparotomy,the diagnosis of multiple jejunal diverticula were confirmed clinically and by the pathology.In a follow-up ranging from 2 to 25 months,1 case died,the others were symptoms free.Conclusions Multiple jejunal diverticula was a less common disorder,occurring mainly in old man,with a low preoperative definite diagnosis.Resection of affected intestinal segment with primary anastomosis results in satisfactory prognosis.
ABSTRACT
Objective To establish a stable animal model for sequentially dynamic and direct monitoring of the skin wound infection. Methods The mice with full-thickness skin incisions were replicated. After immediate subcutaneous suture,the mice were randomly divided into four groups,ie,Group A was inoculated with 50 μl sterile PBS solution),Groups B,C and D were inoculated with 50 μl suspension containing 1 × 106,1 × 108 and 1 × 1010 colony forming unit (CFU)/ml bioluminescent methicillin-resistant staphylococcus aureus (MRSA) respectively.Then,the diet behavior of each group was observed and the mean weight and mortality of each group were also recorded at different time points.The bioluminescent intensity of fluoresce in the wounds was recorded at different time points by using the charge-coupled device (CCD) based imaging system.Local wound tissues were incised at 24 hours after inoculation for HE staining so as to observe wound inflammatory reaction in each group.Wound healing time of each group was also recorded. Results ( 1 ) Average weight:Groups A and B showed unobvious changes in weight; Group C lightened until day 3 after inoculation and then recovered gradually to the preinoculation level at day 14; Group D lightened gradually until death.(2)Mortality:Groups A and B had no death; Group C had 10％ deaths at day 14; Group D had 100％ deaths.(3) Bioluminescent intensity of wounds:Groups A and B showed a gradual weakened luminescence since the day of inoculation and had almost complete disappearance at days 5 and 7 respectively; there was no sign of obvious increase or decrease in Group C from the day of inoculation till day 14 ; Group D had a gradual increase since the day of inoculation and the luminous area expanded until the death.(4) HE staining at 24 hours after inoculation:all the four groups showed inflammatory cell infiltration,especially in Groups C and D.(5) Wound healing time:wound healed at days 5 and 7 after inoculation in Groups A and B; the wounds showed no healing even at day 14 in the Group C,but the wounds length and area did not show obvious enlargement or diminishment ; the wounds extended gradually until the death in the Group D,since the day of inoculation. Conclusions The inoculation of 50 μl suspension with 1 × 108 CFU/ml bioluminescent MRSA to full-thickness skin incision rats allows direct,real-time dynamic and continuous detection of the occurrence and development of the wound infections.The infection model is easy to make and has stability and high repeatability.
ABSTRACT
ObjectiveTo develop a new sutureless technique (photochemical tissue bonding,PTB ) for repair of corneal perforation. Methods A total of 60 rabbits were used for creating corneal perforation models.The corneal perforation on the left eye was repaired by sutures and the injury on the right eye was fixed with the use of amniotic membrane with PTB.The outcomes of the two mentioned repair methods were compared by observing the leakage of aqueous and the morphology of the anterior chamber at different instants,measuring the intraocular pressure (IOP) and observing the formation of neo-vessels and scars of cornea in the use of histological analysis. Results There was no leakage of aqueous and no difference for morphology evaluation in both treatments.PTB could adhere AM on the cornea to restore the corneal perforation.The peak IOP in the PTB treatment group at days 0,7 and 14 postoperative [ (531.2 ±49.5) mm Hg,(542.6 ±74.8) mm Hg and (603.9 ±69.1) mm Hg,respectively] was significantly higher than that in the suture group at the same instants [ (41.3 ±12.7) mm Hg,(142.6 ±25.4) mm Hg and (333.3 ± 66.7) mm Hg,respectively] (P ＜0.O1 ).Compared with suture repair,the treatment with PTB resulted in a better outcome of wound healing with less neo-vessels and less scars of cornea. Conclusion PTB treatment for repair of corneal perforation is superior to suture repair.
ABSTRACT
ObjectiveTo observe production of vascular endothelial growth factor (VEGF) induced by granulocyte/macrophage colony-stimulating factor (GMCSF)via ERK nerve growth factor (NF)-κB singling pathway in human fibroblasts during wound healing and explore relating mechanism.MethodsHuman fibroblasts from the injured skin were used for this study and treated with GMCSF.RT-PCR was used for analyzing the protein and mRNA levels of VEGF and Western blotting was employed to determine the phosphorylation of ERK. The fibroblasts were pre-treated with ERK specific inhibitor PD98059 and further treated with GMCSF, then the fibroblasts and the supernatant were collected for detection of protein level of VEGF by means of Western blot. ERK signal pathway was inhibited to detect the activation of NF-κB by means of immunofluorescence staining. Furthermore, the nuclear and cytoplasmic extraction kit was used to separate the cytoplasm and nucleus and Western blot employed for observation of the NF-κB activation. ResultsThe mRNA level and protein level of VEGF were increased significantly with treatment with higher concentration of GMCSF in a dose-dependent manner. VEGF mRNA level was increased two hours after administration with GMCSF and reached peak at 4-6 hours. GMCSF could remarkably activate the ERK phosphorylation. Compared with GMCSF, the ERK specific inhibitor PD98059inhibited significantly the effect of GMCSF in inducing VEGF expression (P ＜ 0.05). Western blot and immunofluorescence staining analyses showed that the activation of NF-ΚB was inhibited with reduced production of VEGF after GMCSF treatment.Conclusion GMCSF up-regulates production of VEGF through activating NF-κB via ERK signal pathway in the human fibroblasts.
ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of transanal drainage tube followed by laparoscopic surgery in management of malignant colorectal obstruction.</p><p><b>METHODS</b>From March 2007 to October 2010, 37 patients with colorectal cancer manifesting acute complete mechanical obstruction were treated by ileus tube drainage. After irrigation and drainage ranging from 4 to 10 days, the radical operations and anastomosis were performed by laparoscopy.</p><p><b>RESULTS</b>The drainage tubes were successfully implanted in 34 patients. The decompression time of patients was (5.8 ± 1.6) d, ranging from 4 to 10 d. The abdominal pain and bloating symptoms were faded away after (3.8 ± 1.3) d (1 to 7 d) drainage. And comparing to that of patients when admission, abdominal circumference significantly reduced from (92 ± 7) cm to (84 ± 6) cm (P = 0.013) before surgery. Thirty-one cases were performed radical resection and anastomosis by laparoscopy after decompression. Postoperative recovery was smooth, and there was no serious complication.</p><p><b>CONCLUSIONS</b>Laparoscopic surgery followed decompression by transanal ileus tube is effective and safe for acute lower colorectal obstruction. Emergency surgery may be converted to limit surgery by this method. After appropriate bowel preparation, laparoscopic radical surgery and anastomosis is feasible.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Colorectal Neoplasms , Pathology , General Surgery , Drainage , Methods , Intestinal Obstruction , General Surgery , LaparoscopyABSTRACT
Objective To investigate the effect of GDNF on pancreatic cancer cell proliferation and chemotaxis.Methods The cell counting, MTT and flow cytometry were employed to investigate whether the neurotrophic factor GDNF can stimulate the proliferation of pancreatic carcinoma cells.Meanwhile, the trans-well invasion chamber was used to observe the chemotactic effect of GDNF on pancreatic cancer cells.Results The cells were exposed to incremental concentrations of human re-combinant GDNF (0-120 ng/mL).We found that the proliferation of pancreatic cancer cells was stim-ulated by GDNF in a dose-dependent manner and the number of cells in "S" phenotype was increased;The count of cells was increased by GDNF in a dose-dependent manner.Conclusion GDNF can stimu-late the proliferation and invasion of pancreatic cancer cells in a dose-dependent manner.
ABSTRACT
Objective To investigate the feasibility and safety of autologous tumor tissue lysate loading den-dritic cells(DC) for the treatment of hepatocellular carcinoma (HCC). Methods The monocytes-derived DC were induced and antigen loaded with tumor tissue lysate to produce DC vaccine. Vaccination and clinical observation were conducted in 12 HCC patients for 41 times. Results The average output of DC was 1.69×107(1.69×107±9.44×106>) from 90 ml peripheral blood. 63.41% (26/41)patients appeared to develop delayed-type hypersensitivity after intradermal injection. After an average of 9 months follow up, 1 patient out of 4 recurrence and metastasis pa- tients survived for 17 months. The other three patients progressed. Out of 8 patients undergoing immunotherapy post- operatively,6 patients had no signs of recurrence and the others were found to have liver rceurrence and progression. Conclusion DC based immunotherapy is safe and feasible,with no side effects,which can be applied in the immu- notherapy strategy of HCC patients.
ABSTRACT
<p><b>OBJECTIVES</b>To introduce a new arthroscopic Bankart repair by vertical mattress suture with anchors, and to evaluate its clinical effectiveness.</p><p><b>METHODS</b>A new arthroscopic Bankart repair by vertical mattress suture with anchors was performed, including to insert only 2 anchors at 3 o'clock and 5 o'clock position and make vertical mattress suture of labrum-ligament complex at 2, 4 and 6 o'clock of labrum, and to shift up the anterior-inferior capsule. Nine cases of anterior glenohumeral instability without severe glenoid bone defect were followed-up for an average period of 14 months (range from 6 to 26 months). The average surgery age was 28 years (range from 21 to 46 years).</p><p><b>RESULTS</b>The average surgery time was 51 min (40 - 75 min). Clinical scores as evaluated by the modified Rowe score advanced from 40 +/- 16 points to 92 +/- 19 points (75 - 94). There was no any recurrence and complication. External rotation was reduced by 5 degrees at 0 degrees adduction and by 3 degrees at 90 degrees of abduction.</p><p><b>CONCLUSIONS</b>The arthroscopic Bankart repair by vertical mattress suture with anchors for anteroinferior glenohumeral instability is favorable as an easy, short-time surgery with excellent clinical results in short-term follow-up.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Arthroscopy , Methods , Follow-Up Studies , Joint Instability , General Surgery , Shoulder Dislocation , General Surgery , Suture Anchors , Suture Techniques , Treatment OutcomeABSTRACT
0.05).The protein and mRNA expression of MIP-2 in high glucose group significantly increased after culture for 4 h,and guadually decreased then.The protein and mRNA expression of MCP-1 began to increase significantly after culture for 8 h,reached peak at 12 h,and slightly decreased after culture for 24 and 48 h. Conclusion High glucose promotes the protein and mRNA expression of MIP-2 and MCP-1 from mouse peritoneal macrophages cultured in vitro,which indicates that high glucose may delay the wound healing by increasing the expression of chemokines in diabetic mice.
ABSTRACT
Objective:To investigate the most effective strategy for mature induction of dendritic cells.Methods:Human monocyte-derived dendritic cells were induced in the presence of cytokines GM-CSF and IL-4. On day 6, the immature DCs were pulsed with each of CD40L, LPS, TNF-? or a cocktail of cytokines(TNF-?, IL-6, IL-1?, PGE2). DCs were harvested after 24 h induction. The surface markers for maturation CD80,CD83,CD86 and HLA-DR were detected by FCM. FITC-Dextra endocytic activity was measured by FCM. IL-12 production was detected by ELISA. The capacity of DCs for T cell activation was detected by MTT assay.Results:CD40L,LPS,TNF-? and the cocktail of cytokines all could induce DCs’ maturation. The most effective scheme for induction of maturation was the cocktail of cytokines, and the expression rate of CD83 was up to 66.91%(P