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In recent years, although the quantity of organ donation after citizen's death has been constantly increased, a large number of patients with end-stage renal diseases are waiting for kidney transplantation every year. The imbalance between donor and recipient is still one of the main problems affecting kidney transplantation in clinical practice. Therefore, it is of clinical significance to accurately evaluate the quality of donor kidney and fully utilize the expanded criteria donor kidney. Contrast-enhanced ultrasound has been gradually applied in the detection of multiple solid organs due to its safety, portability, real-time detection, quantification and other characteristics, and it also has promising application prospect in the evaluation of donor kidney quality. In this article, the advantages and limitations of current evaluation methods for donor kidney and current status and advantages of contrast-enhanced ultrasound in donor kidney evaluation were reviewed, and the application prospect of contrast-enhanced ultrasound in the evaluation of donor kidney quality was discussed, aiming to increase the methods and enhance the accuracy for donor kidney evaluation, and provide reference for rational use of expanded criteria donor kidney.
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Objective:To investigate the diagnostic value of the post-vascular phase of contrast-enhanced ultrasound in the differentiation of hepatocellular carcinoma (HCC).Methods:The contrast-enhanced ultrasound data of 115 patients who were admitted to Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology for liver space-occupying lesions from September 2020 to September 2021 were retrospectively analyzed. All patients underwent contrast-enhanced ultrasound with perfluorobutane microspheres for injection within 1 week before operation and were confirmed to be HCC by postoperative pathology. According to the pathological results, the lesions were divided into two groups—a well differentiated group and a poorly differentiated group. The time intensity curves of the regions of interest were drawn to obtain the quantitative parameters of arterial phase and the post-vascular phase. The diagnostic performance of each quantitative parameter in differentiating the two groups of lesions was evaluated and the cut-off value was calculated.Results:117 lesions from 115 patients were finally included in the study, including 70 lesions in the well differentiated group and 47 lesions in the poorly differentiated group. There were no significant differences in the initial growth time, peak time, rise time and the absolute value of peak intensity of lesions between the two groups in the arterial phase (all P>0.05). In the post-vascular phase(12 min), the absolute value of enhancement intensity, intensity ratio and intensity difference of the well differentiated group were lower than those in the poorly differentiated group, and the difference was statistically significant (all P<0.01). The sensitivity and specificity of the absolute value of enhancement intensity<56.117 dB, intensity ratio<1.212, intensity difference<9.184 dB to distinguish the HCC lesions as well-differentiated group were 48.9% and 80.0%, 87.2% and 77.1%, 89.4% and 75.7%, respectively. Conclusions:The quantitative analysis of the post-vascular phase of contrast-enhanced ultrasound is helpful to identify the differentiation degree of HCC and has certain clinical application value.
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OBJECTIVE： To study improvement effects of different proportions of total glucosides of ginseng （TGG）， total glucosides of moutan cortex （TGM） and paeonol containing serum on the injury of human umbilical vein endothelial cells （HUVEC） injury induced by hydrogen peroxide （H2O2）， screen the optimal proportion and investigate its mechanism. METHODS： The rats were randomly divided into blank group （distilled water）， TGG group （TGG， 2.025 g/kg）， TGM group （TGM， 4.05 g/kg） and paeonol group （paeonol， 1.08 g/kg）， with 12 rats in each group. They were given relevant medicine twice a day for consecutive 7 days. 1 h after last medication， the blood samples were collected via abdominal aorta to prepare drug containing serum. Using survival rate of HUVEC as evaluation indexes， different proportions of TGG， TGM and paeonol containing serum as factors， L9（34） orthogonal test was designed to optimize the optimal proportion of 3 kinds of drug containing serum. HUVEC were divided into blank group， model group， TGG group， TGM group， paeonol group and optimal proportion group. Except that blank group were treated with relevant medium， other group were treated with 1.2 mmol/L H2O2 to induce HUVEC injury， and then TGG group （volume fraction of drug containing serum was 0.000 5％）， TGM group （volume fraction of drug containing serum was 0.000 5％）， paeonol group （volume fraction of drug containing serum was 1％） and optimal proportion group were intervened with drug containing serum. The levels of LDH， NO and ET-1 in cells were detected by microplate method and ELISA. RESULTS： The optimal proportion of drug containing serum were TGG 0.000 5％， TGM 0.000 5％ and paeonol 1％. Compared with blank group， the levels of LDH and ET-1 were higher in model group （P＜0.01）， while NO level was lower （P＜0.05）. Compared with model group， the levels of NO were higher in TGG group， TGM group and optimal proportion group （P＜0.01）， while the levels of LDH and ET-1 were lower （P＜0.05 or P＜0.01）. Compared with TGG group， TGM group and paeonol group， the level of LDH was lower in optimal proportion group （P＜0.05 or P＜0.01）， while the level of NO was higher （P＜0.05 or P＜0.01）. CONCLUSIONS： TGG and TGM combined with paeonol can significantly improve HUVEC injury induced by H2O2， and the mechanism of which may be associated with the decrease of LDH and ET-1 and the increase of NO.
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Objective To assess scoliosis in adolescence and adults by three-dimensional ( 3-D ) ultrasound imaging . Methods A commercial available ultrasound instrument with a magnetic sensor system was used for long distance 3-D ultrasound imaging .Specific phantoms were imaged to evaluate the precision of this imaging system . Twenty healthy adults and 20 patients with scoliosis were imaged by 3-D ultrasonography and radiography . The deformity angle of the patients with scoliosis was measured on the reconstructed coronal plane ( C plane) of 3-D ultrasound imaging . The relevance between the curvature measured by ultrasound and the Cobb angles originated by radiography were evaluated . Results There was no significant difference between the angles of the phantom measured by the 3-D ultrasound imaging system and that measured by an angle gauge ( P = 0 .479) . The transverse process ,vertebral arch and acoustic shadow of the central spinous process of spines in healthy adults can be displayed on the reconstructed C plane by 3-D ultrasound imaging . The morphology of scoliosis in all the twenty patients can be observed on the reconstructed C planes ( multi-layers) by 3-D ultrasound imaging ,which accorded well with that observed on radiograph . In 9 patients ,part of the spinal segment could not be totally displayed on one single coronal plane and no additional measurement was carried out . In 11 patients ,all the segments of the spine could be clearly displayed on a single coronal plane and the curvature of scoliosis was then measured . There were no significant differences between the angle measured on 3-D ultrasound imaging and the Cobb angle measured on radiograph( P =0 .974) and the two measurement methods have high correlation( r =0 .991 , P <0 .0001) . Conclusions The commercial available 3-D ultrasound imaging system applied in this study offers a viable method to assess scoliosis in adolescence and adults in a reliable and radiation-free manner .
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To investigate the safety and feasibility of indocyanine green ( ICG ) fluorescence staining guided by laparoscopic ultrasound guiding portal branch puncture approach in anatomical segmentectomy of the liver . Methods The clinical data of 22 patients with malignant liver diseases underwent anatomical segmentectomy between February 2018 and M ay 2018 were retrospectively analyzed . ICG 0 .125～0 .250 mg was directly injected into the portal branches supplying blood flow to the tumor‐bearing hepatic segment , after puncturing of the target portal branch under intraoperative laparoscopic ultrasound guidance in all patients . T he fluorescence imaging system ( Pinpoint) was used for the resection procedure . Observation indicators :intraoperative conditions ( tumor diameter ,success rate of portal branches puncture ,success rate of staining the target hepatic segment ,intraoperative complications , time of operation ,volume of intraoperative blood loss , blood transfusion , and transit of laparotomy ) . Postoperative conditions :postoperative complications ,and length of hospital stay . Results Twenty‐two patients with liver tumors were all performed anatomical hepatectomy assisted by laparoscopic ultrasound guiding ICG injection for liver segment staining . All the liver tumors were hepatocellular carcinoma . ①Intraoperative conditions : T he portal branches puncture successful rate was 100% ( 22/22 ) . Eighteen patients achieved expected effect of ICG fluorescence staining ,with a satisfaction rate of 81 .8% (18/22) and 4 failed to get expected effect ,including 2 with uneven dying ,and 2 with adjacent hepatic segmental staining induced to unclear boundary . No complication such as allergy occurred in all patients after ICG injection . T he mean operation time was ( 209 ± 89 ) min ( range :97 ～ 325 min) and the target portal branches ICG puncture injection time under intraoperative laparoscopic ultrasound guidance was ( 11 ± 5) min ( range 3－25 min) . T here was no intraoperative blood transfusion or transit of laparotomy .Average tumor diameter was ( 3 .9 ± 1 .3) cm( range :2 .2－7 .0 cm ) . ②Postoperative conditions of 22 patients ,4 with grade Ⅰ － Ⅱ of Clavien‐Dindo classification were improved by drug treatments ( 1 with deep venous thrombosis of the lower extremities and 3 with pleural effusion ) , no patient had grade Ⅲ and above complications , and no perioperative death occurred . Average duration of hospital stay was ( 7 ± 2 ) days in 22 patients ( range :5 .0－14 .0 days) . Conclusions ICG fluorescence staining guided by laparoscopic ultrasound guiding portal branch puncture ,obtains accurate and lasting fluorescence markers on the liver surface and inside the parenchyma . ICG staining guides the selection of liver section in the operation of liver in real time ,and helps surgeons to perform laparoscopic anatomical segmentectomy of the liver .
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To investigate the feasibility ,safety and clinical effect of No touch liver pedicle microwave ablation . Methods T he clinical data of 229 patients with hepatocellular carcinoma treated in the Department of Hepatology ,Wuhan Tongji Hospital from M ay 2014 to October 2016 were retrospectively analyzed . T he patients were divided into 3 groups .In group A ,82 patients underwent ultrasound‐guided No touch liver pedicle microwave ablation ,69 patients in group B were treated with anatomical hepatectomy ,and 78 patients in group C underwent traditional microwave ablation . T he preoperative basic data ,intraoperative data ( treatment time , intraoperative blood loss ) and postoperative data ( postoperative liver function indicators ,complications ,hospitalization time ,local recurrence ,survival rate) were compared among the 3 groups . Results T he treatment time ,intraoperative blood loss ,postoperative liver function index and hospitalization time in group A and group C were significantly lower than those in group B( all P ＝0 .000) . T here was no difference in complete elimination rate ,between the two groups in group A and group B( P ＞0 .05) ,which was significantly better than those of group C ( P ＝ 0 .019 ) . T here was no significant difference in the local recurrence rate between the three groups after 1 year and 3 years . Conclusions No touch liver pedicle microwave ablation damage is safe and reliable ,in line with the principle of oncology treatment ,it worthes further promotion in the clinic .
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Objective To explore the clinical value of the Liver Imaging Report and Data System ( LI-RADS) with contrast enhanced ultrasound(CEUS) in the diagnosis of hepatocellular carcinoma ( HCC) . Methods From October 2012 to July 2018 , the CEUS data of patients at high risk for HCC were retrospectively analyzed . A total of 197 lesions in 178 patients were classified with reference to the 2017 version of CEUS LI-RADS classification standard . Diagnostic reference standard was surgical pathology . The relationship between the LI-RADS classification and the pathological diagnosis was evaluated . Results One hundred and ninety-seven lesions ,with an average size of ( 2 .9 ± 1 .6)cm ,were pathologically confirmed to be 170 HCC ( 86 .3% ) ,17 non-HCC malignant lesions ( 8 .6% ) ,and 10 liver benign lesions ( 5 .1% ) . There were 6 (3 .0% ) ,37(18 .8% ) ,134 (68 .0% ) and 20 (10 .2% ) lesions classified into LR-3 ,LR-4 ,LR-5 and LR-M category ,respectively . Positive predictive values of HCC in LR-3 ,LR-4 and LR-5 category were 16 .7% (1/6) ,89 .2% (33/37) ,97 .0% (130/134) ,respectively . LR-5 category had high positive predictive value of HCC( 97 .0% ) ,but low sensitivity ( 76 .5% ) . If LR-5 category combined with LR-4 category were diagnosed as HCC ,the diagnostic accuracy was significantly higher than that of LR-5 category ( 92 .4% vs 77 .7% ) ,and the difference was statistically significant ( P ＜ 0 .05 ) . 95 .0% ( 19/20 ) lesions of LR-M category were malignant ,of which 30 .0% ( 6/20 ) lesions were HCC . 76 .9% ( 10/13 ) of intrathecal cholangiocarcinoma was characterized by LR-M . Conclusions The LI-RADS classification of CEUS has high application value for diagnosis and differentiation of HCC .
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Objective To evaluate and explore the diagnostic value of focal liver lesion ( FLL) ( ≤2 cm) undetectable on conventional ultrasound by image fusion with contrast-enhanced ultrasound(CEUS) . Methods A total of 50 patients with 65 lesions( ≤2 cm) were enrolled . All lesions were undetectable on conventional ultrasound but showed clearly in CT/MRI images . Ultrasound-CT/MRI image fusion with CEUS was performed ,and the nodule detection rate and enhancement perfusion mode were analyzed . Results All the 50 patients were matched successfully ,56 lesions (86 .2% ) were detected by image fusion combined with CEUS ,among which 27 lesions (41 .5% ) were significantly different from surrounding parenchyma on conventional ultrasound , 54 lesions ( 83 .1% ) showed different enhancement from the surrounding parenchyma on CEUS . There were 46 lesions that were eventually diagnosed by surgical pathology or clinical comprehensive diagnosis . The diagnostic accuracy of image fusion with CEUS was 91 .3% (42/46) . According to different groups of MRI matching sequences ,the detection rates of T 2 sequence group and enhanced sequence group were 87 .5% (28/32) and 91 .3% (21/23) ,respectively ,there was no statistically significant difference between the two groups ( P ＝0 .686) . Conclusions CT/MRI image fusion combined with CEUS has high detection rate and diagnosis accuracy for small FLL undetectable on conventional ultrasound .
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Objective To explore the application and significance of intraoperative laparoscopic ultrasound( IOUS) in robot-assisted laparoscopic hepatectomy . Methods From February 2015 to February 2017 ,135 patients undergoing liver resection with robotic approach were enrolled in the study . All data about demographic ,surgical procedure and postoperative course were collected prospectively and analyzed . IOUS was routinely performed in these patients . To assist the localization and resection of liver tumor ,a four steps IOUS protocol in robotic liver surgery was proposed ,including exploration ,verification ,guidance , and confirmation . If necessary ,intraoperative laparoscopic ultrasound guided microwave ablation of liver tumor to complete the treatment . Results A total of 11 additional lesions in 11 patients were detected in 135 patients ,7 patients accepted strategic surgical modification : 4 cases were enlarged resection ,and 3 cases were treated with microwave ablation . There were only 17 patients lost blood more than 1000 ml in all patients . No patient suffered from any single or multiple organ dysfunctions ,and there was no mortality observed . Conclusions IOUS is indispensable to understand lesions and vessels ,confirm the complete resection of the tumor in robot-assisted laparoscopic hepatectomy . It is also a necessary tool for the microwave ablation of liver tumor .
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Objective Budd-Chiari syndrome is apt to be misdiagnosed,so we explore its diagnosis and treatment by liver transplantation.Methods We retrospectively analyzed the clinical data of two patients who underwent liver transplantation for Budd-Chiari syndrome.One patient was misdiagnosed before the transplantation and another was diagnosed correctly.Results Both patients were grouped to Child C category with decompensated liver cirrhosis.Patient 1 was diagnosed as recurrent hepatocellular carcinoma,but the etiology of liver disease was first unknown then suspected to be schistosomiasis.This patient underwent piggyback liver transplantation.Because there was significant swelling in the perineum and lower extremities after liver transplantation,we re-reviewed the preoperative imaging data and found communicant veins between hepatic veins,which proved that the patient was actually suffered from Budd-Chiari syndrome with hepatic vein and suprahepatic vena cava occlusion before the transplantation.After conservative treatment,the swelling of the lower body was alleviated,however,the long-term survival of the patient would be compromised.Learning from the first case,we found communicant veins between hepatic veins in imaging data of patient 2,resulting in correct diagnosis of Budd-Chiari syndrome with hepatic vein and retrohepatic vena cava diseases before the transplantation,so the patient underwent orthotopic liver transplantation,in which the liver and retrohepatic vena cava were resected,and recovered uneventfully.Liver function was normal during the follow up period of 7 months.Conclusion We should consider the possibility of Budd-Chiari syndrome in patients with unexplained end-stage liver diseases.Communicant veins between the hepatic veins shown in thin CT or MRI image are the characteristic sign for diagnosing Budd-Chiari syndrome.Simultaneously hepatic vein or cava vena disease determines the choice of various technique of liver transplantation.
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OBJECTIVE:To optimize the processing technology of rehmanniae radix praeparata. METHODS:Using transfer rates of catalpol,rehmaionoside D,acteoside,isoacteoside,polysaccharide as indexes for comprehensive score,heating tempera-ture(pressure),heating time and heating times as investigating factors,L9(34)orthogonal test was used to optimize the processing technology of rehmanniae radix praeparata,and verification test was conducted. RESULTS:The optimal processing technology of rehmanniae radix praeparata was as follow as heating temperature of 125 ℃,pressure of 150 kPa for twice,2 h every time. The comprehensive scores of 3 batches of samples were 0.6985,0.6755,0.7016 in the verification test,respectively,RSDs were less than 5%(n=3). CONCLUSIONS:Optimized processing technology is simple,stable,feasible,and can provide reference for in-dustrial production of rehmanniae radix praeparata.
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Objective To explore the therapeutic results of percutaneous microwave ablation for patients with recurrence primary liver cancer after surgery and the factors influencing the survival after ablation therapy.Methods 102 patients who underwent hepatectomy for primary liver cancer in April 1998 to December 2010,and subsequent microwave ablation for recurrence hepatocellular carcinoma,were enrolled.Long term survival rates and prognostic factors after ablation were analyzed.Results The 1,3,5,and 7 year overall survival rates after ablation were 73.5％,53.5％,40.5％ and 17.7％.The 1,3,and 5 year overall survival rates for patients within one year recurrence after hepatectomy were 63.3％,38.9％,and 27.1％,respectively,which was significantly lower than that for patients after this time period in which the 1,3,and 5 year overall survival rates were 86.3％,72.3％ and 63.0％,respectively (P =0.003).Univariate analysis revealed that recurrence tumor size more than 3 cm,multiple tumors,poor Child-Pugh score,and AFP level ＞100 μg/L were risk prognostic factors of overall survival for patients who underwent ablation.Multivariate analysis identified multiple tumors,poor Child-Pugh score,and AFP level ＞ 100μg/L were the factors affecting overall survival.Conclusions Microwave ablation is of high clinical application value and is an effective minimally invasive treatment for recurrence hepatocellular carcinoma.Microwave ablation is equally effective when used in late recurrence,single tumor and tumor size≤3 cm.
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Liver resection is the most effective treatment for hepatocellular carcinoma (HCC). The Barcelona Clinic Liver Cancer (BCLC) staging system is commonly accepted as a guideline for HCC treatment, but it only recommends liver resection for the patients with HCC at stage 0 to A1. The surgical indications of the BCLC staging system need to be re-evaluated. 120 HCC patients undergoing curative liver resection were retrospectively stratified to the BCLC staging system, and the survival of the patients at stages A, B and C was analyzed. The justification of the BCLC staging system was re-evaluated. Fifty-two patients were classified at stage A, 51 at stage B and 17 at stage C respectively. The hospital mortality of this cohort was zero and the morbidity was 24.1%. The 1-, 2-, 3-year overall survival rate of this cohort was 81.6%, 68.3%, and 57.5% respectively. There was no significant difference in the survival rate between the patients at stage A and B (P>0.05). If the treatment guidelines of BCLC staging system were followed, the majority of the patients at stages A and B (77.7%, 80/103) would not have been treated surgically. Our data suggest that the surgical indications of the BCLC staging system are not justified for HCC treatment. More studies may be needed as for how to further broaden the surgical indications of the BCLC staging system in the future.
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This study examined the effect of P85 (a pluronic block copolymer) and microbubble (MB) ultrasound contrast agents under ultrasound irradiation on gene transfection and expression. The pEGFP plasmids that can encode enhanced green fluorescent protein (pEGFP) served as a report gene and were mixed with different concentrations of MB/0.05% (w/v) P85. Then the plasmids were transfected into human hepatoma G2 (HepG2) cells. The HepG2 cells treated with MB/P85 or without treatment were exposed to ultrasound (US parameters: 1 MHz, 1.0 W/cm(2), 20 s, 20% duty cycle). Twenty-four hours later, the transfection efficiency was assessed by fluorescence microscopy and fluorescence activated cell sorting (FACS) analysis. The cell viability was evaluated by Trypan blue exclusion test. The results showed that the gene transfection efficiency in HepG2 cells under ultrasound irradiation was significantly higher than that without ultrasound irradiation. HepG2 cells in the MB or P85 group in the absence of ultrasound expressed less amount of green fluorescent protein. The expression efficiency reached (22.14±3.06)% and the survival rate was as high as (55.73±3.32)% in the 30% MB plus P85 group. It was concluded that MB and P85 in the presence of ultrasound can enhance gene transfection and expression.
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Objective To investigate the influencing factors and prognosis of early and late recurrence after radical resection of primary hepatocellular carcinoma(HCC).Methods The clinical data of 117 patients who received radical resection of HCC at the Tongji Hospital of Huazhong University of Science and Technology from January 2003 to December 2006 were retrospectively analyzed.Tumor recurrence occurred within 2 years after operation was defined as early recurrence,and tumor recurrence occurred latter than 2 years after operation was defined as late recurrence.Relationship between postoperative tumor recurrence and level of alpha-fetoprotein (AFP),AFP/V,tumor diameter,tumor number,blood vessel invasion,tumor differentiation,hepatic cirrhosis,hepatic function,hepatitis B surface antigen,procedure of hepatic resection and blood transfusion was analyzed.The overall survival and disease-free survival rates were determined by Kaplan-Meier method,and the survival rate was analyzed by Log-rank test.Results Eighty-five(72.6％)patients were found with tumor recurrence,including 59(50.4％)with early tumor recurrence and 26(22.2％)with late tumor recurrence.Levels of AFP,AFP/V,tumor diameter,tumor number,blood vessel invasion,tumor differentiation and blood transfusion were the influencing factors of early recurrence(x2 = 12.78,13.40,5.79,9.98,10.26,9.48,8.32,P ＜ 0.05).Level of AFP and hepatic cirrhosis were the influencing factors of late recurrence(x2 =4.46,7.75,P ＜ 0.05).AFP/V,tumor number and blood vessel invasion were the independent risk factors of early recurrence(RR = 0.170,0.172,0.064,P ＜ 0.05).Hepatic cirrhosis was the independent risk factor of late recurrence(RR = 2.809, P ＜ 0.05).The 1-,3-,5-year overall survival rates and tumor-free survival rates were 82.6％,60.8％,54.9％ and 65.0％,38.5％,23.1％.There were significant differences in overall survival and disease-free survival rates among patients with AFP ＜20 μg/L,AFP/V ＜ 14 μg/(L · cm3)or AFP/V ≥ 14 μg/(L · cm3)(P ＜ 0.05).The 1-,3-,5-year overall survival rates of patients with early tumor recurrence were 64.9％,23.0％ and 20.5％,respectively,and the 1-,3-,5-year overall survival rates of patients with late tumor recurrence were 100.0％,88.5％ and 72.5％,respectively.A significant difference in the 1-,3-,5-year overall survival rates between patients with early or late tumor recurrence was observed(x2 = 26.918,P ＜0.05).Conclusions AFP/V,tumor number,blood vessel invasion were independent risk factors of early tumor recurrence,and hepatic cirrhosis was the independent risk factor of late tumor recurrence.There is a significant difference in the survival rate between patients with early or late tumor recurrence.
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We report a case of reversible hepatofugal portal flow after auxiliary partial orthotopic liver transplantation (APOLT) from a living donor in this study. On postoperative day 6, continuous hepatofugal portal flow was observed in the grafted liver without portal thrombosis and obstruction of the hepatic vein. Based on histological findings, acute rejection was the suspected cause. The normal portal venous flow was restored after steroid pulse and antithymocyte globulin (ATG) therapies. The patient was discharged on the 30th postoperative day. It was concluded that hepatofugal flow after liver transplantation is a sign of serious acute rejection, and can be successfully treated by anti-rejection therapy.
Subject(s)
Adult , Humans , Male , Antilymphocyte Serum , Therapeutic Uses , Graft Rejection , Hepatic Artery , Diagnostic Imaging , Physiology , Hepatolenticular Degeneration , General Surgery , Immunosuppression Therapy , Methods , Immunosuppressive Agents , Therapeutic Uses , Liver Transplantation , Methods , Living Donors , Portal Vein , Diagnostic Imaging , Tacrolimus , Therapeutic Uses , UltrasonographyABSTRACT
We report a case of reversible hepatofugal portal flow after auxiliary partial orthotopic liver transplantation (APOLT) from a living donor in this study. On postoperative day 6, continuous hepatofugal portal flow was observed in the grafted liver without portal thrombosis and obstruction of the hepatic vein. Based on histological findings, acute rejection was the suspected cause. The normal portal venous flow was restored after steroid pulse and antithymocyte globulin (ATG) therapies. The patient was discharged on the 30th postoperative day. It was concluded that hepatofugal flow after liver transplantation is a sign of serious acute rejection, and can be successfully treated by anti-rejection therapy.
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Objective To explore the effects of P85,microbubbles and ultrasound on plasmid DNA skeletal muscle gene transduction of mice in vivo. Methods Plasmid encoding green fluorescent protein (GFP) ,which conjugated with 0.05% P85 and/or microbubbles, 10% Optison,was injected into the tibialis anterior(TA) muscle of mice with or without ultrasound irradiation (1 MHz, 1 W/cm2 2 min,20% duty cycle). Mice were killed 1 week after injection. The TA muscles were removed and snap-frozen immediately in isopentane cooled by liquid nitrogen and sections 7 μm thick were cut at intervals. One set of sections mounted with DAPI were used to assess the transfection efficiency by counting the number of GFP-positive fibers under fluorescence microscopy,and the other set of sections were stained with haematoxylin and eosin to assess the tissue damage area. Results The P85 and Optison significantly enhanced the plasmid DNA skeletal muscle gene delivery in vivo separately (P<0.01, P<0.05).Ultrasound exposure could significantly enhance the efficiency of P85 induced gene delivery(P<0.01) but not of Option(P>0.05).The gene delivery efficiency induced by P85 was higher than that by Optison no matter with or without ultrasound irradiation(P<0.01). When the P85 conjugated with Optison, they could further significantly enhance gene delivery efficiency with ultrasound exposure (P<0.01). Meanwhile, ultrasound exposure could increase the muscle damage areas in the groups with microbubbles (P<0.01). Conclusions The P85,microbubbles and ultrasound exposure display synergistic effect to enhance plasmid DNA transduction in skeletal muscle of mice in vivo.
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Objective To investigate the relationship of gene transfection efficiency with different ultrasound exposure time and different dose of microhuhble,and to find the appropriate ultrasound parameters for gene transfection. Methods Plasmid encoding enhanced green fluorescent protein(pEGFP) was chosen as a report gene and HepG2 cells were chosen as research object. The HepG2 cells plus pEGFP and different dose of microbubble were exposed to ultrasound(1 MHz,0.5 W/cm2) with varying time. Twenty-four hours later, the expression of EGFP in the cells was observed by fluorescence microscope,the transfection efficiency was assessed by FACS and the cell viability was observed by trypan blue exclusion. Results The expression of EGFP in all experimental groups was different,and the approving transfection efficiency was got by ultrasound exposed for 20 s when the dose of microbubble was 60 μl. Conclusions With fixed ultrasound frequency and power, different transfection efficiency was got when the exposure time and dose of microbubble were different. The appropriate parameter was 20 s,60 μl, which can supply information for further study.
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The value of color Doppler flow imaging (CDFI) and intravenous contrast-enhanced ultrasound (CEUS) for assessing the transplanted liver and early diagnosing complications by examining hemodynamic changes was discussed. Seventy-five patients with orthotopic liver transplantation (OLT) underwent CDFI. The following parameters were measured: peak systolic velocity (PS), resistance index (RI) and Doppler perfusion index (DPI) of the hepatic artery (HA), time average velocity (TAV) of portal vein (PV) and velocity of hepatic vein (HV) in different stages postoperation. And 11 patients of them received CEUS. Thirty healthy subjects were enrolled as controls. The results showed that: (1) In 23 patients without obvious complications, TAV of PV within 15 days post-operation was significantly higher than in controls (P<0.05), PS and DPI of HA within 7 days postoperation were lower, but RI was higher than in controls (P<0.05); (2) When the hepatic artery thrombosis (HAT) occurred, PS and DPI of HA were obviously decreased, but TAV of PV significantly increased like a high saw-tooth wave; (3) While rejection occurred, both TAV of PV and PS of HA were decreased with the increase in RI of HA, and the triphasic wave of HV disappeared and displayed as saw-tooth wave; (4) The incidence of biliary complications in liver transplantation was increased when DPI was reduced; (5) Seven cases of hepatic carcinoma relapse after OLT demonstrated hyperecho in the arterial phase and hypoecho in the portal and later phase on CEUS; (6) In 2 cases of HA thrombus, there was no visualized enhancement in arterial phase of CEUS, but enhancement during the portal vein and parenchymal phase. It was concluded that the hemodynamic changes of PV, HA and HV in the transplanted liver are valuable for assessing the transplanted liver and early diagnosing complications on CDFI and CEUS.