Clinical pathology of recurrent hepatitis B after liver transplantation / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the clinical pathology of recurrent hepatitis B after orthotopic liver transplantation (OLT).</p><p><b>METHODS</b>The clinical manifestation and hepatic pathological characteristics of 12 patients with recurrent hepatitis B after OLT were examined in this study by using hematoxylin and eosin staining,immunochemical staining of hepatitis B surface antigen and hepatitis B core antigen,tissue in situ hybridization of hepatitis B virus (HBV) DNA, and Mallory's trichrome staining.The survival rate of these OLT patients was assessed by Kaplan-Meier analysis.</p><p><b>RESULTS</b>The early stage of recurrent HBV infection in patients with OLT was characterized by active HBV replication and mild-to-moderate inflammation in the liver. Three of the 12 patients who were treated with combination therapy group were carriers of YMDD mutants and all three showed improvement in liver function and hepatic histology after receiving adefovir dipivoxil,instead of lamivudine,in the early stage of recurrent hepatitis B after OLT. Among the patients treated with lamivudine monotherapy, four did not achieve improvement at the early stage of recurrent hepatitis B and developed fibrosing cholestatic hepatitis (FCH).</p><p><b>CONCLUSION</b>Recurrent hepatitis B in patients who underwent OLT was characterized by mild-to-moderate viral hepatitis at the early stage and FCH at the later stage. Effective antiviral intervention at the early stage may reverse recurrent hepatitis B and prevent the disease progression to fatal FCH.</p>

Post market trial of hepatitis B immunoglobulin for intravenous administration / 中华肝胆外科杂志

Objective To observe the efficacy and adverse reaction of the test drug hepatitis B immunoglobin on the post market.Method Employed by the methods of multiple center's clinical trials and using the recommended dosage of hepatitis B immunoglobulin for intravenous administration,the clinical efficacy of either prevention or treatment for hepatitis B recurrence and drug related adverse reactions were observed.This consisted of 22.1 months,13 hospitals,and 525 patients with hepatitis B related liver transplantation.Result The results showed a contrasting probability of adverse reactions for different doses among the observation period.Within 6 months postoperatively with a greater or equal to recommended drug dose,the infection rate was less than 4％.In contrast,the infection rate was greater than 12％ in the group with less than the recommended drug dose.Conclusion There was an obvious dose effect relationship,and the drug safety and recommended treatment rationality were verified.

The early postoperative complications in living liver transplantation donors / 中华器官移植杂志

ObjectiveTo investigate the incidence of early postoperative complications in living donor liver transplantation.MethodsPostoperative data of 170 living liver donors were retrospectively collected from January 2002 to August 2009 and the collected data were divided into two groups according to the type of donors (right-lobe graft,R group and left lobe graft,L group). Early postoperative complications were analyzed using Clavien classification system.ResultsThe difference between two groups was no statistically significant in donor's age,body mass index,operation time and other characters (P＞0.05).R group had a bigger actual cut weight of donor liver (P＜0.05),smaller residual liver weight (P＜0.05) which also smaller than standard liver weight (P＜0.05),and a longer hospital stay (P＜0.05) than L group.During hospitalization,62 complications occurred in 55 cases with the total complication rate being 32.35％ (55/170). In detail,the incidence of complications was 34.39％ (54/157) in R group,and 7.69％ (1/13) in L group (chi-square value =2.787,P＞0.05).Among these 62 complications,there were 39 times of Ⅰ grade,5 times of Ⅱ grade,16 times of Ⅲ grade,2 times of Ⅳ a grade. All the complications were cured by active treatment and all donors survived well.Conclusion Although the security of living donor liver transplantation is better,the risk of serious complications must be faced.We must strictly select and assess the donor before the operation,very carefully carry out surgical operation,and pay more attention to postoperative management in order to avoid postoperative complications of donors.

The early liver function recovery in living liver transplantation donors / 中华普通外科杂志

Objective To investigate the liver function injury and the rate of complications in living liver transplantation donors in different graft type transplantation.Methods Postoperative data of 154 living liver donors satisfying our inclusion criteria were prospectively collected and registered from Jan 2002 to May 2009 in our hospital.We divided the donors into two groups (right-lobe graft, R group and left-lobe graft, L group), and made comparison on the liver function and complications.Results Remnant liver weight in R group were smaller than those in L group (t = 11.418, P ＜ 0.05).the ratio of remnant liver weight to standard liver weight in R group were smaller than those in L group (t = - 5.040, P ＜ 0.05 ) .Peaks of ALT, AST and INR in both groups appeared on the first day after operation, while the peak of TB in R group appeared on the third day after operation.All the index values returned to a normal baseline after reaching its peak.Mean values of TB in R group were higher than those in L group on the 1st, 3rd, 7th day after operation (seperately t1 = 5.285, t3 = 3.747, t7 = 2.729, all P ＜ 0.05).Mean values of INR in R group were higher than those in L group on the 1st, 3rd, 7th day after operation (seperately t1 = 5.260, t3 = 5.035, t7 = 2.267, all P ＜ 0.05).The level of TB in both groups returned to normal range on the 7th postoperative day, while the level of ALT and AST remained twice the upper limits of the normal.There were no deaths; Complications occurred in 53 of 154 donors (34.42% ) , 52/141 (36.88% ) in R group and 1/13 (7.69% ) in L group (x2 = 3.292, P ＞ 0.05).Conclusions Ramnant liver function of R group during early postoperative period was poorer than that of the L group.Donors were safe, though suffering from comparatively high complication rate.

Suppression of mrp1 expression and restoration of sensitivity to chemotherapy in multidrug-resistant hepatocellular carcinoma cell lines HepG2/mrp1 by RNA interference in vitro / 中华肝胆外科杂志

Objective To investigate the suppression of mrp1 and MRP1 induced by small interfering RNA and the restoration of sensitivity to chemotherapeutic drugs in the multidrug-resistant hepatocellular carcinoma cell lines HepG2/mrp1. Methods mrp1-targeted small interfering RNA duplexes were designed and composed and introduced into multidrug-resistant hepatocellular carcinoma cell lines HepG2/mrp1. The suppression of mrp1 mRNA and its gene product MRP1 was examined by RT-PCR and flow cytometry (FCM), respectively. MTT assay was performed to measure the reverse effect of small interfering RNA based on the results of ICs0. Results The overexpression of mrp1 mRNA and MRP1 was effectively suppressed by small interfering RNAs. The level of mrp1 mRNA in the transfected HepG2/mrp1 cells was reduced to (86.36±2.76)% and MRP1 to (89.38±3.76)%compared with those of the controls. The resistance to ADR was reversed five-fold, which indicated the restoration of sensitivity to drugs. Conclusion Small interfering RNA can inhibit mrp1 expression effectively and reverse the multidrug resistance mediated by MRP1.

Construction of expressing vector of pSUPER-shRNA/mrp1 and its expression in vitro / 中华肝胆外科杂志

Objective To construct the expressing vector of shRNA/mrp1 and study its expression in vitro. Methods 64bp oligonucleotides of pSUPER and the targeted senquence of siRNA/mrp1 were synthesized and annealed to form duplex strand, then were cloned into pSUPER to construct pSUPER-shRNA/mrp1 vector. Competenced Ecoli was transfected by vector of pSUPER-shRNA/ mrp1 to screen the positive clones for sequencing and extracting plasmid. The plasmids extracted were used to transfected HepG2/mrp1 cells with a control groups by negative vectors. The expression of mrp1 mRNA and MRP1 was measured by real-time PCR and resistance of HepG2/mrp1 by flowcytometry. Results pSUPER-shRNA/mrp1 was established successfully and was sequenced to test its accuracy. Expression of mrp1 mRNA in HepG2/mrp1-si was lower than that in HepG2/mrp1 (1-fold vs 179.76-fold, P<0.001). Compared to HepG2/mrp1, the expression of MRP1 in HepG2/mrp1-si was lower (11.2% vs 97.6%, P<0. 05). The sensitivity of HepG2/mrp1-si to adiramycin was higher than that of HepG2/mrp1(45.0-fold vs 1.2-fold, P<0.01). Meanwhile, the accumulation of DNR in HepG2/mrp1-si increased significantly as compared with the control (78.58 % vs 38.44%,P<0.05).Conclusion Vector of pSUPER-shRNA/mrp1 can be constructed by the technique of enzymatic incision. The multidrug resistance of HepG2/mrp1 can be reversed by RNA interference.

Segmental living related liver transplantation for very small infant with biliary atresia / 中华器官移植杂志

Objective To summarize the clinical experience of segmental living related liver transplantation for very small infant with biliary atresia. Methods The recipient was a 145-day-old male with congenital biliary atresia. The infant was 66 cm in height and weighed 3.08 kg. The donor was his 36-year-old mother. Her segment Ⅱ of the liver was excised and orthotopically transplanted into the infant's body as the graft. The portal vein of the graft was end-to-end anastomosed to the portal vein of the recipient, the hepatic artery of the graft was end-to-end anastomosed to the proper hepatic artery of the recipient with lateral superficial vein of left great saphenous vein from donor as a bridge, and the hepatic vein was end-to-end anastomosed to the hepatic vein of the recipient whose hepatic vein was conformed from right, middle and left hepatic vein. Biliary tract was reconstructed via Roux-en-Y operation. Results Segment Ⅱ (160 g) of liver from donor was resected, and there was no blood infusion. The donor retained her liver function within 5 days and was discharged on the eighth day. The operating time of graft implantation was 451 min. The blood loss was 250 ml. Non-liver stage was 71 min. The cold ischemic time was 132 min. Cyclosporine, mycophenolate mofetil (MMF) and prednisone were used for postoperative immunosuppression. The bilirubin level of the infant was decreased to the normal level one week after operation, and the liver function became normal in 9 days. Jejuno-leakage on the 7th day after the transplantation was recovered by mend and drainage and discharged on the 35th day. The donor and recipient were in satisfactory condition to present. Conclusion The segmental living related liver transplantation is advisable for very small infant with biliary atresia. Perfect operative technique and postoperative intensive care are the keys to ensure the success of the procedure.

Evaluation of standard liver volume formulas by right liver living donor liver transplantation / 中华普通外科杂志

Objective To evaluate the suitability of reported standard liver volume formulae for Chinese adults based on the practice of 216 cases of living donor liver transplantation in our transplantation center. Methods The graft volume was preoperatively estimated in 179 adult-to-adult right liver living donors by two methods: first, the radiological right liver volume by computed tomography (CT) and second,calculated graft volume obtained by reported standard liver volume formula and the percentage of the right liver volume ( given by CT). Both results were compared to the actual graft volume measured during surgery.Results The mean percentage of right liver volume was 55.4% (SD 5.41%). The results of Urata、Heinemann、Vauthey、 Lee、 Yoshizumi formula were significantly larger than the actual right liver volume (P ＜0. 01 ). The result of Sheung-tat Fan was less than the actual right liver volume, there was statistical ESLV =334. 024 + 11. 508 × BW, is most suitable to estimate adult Chinese donor's right liver volume.

A rare case of anatomical variations of cystic duct / 中华肝胆外科杂志

Objective To discuss the influence of anatomical variations of the cystic duct on preoperative diagnosis and operational scheme for cholecystectomy. Methods A 47-year-old woman was admitted to our hospital with diagnosis of cholecystolithiasis. Ultrasonography suggested minimal intra- and extrahepatic ductal dilatation. Laboratory tests showed that serum levels of alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase were 189 IU/L, 366 IU/L and 144 IU/L, respectively. In order to make a certain diagnosis, the patient received both magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). Results MRCP showed the bile duct slightly dilated with a shuttle shape figure and a lower signal with a strip form in it. MRCP could not confirm the quality of this signal and was doubtful of choledochus diaphragma. Subsequently, ERCP was applied to demonstrate that the cystic duct was collateral with the common hepatic duct when arriving into its left side and converged into the bile duct with a lower position, which was the reason for why MRCP misjudged the formation of choledochus diaphragma in the bile duct. Finally, the patient underwent open cholecystectomy. Conclusion There are some kinds of variations in the cystic duct including course, appearance and location of confluence. Combing MRCP with ERCP can significantly elevate the diagnostic accuracy of the cystic duct before operation, especially in those patients with doubtful diagnosis upon admission. To avoid biliary injury as much as possible, open cholecystectomy is superior to the laparoscopic cholecystectomy (LC)with regard to the patients suffering from cholecystolithiasis complicated with variation of the cystic duct.

Liver transplantation for Caroli's disease-report of seven cases from a single center / 中华器官移植杂志

Objective To investigate the clinical effects of liver transplantation including living related liver transplantation for Caroli's disease (CD). Methods Seven consecutive patients with diffused type of Caroli's disease had undergone liver transplantation (LT) from September 1999 to February 2007 in our single center. The clinical characteristics and survival of these patients were retrospectively reviewed. Results All 7 patients were diagnosed as Caroli's disease with diffused type which manifested recurrent cholangitis in clinical symptoms. Among them, 4 were female and 3 male.The mean age was 16 years old (ranging from 10 to 31 years old). Six patients were subjected to conservative therapy and only one patient had previously undergone cholecystectomy and T tube drainage before transplantation. In types of surgery, 4 patients accepted split liver transplantation with right liver lobe, two got whole liver transplantation and only one underwent living related liver transplantation. In two patients venovenous bypass was done during the operation. The mean duration of surgery was 9. 1 h. Post-transplant complications included pulmonary infection (3 cases), acute rejection (2 cases), pleural effusion (2 cases) and biliary leakage in the split section of donor liver (1 case). One patient died within 19 days caused by acute renal failure and multiple organs dysfunction.The rest six patients are alive without any signs of recurrence of protopathy and the longest survival time is 7 years. Conclusion Liver transplantation is a valuable treatment to Caroli's disease with diffused type. Due to the organ shortage, living related liver transplantation may own identical effects on LT.

Oxidative stress in liver tissues in HCC patients after TACE / 中华普通外科杂志

Objective To investigate the levels of oxidative stress in liver tissues of hepatocelluar carcinoma(HCC)patients after transcatheter arterial chemotherapy(TAC).Methods Immunohistochemistry streptavidin biotinylated peroxidase(S-P)method was used to detect the cellular levels of 8-hydroxy-2'-deoxyguanosine(8-OHdG),p53 and p21~(waf1/cip1).Eighty-nine HCC patients were divided into TAC group(39 cases)and Non-TAC group(50 cases).15 Non-HCC liver tissues served as controls.Result 8-OHdG level was higher in Non-TAC group than that in TAC group in tumor tissues (F=9.516,P＜0.05),with that being the lowest in control group(F=9.516,P＜0.01);8-OHdG levels in cancer tissues were significantly higher than that in tumor surrounding tissues in both TAC group (t=7.101,P＜0.001)and Non-TAC group(t=8.020,P＜0.001),there was no significant difference of 8-OHdG levels between para-tumor tissues and controls.The levels of 8-OHdG between tumor and its surrounding tissues in TAC group(r=0.651,P＜0.001)and non-TAC group(r=0.493,P＜0.01)was in positive correlation.The difference of p53 levels in cancer tissues in TAC group and Non-TAC group were not statistically significant and p53 was not detected in para-tumor tissues.The difference of p21~(waf1/cip1) levels among TAC group,Non-TAC group and controls was statistically significant,the levels of p21~(waf1/cip1) in normal group was the highest(F=13.459,P＜0.001),followed by that in TAC and Non-TAC group in cancer tissues(TAC vs.Non-TAC group,P＜0.01);p21~(waf1/cip1) expression in normal controls was significantly higher than that in both TAC and Non-TAC group in para-tumor tissues(F=16.613,P＜0.001).The correlation of p21 ~(waf1/cip1) levels between tumor and its surrounding tissues was significant in non-TAC group(r=0.872,P＜0.001).Conclusions Oxidative stress levels in HCC tumor tissues were higher than in para-tumor tissues and non-HCC liver tissues.Cancer cells probably survive chemotherapy by fortifying oxidative stress repair mechanism.

Tumor size assessment with ultrasound as a prognostic factor for patients with liver transplantation for hepatocellular carcinoma / 中华超声影像学杂志

Objective To evaluate the assessment of tumor's size with ultrasound in research of prognosis of liver transplantation for hepatocellular carcinoma (HCC). Methods Clinical data of 148 patients with HCC who underwent liver transplantation were analyzed retrospectively. Results One-, 2-,3-,and 5-year overall actuarial survival were 73.3% ,45.6% ,35.4% ,and 32.1%,respectively. One-,2-,3-,and 5-year overall recurrence-free survival were 70.7 %, 44.3 %, 38. 5%, and 34. 5%, respectively. The overall tumor recurrence rate was 43.2%. Univariate analysis indicates that (the Kaplan-Meier method with the Log-Rank test) the total tumor burden (TTB) (χ2=15.098,P=0.001) was found to be significantly affecting the actuarial survival. While TTB (χ2=29. 038, P<0.001) was for recurrence-free survival. In multivariate analysis (with the multivariate Cox proportional hazards model), TTB (R2=1.610, P =0. 008) was found to be an independent predictor of actuarial survival. On the other hand, TTB (R2 =2. 206, P<0.001) was identified as the prognostic factor independently related to recurrence-free survival. Conclusions TTB is an independent prognostic factor for patients with liver transplantation for HCC. Assessment of tumor size with ultrasound is beneficial to the evaluation of indication for liver transplantation when patients with HCC were concerned.

A comparative study on continuous hemihepatic with intermittent total hepatic inflow occlusion in hepatectomy for liver tumors / 中华普通外科杂志

Objective To evaluate if continuous hemihepatic inflow occlusion(HH)during hepatectomy can be as safe and effective as intermittent total hepatic inflow occlusion(TH)in reducing blood loss during hepatectomy.Methods From November 2001 to March 2006.eighty patients undergoing liver resections were included in a prospective randomized study comparning the intra-and postoperative course underTH(n=40)or HH(n=40).TH was performed with periods of 20 minutes of occlusion and 5 minutes of releasing,while HH with continuous occlusion.The surface area of liver transection was measured and blood loss was calculated.The amount of blood loss,levels of alanine aminotransferuse (ALT)and aspartate aminotransferase(AST),and postoperative course were recorded. Results The total ischemic time of the HH groups was longer than in the TH group[(42±13)min,(31±13)min,P=0.37],and the operative time in the HH group was longer than in the TH group[(236 ±49)min,(204±38)min,P=0.02 ].No signincant difierenee was found between HH and TH group in blood loss during liver parenchyma transection[(500 ±269)ml,(416 ±235)ml,P=0.14]and in the changes of ALT and AST on the first postoperative day[ALT:(677±572)IU/L,(577 ±327)IU/L,P=0.12;AST:(591 ±468)IU/L,(512±301)IU/L,P=0.66].There were no difierences on postoperative morbidity between the two groups(22.5%versus 20.0%,P=0.35).Conclusion The technique of continuous hemihepatic inflow occlusion is as safe and effective as intermittent total hepatic inflow occlusion.

Value of helical computed tomography and color doppler flowing imaging in assessing the resectability of pancreatic cancer / 中华消化外科杂志

Objective To determine the value of helical computed tomography (HCT) and color doppler flowing imaging (CDPI) in evaluating the resectability of pancreatic cancer. Methods The clinical data of 114 patients with pancreatic cancer who had been admitted to the Affiliated Hospital of North Sichuan Medical College from January 1995 to December 2002 were retrospectively analyzed. The values of HCT and CDPI in assessing the resectability of pancreatic cancer were determined according to the results of operation and pathological examina-tion. All the data were analyzed by chi-square test and Fisher exact probability. Results Of all patients, 109 were examined by HCT, 97 by CDPI and 96 by HCT+CDPI. For patients examined by HCT, the resection rates of pancreatic head cancer, pancreatic body and tail cancer and total pancreatic cancer were 45.3% (39/86), 26.3% (5/19) and 0 (0/9), respectively. The resection rate of pancreatic head cancer was higher than that of pancreatic body and tail cancer (χ2=8.965, P<0.05). With the increase of tumor size, the invasion rate and metastasis rate were increased and the resection rate was decreased (z=6.15, 5.35, 7.18, P<0.01). The sensitivity rate and specificity rate were 77.8% and 82.2% of HCT, 73.3% and 80.6% of CDPI, 90.6% and 92.4% of HCT+CDPI in assessing the resectability of pancreatic cancer. The values of Kappa identity test of HCT, CDPI and HCT+CDPI were 0.58, 0.52 and 0.82, respectively. Conclusions Combined application of HCT and CDPI can further improve the accuracy in assessing the resectability of pancreatic cancer.

Liver functions after periesophagogastric devascularization / 中华普通外科杂志

Objective To observe changes of hepatic hemodynamics and hepatic functional reserve after splenectomy and periesophagogastric devascularization. Methods From July 2006 to August 2007, thirty patients with portal hypertension caused by hepatitis B cirrhosis underwent splenectomy and periesophagogastric devascuiarization. The PVPG (portal venous pressure gradient) was measured by inductor continually during operation. The HAF (hepatic artery flow), PVF (portal venours flow) and hepatic arterial RI(resistant index) were measured with Doppler sonography. The EHBF(effective hepatic blood flow) and ICGR15 (indocyaninegreen retention rate at 15 minutes) were obtained respectively by indocyaninegreen clearance test before and after the operation. Results PVPG after laparotomy (19±4) mm Hg, ligating the splenic artery(14±4) mm Hg, splenectomy(14±3)mm Hg and periesophagogastric devascularization (12±4) mm Hg showed a tendency to decrease progressively. The PVF decreased [from (42±14) ml/s to (16±8) ml/s] and HAF increased in compensation after operation. The EHBF increased [from (0.48±0.10) L/min to (0.56±0.10) L/min], and the ICGR15 decreased (from 23%±8% to 18%±4%) postoperatively. Conclusion After splenectomy and periesophagogastric devascularization, the hepatic functional reserve improves at least in a short term notwithstanding the decrease of PVPG and PVF.

Reconstruction of hepatic artery in adult-to-adult living donor liver transplantation: a report of 50 cases / 中华消化外科杂志

Objective To summarize the experience in hepatic artery reconstruction in adult-to-adult living donor liver transplantation(ALDLT).Methods Fifty patients underwent ALDLT in our hospital from January 2002 to July 2006.All the hepatic a~ery reconstructions were done under surgical microscope.ResultsTwo patients(4%)presented with hepatic artery thrombosis.All the patients were followed up for 2 to 52 months (median,9 months),and no hepatic artery stenosis nor hepatic artery pseudoaneurysm occurred.The 1-year survival rate was 92%(46/50).Conclusions Systematic evaluation of hepatic artery reconstruction and use of microsurgical technique are key to the reduction of complications of hepatic artery reconstruction in ALDLT.

Hepatic blood flow exclusion for resection of liver tumors involving hepatic hilar region / 中华普通外科杂志

Objective To study hepatic blood flow exclusion for the resection of liver tumors involving hepatic hilar region. Methods The clinical data of 16 cases of liver tumors involving hepatic hilar region from January 2005 to March 2008 were retrospectively analyzed. Liver tumors were resected by the technique combining hepatic portal control ( Pringle's maneuver) and normothermie total hepatic vascular exclusion (NHVE). The relation of liver tumors to major vessels, episodes and durations of hepatic blood flow exclusion, intraoperative blood loss and blood transfusion, postoperative complications were analyzed. Results The technique combining Pringle's maneuver and NHVE was used in 16 cases. The mean episodes and durations of Pringle's maneuver were (3.8±1.6) min and (46.6±28.8) min, respectively. The mean episodes and durations of NHVE were (1.6±0.4) min and (23.5±8.2) min, respectively. The mean amount of intraoperativ blood loss was (1250±320) ml, blood transfusion (860±245) ml. Major hepatic vessel injuried were repaired intraoperatively including inferior vena cave in 4 cases, main hepatic veins in 2 cases and portal veins in 2 cases. The serum alanine transaminase(ALT) and bilirubin raised in different degrees after operation, and recovered gradually to normal level. There was no postoperative mortality and serious postoperative complications. Conclusions Alternative use of hepatic blood flow exclusion combining Pringle maneuver and NHVE reduces the time of total hepatic vascular exclusion, improves safety for resection of liver tumors involving hepatic hilar region.

A correlation between pretransplantation model for end-stage liver disease score and degree of hepatic fibrosis in explanted livers / 中华消化杂志

Objective To investigate the probability of assessment of hepatic fibrosis for liver transplantation using model for end-stage liver disease(MELD) by comparing the correlation of MELD score with Ishak pathological grading method. Methods Fifty-eight patients who underwent liver transplantation because of end-stage liver disease from February 2006 to September 2006 were performed quantitative hepatic fibrosis evaluation using computer-assisted digital image analysis. Pathological diagnosis according to the Ishak modified score was also performed. MELD scores were calculated using the original formula based on the clinical examination data collected on the admission days. The correlations among the image analysis method, Ishak grading and MELD scoring method were analyzed using the Spearman's rank correlation analysis. The linear relationship between the MELD scores and the degree of hepatic fibrosis shown from linear regression analysis was used to define the reference criterion. Results The hepatic fibrosis area ratios of the 58 patients were between 23.2 % and 88.4 % with average of 56.7% by computer-assisted digital image analysis. The MELD scores on the admission clays were between 11 and 38 with average of 22.85±9.32. The semi-quantitative Ishak classification showed that there were 0, 2, 7, 12, 18, 12, and 7 cases in each of the 7 grades respectively, the higher the grade the higher the hepatic fibrosis area ratio and the higher the MELD scores. Spearman rank correlation test indicated that there was significant correlation among these three methods(P ＜ 0.01). Linear regression analysis showed that there was a linear relationship between the MELD scores and the degree of hepatic fibrosis. Conclusions Computer-assisted digital image analysis can evaluate objectively the hepatic fibrosis degree and it is significantly correlated to the MELD system. Hepatic fibrosis degree can be evaluated by MELD scores.

Construction of recombinant adenovirus vector carrying human TIMP-1 cDNA and its expression in vitro / 生物医学工程学杂志

The full-length cDNA of hTIMP-1 was obtained from a surgical patient with HCC by the method of RT-PCR. Then it was cloned into the adenoviral shuttle plasmid pAdTrack-CMV, and subsequently cotransformed into competent BJ5183 cells with the adenoviral backbone plasmid pAdEasy-1. Thereupon, a recombinant adenoviral plasmid containing full-length cDNA of hTIMP-1 was generated by homologous recombination in E. coli. The adenoviruses (AdhTIMP-1) were packaged and amplified in adenoviral packaging cells HEK 293. Then the viral titer was checked by green fluorescent protein (GFP), and the expression of hTIMP-1 was detected by the techniques of Western blot and RT-PCR. The recombinant adenovirus vector carrying human TIMP-1 was successfully constructed and expressed in vitro and may pave the way for further application in liver gene therapy.

Analysis of pulmonary infection and susceptible factors following orthotopic liver transplantation / 中华器官移植杂志

Objective To investigate the characteristics of pulmonary infection and susceptible factors following orthotopic liver transplantation (OLT). Methods Clinical data of 128 patients who underwent OLT from Feb. 1999 to Dec. 2004 were studied retrospectively in order to analyze primary pathogens, infectious time and susceptible factors.Results Forty-eight ( 37.5 %) of 128 patients had pulmonary infections and 27 ( 56.3 %) of them developed within postoperative 7 days. Thirty-four ( 70.8 %) cases suffered from mixed infection and 6 ( 12.5 %) died in the hospital after OLT. The primary pathogenic germs included Pseudomonas aeruginosa, Acinetobacter baumannii/haenolyticus, Golden staphylococcus, Aspergilosis and so on.Conclusion Pulmonary infection can be caused by various pathogens and associated with patients' constitution, mechanical ventilation, immunosuppressive drugs and so on.