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Objective:To explore the changes of disease burden and risk factors of chronic kidney disease (CKD) due to type 1 and type 2 diabetes mellitus in China from 1990 to 2019, and to provide reference data for the prevention and control of diabetic kidney disease (DKD).Methods:The Chinese DKD data were obtained from the 2019 Global Burden of Disease (GBD) database. The morbidity, prevalence, mortality, years lived with disability (YLD), years of life lost (YLL), and disability-adjusted life year (DALY) were used to compare the disease burden of CKD due to type 1 and type 2 diabetes mellitus from 1990 to 2019. In addition, the risk factors of DKD were analyzed.Results:The numbers of CKD patients due to type 1 and type 2 diabetes mellitus in China were 574 (95% UI 495-665) and 31 076 (95% UI 28 152-33 909) thousand, and the numbers of new cases were 9 (95% UI 8-11) and 434 (95% UI 390-481) thousand in 2019, respectively. The numbers of death were 13 (95% UI 8-18) and 63 (95% UI 50-77) thousand, respectively. The age groups with the largest number of patients and new cases of CKD due to type 1 diabetes mellitus were 30-34 years old and <5 years old, respectively. The age group with the largest number of patients and new cases of CKD due to type 2 diabetes mellitus were 50-54 years old and 70-74 years old, respectively. From 1990 to 2019, the age-standardized prevalence rate of DKD patients in China was relatively stable, but the age-standardized incidence rate and YLD rate showed an upward trend, while the age-standardized mortality rate, YLL rate, and DALY rate showed a downward trend. The main risk factors associated with DKD death were high fasting plasma glucose, kidney dysfunction, high systolic blood pressure, high body mass index, high sodium diet, and lead exposure. The proportions of DKD death caused by high systolic blood pressure and high body mass index in the Chinese population were still increasing. Conclusions:From 1990 to 2019, the age-standardized incidence and YLD rate of DKD in China shows an upward trend, while the age-standardized prevalence rate is relatively stable, and the age-standardized mortality rate, YLL rate, and DALY rate show a decreasing trend. High fasting glucose, renal failure, high systolic blood pressure, high body mass index, high sodium diet, and lead exposure are risk factors associated with death in DKD patients. With the progress of aging, the disease burden of DKD in China will continuously increase. Future work should be focused on population-specific interventions, taking into consideration the risk factors identified within the study.
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Objective:To investigate Chinese myocarditis burden and trends in 1990 and 2019.Methods:Based on the Global Burden of Disease (GBD) 2019 data, the number of patients, the number of new cases, the number of deaths, the disability-adjusted life years (DALYs), as well as the morbidity, mortality, DALYs rate and their age-standardized rates were used to analyze the trend and the burden of myocarditis in the Chinese population in 1990 and 2019.Results:In 2019, the number of patients, the number of new cases and the number of deaths with myocarditis in China were 234 900, 275 100 and 13 100 respectively, increasing by 85.62%, 47.51% and 50.22% compared with 1990. The age-standardized incidence and mortality were 16.94/100 000 and 0.92/100 000, respectively. Compared with 1990, the age-standardized incidence in 2019 decreased by 6.06%, and the mortality decreased by 16.04% respectively. The age-standardized incidence and mortality of Chinese male patients with myocarditis were higher than that of female. Compared with 1990, the age group with the largest incidence and mortality of myocarditis in China in 2019 all shifted to the elder group. And, DALYs and age-normalized DALYs due to myocarditis in China showed a decreasing trend in 2019, from 458 600 and 42.51/100 000 in 1990 to 341 300 and 25.39/100 000 in 2019, respectively. The rate of DALYs and age-standardized DALYs in male patients was always higher than female.Conclusions:Compared with 1990, the overall burden of myocarditis in China showed a downward trend in 2019, and the burden of myocarditis in male patients was higher than female. More attention should be paid to the burden of myocarditis in Chinese elderly population.
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Objective:To compare the prognostic accuracy of 16 pre-transplant scoring models in predicting the post-transplant short-term outcome of patients with hepatitis B-related acute-on-chronic liver failure (HBACLF), and to explore an efficient predictive model.Methods:A retrospective analysis of the clinical data of HBACLF patients who underwent liver transplantation at the Liver Transplant Center of Beijing Youan Hospital from August 2004 to September 2014. Score of 16 models (CTP, UNOS-MELD, Updated-MELD, Integrated-MELD, MELD-Na, MLED Na, CLIF-SOFA, CLIF-OFs, CLIF-C ACLFs, CLIF-C ADs, Refit MELD, Refit MELD Na, MELD-AS, Zheng's Risk, UKELD, MESO) was based on time-dependent operation characteristic curve, and the area under the curve (AUC) was calculated to evaluate the prediction accuracy of 3-month survival after transplantation. Selection of univariate factors associated with postoperative short-term mortality was performed, and then 16 scoring models one by one with statistically significant mortality-related factors were entered into LASSO regression (Least Absolute Shrinkage and Selection Operator regression) to confirm the independent variables. Finally, a predictive model was constructed by Cox regression.Results:A total of 135 patients were included in this study, including 106 males and 29 females, aged (45.0±10.5) years old. Among the 16 scoring models, the AUC of MELD-Na and CLIF-SOFA were more than 0.7 in early survival prediction after liver transplant. The MELD-Na was confirmed as an independent predictive variable in the final model with univariate and LASSO regression multivariate selection analysis ( HR=1.0481, 95% CI: 1.0136-1.0838, P<0.05). The model was constructed by MELD-Na and combined with other clinical parameters (female, systemic infection, placement of T tube during operation) could better predict the early survival after liver transplant. The overall C-index of the final model was 0.886, and the C-index at 3-month after liver transplant was 0.844 through internal validation (Bootstrap). Conclusion:Compared with other scoring models, MELD-Na and CLIF-SOFA were better for early survival prediction after liver transplantation for patients with HBACLF. The constructed predictive model based on MELD-Na was superior than single MELD-Na or CLIF-SOFA in prognostic assessment and case selection.
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Objective To study the impact of splenectomy and devascularization on liver function and liver fibrosis in patients with non-cirrhotic portal hypertension (NCPH). Methods The clinical data of patients with NCPH who were treated in Beijing You'an Hospital of Capital Medical University from April 2008 to December 2017 were retrospectively analyzed. The patients were divided into the observation group (n=16 ) and the control group ( n =30 ) according to their treatment methods. The observation group underwent splenectomy combined with devascularization, while the control group received conservative treatment. The changes in liver function, ascites, varicose vein rupture and bleeding before and after treat-ment, and the changes in liver blood flow before and after treatment in the observation group were compared. Results The before and after treatment of the 2 groups in ALT, AST, total bilirubin, albumin showed no statistically significant difference (P＞0. 05). Six months after treatment, the rates of ascites and bleeding were significantly higher than the observation group, (P＜0. 05). Ten patients who had a history of preoper-ative variceal hemorrhage in the observation group did not bleed within 6 months after treatment. Further-more, in the observation group after treatment when compared with the control group, the PC-Ⅲ [(32. 3 ± 12. 1) g/L vs. (56. 7 ± 15. 3)g/L],Ⅵ-C [(46. 6 ± 35. 0) g/L vs. (121. 3 ± 30. 4)g/L], LN [(32. 5 ± 10. 5) g/L vs. (65. 8 ± 11. 1) g/L] were significantly lower than the control group ( P ＜0. 05). The preoperative portal venous blood flow in the observation group was significantly higher than that after surgery [(1 056. 8 ± 679. 8) ml/min vs. (481. 0 ± 227. 6) ml/min, P＜0. 05]. Conclusion Splenectomy and devascularization effectively stopped variceal bleeding and delayed liver fibrosis in NCPH patients without affecting the liver function.
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Idiopathic noncirrhotic portal hypertension (INCPH) is an uncommon disease of intrahepatic portal hypertension with associated clinical manifestations such as esophageal varices,hypersplenism and ascites.This diagnosis is rendered following the exclusion of other causes of portal hypertension,including cirrhosis,other presinusoidal,sinusoidal and post sinusoidal causes of portal hypertension and splanchnic venous thrombosis.INCPH is relatively uncommon in the western world,and the terminology and diagnostic criteria of INCPH remain controversial.Histological features commonly observed in INCPH are nodular regeneration of the hepatocytes,phlebosclerosis,increased number of portal vessels,sinusoidal dilatation,periportal shunting vessels,perisinusoidal fibrosis and rudimentary portal tracts.It's urge to look for this condition in a number of clinical settings,including cryptogenic cirrhosis,a disease known to be associated with INCPH,drug administration,and even chronic alterations in liver fimction tests.Once INCPH is clinically suspected,liver histology becomes mandatory for the correct diagnosis.However,the pathologists should be familiar with the histological features of INCPH,especially in cases in which histology is not only requested to exclude liver cirrhosis.
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Objective To study the value of preoperative MELD-Na score (Model for End-Stage Liver Disease-Sodium) in predicting complication severity grades after liver transplantation (LT) for severe hepatitis.Methods Patients who underwent LT for severe hepatitis between August 1,2004,and September 1,2014 were retrospectively studied.The Accordion severity grading system was used to classify the complication severity grades after LT.The grades were classified as grade 1 (mild),grade 2 (moderate),grade 3-5 (severe),and grade 6 (death).The area under the curve (AUC) was calculated by plotting the receiver operating characteristic curve (ROC) to evaluate the predictive accuracy of the MELD-Na score for the severe and mortality grades after LT.The correlation between the MELD-Na score with the complication severity grade after LT was studied by the Spearman correlation and by multivariate analysis.Results The incidences of postoperative complications for the 159 patients in this study were:grade 2 in 43 patients (27.0％,MELD-Na score 27.3 ±7.4),grade 3 in 41 patients (25.8％,MELD-Na score 32.7 ± 12.4),grade 4 in 31 patients (19.5％,MELD-Na score 34.3 ± 12.1),grade 5 in 9 patients (5.7％,MELD-Na score 30.7 ± 12.3),grade 6 in 35 patients (22％,MELD-Na score 37.1 ± 10.4).There was no grade 1 patient.The AUC of the MELD-Na score for the severe and death groups were 0.631 (P ＜ 0.05;95 ％ CI,0.533 ～ 0.728) and 0.670 (P ＜ 0.05;95 ％ CI,0.574 ～ 0.766) respectively.The MELD-Na score was significantly correlated with the Accordion severity grade (rho 0.297,P ＜ 0.01) on Spearman correlation analysis.Multivariate analysis showed that a MELD-Na score ≥25 was a risk factor of postoperative severe grade complication (P ＜ 0.05,OR =4.35),a MELD-Na score ≥35 was a risk factor of postoperative mortality (P ＜0.01,HR =4.72).Conclusion The MELD-Na score was significantly correlated with the Accordion severity grade,which efficaciously predicted the complication severity grades after liver transplantation.
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Objective To study the safety and efficacy of surgical treatment for hilar cholangiocarcinoma (HC).Methods We retrospectively analyzed the clinical data of 56 patients with HC who underwent resection at the Beijing YouAn Hospital,Capital Medical University,from January 2010 to July 2015.The patients were divided into two groups according to the types of operations:the minor hepatectomy group (n =12) and the major hepatectomy group (n =44).The postoperative complications,mortality and long-term survival rates were compared and the clinical data were analyzed using uni-and multivariate analyses to examine the significant factors of survival.Results (1) The morbidity rates of the two groups were 33.3％ and 63.6％,respectively,with the latter group being significantly higher than the former group;(2) The 1-and 3-year overall survival rates were 60％ and 15％ in the minor liver resection group and 64％ and 15％ in the major resection group,and there was no significant difference between the two groups (P ＞ 0.05).The median survival was 16 months;(3) The median survival of R0 resection was significantly longer than the R1/R2 resection group (22 months vs 10 months,P ＜0.05);(4) Age,preoperative CA19-9 level,vascular invasion,surgical margin,tumor differentiation and nodular metastasis were significantly correlated with prognosis on univariate analysis.Multivariate analysis showed surgical margin and tumor differentiation to be significant prognostic factors.Conclusions RO resection obviously prolonged survival of HC patients,and histopathology negative surgical margin should be emphasized.With R0 resection,minor liver resection significantly reduced postoperative complications and mortality in selected patients.
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Objective To explore the value of the Accordion severity grading system (ASGS) in predicting short-term outcomes after orthotopic liver transplantation for severe hepatitis by classifying post-surgery complications.Methods The clinical documents of 159 patients were retrospectively analyzed who underwent orthotopic liver transplantation for severe hepatitis between Aug.1,2004 to Sept.1,2014 at our center.Complications were categorized according to the ASGS:grade 1 (mild),grade 2 (moderate),grade 3-5 (severe),and grade 6 (death).Outcome measures included ventilator support time,the length of ICU stay,postoperative recovery time.Spearman rank correlation analysis was used to test the correlation between the different grades with these outcome measures.1-year survival trends of different grade complication groups were demonstrated by Kaplan-Meier method and compared by Log-rank test.Results In total,43 (27.0％) patients had a grade 2 complication;41 (25.8％) grade 3;31 (19.5％) grade 4;9 (5.7％) grade 5;and 35 (22.0％) grade 6.There was no grade 1 patient.There was a significant correlation between the complication grades and the ventilator support time,the length of ICU stay and postoperative inpatient time (P＜0.01).With the increase of the complication grades,the outcome measures were even worse.Severe grade complication group had a longer ventilator support time,the length of ICU stay and postoperative inpatient time than the moderate grade complication group (P＜0.01).There was a significant downward trend in 1-year survival with the increase of the complication grade (P＜0.01).Conclusion The ASGS is helpful to assess risks and predict short-term outcomes after liver transplantation for severe hepatitis.Higher Accordion grades are correlated with even worse short-term outcomes.
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Hilar cholangiocarcinoma (HCC) resection is a difficult and complicated surgery with high complication risk because of the special anatomic position.The detailed preoperative assessment is very important.Ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) can provide important information on the tumor location, vascular invasion and distant metastasis, which is necessary for the resection.Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) can be used to determine the tumor location and size, and achieve bile drainage.Magnetic resonance Cholangiopancreatolography (MRCP) as a noninvasive examination with fewer complications has comparable accuracy in identifying tumor extent with PTC and ERCP.The ultimate goal of surgical treatment is R0 resection.Preoperative resectablility evaluation mainly depends on the bile duct involvement, hilar vessels invasion, extent of hepatic lobe atrophy, lymphatic metastasis and nerve plexus infiltration.HCC radical resection often demands extended liver resection and accurate assessment of the residual liver function is very important for clinical strategy.Preoperative biliary drainage could be conducted in patients with cholangitis, long-term refractory jaundice (direct bilirubin level ＞ 200 μmol/L), poor nutrition status and residual liver volume ＜40％ of the total liver volume.Portal vein embolization decreases the long-term complications for HCC patients with enlarged liver resection.Portal vein embolization can be considered when residual liver volume ＜ 30％ ～40％.
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Cirrhotic portal hypertension can lead to changes in the cardiovascular system,including hyperdynamic circulation,increased cardiac output,increased splanchnic blood flow,increased heart rate,peripheral vasodilatation,decreased resistance,and a drop in blood pressure.This hemodynamic disorder not only plays an important role in the maintenance of portal hypertension,but also causes retention of sodium and water,ascites,hepatorenal syndrome,and hepatopulmonary syndrome.Recently,there is an increased interest in clinical research reports that suggest treatments for cirrhotic portal hypertension.Therapies involve internal medicine,interventional treatment,and surgery for preventing and controlling upper gastrointestinal hemorrhage,splenomegaly,hypersplenism,and other symptoms.Various treatments had some positive effects on the hyperdynamic circulatory state of the cardiovascular system.
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<p><b>OBJECTIVE</b>To evaluate the influence of sirolimus on the long-term survival of patients after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>Clinic data of 165 consecutive patients who underwent OLT for HCC from February 2005 to March 2012 was analyzed retrospectively. Among them, 94 patients were treated with a sirolimus-based immunosuppressive protocol after OLT, while the other 71 patients with a FK506-based protocol. Postoperative survival time, survival, disease-free survival (DFS) and tumor recurrence rates between the two groups were compared.</p><p><b>RESULTS</b>The 2 groups were comparable in all clinicopathologic parameters. The sirolimus-based group had higher patient survival rates than the control group at 1-year (87% vs. 97%, P = 0.03), 2-year (80% vs. 88%), 3-year (76% vs. 85%) and 5-year (63% vs. 75%). The 1-year, 2-year, 3-year and 5-year recurrence rates were 12% vs. 3%, 17% vs. 9%, 21% vs. 9% (P = 0.04) and 31% vs. 16% (P = 0.03). Early and mid-HCC (I - II stage) of 131 cases (control group 61 cases, sirolimus-based group of 70 patients). The 1-year, 2-year, 3-year and 5-year survival rates were 90% vs. 97% , 80% vs. 90%, 78% vs. 86% and 65% vs. 82% (P = 0.04) and recurrence rates were 10% vs. 3%, 16% vs. 8%, 18% vs. 8% and 29% vs. 11% (P = 0.01).</p><p><b>CONCLUSION</b>The sirolimus-based immunosuppressive protocol reduce long-term postoperative recurrence rate and improve the survival rate of patients after OLT for HCC significantly (especially early-mid HCC).</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Carcinoma, Hepatocellular , Drug Therapy , Mortality , General Surgery , Immunosuppressive Agents , Therapeutic Uses , Liver Neoplasms , Drug Therapy , Mortality , General Surgery , Liver Transplantation , Neoplasm Recurrence, Local , Retrospective Studies , Sirolimus , Therapeutic Uses , Survival Rate , Tacrolimus , Therapeutic UsesABSTRACT
Hilar cholangiocarcinoma (HCC) is a rare tumor with a poor prognosis.With the development of high definition imaging technology,improvement of surgical instruments,optimization of perioperative surgical strategies and accumulation of surgical experiences,the radical resection rate of HCC is significantly improved.Operation is the main method of treatment for HCC,and radical resection is important for a long-term survival of HCC patients.The clinical data of 66 patients with HCC who were admitted to the Beijing Youan Hospital from April 2004 to April 2012 were retrospectively analyzed.The key points in surgical procedure and prognosis of patients were investigated.
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Objective To evaluate the influence of hepatitis B surface antigen positive or antihepatitis B core positive donors on HBV allograft re-infection or de novo hepatitis B and recipients and grafts survival after liver transplantation.Methods Between June 2004 and December 2011,510 liver transplants were performed at our department while 387 patients were followed up.Among them,9 patients received hepatitis B surface antigen positive grafts,50 patients received anti-hepatitis B core positive grafts,and 328 patients received HBV marks negative grafts.The rate of HBV allograft reinfection or de novo hepatitis B and accumulative recipients as well as grafts survival were compared.Results All recipients with hepatitis B surface antigen positive donors remained hepatitis B surface antigen carriers after operation.HBV allograft re-infection occurred in one recipient of anti-hepatitis B core positive donor group. Five recipients with HBV marks negative donors appeared hepatitis B surface antigen positive,including two cases of Lamivudine resistance leading to HBV allograft reinfection and three cases of de novo hepatitis B from non-related diseases. The 1-,3-,5-year accumulative survival rate in anti-hepatitis B core positive grafts group,hepatitis B surface antigen positive grafts group and HBV marks negative grafts group was 100％,86％,43％; 87％,79％,57％; and 87％,80％,79％,respectively (Log-rank =1.287,P =0.525).And the 1-,3-,5-year accumulative grafts survival rate in these three groups was 100％,86％,43％; 85％,77％,56％;and 86％,79％,77％,respectively (Log rank=1.288,P =0.525).During the follow-up period,no graft loss or death was found to be related to the HBV allograft re-infection or de novo hepatitis B.Conclusion Liver grafts from anti-hepatitis B core positive donors do not increase the risk of graft loss or recipient death due to HBV allograft re-infection or de novo hepatitis B under effective antiviral therapy.Hepatitis B surface antigen positive donors are feasible to save lives or prolong life in emergency situation.
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ObsjectiveTo investigate the clinical data,and to summarize the clinical experience of diagnosis and treatment of graft-versus-host-disease (GVHD) after liver transplantation.Methods 4 of 480 recipients undergone liver transplantation developed GVHD from Apr.2005 to Sep.2011.The 4 recipients'clinical courses and laboratory tests were recorded.ResultsThe diagnosis of GVHD depended on clinical syndrome involved skin rash,bone marrow depression and diarrhea.Skin biopsy and STR-PCR were matched.Among them,2 with successful treatment have been surviving for 7 and 24 months,and 2 died from infection.One recipient had the donor T lymphocyte microchimerism detected by STR-PCR.ConclusionsGVHD after liver transplantation can cause high mortality due to bone marrow depression.A reasonable treatment can be to reduce immunosuppressant and glucocorticoids and IVIG.
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ObjectiveTo summarize and investigate the incidence,reason,diagnosis and treatment of postoperative early cardiac arrhythmia after orthotopic liver transplantation(OLT).Method A retrospective study was made for the incidence,dignosis and treatment of cardiac arrhythmia (two weeks after OLT) following OLT from June 2004 to January 2012 in the Beijing You-An Hospital.ResultsIn 500 patients who received OLT,Cardiac arrhythmia developed in 82 patients (16.4％).Among these cardiac arrhythmia,35(7.0 ％) were sick sinus syndrome (including severe sinus bradycardia ),18 (3.6 ％ ) were paroxysmal supraventricular tachycardia,21(4.2 ％) were atrial fibrillation,8(1.6 ％,including 2 patients with torsades de pointes) were ventricular tachycardia and 4 (0.8 ％ )were cardiac arrest.Mortality rate after OLT relate to cardiac arrhythmia was 0.4％ (2 patients).Cardiac arrhythmia was mainly correlated with four factors:(1)whether patient had heart disease before OLT or not(x2 =15.82,P＜0.01),(2)Prolonged QT interval in patients with end-stage liver disease before OLT(x2 =11.00,P＜0.01).ConclusionsCardiac arrhythmia was common complication after OLT,and it can lead to death of recipients.Careful evaluation to recipients before OLT,controlling fluid load after OLT,keeping the balance of the electrolyte,acidity and alkalescence,giving intensive monitor to patients with heart disease before OLT and prolonged QT interval are the key factor to reduce incidence and mortality of cardiac arrhythmia.Application of medication and cardiac pacemaker can prevent cardiovascular accident after OLT.
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Objective To identify the level of functional immunity as measured by the ImmuKnow assay in Chinese stable liver transplant recipients and to correlate these values with the dose and the trough levels of immunosuppressant, and with other clinical parameters of these patients. Methods Functional immune response was assessed by the ImmuKnow assay in 46 blood samples taken from 46 stable liver transplant recipients from Beijing Youan Hospital, Capital Medical University Liver Transplantation Center. Results The average ATP value in these stable liver transplant recipients was 203±114 ng/ml (range: 38.47 ATP ng/ml to 524.06 ATP ng/ml) at 22± 15 month post liver transplantation. There was no correlation either between ImmuKnow ATP values and the tacrolimus trough levels, or between ImmuKnow ATP values and the liver function (P<0. 05). Stepwise multiple regression analysis identified WBC and CD3+, CD3+ CD4+ as independent predictors of ImmuKnow assay levels when age, gender and underlying diagnosis were taken into account (P<0. 05). Five patients who were detected to have active HCV infection had lower ImmuKnow ATP values (<61 ng/ml). Conclusions The Cylex ImmuKnow assay ATP values were lower in Chinese stable liver transplant recipients compared with American patients. Further investigation is required to determine the role of the ImmuKnow assay in tailoring immunosuppressant therapy in liver transplant recipients.
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Objective To compare the curative results of three different therapies for earlyintermediate stage primary liver cancer. Methods The data of 428 patients with early-intermediate stage primary liver cancer treated with one of three curative therapies from April 2004 to July 2010 in our center were analyzed retrospectively. The patients were divided non-randomly into three groups: group A liver-cancer resection (n = 231), group B radio-frequency ablation (RFA) (n = 63), and group C liver transplantation (n=134). The 1-, 3-, 5-year accululative survival and recurrence rate in each group were compared. Results The accumulative 1-, 3-, 5-year survival rates were 93.3%, 71.9%, 57.2% for group A; 86.7%, 46.5%, 38.8% for group B; 95.7%, 78.3%, 72.1% for group C,respectively. The 1-, 3-, 5-year recurrence rates were 30. 3% , 49. 7%, 68. 6% for group A; 39. 3% , 58. 7% , 79. 3% for group B; 7. 0% , 12. 1% , 12. 1% for group C,respectively. There was a highly significant difference between groups A, B and C in the survival rates and the recurrence rates. The 5-year survival rate was significantly higher for group C than group A and group B (P<0. 01, P<0. 001), and the recurrence rate of 1, 3, 5-years were significantly lower for group C than for group A and B (P<0. 001). Conclusion Liver transplantation was the most effective therapy for the early-intermediate stage primary liver cancer.
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Objective To review the techniques used in biliary reconstruction for adult-adult living donor liver transplantation using a right lobe graft. Methods The clinical data of 21 pairs of donor and recipient who underwent right lobe living donor liver transplantation from April 2007 to May 2009 at Beijing Youan Hospital were analyzed retrospectively. Biliary anastomoses consisted of 10 single right hepatic duct to common hepatic duct anastomoses, 5 donor double branched ducts to recipient double branched ducts anastomoses, 5 single anastomoses between a donor double branched duct which had been converted to a single duct by ductoplasty to a single recipient bile duct, and 1 hepaticojejunostomy. A T-tube was inserted through the anterior wall of the common hepatic duct and splinted across the anastomosis in 2 recipients and a Y-tube was used in 1 recipient. Results 4 recipients died during the first post-transplant month. Another recipient received a retransplantation for acute liver necrosis. The remaining recipients were alive. The 1-year survival rate of the recipients was 77.65 %.5 patients developed biliary leakage and 2 patients developed biliary stricture. The 7 biliary complications were treated and cured by further surgical procedures. There was no significant difference in the biliary complications among the three different types of biliary anastomotic groups (x2 = 0. 659,P=0. 719). Conclusion The different types of biliary anastomoses can be used in living donor liver transplantation depending on the situations found in the donors and recipients. Continuous suturing on the posterior wall of the bile duct, interrupted suturing on the anterior wall and microsurgical techniques in biliary reconstruction are effective modalities to minimize biliary complications.
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Objective To explore the specific brain regions involved in Chinese character radicals visualspatial processing,as well as to explore the relationship between visual-spatial identification and Chinese characters radicals identification.To provide an evidence for understanding the underlying neural mechanism of developmental dyslexic.Methods Twelve healthy Chinese fourth and fifth grade children(7 boys and 2 girls,aged from 10 to 11 years old)were chosen from a primary school in Guangzhou.The children were native Chinese speakers and right handed.The subjects participated in two fMRI experiments on a 3.0 T Siemens MR scanner.Two separate block-designed cognitive tasks were devised,one was figure directions judgement task and the other was Chinese characters radical identification task.A single-shot GE-EPI scan sequence were used for fMRI scans.The BOLD fMRI data were collected and were preprocessed and analyzed in SPM2.Results The subjects had longer reaction time during the two experiments tasks than in control states((879±127)ms vs(805±124)ms,P=0.029;(917±144)ms vs(750±101)ms,P＜0.01),and had same response accuracy in both tasks and control states((96±5)% vs(95±8)%,P=0.515;(89±10)% vs(96±6)%,P=0.130).In figure direction judgement experiment,activations were found in bilateral occipital,right superior parietal,right precuneus and right middle frontal cortices.However,different and more extensive regions including left superior parietal,left precuneus,left hippocampus,right thalamus,right caudate cortices and bilateral occipital cortices were involved in identifying the radicals of Chinese characters.Conclusion Right hemisphere was dominant in judging the figure direction,and left hemisphere is dominant in identifying radicals of Chinese characters.These fMRI results show light on underlying partial similar neurophysiological mechanism between judging figure directions and identifying Chinese character radicals.The visual-spatial ability may be essential for Chinese character radical identification.
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Objective To investigate the safety and efficacy of sirolimus-based immunosuppression therapy in liver transplantation. Methods Immunosuppression in 12 patients after liver transplantation was converted from calcineurin Inhibitor (CNI) to sirolimus for at least one month. Safety evaluations consisted of regular measurements of serum creatinine and liver enzymes to assay the restoration of CNI related nephrotoxicity and hepatoxicity. Efficacy analysis was performed by biopsy to evaluate the rejection incidence. Results The patients were followed up for a mean of 37 months after liver transplantation. Immunosuppression therapy was converted after a mean of 11 months. The average sirolimus conversion therapy period was 14 months. Among 12 patients experiencing sirolimus conversion therapy, 6 did not develop rejection on biopsy. Among 7 patients with CNI-related nephrotoxicity, 5 showed the restoration of serum creatinine to normal but1 developed albuminuria. All four patients with mild liver dysfunction did not improve. Conclusion The conversion from CNI to sirolimus is treatable based on liver biopsy in some selected liver transplant recipients,