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Objective:To explore the value of diffusion tension imaging (DTI) in the evaluations of hepatic ischemia-reperfusion injury (WIRI) regulation of liver regeneration after partial hepatectomy.Methods:Thirty healthy adult male New Zealand white rabbits were randomly divided into five groups of control and 10/20/30/40 min warm ischemia time (A0-A4)( n=6 each). Routine magnetic resonance (MR) and diffusion tensor imaging (DTI) were performed at 6 h, 3 d, 7 d, 14 d, 30 d post-keratectomy. The serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) were measured at Day 30 post-keratectomy. The levels of malondialdehyde (MDA), myeloperoxidase (MPO), superoxide dismutase (SOD), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and proliferating cell nuclear antigen (PCNA) in frozen liver tissues were examined and histopathological examination was performed. The values of apparent diffusion coefficient (ADC), fractional anisotropy (FA) and liver volume were measured and liver regeneration rate (LRR) was calculated. Repeated measurement analysis of variance was employed for comparing the difference of DTI and LRR in different groups at different follow-up times. One-way analysis of variance was utilized for comparing the differences of DTI and LRR between groups at the same follow-up time. Pearson or Spearman correlation analysis was employed for evaluating the correlation between DTI, LRR and biochemical parameters. Results:The interaction between time and warm ischemic factor ( P<0.05) and the effect of both alone ( P<0.001) had statistically significant effects on ADC values. FA value and LRR interaction were not significant between time and warm ischemic factor. However, the dominant effect of time factor was significant ( P<0.05). A significant positive correlation existed between ADC value and LRR in the same warm ischemia group ( P<0.01). FA and LRR were negatively correlated ( P<0.05), except for A3 group. FA had a weak correlation with IL-6 at Day 30 post-operation. Conclusions:DTI can non-invasively and quantitatively evaluate the effect of hepatic WIRI on liver regeneration after partial hepatectomy in rabbits. A certain degree of WIRI (≤30 min) can promote liver regeneration after partial hepatectomy. The longer warm ischemia time, the more obvious promotion effect. However, the promotion effect declines significantly after 30 min.
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Objective To quantitatively evaluate the diagnostic value of blood oxygen leveldependent (BOLD) MRI in the diagnosis of different degrees of liver warm ischemia-reperfusion injury (WIRI) in rabbits and evaluate the intervention effect of liposomal prostaglandin E1 (Lipo-PGE1).Methods Seventy healthy adult New Zealand white rabbits were randomly divided into sham -operated group (A0),thermal ischemic groups (A1～A3) and intervention groups (A4～A6).All experimental rabbits were scanned by routine MR and BOLD MRI after 6-hour reperfusion.R2* images were calculated by two radiologists.The levels of alanine aminotransferase (ALT),asparate aminotransferase (AST) and lactate dehydrogenase (LDH) were examined.And liver pathological sectioning was performed.All data were processed by one-way,Spearman's correlation and receiver operating characteristic curve analyses.Results The intraclass correlation coefficient (ICC) was 0.805 of two measurements suggesting that the repeatability of the outcome was decent.R2* values among sham-operated,thermal ischemia and intervention groups were statistically significant (P＜0.05).R2 * values in sham-operated and ischemia groups were statistically significant (P＜0.05).As warm ischemia time elapsed,R2* value showed a rising trend.R2* values in sham-operated and intervention groups were statistically significant (P＜0.05).R2* values of sham-operated group at the same timepoint of thermal ischemia and intervention groups were statistically significant (P＜0.05).Under the same ischemic time,R2* values of intervention groups were smaller than those of thermal ischemia groups.With the prolongation of ischemia time,reduction of R2* values became more pronounced.However,it did not reach the level of A0 group.R2* values were significantly positively correlated with ALT,AST and LDH (r＞0.5,P＜0.05).ROC analysis indicated that R2* had an excellent diagnostic performance.Conclusions BOLD MRI may be applied for noninvasive assessment of liver ischemia-reperfusion injury in different degrees.Lipo-PGE1 alleviates ischemia -reperfusion injury and BOLD MRI can evaluate the relieving degree of Lipo-PGE1.
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Objective To evaluate the feasibility and diagnostic value of diffusion tensor imaging (DTI) in hepatic warm ischemia-reperfusion injury (WIRI) in rabbits.Methods Fifty healthy adult New Zealand white rabbits were randomly divided into control group (n =10) and four experimental groups (n =10 per group) according to different periods of hepatic warm ischemia.Four experimental groups were given hepatic arteries and portal veins clamp for 10,20,30,40 min respectively and reperfusion for 6 h to establish the rabbit model of hepatic WIRI.The control group was given perihepatic ligament separation but no vessel clamp.All the rabbits were scanned with MAGNETOM Trio Tim 3.0T MRI DTI MR Siemens and the data were collected by Nero 3D Siemens.The apparent diffusion coefficient (ADC),and fractional anisotropy (FA) values were separately measured by 2 qualified radiologists.Then intra class correlation coefficient (ICC) was used to check their consistency and repeatability.The liver function of rabbits was tested after MR examination,and pathologic examination was performed after sacrifice.Spearman correlation analysis was used to evaluate the correlation between ADC value and liver function parameters.The ROC curve was used to evaluate the diagnostic value of ADC value.Results The ADC and FA values of the two observers were consistent,with ICC values of 0.824 and 0.807,respectively.There were significant differences in ADC value between the control group and 4 experimental groups [P =0.000,(1.42 ± 0.15) 10-3mm2/s,(1.34± 0.11) 10-3mm2/s,(1.22 ± 0.20) 10-3mm2/s,(1.19 ± 0.13) 10 3mm2/s,(1.83 ±0.20) 10-3 mm2/s respectively],but there was no significant difference in the FA value among groups (0.40 ± 0.04,0.38 ± 0.03,0.41 ± 0.04 and 0.37 ± 0.04,respectively;P＞0.05).The differences in serum alanine aminotransferase (ALT),aspartate aminotransferase (AST),lactate dehydrogenase (LDH),the total superoxide dismutase (SOD),malondialdehyde (MDA) and myeloperoxidase (MPO) were statistically significant (P＜0.01).There was a negative correlation between ADC value and ALT,AST,LDH,MPO and MDA (P＜0.05),and a positive correlation between ADC value and total SOD (P =0.000).ADC value has a higher diagnostic efficacy to evaluate hepatic WIRI in T1,T2,T3,T4 group and the AUC was 0.985,0.900,0.970 and 0.833 respectively.Conclusion DTI can quantitatively and noninvasively evaluate the changes of liver water molecule diffusion caused by hepatic I/R injury in rabbits,and the ADC value could dynamically evaluate the degree of hepatic WIRI in rabbits.
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Objective To prospectively investigate the changes of hepatic CT perfusion parameters and the correlation with serum amylase (AST,ALT,LDH,SOD,MAD and MPO) in rabbits hepatic warm ischemia-reperfusion injury (WIRI) models undergoing different warm ischemia time.Methods New Zealand rabbits underwent 40 min and 60 min of right posterior lobe ischemia followed by 6 h reperfusion (n =10 each),named as W1,W2 groups respectively.Ten rabbits served as normal controls (W0).All the rabbits were given CT perfusion protocol.The perfusion indices of arterial flow (AF),portal flow (PF),and perfusion index (PI) were measured after obtaining perfusion index maps on the workstation.Blood samples were taken from the rabbit ear vein to measure the levels of ALT,AST,and LDH.The contents of SOD,MDA and MPO in liver tissues were determined,and histopathological changes were examined.Results Significant differences were found between the group W0,W1and W2 in the infarcted areas and non-infarcted areas by PI and AF and PF (P＜0.05),except that in the infarcted areas the AF value betwween the group W0 and W2,the PF value between the group W1 and W2 had no statistical difference,and in the non-infarcted areas the difference of the PI and AF value betwween the group W1 and W2,the PF value between the group W0 and W2 was not significant eihter.In the infracted area,PI and PF of WIRI groups positively correlated with biochemical parameters.AF was not correlated with biochemical parameters.In the non-infracted area,PI,AF was correlated with biochemical parameters,PF was not correlated with biochemical parameters.The PI and PF value could efficiently diagnose rabbit hepatic WIRI in the infarcted area (for PI,AR and PR,AUC=0.965,0.736 and 1.00 respectively),and PI and AF value could efficiently diagnose rabbit hepatic WIRI in the non-infarcted area (for PI,AF and PF,AUC=0.938,0.993 and 0.618 respectively).Conclusion CT perfusion can dynamically monitor the hemodynamic changes after WIRI and may suggest potential microcirculatory disturbances.
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Objective To investigate the applied value of 3.0T blood oxygen level dependent(BOLD) MRI in the diagnosis of hepatic warm ischemia-reperfusion injury (WIRI) in rabbits.Method Twenty healthy adult New Zealand white rabbits were randomly divided into two groups by using the stochastic indicator method.In 10 rabbits enrolled in the treatment group,the model of hepatic WIRI after ischemia for 30 min followed by 6-h reperfusion was established,and the remaining 10 rabbits were chosen as the normal control group and were not subjected to any surgery.All the experimental rabbits were scanned by 3.0T MRI and BOLD MRI.T2* values were separatelymeasured by 2 considered radiologists and the R2* values were calculated (R2* =1/T2*).Thereafter,the intra-class correlation coefficient (ICC) was used to check the consistency.All rabbits were killed after MR examination and routine assays were performed for testing the levels of alanine aminotransferase (ALT),aspartate aminotransferase (AST),and lactate dehydrogenase (LDH) in the ear vein blood serum.The contents of total superoxide dismutase (SOD),malondialdehyde (MDA) and myeloperoxidase (MPO) in liver tissues were determined,and histopathological changes were examined.The correlation between R2 * value and clinical test index was evaluated by Spearman correlation analysis.The R2* value was evaluated by ROC curve.Result ICC =0.87 ＞ 0.75,suggesting that the repeatability of the outcome is good.Compared to the normal control group,R2*value of the warm ischemia-reperfusion injury group was increased (P =0.000).The differences in ALT,AST,LDH,total SOD,MDA and MPO between the two groups were statistically significant (P＜0.01).R2* values were significantly positively correlated with ALT,AST,LDH,MDA and MPO (r＞0.6,P＜0.05),and there was a significantly negative correlation between R2* and total SOD (r=-0.663,P=0.001).The R2* value could efficiently diagnose rabbit hepatic WIRI (AUC =0.99) with the best diagnostic threshold being 116.40 Hz.Conclusion 3.0T BOLD MRI can accurately and non-invasively assess the pathophysiologic changes caused by WIRI.It is of great importance for 3.0T BOLD MRI in dynamically monitoring and evaluating hepatic WIRI.
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Objective To detect the volume changes of cerebral gray and white matter in patients with maintaining hemodialysis using voxel-based morphometry(VBM) and to correlate these changes with cognitive function. Methods Forty-two patients with maintaining hemodialysis and 41 age and sex matched normal subjects were recruited in this study. MMSE was obtained to evaluate their neuropsychiatric conditions. Whole brain high-resolution T1WI was performed on 3.0 T MR scanner in both patients and normal controls. The data were analyzed by VBM based on SPM8, using analysis of functional neuroimages (AFNI) software package with the Monte Carlo simulation method(AlphaSim method) for multiple cluster level comparisons correction. Independent sample t test analysis was used to compare the volume of gray and white matter between the patients and normal controls. In addition, Stepwise multiple linear regression analysis was performed to explore the correlation between the voxel value of cerebral volume changes area and dialysis duration and clinical laboratory examination, and Spearman correlation analysis was used for the correlation between the left insula voxel values and neuropsychological test scores. Results Compared with normal controls, patients showed significantly decreased volume in the grey matter of the right putamen, the left putamen, the left insula (numbers of voxel in clusters were 455, 561, 162, t=-9.5681,-5.9516,-5.7185,P<0.001, AlphaSim-corrected). There was negative correlation between decreased grey matter volume of the right putamen[(0.53 ± 0.12)mm3]and the left putamen[(0.48 ± 0.12)mm3] and dialysis duration [19.0(1.5-114.0)months] (r=-0.330,-0.307,P<0.05). MMSE score of patients[29(21-30)score] was significantly lower than normal controls[30(28-30)score] (Z=-30.58,P<0.01). Decreased grey matter volume of the left insula [(0.39 ± 0.12) mm3] was positively correlated with MMSE(r=0.320, P<0.05). Conclusions The patients with maintaining hemodialysis show grey matter atrophy which is associated with neurocognitive dysfunction. Dialysis duration may be an important risk factor for decreased gray matter in patients with maintaining hemodialysis.
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Objective To evaluate and compare liver regeneration between normal donors and recipients at the different stages after right lobe adult living donor liver transplantation (LDLT) using MSCT.Method Sixty-eight living donors and 63 recipients without complications were included in this study.We did CT volumetric measurement of the liver by using IQQA-Liver workstation.The relationship between graft volume measured by preoperative MSCT and intraoperative actual graft volume was evaluated.The liver regenerative ratio at different stages of donors and recipients after LDLT was calculated and compared.Result Preoperative measurement of total liver and grafts resulted in a mean volume of (1366.99 ± 234.75) cm3 (standard deviation) and (862.73 175.94) cm3 (VCT-right),respectively.Intraoperative volume of the grafts was (654.46 ± 151.23) ml (Vintraop).Corresponding pre-and intraoperative data were correlated significantly each other (r =0.795,P=0.000).Vintraop can be calculated with the equation:Vintraop =64.949 + 0.683 VCT-right.There was significantly difference in LRR between donors and recipients at 0.5,1,3 and 6 months after LDLT (P＜ 0.05).Conclusion The patterns of normal liver regeneration between donors and recipients after LDLT are different.The liver of donors regenerates more significantly and quickly than recipients.Liver volumetric measurement by using MSCT is a valid modality to evaluate liver regeneration after LDLT.
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Objective To evaluate the impact of donor age on early remnant liver function and regeneration after right lobe adult living donor liver transplantation (LDLT) donation.Methods 43 living donors were divided into 2 groups:donor age ＞ 50,n =8,and donor age ＜ 30,n =35.Alanine aminotransferase (ALT),aspartate aminotransferase (AST),total bilirubin (TB) and liver regenerative ratio (LRR) of donors between the 2 groups were compared.Results There were no significantly different in ALT,AST and TB on days 1,2,3,5 after LDLT between the 2 groups (respectively t =0.147,1.030,-0.903,0.013,0.043,1.362,0.817,0.003,1.121,0.241,1.061 and 0.943,all P＞0.05).There was significant difference between LRR on day 7 (t =-0.965,P =0.042),but the difference was not statistically significant in LRR when evaluated on day 15 after LDLT (t =0.585,P =0.385).Conclusions Remnant liver regeneration on the first week is reversely affected by donor's age after hepatectomy,while the influence of age decreases significantly after 2 weeks.
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Objective To evaluate graft regeneration and influencing factors after right lobe adult living donor liver transplantation (LDLT) using MSCT.Method Sixty-three living recipients were included in this study.We measured graft volume periodically by using MSCT and IQQA-Liver workstation.The liver regenerative ratio (LRR) of different stages of recipients after LDLT was calculated and compared,and stepwise regression analysis was done to set up the regression equation.Result Within 0.5 month after LDLT,graft volume was increased rapidly,and LRR reached maximum [(106.11 + 30.90)％],then decreased slowly.There was significant difference in LRR among 0.5,1 month and 3,6 months after LDLT (P＜0.05).The following factors,including whether the graft containing middle hepatic vein or not,age and sex of recipients,had no significant influence on LRR after LDLT (P＞0.05).The status of liver function of recipients preoperatively had significant influence on LRR 0.5 month after LDLT (P＜0.05).There was significantly negative correlation between the graft volume and LRRs of recipients at different stages after LDLT (P ＜ 0.05).Regression equation could be derived.Conclusion Most evident graft regeneration occurs in early stage after adult LDLT.There are many and different factors influencing graft regeneration at the different stages after LDLT.Graft volumetric measurement by using MSCT is a valid modality to evaluate graft regeneration after LDLT.
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Objective To evaluate the impact of donor age on graft short-term outcome after right lobe adult living donor liver transplantation (LDLT).Method Thirty living recipients were divided into 2 groups according to donor age:older donor group (O group,donor age ＞50,n =5) and younger donor group (Y group,donor age ＜30,n =25).Alanine transarninase (ALT),aspartate transaminase (AST),total bilirubin (TB),prothrombin time (PT) on the postoperative day 1 to 5 and graft liver regenerative ratio (LRR) on the postoperative month 0.5,1,3,and 6 between 2 groups were determined and compared.Result TB on postoperative day 1,2,3,4 and 5 was significantly higher in O group than in Y group there were significant differences between two groups (P＜0.01).There was no significant difference of other liver function parameters 2 groups (P ＞ 0.05).There was no significant difference in LRRs on the postoperative month 0.5,1,3 and 6 months postoperatively between 2 groups after LDLT (P＞0.05).Conclusion Although allografts from older donors in LDLT have prolonged jaundice than those of their younger counterparts,after strictly preoperative evaluation,donor age has little effect on short-term outcomes of graft after LDLT.
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Objective To evaluate donor remnant liver regeneration and influencing factors at different stages after right lobe adult living donor liver transplantation (LDLT) using multi-slice spiral computed tomography (MSCT).Methods 68 living donors were included in this study,We did CT volumetric measurement of the liver by using IQQA-Liver workstation.Liver regenerative ratio (LRR) at different stages of donors after LDLT were calculated and compared,correlation coefficient and stepwise regression analysis were calculated.Results The difference between LRRs at different stages after LDLT were significant (F =3.323,P =0.009),there were significant difference between LRR of 7-day and 1-month,3-month (respectively t =-2.065,-2.214,all P ＜ 0.05).The inclusion of middle hepatic vein and donor gender had no influence on LRR (respectively t =0.600,-0.622,1.464,0.926,-1.228,0.624,-0.688,0.131,all P ＞ 0.05).There were negative correlation between the remnant liver volume and LRRs (P ＜ 0.05).Conclusions MSCT is a valid modality to evaluate remnant liver regeneration after LDLT.Most evident remnant liver regeneration occurs in early stage after adult LDLT.
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ObjectiveTo investigate the changes and significance of urine kidney injury molecule-1(KIM-1) in liver transplant recipients concurrent with early-stage acute kidney injury (AKI).MethodsThe clinical data of orthotopic liver transplantation in 50 cases was retrospectively analyzed.According to the Acute Kidney Injury Network (AKIN) criteria and whether there was AKI for recipients after operation,the recipients were divided into AKI group (27 cases) and non-AKI group (23 cases).Serum creatinine (SCr),urine creatinine (UCr) and urine KIM-1were determined at the scheduled time points,and relationship between urine KIM-1and AK1was analyzed.By using the receiver operating characteristic (ROC) and the area under the curve (AUC),the diagnostic accuracy of urine KIM-1for AKI was evaluated.ResultsThe level of SCr reached the highest in two groups at 24 h postoperation,that in AKI group was significantly higher than in non-AKI group (P＜0.05),and then gradually decreased to the preoperative level.The level of urine KIM-1was significantly increased immediately at the time of portal vein reperfusion in two groups,and that in AKI group reached the peak at 2nd h after portal vein reperfusion,significantly higher than in non-AKI group (P＜0.01),which continued 12 h after the portal vein reperfusion.The results showed that the sensitivity was 82.6％ and the specificity was 88.9％ when the urine KIM-114.19 ng/g Ucr was taken as the cutoff to the diagnosis of AKI two h after portal vein repeffusion.ConclusionThe level of urine KIM-1is a reliable biomarker to diagnose AKI after liver transplantation.The intraoperative changes of urine KIM-1may be helpful to early prediction of AKI,for recipients with preoperative normal renal function.
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Objective To investigate the possible influence of immunosuppressive therapy,including sirolimus (SRL) and calcineurin inhibitors (CNI, tacrolimus), on level of Treg in the liver allo-graft recipients, Methods Forty-seven liver transplant recipients with stable liver function were assessed for at least 2 years, and divided into two groups: one composed of 15 patients receiving SRL,and another, of those receiving CNI (32 patients with tacrolimus). Thirty-eight age-matched healthy subjects (HS) were used as normal controls. We examined the expression of CD4, CD25, and Foxp3 in peripheral blood monouclear cells. Treg of every group was analyzed using Cell Quest software.Results SRL significantly increased the prevalence of CD4+ CD25high T cells, compared with HS and CNI group. The prevalence of CD4+ CD25high T cells of CNIs group was significantly lower than that of HS. The percentage of CD4+ CD25high T cells in the total CD4+ T cells was 1.88 % (1.56 %-2. 60 %), 1. 15 % (0. 57 %-l. 48 %) and 0. 84 % (0. 46 %-1. 45 %) in SRL, NS and CNI group,respectively (P<0. 01 or P<0. 05). Foxp3 was expressed in more than 95 % of CD4 + CD25high T cells and less than 20 % of CD4+ CD25low T cells, whereas not expressed in CD4+ CD25- T cells.Conclusion Different immunosuppressive therapy (SRL or CNI) might have different roles in tolerance induction in liver transplant recipients. Namely, SRL promoted the induction of allo-antigen tolerance, but CNI hampered the progression.
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Objective To evaluate MSCT appearance and impaction of Ⅴ, Ⅷ segments' hepatic venous congestion ( HVC ) on hepatic functional recovery in living donor liver transplantation (LDLT).Methods In this study, 83 patients undergoing LDLT in our hospital were included, all subjects received plain and contrast MSCT examinations at early stage (within 1 month) and later stage (3 months later) after LDLT. MSCT appearance of HVC was recorded, at the same time, gutamic pyruvic transaminase ( ALT),glutamic oxalacetic transaminase (AST), total bilirubin (TB) and prothrombin time (PT) of 1 to 7 days after LDLT between congestion group and non-congestion group were recorded and compared.Results Segments Ⅴ and Ⅷ congestion was identified by after LDLT CT scanning in 20 patients (24. 10% ). Congestion volume and congestion ratio was (218. 25 ± 130. 29) cm3 and 16. 68% ±8. 81%,respectively. HVC often appear as hypoattenuation on plain CT scan and arterial phase, mixed or hyperattenuation on portal vein phase. There was no significant difference of ALT, AST, TB and PT after LDLT between congestion group and non-congestion group (P ＞ 0. 05). Conclusions MSCT is a valuable method to evaluate Ⅴ, Ⅷ segments' HVC after LDLT, most HVC has no impaction on hepatic functional recovery in LDLT patients.
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AIM: To elucidate the relationship of inflammation, coagulation and cholesterol gallstone formation. METHODS: Hamsters were divided into four groups: control group (feeding normal diet), lithogenic diet (LD) 2 weeks group, LD 6 weeks group and LD+aspirin 6 weeks group. Gallstone incidence, antithrombin antigen (AT-Ⅲ:Ag), antithrombin activity (AT-Ⅲ:Ac), thrombin (F-Ⅱa:Ac), plasminogen activator inhibitor activity (PAI:Ac), plasmin activity (Plm:Ac), D-dimer:Ag and C-reactive protein (CRP) in gallbladder bile were observed as read-out parameters. RESULTS: The incidence of gallstones in control group, LD 2 weeks group, LD 6 weeks group and LD+aspirin group were 0%, 20%, 73% and 25%, respectively. AT-Ⅲ:Ag, F-Ⅱa:Ac, D-dimer and CRP in LD 2 weeks group and LD 6 weeks group were significantly higher than those in the control group (P