Predictive values of ALBI and EZ-ALBI scores for early survival of recipients with liver failure after liver transplantation / 器官移植

Objective To evaluate the predictive values of albumin-bilirubin (ALBI) and easy albumin-bilirubin (EZ-ALBI) scores for early survival (postoperative 3 months) of recipients with liver failure after liver transplantation. Methods Clinical data of 137 recipients diagnosed with liver failure and underwent liver transplantation were retrospectively analyzed. The optimal cut-off values of preoperative ALBI, EZ-ALBI and MELD scores to predict early survival of recipients with liver failure after liver transplantation were determined by the area under the receiver operating characteristic (ROC) curve. The risk factors of early death of recipients with liver failure after liver transplantation were identified by univariate and multivariate Cox regression analyses. The effects of different ALBI and EZ-ALBI levels upon early prognosis of recipients with liver failure after liver transplantation were analyzed. Results The optimal cut-off values of ALBI, EZ-ALBI and MELD scores were 0.21, -19.83 and 24.36, and the AUC was 0.706, 0.697 and 0.686, respectively. Univariate Cox regression analysis showed that preoperative alanine aminotransferase(ALT)≥50 U/L, aspartate aminotransferase(AST)≥60 U/L, ALBI score≥0.21 and EZ-ALBI score≥-19.83 were the risk factors for early postoperative death of recipients with liver failure after liver transplantation (all P < 0.05). Multivariate Cox regression analysis demonstrated that preoperative ALBI score≥0.21 was an independent risk factor for early postoperative death of recipients with liver failure after liver transplantation (P < 0.05). According to the optimal cut-off value of ALBI score, the early survival rates in the ALBI < 0.21 (n=46) and ALBI≥0.21(n=91) groups were 93.5% and 64.8%, and the difference was statistically significant (P < 0.05). According to the optimal cut-off value of EZ-ALBI score, the early survival rates in the EZ-ALBI < -19.83(n=60) and EZ-ALBI≥-19.83(n=77) groups were 88.3% and 63.6%, and the difference was statistically significant (P < 0.05). Conclusions Preoperative ALBI score is of high predictive value for early survival of recipients with liver failure after liver transplantation, which could be utilized as a reference parameter for selecting liver transplant recipients.

Predictive value of platelet-albumin-bilirubin score for tumor recurrence after liver transplantation for hepatocellular carcinoma / 中华器官移植杂志

Objective:To explore the predictive value of platelet-albumin-bilirubin(PALBI)score for tumor recurrence after liver transplantation(LT)in patients with hepatocellular carcinoma(HCC).Methods:Clinical data were retrospectively reviewed for 102 HCC patients undergoing LT from January 2010 to December 2020.The predictive value of PALBI score for tumor recurrence after LT and the risk factors for tumor recurrence after LT were examined by receiver operating characteristic(ROC)curve, Kaplan-Meier method and univariate/multivariate Cox regression.Results:The optimal cutoff value of preoperative PALBI score for predicting recurrence was -3.82 with ROC curve, Youden's index 0.317 and area under the ROC curve 0.679.Survival analysis was performed using a PALBI cutoff value of -3.82 as boundary group.The results showed that significant differences existed in 1/3/5-year tumor recurrence rates(17.9% vs.50.0%, 26.9% vs.62.5%, 29.5% vs.62.5%)after low PALBI and high PALBI( P<0.05 for all). Univariate analysis indicated that preoperative tumor maximal diameter, tumor number, Milan criteria, alpha fetoprotein(AFP)level, microvascular invasion, portal venous tumor thrombus, and PALBI score were significantly associated with postoperative tumor recurrence( P<0.05 for all). And multivariate analysis revealed that Milan criteria, AFP level and PALBI score were independent risk factors for postoperative tumor recurrence( P<0.05). Conclusions:Preoperative PALBI score offers some predictive value for postoperative tumor recurrence in HCC patients post-LT.When preoperative PALBI score ≥-3.82 in HCC patients, postoperative tumor recurrence rate is relatively high.

Liver transplantation for treatment of hilar cholangiocarcinoma with a report of three Cases / 国际外科学杂志

Objective To investigate the feasibility of liver transplantation in the treatment of inoperable hilar cholangiocarcinoma. Methods The clinical data for 3 patients with unresectable hilar cholangiocarcinoma who underwent liver transplantation in the Department of Hepatobiliary Surgery of Fuzhou General Hospital of People's Liberation Army from January 2006 to December 2012 were retrospectively analyzed. The patients were followed up by phone, outpatient service, and hospitalization. The starting point of the follow-up was the operation date. The patients death was the end point. The clinical and pathological features, postoperative survival, tumor recurrence, and prognostic factors were observed. The follow-up deadline was December 2017. Results All 3 patients underwent classical orthotopic liver transplantation using retrograde perfusion through inferior vena cava and no perioperative deaths occurred. All 3 patients were followed up for 10 to 132 months. During the follow-up period, of 1 patient who died of tumor recurrence, the pathological TNM stage was T4a N1 M0, and both had Union for International Cancer Control stage Ⅳa, and the tumor-free survival time was 3 months, and the survival time was12 months. Of 1 patient who died of other causes, the pathological TNM stage was T3N1 M0, and both had Union for International Cancer Control stage Ⅲ, and the tumor-free survival time was 12 months, and the survival time was12 months. One case as of the end of follow-up, the patient has survived for 132 months, the pathological TNM staging was T2a NOM0, and both had Union for International Cancer Control stage Ⅱ. Conclusions Lymph node positive and high pathological TNM stage were poor prognosis factor for hilar cholangiocarcinoma who underwent liver transplantation. Patients with early hilar cholangiocarcinoma who don't have lymph node metastasis are expected to benefit from liver transplantation.

Clinical value of the conventional liver function test in liver reserve function assessment for large hepatocellular carcinoma / 国际外科学杂志

Objective To study the clinical value of the conventional liver function tests in liver reserve function assessment for large hepatocellular carcinoma.Methods The clinicopathological data of 113 patients with ChildPugh A hepatocellular carcinoma who underwent radical resection with large hepatocellular carcinoma in the Department of Hepatobiliary Surgery of Fuzhou General Hospital of People's Liberation Army from January 2014 to December 2016 were retrospectively analyzed.The patients were divided into two groups according to the recovery of postoperative liver function,which 105 patients recovered well and 8 patients had hepatic decompensation among them.The liver function index of two groups were analyzed.Measurement data with approximately normal distribution were represented by and groups were compared using t test;measurement data with skewed or uneven disstribution were represented by M (range)and group werecompared using Man-Whitney U test;count data were compared using Fisher exact test;risk factors for postoperative liver dysfunction were analyzed using Logistic single factor and multivariate and ROC curve were drawn.Results Preoperative prothrombin time,international standardization ratio,platelet,prealbumin,total bilirubin,alkaline phosphatase,γ-glutamyl transpeptidase comparison between the two groups were statistically significant (Z =-1.983,-2.180,-2.608,-2.007,-3.577,-2.228,-2.575,P ＜ 0.05).Logistic univariate analysis showed that platelet,total bilirubin and prealbumin were the risk factors for the recovery of liver function of radical resection hepatic decompensation with large hepatocellular carcinoma.Logistic multivariate regression analysis showed that preoperative high total bilirubin and low preabumin were independent risk factors of radical resection hepatic decompensation with large hepatocellular carcinoma.Logistic univariate analysis showed that preoperative high total bilirubin and low prealbumin were not risk factors of radical resection liver failure with large hepatocellular carcinoma.The area under the curve of total bilirubin was 0.880,P =0.000,95％ CI:0.808-0.953,the sensitivity was 87.5％,specificity was 84.8％ and the area under prealbumin curve was 0.769,P =0.011,95％ CI:0.648-0.891,sensitivity was 75.2％,specificity was 77.5％ by the ROC curve.The best threshold of total bilirubin and prealbumin after radical resection with large hepatocellular carcinoma were 17.55 μmol/L and 0.18 g/L respectively by the ROC curve.Conclusion The Child-Pugh A patients in radical resection hepatic decompensation with large hepatocellular carcinoma recover well when the preoperative liver function is as follows:total bilirubin ＜ 17.55 μmol/L and prealbumin ≥0.18 g/L.

The expression of GHET1 in hepatocellular carcinoma and its effect on prognosis of the patients / 中华肝胆外科杂志

Objective To investigate the expression of long-chain non-coding RNA gastric cancer high expression transcription factor 1 (GHET1) in hepatocellular carcinoma (HCC) and the correlation with prognosis,cell proliferation,migration and invasion.Methods 20 HCC patients who underwent surgery from Fuzhou General Hospital of Chinese People's Liberation Army from March to May 2016 were included.The HCC tissue and adjacent normal tissue of 182 patients from June 2012 to December 2013 were retrospectively collected.According to the median value of GHET1 expression,it was divided into GHET1 high expression group and low expression group,91 cases each.Huh7 and HepG2 cells were divided into:blank control group (Con) with serum-free medium,siRNA-GHET1 group transfected with siRNA-GHET1,and negative control group (siRNA-NC) transfected with negative control sequence.The expression of GHET1 was detected by real-time fluorescence quantitative polymerase chain reaction,and the effect of GHET1 on HCC cells was analyzed by CCK-8,Transwell assay and Western blot.Results Compared with adjacent normal tissue,the relative expression of GHET1 mRNA in HCC tissues was significantly increased.Compared with LO2 cells,the mRNA expression of GHET1 in Huh7 and HepG2 cells was higher (P＜0.05).The GHET1 high expression group had tumor＞5 cm,vascular invasion,AFP＞400 μg/L,Edmonson grade Ⅰ,and the tumor-free ratio was lower in the expression group (P＜0.05).Survival analysis showed that HCC patients with high GHET1 expression had a poorer prognosis than patients with low expression.Multivariate Cox regression analysis showed that high expressed GHET1,vascular invasion (HR=2.067,95％ CI:1.350 to 3.162),and without tumor capsule are independent predictors of recurrence in HCC patients.After transfection with Huh7 and HepG2 cells,the proliferation of siRNA-GHET1 group was significantly decreased comparing with Con and siRNA-NC groups.Compared with siRNA-NC group,the migration and invasion ability of siRNA-GHET1 group decreased,and E-cadherin expression increased.The expression of fibronectin and vimentin decreased,and the difference was statistically significant (P＜0.05).Conclusions The expression of GHET1 in HCC tissue is higher comparing with normal tissue,which increases the proliferation,migration and invasion of hepatoma cells.It is an independent predictor of prognosis in HCC patients and a potential target for clinical treatment.

Biliary complications and recovery of liver function after liver transplantation from citizen's deceased donors versus standard criteria donors / 中华肝胆外科杂志

Objective To investigate the biliary complications and recovery of liver function after liver transplantation from citizen's deceased donors (DCD) versus standard criteria donors (SCD).Method The clinical data of 269 patients who underwent orthotopic liver transplantation from January 2009 to December 2016 at the Fuzhou General Hospital were collected.197 livers were from SCD and 72 from DCD.Propensity score matching (PSM) was used to compare the biliary complications and recovery of liver function after liver transplantation in the two groups.Results PSM matched 61 pairs of patients.There were 10 (16.4％) and 8 (13.1％) biliary complications in the DCD and the SCD groups,respectively,with no significant difference between them (P ＞ 0.05).The recovery of liver function was significantly delayed in the DCD group when compared with the SCD group.The levels of ALT,AST,GGT and AKP in the DCD group were significant different on the postoperative first,third,fifth,seventh and fourteenth day (P ＜ 0.05).At 30 days after surgery,there was no significant difference in liver function between the two groups.Conclusions Liver grafts from DCD had a significant impact on the recovery of liver function.When compared with the SCD group,the DCD group recovered significantly slower in liver function.There was no significant increase in the incidence of biliary complications.

The influence of different sequences of revascularization on ultrastructural changes in the graft liver and the recovery of short-term liver function after liver transplantation with retrograde reperfusion / 中华肝胆外科杂志

Objective To study the influence of sequential and contemporaneous revascularizations of portal vein and hepatic artery during liver transplantation with retrograde reperfusion on the ultra-structural changes in intrahepatic cholangiocytes of the graft with liver ischernia reperfusion injury,and the recovery of short-term liver function after operation.Methods The clinical data of 97 patients who underwent orthotopic liver transplantation (OLT) using retrograde reperfusion via the vena cava (IVC) in our hospital from January,2009 to June,2013 were retrospectively analyzed.Using to the different sequences of revascularization,97 digible patients were divided into three groups:group R-IPR:the initial arterial revascularization group (35 patients);group R-IAR:the initial portal revascularization group (30 patients);group R-SAPR:simultaneous reperfusion group (32 patients).Liver function,coagulation function and other related parameters were continuously monitored for the transplant recipients at the following time points:1 day before operation,2 hours after reperfusion and on postoperative Day 1,2,5 and 7.The ultra-structure of intrahepatic bile duct epithelial cells at 2 hours after reperfusion were studied by transmission electron microscopy and morphometric analysis of mitochondria was performed by the computer image analysis system.Results The levels of ALT,GGT and TB in group R-IAR were significantly lower than those in group R-IPR and group R-SAPR (P＜0.05).There were no significant differences among the three groups in other parameters that reflected liver function at any time point (P＞0.05).In group R-IAR and group R-IPR,mitochondrial swelling of bile duct epithelial cells was more severe than that in group R-SAPR.There were significant differences among the three groups in the mitochondrial average area and the average perimeter (P＜0.05).Mild swelling of mitochondria in hepatic cells was observed in group R-IAR and group R-IPR.There was no significant difference in the mitochondrial average area and average perimeter between the two groups (P＞0.05).Mitochondrial swelling of hepatic cells was most severe in group R-SAPR.There were significant differences in the average area and average perimeter of hepatic cell mitochondria between group R-SAPR and the other two groups (P＜0.05).Conclusion During liver transplantation with retrograde reperfusion,initial arterial revascularization reduced the short-term levels of transaminases,improved early liver function after operation and protected the intrahepatic bile duct against the second ischemia reperfusion injury.

Study on complex impedance properties of human lung tissue / 生物医学工程学杂志

In order to study the variation of complex impedance and characteristic parameters on human normal and tumor lung tissue during the extracorporeal time, we established a real part-imaginary part chart of complex impedance on lung tissue which provided the basic theory and the reference data for research on elementary medicine and clinical diagnosis of lung cancer and meanwhile provided prior information for electrical impedance tomography (EIT) research. In the experiment carried out in our laboratory, when operation was finished, we kept the lung cancer tissue and normal tissue neatly separated into the cylindrical testing cavities and kept the temperature and humidity at expected values. Then the measurements of complex impedance property are performed at frequency from 1 000 Hz to 30 MHz using 4294A impedance analyzer of Aglient Company. With time changing, the results showed that there was a significant change occurring on the complex impedance of human normal and tumor lung tissue. However, the impedance of normal lung tissue is greater than that of tumor lung tissue. We consider that this change should be related to the change in extracellular fluid, intracellular fluid and cell membrane.

Research on respiration course of human at different postures by electrical impedance tomography / 生物医学工程学杂志

In this paper, the respiration courses of human at different postures are reconstructed by electrical impedance tomography (EIT). Conjugate gradient least squares (CGLS) algorithm is applied to reconstruct the resistivity distribution during respiration courses, and the EIT images taken from human at flat lying, left lying, right lying, sitting and prone postures are reconstructed and compared. The relative changes of the resistivity in region of interest (ROI) are analyzed to evidence the influences caused by different postures. Results show that the changes in postures are the most influential factors for the reconstructions, and the EIT images vary with the postures. In human at flat-lying posture, the left and right lungs have larger pulmonary ventilation volume simultaneously, and the EIT-measured data are of lower variability.

A hybrid reconstruction method in electrical impedance tomography based on GMRES and Tikhonov regularization / 生物医学工程学杂志

Electrical impedance tomography (EIT) is a technique for reconstructing the conductivity distribution of measured field owing to its characteristics of being non-homogeneous, of injecting current at the boundary of the measured subject,of measuring the.corresponding changes in voltage, and of reconstructing the image of the subject consequently. However, the limited measurement data of EIT, and the serious nonlinearity of the field result in ill-posed problem, and the resolution of reconstructed image is poor. To solve the problem, a new hybrid algorithm is herein proposed. The method combines the characteristics of Krylov subspace and Tikhonov regularization, which can improve the real time performance, the quality and robustness of reconstructed image.

Mixed Programming Strategy of VC++ and Matlab in Images Reconstruction Based on Electrical Impedance Tomography / 医疗卫生装备

Obiective To realize real-time data processing in lung ventilation reconstruction based on electrical impedance tomography(EIT). Methods The image reconstruction algorithms, plotting functions and matrix calculations are dynamic transferred with Matlab C++, Mathtools and VC++ to meet the requirements of data processing and imaging in real time.Results Image reconstruction and real-time data processing were realized successfully in lung ventilation based on EIT. Conclusion It provides a new strategy for real-time data processing of image reconstruction by EIT.

Study on double feedback current source for biologic impedance measurement / 生物医学工程学杂志

A double feedback current source for biologic impedance measurement is designed in order to solve the problem on the poor constant-current characteristic under higher frequency and meet the request for the ability to eliminate the direct current signal. The voltage controlled current source based on the second generation current conveyor theory is presented, which has good output impedance and anti-direct current characteristics by using the direct current feedback unit and input buffer. The closed loop control of current amplitude is implemented by means of the direct digital synthesizer and multiplication demodulation technique, which improves the constant-current characteristic of the current source.

Application of image identification technology to the analysis system of gene chip and image processing by VB / 生物医学工程学杂志

Because of the anomalous points distributed in the image, gene chip is hard to be distinguished effectively in fact. This article offers some arithmetic of image processing by VB such as increasing contrast, self-adapt thresholds, two-values and searching for spares and disperse templet which can distinguish all kinds of gene chip quickly, well and truly.

Electrical Impedance Tomography System for lung function monitoring / 医疗卫生装备

A complete Electrical Impedance Tomography system that can monitor lung function is introduced in this paper. The master PC is responsible for visual control and image reconstruction, while DSP carries out tasks such as electrode selection, data acquisition and data communication with the master. Based on the DDS technique, the exciting signal source has high accuracy, and the data can be acquired by phase-sensibility demodulation. The vivo experiment proves that gravity exerts an effect on the distribution of intrapulmonary ventilation, and shows that the Electrical Impedance Tomography is able to monitor lung circulation and check pathological changes.

Pulmonary Electrical Impedance Tomography System / 医疗卫生装备

It is very important for pulmonary disease treatment to monitor the pulmonary function continuously. In this paper, the hardware of electrical impedance tomography (EIT) system is designed, and simulative model of human thorax is established for image reconstruction based on Landweber pre-iteration method. Compared with linear back projection, the method above results in the better image reconstruction with little trailing and increased speed of real-time reconstruction.

Electrical impedance tomography system for body complex impedance / 医疗卫生装备

A master-slave electrical impedance tomography (EIT) system for body complex impedance based on digital signal processor (DSP) is designed in this paper. Used as the master computer, a PC performs the image reconstruction and display on time, while DSP carries out such tasks as electrode selection, data acquisition and data communication with the master. Based on DDS technique, the signal generator can create the sine wave signals, and it's amplitude, frequency and phase can be continuously adjusted. The designed feedback unit can improve the linearity and the stability of the voltage-controlled current source effectively. Undersampling technology and digital demodulation technology are used in this system in order to attain the information of real and imaginary components of the body complex impedance. Back projection method is adopted to reconstruct the image in this system. Experimental results show that this system improves the data acquisition speed and the image resolution.