Combining neutrophil-lymphocyte ratio and platelet-lymphocyte ratio predicted the prognosis of hepatocellular carcinoma patients after liver transplantation / 中华器官移植杂志

Objective:To explore the prognostic values of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio(PLR)and NLR-PLR score for carcinoma(HCC)patients undergoing liver transplantation(LT).Methods:From July 2015 to October 2021, clinical data are retrospectively reviewed for 110 HCC patients undergoing orthotopic LT at Third Hospital of Hebei Medical University.The values of NLR and PLR were calculated.And the cut-off values of NLR and PLR were obtained by receiver operating characteristic (ROC) curve and then grouped according to the cut-off values.Survival time is analyzed by Kaplan-Meier method and Log-rank test performed for inter-group comparison.Univariate and multivariate analyses are performed based on Cox proportional risk regression model.NLR <3.37 and PLR <105.96 are denoted as 0 point while NLR ≥3.37 and PLR ≥105.96 as 1 point.Two points are added up as NLR-PLR score.According to NLR-PLR score, they are divided into 3 groups of 0, 1 and 2.Results:Median overall survival(OS)is 27 months in patients with NLR-PLR score 0, 26.5 months in patients with NLR-PLR score 1 and 6 months in patients with NLR-PLR score 2.Median OS in patients with NLR-PLR score 2 is significantly shorter than that in those with NLR-PLR score 0/1.And the difference is statistically significant( P<0.001).Median disease-free survival(DFS)is 24.5 months in NLR-PLR 0 group, 24 months in NLR-PLR 1 group and 6 months in NLR-PLR 2 group.The difference is statistically significant( P=0.002).Univariate analysis show that Child-Pugh grade, MELD score, NLR/PLR level, NLR-PLR score, complying with University of California San Francisco Criteria(UCSF)criteria and absence/presence of microvascular invasion(MVI)have an impact on patient survival.Further multivariate analysis show that NLR-PLR score, complying with UCSF criteria and MELD score are independent risk factors affecting patients' prognosis and survival. Conclusions:NLR, PLR and NLR-PLR score may predict long-term survival of patients.And NLR-PLR score is an independent risk factor for patient survival.It has more predictive value than NLR/PLR.

Value of hepatic venous pressure gradient in preoperative evaluation and prognosis prediction in liver transplant recipients / 器官移植

Hepatic venous pressure gradient (HVPG) is the "gold standard" for the diagnosis of portal hypertension, which could be applied in the evaluation of liver cirrhosis. Combined use of HVPG with model for end-stage liver disease (MELD) scoring system may more accurately match the donors and recipients undergoing liver transplantation for liver cirrhosis, select the appropriate timing of surgery, and provide guidance for bridging treatment for patients on the waiting list for liver transplantation. Besides, HVPG may also predict clinical prognosis of liver transplant recipients, and provide evidence for early detection and intervention of potential complications. Therefore, the value of HVPG in preoperative evaluation and prognosis prediction of liver transplant recipients was reviewed, aiming to provide guidance for clinical diagnosis and treatment of liver transplant recipients before and after surgery.

Expression of human epidermal growth factor receptor 2 in pancreatic ductal adenocarcinoma and its clinical significance / 中华胰腺病杂志

Objective:To investigate the expression of human epidermal growth factor receptor 2 (HER2) in pancreatic ductal adenocarcinoma(PDAC) and its relationship with the prognosis of patients with PDAC.Methods:From January 2001 to December 2012, 109 paraffin embedded PDAC tissue samples and 27 normal pancreatic tissue samples were collected from the Department of Pathology, Huadong Hospital Affiliated to Fudan University. The expression of HER2 protein in pancreatic tissue was detected by immunohistochemical Envision two-step method. HER2 expression was evaluated according to Hercept test, and its relationship with clinicopathological features and survival time was analyzed.Results:The expression of HER2 protein was negative (-) in 29.4% of PDAC tissues, weakly positive (+ ) in 35.8%, positive (+ + ) in 25.7% and strongly positive (+ + + ) in 9.2%, respectively, and the overexpression rate (+ + , + + + ) was 34.9%; the negative (-) and weakly positive (+ ) expression of HER2 protein in normal pancreatic tissues accounted for 88.9% and 11.1% respectively. There was no expression with positive (+ + ) or strongly positive (+ + + ), therefore, the overexpression rate was 0. The overexpression rate of HER2 protein in PDAC and normal pancreatic tissues was significantly different ( P=0.000). The expression of HER2 protein was significantly correlated with age, and the expression of HER2 protein in patients with PDAC over 65 years old was significantly higher than that in patients with PDAC under 65 years old ( P=0.043), but not with gender, tumor location, tumor grade, T stage, N stage and nerve invasion (all P>0.05). Univariate Cox proportional hazards analysis showed that HER2 expression was associated with postoperative survival time of patients with PDAC ( P=0.032). Multivariate Cox proportional hazards analysis showed that HER2 expression was an independent prognostic factor for survival of patients with PDAC ( P=0.040). The median survival period of patients with HER2 expression + + + was significantly longer than that of patients with HER2 expression -~+ + (128.4 months vs 21.5 months), and the difference was statistically significant ( P=0.038). Conclusions:The overexpression of HER2 in PDAC tissue was related to the age of patients. The survival time of patients with HER2 strongly positive PDAC was significantly longer. HER2 can be considered as an index to evaluate the biological behavior and prognosis of PDAC.

Comparison of two Taq-man Real-time PCR methods for detection of HBV cccDNA / 中华实验和临床病毒学杂志

Objective@#To compare two Taq-man Real-time PCR methods for detection of hepatitis B virus covalently closed circular DNA (HBV cccDNA) in serum or liver tissue.@*Methods@#Two sets of primers and probes (common Taq-Man probe and MGB Taq-Man probe) were synthesized according to the reference papers, and the sensitivity and specificity of the two methods were compared using prepared plasmid as standard curve, and HBV DNA samples were exlracted from serum and liver tissue samples of hepatitis B patients. The samples were tested with both methods separately before or after the digestion with a Plasmid-Safe ATP-dependent Dnase (PSAD).@*Results@#Both of these two kinds of detection methods had a good linear relationship with the prepared plasmid as standard curve (R2 0.989 or 0.976 respectively, CV were within 4% ), and obtained good specificity when the HBV DNA samples were tested before or after digestion with PSAD. The common Taq-Man probe had lower Ct value than MGB probe when the samples in the same concentration.@*Conclusions@#Both methods can be used for HBV cccDNA detection. The common Taq-Man probe has slightly higher sensitivity than MGB probe, while the MGB probe has lower background than the common Taq-Man probe in our test. One can select the appropriate probe according to the need.

Peripheral Th17 cell frequencies predict postoperative complications in patients with hepatitis B virus-related liver cirrhosis following liver transplantation / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the relationship between level of Th17/CD4+T cell ratio in peripheral blood and postoperative complications in patients with hepatitis B virus (HBV)-related cirrhosis after orthotopic liver transplantation (OLT).</p><p><b>METHODS</b>Fifty-one patients with HBV-related cirrhosis who received OLT were enrolled in this study. Flow cytometry analysis was performed to measure the proportion of Th17 cells to CD4+T cells at the following time points:pre-OLT, and post-OLT days 7, 14 and 21. The relevant hepatic biochemistry indexes, serum concentration of FK506 and level of procalcitonin (PCT) were detected for all patients after OLT.</p><p><b>RESULTS</b>The transplant recipients were divided into four groups according to the postoperative complication, which included acute rejection (AR, n=12), postoperative infection (POI, n=10), transient intrahepatic cholestasis (TIHC, n=12) and no complications (n=17). The Th17/CD4+T cell frequencies were notably higher in the AR patients after OLT (vs. before OLT, P less than 0.01) and this increase was positively correlated with rejection activity index (RAI; r=0.759, P=0.004). Up to post-OLT day 14, the frequencies of Th1 7/CD4+T cells in the POI group were similar to those of the AR group but they decreased to near-baseline level at post-OLT day 21.Furthermore, the percentage of Th17/CD4+T cells in the POI group was positively correlated with PCT (r=0.768, P=0.010). The frequencies of Th17/CD4+T cells in the TIHC and no complications groups showed a slowly decreasing trend after OLT and became markedly lower than the before OLT levels (P<0.01). The concentration of FK506 in the AR group was significantly lower than that in the other groups at post-OLT day 14 (P=0.000).</p><p><b>CONCLUSIONS</b>Th17/CD4+T cell level in peripheral blood might be a useful marker for risk assessment and monitoring of OLT postoperative complications, such as acute rejection and postoperative infection, in the early stage, and might help to improve patient prognosis by allowing for timely application of anti-rejection and antibacterial agents.</p>

Protective effect of creatine phosphate on isolated rat liver against cold preservation / 器官移植

Objective To discuss the protective effect of creatine phosphate (CP)on isolated rat liver against cold preservation.Methods Isolated perfused rat liver model under simple cold preservation was established.The liver of the control group was perfused with pure University of Wisconsin (UW)solution. With UW solution as the base fluid,the liver of the low-dose group was perfused with 1 g/100 ml CP in UW solution;the liver of the middle-dose group was perfused with 2 g/100 ml CP in UW solution;the liver of the high-dose group was perfused with 3 g/100 ml CP in UW solution.The livers of each group were cold preserved in the corresponding perfusion fluid at 4 ℃.The content of alanine aminotransferase (ALT)and lactate dehydrogenase (LDH)in preservation solution in infrahepatic vena cava were determined.The content of malondialdehyde (MDA)and activity of myeloperoxidase (MPO)in liver tissues were detected.The apoptosis index (AI)of liver cells in liver tissues and positive expression rate of NF-κB in liver tissues were observed. Pathologic changes of liver tissues were observed under optical microscope.Results At 12 h after the cold preservation,the content of ALT and LDH in the rat livers of low-,middle-and high-dose groups were lower than those of the control group (all in P <0.05).At 18 h after the cold preservation,the content of MDA and MPO in the liver tissues of low-,middle-and high-dose groups were lower than those of the control group (all in P <0.05).At 12 h and 18 h after the cold preservation,AI and positive expression rate of NF-κB in liver cells in the rat livers of low-,middle-and high-dose groups were lower than those of the control group (all in P<0.05).At 24 h after the cold preservation,the content of ALT and MDA in preservation solution of the high-dose group was obviously higher than that of the control group as well as the low-and middle-dose groups (all in P <0.05).The results of pathological examination indicated that the injuries to the livers of the high-,middle-and low-dose groups were obviously lighter than that of the control group.There was no obvious difference among each dose group.Conclusions CP in UW solution may well protect the isolated rat liver against cold preservation,which is better than pure UW solution.

Analysis of risk factors of developing cardiac arrest in postreperfusion syndrome of orthotopic liver transplantation / 器官移植

Objective To investigate the risk factors of developing cardiac arrest in postreperfusion syndrome ( PRS) of orthotopic liver transplantation ( OLT ).Methods Clinical data of 192 patients who underwent OLT in the Third Hospital of Hebei Medical University from 2003 to 2013 were retrospectively analyzed.Among them, 38 patients developed PRS.According to the occurrence of cardiac arrest or not , the patients were divided into 2 groups, including 7 cases in cardiac arrest group (5 males and 2 females) and 31 cases in non-cardiac arrest group (23 males and 8 females).The probable influence factors of cardiac arrest were selected, including gender, age, preoperative cardiac indexes ( electrocardiogram or color doppler ultrasound of heart ) , preoperative albumin , borderline pH value during opening circulation , borderline temperature, borderline blood potassium level , blood calcium level after opening , degree of donor fatty liver , time of occluding inferior vena cava , and cold ischemia time of donor liver.Comparison of data between two groups was used t-test or Fisher exact probability test.Rick factors with significance differences between two groups were analyzed by unconditional Logistic regression analysis.Results Probable risk factors of developing cardiac arrest in PRS included borderline pH value <7.35 during opening circulation , borderline temperature<36 ℃during opening circulation , borderline blood potassium level >4 mmol/L during opening circulation and moderate fatty liver ( all in P<0.05 ).Results of unconditional Logistic regression analysis showed that moderate fatty liver was an independent risk factor of cardiac arrest in PRS.Conclusions Moderate fatty liver is an independent risk factor of cardiac arrest in PRS.The rational application of liver donors and paying more attention to perioperative treatment of recipients have important significance for reducing the incidence of cardiac arrest.

Reasons and treatments of lung hypervolemia in patients after liver transplantation / 中华器官移植杂志

Objective Objective To explore the reasons of lung hypervolemia after liver transplantation and the corresponding treatment strategies.Method 291 patients received liver transplantation,in which 35 cases underwent pulmonary edema at early stage (pulmonary hypervolemia group),and the rest without pulmonary hypervolemia served as control group.Average central venous pressure (CVP) was recorded pre-,intra-and post-operatively.Total intake,total discharge and fluid balance were also recorded intraoperatively and 3 days post-operatively.Result In pulmonary hypervolemia group,CVP was (12.33 ± 5.08),(14.33 ± 3.03) and (16.50 ± 4.57) mmHg pre-,intra-and post-operatively,significantly higher than that in control group (P＜0.05 for all).Total intake,total discharge and fluid balance in pulmonary hypervolemia group were significantly higher than those in control group intraoperatively and 3 days post-operatively (P＜0.05 for all).After diuretic therapy and hemodialysis,30 cases in pulmonary hypervolemia group recurred,and 5 cases died of infection.Conclusion Pulmonary hypervolemia at early stage after liver transplantation is related to fluid balance.The reasonable control of total intake,total discharge and fluid balance is necessary.

Long-term efficacy of surgical treatment of slow transit constipation with pelvic floor hernia and rectal mucosal prolapse / 中华普通外科杂志

Objective To evaluate the long-term therapeutic efficacy of subtotal colectomy,ascending colon-rectum anastomosis, pelvic floor hernia repair, functional rectal suspension, and uterine suspension surgery for slow transit constipation with pelvic floor hernia and rectal mucosal prolapse.Methods From June 2007 to May 2008, 35 patients with intractable constipation caused by slow colonic transit combined with pelvic floor hernia and rectal mucosal prolapse underwent subtotal colectomy and ascending colon-rectum anastomosis, pelvic floor hernia repair, functional rectal suspension, and uterine suspension surgery. Postoperative defecation, complications, quality of life, and degree of satisfaction were followed-up. Results The average follow-up period was two years. At one month after the operation, the average defecation frequency was five times (2 -8 times) a day, with a semi-liquid stool consistency; After two years the frequency was twice ( 1 -3 times) a day, with solid stool consistency. Of the 35 patients, 19 were satisfied with the surgical efficacy, and 16 were very satisfied. All the patients' quality of life improved significantly. Conclusions For patients suffering from slow transit constipation with pelvic floor hernia and rectal mucosal prolapse subtotal colectomy, ascending colon-rectum anastomosis, pelvic floor hernia repair,functional rectal suspension, and uterine suspension surgery has satisfactory results.