Impact of Intraoperative Blood Pressure Control and Temporary Parent Artery Blocking on Prognosis in Cerebral Aneurysms Surgery.

Objective In cerebral aneurysm clipping and embolization, blood pressure control and temporary parent artery blocking are common methods to prevent aneurysm rupture. Their influence on the prognosis is uncertain. In this study, we try to find out the association between methods above and prognostic indicators.Methods We held a retrospective analysis on patients' medical records of cerebral aneurysms surgical clipping and endovascular coiling , and recorded gender, age, diagnosis, Hunt-Hess grade, Glasgow coma scale score, treatment methods, a history of hypertension, preoperative systolic blood pressure, with or without controlled hypotension, systolic blood pressure difference before and after controlled hypotension, with or without temporary artery blocking, with or without hypertension after treated aneurysm, prognostic indicators including mortality after 1 month, intensive care unit (ICU) stay time of survivors, discharged Glasgow outcome scale (GOS) score. Prognostic indicators were regarded as dependent variable, all the factors were regarded as independent variable, and the strength analysis of influence factors on prognostic indicators was made by binary logistic regression.Results Total cases were 165, including 68 males and 97 females, with an average age of 56 (12-85) years. The mortality after 1 month was 10.9% (18 cases). The ICU stay time of survivors was 7.35 (0-67) days. GOS score at discharge was 1-3 in 40 (24.2%) patients and 4-5 in 125 (75.8%) patients. Systolic blood pressure difference before and after controlled hypotension was an independent factor influencing mortality (t=2.273, P=0.024), and the greater the difference was, the higher the mortality would be. Timely hypertension after aneurysm treated was an independent factor affecting ICU stay time of survivors and patients with hypertension had shorter ICU stay time (χ2=10.017, P=0.001). Blood pressure control (χ2=0.088, P=0.767) and temporary blocking (χ2=1.307, P=0.253) did not show significant influence on GOS score at discharge.Conclusions Timely controlled hypertension after aneurysm clipping and embolization can significantly shorten the stay time in ICU. The degree of controlled hypotension associates with postoperative mortality, the greater systolic blood pressure difference before and after antihypertensive treatment is, the higher the mortality will be.

Risk of renal cancer in liver transplant recipients: A systematic review and meta-analysis.

Liver transplantation is associated with a significantly increased risk of de novo malignancies, but for renal cancer this risk is less clear. We therefore performed a meta-analysis of published studies to determine whether renal cancer risk in liver transplant recipients (LTRs) was increased. To obtain a more precise conclusion, a systematic search was performed in PubMed and Web of Science databases until June 10, 2015. Standardized incidence ratio (SIR) corresponding 95% confidence interval (CI) were used to estimate risk of renal cancer in LTRs. Heterogeneity test, sensitivity analysis, and publishing bias were also performed. We identified 8 eligible studies and performed a meta-analysis on data of 49,654 LTRs with a total follow-up of 121,514.6 patient-years. The SIR for renal cancer was identified a 3.275-fold higher SIR (95% CI: 1.857-5.777; P < 0.001) in LTRs compared with the general population. This systematic review and meta-analysis demonstrated that the LTRs was associated with a significant increase in the incidence of renal cancer. Such association suggests that yearly routine post-transplant surveillance is need for renal cancer in LTRs.

Impact of Intraoperative Blood Pressure Control and Temporary Parent Artery Blocking on Prognosis in Cerebral Aneurysms Surgery / 中国医学科学杂志(英文版)

Objective In cerebral aneurysm clipping and embolization, blood pressure control and temporary parent artery blocking are common methods to prevent aneurysm rupture. Their influence on the prognosis is uncertain. In this study, we try to find out the association between methods above and prognostic indicators.Methods We held a retrospective analysis on patients' medical records of cerebral aneurysms surgical clipping and endovascular coiling , and recorded gender, age, diagnosis, Hunt-Hess grade, Glasgow coma scale score, treatment methods, a history of hypertension, preoperative systolic blood pressure, with or without controlled hypotension, systolic blood pressure difference before and after controlled hypotension, with or without temporary artery blocking, with or without hypertension after treated aneurysm, prognostic indicators including mortality after 1 month, intensive care unit (ICU) stay time of survivors, discharged Glasgow outcome scale (GOS) score. Prognostic indicators were regarded as dependent variable, all the factors were regarded as independent variable, and the strength analysis of influence factors on prognostic indicators was made by binary logistic regression.Results Total cases were 165, including 68 males and 97 females, with an average age of 56 (12-85) years. The mortality after 1 month was 10.9% (18 cases). The ICU stay time of survivors was 7.35 (0-67) days. GOS score at discharge was 1-3 in 40 (24.2%) patients and 4-5 in 125 (75.8%) patients. Systolic blood pressure difference before and after controlled hypotension was an independent factor influencing mortality (t=2.273, P=0.024), and the greater the difference was, the higher the mortality would be. Timely hypertension after aneurysm treated was an independent factor affecting ICU stay time of survivors and patients with hypertension had shorter ICU stay time (χ=10.017, P=0.001). Blood pressure control (χ=0.088, P=0.767) and temporary blocking (χ=1.307, P=0.253) did not show significant influence on GOS score at discharge.Conclusions Timely controlled hypertension after aneurysm clipping and embolization can significantly shorten the stay time in ICU. The degree of controlled hypotension associates with postoperative mortality, the greater systolic blood pressure difference before and after antihypertensive treatment is, the higher the mortality will be.

Effect of gradient decompression on the occurrence of intraoperative hypotension and prognosis in traumatic brain injury.

AIM: To investigate the effect of gradient decompression on the occurrence of intraoperative hypotension and prognosis in traumatic brain injury. MATERIAL AND METHODS: A retrospective analysis was performed in 186 hospitalized patients from January, 2008 to January, 2012 in the Affiliated Hospital of Jiangsu University. Demographic data, the abnormality of pupils, and Glasgow Coma Scale (GCS) before operation, and gradient decompression measures, and intraoperative hypotension during operation, and mortality after operation were recorded. Gradient decompression measures were mannitol, hyperventilation, graded craniotomy, and Chi-square test was conducted to evaluate the association of gradient decompression with intraoperative hypotension and prognosis. RESULTS: All the gradient decompression measures were shown non-significantly associated with the occurrence of intraoperative hypotension and prognosis, including mannitol (p=0.852, p=0.328), hyperventilation (p=0.484, p=0.619) and graded craniotomy (p=0.326, p=0.605). Mannitol with hyperventilation (p=0.733, p=0.758), mannitol with graded craniotomy (p=0.319, p=1.000), hyperventilation with graded craniotomy (p=0.269, p=0.685) and all the three measures (p=0.135, p=0.589) were also non-significantly associated with the occurrence of intraoperative hypotension and prognosis. The abnormality of pupils (p=0.006), GCS (p<0.001) and hypotension (p=0.006) were closely associated with the prognosis. CONCLUSION: Gradient decompression is not effective in avoiding the occurrence of intraoperative hypotension and improving the prognosis. It provides a new insight into clinical measures for curing patients with severe traumatic brain injury (sTBI).

Effect of allogenic hematopoietic stem cell transplantation on tumor recurrence and metastasis of hepato-cellular carcinoma after radical hepatectomy / 中华肝胆外科杂志

Objective To evaluate the effect of alIoHCT on recurrence and metastasis of HCC after hepatic radical resection. Methods Umbilical cord blood were collected after labor. The efficacy of separa-tion by 6% hydroxyethyl starch (6% HES) and NH4CL lysing solution were examined. Twenty-two SCID mice were randomized into the scheduled transplantation group (n=8), the single transplantation group (n =8) and the normal saline group (n=6). Human nucleated cells (NC)at a amount of 5×107 were transfused through the tail vein into the 2 groups of transplantation. All the mice in the 3 groups received cyclophospha-mide (CTX) as conditioning regimen before tansplantation and Methylprednisolone (MP) for 1 week continu-ously after trasplantation. Hematopoietic and immune recovery, graft versus host disease (GVHD), engraft-ment and survival rate were observed after transplantation. Six weeks after alloHST, the orthotopic tumor model in SCID mice was established by implanting histologically intact tissue under the embrane of liver. Ten days later, the mice received radical resection of lobe bearing tumor. The condition of recurrence and metas-tasis was observed 4 weeks after operation. Results A murine model of umbilical cord blood transplantation using CTX and MP as conditioning regimen could be successfully established in SCID mice. The percentage CD34+ cells of peripheral blood NC in scheduled transplantation group and single transplantation group was 1.66%±0.47% and 0.68% + 0.56%, respectively. There was significant statistical significance (P<0.01). The intrahepatic recurrence rate after operation was 100% in all the 3 groups. However, the recur-rent tumor volume was (367.18±31.86) mm3 , (648.26±155.22) mm3, (811.38±127.36) mm3, re-spectively in the 3 groups. There was marked difference among the 3 groups (P<0.01). The inhibitory rate of group A and B was 54.7% and 20.1%. The incidence of lung metastasis was 14.3 (1/7), 6.7% (4/6) and 100% (5/5), respectively in the 3 groups and there was remarkable difference (P<0.01). The inci-dence of celiac lymph node metastasis was 14.3 (1/7), 33.4% (2/6) and 40% (2/5), respectively in the 3groups and there was no significant difference (P=0.58). Conclusion AlloHSCT is a useful method for de-creasing metastasis and recurrence of liver cancer after radical resection in early stage.

[The construction of lentivirus-mediated RNAi vector containing hTERT].

OBJECTIVE: To construct a recombinant lentivirus RNA interference (RNAi) vector carrying hTERT gene, and to obtain the titer of the lentiviral stock for investigating the expression in the eukaryotic cells and the effect on the hTERT gene silencing in the eukaryotic cells. METHODS: Two complimentary oligos of small interference RNA (siRNA) with hairpin structures targeting the hTERT gene and a negative control were synthesized, then ligated with pLVTHM vector and sequenced. The recombinant vectors were then transfected with viral packaging mix into T293 cells, viral supernatant was harvested to determine the titer. U87 cells infected by virus were harvested and the expression of hTERT, telomerase activity and apoptosis were detected by reverse transcription-PCR(RT-PCR), TRAP assay and flow cytometry separately. RESULTS: Sequencing data showed that the constructed plasmids contained the correct sequences of hTERT siRNA transcript templates. A vector producing cell line T293 was established, and the titer for transfection was obtained. RT-PCR and TRAP flow cytometry analyses demonstrated that hTERT shRNA expression construct could suppress the expression of hTERT and telomerase activity and induce apoptosis. CONCLUSION: A lentivirus RNAi vector targeting hTERT gene was successfully constructed, which decreased the expression of hTERT and telomerase activity effectively and induced apoptosis. It has set up a research platform for the gene therapy of tumors which take hTERT as the target.

The construction of lentivirus-mediated RNAi vector containing hTERT / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To construct a recombinant lentivirus RNA interference (RNAi) vector carrying hTERT gene, and to obtain the titer of the lentiviral stock for investigating the expression in the eukaryotic cells and the effect on the hTERT gene silencing in the eukaryotic cells.</p><p><b>METHODS</b>Two complimentary oligos of small interference RNA (siRNA) with hairpin structures targeting the hTERT gene and a negative control were synthesized, then ligated with pLVTHM vector and sequenced. The recombinant vectors were then transfected with viral packaging mix into T293 cells, viral supernatant was harvested to determine the titer. U87 cells infected by virus were harvested and the expression of hTERT, telomerase activity and apoptosis were detected by reverse transcription-PCR(RT-PCR), TRAP assay and flow cytometry separately.</p><p><b>RESULTS</b>Sequencing data showed that the constructed plasmids contained the correct sequences of hTERT siRNA transcript templates. A vector producing cell line T293 was established, and the titer for transfection was obtained. RT-PCR and TRAP flow cytometry analyses demonstrated that hTERT shRNA expression construct could suppress the expression of hTERT and telomerase activity and induce apoptosis.</p><p><b>CONCLUSION</b>A lentivirus RNAi vector targeting hTERT gene was successfully constructed, which decreased the expression of hTERT and telomerase activity effectively and induced apoptosis. It has set up a research platform for the gene therapy of tumors which take hTERT as the target.</p>

[Study on combined gene therapy for malignant gliomas transfected with antisense hTERT/PTEN in vitro and in vivo].

OBJECTIVE: To study inhibitory efficacy of combined gene therapy for malignant gliomas transfected with antisense human telomerase reverse transcriptase (hTERT)/PTEN in vitro and in vivo. METHODS: To construct two adenovirus recons which contained antisense hTERT and wild-type PTEN respectively with high performance homologous recombination system in bacteria. The two adenovirus recons were transfected into U251 human malignant glioma cells combinedly or respectively in vitro and in vivo. U251 cell proliferation in vitro was determined by MTT assay and flow cytometry, tumor growth in vivo was measured by the volume of glioma in nude mice. Telomerase activity was detected by telomeric repeat amplification protocol (TRAP) assay. Expression of hTERT and PTEN protein was detected by Western blotting methods. RESULTS: After transfection in vitro, the growth of U251 cells was inhibited significantly. The inhibitory effect was time-dependent. The strongest inhibition was observed in combined transfection group, at the 6th day, the survival rate was 37.6%, telomerase activity (only 28.8TPG) was inhibited significantly, hTERT protein expression was inhibited significantly too, which was 0.2106, but PTEN protein expression was increased significantly, which was 0.9630. In vivo, the growth of tumors was also effectively inhibited. CONCLUSION: Growth of malignant glioma cells is effectively inhibited after transfection with combined antisense hTERT and PTEN in vitro and in vivo.

Study on combined gene therapy for malignant gliomas transfected with antisense hTERT/PTEN in vitro and in vivo / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To study inhibitory efficacy of combined gene therapy for malignant gliomas transfected with antisense human telomerase reverse transcriptase (hTERT)/PTEN in vitro and in vivo.</p><p><b>METHODS</b>To construct two adenovirus recons which contained antisense hTERT and wild-type PTEN respectively with high performance homologous recombination system in bacteria. The two adenovirus recons were transfected into U251 human malignant glioma cells combinedly or respectively in vitro and in vivo. U251 cell proliferation in vitro was determined by MTT assay and flow cytometry, tumor growth in vivo was measured by the volume of glioma in nude mice. Telomerase activity was detected by telomeric repeat amplification protocol (TRAP) assay. Expression of hTERT and PTEN protein was detected by Western blotting methods.</p><p><b>RESULTS</b>After transfection in vitro, the growth of U251 cells was inhibited significantly. The inhibitory effect was time-dependent. The strongest inhibition was observed in combined transfection group, at the 6th day, the survival rate was 37.6%, telomerase activity (only 28.8TPG) was inhibited significantly, hTERT protein expression was inhibited significantly too, which was 0.2106, but PTEN protein expression was increased significantly, which was 0.9630. In vivo, the growth of tumors was also effectively inhibited.</p><p><b>CONCLUSION</b>Growth of malignant glioma cells is effectively inhibited after transfection with combined antisense hTERT and PTEN in vitro and in vivo.</p>

Application of simulect in liver transplantation patients / 中华器官移植杂志

Objective To evaluate the efficacy and safety of simulect (basiliximab) after orthotopic liver transplantation (OLT). Methods Forty adult recipients with benign end-stage liver disease between November 2003 to November 2004 were assigned randomly in a 1∶1 ratio to receive either two doses of simulect or matching placebo. The patients in the two groups received baseline triple immunosuppression with the calcineurin inhibitor (CsA or FK506), MMF and steroids. A total of 40 mg simulect was given in two doses of 20 mg each on the day 0 before inferior vena was opened and the day 4 after transplantation respectively. Acute rejection, infection and serum ALT, AST, TBIL, DBIL and ALP in both groups were observed in the first 30 days after OLT. Results In Simulect group had less frequent incidence of acute refection during the first 30 days after OLT. In Simulect group and matching placebo, incidence of acute refection was 10 % (2/20) abd 45 % (9/20) respectively (P= 0.034), and that of infection was 40 % (8/20) and 45 % (9/20) respectively (P= 0.749). Bilirub and aminopherase in both groups were declined gradually and ALP increased. There were significant difference in ALT and TBIL between two groups. Conclusion The application of simulect in combination with CsA/FK506, MMF and prednisone is safe and well tolerated, and can effectively reduce the incidence of acute refection, and does not lead to increased opportunistic infections.