Study on the Mechanism of Multi-Drug Resistance of Agaricus Blazei Extract FA-2-b-β Mediated Wnt Signaling Pathway to Reverse Acute T Lymphoblastic Leukemia / 中国实验血液学杂志

OBJECTIVE@#To investigate the mechanism of drug reversing resistance of Agaricus blazei extract FA-2-b-β on T cell acute lymphoblastic leukemia (T-ALL) cell lines.@*METHODS@#Cell proliferation was detected by CCK-8 assay; the apoptosis, cell cycle mitochondrial membrane potential, and intracellular rhodamine accumulation were detected by flow cytometry, and apoptosis-related gene and protein expression were detected by qPCR and Western blot; the membrane surface protein MDR1 was observed by immunofluorescence microscopy.@*RESULTS@#Different concentrations of FA-2-b-β significantly inhibited proliferation and induced apoptosis of CCRF-CEM and CEM/C1 (P<0.05), and CCRF-CEM cell cycle were arrested at S phase, and CEM/C1 cells were arrested at G0/G1 phase. Western blot and qPCR results show that FA-2-b-β inhibited ABCB1、ABCG2、CTNNB、MYC and BCL-2 expression, but upregulated Bax expression. In addition, FA-2-b-β reversed the resistance characteristics of CEM/C1 drug-resistance cells, which decreased mitochondrial membrane potential, and significantly increased the intracellular rhodamine accumulation, and weakening of the expression of the membrane surface protein MDR1. With the Wnt/β-catenin inhibitor (ICG001), the process was further intensified.@*CONCLUSION@#Agaricus Blazei Extract FA-2-b-β inhibits cell proliferation, promotes apoptosis, regulates the cell cycle, reduces mitochondrial energy supply, and down-regulate MDR1 expression to reverse the resistance of CEM/C1, which all suggest it is through regulating the Wnt signaling pathway in T-ALL.

Inhibitory Effects of Agaricus Blazei Murrill (FA-2-b-β) on Proliferation of Chronic Myeloid Leukemia Cells in vivo and Its Mechanism / 中国实验血液学杂志

OBJECTIVE@#To investigated the anti-tumor in vivo effect and mechanism of the acid RNA protein complex (FA-2-b-β) of Agaricus blazei Murrill extract.@*METHODS@#CCK-8 method was used to detected the inhibitory effect of FA-2-b-β on proliferation of primary CML cells from newly diagnosed CML patients, the CML mouse model was established by trail-venous injection of primary CML cells, and the survival time, blood cell count and body weight were observed, the immunoflouresence and immunehistochemistry analysis, RT-qPCR, Western bolt were used to detemine the expression of caspase-3 signal pathway-related apoptosis genes and proteins.@*RESULTS@#The experiments in vitro showed that the proliferative inhibitory rate in drug-treated group increased with concentration- and time-dependent manner (r@*CONCLUSION@#The FA-2-b-β can induce apoptosis of primary CML cells and prolong the survival time of CML model mouse, which may be related with the caspase-3 signal pathway related genes and proteins.

Associations of distribution of time spent in physical activity and sedentary behavior with obesity / 北京大学学报(医学版)

OBJECTIVE@#To explore associations of distribution of time spent in physical activity (PA) and sedentary behavior (SB) with obesity with taking account that time is finite during the day of adult residents in Wuhai City.@*METHODS@#A cross-sectional study was undertaken in Wuhai City, and we carried out a sampling of local residents aged 18-79 by using multiple stratified cluster sampling method. Data about social demographic characteristics, time spent in PA and SB, diet intake, controlling situation of chronic disease and other covariates were obtained by qualified investigators for face-to-face questionnaire survey. Data about height, weight, and waist circumstance, were obtained by doctors in a secondary hospital or above for body measurements. The statistical method used in our study was known as compositional data analysis, which had been used to process compositional data in many fields. Liner regression analysis with compositional data was used to synthetically analyze the associations of distribution of time spent in PA and SB with obesity,and to investigate the effect of re-allocating time from one behavior to another one whilst the remaining one was kept stable.@*RESULTS@#The investigation revealed the special advantage of compositional data analysis in processing time-use data. The result of liner regression analysis with the compositional data showed that after controlling the potential confounding factors, the associations of distribution of time spent in PA and SB was significantly associated with body mass index (BMI, P<0.001) and the negative natural logarithm of waist to height ratio (-lnWHtR, P<0.001). Among them, in professional population, the proportion of time spent in moderate-to-vigorous physical activity (MVPA) was negatively correlated with -lnWHtR (β=-0.008, P=0.022), while the proportion of time spent in SB was positively correlated with BMI and -lnWHtR (β=0.117, P=0.003; β=0.007, P=0.005). However, in nonprofessional population, the proportion of time spent in MVPA was only negatively correlated with BMI (β=-0.079, P=0.041). Nevertheless, the proportion of time spent in low-intensity physical activity (LIPA) was not significantly associated with BMI and -lnWHtR in both professional and nonprofessional population. In addition, the effects of MVPA replacing another behavior and of MVPA being displaced by another behavior were not symmetrical, and 10 minutes of MVPA replacing LIPA or SB had a greater influence on intervention and prevention of obesity than 10 minutes MVPA being replaced by LIPA or SB.@*CONCLUSION@#The research has resulted in a solution of the associations of the distribution of time spent in PA, SB with health risk. Our results suggest that public health messages should target the health effects of the distribution of time of PA and SB synergistically in developing PA guidelines and health management practice, rather than simply increasing or decreasing the absolute time of PA or SB, so that we can provide scientific suggestions to make people get a profounder healthy effect.

Primary Mechanisms of CD34CD38--KG1a Leukemia Stem Cells Apoptosis Induced by FA-2-b-β Extracted from Qinba Selenium- Mushroo / 中国实验血液学杂志

OBJECTIVE@#To investigate the apoptosis of CD34CD38-KG1a leukemia stem cells induced by Qinba selenium-mushroom extract(FA-2-b-β), and its related mechanism.@*METHODS@#CD34CD38--KG1a cells were isolated from KG1a cell line by magnetic activated cell sorting. The proliferation ability of KG1a stem cells treatd by various concentration of FA-2-b-β(1.2-2.4 mg/ml) in vitro for 24 and 48 hours were tested by cell counting Kit-8(CCK8). Flow cytometry was used to detect the apoptosis rate of KG1a stem cells in each group after treated by FA-2-b-β in vitro. Expression of BAX,BCL-2,Casepase-3 and Cyclin D1 protein were detected by Western blot.@*RESULTS@#The proportion of CD34CD38--KG1a stem cells was (95.35±2.63）% after immunomagnetic isolation. The proliferation of KG1a stem cells was inhibited significantly by FA-2-b-β, which shows a time- and dose-dependent manner (24 h,r=0.943; 48 h,r=0.976). Flow cytometry shows that with the increasing of drug concentration, the apoptosis was also increased, when KG1a stem cells was treated by FA-2-b-β for 24 h. Western blot indicated that the expression of apoptosis-related protein BAX and Casepase-3 were up-regulated, the expression of BCL-2 and Cyclin D1 were down-regulated.@*CONCLUSION@#FA-2-b-β can regulate proliferation and apoptosis KG1a stem cells, the involved mechanism may be related with the activation of mitochondrial-mediated apoptotic pathway.

Relationship between sugary drinks and diabetes of adults in Wuhai city / 北京大学学报(医学版)

OBJECTIVE@#To explore the relationship between sugary drinks and diabetes of adults in Wuhai city.@*METHODS@#A multiple stage stratified cluster sampling was conducted on 8 131 residents who were between 35 and 79 years by cross-sectional study in Wuhai city. Questionnaires, physical measurements and laboratory tests were used to collect information on demographic information, dietary behavior, health status, blood glucose indicators. Besides, other covariate information was also collected by these ways. The analysis was carried out by chi-square test, trend chi-square test and multifactor Logistic regression.@*RESULTS@#The detection rates of impaired fasting glucose and diabetes of people who were 35 years old and above in Wuhai city were 6.0% and 18.4%, respectively, and they both increased with age (P<0.01, P< 0.01). The detection rates of impaired fasting glucose and diabetes of the men were both far higher than the women (P< 0.01, P< 0.01). For the men, the detection rate of diabetes increased with age (Ptrend<0.01), but for the women, and the detection rate of impaired fasting glucose and diabetes both increased with age (Ptrend<0.01, Ptrend<0.01). The consumption rate of sugary drinks of the people who were 35 years old and above in Wuhai city was 30.2%. And after all the subjects were classified into three groups, A (0- mL/d), B (16- mL/d), and C (237- mL/d) according to the daily different drinking quantities, statistical results found that group A accounted for 75.4%, group B for 21.5%, and group C for 3.1%. In group A, for comparison, the impaired fasting glucose OR values of group B and group C were 1.4 and 2.2, respectively. And diabetes OR values of group B and group C were 1.2 and 2.1 respectively compared with group A, and the trend of OR values increased both had statistical significance (Ptrend <0.01, Ptrend < 0.01). Also, after adjusting for other covariates in multifactor Logistic regression, the OR values of impaired fasting glucose in group B and group C were 1.6 and 3.8 respectively, and the OR values of diabetes were 1.9 and 4.9 respectively, compared with group A, and besides, the trend of OR values increased both still had statistical significance (Ptrend <0.01, Ptrend < 0.01).@*CONCLUSION@#Increased consumption of sugary drinks will increase the risk of impaired fasting glucose and diabetes. Residents in Wuhai city should control their consumption of sugary drinks.

Pathological characteristics of liver allografts from donation after brain death followed by cardiac death in pigs / 华中科技大学学报（医学）（英德文版）

Donation after brain death followed by circulatory death (DBCD) is a unique practice in China. The aim of this study was to define the pathologic characteristics of DBCD liver allografts in a porcine model. Fifteen male pigs (25-30 kg) were allocated randomly into donation after brain death (DBD), donation after circulatory death (DCD) and DBCD groups. Brain death was induced by augmenting intracranial pressure. Circulatory death was induced by withdrawal of life support in DBCD group and by venous injection of 40 mL 10% potassium chloride in DCD group. The donor livers were perfused in situ and kept in cold storage for 4 h. Liver tissue and common bile duct samples were collected for hematoxylin and eosin staining, TUNEL testing and electron microscopic examination. Spot necrosis was found in hepatic parenchyma of DBD and DBCD groups, while a large area of necrosis was shown in DCD group. The apoptosis rate of hepatocytes in DBD [(0.56±0.30)%] and DBCD [(0.50 ± 0.11)%] groups was much lower than that in DCD group [(3.78±0.33)%] (P<0.05). And there was no significant difference between DBD group and DBCD group (P>0.05)). The structures of bile duct were intact in both DBD and DBCD groups, while the biliary epithelium was totally damaged in DCD group. Under electron microscope, the DBD hepatocytes were characterized by intact cell membrane, well-organized endoplasmic reticulum, mild mitochondria edema and abundant glycogens. Broken cell membrane, mild inflammatory cell infiltration and sinusoidal epithelium edema, as well as reduced glycogen volume, were found in the DBCD hepatocytes. The DCD hepatocytes had more profound cell organelle injury and much less glycogen storage. In conclusion, the preservation injury of DBCD liver allografts is much less severe than that of un-controlled DCD, but more severe than that of DBD liver allografts under electron microscope, which might reflect post-transplant liver function to some extent.

Study on safety of Tibetan medicine zuotai and preliminary study on clinical safety of its compound dangzuo / 中国中药杂志

Zuotai (gTso thal) is a typical representative of Tibetan medicines containing heavy metals, but there is still lack of modem safety evaluation data so far. In this study, acute toxicity test, sub-acute toxicity test, one-time administration mercury distribution experiment, long-term mercury accumulative toxicity experiment and preliminary study on clinical safety of Compound Dangzuo were conducted in the hope of obtain the medicinal safety data of Zuotai. In the acute toxicity test, half of KM mice given the lethal dose of Zuotai were not died or poisoned, and LD50 was not found. The maximum tolerated dose of Zuotai was 80 g x kg(-1). In the subacute toxicity test, Zuotai could reduce ALT, AST, Crea levels in serums under low dose (13.34 mg x kg(-1) x d(-1)) and medium dose (53.36 mg x kg(-1) x d(-1)), with significant difference under low dose, and increase the levels of ALT, AST, MDA, Crea in serums under high dose (2 000 mg x kg(-1) x d(-1)); besides, the levels of BUN and GSH in serums reduced with the increase in dose of Zuotai, indicating a significant dose-effect relationship. In the one-time administration distribution experiment, the content of mercury in rat kidney, liver and lung increased after the one-time administration with Zuotai, with a significant dose-dependent relationship in kidney. In the long-term mercury accumulative toxicity experiment, KM mice were administered with equivalent doses of Zuotai for 4.5 months and then stopped drug administration for 1.5 months. Since the 2.5th month, they showed significant mercury accumulation in kidney, which gradually reduced after drug withdrawal, without significant change in mercury content in liver, spleen and brain and ALT, AST, TBIL, BUN and Crea in serum. At the 4.5th month after drug administration, KM mice showed slight structural changes in kidney, liver and spleen tissues, and gradually recovered to normal after drug withdrawal. Besides, no significant difference in weight gain was found between the Zuotai group and the control group. According to the findings of the clinical safety study of Dangzuo, after subjects administered Dangzuo under clinical dose for one month, their serum biochemical indicators, blood routine indicators and urine routine indicators showed no significant adverse change. This study proved that traditional Tibetan medicine Zuotai was slightly toxic, with a better safety in clinical combined administration and no adverse effects on bodies under the clinical dose and clinical medication cycle. However, long-term high-dose administration of Zuotai may have a certain effect on kidney.

Pathological characteristics of liver allografts from donation after brain death followed by cardiac death in pigs / 华中科技大学学报（医学）（英德文版）

Donation after brain death followed by circulatory death (DBCD) is a unique practice in China. The aim of this study was to define the pathologic characteristics of DBCD liver allografts in a porcine model. Fifteen male pigs (25-30 kg) were allocated randomly into donation after brain death (DBD), donation after circulatory death (DCD) and DBCD groups. Brain death was induced by augmenting intracranial pressure. Circulatory death was induced by withdrawal of life support in DBCD group and by venous injection of 40 mL 10% potassium chloride in DCD group. The donor livers were perfused in situ and kept in cold storage for 4 h. Liver tissue and common bile duct samples were collected for hematoxylin and eosin staining, TUNEL testing and electron microscopic examination. Spot necrosis was found in hepatic parenchyma of DBD and DBCD groups, while a large area of necrosis was shown in DCD group. The apoptosis rate of hepatocytes in DBD [(0.56±0.30)%] and DBCD [(0.50 ± 0.11)%] groups was much lower than that in DCD group [(3.78±0.33)%] (P0.05)). The structures of bile duct were intact in both DBD and DBCD groups, while the biliary epithelium was totally damaged in DCD group. Under electron microscope, the DBD hepatocytes were characterized by intact cell membrane, well-organized endoplasmic reticulum, mild mitochondria edema and abundant glycogens. Broken cell membrane, mild inflammatory cell infiltration and sinusoidal epithelium edema, as well as reduced glycogen volume, were found in the DBCD hepatocytes. The DCD hepatocytes had more profound cell organelle injury and much less glycogen storage. In conclusion, the preservation injury of DBCD liver allografts is much less severe than that of un-controlled DCD, but more severe than that of DBD liver allografts under electron microscope, which might reflect post-transplant liver function to some extent.

Impact of hepatitis B virus infection on liver function after hematopoietic stem cell transplantation / 中国实验血液学杂志

To analyze the impact of hepatitis B virus (HBV) infection on liver function of patients after hematopoietic stem cell transplantation (HSCT), the transplantation outcome of 48 patients infected with HBV prior to transplantation among 185 patients received HSCT was investigated retrospectively. The results showed that during a follow-up for 6 months after HSCT, the alanine aminotransferase (ALT) peak average values of the patients with HBsAg(+), HBsAb(+) and control groups were (281.6 ± 414.6), (95.4 ± 79.9) and (65.1 ± 44.2) U/L, respectively. The incidences of abnormal liver function of the patients with HBsAg(+), HBsAb(+) and control groups were 61.54%, 40.00% and 30.23% respectively. There were no significant differences between any two groups (P > 0.05). The lethality of those patients at late period after transplantation was not related to HBV infection. The hepatocirrhosis and hepatocarcinoma caused by HBV infection have not become major problems in long-term survivors. It is concluded that in HBsAg(+) patients received HSCT, the damage of liver function is more severe than control group, possibly increasing the development of abnormal liver function. The measures against the liver function damage should be taken. The prophylactic administration of ganciclovir for virus may be effective to prevent the activation of HBV.

Clinical characteristics, diagnosis and treatment of digestive tract leakage after orthotopic liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical characteristics, diagnosis and treatment of digestive tract leakage after orthotopic liver transplantation (OLT).</p><p><b>METHODS</b>Sixty-one recipients had digestive tract leakage in early stage after OLT among 1173 cases from January 2000 to December 2010. There were 55 male and 6 female patients, aging from 36 to 61 years, with a median of 45 years. Digestive tract leakage included bile leakage (46 cases), gastric leakage (5 cases), duodenal leakage (1 case), jejunal leakage (4 cases), ileal leakage (1 case) and colon transversum leakage (4 cases). Ten of recipients with gastrointestinal leakage had 1 to 3 times of abdominal surgery before OLT. Abdominal drainage was used in 28 cases with bile leakage, and additionally, endoscopic retrograde cholangiopancreatography, endoscopic nasobiliary drainage and stenting were performed for 8 of them, and surgical neoplasty for another 18 patients with bile leakage. Simple surgical neoplasty of perforation was performed for 13 patients with gastrointestinal leakage, and diverticulectomy and neoplasty for 1 case with duodenal leakage, and partial jejunostomy for one severe jejunal leakage. Nutritional support was administered for all of cases.</p><p><b>RESULTS</b>The incidence rate of digestive tract leakage in early stage after OLT was 5.20% (61/1173). Intra-operative iatrogenic injury of gastrointestinal tract was occurred in 6 cases with gastrointestinal leakage. After treatment, 11 cases died of multiple organ failure resulted from severe infection, with mortality of 18.0% (11/61), including 4 cases with bile leakage, with the mortality of 8.6% (4/46), and 7 cases with gastrointestinal tract leakage, with the mortality of 46.6% (7/15). The remanent 50 cases through comprehensive treatment with a span of 1 to 3 months recovered and discharged healthily. No digestive tract leakage reoccurred in the follow-up of 6 to 84 months.</p><p><b>CONCLUSIONS</b>The morbidity of digestive tract leakage in early stage after OLT is low, but its mortality is high, especially for gastrointestinal tract leakage. High dose corticosteroids therapy, history of abdominal operation and intra-operative iatrogenic injury may be high risk factor. Comprehensive treatment is crucial for improving prognosis.</p>

A study of the efficacy and safety of using hepatitis B surface antigen-positive donors for liver transplantation / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To evaluate the outcomes of liver transplant recipients who received liver allografts from hepatitis B surface antigen (HBsAg)-positive donors.</p><p><b>METHODS</b>The medical records of 23 male patients (median age, 42.5 years; range: 29-61) who received HBsAg-(+) liver allografts in our organ transplant center were retrospectively analyzed. All patients had confirmed diagnosis of end-stage liver disease (ESLD) secondary to hepatitis B virus (HBV) infection, including 13 HBsAg(+)/HBeAg(-)/HBcAb(+) cases and 10 HBsAg(+)/HBeAb(+)/HBcAb(+) cases. After transplantation, all patients were administered oral entecavir and intravenous anti-hepatitis B immunoglobulin (HBIG) (2000 IU/d during the first week), along with a steroid-free immune suppression regimen. HBV-related antigen and antibody and HBV DNA were detected on post-transplantation days 1, 7, 14, 21, and 30. The liver allografts were monitored by ultrasound imaging. After discharge, monthly follow-up recorded liver function, renal function, acute rejection, infections, vascular complications, biliary complications, HBV recurrence, cancer recurrence, and patient survival.</p><p><b>RESULTS</b>Two of the recipients died from severe perioperative pneumonia. The remaining 21 recipients were followed-up for 10 to 38 months, and all 21 patients remained HBsAg(+). One recipient developed biliary ischemia and required a second liver transplantation at five months after the primary transplantation. Three recipients (all primary) died from tumor recurrence at 9, 14, and 18 months post-transplantation, respectively. All other recipients survived and had acceptably low HBV DNA copy levels. Color Doppler imaging showed good graft function and normal texture. The patient and graft survival rates were 78.3% (18/23) and 73.9% (17/23), respectively. The recurrence rate of HBV infection was 100% (23/23). In surviving patients, no liver function abnormality, graft loss, or death was found to be related to the recurrence of HBV infection.</p><p><b>CONCLUSION</b>Liver transplantation using HBsAg(+) liver grafts was safe for patients with ESLD secondary to HBV infection.</p>

Effect of Campath-1H induction on immunosuppression in small intestine transplantation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of Campath-1H induction on immunosuppression in small intestine transplantation.</p><p><b>METHODS</b>Clinical data of a patient who underwent small intestine transplantation were retrospectively summarized.</p><p><b>RESULTS</b>Intraoperative Campath-1H induction by intravenous injection was administered. Triple immunosuppression(FK506, MMF and methylprednisolone) was used postoperatively. The lymphocyte and leukocyte decreased significantly following Campath-1H induction, and returned to normal after adjusting the dose of immunosuppressant and use of colony stimulating factor. There were no acute rejection, graft versus host disease, or severe infection during the immediate postoperative period. The patient recovered and discharged.</p><p><b>CONCLUSION</b>Intraoperative Campath-1H induction and postoperative triple immunosuppression using FK506, MMF, and methylprednisolone may prevent rejection and graft versus host disease in the early stage after small intestine transplantation.</p>

Analysis on treatment outcomes in five patients with combined en bloc liver and pancreas transplantation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the treatment outcomes after combined en bloc liver and pancreas transplantation.</p><p><b>METHODS</b>Five patients with end-stage liver disease and type 2 diabetes mellitus received combined en bloc liver and pancreas transplantation after hepatectomy.</p><p><b>RESULTS</b>Five operations were performed successfully. The operative time ranged from 9 to 16 hours and blood loss from 1600 to 3000 ml. Postoperatively, one patients developed pulmonary infection, one died of graft-versus-host disease(GVHD), and one experienced acute renal failure. No intestinal fistula, anastomotic leakage, biliary complications, chronic and acute rejection and pancreatitis were seen. Liver function index including alanine aminotransferase, aspartate aminotransferase and total bilirubin returned to normal levels a week after surgery, while levels of C peptide and blood glucose resumed within 1 to 2 weeks. Apart from 1 case died of GVHD, the other 4 maintained normal liver function during the follow up ranging from 2 to 23 months and no insulin was required for the diabetes.</p><p><b>CONCLUSION</b>Combined en bloc liver and pancreas transplantation is technically feasible and an effective treatment for multi-organ diseases.</p>

Application of steroids minimization immunosuppressive regimen in liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the safety and feasibility of steroids minimization immunosuppressive regimen in liver transplantation.</p><p><b>METHODS</b>One hundred and sixteen patients in line with the selecting criteria from January 2005 to June 2008 were divided into three groups according to the withdrawal of steroids: 40 cases in 3 months withdrawal group, 40 cases in 7 d withdrawal group and the other 36 cases in 24 h withdrawal group. The difference of recipients' survival, infection, acute rejection and steroids resistant acute rejection, wound healing, recurrence of HBV and hepatocellular cell (HCC), new on-set of diabetes, hyperlipidemia and hypertension between the three groups were compared.</p><p><b>RESULTS</b>The difference of recipients' survival, acute rejection including steroids resistant acute rejection, recurrence of HBV and HCC, hyperlipidemia between the three groups were not significant (P > 0.05), the incidence of wound un-healing and hypertension in 24 h withdrawal group was significantly lower than that in the other 2 groups (P < 0.05), the incidence of infection and new on-set diabetes in 24 h withdrawal group and 7 d withdrawal group was significantly lower than that in 3 months withdrawal group (P < 0.05).</p><p><b>CONCLUSION</b>Steroids minimization immunosuppressive strategy is safe and feasible in liver transplantation field, it will significantly reduce the steroids related complications without increasing the risk of rejection.</p>

Etiology and management of postoperative gastrointestinal bleeding after orthotopic liver transplantation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the causes and treatment of postoperative gastrointestinal bleeding after orthotopic liver transplantation (OLT).</p><p><b>METHODS</b>Clinical data of 776 patients after OLT between January 2000 and December 2006 were analyzed retrospectively.The experiences in diagnosis and treatment of postoperative gastrointestinal bleeding after OLT were reviewed.</p><p><b>RESULTS</b>Gastrointestinal bleeding occurred in 18 patients (2.3%) after OLT, among whom 8 (44.5%) were from peptic ulcer, 3 (16.7%) from gastric and esophageal varices, 3 (16.7%) from gastroduodenitis, 3 (16.7%) from hemobilia, and 1 (5.6%) had diverticular bleeding in the jejunum. These 18 patients with gastrointestinal bleeding were managed with conservative treatment, endoscopic treatment, radiological interventional embolism,or exploratory laparotomy. Five patients died of gastrointestinal bleeding and the gastrointestinal bleeding-related mortality rate was 27.8%. After a mean follow up of 3.5 years, only 1 patient died of recurrence of hepatic cellular carcinoma while others survived disease-free.</p><p><b>CONCLUSIONS</b>Gastrointestinal bleeding may occur from different sites after OLT and the mortality is high. Prompt identification of the source of bleeding and correct management are required to improve the prognosis.</p>

Clinical analysis on multivisceral transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the indication, surgical and post-operative complications of the multivisceral transplantation.</p><p><b>METHODS</b>The post-transplant complications of 8 patients who underwent multivisceral transplantation between May 2004 and May 2010 were analyzed. There were 7 male and 1 female, aged from 28 to 65 years. Five patients who suffered from non-resectable advanced upper abdominal malignancy experienced the liver, stomach, spleen, pancreas, duodenum, omentum and variable amounts of the colon resection, and then underwent standard multivisceral transplantation (included liver, stomach, pancreaticoduodenal and small bowel). After underwent hepatectomy while retaining the native pancreas and entire gastrointestinal, three recipients with end-stage liver cirrhosis and type 2 insulin-dependent diabetes mellitus (IDDM) was performed combined en bloc liver/pancreaticoduodenal transplantation.</p><p><b>RESULTS</b>Since the third day post-operation, all recipients no longer needed exogenous insulin and had normal blood glucose concentrations. Two weeks after transplantation, their liver function almost became normal. For the 5 recipients who suffered abdominal malignancy, the longest survival period was 326 days. Cause of death are recurrent tumor (n = 2), multiple organ failure (n = 3). All the 5 patients experienced infection. For 3 patients suffered cirrhosis and IDDM, the longest survival was over 18 month. Excepting the case 8 died of graft versus host disease, all were still living without apparently post-transplant complication.</p><p><b>CONCLUSIONS</b>Multivisceral transplantation is an alternative in the treatment of the patients with benign massive abdominal pathologies. Careful patient selection and technical modification are crucial to improve the outcome of these patients.</p>

Evaluation of quality of life after simultaneous pancreas-kidney transplantation / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the influence of simultaneous pancreas-kidney (SPK) transplantation on the quality of life of diabetic recipients with end-stage renal disease.</p><p><b>METHODS</b>We performed a retrospective analysis of the data of diabetic patients with end-stage renal disease and evaluated the quality of life of the recipients using SF-36 health survey.</p><p><b>RESULTS</b>One patient died of cerebrovascular accident, and 7 patients recovered smoothly. During the follow-up lasting for a mean of 23.3 months, the blood glucose, C-peptide and creatine levels of the patients remained stable. The score of 8 domains of SF-36 of the diabetic recipient at 2 years after SPK transplantation showed a significant improvement compared with that before the operation, similar to that of Chinese normal population(P > 0.05).</p><p><b>CONCLUSIONS</b>SPK transplantation can achieve a significant improvement of the quality of life of diabetic patients with end-stage renal disease.</p>

Two-dose steroid combined with two-dose daclizumab and tacrolimus regimen in liver transplant recipients / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the efficiency and safety of two-dose steroid combined with two-dose daclizumab and tacrolimus (FK506) regimen in liver transplant recipients.</p><p><b>METHODS</b>There were 74 patients who treated in the First Affiliated Hospital of Sun Yat-Sen University from September 2006 to March 2008. Expect for 7 patients who didn't measure up, 67 adult liver transplant recipients were randomized into two groups: conventional protocol group (n = 35) in which steroid was withdrawn in 3 months after operation, and two-dose steroid group (n = 32). Comparison of rejection, infection (bacteria, fungal and cytomegalovirus) and metabolic complications rates were studied between two groups.</p><p><b>RESULTS</b>There were significant differences between two groups in the rate of early postoperation hyperglycemia, the average dosage of insulin consumption among hyperglycemia recipients as well as the rate of diabetes mellitus, hypertension and infection during the follow-up period (P < 0.05). The rate of hypertension in early postoperation period, hyperlipemia and rejection rate during the follow-up period were similar in two groups (P > 0.05).</p><p><b>CONCLUSIONS</b>Two-dose steroid combined with two-dose daclizumab and tacrolimus would be a safe and efficient immunosuppression strategy without increase the acute rejection rate hazard, that could reduce post-transplant infection and other complications from side-effect of long-term usage of steroid.</p>

Evaluation of efficacy and safety on steroid withdraw at the seventh day after liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate efficacy and safety on steroid withdrawal at the seventh day after liver transplantation.</p><p><b>METHODS</b>Seventy-six adult patients undergoing first cadaveric liver transplantation from October 2005 to October 2007 were randomly divided into 7 day (n = 40) and 3 month (n = 36) steroid withdrawal groups. All patients received FK506 3 mg and intravenous methylprednisolone 1000 mg during intra-operation and FK506 thereafter was adjusted to predefined 8 - 12 microg/L from day 1 to month 6. Patients in 7 day steroid withdrawal group received 500, 240, 200, 160, 80, 40 and 20 mg intravenous methylprednisolone tapered daily from postoperative day 1 to day 7. In 3 month steroid withdrawal group, patients received the same protocol as 7 day steroid withdrawal group for intravenous methylprednisolone tapered daily from postoperative day 1 to day 7 and thereafter received oral prednisone 48, 40, 32, 24, 16, 8, 4 mg tapered every 3 days and maintained 4 mg to the 3(rd) month. All patients were followed up for 6 months. The incidence of treated acute rejection and side effects were evaluated between two groups.</p><p><b>RESULTS</b>A total of 69 cases were fully followed up, and 7 cases were discontinued including death (n = 2), server infection (n = 2), protocol violation (n = 2) and retransplantation (n = 1). There were no statistical difference between 2 groups concerning the incidence of acute rejection, hypertension, hyperlipemia and other adverse events (P > 0.05), but significant difference in incidence of diabetes (17.5% vs. 38.9%, P = 0.047).</p><p><b>CONCLUSION</b>Steroid withdrawal strategy at day 7 is same safety and efficacy as steroid withdrawal at 3 month.</p>

The cause and management of postoperative venous outflow obstruction after orthotopic liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the causes and treatment of postoperative venous outflow obstruction after orthotopic liver transplantation (OLT).</p><p><b>METHODS</b>Clinical data of 776 patients after OLT were analyzed retrospectively between January 2000 and December 2006. The accumulated experiences in diagnosis and treatment of postoperative outflow obstruction after OLT were reviewed.</p><p><b>RESULTS</b>Venous outflow obstruction occurred in 10 patients (1.29%) after OLT, among those 6 had supra-hepatic inferior vena cava (IVC) stenosis, 2 had IVC stenosis of the post-hepatic segment, and 2 had outflow obstruction of hepatic vein. The diagnosis was confirmed by inferior vena cavography in all the patients. Of the 10 patients, 8 received percutaneous transluminal angioplasty (PTA) or metallic stent replacement, and 2 underwent liver retransplantation (re-LT) when interventional therapy failed. Three patients died from outflow obstruction, so the outflow obstruction related mortality was 30% in the patients.</p><p><b>CONCLUSIONS</b>Complications of outflow obstruction after OLT were associated with surgical technique like vascular anastomosis, various types of cavo-caval anastomosis and graft size mismatch between donor and recipient. Making an early diagnosis and giving timely treatment including interventional therapy or re-LT is the key to improve the prognosis of outflow obstruction.</p>