Epidemiological characteristics, diagnosis, treatment and prognosis of gallbladder cancer in China: a report of 6 159 cases / 中华消化外科杂志

Objective:To investigate the epidemiological characteristics, diagnosis, treat-ment and prognosis of gallbladder cancer in China from 2010 to 2017.Methods:The single disease retrospective registration cohort study was conducted. Based on the concept of the real world study, the clinicopathological data, from multicenter retrospective clinical data database of gallbladder cancer of Chinese Research Group of Gallbladder Cancer (CRGGC), of 6 159 patients with gallbladder cancer who were admitted to 42 hospitals from January 2010 to December 2017 were collected. Observation indicators: (1) case resources; (2) age and sex distribution; (3) diagnosis; (4) surgical treatment and prognosis; (5) multimodality therapy and prognosis. The follow-up data of the 42 hospitals were collected and analyzed by the CRGGC. The main outcome indicator was the overall survival time from date of operation for surgical patients or date of diagnosis for non-surgical patients to the end of outcome event or the last follow-up. Measurement data with normal distribu-tion were represented as Mean±SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and com-parison between groups was conducted using the U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was performed using the Logistic forced regression model, and variables with P<0.1 in the univariate analysis were included for multivariate analysis. Multivariate analysis was performed using the Logistic stepwise regression model. The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves. Log-rank test was used for survival analysis. Results:(1) Case resources: of the 42 hospitals, there were 35 class A of tertiary hospitals and 7 class B of tertiary hospitals, 16 hospitals with high admission of gallbladder cancer and 26 hospitals with low admission of gallbladder cancer, respectively. Geographical distribution of the 42 hospitals: there were 9 hospitals in central China, 5 hospitals in northeast China, 22 hospitals in eastern China and 6 hospitals in western China. Geographical distribution of the 6 159 patients: there were 2 154 cases(34.973%) from central China, 705 cases(11.447%) from northeast China, 1 969 cases(31.969%) from eastern China and 1 331 cases(21.611%) from western China. The total average number of cases undergoing diagnosis and treatment in hospitals of the 6 159 patients was 18.3±4.5 per year, in which the average number of cases undergoing diagnosis and treatment in hospitals of 4 974 patients(80.760%) from hospitals with high admission of gallbladder cancer was 38.8±8.9 per year and the average number of cases undergoing diagnosis and treatment in hospitals of 1 185 patients(19.240%) from hospitals with low admission of gallbladder cancer was 5.7±1.9 per year. (2) Age and sex distribution: the age of 6 159 patients diagnosed as gallbladder cancer was 64(56,71) years, in which the age of 2 247 male patients(36.483%) diagnosed as gallbladder cancer was 64(58,71)years and the age of 3 912 female patients(63.517%) diagnosed as gallbladder cancer was 63(55,71)years. The sex ratio of female to male was 1.74:1. Of 6 159 patients, 3 886 cases(63.095%) were diagnosed as gallbladder cancer at 56 to 75 years old. There was a significant difference on age at diagnosis between male and female patients ( Z=-3.99, P<0.001). (3) Diagnosis: of 6 159 patients, 2 503 cases(40.640%) were initially diagnosed as gallbladder cancer and 3 656 cases(59.360%) were initially diagnosed as non-gallbladder cancer. There were 2 110 patients(34.259%) not undergoing surgical treatment, of which 200 cases(9.479%) were initially diagnosed as gallbladder cancer and 1 910 cases(90.521%) were initially diagnosed as non-gallbladder cancer. There were 4 049 patients(65.741%) undergoing surgical treatment, of which 2 303 cases(56.878%) were initially diagnosed as gallbladder cancer and 1 746 cases(43.122%) were initial diagnosed as non-gallbladder cancer. Of the 1 746 patients who were initially diagnosed as non-gallbladder cancer, there were 774 cases(19.116%) diagnosed as gallbladder cancer during operation and 972 cases(24.006%) diagnosed as gallbladder cancer after operation. Of 6 159 patients, there were 2 521 cases(40.932%), 2 335 cases(37.912%) and 1 114 cases(18.087%) undergoing ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) examination before initial diagnosis, respec-tively, and there were 3 259 cases(52.914%), 3 172 cases(51.502%) and 4 016 cases(65.205%) undergoing serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis, respectively. One patient may underwent multiple examinations. Results of univariate analysis showed that geographical distribution of hospitals (eastern China or western China), age ≥72 years, gallbladder cancer annual admission of hospitals, whether undergoing ultrasound, CT, MRI, serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis were related factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.45, 1.98, 0.69, 0.68, 2.43, 0.41, 1.63, 0.41, 0.39, 0.42, 95% confidence interval as 1.21-1.74, 1.64-2.40, 0.59-0.80, 0.60-0.78, 2.19-2.70, 0.37-0.45, 1.43-1.86, 0.37-0.45, 0.35-0.43, 0.38-0.47, P<0.05). Results of multivariate analysis showed that geographical distribution of hospitals (eastern China or western China), sex, age ≥72 years, gallbladder cancer annual admission of hospitals and cases undergoing ultrasound, CT, serum CA19-9 examination before initially diagnosis were indepen-dent influencing factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.36, 1.42, 0.89, 0.67, 1.85, 1.56, 1.57, 0.39, 95% confidence interval as 1.13-1.64, 1.16-1.73, 0.79-0.99, 0.57-0.78, 1.60-2.14, 1.38-1.77, 1.38-1.79, 0.35-0.43, P<0.05). (4) Surgical treatment and prognosis. Of the 4 049 patients undergoing surgical treatment, there were 2 447 cases(60.435%) with complete pathological staging data and follow-up data. Cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb were 85(3.474%), 201(8.214%), 71(2.902%), 890(36.371%), 382(15.611%), 33(1.348%) and 785(32.080%), respectively. The median follow-up time and median postoperative overall survival time of the 2 447 cases were 55.75 months (95% confidence interval as 52.78-58.35) and 23.46 months (95% confidence interval as 21.23-25.71), respectively. There was a significant difference in the overall survival between cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb ( χ2=512.47, P<0.001). Of the 4 049 patients undergoing surgical treatment, there were 2 988 cases(73.796%) with resectable tumor, 177 cases(4.371%) with unresectable tumor and 884 cases(21.833%) with tumor unassessable for resectabi-lity. Of the 2 988 cases with resectable tumor, there were 2 036 cases(68.139%) undergoing radical resection, 504 cases(16.867%) undergoing non-radical resection and 448 cases(14.994%) with operation unassessable for curative effect. Of the 2 447 cases with complete pathological staging data and follow-up data who underwent surgical treatment, there were 53 cases(2.166%) with unresectable tumor, 300 cases(12.260%) with resectable tumor and receiving non-radical resection, 1 441 cases(58.888%) with resectable tumor and receiving radical resection, 653 cases(26.686%) with resectable tumor and receiving operation unassessable for curative effect. There were 733 cases not undergoing surgical treatment with complete pathological staging data and follow-up data. There was a significant difference in the overall survival between cases not undergoing surgical treatment, cases undergoing surgical treatment for unresectable tumor, cases undergoing non-radical resection for resectable tumor and cases undergoing radical resection for resectable tumor ( χ2=121.04, P<0.001). (5) Multimodality therapy and prognosis: of 6 159 patients, there were 541 cases(8.784%) under-going postoperative adjuvant chemotherapy and advanced chemotherapy, 76 cases(1.234%) under-going radiotherapy. There were 1 170 advanced gallbladder cancer (pathological staging ≥stage Ⅲa) patients undergoing radical resection, including 126 cases(10.769%) with post-operative adjuvant chemotherapy and 1 044 cases(89.231%) without postoperative adjuvant chemo-therapy. There was no significant difference in the overall survival between cases with post-operative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.23, P=0.629). There were 658 patients with pathological staging as stage Ⅲa who underwent radical resection, including 66 cases(10.030%) with postoperative adjuvant chemotherapy and 592 cases(89.970%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.05, P=0.817). There were 512 patients with pathological staging ≥stage Ⅲb who underwent radical resection, including 60 cases(11.719%) with postoperative adjuvant chemotherapy and 452 cases(88.281%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemo-therapy and cases without post-operative adjuvant chemo-therapy ( χ2=1.50, P=0.220). Conclusions:There are more women than men with gallbladder cancer in China and more than half of patients are diagnosed at the age of 56 to 75 years. Cases undergoing ultrasound, CT, serum CA19-9 examination before initial diagnosis are independent influencing factors influencing initial diagnosis of gallbladder cancer patients. Preoperative resectability evaluation can improve the therapy strategy and patient prognosis. Adjuvant chemotherapy for gallbladder cancer is not standardized and in low proportion in China.

Role of PD-1/PD-L1 signaling pathway in immune response of liver transplantation / 器官移植

Primary liver cancer (liver cancer) is one of the main indications of liver transplantation. However, postoperative recurrence of liver cancer severely affects the long-term clinical efficacy of liver transplantation. Programmed cell death protein 1 (PD-1) is an immunosuppressive molecule. Activation of PD-1/programmed cell death protein-ligand 1 (PD-L1) signaling pathway plays a pivotal role in the immune tolerance of grafts. In recent years, immune checkpoint inhibitor(ICI), such as PD-1/PD-L1 inhibitor, has become one of the effective approaches to treat advanced liver cancer, whereas ICI can be applied in liver transplant recipients is highly controversial, and the efficacy and safety remain to be studied. In this article, the expression of PD-1/PD-L1 in liver allograft tissues, the mechanism of PD-1/PD-L1 inducing transplantation immune tolerance and clinical application of PD-1/PD-L1 inhibitor in liver transplantation for liver cancer were reviewed.

Research progress on circular RNA in pancreatic cancer / 中华肝胆外科杂志

Circular RNA (circRNA) are a class of biologically conserved non-coding RNA. It has been found that various circRNA are differentially expressed in tumor tissues and are related with patients’ survival and prognosis. It’s shown that circRNA regulates microRNA (miRNA), interacts with proteins, regulates host gene expression, and translation of peptides. The early diagnosis rate of pancreatic cancer is low, and systemic chemotherapy has limited effect on the advanced patients with certain side effects. Basic researches showed that circRNAs affected the biological behavior of pancreatic cancer through a variety of signaling pathways, including MET/PI3K/Akt, ERK/VEGF, and Bcl-2/Caspase, suggesting that circRNAs are expected to be the biological markers and therapeutic targets for early diagnosis of pancreatic cancer. This paper intends to summarize the characteristics, classification, function and mechanism of action of circRNA, as well as the research progress in pancreatic cancer, in order to provide basic theoretical support for the transformation of medical research into clinical application.

Research progress on dendritic cell in immune tolerance of organ transplantation / 器官移植

Dendritic cell (DC) is professional antigen presenting cell with specific functions. DC can specifically phagocytize antigen, and process and deliver to effector T cell, which play an important role in immune tolerance and immune response. Tolerance DC (tol-DC) is a group of DC with negative immune regulatory function, which can induce immune tolerance of organ transplantation through central and peripheral mechanism. In this article, the phenotype and functional characteristics of DC, mechanism of immune tolerance induced by DC, and the application of tol-DC in organ transplantation of DC were summarized, aiming to provide basic theoretical support for clinical translational medicine research.

Comparison between different perfusion methods for donor liver acquisition in rat liver transplantation model under direct vision of single operator / 器官移植

Objective To establish a rat liver transplantation model under direct vision of single operator and to explore the effect of different perfusion methods on the quality of the donor liver. Methods On the basis of the "two-cuff method" established by Kamada, the operation details were improved to established the rat liver transplantation model. The recipient rats were divided into two groups according to different perfusion methods, group A (perfusion via abdominal aorta) and group B (perfusion via portal vein). The perfusion effect, operation time, operation success rate, postoperative liver function, liver graft pathological manifestations and survival were compared between the two groups. Results There were more residual red blood cells in sinus hepaticus in group B than in group A after perfusion. Both the donor liver perfusion time and donor operation time were longer in group A than those in group B, and the differences were statistically significant (both P < 0.01). The success rate of operation in group A and group B was 77% and 71%, respectively. At 3 d after liver transplantation in rats, the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TB) of the rats in the two groups were significantly higher than normal. At 7, 30 d after operation, compared with group A, the levels of ALT, AST and TB in group B were significantly increased, and the differences were statistically significant (all P < 0.01-0.05). The liver pathological examination showed that the degree of inflammatory reaction in the liver and degree of destruction of liver tissue in group B were more severe than those in group A, but there was no significant difference in long-term survival rate between the two groups. Conclusions Although the perfusion time and donor operation time of rat liver transplantation model were slightly prolonged by means of abdominal aorta perfusion, the perfusion effect was better, which can reduce liver tissue damage after operation and restore liver function to normal levels more quickly.

Advance of the role of Aromatic hydrocarbon receptor in immunoregulation related to tryptophan metabolism / 国际外科学杂志

Aromatic hydrocarbon receptor (AhR),an intracellular receptor,contains multiple ligand binding sites.Various ligands of AhR are divided into exogenous and endogenous ligands according to the origination.Different ligands bind and activate AhR,regulating the transcription of downstream target genes,especially CYP1 from Cypcytochrome P450 gene family,which plays an essential role in different pathological problems,as well as in the normal development and function of organism.Kynurenine(Kyn),a key metabolic product of tryptophan (Trp),metabolic products of which are major types of endogenous ligands of AhR,has an impact on adaptive immune by manipulating the polarization and activity of immunocytes.Kyn has been focus for its supressive effect in anti-tumor immunity and raised concern recently for its intriguing role in allograft immunoregulation.Research advances in the role of AhR in immunoregulation related to tryptophan metabolism will be illustrated in this review in detail.

Risk factors for recurrence after 5-year endocrine therapy in postoperative breast cancer patients / 中华普通外科杂志

Objective To evaluate recurrence risk factors in postoperative breast cancer patients after 5-year adjuvant endocrine therapy.Methods From Jan 2006 to Dec 2011,a total of 327 patients were enrolled for this study.Kaplan-Meier curves were applied to estimate survival rates and COX's proportional hazards model to identify prognostic variables.Results Among these 327 eligible patients,42 (12.8％) patients suffered from distant metastasis and 34 (10.4％) patients experienced locoregional recurrence after 5-year adjuvant endocrine therapy.Survival analysis showed that patients with histologic grade 3 disease,lymph node metastasis,Ki-67 high expression,high TNM stage and radiotherapy were statistically significant with poorer relapse-free survival (RFS,P =0.000,0.003,0.000,0.003,0.034)and poorer distant metastasis-free survival (DMFS,P =0.000,0.002,0.000,0.002,0.023),respectively.In multivariate analysis,patients with histological grade 3 disease (P =0.002) and more than 3 positive nodes (P =0.032) were risk factors for lower RFS.However,only histological grade 3 (P =0.015) was risk factor for DMFS.Conclusions Late relapse after completion of 5-year adjuvant endocrine therapy was still common,patients with grade 3 disease and more than 3 positive nodes may benefit from extended endocrine therapy.

Extended endocrine therapy of breast cancer / 国际肿瘤学杂志

Endocrine therapy is an important treatment of estrogen receptor (ER) positive breast cancer.However,late relapse after completion of 5-year adjuvant endocrine therapy is still common.Extended endocrine therapy (EET) is a promising strategy to further reduce the risk of recurrence and increase the cure rate in early-stage patients.The decision-making to EET should be individually implemented by weighing the risk of late recurrence,menopausal status,side effects,and patients' preference.Future studies are still needed to identify the patients who are most likely to benefit from EET.

Effects of the tryptophan 2,3-dioxygenase in tryptophan metabolism and immunoregulation / 国际外科学杂志

Tryptophan 2,3-dioxygenase (TDO)is the rate-limiting enzyme in the catabolism of Trp along the kynurenine pathway.Trp is mainly catabilized by the TDO in the liver,which could not only regulate the concentration of the Trp and suppress the T cells proliferation,but also participate in antibacterial action and inflammatory response.The metabolin kynurenines as an endogenous ligand of the AhR receptor,the TDO enzymes,Kyn and AhR form the TDO-Kyn-AhR pathway have effects of regulatory the growth of tumor.With the research of the mechanism of immune regulation goes futher,it is expected to be a promising prospect in cancer therapy and the immune tolerance of transplantation.We reviewed in the article,which summarized the TDO mediated catabolism of Trp and immunomodulatory effect.

Correlations between P53 expression and clinicopathologic factors and the prognosis of Luminal breast cancer / 国际肿瘤学杂志

Objective To investigate the correlations between P53 expression and clinicopathologic factors and prognosis of Luminal breast cancer.Methods From January 2009 to December 2012,a total of 283 patients with Luminal breast cancer in the Shanghai General Hospital Affiliated to Shanghai Jiaotong Univer-sity were included.P53 expressions of them were assayed by immunohistochemistry.Survival analysis was applied using Kaplan-Meier curve and Log-rank test.Single factor analysis and mutiple-factor analysis were applied using Cox proportional hazard regression model.Results The rate of P53 expression was associated with tumor size (χ2 =6.285,P =0.043),lymph node metastasis (χ2 =15.881,P =0.000),histological grade (χ2 =8.132,P =0.043)and Ki-67 (χ2 =6.476,P =0.039),but it was not associated with age (χ2 =0.955,P =0.328),menopausal status (χ2 =3.808,P =0.051),pathological pattern (χ2 =0.847,P =0.655),estrogen receptor (χ2 =1.867,P =0.172),progesterone receptor (χ2 =0.937,P =0.333)and human epidermal growth factor receptor-2 (χ2 =0.110,P =0.741 ).In all the 283 patients,the 5-year relapse-free survival rates for P53-positive group and P53-negative group were 66.7% and 90.7% respectively (χ2 =12.609,P =0.000),while the 5-year overall survival rates were 84.4% and 93.4% respectively (χ2 =4.153,P =0.042),with significant differences.In Cox mutiple-factor analysis,lymph node metastasis (HR =2.484,95%CI:1.393-4.431,χ2 =9.497,P =0.002)and P53 over-expression (HR =3.627,95%CI:1.061-12.401,χ2 =4.220,P =0.040)were independent prognostic factors for the relapse-free survival of patients with Luminal breast cancer,and lymph node metastasis (HR =3.451,95%CI:1.891-6.297,χ2 =16.290,P =0.000)and higher histological grade (HR =2.806,95%CI:1.091-7.219,χ2 =4.582,P =0.032)were independent prognostic factors for overall survival.Conclusion P53 over-expression of patients with Luminal breast cancer is associated with prognostic factors such as lymph node metastasis and histological grade,which indicates the worse prognosis.

Research development of prophylactic central lymph node dissection for papillary thyroid cancer / 国际外科学杂志

Papillary thyroid cancer (PTC) is the most common malignant neoplasm originating from the thyroid gland and has an excellent prognosis.But cervical lymph node metastases are common and the most common sites of metastases are the central lymph nodes of the neck (level Ⅵ).While therapeutic central lymph node dissection for involved lymph nodes is needed in our nation and others,the controversial topic is whether routine prophylactic central lymph node dissection in patients without evidence of lymph node metastasis should be performed in patients with PTC.The author reviewed the research development of prophylactic central lymph node dissection for papillary thyroid cancer in the article.

Research progress on the clinical value of Ki-67 in early breast cancer / 国际外科学杂志

Ki-67 is a common proliferation marker,especially used to reflect the proliferation activity of malignancy cells.Recently this marker has been widely studied among early breast cancer patients,However,to date,whether include Ki67 in the list of required routine biological markers there is still a hot argument.This review mainly explores and summarizes the prognostic and predictive role of this marker in breast cancer,the clinical value of the combination of Ki-67 and other makers,and the problems lie in the application of Ki-67 in clinical practice.

Protective effect of PPAR-αagonist on PAN-induced podocyte injury / 中国药理学通报

Aim To investigate the function of fenofi-brate on PAN ( puromycin aminonucleoside )-induced podocyte injury. Methods SD female rats of 18-week-old were randomly assigned into 3 groups ( n =6 ) . Mice in PAN group and fenofibrate treated group received a single intravenous injection of PAN ( 65 mg ·kg-1 ) , while those in control group received equal volume of saline. Mice in fenofibrate treated group re-ceived 40 mg · kg-1 · d-1 of fenofibrate ( intragastric administration ) on day 1 after PAN injection , while those in PAN group and control group received equal volume of vehicle. 24 hours urine samples from all group were collected on day 0(1 day before PAN injec-tion), day 6, day 10. The 24 hours urine protein was detected by Bradford assay. All the rats were sacrificed 10 days after the induction of podocyte injury, and glo-merulus sample were collected. The expression of podocyte injury marker and transcription level in apop-tosis, podocyte cytoskeleton protein, slit diaphragm protein were evaluated by Western blot and real-time PCR. Results Compared with the control group, 10 days after injection of PAN, 24 hours urine protein was obviously increased, and the expression and transcrip-tion level of podocyte injury marker desmin, apoptosis, podocyte cytoskeleton protein, slit diaphragm protein were upregulated greatly, however, those were signifi-cantly lower in fenofibrate treated group as compared with those in PAN group. Conclusions PPAR-α ago-nist fenofibrate can ameliorate PAN-induced glomerulus podocyte injury, and the mechanism involved may be associated with inhibition of the mitochondria apopto-sis, TGF-β/Smad pathway and p38 pathway.

Effect of post-liver transplantation administration of ursodeoxycholic acid on serum liver tests and biliary complications: a randomized clinical trial / 中华肝脏病杂志

<p><b>OBJECTIVE</b>Endogenous hydrophobic bile acids may be a pathogenetic factor of biliary complications after orthotopic liver transplantation (OLT).This study was designed to investigate the effects of hydrophilic ursodeoxycholic acid (UDCA), when administered early after OLT, on serum liver tests and on the incidence of biliary complications.</p><p><b>METHODS</b>A total of 112 adult patients undergoing OLT were randomly assigned to one of two groups for receipt of UDCA (13 to 15 mg/kg/d for 4 weeks, n=56) or a placebo (n=56). All patients underwent serum liver testing and measurement of serum bile acids during the 4 weeks following OLT.Patients with T-tube underwent measurement of biliary bile acids during the 4 weeks following OLT.Biliary complications, as well as patient and graft survival rates, were analyzed during the follow-up period (mean of 65.6 months).</p><p><b>RESULTS</b>At post-OLT days 7, 21 and 28, the UDCA-treated patients showed significantly lower levels of alanine aminotransferase, aspartate aminotransferase and gamma glutamyl transpeptidase (all P less than 0.05).In addition, the UDCA-treated patients showed significantly lower incidence of biliary sludge and casts within the first year post-OLT (3.6% vs.14.3%; x2=3.953, P=0.047). However, there were no significant differences for the incidence of other biliary complications at post-OLT years 1, 3 and 5.The graft and patient survival rates were also similar between the two groups.</p><p><b>CONCLUSION</b>UDCA, when administered early after OLT, improves results from serum liver tests and decreases the incidence of biliary sludge and casts within the first postoperative year.</p>

Effects of the indoleamine 2,3- dioxygenase- initiated L- tryptophan metabolism in organ transplantation / 国际外科学杂志

Tryptophan is the essential amino acid in the growth of cell.Indoleamine 2,3-dioxygenase is the rate-limiting enzyme in the catabolism of tryptophan along the kynurenine pathway.Indoleamine 2,3-dioxygenase enzyme mainly promotes tryptophan consumption of local micro-environment,causing tryptophan lack,thus inhibiting proliferation and activation of T cell.Tryptophan-derived catabolites suppress allogeneic T-cell proliferation (kynurenine,3-hydroxykynurenine,and 3-hydroxyanthranilate).Indoleamine 2,3-dioxygenase dendritic cells may interact with regulatory T cells forming an immunomodulatory network to promote immune tolerance induction.Though the immune regulation mechanism of the indoleamine 2,3-dioxygenase-initiated L-tryptophan in transplantation remains unclear,Numerous researches indicate that its role of tolerance induction in transplantation will be significant.

The clinical efficacy and safety of intravenous cefmetazon for prevention of postoperative infections and treatment of infectioons in general surgery / 中华普通外科杂志

ObjectiveTo evaluate the clinical efficiency and safety of cefmetazon in the prevention Department of General Surgery,First People's Hospital,Shanghai Jiaotong University,Shanghai 200080,Chinaand or treatment of infections in general surgery. MethodsA multicenter,prospective and open-labeled trial was conducted. In the prevention group,1700 patients were enrolled in clean-infection surgery,cefmetazon was given 1 g iv half an hour before the surgery started,and 1 g iv twice daily after the surgery for 3 days.Clinical response was evaluated in terms of both cure ( disappearance of pre treatment symptoms)and pathogen. In the treatment group,897 patients were diagnosed as peritonitis, cholecystitis and cholangitis,the patients were given cefmetazon 2 g iv twice a day for 7 - 14 days,clinical response and microbiological efficacy were assessed.ResultsIn prophylactic group,1449 patients were finally included.The clinical efficacy was 100％ (1449/1449).In the treatment group,a total of 897 patients were enrolled,and 110 patients failed for assessment of clinical efficacy,787 patients were included in the PPS population,the clinical efficacy was 90.7％ (714/787); Bacterial eradication rate was 92％ (46/50).Adverse reaction rates in prevention group and treatment group were 1.3％ (22/1700) and 1.2％ (11/897),including mild nausea and vomitting.ConclusionsCefmetazon is effective and safe in prevention and treatment of Postoperative infections in general surgery.

Combined liver-kidney transplantation and orthotopic liver transplantation in the treatment of severe hepatitis B / 中华普通外科杂志

ObjectiveTo compare orthotopic liver transplantation (OLT)and combined liverkidney transplantation (CLKT) in the treatment of severe hepatitis B.MethodsIn this study 52 patients of severe hepatitis B were allocated to OLT (40 cases) or CLKT( 12 cases) at our department from Jan.2001 to Sep.2005.The perioperative complications and the result of follow-up were analyzed.ResultsThe preoperative renal functions in CLKT cases were severer than that in OLT cases.Postoperative severe infection was more common in CLKT cases than that in OLT cases.In OLT group 28 patients (70％)suffered from early posttransplant renal dysfunction,among them 11 patients needed dialysis,whilst there were 2 (16.7％ ) patients who needed dialysis in CLKT group (P ＜0.01 ).The posttransplant mortality in OLT group was 40％ ( n =16),significantly higher than that in CLKT ( 16.7％,n =2) ( P ＜ 0.01 ).In OLT group,9 cases developed severe renal failure and died.No one died of renal failure in CLKT group.ConclusionsThe prognosis is more favorable to perform CLKT in patients who suffered from severe hepatitis B with chronic renal dysfunction before transplantation.

One-stage combination of renopancreatic transplantation:a report of 5 cases / 中国普通外科杂志

Objective To summarize the clinical technique and experience of one stage combination of renopancreatic transplantation(SKPT) with portal venous drinage of pancreatic endocrine and enteric drainage of exocrine(PE).Methods Five patients with insulin-dependent diabetes mellitus and end-stage renal disease underwent SKPT with PE drainage.The clinical data,operative techbuque,and the prevention of non-technical complications were summarized.Results This procedure was successfully applied in the 5 patients.Three patients recovered excellently;but 2 died perioperatively,one died of sepsis due to pancreatic leakage,and one of FK506 toxicity.On postoperative day 3,in the 3 survivors,blood creatinine and urea nitrogen levels returned to normal;insulin administration was discontinued on 7d postoperatively,and the endogenous and exogenous secretory functions of the graft were normal.Conclusions SKPT with PE is a resonable procedure,because of its potential physiologic,metabolic,and immunologic advantages.PE drainage may become the prefer technique of pancreas transplantation.Intensive perioperative managements are effective methods to prevent complications and to improve the therapeutic effects.

Simultaneous kidney-pancreatic transplantation with portal venous and enteric drainage:a report of 6 cases / 中国普通外科杂志

Objective To evaluate clinical effect of simultaneous kidney-pancreatic transplantation(SKPT) with portal venous and enteric drainage. Method Between June 2001 and June 2004, six insulin-dependent diabetes mellitus(IDDM) and renal failure patients underwent this procedure. The venous drainage of the graft was established between donor′s portal vein and recipient′s superior mesenteric vein. The exocrine secretion was drained into proximal jejunum via side-to-side anastomosis between donor′s duodenum and recipient′s proximal jejunum. Steroids, mycophenolate mofetil, tacrolimus and Zenapax were used as immunosuppressants. Results Procedures were successful in all 6 cases. Excellent renal function and euglycemia were achieved in 4 cases. Follow-up of 4-34 months on the 4 survivers found excellent kidney-pancreatic function without any rejection episode. Two patients died perioperatively due to sepsis secondary to pancreatic leakage and drug toxicosis of excessive FK506. Conclusion Our preliminary experience suggests that simultaneous pancreas-kidney transplantation with enteric and portal drainage is reliable procedure for the treatment of IDDM with renal failure.

Rapid liver and kidney graft procurement:a report of 138 cases / 中国普通外科杂志

Objective To summarize the experience of rapid liver and kidney graft harvesting. Methods From Jan 2001 to Sep 2003,a quick procedure for combined liver and kidney procurement were used in 138 cases. The procedure includes in situ perfusion through aorta and superior mesenteric vein(SMV) plus drainage through inferior vena cava. Liver,pancreas,spleen and kidney were harvested en bloc. Results The warm ischemia time averaged at 2 to 6 minutes for kidneys and 3 to 8 minutes for livers. The total procurement time averaged at 20 to 30 minutes. All aberrant arteries were preserved. After transplantation there was no primary non-function in all 131 liver grafts,and the peak sALT level during the first 3 post-operative days was (581?392) U/L. Acute tubular necrosis rate was 3.3%(9/274) in renal grafts. Conclusion[WT5”BZ] This rapid procurement protects the quality of liver and kidney simultaneously. It is a simple,effective,safe and reasonably standardized procedure.