Sarcopenia Affects Liver Regeneration and Long-Term Survival Rate After Living-Donor Liver Transplantation in Patients With Hepatocellular Carcinoma.

PURPOSE: Despite technological and immunologic innovations, some living-donor liver transplant (LDLT) recipients still face poor liver regeneration. Sarcopenia is often recognized as a biomarker for poor outcomes in surgical patients. This study aimed to evaluate associations between sarcopenia and liver regeneration in LDLT recipients. MATERIALS AND METHODS: This retrospective review included consecutive patients who had received LDLT at Chang Gung Memorial Hospital between 2005 and 2017. Sarcopenia was assessed using the psoas muscle index (PMI) in cross-sectional images. Receiver operating characteristic curve analysis was used to determine the ability of PMI to predict relatively poor survival rates. Correlations between liver regeneration and sarcopenia were evaluated using regression analysis. RESULTS: A total of 109 LDLT recipients were included. The 1-, 3-, 5, 10-, and 15-year survival rates were 93.7%, 84.8%, 79.7%, 74.7%, and 73.3% in males and 93.3%, 83.3%, 83.3%, 71.4%, and 71.4% in females. PMIs were significantly different based on 10- and 15-year overall survival rates (P = .001 and P = .000) in male patients. Receiver operating characteristic curve analysis revealed the PMI cutoff point at 6.7 cm2/m2 (sensitivity = 48.3%, specificity = 81%, AUC (area under the ROC curve) = 0.685) based on 10-year survival. Linear regression analysis revealed that PMI was significantly associated with liver regeneration in males (P = .013). CONCLUSIONS: Sarcopenia and low PMI are associated with poor liver regeneration and long-term survival after LDLT in male patients. Further studies, including sarcopenia with conventional scores, may help to more reliably predict liver regeneration and mortality among LDLT patients with hepatocellular carcinoma.

Comparative study of the safety and efficacy of SMOFlipid vs non SMOFlipid as TPN for liver transplantation.

BACKGROUND: Liver transplantation (LT) is one of the widely recognised and leading treatments for end-stage liver disease. Nutrition impacts its success. Total parenteral nutrition (TPN) is usually prescribed for patients recommended prolonged fasting after LT. The supplement of SMOFlipid (soybean oil, MCT oil, olive oil, and fish oil) is easily metabolised to produce energy, and it possesses anti-inflammatory effects; however, SMOFlipid emulsion use raises concerns regarding coagulopathy after LT. This study investigated the postoperative correlation between SMOFlipid and coagulation in LT. MATERIALS AND METHODS: The medical records of 54 recipients of living donor LT between January 2012 and June 2015 were retrospectively reviewed. Patients with pretransplant platelet count <40,000/µL and >40,000/µL were assigned to the non-SMOFlipid (n = 23) group and the SMOFlipid (n = 31) group, respectively. RESULTS: The coagulation and nutrition profile of patients improved significantly after TPN support. No significant difference was observed in the coagulation profile between SMOFlipid and non-SMOFlipid groups. Although the SMOFlipid group exhibited a higher platelet count than the non-SMOFlipid group on day 7 (P < 0.001), no significant differences were observed in the platelet count on 14 and 30 days after TPN support between the 2 groups. CONCLUSION: TPN using SMOFlipid after LT is a good strategy for improving nutritional status without increasing the risks of bleeding and coagulation in patients intolerant of early enteral nutrition. Moreover, SMOFlipid use may not cause coagulopathy up to 14 days after LT. Overall, SMOFlipid provides nutritional benefits without increasing the risk of bleeding.

Sarcopenia adversely impacts postoperative complications in living-donor liver transplantation recipients.

Despite technological and immunological innovations, living-donor liver transplant (LDLT) recipients still face substantial risk of postoperative complications. Sarcopenia is being recognized more and more as a biomarker that correlates with poor outcomes in surgical patients. The purpose of this study was to evaluate the relationship between sarcopenia and significant surgical complications in LDLT recipients. This retrospective review included patients who had received LDLT at our institute from 2005 to 2017. Sarcopenia was assessed using the psoas muscle index (PMI) in cross-sectional images. ROC curve analysis was used to determine the ability of PMI to predict postoperative complications. Correlations between major postoperative complications and sarcopenia were evaluated using regression analysis. A total of 271 LDLT recipients were included. No significant differences were found between PMI and major postoperative complications in male patients. Female recipients with major postoperative complications had significantly lower mean PMI values (P = 0.028), and the PMI cut-off value was 2.63 cm2/m2. Postoperative massive pleural effusion requiring pigtail drainage occurred more frequently in the sarcopenia group than in the non-sarcopenia group (P = 0.003). 1-, 3-, 5- and 10-year overall survival rates in female were significantly poorer in the sarcopenia group (n = 14) compared with the non-sarcopenia group (n = 108), at 92.9% versus 97.2%, 85.7% versus 95.4%, 85.7% versus 92.5% and 70.1 versus 82.0%, respectively (P = 0.041) and 94.6%, 89.9%, 85.9% and 78.5% in male patients. Sarcopenia is associated with a significantly higher risk of major postoperative complications in females. PMI and sarcopenia together are predictive of major postoperative complications and survival rates in female LDLT recipients.

[Primary study on the influence of blood transfusion on the STR genotypes of recipient's blood].

OBJECTIVE: To investigate whether any change occurred in recipients' blood collected at different times after transfusion with different quantity of blood. METHODS: Three patients were transfused with 400 ml, 800 ml and 1200 ml blood separately. The blood samples were collected from the recipients before transfusion and at 4 h, 8 h, 12 h after transfusion, and from the donors. DNA were extracted by Chelex-100 method and were amplified by the polymerase chain reaction (PCR). Six loci of D1S549, D18S865, D3S1754, D12S391, D12S375, D6S477 were selected. The PCR products were analyzed by polyacrylamide gel (PAG) vertical electrophoresis and silver staining. RESULTS: The investigations on the six STR loci revealed that the patients' STR genotypes remained unchanged within 12 h after blood transfusion. CONCLUSION: The STR genotypes of the donors would have no influence on the STR genotypes of the patients within 12 h after transfusion providing the volume of blood transfused is less than 1200 ml.

[Sequence polymorphisms of the mitochondrial DNA control region in 100 Chengdu Hans in China].

OBJECTIVE: To study the genetic polymorphisms of the mitochondrial DNA (mtDNA) control region in Chengdu Han population. METHODS: Sequence polymorphisms of the mtDNA control region, hypervariable regions I and II from 100 unrelated Chinese Hans were determined by PCR and direct sequencing. RESULTS: Sequences of 404 nucleotides for hypervariable region I and 379 nucleotides for region II were obtained. Ninety-two and fifty variable sites were revealed in region I and region II respectively as compared to the reference sequence, and a total of 97 different genetic patterns from both the regions I and II were determined. The probability of identity was estimated at 1.84% for region I, 1.94% for region II, and 1.18% for both the regions. CONCLUSION: These results suggest that sequence polymorphism of mtDNA control region would be very useful in forensic practice as a marker for individual identification.

[Study on the genetic polymorphisms of D8S1132 locus in Chinese Han, Mongolian and Thai populations].

OBJECTIVE: The aim of the present study was to obtain the population genetic data of short tandem repeat (STR) locus D8S1132 and study the difference of allelic frequency distributions among different populations. METHODS: A sample of 380 unrelated individuals from 3 populations (Han, Mongolian, Thai) were studied using single PCR followed by polyacrylamide gel electrophoresis and silver staining. RESULTS: Eleven allels and 42 genotypes were observed. The observed heterozygosity and the discrimination power were 85.0%-89.5% and 94.1%-95.5%, respectively. The genotype distributions of D8S1132 locus in 3 populations were in accordance with Hardy-Weinberg equilibrium and the difference of allelic frequency distributions among 3 populations was obvious. CONCLUSION: The methods established are easy-to-perform and sensitive. The discrimination power and exclusion chances of this locus are desirable for forensic analysis.

[A population study of three Y-STR loci by multiplexing in Han population in Chengdu, China].

OBJECTIVE: To establish a better method determining three Y-STR loci. METHODS: A multiplex of Y-STRs and amplify simultaneously three Y-STRs loci. RESULTS: Establish successfully a multiplexing system of three Y-STR loci (DYS390, DYS391 and DYS393) followed by a population genetic study of Han population in Chengdu, China. CONCLUSION: The diversity of haplotype is 0.8965, the value of discrimination and the chance of exclusion chance is 0.8965 with the standard error 0.0081. This established system is one of the good tools in personnel identification and genetic study.

[The expression of bFGF and its receptor FGFR1 in rat after fluid-percussive brain injury].

OBJECTIVE: Study on the pattern of changes of bFGF and FGFR1 immunoreactivity occurred in the experimental brain injury model for the purpose of providing the scientific basis for molecular pathological diagnosis, forensic identification, clinical treatment as well as further ascertaining the molecular mechanism of brain injury. METHODS: Male SD rats were divided into normal control, sham operation control and injury groups. The rats of injury groups were subjected to moderate lateral fluid percussion brain injury (0.2 mPa). The injury groups were then subdivided into 30 min, 1, 3, 6, 12 h, 1, 3, 7 d groups according to the time elapsed after injury. The SP immunohistochemistry method was used to examine the expression of both bFGF and FGFR1 factors in rat brain. RESULTS: In the brain of normal control and sham operation control groups, the low expression levels of bFGF and FGFR1 were observed. The increase of bFGF and FGFR1 immunoreactivity could be observed 6 h after injury in cortex and brain stem, reached to the peak at 1 d and remained at the high level up to 3 d, then partly declined at 7 d. In hippocampus, however, the increase occur as early as 3 h after injury, reached to the peak at 1 d and then decreased progressively, and returned to basal level at 7 d. CONCLUSION: The results suggested that brain injury induced the gene expressions of bFGF and FGFR1. The bFGF may contribute to maintenance of nerve cell survival and the repair of damaged neural tissues after CNS injury and the patterns of their level change were quite regular and can be used for timing of injury in forensic medicine aspect.

[DNA-based technique and species identification].

The species identification plays a key role in forensic analysis. Generally, three methods have been applied for this purpose, they are morphologic-based, serologic-based and DNA-based techniques. This review mainly discussed the DNA-based technique and evaluate it's value in species identification of forensic science.

[Genetic polymorphism of the STR DXS9898 locus in Han population].

OBJECTIVE: Studying the genetic polymorphism of X-STR locus DXS9898 in Han population. METHODS: 296 unrelated Chinese individuals (199 females and 97 males) living in Chengdu were investigated using PCR and PAG electrophoresis followed by silver staining. RESULTS: 6 alleles were observed and the range of fragment size was 189-214 bp. The genotype distribution of DXS9898 locus was in accordance with Hardy-Weinberg equilibrium. Family survey confirmed Mendelian inheritance of alleles. The observed heterozygosity in females was 0.5930, the discriminating power (Dp) were 0.5667 and 0.9420 for males and females respectively. The power of exclusion were 0.5862 and 0.4392 for trio and duo respectively. CONCLUSION: The results demonstrated that the locus is highly polymorphic and can be used in forensic identification and parentage testing.

Enalapril increases ischemia-induced endothelial progenitor cell mobilization through manipulation of the CD26 system.

Enalapril, an angiotensin-converting enzyme (ACE) inhibitor, reduces cardiovascular events in patients with acute myocardial infarction. However, whether the beneficial effect of enalapril is mediated in part through endothelial progenitor cells (EPCs) has yet to be elucidated. This study investigated the role of the CD26/dipeptidylpeptidase IV (DPP IV) system in enalapril-modulated EPC mobilization. C57 BL/6 mice were divided into control and enalapril-treated groups. Peripheral EPCs were enumerated before and after ischemic stress. CD26/DPP IV activity and stroma-derived factor-1alpha (SDF-1alpha) levels were measured in the blood and the bone marrow. In response to ischemic stress, the enalapril group displayed a significant increase in circulating EPCs (with a 3.6-fold increase of sca-1+KDR+ cells and a 2.2-fold increase of c-kit+CD31+ cells versus controls at 12 h). Enalapril also caused a sixfold increase in the contribution of bone marrow-derived EPCs to the ischemia-induced neovascularization. In the bone marrow, enalapril did not alter CD26+ cell numbers; however, it did amplify DPP IV activity. In the blood, through the anti-inflammatory effect, enalapril significantly decreased CD26+ cell numbers, leading to a decrease in total DPP IV activity. These phenomena were associated with a lower SDF-1alpha concentration in the bone marrow but higher in the blood in the enalapril group, compared to the controls. All these findings were not demonstrated without ischemic stress. The effect of enalapril on EPC mobilization could be substantially blocked by Diprotin-A, a DDP IV antagonist. This study demonstrates that one of the pleiotropic effects of enalapril on the cardiovascular system involves the modulation of circulating EPC numbers via the CD26/DPP IV system, which may serve as a potential target for mobilizing EPCs for therapeutic purposes.