Prognostic value of preoperative peripheral monocyte count in patients with hepatocellular carcinoma after liver transplantation.

Prognostic value of peripheral monocyte, as a member of inflammatory cells, was widely being investigated. The aim of this study was to evaluate the prognostic value of preoperative peripheral blood monocyte count for hepatocellular carcinoma (HCC) patients who underwent liver transplantation (LT) and the relationship between monocyte count and tumor-related characteristics. We retrospectively analyzed the clinical data of 101 HCC patients after LT. Preoperative monocyte count and demographic, clinical, and pathologic data were analyzed. The optimal cutoff value of monocyte count was 456/mm(3), with the sensitivity and specificity of 69.4 and 61.5 %, respectively. Elevated preoperative peripheral blood monocyte count was significantly associated with large tumor size. The 1-, 3-, and 5-year disease-free survival (DFS) (80.9, 70.1, and 53.3 % vs 55.1, 38.7, and 38.7 %, P = 0.007) and overall survival (OS) rates (95.7, 76.6, and 64.8 % vs 72.2, 44.1, and 36.1 %, P = 0.002) of HCC patients in the peripheral blood monocyte count ≤456/mm(3) group were higher than those in the peripheral blood monocyte count >456/mm(3) group. In conclusion, elevated preoperative peripheral blood monocyte count was significantly associated with advanced tumor stage and it can be considered as a prognostic factor for HCC patients after LT.

Indole Alkaloids from Chaetomium globosum.

Two new indole alkaloids chaetocochin J (1) and chaetoglobinol A (8), along with chetomin (2), chetoseminudin A (3), cochliodinol (9), and semicochliodinol (10), were isolated from the rice culture of the fungus Chaetomium globosum. Their structures were elucidated by spectral analysis. Three new epipolythiodioxopiperazines, chaetocochins G-I (5-7), were identified by the combination of UPLC and mass spectrometric analysis. Chaetocochin I contained two sulfur bridges, one formed by three sulfur atoms between C-3 and C-11a, and the other formed by four sulfur atoms between C-3' and C-6'. Chaetocochin I was readily transformed into chetomin (2), chetoseminudin A (3), chaetocochin D (4), chaetocochin G (5), and chaetocochin H (6) by losing sulfur atoms. Compounds 1-3, and 8 exhibited antibacterial activities against Bacillus subtilis with MICs of 25, 0.78, 0.78, and 50 µg/mL, respectively, but not against Gram-negative bacterium (Escherichia coli). Compounds 2 and 8 were inactive against Candida albicans, Fusarium graminearum, Fusarium vasinfectum, Saccharomyces cerevisiae, and Aspergillus niger even at the high concentrations of 200 and 100 µg/mL, respectively. Compound 8 showed free radical scavenging capacity against the 1,1-diphenyl-2-picryl-hydrazyl (DPPH) and 2,2'-azino-bis-3-ethylbenzothiazoline-6-sulfonic acid radical (ABTS(+•)), with IC50 values of 143.6 and 45.2 µM, respectively. The free radical scavenging capacity rates of compounds 1-3 on the DPPH and ABTS(+•) were less than 20% at the test concentrations (89.9-108.3 µM). The superoxide anion radical scavenging assay indicated that compounds 1-3, and 8 showed 14.8% (90.9 µM), 18.1% (90.9 µM), 51.5% (88.3 µM), and 30.4% (61.3 µM) superoxide anion radical scavenging capacity, respectively.

Liver transplantation using organs from deceased organ donors: a single organ transplant center experience.

BACKGROUND: In 2011, a pilot program for deceased organ donation was initiated in China. We describe the first successful series of liver transplants in the pilot program. METHODS: From July 2011 to August 2012, our center performed 26 liver transplants from a pool of 29 deceased donors. All organ donation and allograft procurement were conducted according to the national protocol. The clinical data of donors and recipients were collected and summarized retrospectively. RESULTS: Among the 29 donors, 24 were China Category II donors (organ donation after cardiac death), and five were China Category III donors (organ donation after brain death followed by cardiac death). The recipients were mainly the patients with hepatocellular carcinoma. The one-year patient survival rate was 80.8% with a median follow-up of 422 (2-696) days. Among the five mortalities during the follow-up, three died of tumor recurrence. In terms of post-transplant complications, 9 recipients (34.6%) experienced early allograft dysfunction, 1 (3.8%) had non-anastomotic biliary stricture, and 1 (3.8%) was complicated with hepatic arterial thrombosis. None of these complications resulted in patient death. Notably, primary non-function was not observed in any of the grafts. CONCLUSION: With careful donor selection, liver transplant from deceased donors can be performed safely and plays a critical role in overcoming the extreme organ shortage in China.

FlyExpress: visual mining of spatiotemporal patterns for genes and publications in Drosophila embryogenesis.

SUMMARY: Images containing spatial expression patterns illuminate the roles of different genes during embryogenesis. In order to generate initial clues to regulatory interactions, biologists frequently need to know the set of genes expressed at the same time at specific locations in a developing embryo, as well as related research publications. However, text-based mining of image annotations and research articles cannot produce all relevant results, because the primary data are images that exist as graphical objects. We have developed a unique knowledge base (FlyExpress) to facilitate visual mining of images from Drosophila melanogaster embryogenesis. By clicking on specific locations in pictures of fly embryos from different stages of development and different visual projections, users can produce a list of genes and publications instantly. In FlyExpress, each queryable embryo picture is a heat-map that captures the expression patterns of more than 4500 genes and more than 2600 published articles. In addition, one can view spatial patterns for particular genes over time as well as find other genes with similar expression patterns at a given developmental stage. Therefore, FlyExpress is a unique tool for mining spatiotemporal expression patterns in a format readily accessible to the scientific community. AVAILABILITY: http://www.flyexpress.net CONTACT: s.kumar@asu.edu.

Steroid elimination within 24 hours after orthotopic liver transplantation: effectiveness and tolerability.

BACKGROUND: Steroids have been the mainstay of immunosuppressive regimen in liver transplantation. However, the use of steroids is associated with various post-transplant complications. This study evaluated the efficacy and safety of reduced immunosuppressive regimen with steroids (steroid elimination within 24 hours post-transplant) in a cohort of Chinese liver transplant recipients. METHODS: Seventy-six patients in line with the selection criteria were enrolled in this prospective study. All patients received anti-IL-2 receptor antibody induction and tacrolimus-based maintenance therapy. The recipients were divided into two groups according to the duration of steroid use: 40 transplant in a 3-month withdrawal group and the remaining 36 in a 24-hour elimination group. Recipient survival, post-operative infections, biopsy-proven acute rejection and steroid-resistant acute rejection, non-healing wound, recurrence of hepatitis B virus (HBV) and hepatocellular carcinoma (HCC), de novo diabetes, hyperlipidemia and hypertension were assessed in the two groups. RESULTS: There was no significant difference in patient survival, incidence of acute rejection episodes and hyperlipidemia, and recurrence of HBV and HCC between the two groups. However, the incidence rates of post-transplant infection, non-healing wound, de novo diabetes and hypertension were significantly lower in the 24-hour elimination group than in the 3-month withdrawal group (all P values <0.05). CONCLUSION: Under anti-IL-2 receptor antibody induction and tacrolimus-based maintainance, steroid elimination within 24 hours post-transplant is associated with reduced steroid-related complications without increasing the risk of rejection.

[Efficacy and safety of sorafenib in the prevention and treatment of hepatocellular carcinoma recurrences after liver transplantation].

OBJECTIVE: To evaluate the efficacy and safety of sorafenib in the prevention and treatment of hepatocellular carcinoma (HCC) relapse after liver transplantation. METHODS: A retrospective cohort study was performed to assess the efficacy and safety of sorafenib for HCC. Forty-four patients who underwent liver transplant for HCC beyond Milan criteria form July 2007 to May 2010 were included study group (sorafenib, n = 22) and control group (without sorafenib, n = 22). The primary endpoints of the study were disease-free survival (DFS), overall survival (OS). Secondary outcomes included the rates of acute rejection and graft survival. RESULTS: The clinical data of 44 patients were completely collected. There were significantly differences between sorafenib group and control group in 1-year DFS (81.8% (n = 18) vs 63.6% (n = 14), P < 0.05) and OS (90.9% (n = 20) vs 72.7% (n = 16), P < 0.05) respectively. The acute rejection rates in Sorafenib were 13.6% (3/22), compared with 18.2% (4/22) in control group (P = 0.524) and 1-year graft survival in Sorafenib group were 86.4% (19/22), compared with 72.7% (16/22) in control group (P = 0.086). The overall incidence of treatment-related adverse events was 68.1% (n = 15) in sorafenib group and 31.8% (n = 7) in the control group (P < 0.01). Adverse events that were reported for patients receiving sorafenib were predominantly grade 1 or 2 in severity including diarrhea (45.5%, n = 10), liver dysfunction (40.9%, n = 9), hand-foot skin reaction (31.8%, n = 7) and pains of head and four limbs (22.7%, n = 5). Two patients with grade 3 adverse events in study group were stopped continuing to use the sorafenib. Three patients with the dose of 400 mg twice daily and 17 patients with the dose reduction of sorafenib continued to the study endpoint. CONCLUSION: Patients with HCC undergoing liver transplantation could get the benefits of Sorafenib in reducing the incidence of tumor recurrence and extending disease-free and overall survival time.

[A study of the efficacy and safety of using hepatitis B surface antigen-positive donors for liver transplantation].

OBJECTIVE: To evaluate the outcomes of liver transplant recipients who received liver allografts from hepatitis B surface antigen (HBsAg)-positive donors. METHODS: 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. RESULTS: 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. CONCLUSION: Liver transplantation using HBsAg(+) liver grafts was safe for patients with ESLD secondary to HBV infection.

[Clinical characteristics, diagnosis and treatment of digestive tract leakage after orthotopic liver transplantation].

OBJECTIVE: To investigate the clinical characteristics, diagnosis and treatment of digestive tract leakage after orthotopic liver transplantation (OLT). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

[Experiences of liver retransplantation for postoperative diffuse biliary strictures].

OBJECTIVE: To investigate the feasibility and management of retransplantation for diffuse biliary strictures occurring after initial liver transplantation. METHODS: The clinical data of 53 consecutive liver retransplantation patients at our hospital from January 2001 to December 2009 were collected and analyzed retrospectively. Among them, 20 (37.7%) were due to diffuse biliary strictures. RESULTS: Diffuse biliary strictures appeared at 3 - 16 months after initial transplantation. The mean time was 6.3 months. The specific types included intra-hepatic diffuse biliary strictures (n = 16) and multi-strictures involving both intra- & extra-hepatic biliary ducts (n = 4). Retransplantation was performed after a failure of intervention or/and other comprehensive treatments. Among them, 14 were cured and 6 died from peri-operative complications including serious abdominal infection & MODS (multiple organ dysfunction syndrome) (n = 3, 50%), biliary fistula (n = 2, 33.3%) and hepatic artery embolism (n = 1, 16.7%). These patients were followed up for a mean time of 1.8 years (range: 1 - 5 years). The accumulative survival rates at 1, 3 and 6 months were 80.0%, 75.0% and 70.0% respectively. CONCLUSIONS: Liver retransplantation is the ultimate treatment for diffuse biliary strictures after liver transplantation. The survival rate is associated with operative timing, surgical techniques and peri-operative management.

[Clinical efficacies of ABO-incompatible adult liver transplantation].

OBJECTIVE: To evaluate the efficacy and safety of ABO-incompatible liver transplantation in adult patients with fulminant hepatitis B. METHODS: The clinical data of 97 cases of adult liver transplantation for fulminant hepatitis B were retrospectively analyzed. The patients were grouped as ABO-identical (ABO-Id, n = 58), ABO-compatible (ABO-C, n = 19) and ABO-incompatible (ABO-In, n = 20). The rates of rejection, infection, biliary tract complications, vascular complications, and patient and graft survivals were compared among 3 groups. RESULTS: The 3-month, 1-year and 3-year graft survival rates were 87.9%/77.6%/65.3% in ABO-Id group, 84.2%/73.7%/66.5% in ABO-C group and 50.0%/35.0%/33.3% in ABO-In group respectively. There were significant differences between ABO-Id and ABO-In (P < 0.05). The incidences of rejection, infection, vascular complications and biliary tract complications were 8.6%, 20.7%, 3.4% and 6.9% in ABO-Id group, 35%, 60%, 20% and 30% in ABO-In group (P < 0.05) and 10.5%, 26.3%, 5.3% and 10.5% respectively in ABO-C group (P > 0.05). CONCLUSION: ABO-C liver transplantation is an important therapeutic option in adult patients with acute liver failure awaiting an emergency procedure. ABO-In transplantation can be used only for life-rescuing in patients with fulminant hepatitis since it is associated with a higher risk of rejection, infection, vascular thrombosis, ischemic bile duct complications and poor patient and graft survival.

[A 17-year study of bloodstream Escherichia coli infection after liver transplantation: resistance rate, risk factor and mortality].

OBJECTIVE: To explore the resistance rate, risk factors and mortality of Escherichia coli bloodstream infections (BSI) after liver transplantation. METHODS: From January 1993 to May 2010, a retrospective analysis of Escherichia coli in liver transplants were conducted. RESULTS: A total of 88 BSI occurred in 83/695 patients and Escherichia coli (n = 23) was most commonly found. Carbapenem and piperacillin-tazobactam were the most consistently active against Escherichia coli while the resistance rate to enterococcus for ciprofloxacin, gentamycin, ampicillin-clavulanic acid was over 60%. Univariate analysis identified the following variables as risk factors for Escherichia coli bacteremia: cholangioenterostomy (P < 0.001) and ductal complications (P < 0.001). Escherichia coli bloodstream infection could increase the mortality at 15 days after bloodstream infection. No significant difference in mortality occurred at 30 days and 1 year after enterococcal bacteremia. CONCLUSION: Escherichia coli after liver transplantation is resistant to agents but commonly active to carbapenem and piperacillin-tazobactam. The risk factor associated with Escherichia coli bloodstream infections are cholangioenterostomy and ductal complications. Escherichia coli bloodstream infection can increase the mortality at 15 days after bloodstream infection.

[A 17-year study of bloodstream infection after liver transplantation: resistance rate, risk factor and mortality of enterococcal bloodstream infections].

OBJECTIVE: To explore the resistance rate, risk factor and mortality of enterococcal bloodstream infections (BSI) after liver transplantation. METHODS: From January 1993 to May 2010, a retrospective analysis of enterococcus in liver transplants were conducted. RESULTS: Fifty-eight BSI occurred in 53 of 695 patients. And a total of 30 enterococci were isolated. Linezolid and glycopeptide antibiotics were the most consistently active against the Enterococcus. The resistance rates to Enterococcus for erythromycin, clindamycin, imipenem, ciprofloxacin, gentamycin and ampicillin-clavulanic acid were all over 70%. The univariate analysis identified the following variables as the risk factors for enterococcal bacteremia: retransplantation (P=0.03) and biliary duct complications (P=0.02). Enterococcal bloodstream infection increased the mortality at Day 15. No significant difference was found in the mortality rate at Day 30 and 1 year after enterococcal bacteremia. CONCLUSION: Enterococcus after liver transplantation is resistant to multiple agents but active to linezolid and glycopeptide antibiotics. The risk factors commonly associated with enterococcal BSI are retransplantation and biliary duct complications. Enterococcal BSI can increase the mortality at Day 15 after liver transplantation.

[Clinical analysis on multivisceral transplantation].

OBJECTIVE: To assess the indication, surgical and post-operative complications of the multivisceral transplantation. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

[Application of steroids minimization immunosuppressive regimen in liver transplantation].

OBJECTIVE: To investigate the safety and feasibility of steroids minimization immunosuppressive regimen in liver transplantation. METHODS: 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. RESULTS: 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). CONCLUSION: 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.

[Two-dose steroid combined with two-dose daclizumab and tacrolimus regimen in liver transplant recipients].

OBJECTIVE: To investigate the efficiency and safety of two-dose steroid combined with two-dose daclizumab and tacrolimus (FK506) regimen in liver transplant recipients. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

[Potential Source Environments for Microbial Communities in Wastewater Treatment Plants (WWTPs) in China].

To better understanding the microbial composition of activated sludge (AS), unique OTUs and their indicators were examined and SourceTracker was used to identify possible source environments for AS communities to thrive in 15 cities across China, based on 16S rRNA gene sequencing. This may help reveal the underlying mechanisms of AS community composition formations in various areas. The results indicated that the dominant phyla in AS in each city were similar; Proteobacteria, Bacteroidetes, and Chloroflexi made up 94.53%-97.04% of the whole microbial communities. Geographic location and environmental conditions were identified as having an effect on microbial compositions. Cities located toward to the edge of China or along the coast tended to harbor more unique OTUs. Moreover, the composition of indicators in wastewater treatment plants (WWTPs) near the sea were more similar, while no indicators were detected in WWTPs in Chengdu and Chongqing. Source environments for AS microbial communities also depended on location and environmental conditions. Overall, microbes from 'plant' and 'soil' sources accounted for a large proportion of the AS microbial communities in each city, while bacteria from 'marine' sources were only detected in coastal AS communities. Cities with more rivers and lakes tended to have more bacteria originating from 'fresh water' sources. Since most of the WWTPs in China play a role in treating industrial wastewater, industrial wastewater was also an important source environment. However, few bacteria originating from the human digestive system were identified in the AS communities. Moreover, a large proportion of bacteria (36%-70%) originated from unknown sources not included in the source database, such as sewage infrastructure, indicating that the source database will need to be expanded in the future.

Azaphilone Alkaloids with Anti-inflammatory Activity from Fungus Penicillium sclerotiorum cib-411.

Nine new azaphilone alkaloids, penazaphilones A-I (1-9), were isolated from the solid fermented rice culture of Penicillium sclerotiorum cib-411. The structures of compounds 1-9 were elucidated based on HRESIMS, NMR, and CD spectroscopic data. The structures of 5 and 8 were confirmed by X-ray crystallographic analyses. Biological evaluation showed that compounds 1, 5, 6, and 8 inhibited the production of nitric oxide (NO) on RAW 264.7 cells stimulated by lipopolysaccharide with IC50 values of 15.29, 9.34, 9.50, and 7.05 µM, respectively. Meanwhile, they did not exhibit obvious cytotoxicity at a concentration of 50.0 µM.

Graft-verse-host disease after liver transplantation: a report of two cases and review of literature.

Graft-verse-host disease (GVHD) is an uncommon fatal complication following liver transplantation (LTx). In mainland China, only six cases have been reported with a morbidity rate up to 1%-2%. Definitive diagnosis was achieved by molecular techniques (HLA typing or PCR-STR) in only two cases and the remaining cases were diagnosed based on typical clinical features with exclusion of other possible causes. All patients died of septic shock or multiple organ failure even after administration of increased corticosteroids and supportive therapy, and reduced immunosuppressive agents. In our center, two cases of GVHD were found among 128 (1.56%) patients. One case was diagnosed by detecting lymphocyte macrochimerism through DNA-STR. Both of them died even after aggressive treatment. In China, the incidence of GVHD is similar to that reported by foreign centers except for an extremely bad prognosis. Rapid diagnosis is crucial for a better prognosis. In China, only 37.5% of cases are diagnosed by molecular methods. We recommend detecting lymphocyte macrochimerism through DNA-STR to get a rapid diagnosis, and interleukin 2-receptor antibody (basiliximab or daclizumab) therapy seems to be a good choice for the disease.

[Prophylaxis and management of biliary complications after orthotopic liver transplantation].

OBJECTIVE: To investigate the risk factors of biliary complications after orthotopic liver transplantation (OLTx) and the relevant prevention and management strategies. METHODS: The clinical data of 368 patients undergoing allograft orthotopic liver transplantation, 282 males and 86 females, aged 47.5 (8 - 73), were collected and analyzed retrospectively. RESULTS: Of the 368 OLTx patients, 36 (9.8%) experienced biliary complications, including simple anastomosis biliary leakage (7 cases), biliary leakage due to injury and omission of accessory hepatic duct (1 case), anastomosis stricture (5 cases), intrahepatic bile duct stricture (3 cases), bile duct stricture secondary to bile duct twist (1 case), calculus of intrahepatic duct (2 cases), bile duct stricture secondary to biliary leakage (2 cases), bile duct stricture combined with intrahepatic biloma (2 cases), bile duct stricture combined with biliary sludge (2 cases), biliary cast syndrome (5 cases), hemobilia (1 case), intrahepatic abscess (3 cases) and Oddi's sphincter dysfunction (2 cases). Among the 36 patients with biliary complications, 23 were cured by nonsurgical therapies; and 13 patients needed abdominal surgical interventions, including retransplantation in 7 cases. CONCLUSION: Biliary complications after OLT are difficult to treat. Most of these complications can be cured conservatively, such as radiological intervention and endoscopic treatment. When the patients are unresponsive to nonsurgical therapies, or when they suffer from hepatic arterial embolism or arterial stricture simultaneously, surgical interventions, even retransplantation should be considered.

[Selection of four surgical techniques in orthotopic liver transplantation].

OBJECTIVE: To compare the advantages and disadvantages of four surgical techniques in orthotopic liver transplantation. METHODS: A total of 135 adult recipients receiving cadaveric whole liver grafts were divided into four groups according to the surgeries they received: group A (n=22) underwent classic orthotopic liver transplantation, group B (n=79) underwent modified piggyback liver transplantation, group C (n=18) underwent classical piggyback liver transplantation, and group D (n=16) underwent modified classic orthotopic liver transplantation. The clinical data of these recipients were retrospectively analyzed. RESULTS: The operation time, anhepatic time, and intra-operation bleeding volume among these four groups were significantly different (P < 0.05). The incidence of transient renal damage in group C was significantly lower than that in other groups (P < 0.05), while the complication rates and survival rates were not significantly different in the early stage after the operation. CONCLUSIONS: Surgery techniques should be carefully selected based on the individual patients's pre-operative condition. The modified classic orthotopic liver transplantation is a preferred technique for tumor patients or patients with surgical history of upper abdomen.