Long-term outcomes of Roux-en-Y gastric bypass versus medical therapy for patients with type 2 diabetes: a meta-analysis of randomized controlled trials.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) has been widely used for type 2 diabetes (T2D) patients with overweight or obesity. However, the long-term outcomes of RYGB versus medical therapy have not been well compared. OBJECTIVES: To evaluate the long-term outcomes of RYGB versus medical therapy for patients with T2D. SETTING: University-affiliated hospital, China. METHODS: Four electronic databases-PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov-were searched for articles published through February 2021. Eligible studies were randomized controlled trials. RESULTS: Of 7 randomized controlled trials (15 articles), 477 patients were included: 239 were randomly divided into RYGB groups and 238 to medical therapy groups. Statistically higher rates of T2D remission were observed in RYGB groups at 1 year (relative risk [RR], 18.01; 95% confidence interval [CI], 4.53- 71.70; P < .0001), 3 years (RR, 29.58; 95% CI, 5.92-147.82; P < .0001), and 5 years (RR, 16.92; 95% CI, 4.15-69.00; P < .0001). Meanwhile, statistically higher rates of achieving the American Diabetes Association's (ADA's) treatment goal were observed in RYGB groups at 1 year (RR, 3.99; 95% CI, 1.01-15.82; P = .05), 2 years (RR, 2.98; 95% CI, 1.62- 5.48; P = .0004), 3 years (RR, 3.16; 95% CI, 1.33-7.49; P = .009), and 5 years (RR, 6.18; 95% CI, 1.69-22.68; P = .006). CONCLUSION: This meta-analysis indicated that RYGB led to higher rates of T2D remission than medical therapy at 1, 3, and 5 years, as well as higher rates of achieving ADA's composite goal at 1, 2, 3, and 5 years.

Emerging Role of Pericytes and Their Secretome in the Heart.

Pericytes, as mural cells covering microvascular capillaries, play an essential role in vascular remodeling and maintaining vascular functions and blood flow. Pericytes are crucial participants in the physiological and pathological processes of cardiovascular disease. They actively interact with endothelial cells, vascular smooth muscle cells (VSMCs), fibroblasts, and other cells via the mechanisms involved in the secretome. The secretome of pericytes, along with diverse molecules including proinflammatory cytokines, angiogenic growth factors, and the extracellular matrix (ECM), has great impacts on the formation, stabilization, and remodeling of vasculature, as well as on regenerative processes. Emerging evidence also indicates that pericytes work as mesenchymal cells or progenitor cells in cardiovascular regeneration. Their capacity for differentiation also contributes to vascular remodeling in different ways. Previous studies primarily focused on the roles of pericytes in organs such as the brain, retina, lung, and kidney; very few studies have focused on pericytes in the heart. In this review, following a brief introduction of the origin and fundamental characteristics of pericytes, we focus on pericyte functions and mechanisms with respect to heart disease, ending with the promising use of cardiac pericytes in the treatment of ischemic heart failure.

Histone Acetyltransferase p300 Inhibitor Improves Coronary Flow Reserve in SIRT3 (Sirtuin 3) Knockout Mice.

Background Coronary microvascular dysfunction is common in patients of myocardial infarction with non-obstructive coronary artery disease. Coronary flow reserve (CFR) reflects coronary microvascular function and is a powerful independent index of coronary microvascular dysfunction and heart failure. Our previous studies showed that knockout of SIRT3 (Sirtuin 3) decreased CFR and caused a diastolic dysfunction. Few studies focus on the treatment of impaired CFR and heart failure. In the present study, we explored the role of C646, a histone acetyltransferase p300 inhibitor, in regulating CFR and cardiac remodeling in SIRT3 knockout (SIRT3KO) mice. Methods and Results After treating with C646 for 14 days, CFR, pulse-wave velocity, and cardiac function were measured in SIRT3KO mice. SIRT3KO mice treated with C646 showed a significant improvement of CFR, pulse-wave velocity, ejection fraction, and fractional shortening. Treatment with C646 reversed pre-existing cardiac fibrosis, hypertrophy, and capillary rarefaction in SIRT3KO mice. Mechanistically, knockout of Sirtuin 3 resulted in significant increases in p300 expression and H3K56 acetylation. Treatment with C646 significantly reduced levels of p300 and H3K56 acetylation in SIRT3KO mice. Furthermore, treatment with C646 increased endothelial nitric oxide synthase expression and reduced arginase II expression and activity. The expression of NF-κB (nuclear factor kappa-light-chain-enhancer of activated B cells) and VCAM-1 (vascular cell adhesion molecule 1) was also significantly suppressed by C646 treatment in SIRT3KO mice. Conclusions C646 treatment attenuated p300 and H3K56 acetylation and improved arterial stiffness and CFR via improvement of endothelial cell (EC) dysfunction and suppression of NF-κB.

Outcomes of laparoscopic gastrectomy for gastric cancer in elderly patients.

PURPOSE: This study aimed to compare the short- and longterm outcomes of elderly and middle-aged patients with gastric cancer who underwent laparoscopic gastrectomy. METHODS: From January 2010 to February 2017, a total of 75 patients with gastric cancer aged ≥70 years (elderly group) underwent laparoscopic gastrectomy, and their short- and long-term outcomes were compared with those of 197 patients with gastric cancer aged 60-69 years (middleaged group) who underwent also laparoscopic gastrectomy during the same period. RESULTS: With respect to the patients' preoperative baseline characteristics, the elderly group had a higher Charlson comorbidity index score, rate of previous abdominal operations, and American Society of Anesthesiologists (ASA) classification score compared to middle-aged patient group. There were no significant differences in the other baseline characteristics. There were no significant between-groups differences in the duration of surgery, intraoperative blood loss, incidence and severity of 30-day postoperative complications, and pathological results. Long-term follow-up results showed that the tumor recurrence rates were similar between groups, as were the overall (OS) and disease-free survival (DFS) rates. Multivariate analysis showed that age was not an independent predictor of OS and DFS. CONCLUSION: In summary, laparoscopic gastrectomy in elderly patients with gastric cancer can achieve similar short- and long-term outcomes as those for middle-aged patients. Age is thus not a contraindication for laparoscopic gastrectomy.

Comparative study of surgical knots using a domestically produced Chinese surgical robot, laparoscope, or barehanded approach.

BACKGROUND: We conducted a comparative analysis of the first domestically produced Chinese surgical robot, 'MicroHand', laparoscopic, and barehanded approaches in tying surgical knots. METHODS: Four surgeons performed square or triple knots individually using the three approaches and documented the operational time, circumference, the bearable tension and action trajectory for each knot. RESULTS: MicroHand took more time than the barehanded method but nearly the same as with the laparoscope. The barehanded method generated the smallest knots among the three approaches and MicroHand produced smaller square knots than those by laparoscope. MicroHand and barehanded methods produced square knots displaying higher bearable tension than those produced by the laparoscope. For the action trajectory, MicroHand operated in a smaller space than that needed by the laparoscope. CONCLUSIONS: The square knots produced by MicroHand were tighter and more solid than those by laparoscope, although the triple knots generated by the two methods were similar. Also MicroHand required a smaller operational space than the laparoscope.

Increasing patients' ability to identify their physicians with a photo album: a prospective study.

OBJECTIVES: Patients in teaching hospitals often encounter difficulty in correctly identifying their physicians. We hypothesized that a photo album of physicians might increase the ability of patients to correctly identify their physicians and hence conducted this study to test the hypothesis. DESIGN: A prospective study was conducted. SETTING: Department of Surgery, The Third XiangYa Hospital. PARTICIPANTS: THE PATIENTS WERE DIVIDED INTO TWO GROUPS ON ADMISSION: group A as intervention group (n = 75) and group B as control group (n = 94). All the patients were verbally informed of their medical team but only the patients in group A (the intervention group) were also shown the photos of their medical team. MAIN OUTCOME MEASURES: One day before being discharged, the patients in group A (the intervention group) were asked to return the photo albums, and all the patients from both groups were asked to give the names of their caring physicians prior to departure from the hospital. RESULTS: Only 53% of the patients (50 out of 94) in group B (the control group) could give at least one of their physicians' name, while 85% of the patients (64 out of 75) in group A (the intervention group) could tell at least one of their physicians' name; there is a significant difference (p < 0.005, 95% CI, 17.4-44.7%). CONCLUSION: Patients' ability to identify their physicians can be significantly increased with a photo album.

High-intensity focused ultrasound treatment for patients with unresectable pancreatic cancer.

BACKGROUND: High-intensity focused ultrasound (HIFU) is a non-invasive method of solid tissue ablation therapy. However, only a few studies have reported the effect of HIFU for unresectable pancreatic cancer. This study aimed to evaluate the clinical benefits, survival time and complications associated with the use of HIFU ablation in patients with unresectable pancreatic cancer. METHODS: Twenty-five patients with unresectable pancreatic cancer were enrolled in our study. All patients received HIFU therapy for tumors at least once. The therapeutic effects of HIFU was evaluated in terms of Karnofsky performance status (KPS) scores, pain relief, serum CA19-9, and imaging by B-US and CT before and after the therapy. We also recorded median overall survival time and complications caused by the treatment. RESULTS: In the 25 patients, KPS scores were above 60, and increased KPS was observed in 23 patients after treatment. Pain relief occurred in 23 patients. Serum CA19-9 levels were significantly reduced one month after HIFU treatment and became negative in 5 patients. B-US revealed enhanced tumor echogenicity in 13 patients and decreased tumor blood supply in 9. Tumor necrosis was confirmed by CT in 8 patients one month after HIFU treatment. The median overall survival time was 10 months, and the 1-year survival rate was 42%. No severe complications were observed after HIFU treatment. CONCLUSION: HIFU can effectively relieve pain, increase KPS, decrease tumor growth and prolong the survival time of patients with unresectable pancreatic cancer.

Multivariate analysis of molecular indicators for postoperative liver metastasis in colorectal cancer cases.

AIMS: To explore the relationship between various molecular makers and liver metastasis of colorectal cancer (CRC). METHOD: Using immunohistochemistry, protein expression of CEA, nm23, c-met, MMP2, COX- 2, VEGF, EGFR, and CD44 was assessed in 80 CRC cases. The Chi-square test and logistic regression were performed to analyze the relationship between these indicators and CRC liver metastasis. RESULTS: There were significant differences in expression of CEA, MMP2, CD44, VEGF and EGFR between the liver metastasis and non metastasis groups (P < 0.05); no significant differences were noted for nm23, c-met, and COX-2 expression. Logistic regression analysis showed that only CEA, VEGF, and EGFR entered into the regression equation, and had significant correlations with CRC liver metastasis (α inclusion= 0.10, α elimination = 0.15, R2 = 0.718). CONCLUSIONS: Combination detection of CEA, VEGF, and EGFR may be an effective means to predict CRC liver metastasis. Nm23, c-met, MMP2, COX-2, and CD44, in contrast, are not suitable as prognostic markers.

Effects of linear-polarized near-infrared light irradiation on chronic pain.

In order to study the efficacy of linear-polarized near-infrared light irradiation (LPNIR) on relieving chronic pain in conjunction with nerve block (NB) or local block (LB), a 3-week prospective, randomized, double-blind, controlled study was conducted to evaluate the pre- and post-therapy pain intensity. Visual analogue scales (VASs) were measured in all patients before and 6 months after therapy visiting the pain clinic during the period of August 2007 to January 2008. A total of 52 patients with either shoulder periarthritis or myofascial pain syndrome or lateral epicondylitis were randomly assigned into two groups by drawing lots. Patients in Group I were treated with NB or LB plus LPNIR; Group II patients, for their part, were treated with the same procedures as in Group I, but not using LPNIR. In both groups, the pain intensity (VAS score) decreased significantly immediately after therapy as compared to therapy. There was a significant difference between the test and control groups immediately after therapy (P < 0.05), while no effect 6 months later. No side effects were observed. It is concluded that LPNIR is an effective and safe modality to treat various chronic pains, which has synergic effects with NB or LB.

[Mechanism research progress of bariatric surgery for type 2 diabetes mellitus].

Patients with type 2 diabetes mellitus experience a complete and comfirm diabetic remission after bariatric surgery. Although weight-loss, reduction of food intake and other factors may play important roles in diabetic resolution after bariatric surgery, the major mechanism is the change in gastrointestinal hormones. Further research is essential to better understand these mechanisms and bariatric surgery may ultimately become a major tool in the treatment of type 2 diabetes mellitus.

Biological properties of carbon/carbon implant composites with unique manufacturing processes.

The goal was to manufacture carbon/carbon (C/C) composites through a unique procedure with improved biocompatibility and reduced debris release. C/C composites were prepared by chemical vapor deposition, and their biological properties were analyzed. With regard to mechanical properties, compressive strength/modulus was 219.1 MPa/9.72 GPa, flexural strength/modulus was 121.63 MPa/21.9 GPa, and interlaminar sheer was 15.13 GPa. Biocompatibility testing revealed: (1) the extract liquid from the C/C composites had no effect on cell proliferation; (2) the extract had no impact on micronucleus frequency as compared with the control groups (P > 0.05); (3) in vivo, there was mild tissue inflammation after implantation within the first 2 weeks, but there was no significant difference compared with the control group (P > 0.05); (4) the implants were well integrated into the host tissue, and debris was limited. The tested samples have excellent biocompatibilities and reduced release of debris. The demonstrated changes in manufacturing procedures are promising.

[Effect of anti-ICOS monoclonal antibody combined with low-dose CsA on chronic rejection of heart grafts in rats].

OBJECTIVE: To evaluate the effect of anti-inducible costimulator monoclonal antibody (anti-ICOS-Ab) combined with low-dose cyclosporine (CsA) on the survival quality and chronic rejection of heart allografts in rats. METHODS: The rats' heterotopic cardiac transplantation model was established by Ono's method. The recipient rats were randomly divided into an isotransplantation control group and an allotransplantation experiment group. The experiment group was re-classified into a placebo group, a normal-dose CsA group, an anti-ICOS-Ab group, a low-dose CsA group, and an anti-ICOS-Ab combined with low-dose CsA group. The survival time of grafts was monitored. The cardiac grafts were harvested for histological analysis. Flow cytometric analysis was employed to detect the population of CD25+CD4+ in peripheral lymphocytes from recipients with a long-term surviving graft. RESULTS: The survival time of the cardiac allografts in CsA-treated groups was significantly longer than that in placebo group (P<0.05). The survival time of the cardiac allografts in anti-ICOS-Ab combined with low-dose CsA group was significantly longer than that in low dose CsA-treated group (P<0.05). There was no significant difference in the survival time of the cardiac grafts between the anti-ICOS-Ab group and the placebo group (P>0.05). Compared with the normal-dose CsA group, the chronic rejection lesions of the anti-ICOS-Ab combined with low-dose CsA treatment group significantly were alleviated in the long-term survival grafts, and the proportion of CD4+CD25+ regulatory T cell increased in peripheral blood. CONCLUSION: The anti-ICOS-Ab combined with low-dose CsA can prolong the survival of cardiac allografts and alleviate the chronic rejection significantly. The high expression level of CD4+CD25+ regulatory T cell is beneficial to the long-term survival of grafts.

[In vitro and in vivo studies on hydroxyapatite nanoparticles as a novel vector for inner ear gene therapy].

OBJECTIVE: To assess the possibility of hydroxyapatite (HAT) nanoparticles as a gene vector for inner ear gene transfection. METHODS: The HAT nanoparticles were prepared by the precipitation hydrothermal technique. DNA binding test under series of pH values and HAT concentrations were carried out by means of DNA electrophoresis to show the DNA binding and protective effect of the HAT nanoparticles. The cytotoxicity of HAT was evaluated via methyl thiazolyl tetrazolium assay (MTT) test with cultured Hela cells. The in vitro green fluorescent protein (GFP) reported transfection test and neurotrophin 3 (NT3) Western blot were completed with both Hela cells and primarily cultured mice cochlear neurons, so as to observe HAT mediated in vitro gene transfection efficiency and consequent NT3 gene expression. The complex consisting of HAT nanoparticles and recombinant plasmid with enhanced GFP and NT3 (HAT-pEGFPC2-NT3) was perfused perilymphatically into the cochlea of the guinea pigs with experimental excitotoxic inner ear damage. Inner ear NT3 gene expression was immunohistochemically demonstrated (DAB method) to evaluate the capability of HAT nanoparticles in mediating NT3 gene transfection in living animals and the possibility of future clinical application. RESULTS: When applied at the lowest concentration of 250 microg/ml and the pH values of 3-7, the 40-50 nm stick-shaped nanoparticles fully loaded the recombinant plasmid pEGFPC2-NT3, and well protected the genes from being destroyed by DNase I. Well biocompatibility between HAT nanoparticles and the cultured Hela cells had been confirmed by methyl thiazolyl tetrazolium assay (MTT) method when the concentration of HAT nanoparticles ranged from 62.5 microg/ml to 500 microg/ml. Immunofluorescence test of the report gene GFP revealed that the transfection efficiency of HAT nanoparticle vector in Hela cells was 15.7% +/- 2.6% (x +/- s). EGFP was immunofluorescently expressed by transfection of HAT-pEGFPC2-NT3 in the primarily cultured cochlear neurons of mice. NT3 immunohistochemical test showed many marked ganglion cells in the cochlea when perilymphatically transfected HAT-pEGFPC2-NT3 complex into the cochlea of guinea pigs with experimental excitotoxic inner ear damage in vivo. CONCLUSIONS: HAT nanoparticles can mediate NT3 gene transfection both in vitro and in the living animal's cochlea. As a non-viral gene vector without the risk of biological disaster, HAT nanoparticle vector is worthy of further fully researches although its transfection efficiency needs to be improved.

Endoscopic variceal ligation combined with Hassab's procedure in preventing the recurrence of esophageal varices.

OBJECTIVE: To assess the efficacy of endoscopic variceal ligation (EVL) combined with Hassab's procedure in the prevention of variceal recurrence. METHODS: One hundred and thirty-five patients with esophageal varices were randomized to receive EVL alone, Hassab's procedure alone or a combination of EVL and Hassab's procedure for variceal eradication. Ultrasonographic venous network images were recorded by an esophageal microprobe before and after the EVL or Hassab's procedure. The clinical outcome and vascular network images of the 3 groups were analyzed. RESULTS: Esophageal varices were obliterated immediately after EVL alone, while both perforating veins and periesophageal collaterals remained patent, and 83% had recurrence of esophageal varices during an initial 3-year follow-up. Esophageal varices were reduced in size, periesophageal collaterals were obliterated after Hassab's procedure alone, and 30% experienced rebleeding and 95% with variceal recurrence. EVL combined with Hassab's procedure obliterated all esophageal varices, perforating veins and periesophageal collaterals, and only 3 patients (8%) recurred. CONCLUSION: The existence of patent perforating veins and periesophageal collaterals is the reason of esophageal variceal recurrence after EVL alone. EVL combined with Hassab's procedure can effectively prevent the recurrence, even if the cirrhojtic portal hypertension persisted.

Preoperative risk factor analysis in orthotopic liver transplantation with pretransplant artificial liver support therapy.

AIM: To assess the value of pre-transplant artificial liver support in reducing the pre-operative risk factors relating to early mortality after orthotopic liver transplantation (OLT). METHODS: Fifty adult patients with various stages and various etiologies undergoing OLT procedures were treated with molecular adsorbent recycling system (MARS) as preoperative liver support therapy. The study included two parts, the first one is to evaluate the medical effectiveness of single MARS treatment with some clinical and laboratory parameters, which were supposed to be the therapeutical pre-transplant risk factors, the second part is to study the patients undergoing OLT using the regression analysis on preoperative risk factors relating to early mortality (30 d) after OLT. RESULTS: In the 50 patients, the statistically significant improvement in the biochemical parameters was observed (pre-treatment and post-treatment). Eight patients avoided the scheduled Ltx due to significant relief of clinical condition or recovery of failing liver function, 8 patients died, 34 patients were successfully bridged to Ltx, the immediate outcome of this 34 patients within 30 d observation was: 28 kept alive and 6 patients died. CONCLUSION: Pre-operative SOFA, level of creatinine, INR, TNF-alpha, IL-10 are the main preoperative risk factors that cause early death after operation, MARS treatment before transplantation can relieve these factors significantly.

Drug resistance of infectious pathogens after liver transplantation.

BACKGROUND: Infection in liver recipients is related to high risk of transplantation failure and mortality. Infectious agents isolated from 55 liver recipients from January 2003 through June 2005 were studied to improve the anti-infectious therapy. METHODS: Pathogens were isolated from routine culture. K-B method was used to examine the drug susceptibility. Extended spectrum beta-lactamase, AmpC beta-lactamase and Van gene in E.coli were examined by the agar-dilution susceptibility test and Nitrocefin test. RESULTS: Thirty-nine of the 55 recipients got infection. The 513 strains of pathogens isolated from 1861 specimens were predominantly Gram negative bacteria and over 40% of them showed resistance to more than 4 drugs. The positive rates of extended spectrum beta-lactamse and AmpC beta-lactamse production in E.cloacae were 32.4% and 36.8%, in E.coli were 33.8% and 10.5%, but the rates of these 2 bacteria producing both lactamses were 24.3% and 7.0%. The beta-lactamse production rates of Enterococcus faecalis and Enterococcus faecium were 8.8% and 11.1%, and the resistance rates to vancomycin were 11.2% and 18.5%, respectively. CONCLUSIONS: Infectious pathogens isolated from liver recipients are potent and multiple drug resistant. ESBLs and AmpC beta-lactamases are the major factors associated with Gram negative drug resistance. The infection of Enterococcal species presents as a particular challenge.

[Biotoxicology and biodynamics of silica nanoparticle].

OBJECTIVE: To investigate the toxicology and biodynamics of silica nanoparticle. METHODS: The silica nanoparticles were injected into mice through tail vein, and the mice were amphimixised, the urine was collected in different time, variations of pathology in organs and tissues of the mice were detected. At the same time, the silica nanoparticles' distribution in the tissues was observed through electron microscope. RESULTS: The silica nanoparticles were detected in all tissues and urine of the mice. The injected mice can reproduce as normal. CONCLUSION: The silica nanoparticles do not have toxicity and can be used in vivo.

[Pathogenic characters of infected bacteria after liver transplantation].

OBJECTIVE: To analyze the main pathogens of infection after the liver transplantation and their antibiotic resistant patterns. METHODS: The main pathogens of infection after the liver transplantation were retrospectively analyzed. Using 3-dimensional tests, ESBLs (extended-spectrum beta-lactamase), and AmpC were detected among the Gram negative bacilli. beta-Lactamase and Van gene in Enterococcus were determined by the standard agar dilution susceptibility tests and Nitrocefin respectively. RESULTS: The main infected strains were Enterococcus faecalis (15.0%), Enterobacter cloacae (13.9%), fungus (13.3%), and Escherichia coli (10.7%) after the liver transplantation. Among them, 32.4% of Enterobacter cloacae and 36.8% of Escherichia coli produced ESBLs; 33.8% of Enterobacter cloacae and 10.5% of Escherichia coli. produced AmpC beta-lactamases. The detectable rate of VanA gene in Enterococcusfaecalis and Enterococcus faecium was 7.5% and 11.1%; VanB was 3.8% and 7.4%; VanC was 1.3% and 0, respectively. CONCLUSION: The infection mainly occurs in the intestinal tract after the liver transplantation. The production of ESBLs and AmpC beta-lactamases is the main mechanism of antibiotic resistance. The increased detectable rate of vancomycin-resistant Enterococcus should be paid attention to.

[Preoperation risk factor analysis in orthotopic liver transplantation with pre-transplant artificial liver support therapy].

OBJECTIVES: Orthotopic liver transplantation (OLT) is an accepted therapy for selected patients with advanced liver diseases. However, the early mortality rate after OLT remains relatively high due to the poor selection of candidates with various serious conditions. The aim of this study is to assess the value of pretransplantation artificial liver support treatment in reducing the pre-operation risk factors relating to early mortality after OLT. METHODS: 50 adult patients in various stages of different etiologies who underwent OLT procedures had been treated with molecular adsorbent recycling system (MARS) preoperatively. The study was designed in two parts: the first one was to evaluate the effectiveness of a single MARS therapy by using some clinical and laboratory parameters which were supposed to be therapeutical pretransplantation risk factors. The second part was to study the patients undergoing OLT by using the regression analysis on preoperation risk factors relating to early (within 30 d after OLT) mortality rate. RESULTS: Among the 50 patients, a statistically significant improvement of the biochemical parameters was observed (pretreatment vs posttreatment). 8 patients cancelled their scheduled LTXs due to significant improvements in their clinical conditions or recovery of their failing liver functions. 8 patients died and 34 patients successfully underwent LTX. The immediate outcome (within 30 postoperative days) of these 34 patients was that 28 were kept alive and 6 died. CONCLUSIONS: Preoperation sequential organ failure assessment (SOFA), level of creatinine, INR, TNFalpha, and IL-10 are the main preoperative risk factors relating to early death after an operation. MARS treatment before a transplant operation can relieve these factors significantly, hence improve survival rate of liver transplantation or even make the transplantation unnecessary.