Volume 89  ·   Issue 22  ·  2009

Objective To evaluate the clinical significance of glycated albumin (GA) measured by enzymatic method and to compare its effect with glycosylated hemoglobin Alc (HbAlc) in type 2 diabetes mellitus(DM). Methods 128 type 2 DM patients and 84 normal subjects from the Chinese PLA General Hospital were enrolled for the study. The levels of GA, HbAlc, FBG, PBG in DM patient were detected at baseline and followed visit at 2,4,8 weeks after blood glucose management. The levels of GA, HbAlc, FBG, PBG and 75 g OGTT were also detected in above normal subjects. Results Intra CV and inter CV of enzymatic were (0.74 -0.9)% and (0.94 - 1.49)% respectivly. In normal subjects GA was in the range of (9 - 14)%. At baseline, the GA level was significantly correlated with HbAlc (r=0.8326, P<0.01), FBG and 2 hour PBG. After 2,4,8 weeks treatment, GA level in DM patients was concomitantly decreased with the improvement of FBG, PBG and HbAlc. At early 2 weeks visit, GA, but not HbAlc, showed significant decrease from its baseline (P<0.05). Conclusion Enzymatic measuring GA was highly correlated with HbAlc, and changing concomitantly with the decrease of HbAlc, FBG, PBG during the 8 weeks treatment. GA was more sensitive than HbAlc for short-term variations of glycemic control during treatment of diabetic patients. GA can be used as a better index of short term mean level of blood glucose in diabetic patients.

Objective To explore the diagnosis and surgical therapy for retropefitoneal neurogenic tumors (PRNTs). Methods The clinical records of 79 surgically treated patients with retroperitoneal neurogenic tumor were retrospectively analyzed. Results Twenty-nine patients presented with abdominal pain, 26 with abdominal mass, 15 with inferior extremities pain and numbness and 9 patients without clinical symptoms. Type B ultrasound (BUS), CT scan and surgical resection were performed for all the patients. Pathological analysis identified 19 patients with neurofibroma, 8 with neurilemmoma, 4 with paraganglioma, 21 with neurofibrosarcoma, 14 with malignant neurilemmoma, 6 with malignant paraganglioma, 5 with neurocetedermal tumor and 2 with neuroblastoma. The mortality rote of PRNT operation is was 1.3%, 3-year recurrence rate of benign tumor 0%, 5-year recurrence rate of benign tumor 12. 9%, reoperation rate 100%, 5-year survival rate 100%. 3 years recurrence rate of malignancy tumor 41.6%, reoperation rate 90%, 5 years recurrence rate of malignancy tumor 79.1% and 5 years survival rate is 62.5%. Conclusion BUS, CT and MRI are decisive for localization diagnosis. Surgical resection is the mainstay of therapy for this disease. Pre-operative preparation of intestinal tract and blood, maintaining the intactness of involved nerve axe important for tumor resection. To prevent tumor recurrence, the key surgical techniques are to minimize tumor residues and . to handle intervertebral foramen properly.

：Objective To explore thepathogenesis of respiratory syncytial viruses (RSV) bronchiolitis and its treatment withglucocorticoids. Methods The pediatric patients with RSV bronchiolitis were divided intoan atopic group (n=50) and a non-atopic group (n=50) based on whether there were IgEelevation, eczema and dermatitis. Another 25 normal subjects were chosen as a controlgroup. Divided into mild, medium and severe groups, they were finally randomly dividedinto hormone (dexamethasone) and non-hormone groups. The proportion of CD4+ CD25+regulatory T cells (Treg) and the expression of Foxp3 mRNA were tested by flow cytometryand RT-PCR retrospectively. Results The proportion of CD4+ CD25+ Treg and the Foxp3 mRNAexpression in the control, non-atopic, and atopic groups reached(10.5±1.6)% and 0.34±0.11,(8.8±2.2)%and 0.26±0.08, (7.6±1.8)% and 0.21±0.09, respectively. There were significantdifferences among these groups (all P<0.05). The mild, medium and severe bronchiolitisgroups reached (9.7±1.6)% and 0.28±0.08, (7.8±2.1) % and 0.24±0.06, (6.7±1.3) % and0.20±0.07 respectively (all P<0.05). The proportion of CD4+ CD25+ Treg and theexpression of Foxp3 showed significantly negative correlations with severity (r=-0.62,-0.71, both P<0.01). That is, they correlated with the severity of disease. Theproportion of the CD4+ CD25+ Treg and the expression of Foxp3 mRNA of the hormone groupwere higher than those of the non-hormone group [(9.5±2.1)% and 0.33±0.10 vs (8.5±1.8)%and 0.27±0.12,P <0.05 and <0.01]respectively. Conclusion CD4+ CD25+ Treg and Foxp3mRNA are involved in the inflanunafion of bronchiolitis. And the levels of CD4+ CD25+ Tregand Foxp3 mRNA level is an objective indicator of the severity of BSV bronchiolitis. Theeffect of glucocorticoids upon RSV bronchiolitis may be in part due to the directenhancement of production and functions of CD4+ CD25+ Treg and Foxp3 mRNA.

Objective To investigate the mixed infection of clarithromycin susceptibility and genotype of Helicobacter pylori resistant strains. Methods Ten single colonies were picked randomly from each of 16 resistant strains. Genomic DNA was prepared from single colony isolates and their parental clarithromycin-resistant strains by the hexadecyltrimethylammonium bromide (CTAB)-phenol extraction method. Susceptibilities of single colony isolates to clarithromycin were determined by agar dilution and mutations in clarithromycin-resistant isolates identified by polymerase chain reaction and restrictions analysis. Genotypes of 16 resistant strains and their single colony isolates were tested by the fingerprinting patterns of random amplified polymorphic DNA (RAPD). Results All single colony isolates derived from 16 resistant strains were also resistant to clarithromycin and had the A2143G point mutation in 23 S rRNA gene. The RAPD fingerprints of single colony isolates derived from the same patient were identical to each other and to the RAPD fingerprint of the corresponding parental isolate. Conclusion Neither mixed susceptibility nor mixed genotype was found in clarithromycin resistant strains.

Objective To explore an anatomical basis and incising scope for the medial plantar artery combined flaps and its feasibility of repairing heel and adjacent vast soft tissue defects. Methods The origin, branches, course and distribution of the medial plantar artery were studied in 20 legs of adult cadavers. The largest area of healthy adult's medial plantar and medialis pedis scope that could be incised for the combined flap was measured. Ten cases of heel and adjacent vast soft tissue defects were repaired by the combined medial plantar and medialis pedis flaps. Age range 28 - 60 years old. The areas of flaps were 9 cm×7 cm - 10 cm × 8 cm. Defects of tendo calcaneus were repaired by the tendon of abductor muscle and plantar fascia in 3 cases with skin grafts on the donor sites. Results The medial plantar artery gave off deep branch (diameter: 1.5 mm ± 0.3 mm) and superficial branch (diameter: 1.0 mm ± 0.2 mm). The length of media plantar artery deep branch was (8.9±0.2) cm and gave off 3-5 cutaneous branches. The largest area of combined flap was about 10.4 cm × 9. 2 cm - 9. 1 cm × 8. 2 cm. Ten flaps survived completely. Eight flaps were followed up for 1 month to 1.5 years. The color, texture and appearance of flaps were excellent. The flaps of two-point discrimination were not different with opposite medial region. The affected limb exercised freely and had no ulceration on the flap. Conclusions The combined flap has a reliable blood supply and it can recover good sensation after operation. It is one of ideal flaps to repair heel and adjacent vast soft tissue defects. Its disadvantage is a complicated operation.

Objective To evaluate retrospectively the feasibility, efficacy and safety of transjuglar intrahepatic portosystemic shunt (TIPS) or percutaneous transhepatic or transsplenic approach to the portal vein with the combination of TIPS for the treatment of patients with portal vein thrombosis with or without cavernous transformation. Methods Sixty-five patients with portal vein thrombosis from July 2002 to August 2007 at our hospital were analyzed retrospectively. Indirect pertography through superior mesenteric artery was performed to determine the approaches for TIPS procedure. If the intrahepatic portal vein branches were visualized, TIPS was implemented directly from transjugular approach; if the intrahepatic portal vein branches failed to be visualized, an ultrasound-guided pereutaneous transhepatie or transsplenic approach was performed to recanalize the thrombosed portal vein initially followed by TIPS placement to reconstruct the portal venous flow. Efficacy and complications were observed and revision and survival rates monitored during the follow-up. Results TIPS were successfully created in 54 of 65 patients with portal vein thrombosis with a success rate of 83.1%. Among them, TIPS were performed directly in 36 of 40 patients; portal vein recanalization were successfully performed via transhepatic access in 15 of 25 patients, and 3 of remaining 5 who failed the transhepatic approach were successfully done from transsplenic access. Then TIPS placement was accomplished with a success rate of 72.0% (18/25). The success rate in cirrhotic patients was 82.4% (42/51) and it was not significant different from those without cirrhosis 85.7% (12/14) (P=0.766). While the success rate in the patients with cavernous transformation 71.8% (28/39) showed a significant difference compared to that without cavernous transformation 100% (26/26) (P=0.002). The success rates in portal vein thrombosis and cavernous transformation with or without cirrhosis were 42.9% (18/42) and 83.3% (10/12) respectively, exhibiting a significant difference (P=0.021). The mortality rate of 30 days post-operation was 3.7% (2/54). From Day 1 to 63 months follow-up, The incidence rate of hepatic encephalopathy was 27.8% (15/54); revision rate 22.2% (12/54); median survival time 31.4 months. Conclusions Conventional TIPS or percutaneous transhepatic or transsplenic approach combined with TIPS for the treatment of portal vein thrombosis with or without cavernous transformation are feasible, safe and effective. It is essential to recanalize the thrnmbosed portal vein initially followed by TIPS placement to reconstruct the portal venous flow.

Objective To compare the therapeutic efficacies and toxicities of single-agent docetaxel or docetaxel plus platinum combination agent in patients with advanced non-small cell lung cancer (NSCLC) so as to provide rationales for standard second-line chemotherapy. Methods The clinical data from 152 patients with NSCLC who were admitted into Chest Hospital Affiliated to Shanghai Jiantong University, from January 2004 to May 2008 were retrospectively analyzed. Forty patients were treated with single-agent docetaxel (single-agent group, 16 and 24 patients with stages Ⅲb and Ⅳ disease respectively; 32 patients with PS score 0-1 before treatment and 8 patients with PS score 2 before treatment), and 112 patients were treated with docetaxel plus platinum combination agent (combination group, 29 and 83 patients with stage Ⅲ b and Ⅳ disease respectively; 98 patients with PS score 0 - 1 before treatment and 14 patients with PS score 2 before treatment). Primary end point was overall survival (OS) ,and secondary end point were progression-free survival time (PFS), disease control rate (DCR), one-year survival, and drug toxicity. Survival analysis was evaluated by Kaplan-Meier. Single factor analysis and Cox regression model were done to analyze the relationship between the influencing factors and the prognosis of disease. Results The median PFS of the single-agent group was 3.0 months, significantly shorter than that of the combination gtoup (4.2 months, P=0.048). However, no statistical differences were found in OS, DCR or one-year survival between the two groups (all P0.05). The most common grade 3 to 4 toxicities were leukopenia (32.5% for single-agent group, and 56.2% for combination group, P=0.000), and gastro-intestinal toxicity (0 for single-agent group, and 4.5% for combination group, P=0.000). Single factor analysis showed that the factors including radiotherapeutic history, operative history, PS score before treatment, clinical stage, and response to second-line treatment influenced the prognosis of NSCLC (all P<0.05). Cox regression analysis demonstrated operative history(HR=0.428, 95% CI: 0.261-0.701), PS score before treatment (HR=1.919, 95% CI: 0.999-3.685), clinical stage (HR=2.297, 95% CI: 1.427-3.696) and response to second-line treatment (HR=0. 318, 95% CI: 0.177-0.571) had effects on survival. Conclusions To those well-selected patients, docetaxel plus platinum combination agent as the second-line treatment of advanced NSCLC significantly prolongs the progression-free survival. But such a regimen is more toxic and does not improve the response rate and overall survival.

Objective To evaluate the clinical significance of using real-time quantitative polymerase chain reaction (RQ-PCR) in monitoring cytomegalovirus infection in allogenic hemapoietic stem-cell transplant (allo-HSCT) recipients. Methods A total of 318 patients who received allo-HSCT in the past 2 years were analyzed retrospectively. RQ-PCR was performed to monitor CMV viremia twice a week after transplantation. Results CMV-DNA was detected in the plasma of 136 patients. The median time for the occurrence of CMV-DNA was 42 days after HSCT. The highest CMV-DNA load was 1.5×104 copies/ml while the CMV-DNA load at onset of reactivation was 4.5×103 copies/ml. CMV pneumonia or CMV enteritis occurred in 23 patients and the incidence of these CMV diseases is 7.2%. The CMV-DNA was detectable before CMV disease among 14 patients and after the clinical manifestation of CMV disease in 4 patients, while 5 patients were diagnosed with CMV disease having no plasma CMV-DNA positive at all. The highest CMV-DNA load was higher in the CMV patients than those with no CMV disease (4.3×104 copies/ml and 1.3×104 copies/ml,P=0.009)although the initial load had no difference (3.7×103 copies/m vs 4.7×103 copies/ml, P=0.63). The highest CMV-DNA load also rose with the occurring frequency of CMV infection occurred from 1 to 4 times. The median values of CMV-DNA were 82.6×102, 261.3×102, 440.8×102 and 10 659.0×102 copies/ml (P<0.01) respectively. Meanwhile, the incidence of CMV disease also increased markedly from 2.7% (5/182)to 50%(2/4) (P=0.001). Conclusion Detection of CMV-DNA in plasma by RQ-PCR appears to be an effective prognostic predictor of CMV diseases. High CMV-DNA load and repeated viremia indicate a high incidence of CMV diseases.

Objective To assess whether variants in the vascular endothelial growth actor receptor 2 (VEGFR-2) gene confer susceptibility to stroke risk. Methods Association between gene variant rs2305948 (Val297Ile) and the risk of stroke was investigated in a multi-center case-control study, which comprised of 1849 patients with stroke (812 cerebral atherothrombosis, 530 lacunar infarction, and 507 intracerebral hemorrhage) and 1798 controls, and then replicated in the second independent stroke study (327 cases and 327 controls). The effect of Val297Ile on the binding ability of VEGFR-2 to VEGF was determined by a radioligand binding assay. Results The frequencies of carriers with variant 297Ile were significantly higher in patients with hemorrhagic stroke than in controls [297Val/Ile: 155 (30.6%) versus 351(19.5% ), 297Ile/Ile: 18 (3.2%) versus 16 (1.0%); P<0.01]. The variant 297Ile was significantly associated with increased risk of hemorrhagic stroke (odds ratio 2.25, 95% confidence interval 1.70-2.96; P<0.01), and replication in the second stroke study obtained similar results. The substitution of Val to Ile at the amino acid residue 297 led to an increased equilibrium dissolved constant between VEGF and its receptor VEGFR-2 [297Val (87±9) pmol/L versus 297Ile (195±36) pmol/L, P<0.01]. Conclusions The VEGFR-2 gene variants may serve as novel genetic markers for the risk of hemorrhagic stroke.

1. The development course of living donor liver transplantation in China After nearly half a century of arduous exploration and development, liver transplantation technology has gradually matured and has become the only effective treatment for end-stage liver disease. At the same time, the lack of donor liver sources has become the biggest obstacle to the widespread clinical application of liver transplantation all over the world. In order to solve the problem of donor liver shortage, on the basis of the maturity of cadaver liver transplantation technology and the successful clinical experience of reduced volume liver transplantation and split liver transplantation, living donor partial liver transplantation (LDLT) technology has been gradually applied in clinic since the late 1980s [1].

Objective To investigate the possibilities of human mesenchymal stem cells (hMSCs) migrating toward the oxidative stress injuries of endothelial cells. Methods hMSCs were isolated and cultured from human marrow in vitro and the multipotential differentiation of P3 hMSCs identified by specific medium induced to differentiate into osteoblasts, adipocytes and endothelial cells. And the marker antigen of P3 hMSCs was detected by flow cytometry (FCM) and immunohistochemistry. Then a cellular model of hMSCs migrating toward the oxidative stress injuries of endothelial cells was created, i.e. 1×105 hMSCs were seeded in Transwell upper chamber, indirectly co-cultured with ECV-304 cells seeded in the Transwell inferior chamber and was injured by adding 3% H2O2 into the medium (final concentration of 0.01 ml/ml) for 1 h, the injured ECV-304 cells + hMSCs group (n=8), as experimental group, and in the mean time, hMSCs indirectly co-cultured with uninjured ECV-304 cells in Transwell chamber, ECV-304 cells + hMSCs group (n=8) and hMSCs monoculture group (n =8) in Transwell chamber as control groups. After a 12-h culture in all groups, the migrating hMSCs in Transwell upper chamber were HE-stained and counted under an inverted phase contrast microscope. To understand the reason why hMSCs migrated to the oxidative stress injured endothelial cells, ELISA was employed to measure the concentration of monocyte chemoattractant protein-1 (MCP-1) and vascular cell adhesion molecule-1 (VCAM-1) of cellular supernatant in ECV-304 cells with H2O2 1-h treating group (H2O2 treatment group) or without H2O2 treating group (control group). Results The multipotential differentiation experiment demonstrated that the cultured P3 hMSCs can be induced to differentiate in vitro into osteoblasts, adipocytes and endothelial cells. And the expressions of CD29, CD44, CD90 and CD106 were positive in hMSCs while CD31, CD34, CD45 and CD49b negative by using FCM and immunohistochemistry. And the effects of hMSCs upon in vitro movement toward oxidative stress injuries of ECV-304 cells were averaged (8.00±0.22) cells/HP in the injured ECV-304 cells +hMSCs group, significantly higher than those of the ECV-304 cells + hMSCs group[(0.20±0.05) cells/ HP, P<0.01] and the hMSCs monoculture group [(0.00±0.00) cells/HP, P<0.01). The concentrations of MCP-1 and VCAM-1 in cellular supernatant of the H2O2 treatment group were significantly higher than those of the control group [(69.2±3.5) ng/ml vs (62.5±3.6) ng/ml, P<0.05; (114.0±7.5) ng/ml vs (97.2±5.0) ng/ml, P<0.01]. Conclusions The oxidative stress injuries of endothelial cells chemoattracted the hMSCs toward the injured site and its mechanism may be correlated with releasing a certain concentration of chemoattractant factor to result in the elevations of MCP-1 and VCAM-1 by oxidative stress injury.

Objective The study was to evaluate the effects of high-salt diet on the blood pressure and myocardium in Sprague-Dawley rats and to investigate the related mechanisms. Methods Rat model of high-salt diet was established by receiving standard rat chow with salt concentration of 0.3% and additional salt load via the drinking water (1% sodium chloride solution). Systolic blood pressure was measured by The indirect tail-cuff method in the rots on high-salt and normal-salt diet. The rats were placed in metabolic cages. Food intake and urine volume were recorded. The sodium and chloride in plasma and urine were measured. Transthoracic echecardiographic studies were performed at the eighth week with an echocardiographic system. The pathological variations of the myocardium were observed by the electron microscopy. The p22phox and p47phox mRNA expressions were analyzed by real time RT-PCR. The p22phox and p47phox protein expressions were analyzed by Western blot. The NADPH oxidase activity of myocardium and the serum 8-isoprostane levels were measured. Results Left ventricular hypertrophy (all P<0.05) and the decreased diastolic function of left ventricle without significantly elevated blood pressure [(128±4)mm Hg versus (125±3)mm Hg in controls, P0.05] were found in the rats on high-salt diet, compared to those in the rats on normal-salt diet. Furthermore, mRNA and protein expressions of the p22phox and p47phox, and the NADPH oxidase activity of myocardium were increased [(0.332±0.015) isoprostane levels [(1117±86) pg/ml versus (327±80) pg/ml in controls, P<0.05] were also significantly increased in the rats on high-salt diet. Condusion High-salt diet might lead to left ventricular hypertrophy and the decreased diastolic function of left ventricle through oxidative stress without significantly elevated blood pressure.

So far, there are few studies on the factors predicting the recurrence of chronic atrial fibrillation (AF). Scholars such as Efremidis of the Public Evangelical General Hospital in Athens, Greece, screened the clinical, electrocardiographic and electrophysiological predictors of AF recurrence in patients with persistent AF after interventional cardioversion, and the results were published in the recent Canadian Journal of Cardiology (Can J Cardiol, 2009, 25: e119-124).

Acquired infection in intensive care unit (ICU) increases the mortality and medical cost of patients. Selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) are the therapeutic measures to prevent infection in ICU patients. They use local and intravenous antibiotics to kill conditional pathogenic bacteria in oropharynx and gastrointestinal tract, avoid their migration and translocation, and cut off the source of pathogenic bacteria in nosocomial infection.

Objective To report the experience of hepatic artery reconstruction with adult-to-adult living donor liver transplantation (ALDLT) using right lobe liver grafts. Methods From January 2002 to August 2007, 104 patients underwent ALDLT using right lobe grafts. Hepatic arteries of donors and recipients were assessed carefully with spiral CT angiography and DSA before ALDLT. All patients underwent reconstruction of hepatic artery between right lobe liver grafts of donor and recipient which included the anastomosis between right hepatic artery of donors and recipients; the reconstruction of right hepatic artery between donor grafts and left hepatic artery of recipients; interpositional bypass using autogenous saphenous vein and cryopreserved lilac artery between right hepatic artery of donors and hepatic artery, common hepatic artery and abdominal aorta of recipients. The microsurgical technique was employed under the magnification of 3.5 times and operative microscope of 5-10 times. Results In these series, HAT occurred in 2 recipients at Days 1 and 7 post-ALDLT (1.9%). Both were revascularizad with autogenous saphenous vein between right hepatic artery of donor and abdominal aorta of recipient. HAT occurred in 1 recipient at Days 90 post-ALDLT, but no symptom was presented. There was no severe complication and mortality related to hepatic artery reconstruction in recipients. No HAT, hepatic artery stenosis and aneurysm occurred during the follow-up period of 2-60 months. The 1,2 and 3-year survival rates were 89.3%, 76.0% and 69. 3% respectively. Conclusion Careful evaluation of hepatic artery condition and using microsurgical techniques are important for safer arterial reconstruction and a long-term patency of hepatic artery in living donor liver transplantation in adults using right lobe liver grafts.

Objective Renal dysfunction caused by calcineurin inhibitor (CNI) after liver transplantation is a major complication among the long-term surviving recipients. Several studies have demonstrated that the adverse events could be prevented or avoided by mycophenolate mofetil (MMF) -based CNI reduced immunosuppressive protocol. In this retrospective study, we analyzed the middle-term effect of this regimen upon improving the CNI-associated renal dysfunction. Methods 124 OLT recipients' data within the recent three years were reviewed in this study. Results Renal dysfunction developed in 14 cases and its incidence was 11.29%. Five cases of them were from eyclosporine A (CsA) group and 9 from tacrolimus (TAC) group. The postoperative time ranged from 3-39 months with a mean follow-up duration of 19.26±9.30 months. The interval between renal impairment and surgery was 12.92±9.04 (1-31) months. CNI were reduced stepwise by about 55% in TAC group (TAC 2.60±1.14 mg/d vs 1.10±0.22 mg/d; t=3. 000, P=0.040) and about 70% in CsA group (CsA 370±179 mg/d vs 105±27; t=3.359, P=0.028). Serum creatinine had decreased from 139±46 μmol/L to 122±46 μmol/L (t=3.152, P= 0.004), 114±53 μmol/L (t=4.180, P=0.001) and 93±18 μmol/L (t=4.721, P=0.000) after administrating a mean MMF dose of 1.05±0.15 g/d (0.5-1.5 g/d) for 1,2 and 3 months respectively. And the creatinine clearance rate increased from 51.83±21.28 mL/min to 63±22 ml/min (t=-3.439, P=0.004), 69±25 ml/min (t=-4.207, P=0.001) and 79±25 ml/min (t=-6.149, P=0.000) during the corresponding period. Improvement was maintained within a follow-up period of 6.00±3.37 (3-14) months without major immunological or non-immunological side effects, except for 1 recipient from another institution who died of CNI-associated renal failure within 1 month after burst. 71.43% (10/14) of recipients achieved the normalization of serum creatinine and 21.43% (3/14) experienced a significant reduction in their serum creatinine levels. Conclusions MMF-based CNI reduced immunosuppressive protocol can improve substantially CNI-associated renal dysfunction after liver transplantation. And the long-term surviving recipients have excellent profiles of safety and tolerance.

Objective To elucidate the mechanisms of graft injury in small-for-size liver transplantation. Methods Animal models were established with skeletonized and denervated anatomic para-hepatic dissection, hepatectomy and perfusion in situ. Chinese Bama miniature pigs were divided into three groups (n=5): Group A, liver transplantation; Group B, partial liver transplantation with right hemi-liver graft and Group C, liver transplantation with right median and caudate lobe graft. Animals were followed for 7 days with regards to survival, dynamical portal venous pressure (PVP), portal blood flow (PBF) and graft histopathological examination. Results Animal survivals were as follows: Group A, 5/5, Group B, 5/5 and Group C, 1/5. PVP rose immediately after reperfusion. PVP in Group C peaked to 28.6±2.07 mm Hg. Portal blood flow (PBF) measured by CDFI showed that the index of PBF per gram liver tissue reached 3.56±showed that severe pathological changes occurred in small-for-size grafts, including sinusoidal congestion, hemorrhage, hepatocytic ballooning change or necrosis, endothelial cell detachment, Disse's space widening or vanishing and significant apoptosis. Conclusion Portal overperfusion and acute portal hypertension are the primary etiological mechanisms of graft injury in small-for-size liver transplantation.

Objective To investigate the role of lipopolysaccharides (LPS), toll-like receptor 2 (TLR2) and inducible nitric oxide synthase (iNOS) in the development of hepatopulmonary syndrome (HPS). Methods Seventy-one patients were divided into 3 groups: end-stage liver disease with HPS (HPS group, n=31), end-stage liver disease without HPS (non-HPS group, n=30) and healthy volunteers (n= 10). Blood was collected at pre-OLT and Days 3, 7, 14, 21 and 28 post-OLT to detect the plasma LPS level, TLR2mRNA and iNOSmRNA in peripheral blood monecytes. Results The LPS, TLR2mRNA and iNOSmRNA at pre-OLT in HPS group were 4.31±3. 267 ng/L, 336 594.10±366 901.14 and 63 982. 24 ±74 127.47 copies/μg RNA respectively; 1.62±1.34 ng/L, 336 321.53±222 317.17 and 44 169.9±24 993.00 copies/μg RNA respectively in non-HPS group and 0.94±69 ng/L, 10 338.28±3 814.64 and 19 168.49±2 417.35 copios/μgRNA in normal control group. LIS, TLR2mRNA and iNOSmRNA at pre-OLT in HPS group were higher than those in non-HPS group without significance (P0.05), but significantly higher than those in control group (P<0.05). The TLR2mRNA decreased in all end-stage liver disease patients at post-OLT with the improvement of liver function and oxygenation. Conclusion The dysfunction of intestinal barrier and intestinal endotoxemia may be the important mechanisms of HPS through the elevation of LPS level and the expressions of TLR2mRNA and iNOSmRNA.

Patients with end-stage liver disease are often complicated with pulmonary complications. Due to the dysfunction of intestinal mucosal barrier, intestinal flora imbalance and flora translocation, the level of endotoxin in the body increases, causing the permeability of pulmonary capillaries increases, and the pulmonary exudation increases. Under the stress of liver transplantation, acute lung injury (ALI), pulmonary infection, and even respiratory distress syndrome (ARDS) are more likely to occur after operation. Patients with end-stage liver disease are often complicated with pulmonary vascular diseases, such as hepatopulmonary syndrome (HPS) and portal pulmonary hypertension (PPH). Besides, patients with end-stage liver disease may also be complicated with primary pulmonary diseases such as chronic bronchitis, emphysema, bronchial asthma, tumor, etc. The severity of these pulmonary complications can affect the smooth progress of liver transplantation and the difficulty of ventilator disconnection or ventilator dependence after transplantation, thus affecting the surgical effect and prognosis.

The 2009 launching meeting of Greater China College of Colorectal Laparoscopic Surgery and the seminar on teaching methods of laparoscopic colorectal surgery were held in Yushan, Shanghai on March 6th, 2009. Professor Zheng Minhua, vice president of Shanghai Ruijin Hospital and general surgeon, served as the chairman of the meeting. More than 30 experts in the field of laparoscopic colorectal surgery from all over the country gathered together to discuss the training norms, learning contents, teaching system and methods of laparoscopic colorectal surgery in China in the form of multimedia round table.

[Editor's Note] In order to guide medical institutions to prepare for the medical treatment of influenza A (H1N1) and respond to the possible epidemic of influenza A (H1N1), the Ministry of Health organized experts to<Based on the Diagnosis and Treatment Scheme of Human Swine Influenza (2009 Edition), combined with the latest experience and related data of the World Health Organization and other countries in the diagnosis and treatment of influenza A (H1N1)<Diagnosis and treatment plan for influenza A (H1N1) (1st edition, 2009)>. With the in-depth study of this new disease and according to the dynamic changes of epidemic situation, the diagnosis and treatment plan will be further revised in time.

A 53-year-old male was admitted to Sir Run Run Shaw Hospital Emergency Department of Zhejiang University School of Medicine on February 28, 2009 due to "upper abdominal pain for 3 days, fever with nausea and vomiting for 1 day".