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29 October 2010, Volume 14 Issue 44 Previous Issue    Next Issue

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Inhibition effect of p53 gene on coronary artery intima hyperplasia following heart transplantation Wang Li-ping, Liu Yue, Jia Zhi-bo, Li Ying, Zhang Yi-na, Yin Xin-hua 2010, 14 (44):  8171-8174.  doi: 10.3969/j.issn.1673-8225.2010.44.001 Abstract ( 341 )   PDF (874KB) ( 398 )   Save BACKGROUND: Wild-type p53 gene can inhibit vascular smooth muscle cells proliferation, relieve graft coronary artery vascular intima hyperplasia and lumina narrow after vascular intima injury.  OBJECTIVE: To evaluate the inhibition effect of wild-type p53 gene transfer on graft coronary artery intima hyperplasia after heart transplantation. METHODS: Rat model of heterotopic (abdomen) heart transplantation was developed. Wistar rats served as donors and SD rats as recipients. After donor hearts were removed, 800 µL adenoviral vector encoding the wild-type p53 gene (Ad-p53 group), adenoviral vector encoding the β-galactosidase gene (LacZ) (Ad-LacZ group) or saline (control group) were infused into the donor heart respectively before transplantation. The donor heart was stored in the 4 ℃ saline for 30 minutes before heart transplantation. p53 gene mRNA expressions in coronary artery of donor hearts were tested by reverse transcription PCR at 5 days after operation. At 28 days after transplantation, the donor hearts and coronary artery were observed under a microscope, and the ratio of intima/media thickness and vessel wall thickness/lumina diameter was calculated.  RESULTS AND CONCLUSION: The expression of p53 gene was found in donor hearts in Ad-p53 group at 5 days after operation. At 28 days after operation, the ratio of intima/media thickness and vessel wall thickness/lumina diameter were lower in Ad-p53 group than in Ad-LacZ and control group (P < 0.05). Ad-LacZ and control group show no significant difference (P > 0.05). The results confirmed that it is feasible to transfer target gene to the donor heart by intracoronarily injection. Wild-type P53 gene transfer to the donor heart can inhibit graft coronary artery intima hyperplasia and lumens narrow significantly. Related Articles | Metrics

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Immunological reaction of allogenic aortic valve transplantation following hypothermic preservation Zhou Zheng, Li Dong-yu 2010, 14 (44):  8175-8178.  doi: 10.3969/j.issn.1673-8225.2010.44.002 Abstract ( 299 )   PDF (253KB) ( 357 )   Save BACKGROUND: Previous studies demonstrated that nitrogen cryopreservation can maintain cell biological activity and tissue construction integrality, however, there are few studies concerning immunological reaction of allogenic aortic valve transplantation. OBJECTIVE: To observe the immune parameters changes following allogenic aortic valve transplantation. METHODS: Hypothermic preserved allogenic aortic valve was transplanted into Wistar rats, and divided into groups. There was no intervention on the allogenic transplantation group; Ciclosporin A was injected into rats in the immune prevention group; in the control group, the aorta was cut down and re-anastomosed directly. The serum specimen was collected at 1, 2, 3, 4 and 5 weeks after transplantation. The MHCⅡ positive expression and percentage of CD4+ , CD8+ cells were measured by immunohistochemistry. The serum interleukin 2 and tumor necrosis factor α levels were measured by ELISA.    RESULTS AND CONCLUSION: MHC positive could be seen at 1-4 weeks after transplantation, and the ratio of CD4+ , CD4+ /CD8+ was obviously increased, the serum interleukin 2 and tumor necrosis factor α levels were dramatically increased, and maintained a high level within 5 weeks after transplantation. Compared with the control group, there was significant difference (P < 0.05). Ciclosporin A exhibited an obvious inhibitory effect on intimal thickening, lymphocyte infiltration, MHCⅡ expression, T lymphocyte activation, as well as increased interleukin 2 and tumor necrosis factor α levels after allogenic transplantation (P < 0.05). The findings demonstrated that, there are obvious immunological rejections of allogenic aortic valve transplantation following hypothermic preservation, but ciclosporin A has notably inhibitory action. Related Articles | Metrics

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Establishment of an allogenic heart transplant model using modified Heron’s technique Cai Xu-dong, Lin Shan-chang, Liu Yu-you, Chen Lu-feng, Liu Dai-xuan 2010, 14 (44):  8179-8182.  doi: 10.3969/j.issn.1673-8225.2010.44.003 Abstract ( 354 )   PDF (468KB) ( 359 )   Save BACKGROUND: Rodents animal heart transplantation model was divided into working cast and non-working casts. Compared with working cast, non-working cast is characterized by short surgical time and high success rate, especially Heron method. OBJECTIVE: To modify Heron’s technique for the model of heart transplant in rats in order to establish a more reasonable and practicable model so that it fits for the requirement of following experiment.  METHODS: Heron’s technique was improved. The recipient’s right external jugular vein cannula was inserted into the donor’s right pulmonary artery. Right common carotid artery cannula was inserted into the heart aorta. Cerclage was used. Donor’s heart left pulmonary artery was ligated, and then model of modified heart transplant was rapidly and effectively established. Success rate, complication, total surgical time, set up time of recipient’s vessel cannula, donor’s heart selection time, transplantation time of the neck part and cold ischemia time of donor’s heart were observed. RESULTS AND CONCLUSION: Formal tests were consecutively performed 25 times by a single person. A total of 24 tests were successful, resulting in a success rate of 96%. There was no anastomosis leakage, recirculation disorder and recipient’s death after operation. The total time of surgical procedure was 50 to 60 minutes for each case. The time was respectively (18±3) minutes for preparing the recipient’s cervical vessel cannulas, (10±1) minutes for selecting the donor’s heart, (6±1) minutes for heart transplantation in cervical part and (16±1) minutes for cold ischemia of donor’s heart. Results suggest that the modified Heron’s technique was a more reasonable and practicable method to establish a reliable and high reproducible model of heart transplant that could be operated by surgeons without minimal microvascular technique and with short cold ischemia time. Related Articles | Metrics

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Establishment of a rat orthotopic left lung transplantation model using modified three-cuff method Fan Kai, Wang Jian-jun, Zhai Wei, Tang Jian, Wan Li 2010, 14 (44):  8183-8185.  doi: 10.3969/j.issn.1673-8225.2010.44.004 Abstract ( 301 )   PDF (225KB) ( 395 )   Save BACKGROUND: Lung transplantation is the sole cure for end-stage lung disease. The basic research addressing lung transplantation is based on animal models. OBJECTIVE: To establish a new simple, stable, and available experimental model of rat lung orthotopic allograft transplantation. METHODS: Fifty male rats were randomly grouped into donors and recipients; lung transplantation was performed with using new three-cuff technique. The donor lung was harvested, placed over left lung of recipients and maintained in 4℃ LPD solution. The donor lung was anastomosed to the recipient following the sequence from the left pulmonary artery, vein to the bronchus. Then the left pulmonary vein-artery was opened successively, and the left lung of recipient was removed. Blood gas of recipients was tested after 5 weeks. RESULTS AND CONCLUSION: The successful rate of surgery was 92%, and the mean time for all the proceedings was (55±3) minutes. All the lung grafts were survivable over 5 weeks. Blood was collected from the left vein at 15 minutes prior to and after right pulmonary hilum occlusion, and the blood gas analysis showed there was no significant difference of the blood gas before and after occlusion (P > 0.05). The findings suggested that, new cuff method is a simple, reproducible and valid method for establishing models of rat orthotopic left lung transplantation. Related Articles | Metrics

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Surgical skills for establishing a rat model of lung transplantation using cuff method Lin Jiang-bo, Chen Dao-zhong, Kang Ming-qiang, Chen Chun, Lin Ruo-bai 2010, 14 (44):  8186-8190.  doi: 10.3969/j.issn.1673-8225.2010.44.005 Abstract ( 298 )   PDF (317KB) ( 427 )   Save BACKGROUND: To establish a lung transplantation model in rats is the foundation and the key to pathophysiological process and treatment following lung transplantation; however, a precise surgical technique is required, as the difficulty is great to limit the application of the model. OBJECTIVE: To investigate the surgical skills of establishing a stable rat lung transplantation model using cuff method. METHODS: A total of 60 rats were included. Orthotopic left lung transplantation models were established in 30 rats by the modified three-cuff anastomotic technique. The techniques of pulmonary vascular and bronchial anastomosis are as follows: The recipient pulmonary vein was distracted by the“4-pin suspension”with the distribution of 90°angle，so that the collapsed vein was fully open and fixed, and reducing the possibility of tearing the vessel wall which was due to short recipient veins or forcible insection. The recipient pulmonary artery was distracted by the “3-pin suspension” with the distribution of 120° angle. However, the direction of donor lung casing should be pay more attention during anastomosis. Finally, the endo-stent was used for bronchial anastomosis. Meanwhile, the operation time and achievement ratio of transplantation at different stages were calculated. RESULTS AND CONCLUSION: The achievement ratio of lung transplantation in 30 cases of rats was 90%; the survival rate of rats after lung transplantation was 100%. The time of left donor lung extraction was (3±1) minutes. The time of in vitro casing in donor lung was pulmonary artery (2±0.5) minutes, pulmonary vein (3±1) minutes, and bronchus (2±0.5) minutes, respectively. The time of arteriovenous and bronchus casing anastomosis was pulmonary artery (4±1) minutes, pulmonary vein (8±3) minutes, bronchus (2±0.5) minutes, respectively. The total operation time was (55±10) minutes. It is indicated that the modified three-cuff technique for establishing lung transplantation models in rats is simple with high achievement ratio of operation. It is a stable model for the study of ischemia-reperfusion injury in rats following lung transplantation. Related Articles | Metrics

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Recipient respiratory arrest during reduced-size liver transplantation in rats Liu Jing, Li Jiang, Zhang Sheng-ning, Li Zhu, Li Lai-bang, Liao Li-qiong, Ran Jiang-hua, Li Li 2010, 14 (44):  8191-8195.  doi: 10.3969/j.issn.1673-8225.2010.44.006 Abstract ( 247 )   PDF (261KB) ( 280 )   Save BACKGROUND: It is the foundation and prerequisite for relative experimental research that whether reduce-size liver transplantation in rat was established successfully. Respiratory arrest is the main cause effecting on rat model of reduce-size liver transplantation. It is important to rise succeed rate of rat-reduce-size liver transplantation by analyzing cause and emergency treatment of intra-operation respiratory arrest.  OBJECTIVE: To analyze cause of respiratory arrest during reduce-size liver transplantation of the rat and to investigate emergency treatments for respiratory arrest.  METHODS: Healthy SD rats were selected. Female rats served as donors and the male rats served as recipients. Operation of donor was performed by only one person with the naked eye, which reduced-size donor liver was performed in the donor operation. Operation of the receptor was performed by two persons with the naked eye, with improved dual-cuff technique of Kamada and stay pipe of biliary tract. The recipients with respiratory arrest were divided into 3 groups as follows: Experimental group 1: the recipients with respiratory arrest accepted “simple equipped artificial respiration” and external chest compression; Experiment group 2: the recipients with respiratory arrest only accepted “simple equipped artificial respiration”; Control group: the recipients with respiratory arrest only accepted external chest compression.  RESULTS AND CONCLUSION: A total of 270 rats were accepted reduce-size liver transplantation successfully, 50 of 270 rats underwent intra-operative respiratory arrest, the cause of intra-operative respiratory arrest as follows: 42 rats showed anesthesia overdose, 3 rats showed excessive gas embolism, 3 rats showed pneumothorax and 2 rats showed acute pulmonary edema. The success rates of emergency treatment for respiratory arrest in the experimental group 1, experimental group 2, and the control group were: 84.6% (22/26), 54.5% (6/11), and 30.8% (4/13), respectively. The success rate of emergency treatment for anesthesia overdose-induced respiratory arrest in the experimental group 1, experimental group 2, and the control group were was 95.6% (22/23), 66.7﹪(6/9), and 40% (4/10), respectively. The most common respiratory arrest cause during reduce-size liver transplantation of rat was anesthesia overdose, then excessive gas embolism, pneumothorax and acute pulmonary edema in proper order. The most effective emergency treatment of respiratory arrest of rats was “simple equipped artificial respiration” and external chest compression, then “simple equipped artificial respiration” and external chest compression in proper order. Related Articles | Metrics

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Feasibility of ABO-incompatible liver transplantation Lin Jian-hua, Zhou Jie, Zhang Qi-fan, Lin Yi-xiong 2010, 14 (44):  8196-8198.  doi: 10.3969/j.issn.1673-8225.2010.44.007 Abstract ( 303 )   PDF (200KB) ( 300 )   Save BACKGROUND: According to its fine clinical results reported in recent years, ABO blood type in-compatible liver transplantation can be performed in order to shorten the time of waiting for donors, which gives this kind of patients the opportunity to receive liver transplantation and survive. OBJECTIVE: To study the clinical effect and feasibility of ABO-incompatible liver transplantation. METHODS: Data of 7 patients, who had performed ABO-incompatible liver transplantation in Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University from November 2005 to January 2010, were reviewed. Discussions were focused on the clinical effect and main complications and treatment measures improving, in order to analyze the feasibility of ABO-incompatible liver transplantation. RESULTS AND CONCLUSION: There was bile duct stenosis in case 1 after operation. Bile exterior and interior pedestal drainage tube was set until cholangiography demonstrated that the bile duct was unobstructed and the drainage tube was removed 2 years later. Up to now there is no evidence of bile duct obstruct. Only case 4 died at five months postoperative due to the tumor metabases, other 6 patients survived well. Acute rejection was occurred in case 7 at 1 week postoperative on account of the abnormal rising of serum bilirubin level, urbason therapy was performed immediately and the serum bilirubin was decreased gradually to normal. There were no complications in other patients. ABO-incompatible liver transplantation is feasible for patients in emergency or other special conditions. Related Articles | Metrics

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Microcirculation perfusion characteristics of renal graft cortex when chronic renal glomerular filtration insufficiency occurred　 Xing Jin-fang, Du Lian-fang, Li Fan, He Ying-qian 2010, 14 (44):  8199-8202.  doi: 10.3969/j.issn.1673-8225.2010.44.008 Abstract ( 294 )   PDF (307KB) ( 376 )   Save BACKGROUND: The pathological changes of chronic transplant kidney function insufficiency can influence directly the blood flow perfusion of renal glomerula. The blood flow perfusion of renal glomerula can be evaluated by monitoring microcirculation perfusion of renal graft cortex. When chronic renal glomerular filtration insufficiency occurred, it has important clinical value to real-time monitor pathological changes of microcirculation perfusion of renal graft cortex. OBJECTIVE: To summarize pathological changes of microcirculation perfusion of renal graft cortex when chronic renal glomerular filtration insufficiency occurred by SonoVue ultrasound contrast imaging. METHODS: Totally 32 patients received allogeneic kidney transplantation, including 21 males and 11 females, with aged 38-60 years. The post-operation times of all patients were above 6 months. The serum creatinine and urea nitrogen values of all patients were above normal. The microcirculation perfusion of renal graft cortex was monitored real-time by SonoVue ultrasound contrast imaging. The images were stored real-time and analyzed by review. RESULTS AND CONCLUSION: All 32 patients were successfully examined with ultrasound contrast imaging. PT of all patients was above 25 ms, T of all patients was above 15 ms, the distribution of agent was not uniform. The results show that the pathological changes of microcirculation perfusion of renal graft cortex could be real-time monitor by SonoVue ultrasound contrast imaging when chronic renal glomerular filtration insufficiency occurred.　 Related Articles | Metrics

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Detection of cytomegalovirus immediate early antigen in kidney and bone marrow transplantation recipients Wu Guo-hua, Luo Can-qiao, Lai Ying-rong, Liang Hui-zhen, Zhong Jue-min, Liang Ying-jie, Wu Rong-pei 2010, 14 (44):  8203-8206.  doi: 10.3969/j.issn.1673-8225.2010.44.009 Abstract ( 238 )   PDF (305KB) ( 347 )   Save BACKGROUND: With the application of immunosuppressive agents, latent cytomegalovirus (CMV) will be activated following kidney or bone marrow transplantation. Therefore, accurate diagnosis of early CMV infection has great significance. The key point of controlling CMV infection is detecting the CMV replication in blood rapidly and quantitatively.  OBJECTIVE: To detect CMV immediate early antigen in renal and bone marrow transplantation recipients and to explore its clinical diagnostic value.  METHODS: The immediate early antigens of peripheral blood leukocytes with active CMV infection in 1 215 cases receive kidney and bone marrow transplantation were detected by immunohistochemistry. RESULTS AND CONCLUSION: There were 492 cases (40.0%) with positive CMV immediate early antigen index and 723 cases with negative immediate early antigen index (60.0%), CMV IgG antibodies were significantly increased in 318 cases (26.0%), and CMV IgM antibody could be found in 90 cases (7.0%). CMV antigenemia detection technology exhibits highly sensitivity and specificity in diagnosing active CMV infection and has important prognostic significance in detecting CMV incidence, thus, it is an economical and viable diagnostic method. Related Articles | Metrics

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Effects of cyclosporine A and tacrolimus on blood lipid of renal transplant recipients Guo Juan, Qu Qing-shan, Zhu Ming-hui, Liu Xu-hua 2010, 14 (44):  8207-8210.  doi: 10.3969/j.issn.1673-8225.2010.44.010 Abstract ( 392 )   PDF (287KB) ( 409 )   Save BACKGROUND: Hyperlipidemia following successful renal transplantation is a frequent and persistent complication. Several immunosuppressive agents, including cyclosporine A (CsA), corticosteroids, and tacrolimus, appear to have a significant pathogenetic role. OBJECTIVE: To investigate the differential effects of tacrolimus and CsA on blood lipids in renal transplant recipients. METHODS: Renal transplant recipients treated with a different combination of immunosuppressive agents were divided into CsA (n=20) group, who received CsA+mycophenolatemofetil (MMF)+steroids and tacrolimus (n=23) group, who treated by tacrolimus+MMF+steroids. Plasma lipids, including total cholesterol, triglycerides, low-density lipoprotein cholesterol (C-LDL) and high-density lipoprotein cholesterol (C-HDL) were examined prior to, 1 and 6 months after transplantation. RESULTS AND CONCLUSION: There were statistically significant differences between the two groups prior to and after transplantation. Total cholesterol levels and C-LDL levels were significantly different when compared between the two groups at 1 and 6 months after transplantation. The differences of C-HDL and triglycerides were not statistically significant. The results demonstrated that, triglycerides and C-LDL levels are prone to increase in renal transplant recipients received CsA therapy, and the hyperlipidemia is less pronounced in patients given tacrolimus. Compared with CsA, tacrolimus appears lower the attack rate of lipid metabolism. Related Articles | Metrics

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Protective effects and mechanism of different ischemic postconditionings for rat pancreas after transplantation Zhang Zhao-hui, Wang Wei-zhong, Li Xi, Niu Wan-cheng, Chen Dang-ying, Zhang Yun-min 2010, 14 (44):  8211-8214.  doi: 10.3969/j.issn.1673-8225.2010.44.011 Abstract ( 254 )   PDF (260KB) ( 344 )   Save BACKGROUND: Ischemia/reperfusion injury is one of main reasons of thrombosis and acute pancreatitis following pancreatic transplantation, and is the unavoidable process of pancreatic transplantation, finally results in affecting the function of transplanted pancreas. How to relieve ischemia/reperfusion injury is a hot point of transplantation surgery at present. OBJECTIVE: To evaluate the protective effects of different ways of ischemic postconditioning on ischemia/reperfusion injury in rat pancreas after transplantation. METHODS: A total of 48 diabetic Sprague Dawley rats were randomly assigned to four groups: control group (C，n=12), ischemic postconditioning 1 group (30-second reperfusion followed by 30-second ischemia once), ischemic postconditioning 2 group (30-second reperfusion followed by 30-second ischemia thrice), and ischemic postconditioning 3 group (30-second reperfusion followed by 30-second ischemia six times). All groups received pancreas transplantation. A total of 48 healthy Sprague Dawley rats served as donors. The blood glucose pre- and post-reperfusion, malondialdehyde (MDA), superoxide dismutase (SOD) and myeloperoxidase (MPO) changes at 2 hours postreperfusion were detected in the pancreatic tissue in each group. Apoptotic cells in graft were monitored by TUNEL assay. RESULTS AND CONCLUSION: Glucose levels were decreased in the ischemic postconditioning groups compared with control group following ischemia/reperfusion group (P < 0.01). Glucose levels were lower in the ischemic postconditioning 2 group compared with ischemic postconditioning 1 group and ischemic postconditioning 3 group (P < 0.05). The SOD levels were greater (P < 0.01), but MDA and MPO levels were lower (P < 0.01) in the ischemic postconditioning groups compared with control group following ischemia/reperfusion. SOD levels were greater (P < 0.05), but MDA and MPO levels were lower (P < 0.05) in the ischemic postconditioning 2 group compared with ischemic postconditioning 1 group and ischemic postconditioning 3 group. Apoptotic index was low in the ischemic postconditioning groups compared with control group following reperfusion (P < 0.01). Apoptotic index was lower in the ischemic postconditioning 2 group compared with ischemic postconditioning 1 group and ischemic postconditioning 3 group (P < 0.05). These indicated that ischemic postconditioning can protect graft from ischemia/reperfusioin injury and reduce apoptosis of the graft during pancreas transplantation. Three cycles of 30-seconds ischemia and 30-seconds reperfusion are the best way to induce ischemic preconditioning in rat pancreas transplantation. Related Articles | Metrics

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Vitrification treatment of allograft artery transplantation Ma Guang-ren, Liu Xing-yan, Chen Ke-ming, Ge Bao-feng, Bai Meng-hai, Kong Fan-bin 2010, 14 (44):  8215-8219.  doi: 10.3969/j.issn.1673-8225.2010.44.012 Abstract ( 236 )   PDF (327KB) ( 353 )   Save BACKGROUND: Previous research has demonstrated that in vitro pre-treatment and conservation of blood vessels were improved remarkably; however, they remained still satisfactory. Therefore, to look for effective method still needs to be further studied. OBJECTIVE: To compare vitrification and traditional freezing to preserve the allograft vascular effects after transplantation, and to find a more practical and easy production of vascular treatment methods. METHODS: A total of 96 health bruising-blue rabbits, undergoing surgical resection of bilateral femoral artery, were divided into 3 groups: fresh vascular autograft (group A), irradiation pretreatment frozen vascular allograft (group B), and vitrification + irradiation pretreatment of vascular allograft (group C), according to different methods of in vitro vascular preconditioning experiment. At 1, 4, 8, and 12 weeks after transplantation, six experimental animals were taken from each group for abdominal aortic digital subtraction angiography, scanning electron microscopy, histopathology and other methods to observe the rate of aneurysm formation, morphological changes and organization of the vascular graft. RESULTS AND CONCLUSION: At 12 weeks after transplantation, the cumulative patency rate in the group A was significantly higher than that in the group B (P < 0.05); however, there was no significant difference between group C and group A as well as group B (P > 0.05). Histopathological examination revealed that allograft vascular smooth muscle proliferation in endometrium and middle layer of group C was slightly compared with group B, showing unclear lumen stenosis and light inflammatory reaction. The vitrification irradiation preservation of allograft blood vessels, making the procedure easy, high patency rate of grafts, tissue reaction to light, was an ideal way to deal with allogenic blood vessels in vitro. Related Articles | Metrics

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Effects of cardiothoracic ratio following cardiac valve replacement: A Meta-analysis Hou Yuan-yuan, Zhou Ping 2010, 14 (44):  8220-8224.  doi: 10.3969/j.issn.1673-8225.2010.44.013 Abstract ( 358 )   PDF (404KB) ( 364 )   Save BACKGROUND: Because of the high risk and high cost of cardiac valve replacement, it is necessary to perform pre-operative assessment for a successful operation. It can accurately measure cardiothoracic ratio (CTR) and clearly show the structure and function of the heart from the chest X-ray. If the CTR ≥ 0.7, it means severe cardiac valve disease, and operation risk is higher. OBJECTIVE: To investigate the effects of CTR on mortality rate and complications after cardiac valve replacement according to Meta analysis, and to calculate the CTR mean of four heart function using the data mining method. METHODS: The CNKI database, Wanfang database, and Vip database were retrieved. The literatures addressing cardiac valve replacement in China were collected from the relevant date. Meta analysis was carried out based on two groups of CTR > 0.7 and CTR < 0.7. The differences in evaluation were expressed by odds ratio (OR) and 95% confidence interval (CI). RevMan 4.2 software was used for statistical analysis. The preoperative CTR mean of four cardiac functions was calculated by the data mining method. RESULTS AND CONCLUSION: A total of 8 articles about mortality rate, and 9 articles about complications were included. Result of meta- analysis showed that CTR had significant effects on postoperative mortality rate and complications in the two groups of CTR. Eight sets of data in postoperative mortality in the 8 literature had the same results after the heterogeneity inspection (P=0.19); however, 6 sets of data in postoperative complications in the 9 literature had the inconsistent results after the heterogeneity test (P < 0.000 1). The CTR mean of preoperative cardiac function in II, III, IV patients was 0.555 9, 0.669 0, and 0.671 2 respectively. It is indicated that if preoperative CTR > 0.7 in patients, the early mortality rate and complications is higher after the cardiac valve replacement. The CTR can be used as one of the preoperative risk assessment indexes for cardiac valve replacement. It is valuable to statistics CTR according to preoperative heart level. Related Articles | Metrics

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Effects of astilbin on peripheral blood T cell activation in rats with lung transplantation Lin Hui-qing, Huang Jie, Shu Yun 2010, 14 (44):  8225-8229.  doi: 10.3969/j.issn.1673-8225.2010.44.014 Abstract ( 346 )   PDF (357KB) ( 382 )   Save BACKGROUND: Currently, rejection is inhibited by blocking T cell activation. Many in vitro experiments showed that, astilbin and their analogs exhibit typical selective immunosuppression.    OBJECTIVES: To investigate the expression and implication of astilbin on peripheral blood T cell activation in rats with lung transplantation. METHODS: Fifty rats were randomly divided into 3 groups. Ten rats were taking peripheral blood as the blank group. The remained 40 rats were randomly assigned to donors and recipients. Model of rat left lung transplantation was set up. Twenty lung transplanted rats were divided in to 2 groups randomly: the control group, which was lavaged with normal saline, the experimental group was lavaged with astilbin. The expressions of T cell activation antigen CD69, CD25 and CD71 were determined by fluorescent-labeled antibody staining and flow cytometry (FCM) prior to and at 2, 5 days after transplantation. RESULTS AND CONCLUSION: The levels of CD69, CD25 and CD71 in the astilbin group were markedly higher at 2 days after lung transplantation than that of the blank group (P < 0.01), but lower than the control group (P < 0.05). At 5 days after lung transplantation, the levels of CD69, CD25 and CD71 in the astilbin group were declined into normal levels, which was notably lower than that of the control group (P < 0.01). Astilbin significant suppresses acute rejection-induced T cell activation and shows strong inhibition effect on rejective reaction after lung transplantation. Related Articles | Metrics

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Body temperature changes of patients during renal transplantation under general anesthesia Lü Xiao-ming, Li Rui-kun, Ning Ji-shun 2010, 14 (44):  8230-8232.  doi: 10.3969/j.issn.1673-8225.2010.44.015 Abstract ( 330 )   PDF (189KB) ( 380 )   Save BACKGROUND: With advances of anesthetic techniques, the use of general anesthesia gradually increased in renal transplantation, however, the changes of body temperature during surgery has rarely reported. OBJECTIVE: To investigate body temperature changes of patients during renal transplantation under general anesthesia.  METHODS: A total of 20 cases that underwent renal transplantation under general anesthesia with remifentanil-propofol were selected. The body temperature was recorded at 6 points, namely, after anesthesia induction, before anastomosis of transplanted renal vascular, before transplanted renal artery opening, at minutes 5, 30 and 60 after transplant renal artery opening. RESULTS AND CONCLUSION: Compared with after anesthesia induction, the body temperature had no obviously changes at before anastomosis of transplanted renal vascular and before transplanted renal artery opening, which dramatically decreased at minutes 5 and 30 after transplant renal artery opening, but recovered at minutes 60 after transplant renal artery opening. It demonstrated that the body temperature indeed depressed during renal transplantation. However, by observing the whole process, it found that there was no significant drop in body temperature from after induction of anesthesia to before transplant renal artery opening, which revealed anesthesia drugs and the surgery process was not the main reason for low body temperature. While, at 5 minutes after transplant renal artery opening, the body temperature rapidly decreased, it indicating cold irrigation fluid into patient’s blood circulation after the opening of transplant renal artery was the main reason for the low body temperature, and this could continue for a very long time, even could not recovered at 30 minutes and 60 minutes after transplant renal artery opening. Result suggests that patients underwent renal transplantation with general anesthesia prone to hypothermia, the cold irrigation fluid into the patient’s blood circulation after the opening of transplant renal artery is the main reason for hypothermia. Related Articles | Metrics

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Effect of cholera toxin B subunit on the maturation of dendritic cells Guo Lu-sheng, Zhang Pei, Lun Heng-zhong, Yan Xiao-fang 2010, 14 (44):  8233-8236.  doi: 10.3969/j.issn.1673-8225.2010.44.016 Abstract ( 304 )   PDF (358KB) ( 335 )   Save BACKGROUND: The existing experimental results showed that cholera toxin can induce dendritic cell maturation. Cholera toxin B is non-toxic subunit of cholera toxin, which is a good adjuvant and antigen delivery vector, whether it can promote dendritic cell maturation has not yet been confirmed. OBJECTIVE: To observe the dendritic cell phenotype and function of 2.4 changes in the initial study of cholera toxin B on dendritic cell maturation.  METHODS: Dendritic cell 2.4 was proliferated by cell culture. Dendritic cells were divided into five groups: control group: there was no treatment; cholera toxin B 0.1, 1.0, 10 mg/L groups: cholera toxin B with the respective final concentrations were added in the culture medium; positive control group: lipopolysaccharide, with final concentration of 1 mg/L, was added into the culture medium. There were 6 holes in each group. Expression of 2.4 cell surface CD80, CD86, MHC-Ⅱ molecule in dendritic cells cultured at different times were detected by flow cytometry, followed by parallel in vitro mixture with lymphocyte reaction. Types of dendritic cells on T cells with stimulation capacity were observed by MTT.  RESULTS AND CONCLUSION: 10 mg/L cholera toxin B significantly enhanced dendritic cell surface molecules (CD80, CD86 and MHC-Ⅱ) expression (P < 0.01), and significantly improved the dendritic cells to T cell activation capacity (P < 0.01). There were significant differences between positive control group and blank control group (P < 0.01). Cholera toxin B can enhance the activation of dendritic cells mature, its immune function from the positive regulatory role. Related Articles | Metrics

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Investigation of normal values of T-lymphocyte subsets in healthy Dai adolescents and adults Su Ying-zhen, Yu Shou-yi, Jia Man-hong, Yang Li, Shi Yu-hua, Chen Ling, Yang Chao-jun, Ma Yan-ling　 2010, 14 (44):  8237-8240.  doi: 10.3969/j.issn.1673-8225.2010.44.017 Abstract ( 364 )   PDF (281KB) ( 344 )   Save BACKGROUND: Under healthy status, T-lymphocyte subsets and other immunocyte maintain stable condition in quantity. As the normal value of T-lymphocyte subsets is influenced by age, gender and race, it may induce infectious disease or autoimmune disease. Therefore, establishment of normal value is important for identifying immune function, disease development and recovery of various diseases. OBJECTIVE: To investigate the normal value of peripheral blood T-lymphocyte subsets in healthy adolescents and adults. METHODS: Peripheral blood was collected from 392 Dai healthy adults and adolescents and stained with monoclonal antibodies supplied by Multi TEST four colors T lymphocyte kit. The samples were tested and analyzed by FACS Calibur. RESULTS AND CONCLUSION: The absolute counting mean of the T-lymphocyte subsets and reference ranges of 82 healthy Dai adolescent subjects were as follows: Lymphocytes 3 054×106 (1 691×106-4 845×106)/L; CD3+ cells 2 055×106 (1 183×106-  3 280×106)/L; CD4+cells 1 072×106 (583×106-1 666×106)/L; CD8+ cells 825×106 (381×106-1 665×106)/L, and the ratio of CD4+ /CD8+ was 1.38 (0.44-2.36). The absolute mean of the T-lymphocyte subsets and reference ranges of 310 healthy adults subjects were as follows: Lymphocytes 2 649×106 (1 243×106-4 754×106)/L; CD3+ 1 763×106 (828×106-3 115×106)/L; CD4+985×106 (450×106-1 708×106)/L; CD8+ 663×106 (275×106-1 335×106)/L; the ratio of CD4+ /CD8+ was 1.64 (0.74-2.00). The absolute numbers of lymphocyte subsets and CD8+ of male were significantly more than the female, while the percentage of CD3+ and CD4+of male was remarkably less than the female (P < 0.05). except of CD4+T-lymphocyte, lymphocyte number, T-lymphocyte absolute number, CD8+T cells absolute number and percentage in healthy people of each age stage were different, in particular, CD8+T cells absolute number and percentage in adolescents were greater than other age groups, and decreased with aging. Compared with healthy populations in other regions, the absolute numbers of CD4+T cells in healthy Dai minority were greater. This study established immunophenotyping of lymphocyte and T cell subsets reference ranges for healthy Dai populations. Related Articles | Metrics

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Identification of a novel human leukocyte antigen allele A*1155 in a Chinese Han population Zhou Dan 2010, 14 (44):  8241-8244.  doi: 10.3969/j.issn.1673-8225.2010.44.018 Abstract ( 286 )   PDF (314KB) ( 322 )   Save BACKGROUND: Most of novel alleles in China are found due to abnormal reaction patterns in low-resolution human leukocyte antigen (HLA) typing and identified by further gene sequencing or gene cloning. Thus, some novel alleles may be missed. Gene sequencing is considered to be the golden standard for HLA typing, which can obtain exact nucleotide sequence. OBJECTIVE: To detect the samples in Chinese Bone Marrow Bank by gene sequencing typing, and to identify novel allele in Chinese Han population. METHODS: Blood (5 mL) suspected as a new gene were redraw. An unknown HLA-A allele was detected by sequence-based typing (SBT) in a Chinese bone marrow donor. SBT showed that there was 1 difference compared with database in exon 2. Its anomalous patterns suggested the possible presence of either a novel A*03 or a novel A*11. To separate the two alleles and to determine whether the allele was novel, TOPO TA cloning was performed. The sequencing result was compared with known HLA allele sequence. RESULTS AND CONCLUSION: Heterozygous allele was separated by cloning. A novel allele was identified with sequencing. The novel allele was most similar to A*1155 except for one nucleotide exchange in exon 2 at position nt 330 C>G, codon 86 N (AAC)>K (AAG), resulting in amino acid exchange. This allele is a novel HLA-A allele and has been officially named HLA-A*1155 by the Nomenclature Committee of World Health Organization on 31 October 2009. Related Articles | Metrics

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Performance evaluation of human leucocyte antigen-DQA1 genotyping by fabricated low-density Oligonucleotide microarrays: Compared with PCR-SSP method in 100 samples Wang Tong, Wang Tian-jiao, Peng Li, Wang Jie 2010, 14 (44):  8245-8248.  doi: 10.3969/j.issn.1673-8225.2010.44.019 Abstract ( 292 )   PDF (380KB) ( 348 )   Save BACKGROUND: The genotype of human leukocyte antigen (HLA) alleles has important effect on organ transplantation and medicolegal expertise. The presented genotyping can not reach high-flux or integration, without accuracy or repetitiveness. OBJECTIVE: To evaluate the accuracy and reliability of self-fabricated oligoneucleotide array by comparing with polymerase chain reaction with sequence-specific primers (PCR-SSP) in identification of HLA-DQA1 alleles. METHODS: A total of 100 clinical samples were enrolled in the study. HLA-DQA1 genotyping were performed by PCR-SSP and oligoneucleotide array, respectively. A pairs of group-specific primers were designed according to the sequence polymorphism of HLA-DQA1 exon two. The target DNA was asymmetrically amplified with the labeled sense primer. The labeled PCR products were hybridized with the specific allele typing probes immobilized on a glass support, and the signals were scanned by scanner and then analyzed. The discordant samples by arrays and PCR-SSP were verified by sequencing. RESULTS AND CONCLUSION: All 100 samples have been genotyped by oligoneucleotide array and PCR-SSP successfully. The coincidence rate was 94%. Four homozygous samples typed by PCR-SSP were actually heterozygous by array. The other two unidentified samples were typed by sequencing. The results showed that a mistake for one sample was made by PCR-SSP or array. In reproducible tests, the signal reappear rate was 95%. That is, the self-fabricated oligoneucleotide array with ideal stability, specificity and sensitivity, which provide a suitable plateau for HLA-DQA1 genotyping domestically. Related Articles | Metrics

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Identification of a novel allele HLA-B*5145 Ju Rui-qing, Chen Lin, Lin Qian-fei, Yang Fan, Han Yu, Jiao Li-xin, Ren Hai-bo, Ma Xiu-jie 2010, 14 (44):  8249-8252.  doi: 10.3969/j.issn.1673-8225.2010.44.020 Abstract ( 306 )   PDF (375KB) ( 362 )   Save BACKGROUND: When the authors performed classification experiments using human leucocyte antigen reagent (HLA reagent, onelamba company, USA) and imported the HLA data into the analysis software, an abnormal reaction pattern was found at HLA-B locus with normal reactions of negative and positive magnetic beads. Thus, it is suspect that a novel gene existed. OBJECTIVE: To identify a novel HLA-B allele.  METHODS: The blood samples were collected from China Bone Marrow Bank, and screened using PCR-SSO genotyping methods to search possible existed novel allele based on Luminex platform and sequencing-based typing (SBT). RESULTS AND CONCLUSION: PCR-SSO genotyping showed that HLA-A locus genotypes were A*02XX, A*33XX; HLA-DRB1 locus genotypes were DRB1*1202, DRB1*1302, but the pattern of HLA-B locus showed abnormal reaction, which can not identified any HLA-B alleles, HLA tools suggested that “B*44XX, B*53XX; 90FN, 91FP”, using other reagents (Dynal, PCR-SSO) genotyping method to analyze, also showed no result. SBT result indicated the novel allele is the variant of allele HLA-B*5106. It differed from the allele HLA-B*5106 by three nucleotide substitution at position 339 where A→G resulting in a coding change 113 N to D, at position 346 where A→C resulting in a coding change 115 Y to S, but at position 362 where A→G doesn’t result any change in exon 3. The sequence has been designated HLA-B*5145 by the Nomenclature Committee for Factors of the HLA System in World Health Organization in October 2006. Related Articles | Metrics

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Separation of rat hepatocytes using modified collagenase perfusion via the abdominal aorta Yu Song-lin1, Han Bao-san1, Zhang Rui, Du Zhi-yong, Wu Xu-bo, Wu Wei, Wang Jia-xiang, Huang Fang, Li Hong-wei, Shen Bo-yong, Peng Cheng-hong 2010, 14 (44):  8253-8256.  doi: 10.3969/j.issn.1673-8225.2010.44.021 Abstract ( 291 )   PDF (385KB) ( 849 )   Save BACKGROUND: Good separation technique is the basis of harvesting hepatocytes with high viability. At present, two-step collagenase perfusion method via portal vein is extensively used in the world. However, this method has some problems, such as high dose of collagenase, complicated operation, long process and high requirement for the instrument. OBJECTIVE: To investigate a simple effective method of separation and primary culture of rat hepatocytes.  METHODS: A total of 10 Sprague Dawley rats were obtained to harvest hepatocyte by modified perfusion method through the abdominal aorta. Hepatocyte tests were repeated ten times to observe results of each index and to compare with published literatures. SD rats served as hepatocyte donors using Ⅳ type collagenase perfusion via the abdominal aorta. Liver hepatic portal structures, the upper and inferior vena cava of the donors were closed to retain collagenase digestion to obtain hepatocytes. Following filtration through 200-mesh and 300-mesh sieves, the suspension was transferred to a centrifuge tube, and then purified hepatocytes at 1 000, 500, 300 r/min centrifugation about respectively (each 3 minutes). Trypan blue staining was utilized to measure cell viability. The purity and morphology of hepatocytes were observed under the inverted microscope. RESULTS AND CONCLUSION: Hepatocytes obtained by collagenase digestion were pure, intact and have a very good viability. The modified collagenase perfusion through the abdominal aorta was a better method for isolation of hepatocytes. Related Articles | Metrics

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Expression of transforming growth factor beta 1 in regenerated liver tissues following partial hepatectomy in rats Song Hai-yan, Gao Zhi-tao, Liu Heng-xing 2010, 14 (44):  8257-8260.  doi: 10.3969/j.issn.1673-8225.2010.44.022 Abstract ( 410 )   PDF (2100KB) ( 377 )   Save BACKGROUND: The safety of partial hepatectomy depends on the regeneration capacity of residual livers. Thus, it is significant to understand the liver regeneration following partial hepatectomy for patients with cirrhosis. OBJECTIVE: To investigate the expression and significance of transforming growth factor-β1 (TGF-β1) in liver tissue of hepatic cirrhosis after partial hepatectomy in rats. METHODS: The model of hepatic cirrhosis was made in control group and model group, and then partial hepatectomy was deployed as regeneration models. The expressions of TGF-β1 in liver tissues were determined by immunohistochemical methods and Western blotting 12, 24, and 72 hours after partial hepatectomy. RESULTS AND CONCLUSION: There was no significant difference between the model and regeneration groups in the expression of TGF-β1 in liver tissues at 12 and 24 hours after partial hepatectomy (P > 0.05), but the expression of TGF-β1 was notably increased at 72 hours (P < 0.01). The findings demonstrated that the expression of TGF-β1 in liver tissue has no strong increase at the early stage after partial hepatectomy, which can promote liver regeneration mainly from the later stage interacted with other factors. Related Articles | Metrics

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Dorsal petal artery transplantation for finger reconstruction and its anatomic variation Qiu Nan-hai, Zhang Wen-long, Gao Wei, Li Rui-hua, Wang Li, Miao Rui-rui, Li Jian-hua, Yu Ming 2010, 14 (44):  8261-8264.  doi: 10.3969/j.issn.1673-8225.2010.44.023 Abstract ( 290 )   PDF (234KB) ( 341 )   Save BACKGROUND: The second toe and toe-nail flap with dorsal petal artery as blood supply for finger reconstruction have been widely practiced in clinic. However, there is a difficulty in the process of operation since anatomic variation of dorsal petal artery happens to some patients. The second set of blood supply system- the first dorsal metatarsal artery and the second dorsal petal artery- provides a solution to the problem. OBJECTIVE: To explore the clinical significance of free second toe or toe-nail flap transplantation for finger reconstruction and dorsal petal artery variation. METHODS: The free second toe or toe-nail flap transplantation for thumb reconstructon were performed in 15 cases, and the second blood supply system was adopted -the first dorsal metatarsal artery and the second dorsal petal artery. According to the probational standard (2005-3-25) issued by the Chinese Medical Association for surgery of the hand, patients evaluated reconstructed thumb function themselves considering the length, shape, function, and feeling recovery of the thumb. RESULTS AND CONCLUSION: The reconstructed thumbs all survived without complications. All patients were followed up for 5 months to 2 years, and the excellent rate was 93% as the function was well recovered, length was suitable, and recovering feeling was good. Reexamination of the donor foot showed that its outline was still good and patients could reposefully walk without pain. The key to the success of thumb reconstruction is a good job for preoperative preparation, intra-operative non-invasive operation followed by careful observation, familiar with the foot anatomy, especially the dorsal petal artery variation and the anatomy in the second set of blood supply system. Related Articles | Metrics

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Reconstruction of multiple arteries of donor kidney in living related renal transplantation Lai Yan-hua, Sun Xu-yong, Nie Feng, Tan Qing, Dong Jian-hui, Xiao Shu-feng, Huang Ying, Cao Song 2010, 14 (44):  8265-8268.  doi: 10.3969/j.issn.1673-8225.2010.44.024 Abstract ( 267 )   PDF (277KB) ( 361 )   Save BACKGROUND: Artery variations in living related renal transplantation occur frequently, so the methods of renovascular reconstruction should be paid more attention in order to make sure rationality and security of the surgery. In clinic, multiple arteries of the donor kidney are commonly found. Living related renal transplantation is at the early stage in China, and the related experience is few. OBJECTIVE: To discuss application of renovascular reconstruction of multiple arteries during living related donor kidney transplantation. METHODS: A total of 38 cases undergoing living related donor kidney transplantation from January 2006 to December 2008 were analyzed, including 30 cases in single renal artery group and 8 cases in multiple artery group. In multiple artery group, there were 5 cases of double arteries and 2 cases of three arteries and 1 case of four arteries. The multiple arteries were reconstructed by end to side or side to side conjoined anastomosis respectively, and then anastomosed the internal iliac artery or external iliac artery respectively. RESULTS AND CONCLUSION: No blood transfusions were needed and no complications occurred in eight cases of multiple artery donors. The 8 donors were discharged from hospital at 7-10 days postoperatively. Follow-up examinations were for 6-36 months (mean 13 months). Renal tubule necrosis, renal artery embolism, renal pseudoaneurysm, and vascular stenosis, were not found. The color Doppler ultrasound examination showed that the transplanted kidney had good blood supply. There was no significant difference in the time of urine secretion, serum creatinine level between the multiple arteries group and the single artery group (P > 0.05). These indicated that blood vessel reconstruction using a suitable method cannot affect outcomes of renal transplantation. It is feasible to reconstruct blood vessel using recipient’s internal iliac artery and its branches. Related Articles | Metrics

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Clinical characteristics and prognosis of acute rejection in living renal transplantation Zhu Yun-song, Shen Wen, Nie Hai-bo, Zhang Li-chao, Xiao Yuan-song, Liu Jun, Hu Wei-lie, Lü Jun 2010, 14 (44):  8269-8272.  doi: 10.3969/j.issn.1673-8225.2010.44.025 Abstract ( 435 )   PDF (249KB) ( 396 )   Save BACKGROUND: Clinical practice has confirmed that acute rejection is not rare during living renal transplantation. Steroid-resistant-induced rejection commonly occurs, and the clinical manifestation is not typical, so it is easy to do missed diagnosis and misdiagnosis. If severity, it will induce transplantation failure, and affect human/kidney long-term survival rate. OBJECTIVE: To discuss clinical characteristics and prognosis of acute rejection in living renal transplantation METHODS: Clinical date of 168 patients who received cadaver renal transplantation and 192 patients who received living renal transplantation from February 2005 to September 2008 were retrospectively analyzed, including clinical symptoms, complication and therapeutic outcomes. Acute rejection features of living renal transplantation were analyzed. RESULTS AND CONCLUSION: The incidence of acute rejection and corticoid-resistent acute rejection in living and cadaver renal transplantation were 9.8%, 46.2 % and 22.8 %, 57.8% (P < 0.05). The symptoms of fever, hematuria, oliguria, transplanted renal pain and complication of infection, perirenal hematoma were less in acute rejection patients with living renal transplantation. All 19 cases of acute rejection with living renal transplantation were reversal; of 38 cases, 35 cases of acute rejection with cadaver renal transplantation were reversal; 2 cases transplanted renal fracture; 1 case with renal vein thrombus. Clinical analysis has indicated that the incidence of acute rejection and corticoid-resistent acute rejection in living renal transplantation were less than cadaver renal transplantation. Clinical symptoms were light, easy to reversal. But, the incidence of corticoid-resistent acute rejection in living renal transplantation was still high, so we must pay attention to kidney function and clinical symptom, and treated immediately. Related Articles | Metrics

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Superiority analysis of 69 living-related renal transplant recipients in a single center within 2 years Wang Qiang, Li Xiao-li, Cai Ming, Shi Bing-yi, Qian Ye-yong, Li Zhou-li, Xu Liang 2010, 14 (44):  8273-8276.  doi: 10.3969/j.issn.1673-8225.2010.44.026 Abstract ( 229 )   PDF (290KB) ( 322 )   Save BACKGROUND: Living-related renal transplantation is still at the beginning stage in China, and the large sample clinical data are insufficient. Thus, Boao consensus was achieved for the normalization of living-related renal transplantation. OBJECTIVE: To retrospectively analyze the clinical experience of living-related renal transplant recipients in a single center. METHODS: Totally 69 living-related renal transplant recipients at the Organ Transplantation Center, 309 Hospital of Chinese PLA, between January 2006 and March 2008, were retrospectively analyzed, 39 cases were parents donation to the children; 1 was children donation to parents; 19 were sibling donation; 7 cases were three generations of collateral serum; 3 cases of donation happened between husband and wife. 66 cases had the same ABO blood group, 3 cases of which were compatible; there are 5 cases with HLA mismatch, 31 cases of mismatch in 2 points, 32 in one point and 1 in 4 points; 66 persons were admitted for the left kidney and 3 persons for right kidney; 69 cases were all admitted for kidney through open surgery. Rejection was prevented by the use of cyclosporine / Prograf+ Mycophenolate Mofetil / azathioprine + Prednisone. RESULTS AND CONCLUSION: Of 69 living-related renal transplant recipients, none had renal failure after transplantation, and the 1-year survival rate was 100%. The average warm ischemia time was (3.56±1.42) minutes and the average cold ischemia time was (45.12±25.34) minutes: the time when postoperative renal function returned to normal level was (5.6±7.0) days. 9 cases showed rejection at 3 months after surgery, 2 cases showed pulmonary infection, 3 cases had delayed graft function, 1 case got renal artery stenosis, 2 cases with bone marrow suppression, 1with brain root block, and 1 case with urinary fistula. With the rigorous and comprehensive assessment of living renal transplantation, living kidney transplantation has advantages of few complications, fast recovery and low incidence of rejection, is one of the main ways uremic patients take home self-help. Related Articles | Metrics

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Thirty-five kidney transplant recipients after conversion to tacrolimus from ciclosporin A: A one-year follow-up Yang Lei, Guo Juan, Zhu Ming-hui, Miao Shu-zhai, Qu Qing-shan, Guo Kai 2010, 14 (44):  8277-8280.  doi: 10.3969/j.issn.1673-8225.2010.44.027 Abstract ( 528 )   PDF (257KB) ( 603 )   Save BACKGROUND: Since cyclosporine A has been used in clinical, the survival rate of transplanted kidney have been significantly improved, but renal toxicity, hypertension, hyperlipidemia and other adverse reactions subsequently, increased the incidence of rejection. OBJECTIVE: To evaluate the effect of Tacrolimus on renal function, blood fat, and blood pressure of patients following renal transplantation. METHODS: A total of 35 patients with allograft renal transplantation, including 21 males and 14 females, average aging (38.3±22.6) years, were selected from People’s Hospital of Zhengzhou. All received the immunosuppressive regimen of cyclosporine A, mycophenolate mofetil, and prednisone. Transplantation time was 27 (11-53) months, and serum creatinine level was 134.4-232.8 µmol/L. Following one-year following up, blood pressure of 12 patients was up to 140/90 mm Hg (1 mm Hg= 0.133 kPa), 6 patients had hypertrichosis and gingival hyperplasia, and 17 patients had hyperlipoidemia. After stopping taking cyclosporin A, mycophenolate mofetil was adjusted to 750 mg, and administrated twice a day. Two days later, tacrolimus (0.10-0.15 mg/kg) was additionally given. According to serum concentration, the dose was adjusted correspondingly. Serum creatinine (SCr), glomerular filtration rate (GFR), 24-hour urinary protein, blood lipids and other biochemical parameters were monitored, and the adverse drug reactions were observed during the following-up. RESULTS AND CONCLUSION: A total of 32 out of 35 patients finished the one-year following up. Two patients were given cyclosporine A due to diabetes mellitus and moderate alopecia, and one patient was lost during following up. After 1 year, blood pressure of 12 patients was improved remarkably (P < 0.05), and blood fat level of most patients significantly decreased, including the level of 7 patients was normal. Additionally, hypertrichosis and gingival hyperplasia of 6 patients were improved obviously, and diabetes mellitus or aggravation was not checked out after change of dressing. Serum creatinine (SCr) and urea nitrogen clearance ratio of all patients were significantly improved (P < 0.05). This suggested that tacrolimus remarkably improved cardio-cerebral vessel and renal function, and relieved or eliminated adverse effects. Related Articles | Metrics

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Progress of xenotransplantation Zhou Song, Peng Long-kai, Xie Xu-biao, Yu Shao-jie 2010, 14 (44):  8283-8287.  doi: 10.3969/j.issn.1673-8225.2010.44.029 Abstract ( 456 )   PDF (388KB) ( 446 )   Save BACKGROUND: With the constant deepening of the basic research and improving of clinical transplantation technology, organ transplantation has become the preferred treatment for end-stage organ disease. Recently, xenotransplantation has become a hotspot research because of a serious shortage of human donor.  OBJECTIVE: To summarize research of xenotransplantation in the aspects of history, rejection, porcine endogenous retrovirus (PERV) infection and the solving approach. METHODS: Databases of PubMed, SCI, Wangfang and CNKI were searched by the first author with key words of “xenotransplantation, Porcine, rejection and PERV” to search literatures concerning history, rejection, PERV infection and the solving approach of xenotransplantation. The language was limited for Chinese and English.  RESULTS AND CONCLUSION: Most xenotransplantation studies have been done, which showed pig has unique condition as donor source of human organ-transplantation. However, xenotransplantation would appear more complex transplant rejection than homeotransplantation, and the potential threat of PERV infection to humans is indispensable. Selecting suitable porcine species (especially the miniature pig), modifying animals using genetic engineering technology, and developing new antiviral drug, improving detection means, as well as establishing models to research PERV, could drop the possibility of PERV transmission to the lowest. The mechanisms and possible solving methods have been in-depth understood, but the clinical application of xenotransplantation has a long way to go. Related Articles | Metrics

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Diagnosis and treatment of pneumonia after kidney transplantation Zhang Jun 2010, 14 (44):  8288-8292.  doi: 10.3969/j.issn.1673-8225.2010.44.030 Abstract ( 1245 )   PDF (308KB) ( 354 )   Save BACKGROUND: Pulmonary infection is the common complication and main cause of death after renal transplantation. OBJECTIVE: To comprehensively analyze the characteristics, clinical manifestations, diagnosis and treatment of pulmonary infection after renal transplantation. METHODS: A computer-based database online search of PubMed Database was undertaken to identify articles of the characteristics, clinical diagnosis and treatment of pulmonary infection after renal transplantation published in English from 1997 to 2010 with key words of "kidney transplantation, pulmonary infection". Wanfang Database was searched for the same articles published from 2001 to 2010 in Chinese with the key words of “kidney transplantation, pulmonary infection”. The repetitive study was excluded. Finally, 21 articles were included according to inclusion criteria. RESULTS AND CONCLUSION: The clinical symptoms of pulmonary infection in renal transplantation are not identical to that of the common man. The symptoms are not typical. They can be detected by various means, and need to adjust immunosuppressant and regulatory treatment. Pulmonary infection should be prevented and treated with early diagnosis and treatment, drug combination, sufficient dose and full course of treatment. The dose of immunosuppressive drug should be adjusted according to the patients’ body condition and at various periods. Related Articles | Metrics

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Tuberculosis after renal transplantation Xu Chao, Zhang Zhe, Wen Ji-qiu 2010, 14 (44):  8293-8296.  doi: 10.3969/j.issn.1673-8225.2010.44.031 Abstract ( 1171 )   PDF (314KB) ( 398 )   Save BACKGROUND: The lung tuberculosis incidence of the patients after renal transplantation is much higher than the healthy people. The clinical manifestation is atypical, leading to the difficulty of diagnosis and treatment. OBJECTIVE: To summarize the epidemiology, clinical manifestation, early diagnosis, management and precautionary measures of the patients with tuberculosis after renal transplantation. METHODS: Articles about tuberculosis after renal transplantation were retrieved from CNKI, Medline, and Foreign Journals Integration System with the key words of “renal transplantation, tuberculosis, diagnosis, therapy, precautionary” in both Chinese and English from January 2001 to December 2009. Reproductive research and atypical report were excluded. A total of 39 articles were included in the final analysis. RESULTS AND CONCLUSION: The key of early diagnosis depended on chest X-ray, tuberculosis culture, PPD, blood antituberculotic antibody, or PCR combining with clinical manifestation. The empirical treatment was performed for the tuberculosis-suspected patients. Once the diagnosis of tuberculosis was determined, immunosuppressant dosage was adjusted, anti-tuberculosis treatment was decisively performed, and early management with nutrition supply was important for the treatment of patients with tuberculosis after renal transplantation. The proper immunosuppressant dosage would make an empirical treatment to the tuberculosis-suspected patient, and it was also important to decrease the tuberculosis incidence after renal transplantation. Related Articles | Metrics

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Calcineurin inhibitors-induced nephrotoxicity: Early prevention and treatment following renal transplantation Bao Ze-qing, Shi Lei, Zhao Shu-jin 2010, 14 (44):  8297-8302.  doi: 10.3969/j.issn.1673-8225.2010.44.032 Abstract ( 366 )   PDF (460KB) ( 373 )   Save OBJECTIVE: To review the prevention and treatment for calcineurin inhibitors-induced nephrotoxicity. METHODS: Using key words of “Ciclosporine A, Tacrolimus, CNIS drug-induced chronic nephrotoxicity”, documents published between January 1980 and January 2010 in databases of PubMed and CNKI were searched. Totally 44 articles closely related to calcineurin inhibitors-induced nephrotoxicity were reviewed. RESULTS: Ciclosporin and tacrolimus were often employed as immunosuppressants, which notably improve life quality and survival rates of transplant recipients. However, long-term use of calcineurin inhibitors caused a characteristic type of chronic nephrotoxicity after renal transplantation and resulting in a decline of renal function. Currently, it has been confirmed that chronic allograft nephropathy and calcineurin inhibitors-induced nephrotoxicity are the main reasons for graft failure. The calcineurin inhibitors-induced nephrotoxicity plays an important role in natural course of chronic allograft nephropathy. CONCLUSION: There is not an effective method for preventing or treating calcineurin inhibitors-induced nephrotoxicity. Thus, it may be a good choice for preventing calcineurin inhibitors-induced nephrotoxicity by reducing dose or withdraw of calcineurin inhibitors. Related Articles | Metrics

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Factors and control strategies for pulmonary infection following liver transplantation Ding Li-min, Shi Jun 2010, 14 (44):  8303-8306.  doi: 10.3969/j.issn.1673-8225.2010.44.033 Abstract ( 433 )   PDF (321KB) ( 642 )   Save BACKGROUND: Liver transplantation has gained remarkable development, but infection after transplantation is the main reason which threatens the patient’s life. Pulmonary infection is the most common infectious complications after liver transplantation, which is one of the important reasons that cause the death of the patient. OBJECTIVE: Based on the overview of progress regarding the clinical research of pulmonary infection after liver transplantation for the past few years, to provide the clinical advices for further research on treating the pulmonary infection after liver transplantation. METHODS: The databases of SPRINGER (http://springer.lib.tsinghua.edu.cn/home/main.mpx) and CNKI (http://dlib.cnki.net/kns50/) were retrieved by the first author with key words of “liver transplantation, pulmonary infection, treatment” in both Chinese and English from 1995 to 2009. The repetitive studies were excluded. RESULTS AND CONCLUSION: Total 217 articles were gotten by computers according to criteria, 29 articles of which were included in the final analysis. The results demonstrated that, reasonable prevention, early diagnosis and timely treatment of pulmonary infection play an important role in elevating outcomes of liver transplantation. The clinical doctor should modify diagnosis and treatment for patients according to characteristics of pathogenic microorganism epidemiology in local area combine with individuals, more importantly, constitute schemes of prevention and treatment reasonably based on practice medicine conditions. Related Articles | Metrics

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Genetic modified olfactory ensheathing cells for treating spinal cord injury: Possibility to be the first choice Yuan Meng-lang, Guo Jin-hai, Yang Zheng, Zhang Xiao, Zheng Qu 2010, 14 (44):  8307-8310.  doi: 10.3969/j.issn.1673-8225.2010.44.034 Abstract ( 271 )   PDF (277KB) ( 348 )   Save BACKGROUND: Previous studies demonstrated that olfactory ensheathing cells can play its role as target cells to carry target genes; however, this therapy still meets many problems. OBJECTIVE: To review the functions of genetic modified olfactory ensheathing cells, and the problems existing between gene modification and cell expression.  METHODS: Databases of CNKI and PubMed were retrieved using key words of “olfactory ensheathing cells and spinal cord injury” both in Chinese and English. Basic research related treating spinal cord injury using genetic modified olfactory ensheathing cells were included. Repetitive study or unrelated papers were excluded. Totally 29 documents were collected for further study. RESULTS AND CONCLUSION: Olfactory ensheathing cells can secrete a variety of cytokines after spinal cord injury, and form accurately target-specific axonal connections to promote functional recovery. After genetic modification, the olfactory ensheathing cells can express genes efficiently, produce a large number of gene products, affect reconstruction of the microenvironment and growth of neurons at the spinal cord injured region and recover nervous function. These cytokines can antagonize inhibitive factor, protect neuron and accelerate neuronal development, thus, promoting neural regeneration and functional recovery. This article reviews function of different genetical modified olfactory ensheathing cells and existed problems of genetic modification and cell expression. Related Articles | Metrics

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Biological characteristics and research progress of sertoli cells Yu Xiao-hui, Hu Yun-fei 2010, 14 (44):  8311-8314.  doi: 10.3969/j.issn.1673-8225.2010.44.035 Abstract ( 400 )   PDF (341KB) ( 925 )   Save BACKGROUND: Sertoli cell has become one of the research focuses in the fields of cell separation, tissue engineering and organ transplantation, and it has a promising application in clinical transplantation. OBJECTIVE: To summarize the biological characteristics and research progress of sertoli cell at home and abroad. METHODS: Articles addressing sertoli cell were retrieved from CNKI and Pubmed databases with the key words of “immune privilege, transplantation, function, progress of investigate” in both Chinese and English between January 1998 and October 2009. Articles in the same circle published in the authoritative journals or recently published were selected. There were 215 articles after the initial survey, and 34 articles related sertoli cell were included in the final analysis. RESULTS AND CONCLUSION: Sertoli cell has the function of immune privilege and can secrete various nutrition factors. And it is widely drawn by providing new therapy for organ transplantation, Parkinson disease and diabetes mellitus. The research about sertoli cell has achieved a lot and presented an extremely captivating prospect in clinical field. It will make a great contribution to the clinical development of mankind. The clinical application of sertoli cell will be wider along with the development of transplantation of tissue engineering and organ transplantation. Related Articles | Metrics

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Gene therapy for vein graft restenosis Cao Yuan-ping, Liu Ji-chun 2010, 14 (44):  8315-8319.  doi: 10.3969/j.issn.1673-8225.2010.44.036 Abstract ( 281 )   PDF (318KB) ( 372 )   Save BACKGROUND: Vein graft restenosis and occlusion seriously affected postoperative long-term effect of coronary artery bypass grafting, which is the difficult medical problem to be solved at present. OBJECTIVE: To review the therapeutic gene, vectors and transplanted pathway of gene therapy for vein graft restenosis. METHODS: The relevant articles between January 1995 and July 2009 were retrieved from PubMed (http://www.ncbi.nlm.nih.gov/PubMed) and database of Chinese knowledge (CNKI http://ckrd.cnki.net) using key words of “vein graft, gene, therapy”, and restricting the language as English and Chinese by computer. Literatures addressing therapeutic gene, vectors and transplanted pathway of gene therapy for vein graft restenosis were included. Old or duplicated studies were excluded. RESULTS AND CONCLUSION: Vein graft restenosis seriously affected postoperative long-term effect of coronary artery bypass grafting. The traditional drug therapy brings little effect. Gene therapy can precisely target specific gene transfection to vascular wall and achieve the expression of exogenous gene, playing the maximum biological effect in the local, reducing systemic side effects. It is considered as a very promising approach. Gene therapy for vein graft restenosis will be broad prospects for development thank to its unique advantages. With the further study of the mechanism of restenosis and the appearance of safe and efficient vectors, the application of multi-gene therapy, drug therapy and physical therapy combination therapy will be the prevention of vein graft restenosis development. Related Articles | Metrics

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Cavoportal hemitransposition liver transplantation for diffuse portal and superior mesenteric venous thrombosis in one case Zhou Xian-ting, Zhang Cui-sheng, Sun Shi-jieSun Shi-jie, Sun Li-chen, Li Shao-jun 2010, 14 (44):  8320-8322.  doi: 10.3969/j.issn.1673-8225.2010.44.037 Abstract ( 339 )   PDF (244KB) ( 359 )   Save A male patient, 53 years old, suffered from hepatitis B over 20 years and underwent right posterior lobe hepatectomy for primary liver cancer at General Hospital of Chinese PLA, followed by twice liver intervention therapy. On April 28th, 2004, the patient received recurrent tumor resection attached splenectomy and ligation of pericardial vein for hepatic cirrhosis portal hypertension at Yuhuangding Hospital, Qingdao University Medical College. After 14 months, the patient was admitted and received a liver transplantation for recurrent tumor. During operation, diffuse thrombosis was found in portal and mesenteric venous and pathological report of fast frozen section showed organized thrombus. A liver transplantation was performed by applying a cavoportal hemitransposition technique rather than orthotopic liver transplantation. The patient was discharged from hospital after 30 days. After 170 days postoperatively, hemorrhage occurred 5 times successively accompanied with hematemesis, tarry stools and hemorrhagic shock. The patient survived 14 months and died from metastatic carcinoma of the brain and lung. Results show that the modified cavoportal hemitransposition technique and using the donor iliac vein to act as a bridge between the donor portal vein and host superior mesenteric vein in liver transplantation is effective as a salvage measure for preventing hemorrhage of digestive tract. In addition, protocol anticoagulant therapy for preventing portal thrombosis is essential for the patients received splenectomy and ligation of pericardial vein, which provide conditions for liver transplantation and improve life quality of patients. Related Articles | Metrics

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Anterolateral thigh flap transplantation for repair of soft tissue defects in limbs as well as oral and maxillofacial regions Li Yuan-hui, Zhang Guang-ming, Yang Yun-fa, Wang Jian-wei 2010, 14 (44):  8323-8326.  doi: 10.3969/j.issn.1673-8225.2010.44.038 Abstract ( 367 )   PDF (2386KB) ( 397 )   Save BACKGROUND: Massive soft tissue defects of limbs caused by high-energy injuries and oral and maxillofacial soft tissue defects caused by tumor resection are common tissue defects in clinic. Anterolateral thigh flap for repair of these defects can cover wound surface without bad effects on the flap donor site. OBJECTIVE: To summarize and analyze the clinical effects and treating experience of free anterolateral thigh flap in repairing soft tissue defects in limbs and the oral and maxillofacial regions. METHODS: Forty-one cases of soft tissue defects in limbs and oral and maxillofacial regions caused by injuries or tumor resection were collected. The size of soft tissue defects ranged from 12 cm to 25 cm in length and 5 cm to 11 cm in width. According to the size and shapes of soft tissue defects, the anterolateral thigh flaps were designed, followed by arteriovenousanstomosis between the flap and defects. The survival situation of anterolateral thigh flaps, healing condition, function restoration and patents’ satisfaction were all observed. RESULTS AND CONCLUSION: All flaps survived. Among them, vascular crisis occurred in 2 flaps, as black silts appeared in flaps within 24 to 36 hours after operation. Vascular detection found that both flaps were presented with vein thrombosis, and eventually survived following timely thrombolysis. Forty-one cases were all found successfully covering the wound surface after a follow-up of 4 months to 3 years. Two patients with bloated flaps were satisfied after featheredge surgery. Free anterolateral thigh flap is safe and reliable for repairing limbs defects as well as oral and maxillofacial soft tissue defects, especially for some large-size skin mucocutaneous defects, since its vessels are invariable with heavycalibre and large dermatomic area. Related Articles | Metrics

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Short and mid-term results of vacularized iliac crest graft for femoral head necrosis with sickle cell disease in juvenile patients Wu Hao, Liang Yuan, Hernigou Philippe 2010, 14 (44):  8327-8330.  doi: 10.3969/j.issn.1673-8225.2010.44.039 Abstract ( 285 )   PDF (2086KB) ( 475 )   Save BACKGROUND: Sickle cell disease is the main reason for the ischemic necrosis of the femoral head in African juvenile patients. There are more reports concerning vascularized iliac graft for femoral head necrosis. It is also effective for the treatment of femoral head necrosis with sickle cell disease. OBJECTIVE: To investigate the short and mid-term results of the vacularized iliac graft for ischemic necrosis of the femoral head in young patients with sickle cell disease. METHODS: Totally 12 patients suffered from ischemic necrosis of the femoral head with sickle cell disease were treated with vascularized iliac graft in Maradi Province Hospital of Niger. The patients were followed up 24-30 months after operation (mean 27 months). The effects were evaluated on the basis of the Harris hip score and radiological examination. RESULTS AND CONCLUSION: The clinical results were satisfactory though the radiological was not satisfied. The mean Harris hip score increased from 75 points to 90 points. Pain relief and hip function improvement were achieved in all patients. No patients needed revision during short and mid-term follow up. This method is recommendation for treatment of ischemic necrosis of the femoral head in the Ficat Stages Ⅲ-Ⅳ in juvenile patients with sickle cell disease for pain relief and restoration of hip joint function. Related Articles | Metrics

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Reconstruction of coracoclavicular ligament with allogenic tendon for treating dislocation of acromino-clavicular joint and distal clavicular fracture in 23 cases Sun He, Zhang Yi-long, Li Zhe, Sun Bo 2010, 14 (44):  8331-8334.  doi: 10.3969/j.issn.1673-8225.2010.44.040 Abstract ( 376 )   PDF (228KB) ( 318 )   Save BACKGROUND: Clinical studies demonstrated that allogenic tendon can not result in systemic immunological reaction following sterilization and profound hypothermia, and the local reaction is also slightly, thus, it has no obviously difference in treating knee ligaments injuries using allogenic or autologous tendons. OBJECTIVE: To evaluate the effects on clinical application coracoclavicular ligament with allogenic tendon for treating dislocation of acromino-clavicular joint and distal clavicular fracture. METHODS: Totally 23 patients, including 17 males and 6 females, aged 19-45 years, mean aged 30.4 years were selected. There were 18 cases with Tossy-Ⅲ acromino-clavicular joint dislocation and 5 cases with Neer-Ⅱdistal clavicular fracture. Fifteen patients at right sides and 8 at left sides, all of them were fresh dislocation or fracture. One patient suffered from acromino-clavicular joint dislocation combined with brachial plexus strain injury. The trapezoid ligament and conoid ligament were reconstructed using allogenic tendon through 2 drilled hole within the clavicular distal end and inferior part of coracoid process.  RESULTS AND CONCLUSION: All patients were followed up from 12 to 26 months, with an average of 16.5 months. All the incisions were healed primarily, and the union of distal claviclar fracture of 5 cases took place and healed within 4 months without malunion. There were 19 cases excellent and 4 cases good according to the criterion of Karlsson. No biocompatibility, systematic or local immunological reaction occurred. The reconstruction of the coracoclavicular ligament with allogenic tendon is characterized by simple operation, minimal trauma and satisfactory results. Related Articles | Metrics

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Curative effects of transplantation of micro-skin floating versus skin pulping for patients with extremely severe burn Zhang Ming-zhu, Zhou Gui-fen, Dong Yun-feng, Qi Chang-chun, Zhao Zhi-wei, Guo Zhen-cun, Dong Li-kun, Li Xing-hua, Dong Lai-cheng, Pei Yin-hui 2010, 14 (44):  8335-8338.  doi: 10.3969/j.issn.1673-8225.2010.44.041 Abstract ( 260 )   PDF (393KB) ( 409 )   Save BACKGROUND: It has already become being close to the style restoring classical skill to adopt the method of floating to transplant tautologies micro-skin during the past 30 years, and has got the fine clinical curative effect. But by means of skin pulping auto-epithelium grafting has also got fairly good clinical effect. However, the effect of these two treatment methods of the comparative study has not been reported. OBJECTIVE: To observe the clinical effects of the skin pulping auto-epithelium grafting and do a compare of clinical effects with the routine skill of antilogous micro-skin floating transplantation. METHODS: A total of 72 severe burn patients were recruited. In each patient, 2 symmetrical spots of Ⅲ-degree burn post-escharectomy were selected and were divided equally into micro-skin floating group and skin pulping ones. The skin pulping group was transplanted by skin pulping, while the micro-skin floating group by floating. Wound healing rates of every section were analyzed at the end of 3, 4 and 5 weeks after micro-skin transplantation by grid counting. RESULTS AND CONCLUSION: The recovery rates of the first two sections with expansion ratio less than 12.5: 1 were similar at the end of 3, 4 and 5 weeks after transplantation (P > 0.05), but the ones of the later two sections (greater than 12.6: 1) were different, and the micro-skin floating group were obviously better then the skin pulping one at the same times (P < 0.05 or P < 0.01). Whether it was necessary to select the method of micro-skin floating depends on the condition that the expansion ratio was lager than 12.5: 1. Related Articles | Metrics

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Collection of greater sapheous vein for coronary bypass grafting: Multiple interrupted incisions versus a single incision Wei Yu-tao, Chen Xin-zhong, Dong Nian-guo, Zhu Jia-long, Luo Bo, Hou Liang 2010, 14 (44):  8339-8342.  doi: 10.3969/j.issn.1673-8225.2010.44.042 Abstract ( 387 )   PDF (437KB) ( 315 )   Save BACKGROUND: The greater saphenous vein is common used as bypass grafts during coronary bypass grafting, but it is hard to collect. OBJECTIVE: To investigate advantages and disadvantages between multiple interrupted incisions and traditional single incision in harvesting the greater saphenous vein. METHODS: Harvesting time of great saphenous vein, total incision length, suture time, total operation time and incidence of the post operative wound complications were observed in 258 coronary artery bypass grafting patients, who underwent great saphenous vein harvesting by either multiple interrupted incisions (n=112) or traditional single incision (n=146) . RESULTS AND CONCLUSIONS: Harvesting time of great saphenous vein by using the interrupted incision was significant longer than that using traditional single incision (P < 0.05). However, suture time of the interrupted incision group was shorter than those in the traditional single incision group (P < 0.01). There was no difference between two groups in total operation time (P > 0.05). Complication rate in 12 days after the operation of the leg wound in interrupted incision group was significantly less than that in the traditional single incision group (P < 0.01). Complication rate of the traditional single group for patients with diabetes was significantly higher than that in the interrupted incision group (P < 0.01). Interrupted incisions significantly reduced incidence of leg complications, especially for patients with diabetes and complicated coronary heart disease, although it increased harvesting time of the great saphenous vein. Related Articles | Metrics

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Subperitoneal embedding of autologous cranial valve with periosteum for repair of cranial defects in 100 cases Zhang Xiao-jian 2010, 14 (44):  8343-8346.  doi: 10.3969/j.issn.1673-8225.2010.44.043 Abstract ( 327 )   PDF (354KB) ( 524 )   Save BACKGROUND: Cranial defects need decompressive craniectomy owing to severe craniocerebral injury or spontaneous cerebral hemorrhage. Cranioplasty is generally necessary at 3-9 months after first surgery. Autologous cranial bone, as an ideal repair material, has aroused wide attention from neurosurgeons.  OBJECTIVE: After 3-9 months of subperitoneal embedding, autologous cranial valves with periosteum were taken out for repair of cranial bone defects. Cranial valves were observed in terms of size and shape as well as periosteal changes. METHODS: In totally 100 severe cranial injury patients presenting with severe cerebral hemorrhage, brain herniation and high intracranial pressure after hematoma removal needed decompressive craniectomy and were included in this study. Craniotomy was performed with intact periosteum left. The mid/upper left quadrant abdominal skin was dissected to expose the superficial fascia. The convex surface of cranial valve was made close to the subcutaneous fat, followed by incision suture. Autologous cranial valves with periosteum were taken out after 3-9 months. Prior to and after preservation, the length, width, thickness, and diagonal length of cranial valves with periosteum were measured. RESULTS AND CONCLUSION: 6-year clinical observation revealed that 72 cases of cranial valves were preserved for 3-4 months, showing sharp valve edge, without absorption or shrank cranial valve, bright red, soft, slightly thickened periosteum; 1 case of cranial valve was preserved for 9 months, showing blunt valve edge, obvious absorption, markedly reduced valve, light-colored periosteum, obvious osseous hyperplasia; the cranial valves of other cases showed phenomena between these two. These findings demonstrate that subperitoneal preservation of autologous cranial valve with periosteum can maintain the size, shape, and activity of cranial bone. Related Articles | Metrics

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Anti-inducible costimulator immunotherapy inhibits accelerated and chronic cardiac allograft rejections in rats Sun Zhi-peng, Aminbuhe, Zhu Bin, Gong Ke, Zhang Neng-wei 2010, 14 (44):  8347-8351.  doi: 10.3969/j.issn.1673-8225.2010.44.044 Abstract ( 348 )   PDF (488KB) ( 389 )   Save BACKGROUND: In a DA (RT1a) to LEW (RT1l) rat model, inhibition of B7-CD28 co-stimulatory signal blockade by adenovirus-mediated cytotoxic T-lymphocyte-associated antigen 4 immunoglobulin (AdCTLA-4Ig) induces long-term acceptance of cardiac allografts. However, allograft tolerance is incomplete and rejection eventually occurs. In particular, donor-type skin grafting to recipients with functional cardiac allografts causes accelerated heart rejection.  OBJECTIVE: To evaluate the combined effects of inducible co-stimulator (ICOS) therapy and AdCTLA-4Ig treatment on preventing accelerated cardiac rejection caused by donor-strain skin grafting and validate that ICOS therapy can block accelerated cardiac rejection, no matter with or without AdCTLA-4Ig treatment. METHODS: DA hearts were transplanted into the abdominal cavity of LEW recipients. The recipients intravenously received a single dose of 109 plaque-forming units of AdCTLA-4Ig immediately after transplantation. Recipients with grafts surviving > 50 days were given a full-thickness donor-type skin graft to the lateral thoracic wall. These recipients received intravenous injection of anti-ICOS antibody (1 mg/kg) or control IgG from the 50th day, once every other day, for 2 weeks. Complete graft rejection was defined as cessation of beating and was histologically confirmed by mononuclear cell infiltration and cardiac myocyte necrosis using hematoxylin and eosin staining of graft sections. RESULTS AND CONCLUSION: Cardiac sections of AdCTLA-4Ig-treated recipients surviving > 100 days showed typical ICOS-positive mononuclear cell infiltration and vasculopathy. AdCTLA-4Ig treatment combined with anti-ICOS therapy induced stable tolerance to chronic rejection. Anti-ICOS therapy significantly reduced ICOS-positive inflammatory cell infiltration, and prevented accelerated cardiac graft rejection following secondary skin grafting. These findings identify a critical role of ICOS in chronic and accelerated cardiac allograft rejection and suggest a novel approach to prevent chronic rejection of vascularized organ allografts. Related Articles | Metrics

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Donor antigenic specificity CD4+CD25+Treg cells prolong the survival of allograft kidney in rats Li Jian, Xu Ya-hong, Ma Xiao-ping, Gu Xin-wei, Zhang Gen-fu, Huang Chi-bing 2010, 14 (44):  8352-8356.  doi: 10.3969/j.issn.1673-8225.2010.44.045 Abstract ( 255 )   PDF (568KB) ( 375 )   Save BACKGROUND: the development of magnetic separation technique, it is feasibility to in vitro sort and amplify CD4+CD25+Treg cells for transplantation; however, the application dosage and immune tolerance have been less reported yet. OBJECTIVE: To investigate dose-effect relationship of CD4+CD25+Treg cells during allograft transplantation. METHODS: SD rats which were considered as the donors and Wistar rats as receptors were used to establish allograft kidney transplantation models. CD4+CD25+Treg cells were separated from splenic cells of Wistar rats and induced phenotype of donor antigenic specificity in vitro. According to the quantities of CD4+CD25+Treg cells injecting through tail vein during the operation of allograft kidney transplantation, models were rolled into four experiment groups: group 1 (2×105), group 2 (5×105), group 3 (1×106), and group 4 (2×106). The models out injection were considered as controls. Survival status of kidney was detected at day 15 postoperatively; creatinine level and pathological changes were detected at days 4, 9 and 15 according to Banff Schema diagnostic standard; semi-quantitative scores were measured Watanabe technique. RESULTS AND CONCLUSION: The death rate was the highest in control group (83.3%), and then group 1 (66.7%), group 4 (58.3%), and group 2 (33.3%); but rats in the group 3 were all survival. Creatinine level in experimental groups was significantly less than control group at days 4, 9, and 15 postoperatively (P < 0.05, P < 0.01); the creatinine levels in the group 1 and group 2 were significantly greater than in the group 3 and group 4 at days 9 and 15 postoperatively (P < 0.05). Semi-quantitative scores demonstrated that there was no significant difference between group 2 and group 1; but the scores in the group 3 and group 4 were significantly greater than control group (P < 0.05). The results indicated that CD4+CD25+Treg cells could improve kidney function following transplantation, and prolong survival time of transplanted kidney. The 1×106 was the best dosage for application. Related Articles | Metrics

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Orthotopic liver transplantation for primary hepatic cancer Zhang Kun, Jiang Yi, Lü Li-zhi, Zhang Xiao-jin, Yang Fang, Chen Yong-biao, Cai Qiu-cheng, Pan Fan 2010, 14 (44):  8357-8360.  doi: 10.3969/j.issn.1673-8225.2010.44.046 Abstract ( 378 )   PDF (240KB) ( 440 )   Save BACKGROUND: The affected liver can be completely removed by liver transplantation, long-term efficacy is superior to liver resection, the 5-year survival rate reaches 70% H1. In addition, liver transplantation can avoid a serious risk for incomplete liver function caused by hepatic resection in the case of liver dysfunction. OBJECTIVE: To retrospectively analyze the treatment effects and importance of orthotopic liver transplantation for primary hepatic cancer patients. METHODS: A total of 75 patients with primary hepatic cancer treated by orthotopic liver transplantation in Department of Hepatobiliary Surgery, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from March 1980 to December 2008 were involved in the analysis for the postoperative survival rates and recurrence of tumors. RESULTS AND CONCLUSION: For all the patients, the total postoperative survival rate in the 1st, 2nd and 3rd year was 86.6%, 66.7% and 53.3% respectively, the disease free survival rate was 65.2%, 53.9%, 34.1%. Their mean survival time is 25 months. For the patients in line with Milan standard, the postoperative survival rate in the 1st, 2nd and 3rd year was 88.4%, 72.5% and 57.9% respectively, the disease free survival rate was 77.6%, 62.3%, 51.8%. Their mean survival time is 39 months. Tumor recurrence occurred within one year in all six patients who were beyond Milan standard. Two patients died in one year after operation, the survival rate at postoperative one year was 66.7% and the remanent four patients all died in the 2nd year after operation. Orthotopic liver transplantation was one of the effective treatments for primary hepatic cancer patients. The patients which were measured up to Milan standard would have the best curative effects. References | Related Articles | Metrics