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29 January 2013, Volume 17 Issue 5 Previous Issue    Next Issue

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Autologous pericardium patch repairs the aortic annulus to assist aortic valve replacement Xia Bing, Wen Bing, Xu Hua-shan, Fu Guo-wei, Zhao Wen-zeng 2013, 17 (5):  761-768.  doi: 10.3969/j.issn.2095-4344.2013.05.001 Abstract ( 775 )   PDF (601KB) ( 723 )   Save BACKGROUND: Annulus calcification and paravalvular cysts often appear during aortic valve replacement. At this time, special techniques are generally used to assist the aortic valve replacement. OBJECTIVE: To investigate the clinical feasibility of pericardium patch repaired aortic annulus to assist aortic valve replacement for the treatment of calcific aortic stenosis complicated by annulus calcification. METHODS: Forty two patients with calcific aortic stenosis complicated by annulus calcification were selected from the First Affiliated Hospital of Zhengzhou University during January 2009 and January 2012. Their clinical data were retrospectively analyzed. The effective orifice area index of aortic valve, maximum transvalvular pressure gradient, peak blood flow velocity and left ventricular ejection fraction were analyzed with statistical software before and after pericardium patch repaired aortic annulus assisted aortic valve replacement, and then the effect of autologous pericardium patch repaired aortic annulus to assist aortic valve replacement was analyzed. RESULTS AND CONLUSION: There was no intraoperative death during the pericardium patch repaired aortic annulus assisted aortic valve replacement. The intraoperative aortic clamping time was 52-88 (63.0±18.1) minutes, and the cardiopulmonary bypass time was 78-122 (102.6±25.1) minutes. One patient appeared acute renal failure after replacement, and cured after the bedside hemodialysis treatment. The rest patients had no serious complications. The length of hospital stay was 7-20 (13.6±5.5) days. The postoperative Doppler echocardiography showed the heart valve prosthesis was good, and no paravalvular leaks were found. The orifice area index of aortic valve, maximum transvalvular pressure gradient, peak blood flow velocity and left ventricular ejection fraction were significantly improved at 6 months after replacement, and the differences were significant when compared with those before replacement (P < 0.05). In patients with appropriate surgical indications, the autologous pericardium patch repaired aortic annulus assisted aortic valve replacement surgery can achieve satisfactory effects, and the operation is safe and simple, which is considered as a practicable technology. Figures and Tables | References | Related Articles | Metrics

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DNA extraction from the spleen in human leukocyte antigen matching Li Hai-bin, Guo Hai-ge, Cai Wen-e, Qin Yin-hong, Sun Xu-yong 2013, 17 (5):  769-776.  doi: 10.3969/j.issn.2095-4344.2013.05.002 Abstract ( 468 )   PDF (492KB) ( 616 )   Save BACKGROUND: Whether human leukocyte antigen matching results are accurate or not may directly affect the pairing choice between the donors and recipients. Moreover, the quality of the matching samples may influence the pros and cons of the results.  OBJECTIVE: To establish an experimental technology platform for DNA extraction from the spleen in human leukocyte antigen matching.  METHODS: Lymphocytes were isolated and DNA was extracted from the spleen for the human leukocyte antigen matching, compared with DNA extracted from the whole blood which was normal peripheral blood or hematolytic sample.   RESULTS AND CONCLUSION: Intact electrophoretogram of DNA extracted from the spleen and normal peripheral blood was obtained after amplification and electrophoresis, and the electrophoretogram of DNA extracted from spleen was clearer than that extracted from the normal peripheral blood. However, the intact electrophoretogram of DNA extracted from hematolytic sample was not obtained. An experimental technology platform for DNA extraction from the spleen in human leukocyte antigen matching has been successfully established. Figures and Tables | References | Related Articles | Metrics

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Application of mycophenolate mofetil combined with low-dose tacrolimus and corticosteroid regimen after renal transplantation Ji Shu-ming1, Chen Jiang-hua2, Tan Jian-ming3, Zhang Xiao-dong4, Zhu Tong-yu5, Chen Li-zhong 2013, 17 (5):  777-784.  doi: 10.3969/j.issn.2095-4344.2013.05.003 Abstract ( 520 )   PDF (336KB) ( 849 )   Save BACKGROUND: Sufficient dose of mycophenolate mofetil combined with low-dose tacrolimus and corticosteroid regimen may be an ideal treatment option for renal transplant recipients, and the regimen has been widely used in clinic due to its low nephrotoxicity, few adverse reactions and strong immunosuppressive effects. OBJECTIVE: To investigate the efficacy and safety of mycophenolate mofetil combined with low-dose tacrolimus and corticosteroid regimen in renal transplantation patients with the control of mycophenolate mofetil combined with standard-dose tacrolimus and corticosteroid.  METHODS: A total of 210 patients receiving a single-organ renal allograft were randomly divided into standard-dose tacrolimus group (n=104) and low-dose tacrolimus group (n=106). Individual patients were treated for 12 months. The primary efficacy endpoints were the chronic allograft damage index and glomerular filtration rate at 12 months after transplantation. The secondary efficacy end points mainly included the acute rejection rate, treatment failure rate, and the survival rate of patient and transplant kidney. The safety parameters such as new onset of post-transplantation diabetes mellitus, hypertension and hyperlipidemia were also evaluated.  RESULTS AND CONCLUSION: The vast majorities of patients were administrated with sufficient dose of mycophenolate mofetil (1.5 g/d or above) in two groups. The majority of the patients in standard-dose tacrolimus group had the mean trough level below the protocol-defined, which led to the similar mean trough level between standard-dose and low-dose tacrolimus group. These could also confirm that the regimen of mycophenolate mofetil combined with low-dose tacrolimus and corticosteroid had been wildly accepted and used by clinicians. The efficacy and safety of two groups were similar. The mean chronic allograft damage index of the renal pathological changes at 12 months after transplantation in standard-dose and low-dose tacrolimus group were 1.82 and 2.13 respectively (P=0.081 3), the mean glomerular filtration rates were 77.08 mL/min and 80.12 mL/min (P=0.794 9), acute rejection rates were 2.6% and 5.2% (P=0.681 2), and the survival rates of patients and transplant kidney were 100% and 99.1% (P=1.000 0). The rates of new onset of post-transplantation diabetes mellitus in the standard-dose and low-dose tacrolimus group were 2.9% and 1.9%, and the rates of hyperlipidemia were 2.9% and 3.8%, respectively. For the regimen of mycophenolate mofetil combined with tacrolimus and corticosteroid, the utilization of sufficient dose of mycophenolate mofetil could reduce the dose of tacrolimus, thereby significantly reducing the nephrotoxicity, hyperlipidemia and new onset of post-transplantation diabetes mellitus caused by tacrolimus and achieving a good balance of efficacy and toxicity when maintaining a strong immune inhibition and reducing the acute rejection incidence successfully. Figures and Tables | References | Related Articles | Metrics

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Kidney allograft biopsy: Pathological and histological values in early diagnosis Han Yong, Guo Hui, Cai Ming, Xu Xiao-guang, Huang Hai-yan, Xu Yan-jie, Wang Qiang, Feng Kai, Shi Bing-yi 2013, 17 (5):  785-790.  doi: 10.3969/j.issn.2095-4344.2013.05.004 Abstract ( 481 )   PDF (379KB) ( 649 )   Save BACKGROUND: The kidney allograft biopsy has great pathological and histological significance in the early diagnosis. However, the retrospective study of clinical diagnosis and treatment is rare.  OBJECTIVE: To observe the effect of clinical treatments selected according to the pathological diagnosis which obtained through the wellness puncture biopsy on insufficiency renal allograft, and to identify the security and significance of grafted renal puncture biopsy in the clinical treatment. 　 METHODS: 202 patients with renal transplantation were selected from the Organ Transplant Center, the 309th Hospital of Chinese PLA. Among them, 80 patients with delayed recovery of kidney function after kidney transplantation and 122 patients were found increasing creatinine content without explanation. With the guidance of B-ultrasound, a puncture needle was used to perform the kidney allograft biopsy, and the biopsy specimens were stained and histopathologically by observed for the corresponding clinical treatment. RESULTS AND CONCLUSION: All the patients were well accepted by biopsy, except three patients (1.5%) were difficult to be diagnosed because of less tissue. Twelve patients (5.9%) had normal graft kidney, 28 patients (13.9%) suffered from ischemia/reperfusion injury combined with acute tubular necrosis, 22 patients (10.9%) appeared with mild acute toxic injury caused by calcium calcineurin inhibitor immunosuppressive drugs, 12 patients (5.9%) had mild chronic toxic injury caused by calcium calcineurin inhibitor immunosuppressive drugs, one patient (0.5%) appeared with hyperacute rejection, 29 patients (14.4%) were doubted with acute rejection, 34 patients (16.8%) suffered with acute T-cell rejection, 10 patients (9.4%) appeared with acute antibody-mediated rejection, 16 patients (7.9%) appeared with chronic T cell-mediated rejection, 12 patients (5.9%) suffered from chronic T cell-mediated rejection combined with acute T cell-mediated rejection, three patients (1.5%) displayed chronic antibody-mediated rejection, four patients (2.0%) showed hypertension and related factors, two patients (1.0%) suffered from interstitial fibrosis and tubular atrophy without specific risk factors caused lesions, two patients (1.0%) presented with ischemic necrosis, three patients (1.5%) presented with nephropathy recurrence after transplantation and 23 patients were positive for C4d immunohistochemical staining. No adverse reaction was found in the patients or in the graft kidney. Figures and Tables | References | Related Articles | Metrics

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Novel mutations of the cytochrome P450 3A4 gene in Chinese renal transplant recipients Shi Lei, He Bao-xia, Zeng Xiao-hui, Zhu Yun-song, Zhang Hong-bin, Bao Ze-qing, Zhao Shu-jin 2013, 17 (5):  791-796.  doi: 10.3969/j.issn.2095-4344.2013.05.005 Abstract ( 292 )   PDF (372KB) ( 726 )   Save BACKGROUND: Cyclosporine A is metabolized mainly by cytochrome P450 3A4 (CYP3A4). Previous studies have suggested that genetic polymorphisms of CYP3A4 have an effect on the pharmacokinetics of cyclosporine A. Moreover, cyclosporine A -related chronic nephrotoxicity is caused by long-term exposure to cyclosporine A. It is conceivable that genetic polymorphisms of CYP3A4 may be responsible for the cyclosporine A-related chronic nephrotoxicity in renal transplant recipients. OBJECTIVE: To analyze the relationship between CYP3A4 gene polymorphism and cyclosporine A- related chronic nephrotoxicity. METHODS: A total of 200 patients (105 diagnosed as having cyclosporine A-related chronic renal toxicity through renal biopsy and (or) serum creatinine values change and 95 without nephrotoxicity) undergoing cyclosporine A therapy participated in this study. Peripheral venous blood samples were collected and genomic DNA was extracted. Mutations in exons 5, 7, 9, and 12 of the CYP3A4 gene were screened by PCR and direct DNA sequencing. RESULTS AND CONCLUSION: Three novel mutations of CYP3A4 gene were discovered in this study, namely 336 A>G, 837 G>A and 406 A>C. The novel mutation 336 A>G was detected in three renal transplant recipients and 837 G>A was detected in eight recipients. Importantly, the novel mutation at 406A>C was detected only in three patients with cyclosporine A nephrotoxicity, and the novel mutation 406 A>C could result in the changes from 136 Threonine in the conserved region of CYP3A4 gene to phenylalanine. However, the known polymorphisms of exons 5, 7, 9, and 12 of the CYP3A4 gene were not detected in Chinese population. Three novel mutations at 336 A>G, 837 G>A and 406 A>C were detected in CYP3A4 gene in Chinese renal transplant recipients. The novel mutation at 406 A>C was predicted to change the enzyme activity of CYP3A4 enzyme. Figures and Tables | References | Related Articles | Metrics

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Investigation in women of childbearing age after renal transplantation: Menstruation, sexual life and birth condition Zuo Fu-jie, Han Shu, Wang Li-ming, Min Min, Feng Xiao-fang, Zhou Mei-sheng, Li Qun 2013, 17 (5):  797-804.  doi: 10.3969/j.issn.2095-4344.2013.05.006 Abstract ( 1129 )   PDF (341KB) ( 794 )   Save BACKGROUND: Theoretically, successful renal transplantation can normalize the menstruation and significantly improve the sexual life of women of childbearing age, and these women can give birth after renal transplantation, but the related domestic reports are rare. OBJECTIVE: To investigate the menstruation, sexual life and birth condition of fertility age women with different ages and to explore the affecting factors through the homemade questionnaire of menstruation, sexual life and birth condition in women of childbearing age after renal transplantation combined with the quality of life scale and female sexual function index scale. METHODS: Sixty-eight women of childbearing age who were treated with renal transplantation in the Changzheng Hospital were selected from January 2006 to December 2011. The patients were divided into young group (n=41) and middle aged group (n=27) on the basis of the age, and then the patients in the two groups received the outpatient and telephone follow-up with a homemade questionnaire of menstruation, sexual life and birth condition questionnaire in women of childbearing age after renal transplantation combined with the quality of life scale and female sexual function index scale. The menstruation, sexual life and birth condition of the patients in two groups were observed at 3 years after transplantation and during the blood dialysis stage.  RESULTS AND CONCLUSION: For the menstruation of patients, 54 cases (38 cases in the young group and 16 cases in the middle aged group) were improved at (3.46±1.23) months after transplantation; 11 cases (three cases in the young group and eight cases in the middle aged group) were improved not obviously; and three cases (0 case in the young group and three cases in the middle aged group) suffered deterioration before blood dialysis, and due to the excessive menstrual volume, two cases received curettage surgery and one case received hysteroscopy hemostatic surgery. For the sexual life of the patients, 45 cases (34 cases in the young group and 11 cases in the middle aged group) were improved at (3.43±1.27) months after transplantation; 11 cases (two cases in the young group and nine cases in the middle aged group) were improved not obviously; 12 cases (five cases in the young group and seven cases in the middle aged group) without sexual life after transplantation. For the birth condition of the patients, there were seven cases of pregnancy (five cases in the young group and two cases in the middle aged group) at (30.24±7.86) months after transplantation, and two cases in the young group had children successfully and the other five cases of abortion. The MOS 36-item short-form health survey before and after transplantation showed that the physical function, bodily pain, general health and vitality field score were significantly increased compared with those before transplantation (P < 0.05), and there were no significant differences in emotional function, mental health and social function score before and after transplantations (P > 0.05). Comparison of the female sexual function index before and after transplantation showed that the scores on sexual desire, sexual excitement, vaginal lubrication, orgasm and satisfaction were increased after transplantation; while the pain score was decreased, and the differences were statistically significant (P < 0.05). The results showed that the menstruation and sexual life of the older recipients were not improved obviously, but the pregnancy of the female recipients was feasible and safe under the strict monitoring and control according to the standard seriously conception. Figures and Tables | References | Related Articles | Metrics

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Bortezomib combined with rituximab and plasmapheresis for the treatment of highly sensitized renal transplant candidates Hu Jian-min, Zhao Ming, Li Min, Guo Ying, Chen Hua, Liu Yong-guang 2013, 17 (5):  805-810.  doi: 10.3969/j.issn.2095-4344.2013.05.007 Abstract ( 589 )   PDF (430KB) ( 570 )   Save BACKGROUND: Highly sensitized is the barrier to successful renal transplantation. At present, the renal transplant desensitization treatment methods include the intravenous immunoglobulin, plasmapheresis and rabbit anti-human lymphocyte globulin, but the treatment effect is often unsatisfied. OBJECTIVE: To perform the desensitization treatment through bortezomib and rituximab in order to find a treatment regimen with satisfactory results. METHODS: One highly sensitized renal transplant candidate was selected to receive triple desensitization treatment. After plasmapheresis treatment, intravenous infusion of 500 mg rituximab was performed immediately. After infusion for 2 days, 1.3 mg/m2 bortezomib was injected at 1, 4, 8 and 11 days. The panel reactive antibody was observed during follow-up. RESULTS AND CONCLUSION: During a nine-month follow-up period, cytotoxic panel reactive antibody decreased from 92% to17%. The patient represented no adverse effects. Our initial experience suggests that triple desensitization treatment of plasmapheresis, rituximab and bortezomib was effective to reduce circulating antibodies against human leucocyte antigen. Bortezomib may be useful in desensitization protocols. Figures and Tables | References | Related Articles | Metrics

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Immune function monitoring for rejection and infection after renal transplantation Wang Qing-hua, Shang Le-le, Chen Tai-chun, Wang Jin, Tang Min-ying, Wu Lin, Tan Jian-ming 2013, 17 (5):  811-816.  doi: 10.3969/j.issn.2095-4344.2013.05.008 Abstract ( 515 )   PDF (378KB) ( 643 )   Save BACKGROUND: Cylex ImmuKnow is the first and only U S Food and Drug Administration-cleared blood test to measure immune cell function, it can reflect the immune function of the cells directly, which is a valuable tool with good qualities of high sensitivity and specificity. OBJECTIVE: To investigate the correlation between immune cell function and the rejection and infection after renal transplantation through monitoring of immune function intracellular adenosine triphosphatei value. METHODS: We collected 140 renal transplant patients. The immune cell function levels were measured by ImmuKnowTM-Cylex®. The patients were divided into three groups according to clinical status of patients, namely, rejection group (n=18), infection group (n=35) and stability group (n=87). In addition, the cellular immune function data in the blood of 61 samples from healthy people were collected as control group. Then the correlation of the immune cell function and infection to rejection after renal transplantation was analyzed. RESULTS AND CONCLUSION: The measurement of intracellular adenosine triphosphatei value showed that about 71.4% (n=25) patients in the infection group distributed in the low immune response zone, and the percentage in the infection group was significantly higher than that in the other three groups (P < 0.05). The intracellular adenosine triphosphatei value in the infection group was significantly lower than that in the other three groups. That indicated that the infection was correlated with low cellular mediated immune function, and the detection of immune cell function played an important role in monitoring the infection after renal transplantation. The immune cell function monitoring with ImmuKnowTM-Cylex® assay provides reliable and objective basis for the diagnosis and treatment of infection after renal transplantation, but it has no correlation with the rejection after renal transplantation, and that needs further investigation with a large-sample experiment. Figures and Tables | References | Related Articles | Metrics

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Renal allografts from pediatric donors after cardiac death: One case report Yang Shun-liang, Guo Jun-qi, Zhang Wei, Wu Xiao-zhi, Gao Xia, Cai Jin-quan, Tan Jian-ming 2013, 17 (5):  817-824.  doi: 10.3969/j.issn.2095-4344.2013.05.009 Abstract ( 535 )   PDF (363KB) ( 632 )   Save BACKGROUND: The organ shortage is the common difficulty faced by the global transplant community. In order to expand the donor sources, to ease the growing tension of the organ shortage and to avoid confusion caused by the absence of brain death legislation and diagnostic criteria, the Ministry of Health and the Red Cross Society of China have jointly promote the cardiac death organ donation. OBJECTIVE: To investigate the feasibility of organ donation from pediatric donors after cardiac death.  METHODS: One case of organ donation from a pediatric donor at Fuzhou General Hospital of Nanjing Military Command of PLA was retrospectively analyzed combined with the analysis of the literatures.  RESULTS AND CONCLUSION: A 4-year-old boy was independently diagnosed with brain death after cardiopulmonary resuscitation by two groups of specialists at an interval of 24 hours. The criteria included the Diagnostic Criteria for Brain Death (for adults), the Technological Specification for Brain Death (for adults) and atropine test results. The donor parents should be informed and consent with the donor programs and fully expressed the donation willingness, and the program should be approved by the hospital ethics committee. The following steps including donation application, approval, transportation, organ maintaining, mechanical support removal and organ recovery were conducted according to the organ donation guidelines in China after cardiac death. The warm ischemia time was 13 minutes. Two renal grafts were transplanted to two uremic recipients selected by age, weight and human leukocyte antigen matching. The left kidney recipient was a 13-year-old female patient and the right kidney recipient was a 35-year-old female patient. No complications such as delayed graft function, renal graft vascular thrombosis, urinary fistula or ureteral obstruction were observed. The graft length was increased from 7 cm postoperation to 10 cm at 1 year after operation, with negative proteinuria, serum creatinine of 60 μmol/L and estimated glomerular filtration rate was ranged from 70 to 150 mL/min. No long term complications such as serious infections, hypertension, diabetes, hyperlipidemia or liver dysfunction were observed. The recipients have good levels of daily living activities, psychological status and adherence. Organ donation from pediatric donors after cardiac death was one of the alternative solutions to the shortage of organ sources in transitional period. We should explore the standardized operating procedures of pediatric donation after cardiac death based on the top priority principles of patient interests. Figures and Tables | References | Related Articles | Metrics

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Human leukocyte antigen-G and prognosis of liver transplantation in patients with hepatocellular carcinoma Zeng Xian-cheng, Zhang Tong, Chen Wei, Chen Guan-zhong, Li Hua, Zhang Qi 2013, 17 (5):  825-831.  doi: 10.3969/j.issn.2095-4344.2013.05.010 Abstract ( 488 )   PDF (413KB) ( 665 )   Save BACKGROUND: Human leukocyte antigen-G is a kind of nonclassical human leukocyte antigen Ⅰ gene, which has participated in a variety of pathophysiological processes, especially plays an important role in tumor immune escaping. In addition, it may be one of the mechanisms underlying tumor recurrence and metastasis. OBJECTIVE: To investigate the expression of human leukocyte antigen-G in hepatocellular carcinoma and its significance in the prognosis of liver transplantation in patients with hepatocellular carcinoma. METHODS: The clinical data of 109 patients who had undergone liver transplantation for hepatocellular carcinoma were analyzed retrospectively. The expression of human leukocyte antigen-G in the hepatocellular carcinoma tissue and liver tissue around the hepatocellular carcinoma tissue was detected with immunohistochemical method. The postoperative follow-up was performed. The Kaplan-Meier method was used to calculate the cumulative survival rate and tumor-free survival rate. Log-rank test and Cox regression model were used to analyze the single and multi-factor for tumor-free survival rate respectively. RESULTS AND CONCLUSION: The positive expression of human leukocyte antigen-G in tumor tissues was detected in the hepatocellular carcinoma tissue of 77 cases and in the surrounding tissues of 20 cases. A significant association was found between the expression of human leukocyte antigen-G and preoperative size of tumor (P < 0.05), vascular invasion (P < 0.05), and pathological differentiation (P < 0.05). Single factor analysis showed that expression of human leukocyte antigen-G (P < 0.01) was the risk factors that could affect the tumor-free survival rates of hepatocellular carcinoma after liver transplantation. Cox regression model analysis showed that expression of human leukocyte antigen-G (P < 0.05) was the independent risk factors of tumor-free survival rate. Human leukocyte antigen-G was highly expressed in hepatocellular carcinoma. The expression of human leukocyte antigen-G in hepatocellular carcinoma tissues was the independent risk factor of tumor-free survival rate of liver transplantation patients for hepatocellular carcinoma. Interventional treatment for human leukocyte antigen-G positive patients and strict selection of indication of liver transplantation for hepatocellular carcinoma can reduce the rate of tumor recurrence. Figures and Tables | References | Related Articles | Metrics

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Indications and timing for combined liver and kidney transplantation Du Guo-sheng, Shi Bing-yi, Song Ji-yong, Zhu Zhi-dong, Zheng De-hua, Cui Hong-tao 2013, 17 (5):  832-836.  doi: 10.3969/j.issn.2095-4344.2013.05.011 Abstract ( 407 )   PDF (259KB) ( 577 )   Save BACKGROUND: Since the development of liver and kidney transplantation, renal insufficiency and renal failure are no longer contraindications for liver transplantation. OBJECTIVE: To explore the indications and timing for performing combined liver and kidney transplantation and to allocate the scarce organs rationally.  METHODS: The clinical data were reviewed in 15 patients with combined liver and kidney transplantation including the diagnosis of primary diseases and distinct hepatorenal function before operation, and the situations of transplanted kidneys and original kidneys were analyzed. RESULTS AND CONCLUSION: All patients were operated successfully and being alive now. The follow-up time was 1.5－8 years, and the mean time was (3.6±1.2) years. Among the 15 patients with combined liver and kidney transplantation, one patient had delayed renal function recovery, and then recovered after treated with continuous renal replacement therapy for 2 weeks; for one patient who had hepatorenal syndrome and was treated with continuous renal replacement therapy for 4 weeks prior to transplantation, the renogram examination at 2 months after renal transplantation showed the original kidney function was recovered; for another two patients who had hepatorenal syndrome and were treated with continuous renal replacement therapy for 6 weeks prior to transplantation, the renogram examination after transplantation showed the original kidney function was not recovered. For the patients who had end-stage liver disease and primary nephrotic syndrome, the urine protein > 500 mg, glomerular filtration rate < 30 mL/min or the puncture biopsy confirmed that the glomerulosclerosis rate > 30% before transplantation, the renogram examination after combined liver and kidney transplantation showed original renal dysfunction. The patients with hepatorenal syndrome who had been treated with continuous renal replacement therapy for more than 6 weeks before transplantation should be treated with combined liver and kidney transplantation. However, the patients with end-stage liver disease and primary nephrotic syndromethe should be treated with combined liver and kidney transplantation if the urine protein > 500 mg, glomerular filtration rate < 30 mL/min or the puncture biopsy confirmed that the glomerulosclerosis rate > 30%. Figures and Tables | References | Related Articles | Metrics

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Effects of self-made cryopreservation solution on oxygen free radicals in cryopreserved rat liver Wang Lu-jia, Sun Wen, Zhang Jin-ping, Wang Chao, Zhao Xiao-yu, Zhu Ling-ying, Ma Jing-ru, 2013, 17 (5):  837-842.  doi: 10.3969/j.issn.2095-4344.2013.05.012 Abstract ( 387 )   PDF (328KB) ( 537 )   Save BACKGROUND: During liver transplantation, cryopreservation and ischemia can lead to production of oxygen free radicals by the liver which damages liver tissue. OBJECTIVE: To study the effects of self-made cryopreservation solution on oxygen free radicals in cryopreserved rat liver, and to compare with “gold standard” organ preservation solution-UW solution. METHODS: Sixteen 9-week-old Sprague Dawley rats were randomly divided into two groups: experimental group and control group, 8 rats in each group. Sprague Dawley rat liver perfusion models were established, and the livers in each group were lavaged with self-made organ preservation solution and UW preservation solution, then removed the liver and placed into 4℃preservation solution. The superoxide dismutase, nitric oxide synthase, total antioxidant capacity activity and the malondialdehyde content were detected at 24, 48 and 72 hours after preservation. RESULTS AND CONCLUSION: There were no significant differences in superoxide dismutase, nitric oxide synthase, total antioxidant capacity activity and the malondialdehyde content in rat liver tissue cryopreserved in the self-made organ preservation solution versus UW solution (P > 0.05). These findings suggest that self-made organ preservation solution can reduce the damage of oxygen free radical to the livers of rats after ischemia-reperfusion and the effect is equivalent to UW solution.  Figures and Tables | References | Related Articles | Metrics

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Protective effect of Tanreqing injection on the lung during heart valve replacement Shao Lian-bin, Yang Xiao-gang, Yang Hai-ping, Liu Wen-li, He Jin-xi, Bian Hong 2013, 17 (5):  843-850.  doi: 10.3969/j.issn.2095-4344.2013.05.013 Abstract ( 498 )   PDF (500KB) ( 513 )   Save BACKGROUND: Cardiopulmonary bypass for open heart surgery can cause acute lung injury, and there are many reports on the traditional Chinese medicine in reducing lung injury. OBJECTIVE: To evaluate the protective effect of Tanreqing injection on acute lung injury during cardiopulmonary bypass in patients undergoing heart valve replacement. METHODS: A total of 40 patients undergoing heart valve replacement were randomly divided into Tanreqing group and control group (20 in each group). In Tanreqing group, intravenous drip of 20 mL of Tanreqing injection mixed with 250 mL normal saline was given the night before operation and prior to cardiopulmonary bypass, respectively, while in the control group, intravenous drip of 250 mL normal saline was given. Serial blood samples of radial artery were collected at the following intervals: prior to cardiopulmonary bypass, 40 minutes after cardiopulmonary bypass and 0, 2, 6 and 24 hours after the end of cardiopulmonary bypass. Then the amount of neutrophil was measured with hematology analyzer; the serum levels of soluble intercellular adhesion molecule-1 and interleukin-8 was detected with double-antibody sandwich enzyme linked immunosorbent assay methods. Neutrophil ratio of right and left atrium cordis (transpulmonary polymorphonuclear) was calculated before cardiopulmonary bypass and immediately after the end of cardiopulmonary bypass, and the transpulmonary difference was calculated. We also calculated pulmonary dynamic compliance and respiratory indexes before valve replacement and skin incision, 10 minutes after the termination of cardiopulmonary bypass, at the end of surgery and 4 hours after the end of surgery, respectively. RESULTS AND CONCLUSION: The amount of neutrophil, intercellular adhesion molecule-1, interleukin-8 at different time points after cardiopulmonary bypass were significantly higher than those before cardiopulmonary bypass (P < 0.01), but levels of those in Tanreqing group were significantly lower than those in the control group (P < 0.01). The transpulmonary difference at the end of cardiopulmonary bypass was significantly higher than that before cardiopulmonary bypass (P < 0.01), and the transpulmonary difference in the Tanreqing group was significantly lower than that in the control group (P < 0.01). The respiratory indexes of the two groups were increased compared with those before valve replacement and skin incision (P < 0.01). The pulmonary dynamic compliance of the two groups was significantly decreased compared with that before cardiopulmonary bypass (P < 0.01), and then returned to the level before skin incision at 4 hours after the end of valve replacement. The respiratory index in the Tanreqing group was lower than that in the control group (P < 0.05). The pulmonary dynamic compliance after valve replacement in the Tanreqing group was higher than that in the control group (P < 0.01). Tanreqing injection can reduce the lung injury after valve replacement and protect the lung. Figures and Tables | References | Related Articles | Metrics

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Myocardial ultrastructure and hemodynamic changes of donor heart preserved in normothemic beating status Yang Yong, Lin Hui, Wen Zhao-ke, Huang Ai-lan, Wen Hong, Huang Guo-yong, Hu Yan-yan 2013, 17 (5):  851-858.  doi: 10.3969/j.issn.2095-4344.2013.05.014 Abstract ( 410 )   PDF (398KB) ( 525 )   Save BACKGROUND: For heart transplantation, the development trend of myocardial preservation method has changed from cold static storage to normal beating physiological status for prolonging preservation time and improving the quality of donor heart. Theoretically, the beating donor heart perfusion preservation at normal temperature is the preservation method that most close to the normal life state with a good potential for development. OBJECTIVE: To observe the changes of myocardial ultrastructure and left ventricular hemodynamics of beating donor heart with continuous blood perfusion at normal temperature. METHODS: Twenty-four Guangxi Bama miniature pigs were randomly divided into two groups: non-cardioplegia preservation group and cold preservation group, six pigs in each group. In the non-cardioplegia preservation group, the donor hearts were harvested in beating state and perfused continuously with normothermic oxygened blood. In the cold preservation group, the donor hearts were perfused with cold crystalliod cardioplegia for harvesting and persevered in 0-4 ℃ UW solution. After 8 hours, the donor hearts were transplanted to the recipients. After the transplanted aorta declamping for 3 hours, the left ventricular systolic pressure, left ventricular diastolic pressure, left ventricular mean pressure, left ventricular end-diastolic pressure, and the maximum rising and falling rate of left ventricular pressure of the donor hearts were observed. The changes of heart rhythm after transplantation, the number of required defibrillation and weaned from cardiopulmonary bypass after aortic declamping for 3 hours were recorded. The left ventricular anterolateral wall myocardial tissues of the donor hearts were obtained after aortic declamping for 3 hours to observe the changes of mitochondria and sarcolemma. RESULTS AND CONCLUSION: The left ventricular systolic pressure, left ventricular mean pressure, left ventricular end-diastolic pressure and the maximum rising and falling rate of left ventricular pressure in the non-cardioplegia preservation group were significantly prior to those in the cold preservation group (P < 0.05). After aortic declamping, all donor hearts could maintain sinus rhythm in the non-cardioplegia preservation group, but only one case in the cold preservation group recovered sinus rhythm spontaneously. After aortic declamping for 3 hours, five hearts could wean off extracorporeal circulation in the non-cardioplegia group, but only one case in the cold preservation group. The myocardial ultrastructure of the non-cardioplegia preservation group was superior to that of the cold preservation group. Keeping donor heart in beating status with normothermic perfusion can provide effective myocardial preservation and fit for long-term preservation. Figures and Tables | References | Related Articles | Metrics

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Establishment of a mouse-rat cervical cardiac xenotransplantation model by cuff technique Li Chuan, Qi Feng, Liu Tong, Li Fu-xin, Wang Peng-zhi 2013, 17 (5):  859-865.  doi: 10.3969/j.issn.2095-4344.2013.05.015 Abstract ( 667 )   PDF (404KB) ( 722 )   Save BACKGROUND: Small animal heart transplantation model is a common model and an important mean for basic and clinical research of organ transplantation, and the transplant part is often the neck and abdomen. The biggest advantage of cervical heterotopic transplantation is that the transplanted heart will located in the neck subcutaneous, which is conducive to the direct observation of the beating of donor heart, thus early anticipating the rejection.  OBJECTIVE: To improve the anesthesia, surgical procedures and perioperative management of the mouse-rat cervical cardiac xenotransplantation model, in order to establish a more stable animal model. METHODS: The mouse-rat heterotopic cardiac xenotransplantation models were established by modified cuff technique to transfer the donor heart of mouse to the right side of the neck of rat, the method to remove the donor heart was improved, and the models received inhalation anesthesia of isoflurane with small animal anesthesia machine. The experimental levels of establishing the models were divided into practicing, stable and skilled stages. Part samples were taken for the histopathological examination. RESULTS AND CONCLUSION: In the three stages (practicing, stable, skilled) of establishing the models, the successful rates of surgery were 53.33%, 85.71%, and 96.15% respectively. The successful rate in stable and skilled stages was higher than that in the practicing stage (P < 0.05). The total operation time in the stable and skilled stages was significantly shorter than that in the practicing stage (P < 0.05). Histopathological examination results showed that the cardiovascular endothelial injury, thrombosis, myocardial parenchymal damage, interstitial hemorrhage and inflammatory cell infiltration after heterotopic cardiac xenotransplantation were more serious compared with normal heart transplantation and cardiac allograft, and showed a time-depend manner, which identify the reliability of the model. It suggests that the mouse-rat cervical cardiac xenotransplantation model is simple, reliable, easily operated in a short-time and has a high successful rate. It is an ideal animal model for studying xenotransplantation rejection. Figures and Tables | References | Related Articles | Metrics

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Chemotaxis of vascular endothelial progenitor cells towards rat skin wounds following allogeneic transplantation Liu Chao, Zhao Ji-lin, Miao Lei-ying 2013, 17 (5):  866-871.  doi: 10.3969/j.issn.2095-4344.2013.05.016 Abstract ( 432 )   PDF (552KB) ( 568 )   Save BACKGROUND: It becomes a hotspot that allogeneic endothelial progenitor cells participate in vascular remodeling in ischemic tissues of the body. OBJECTIVE: To observe the chemotaxis of allogeneic transplantation of vascular endothelial progenitor cells to rat skin wounds. METHODS: Endothelial progenitor cells isolated from the peripheral blood of rats were cultured and labeled with BrdU, and then injected into rats with cutting injury on the back skin via the tail vein. Another normal rats served as controls. The number of BrdU positive endothelial progenitor cells in skin wound areas wasdetected by immunofluorescence staining at 1, 3, 7, 14 days after transplantation, and the changes in the number and volume of spleen lymphoid follicles were observed by hematoxylin-eosin staining. RESULTS AND CONCLUSION: Endothelial progenitor cells could move to the injured skin areas. The number of endothelial progenitor cells was most at 3 and 7 days (P < 0.05), and BrdU positive cells could be seen until the 14th day in the vessel wall of the injured skin area. There was no significant difference between the two groups in the number and volume of spleen lymphoid follicles. No significant immunological rejection was caused by the allogeneic transplantation of vascular endothelial progenitor cells. Figures and Tables | References | Related Articles | Metrics

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Deep lamellar keratoplasty for scarring stage keratoconus Ma Li-xiao, Wu Yan-chao, Wang Ke, Wang Xin, Lu Shao-yin 2013, 17 (5):  872-877.  doi: 10.3969/j.issn.2095-4344.2013.05.017 Abstract ( 568 )   PDF (455KB) ( 533 )   Save BACKGROUND: Deep lamellar keratoplasty for the treatment of keratoconus can improve the visual acuity significantly with less complications and low rejection rate, but the treatment of scarring stage keratoconus is mainly depends on the partial penetrating keratoplasty. OBJECTIVE: To evaluate the clinical efficacy of deep lamellar keratoplasty for the treatment of scarring stage keratoconus. METHODS: Fifty-eight patients with Ⅲ and Ⅳ scarring stage keratoconus were divided into two groups: patients with corneal scarring in the superficial corneal stroma (n=37, superficial scar group), patients with corneal scarring in the deep or whole corneal stroma (n=21, deep scar group). The 58 patients who had accepted deep lamellar keratoplasy were followed-up for 12 months and the changes of visual acuity before and after transplantation were compared. RESULTS AND CONCLUSION: Naked eye vision of all patients with deep lamellar keratoplasy was significantly improved compared with that before transplantation, and 58 corneal grafts were all transparent. Only one patient had epithelial rejection after 2 months postoperative, and the corneal graft became transparent after a drug treatment. Two patients with deep keratoconus scars experienced glare after the transplantation in deep scar group, and they were switched to partial penetrating keratoplasty treatment. There was no significant difference of visual acuity at 1 year after transplantation between superficial scar group and deep scar group. Deep lamellar corneal keratoplasty treatments can significantly improve the visual acuity of scarring stage keratoconus patients, while it is low in rejection rate with less complication. It is a safe, effective and feasible treatment method, especially for the treatment of large base keratoconus. Figures and Tables | References | Related Articles | Metrics

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Auto-adipose stem cells facilitate autologous fat transfer for breast augmentation Yan Jun-ling, Di Guo-hu, Ding Hong, Zhang Wei, Liu Jia-qi, Tang Su-yang 2013, 17 (5):  878-885.  doi: 10.3969/j.issn.2095-4344.2013.05.018 Abstract ( 434 )   PDF (743KB) ( 846 )   Save BACKGROUND: Human adipose stem cells have the capability of multipotential differentiation and have a promising prospect in the field of tissue engineering and regenerative medicine. OBJECTIVE: To evaluate the technology and efficacy of human adipose stem cells in autologous fat grafting breast augmentation. METHODS: Fifteen patients with auto-adipose injection breast augmentation were followed-up for 3-6 months. The whole operation was separated into two phases, in the first phase, 15-20 mL adipose tissue was aspirated and digested with collagenase Ⅰ to separate and amplify the human adipose stem cells. When cultured to passage 2, the plastic adherent stem cells were up to 1×108 and verificated by immunophenotype, differentiation and genetic stability assays before transplantation. In the second phase, 300-450 mL adipose tissue was aspirated and transplanted combined with human adipose stem cells. RESULTS AND CONCLUSION: The passage 2 human adipose stem cells exhibited typical mesenchymal stem cells characteristics and maintained genetic stability. The 3-6 months follow-up demonstrated that there was no apparent adipose absorption, infection, pain and upper limb activity limitation, and the effect was good. The authors suggested that autologous adipose derived stem cells-mediated auto-adipose injection breast augmentation is a practical and efficacious method. Figures and Tables | References | Related Articles | Metrics

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Negative immunomodulatory effect of lipoxin receptor stimulating agent on macrophages infected by human cytomegalovirus Chen Xiao-hong, Shu Sai-nan, Liu Xing-lou, Wang Hui, Zhang Ju, Du Xiao-yi, Li Ge 2013, 17 (5):  886-893.  doi: 10.3969/j.issn.2095-4344.2013.05.019 Abstract ( 518 )   PDF (338KB) ( 544 )   Save BACKGROUND: Lipoxin can inhibit the synthesis of inflammatory cells, endothelial cells and mouse spleen dendritic cells into the cytokines, and it can also inhibit the biological effects of inflammatory cytokines on cells. OBJECTIVE: To investigate the negative immunomodulatory effect of lipoxin receptor stimulating agent BML-111 on THP-1 macrophages infected by human cytomegalovirus. METHODS: THP-1 derived macrophages were infected with human cytomegalovirus AD169 (multiplicity of infection=0.5), and the cultured cells were randomly divided into control group, human cytomegalovirus group and human cytomegalovirus+BML-111 group. Then the cell culture supernatant was collected at 0, 1, 2, 4, 12, 24, 48 and 72 hours after infection, and the expression levels of cytokines in each group were detected with enzyme-linked immunosorbent assay; mRNA levels of the factors were tested with real-time PCR; Western blot was used to detect the expression of p65 subunit protein in the nucleus after infection for 4 hours. RESULTS AND CONCLUSION: Compared with the control group, the cytokine protein and mRNA expression both in human cytomegalovirus group and human cytomegalovirus+BML-111 group were increased significantly (P < 0.05). Compared with human cytomegalovirus group, the levels of interleukin-1β and tumor necrosis factor α in human cytomegalovirus+BML-111 group were decreased significantly, and thus the level of transforming growth factor-β was increased greatly (P < 0.05). There was no significant difference of the level of interleukin-10 between the two groups (P > 0.05) mRNA expression. mRNA expression of all the cytokines in human cytomegalovirus+BML-111 group was lower than that in human cytomegalovirus group (P < 0.05). Compared with the control group, the level of p65 subunit protein in the nucleus of human cytomegalovirus group and human cytomegalovirus+BML-111 group was increased significantly (P < 0.05). The level of p65 subunit protein in the nucleus of human cytomegalovirus+BML-111 group was lower than that of human cytomegalovirus group (P < 0.05). BML-111 may decrease the expression of interleukin-1β and tumor necrosis factor α, and promote the expression of transforming growth factor-β by inhibiting the nuclear translocation of nuclear factor-κB p65. Thus it plays negative immunoregulation effect on THP-1 macrophages infected by human cytomegalovirus. Figures and Tables | References | Related Articles | Metrics

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Development and efficacy of a bio-feedback artificial anal sphincter perception system Xiao Zhong, Huang Zong-hai, Shi Fu-jun, Chen Fei, Guo Xiong-bo, Lin Xiao-hua 2013, 17 (5):  894-901.  doi: 10.3969/j.issn.2095-4344.2013.05.020 Abstract ( 326 )   PDF (516KB) ( 629 )   Save BACKGROUND: Artificial anal sphincter is a new way to treat fecal incontinence. However, present artificial anal sphincter lacks of awareness and feedback function, and patients can control their defecation mainly through their habits rather than the existence of the intestinal contents. Research into an awareness and feedback system is the primary issue in the development of artificial anal sphincter. OBJECTIVE: To develop a bio-feedback artificial anal sphincter perception system which could perceive and feedback the change in intestinal pressure and the volume of intestinal contents. METHODS: Twenty healthy New Zealand rabbits were used to test its feasibility, and the experiments were performed on the distal part of proximal colon of the rabbits. The pressure of intestinal canal and pressure sensing cuff were measured after injecting four simulated intestinal contents, including gas, liquid, semi-fluid and solid into the intestinal canal respectively. The relationship between the volume of the four states of intestinal contents and the intestinal canal pressure and the cuff pressure was analyzed. RESULTS AND CONCLUSION: The results of the experiment showed that the pressure of intestinal canal and pressure sensing cuff was increased with the increasing of the volume of intestinal contents, and the pressure and the volume was positively correlated within a certain range. According to the experiment, the bio-feedback artificial anal sphincter perception system could effectively reflect the change of intestinal pressure and the volume of intestinal contents, and may be an effective strategy to address the awareness and feedback problem of artificial anal sphincter, thereby laying the basis for the research of intelligent bio-feedback artificial anal sphincter. Figures and Tables | References | Related Articles | Metrics

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Insight into the three-wavelength hepatic reserve function detection system 徐泽鹏，马腾飞，李凯扬 2013, 17 (5):  902-906.  doi: 10.3969/j.issn.2095-4344.2013.05.021 Abstract ( 361 )   PDF (491KB) ( 547 )   Save BACKGROUND: Preoperative evaluation of hepatic reserve function can offer the message of liver to make the treatment plan early. Indocyanine green excretion test is easy and less-invasive, and has been proved to be an effective method to predict patient’s hepatic reserve function. OBJECTIVE: To design a hepatic reserve function testing system based on indocyanine green excretion test. METHODS: Different wavelength light emitting diode was selected based on human organization’s pulse and absorption of infrared light. The peripheral circuits and probe were designed and the ARM9 platform was selected as the micro-computer in the hardware part; the program was designed in Windows CE in the software part. And the whole system was tested through early experiment. RESULTS AND CONCLUSION: Portable hepatic reserve function testing system could noninvasive and real-time provided the 15 minutes indocyanine green retention rate and blood oxygen saturation. The system used a three-wavelength light emitting diode to light the finger, and used the photoelectric sensor to collect light intensity through the finger. The digital filters and self-learning threshold method were used to remove the interference signal. The experiments show that the system signal is reliable, stable and good effect with practicality. Figures and Tables | References | Related Articles | Metrics

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Comparison of clinical efficacy between orthotopic ileal neobladder and orthotopic sigmoid neobladder in female bladder cancer patients Wang Hai-feng, Wang Jian-song, Xu Hong-yi, Shi Yong-fu, Zuo Yi-gang, Yang De-lin 2013, 17 (5):  907-912.  doi: 10.3969/j.issn.2095-4344.2013.05.022 Abstract ( 376 )   PDF (278KB) ( 789 )   Save BACKGROUND: The orthotopic urinary diversion after radical cystectomy of bladder cancer has good urinary continence. However, there are few reports about the clinical efficacy and follow-up of orthotopic ileal neobladder and orthotopic sigmoid neobladder in female bladder cancer patients. OBJECTIVE: To compare the clinical efficacy of orthotopic ileal neobladder and orthotopic sigmoid neobladder in female bladder cancer patients. METHODS: The clinical data of the female patients with bladder cancer who were treated with orthotopic ileal neobladder (ileal group, n=29) and orthotopic sigmoid neobladder (sigmoid group, n=23) from 1996 to 2008 were retrospective analyzed. The intraoperative and postoperative conditions, urodynamics, urinary continence, pouch-related complications of the patients in two groups were compared. RESULTS AND CONCLUSION: The average follow-up time was 57 months in the ileal group, and 55 months in the sigmoid group. There was no difference in intraoperative blood loss and postoperative urinary continence between two groups, and there were significance differences in operative time, postoperative out-of-bed activity and the orthotopic neobladder’s capacity between two groups (P < 0.05). The early and late pouch-related complication rates in the ileal group were higher than those in the sigmoid group. In the ileal group, tumor recurred in two patients, and no tumor recurred in the sigmoid group. It indicates that orthotopic ileal neobladder and orthotopic sigmoid neobladder in female patients are both safe and effective to achieve satisfactory clinical outcomes. Figures and Tables | References | Related Articles | Metrics

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Effect of semi-permanent double-lumen central venous catheter on micro-inflammatory state in maintenance hemodialysis patients Zhang Xiao-dong, Li Xiao-ping, Song Jie, Li Ying1, Li Hui 2013, 17 (5):  913-919.  doi: 10.3969/j.issn.2095-4344.2013.05.023 Abstract ( 677 )   PDF (348KB) ( 591 )   Save BACKGROUND: Semi-permanent double-lumen central venous catheter as an important supplement of autogenous arteriovenous fistula has been widely used in maintenance hemodialysis patients. But the studies have found that the mortality rate of semi-permanent double-lumen central venous catheters used for hemodialysis vascular access is higher than that of autogenous arteriovenous fistula. The reason is not clear. At present, the effect of different types of vascular access on the micro-inflammatory state is rarely reported. OBJECTIVE: To compare the different levels of inflammation factors in maintenance hemodialysis patients with semi-permanent double-lumen central venous catheter and arteriovenous fistula, and to explore the effect of the hemodialysis vascular access types on the micro-inflammation in maintenance hemodialysis patients. METHODS: Eighty patients with uremia underwent maintenance hemodialysis were selected, and divided into autologous arteriovenous fistula group (n=48) and semi-permanent double-lumen central venous catheter group (n=32) according to different vascular access types. Sixty healthy people were selected as normal control group. The serum high sensitivity C-reactive protein, interleukin-6 and tumor necrosis factor-α of the maintenance hemodialysi group and the normal control group were detected. RESULTS AND CONCLUSION: The serum high sensitivity C-reactive protein, interleukin-6 and tumor necrosis factor-α of the maintenance hemodialysis patients were significantly higher than those of the normal control group (P < 0.01). The serum high sensitivity C-reactive protein, interleukin-6 and tumor necrosis factor-α in the semi-permanent double-lumen central venous catheter group were higher than those in the autologous arteriovenous fistula group (P < 0.05). Micro-inflammatory state exists in maintenance hemodialysis patients, and the utilization of semi-permanent double-lumen central venous catheter as hemodialysis vascular access can aggravate the micro- inflammatory state as compared with the utilization of autologous arteriovenous fistula. Figures and Tables | References | Related Articles | Metrics

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Off-pump coronary artery bypass grafting treats high-risk coronary heart disease Wang Shi-xiong, Li Ning-yin, Zhao Qi-ming, Gao Bing-ren 2013, 17 (5):  920-930.  doi: 10.3969/j.issn.2095-4344.2013.05.024 Abstract ( 579 )   PDF (551KB) ( 642 )   Save BACKGROUND: Off-pump coronary artery bypass grafting and on-pump coronary artery bypass grafting are the two surgical methods for the treatment of coronary atherosclerotic heart disease, but there is no systematic review on the comparison of these two methods in the treatment of high-risk coronary heart disease. OBJECTIVE: To assess the effect and safety of off-pump versus on-pump coronary artery bypass grafting in perioperative period of high-risk coronary heart disease through Meta analysis. METHODS: Relevant clinical trials published in English and Chinese from January 1993 to June 2012 were searched in PubMed database, EMbase database, China National Knowledge Infrastructure database, China Biomedicine Literature database, VIP database, Wanfang database and Cochrane Library (Issue 8, 2012). Manual searches of bibliographies were also performed. All the clinical trials were selected and analyzed according to the inclusion and exclusion criteria. Two reviewers independently selected eligible trials, performed quality assessment, and cross-checked each other. Finally, the abstracted relevant data was processed and analyzed with software RevMan 5.1. RESULTS AND CONCLUSION: A total of 16 studies, including two randomized controlled trials and 14 retrospective studies were identified. A total of 6 441 high-risk patients, involving 2 948 in the off-pump coronary artery bypass grafting group and 3 493 in the on-pump coronary artery bypass grafting group were included. The results of Meta-analyses showed the differences of stroke, the intra-aortic balloon counterpulsation using, recurrent myocardial infarction, respiratory dysfunction and mortality incidence in the perioperative period, the ventilation time, the time in intensive care unit, hospitalization time, postoperative drainage and blood transfusion were significant between off-pump coronary artery bypass grafting and on-pump coronary artery bypass grafting patients. While there were no statistical differences in atrial fibrillation, acute renal injury, wound infection and reoperation rate. Compared with on-pump coronary artery bypass grafting in the perioperative period, using off-pump coronary artery bypass grafting for high-risk patients is safe and effective with the advantages of less trauma, lower operative mortality, rapider postoperative recovery and fewer complications, but because of the limited number of included studies and most is the non-randomized controlled trials, off-pump coronary artery bypass grafting cannot replace on-pump coronary artery bypass grafting. However, the results and long-term efficacy still need to be confirmed by higher-quality, more multi-center, large-sample and randomized double-blind controlled trials in the future． Figures and Tables | References | Related Articles | Metrics

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Meta-analysis of complications following autologous iliac crest bone graft from donor site Zou Sha-sha, Chen Ting-ting, Tian Ru-hui, Chang Yan-yan, Wang Ya-nan, Li Zheng, Hu Hong-liang 2013, 17 (5):  931-937.  doi: 10.3969/j.issn.2095-4344.2013.05.025 Abstract ( 553 )   PDF (635KB) ( 890 )   Save BACKGROUND: Recently, autologous iliac crest bone graft is considered to be the “gold standard” therapeutic method for bone defects. However, there are some complications in iliae crest bone donor site, and the clinical application is limited. OBJECTIVE: To compiled analyze the published articles and evaluate the types of complications and morbidity following autologous iliac crest bone graft by employing evidence-based medicine method. METHODS: A computer-based online search in PubMed Medline database, Ovid Medline database, Cochrane database and Embase database was performed using key words of “Iliac crest bone graft”, “autologous bone graft”, “bone graft donor site”, “complication” or “morbidity” in English. The published dates were limited between January 2002 and December 2011. A total of 174 articles were searched. Then 30 articles, involving 2476 patients, were selected for the clinical Meta analysis according to retrieval conditions and inclusion criteria. All relevant data were extracted and analyzed using SPSS 13.0 and R software and its Meta package. RESULTS AND CONCLUSION: The result indicated that the complications of autologous iliac crest bone graft in donor site included chronic pain (≥6 months) [incidence rates=7.88%，95% confidence interval (CI) 4.76-12.79], infection(incidence rate=4.26%, 95% CI 2.95-6.12]), hematoma or seroma (incidence rate=6.55%, 95% CI 4.90-8.70), nerve injury (incidence rates=5.85%, 95% CI 3.46-9.71), sensory disturbance (incidence rate=10.1%, 95% CI 6.07-16.23) respectively. The postoperative complications of autologous iliac crest bone graft are common; therefore, it should be emphasized by clinicians. Figures and Tables | References | Related Articles | Metrics

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Infection after anterior cruciate ligament reconstruction Xu Chang-ming, Yang Le, Hu Chuan-liang, Hu Yu-hua 2013, 17 (5):  938-944.  doi: 10.3969/j.issn.2095-4344.2013.05.026 Abstract ( 1155 )   PDF (596KB) ( 674 )   Save BACKGROUND: The incidence of infection after anterior cruciate ligament reconstruction is relatively low. However, this infection can lead to disastrous results, and the diagnosis and treatment of this infection have not yet achieved a consensus. OBJECTIVE: To explore the causes of infection after anterior cruciate ligament reconstruction and how to diagnosis and cure the infection, and to investigate the appropriate treatment program, in order to protect the knee functions. METHODS: The PubMed database and Wanfang database were searched for articles published between 2007 and 2012 with the key words of “anterior cruciate ligament, reconstruction, infection” in English and Chinese. Infection after anterior cruciate ligament reconstruction was used as the evaluation index. Articles related to infection after anterior cruciate ligament reconstruction were included, and repeated studies were excluded. RESULTS AND CONCLUSION: Bacterial contaminations of surgical devices or ligament grafts were the most likely causes of infection after anterior cruciate ligament reconstruction, and the fixation method of graft may be related with the infection after reconstruction. The classic clinical symptoms and signs of infection after anterior cruciate ligament reconstruction were similar to general septic arthritis. But classic symptoms of infection were frequently missing. The diagnosis of infection after anterior cruciate ligament reconstruction depended on clinical symptoms and signs, laboratory test such as erythrocyte sedimentation rate and C-reactive protein, and knee aspiration. For the treatment of the infected knee after anterior cruciate ligament reconstruction, culture-specific intravenous antibiotics and surgical joint irrigation with graft retention were considered the overwhelming treatment of choice. Graft removal was recommended if it appeared infected or if there was any difficulty controlling the infection. Figures and Tables | References | Related Articles | Metrics

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Heme oxygenase-1 protects against ischemia-reperfusion injury following liver transplantation Xu Jian-ji, Zeng Zhong, Chen Xi-hua 2013, 17 (5):  945-950.  doi: 10.3969/j.issn.2095-4344.2013.05.027 Abstract ( 414 )   PDF (612KB) ( 545 )   Save BACKGROUND: During liver transplantation, liver ischemia-reperfusion injury induced primary poor liver graft function has been puzzled the majority of transplant experts and scholars. Heme oxygenase-1 is involved in a variety of diseases and pathological processes, and can protect the tissue and organ through its antioxidant, anti-inflammatory, anti-apoptotic and other mechanisms. OBJECTIVE: To review the protective effect of heme oxygenase-1 against ischemia-reperfusion injury in liver graft. METHODS: A computer-based search of PubMed database 1992-01/2009-12 and China Journal Full-Text database 2003-01/2010-12 was performed by the first author for the articles on the protective effect of heme oxygenase-1 on ischemia-reperfusion injury in liver graft. The key words were “heme oxygenase-1, ischemia-reperfusion injury, liver graft” in English and Chinese. The repetitive research and Meta-analysis were excluded, and totally retained 34 articles for review. RESULTS AND CONCLUSION: Heme oxygenase-1 may be the most widely distributed gene in animal body, and it had the most important protective effect. Heme oxygenase-1 and its catalytic product compose an important endogenous protection system that is involved in a variety of diseases and pathological processes, and protects the tissue and organ through its antioxidant, anti-inflammatory, anti-apoptotic and other mechanisms with an important clinical application potential. Heme oxygenase-1 has a significant protective effect on ischemia-reperfusion injury in liver graft. Heme oxygenase-1 has a broad clinical application prospect in reducing the ischemia-reperfusion injury and improving the liver graft survival rate if we know how to apply it in clinic by means of transgene, and that is the research direction in future. Figures and Tables | References | Related Articles | Metrics