ObjectiveTo study the development of methods assessing donor liver viability in liver transplantation.MethodsThe literature in the recent years on the methods of assessing donor liver viability was reviewed.ResultsFrom donor liver morphology to function,there have being developed many methods which assess donor liver viability,including:①donor liver appearance; ②intraoperative biopsies; ③donor liver microcirculation; ④portal pressure; ⑤enzymes levels in liver; ⑥lidocainemetabolizing activity; ⑦energy metabolism of donor liver; ⑧fat content in donor liver.ConclusionThere are many methods to assess the viability of donor liver. Each has its supericrity and defect respectively. Intraoperative biopsies, 31Pmagnetic resonance spectroscopy and portal pressure have more importance in clinical application.
Objective To investigate the effects of tissue inhibitor-3 of matrix metalloproteinases(TIMP-3) genetransfected vascular smooth muscle cells(VSMCs) transplantation on heart structure after acute myocardial infarction (AMI) in rats and to explore the potential mechanisms. Methods Sixty-one female Wistar rats were produced AMI models by ligating the descending left coronary artery. Fifty-four rats were survived and divided into 3 groups randomly(n=18): 0.5 ml PBS containing 1×106 TIMP-3 gene-transfected VSMCs(group A), 1×106 VSMCs(group B) or 0.5 ml PBS without cell(group C) were injected into the ischemic myocardium immediately. Ischemic myocardium samples were harvested at 1 weekafter operation. The heart structure was observed through the tissue morphologic examination. The activity of TIMP-3 gene-transfected VSMCs were measured by immunohistochemical method. Proteins of TIMP-3 and matrix metalloproteinase 9(MMP-9) were determined by Western blot. Results VSMCs were cultivated and had a high purity(98%). TIMP-3 gene was transfected into VSMCs successfully. One week after operation in groups A, B and C, the average percentage of infarction myocardium size 〖KG6〗and left ventricle free wal area were 28.73%±1.56%, 39.63%±1.84% and 46.32%±2.16% separately.Group A was significantly lower than groups B and C(P＜0.01), group B was significantly lower than group C(P＜0.01). In groups A, B and C the averageleft ventricle volume indexes were 5.27±0.21 mm3／g, 6.69±0.34 mm3／g and 9.67±0.88 mm3／g respectively. Group A was significantly smaller than groups B and C(P＜0.01), group B was significantly smaller than group C(P＜0.01). The immunohistochemical observation confirmed that the implanted VSMCs and TIMP-3 gene were survival in ischemic area. The protein content of TIMP-3 in ischemicmyocardium was significantly higher in group A (300 704.8±3 692.8) than in groups B and C(195 548.8±3 014.2，177 991.1±2 502.1)(P＜0.01), the protein content of MMP-9 in ischemic myocardium was significantly lower in group A(594 827.4±5 708.5) than in groups B and C(921 461.4±8 887.4，1 044 445.0±8 788.6)(P＜0.01). Conclusion Implanted TIMP3 gene transfected VSMCs in ischemic myocardium can conspicuously reduce the myocardium remodeling after AMI.
Objective To repair defects at both ends of theblood vessels with a considerable disparity in the diameter of the both sides or with a large diameter in extremities by phleboplasty of branched and double autogenous veins. Methods Three kinds of phleboplasties——funnel-shaped, raincape-shaped and transposed Y-shaped were designed. Experiments in fresh blood vessels in vitro were completed successfully. These methods were used clinically to repair injured external iliac veins, femoral arteries and veins, and popliteal arteries and veins, to replant severed fingers and to transplant toenail flaps on thumbs by harvesting autogenous great saphenous veins,small saphenous veins and forearm veins in 36 cases, including 35 cases in emergency operation and 1 case in selective operation.The length of grafted blood vessels ranged from 1.0 cm to 15.0 cm. Results The phleboplasties of funnel-shaped could enlarge the diameter by 1.0-1.25 times inanastomotic stomas. The phleboplasty of raincape-shaped could enlarge the diameter large enough to meet the demands for various blood vessels in extremities. The phleboplasty of transposed Y-shaped could provide large vein transplants. In36 grafted veins, 35 were in patency. The blood supply in extremities was normal.ConclusionThe funnel-shaped and raincape-shaped phleboplasties of branched veins can enlarge the anastomotic stomas of grafted veins. The transposed Y-shaped phleboplasty of double femoral veins is an ideal way to repair injured primaryblood vessels with a considerable disparity in the diameter of the both sides or with a large diameter in extremities.
【Abstract】ObjectiveTo investigate the prophylactic effect of lamivudine monotherapy on the recurrence of hepatitis B after liver transplantation. MethodsThirtyone patients with hepatitis B related benign decompensated cirrhosis who underwent liver transplantation between February 1999 to June 2002 and survived more than 3 months were analyzed retrospectively. Lamivudine was administered to each patient after operation and some patients before operation for the prophylaxis of HBV recurrence. The HBV markers and HBV DNA in serum and bioptic liver tissues in all patients were evaluated before and after operation. ResultsTotal HBV recurrence rate was 19.4％（6/31） during average 38.2 months (3.2-70.2 months) follow up. HBV recurrence rate was 7.1％(2/28), 16.0％(4/25), 26.1％(6/23) and survival rate was 87.1％(27/31), 80.6％(25/31), 66.1％(20.5/31) after 1-, 3-and 5-year, respectively. One hundred milligram lamivudine administration peroral daily for 2 weeks prior to transplantation enable HBeAg 54.5％(6/11) and HBV DNA 50.0％(5/10) positive patients convert to negative respectively. ConclusionPreoperative administration of lamivudine monotherapy can effectively prevent allograft from HBV re-infection after liver transplantation. Lamivudine should be used to convert HBV DNA and HBeAg to negative.
The femoral veins were excised from 28 dogs and distended with pressure of 40, 80 and 120 kPa, respectively before grafted to femoral arteries. The veins were harvested at different times and Pollak sections were prepared which revealed different stains of elastin, collagen and smooth muscle in each section. The sections were led to image analysis system to computerize the relative contents of theabove components. The results were as follows: Elastin decreased significantly at 4 weeks (P lt;0.01), and was constant between 4 and 16 weeks. No statistical difference was found in 40, 80 kPa and the control group (P gt;0.05), but the elastin of 120 kPa group by the 16th week was still decreasing. Collagen of each group had no difference, but C/E increased significantly with time. Smooth muscle contents were correlated positively with time, and negatively with the pressure at 1 week, then positively with the pressure at 16th week. The changes of the above trends were the same as development of intimal hyperplasia. The contentions were the value of C/E was determined by the arterial pressure but that of 120 kPa pressure was more higher. The preimplant pressure distension was a possible significantfactor leading to excessive intimal hyperplasia of early and middle stage of autogenous vein grafts.
OBJECTIVE: To explore the potential possibility of synaptic connection and 3D adhesion between fetal spinal cord cell suspension (FSCS) and host, and to observe the synapses developing process of FSCS transplantation. METHODS: Spinal cord injury model produced in 42 Wistar rats on T7 by use of modified Allen’s impact method (10 g x 5 cm); 3 days after injury, 20 microliters FSCS with a density of 1 x 10(5)/microliter prepared from E14 rat were injected into the epicenter of the traumatized cavity. Animals were sacrificed after 2, 4, 6, 8, 10 and 12 weeks of transplantation, the graft survival, its differentiation and integration with the host were observed by light and electronmicroscopic study as well as immunohistochemical assay (NF, GFAP, CGRP, 5-HT). RESULTS: In the transplantation area, the neuroblasts stretched out the terminal endings 4 weeks after implantation, followed by the presenting of the pre- and postsynaptic membrane. After 8 weeks, the dense or developed projections were observed in the pre- and postsynaptic membrane; the synaptic cleft filled with the high electron dense substance. All the spherical clear vesicles, granular vesicles, elliptical vesicles and flattened-f type vesicles were seen under the electronmicroscope. After 10 weeks, the axosomatic, dendrosomatic, dendro-dendritic, axo-axonic, dendro-axonic synapses coexisted. Light microscopy showed that the graft cell grew gradually. Immunohistochemical assay showed that NF, 5-HT, CGRP and GFAP positive fibers were in the graft. Synapses, gliafibers and blood brain barrier integrated each other. CONCLUSION: (1) The transplanted FSCS can develop mature synapses with miscellaneous synaptic vesicles in the acute injured spinal cord, host injury cavity wall may induce the FSCS into 3D adhesion. (2) Co-existence of different type of synapse and the immunohistochemistry findings indicate the possibility of synaptic connection between FSCS and host.
Objective To explore immunosuppressive effect and sappan L （WECSL） in heart transplantation of rats. Methods mechanism of watery extract of caesalppinia Wistar rats （donor） heart allografts were transplanted into the abdomen of SD rats （receptor）. Ninety-six SD rats were divided into four groups （24 rats in each group）. Control group： olive oil（8ml/kg·d） treated; group A： cyclosporine A （CsA,5ml/kg·d） treated; groupB： WECSL（37.5g/kg·d） treated; group C： WECSL（25g/kg·d） plus semidose of CsA（2.5mg/kg·d） treated. Median survival time of heart allografts and the histological changes of allografts were examined. Messenger ribonucleic acid （mRNA） of interleukin-2（IL-2）, interleukinf-10（IL-10） in the myocardium were determined by reverse transcription polymerase chain reaction （RT-PCR）, serum level of IL-2 and IL-10 were determined by enzyme-linked immunosorbent assay （ELISA） at 3, 7 days after surgery. Results Compared with control group, median survival time of heart allografts in group A, group B, group C was prolonged （P〈0. 01）, lymphocyte infiltration and myocyte necrosis were relieved, mRNA expression of IL-2 in allografts was lower, mRNA expression of IL-10 was higher （P〈0.01）. The serum levels of IL-2 in group A 3,7days after surgery and in group B, group C 3 days after surgery was lower than that in control group （P〈0.01）. The serum levels of IL-10 in group A 7days after surgery and in group B 3 days after surgery was higher than that in control group （P〈0. 05）. Conclusion Acute rejection of rat heart transplantation can be effectively suppressed by WECSL, Th1 to Th2 polarization induced by WECSL is observed.
Objective To explore an effective way fortreating severe complicated distal femoral fractures. Methods Twenty-six patients with complicated distal femoral fracture who all belonged to 33C3.3type according to AO/ASIF lassification, were treated with a lateral condylar buttress plate or self-desinged aliform anatomical plate, and operated on with allogeneic bone grafting. Results All cases were followed up for an average of 14 months (ranging 5-25 months). Twenty-four wounds were primary healing postoperatively, 2 wounds were infected and healed after dressing change. Twenty-four had bone healing after 411 months, 2 needed to operate again because of earlier weight-bearing resulting in fixation failure. According to shelbourne and Brueckmann score, the excellent and good rate was 88.46%. Conclusion The internal fixation forcomplicated distal femoral fracture by self-designed aliform anatomical plate and lateral condylar buttress plate with a great deal of allograft bone is an effective surgical method. As it has long oval holes and the holes are consecutive ,the aliform anatomical plate is more suitable for severe complicated fractures. At the same time, autogenous-ilium transplantation can be substituted by the allograft bone.
Objective To investigate the feasibility of imaging of bone marrow mesenchymal stem cells (BMMSCs) labeled with superparamagnetic iron oxide(SPIO) transplanted into coronary artery in vivo using magnetic resonance imaging (MRI), and the redistribution of the cells into other organs. Methods BMMSCs were isolated, cultured from bone marrow of Chinese mini swine, and double labeled with SPIO and CMDiI(Cell TrackerTM C-7001). The labeled cells were injected into left anterior descending coronary artery through a catheter. The injected cells were detected by using MRI at 1 week,3weeks after transplantation. And different organs were harvested and evaluated the redistribution of transplanted cells through pathology. Results The SPIO labeled BMMSCs injected into coronary artery could be detected through MRI and confirmed by pathology and maintained more than 3 weeks. The SPIO labeled cells could be clearly imaged as signal void lesions in the related artery. The pathology showed that the injected cells could be distributed into the area of related artery, and the cells injected into coronary artery could be found in the lung, spleen, kidney, but scarcely in the liver, the structures of these organs remained normal. Conclusion The SPIO labeled BMMSCs injected into coronary artery can be detected by using MRI, the transplanted cells can be redistributed into the non-targeted organs.
Objective To investigate the protection on the intrahepatic cholangiocyte mediated by hypoxic preconditioning (HP) after liver transplantation and the role of vascular endothelial growth factor (VEGF). Methods The model of autologous liver transplantation was established, and the rats were divided into 3 groups: autologous liver transplantation group, hypoxic preconditioning before operation group (HP group) and sham operation group. At 6, 12, 24, 48 h after operation, blood samples were collected for examination of the serum total bilirubin (TBIL), direct bilirubin (DBIL) and alkaline phosphatase (ALP), and the expression of VEGF was detected by immunohistochemical method. The pathological changes of cholangiocytes were observed by light microscope. Results As compared with autologous liver transplantation group, the levels of seurm TBIL, DBIL and ALP in HP group were lower (P＜0.05), while the expression of VEGF in HP group was higher at the whole process (P＜0.05). The degrees of billiary epithelium damage and inflammatory infiltration in autologous liver transplantation group were more severe than those in HP group. Conclusion HP has protective effect on cholangiocytes after liver transplantation, in which VEGF may play an important role.
