Protective effect of nitric oxide on hepatopulmonary syndrome from ischemia-reperfusion injury

AIM: To evaluate immunological protection of nitric oxide (NO) in hepatopulmonary syndrome and probable mechanisms of ischemia-reperfusion (IR) injury in rat liver transplantation.METHODS: Sixty-six healthy male Wistar rats were randomly divided into three groups (11 donor/recipient pairs). In group II, organ preservation solution was lactated Ringer’s solution with heparin 10  000/μL at 4 °C. In groups I and III, the preservation solution added, respectively, L-arginine or N^G-L-arginine methyl ester (L-NAME) (1 mmol/L) based on group II, and recipients were injected with L-arginine or L-NAME (50 mg/kg) in the anhepatic phase. Grafted livers in each group were stored for 6 h and implanted into recipients. Five rats were used for observation of postoperative survival in each group. The other six rats in each group were used to obtain tissue samples, and executed at 3 h and 24 h after transplantation. The levels of alanine aminotransferase (ALT), tumor necrosis factor (TNF)-α and NO metabolites (NOx) were detected, and expression of NO synthase, TNF-α and intercellular adhesion molecule 1 (ICAM-1) was examined by triphosphopyridine nucleotide diaphorase histochemical and immunohistochemical staining.RESULTS: By supplementing L-arginine to strengthen the NO pathway, a high survival rate was achieved and hepatic function was improved. One-week survival rate of grafted liver recipients in group I was significantly increased (28.8 ± 36.6 d vs 4 ± 1.7 d, P < 0.01) as compared with groups II and III. Serum levels of ALT in group I were 2-7 times less than those in groups II and III (P < 0.01). The cyclic guanosine monophosphate (cGMP) levels in liver tissue and NOx in group I were 3-4 times higher than those of group II after 3 h and 24 h reperfusion, while in group III, they were significantly reduced as compared with those in group II (P < 0.01). The levels of TNF-α in group I were significantly lower than in group II after 3 h and 24 h reperfusion (P < 0.01), while being significantly higher in group III than group II (P < 0.01). Histopathology revealed more severe tissue damage in graft liver and lung tissues, and a more severe inflammatory response of the recipient after using NO synthase inhibitor, while the pathological damage to grafted liver and the recipient’s lung tissues was significantly reduced in group I after 3 h and 24 h reperfusion. A small amount of constitutive NO synthase (cNOS) was expressed in liver endothelial cells after 6 h cold storage, but there was no expression of inducible NO synthase (iNOS). Expression of cNOS was particularly significant in vascular endothelial cells and liver cells at 3 h and 24 h after reperfusion in group II, but expression of iNOS and ICAM-1 was low in group I. There was diffuse strong expression of ICAM-1 and TNF-α in group III at 3 h after reperfusion.CONCLUSION: The NO/cGMP pathway may be critical in successful organ transplantation, especially in treating hepatopulmonary syndrome during cold IR injury in rat orthotopic liver transplantation.     

Knockdown of liver-intestine cadherin decreases BGC823 cell invasiveness and metastasis in vivo

AIM: To assess BGC823 gastric cancer (GC) cell metastasis after knockdown of liver-intestine cadherin (CDH17) and the therapeutic value of CDH17-RNAi-lentivirus in vivo.METHODS: We evaluated primary tumor growth and assessed local infiltration and systemic tumor dissemination using an orthotopic implantation technique. The therapeutic value of CDH17 knockdown was examined by intratumoral administration of CDH17-RNA interference (RNAi)-lentivirus in an established GC tumor xenograft mouse model. Furthermore, a comparative proteomic approach was utilized to identify differentially expressed proteins in BGC823 and lenti-CDH17-miR-neg cells following CDH17 knockdown.RESULTS: Metastases in the liver and lung appeared earlier and more frequently in animals with tumors derived from BGC823 or lenti-CDH17-miR-neg cells than in tumors derived from lenti-CDH17-miR-B cells. Average tumor weight and volume in the CDH17-RNAi-lentivirus-treated group were significantly lower than those in the control group (tumor volume: 0.89 ± 0.04 cm³ vs 1.16 ± 0.06 cm³, P < 0.05; tumor weight: 1.15 ± 0.58 g vs 2.09 ± 0.08 g, P < 0.05). Fifteen differentially expressed proteins were identified after CDH17 silencing in BGC823 cells, including a variety of cytoskeletal and chaperone proteins as well as proteins involved in metabolism, immunity/defense, cell proliferation and differentiation, cell cycle, and signal transduction.CONCLUSION: Our data establish a foundation for future studies of the comprehensive protein expression patterns and effects of CDH17 in GC.     

Placement of removable metal biliary stent in post-orthotopic liver transplantation anastomotic stricture

Postoperative biliary strictures are the most common cause of benign biliary stricture in Western countries, secondary to either operative injury or bile duct anastomotic stricture following orthotopic liver transplantation(OLT).Surgery or endoscopic interventions are the mainstay of treatment for benign biliary strictures.We aim to report the outcome of 2 patients with refractory anastomotic biliary stricture post-OLT,who had successful temporary placement of a prototype removable covered self-expandable m...     

Positron emission tomography/computed tomography in patients with hepatocellular carcinoma undergoing liver transplantation. Useful,necessary or irrelevant?

Hepatocellular Carcinoma (HCC) is an aggressive tumor entity, with the only curative options being surgical resection or orthotopic liver transplantation (OLT). The presence of one single tumor nodule of less than 5 centimeters diameter or a maximum of 3 nodules, with the largest of these not exceeding 3 centimeters (Milan criteria) constitute the clinical situation in which the best results for OLT in patients with HCC have been achieved. The survival of patients fulfilling the Milan criteria after transplantation is comparable to patients with similar tumor stages without cirrhosis, undergoing hepatic resection. The application of PET in oncology has become increasingly common in the last decade as it is a non-invasive tool that also gathers information about the degree of the biological aggressiveness of the tumor. The objective of this study was to perform a review of the literature, identifying the strengths and weaknesses of the PET as a prognostic tool in patients with HCC after OLT.     

原位肝移植前后胆道及血管的磁共振成像评估*

背景：磁共振成像扫描技术的完善，实现了“一站式”磁共振综合检查，即1次检查过程中运用多种序列，同时对肝脏血管、胰胆管系统及上腹部器官进行影像评估，方便、快速、简捷。 目的：评价磁共振成像检查在肝移植前后的应用价值。 方法：选择中南大学湘雅三医院移植中心收治的肝硬化及肝癌患者38例，男27例，女11例，年龄23~68岁。原位肝移植前后进行磁共振成像检查，同时行双排螺旋CT检查，比较两种方法的优劣，最后以手术、病理检查结果确认。 结果与结论：所有终末期肝脏疾病患者原位肝移植前后经磁共振成像检查，能较准确地描述出肝癌病灶的情况，血管及胆道系统的异常解剖形态及其内栓子和结石的情况，其结果明显优于双排螺旋CT检查。说明磁共振成像在肝移植前评估和移植后并发症早期发现中有非常重要的作用。     

C57BL/6小鼠前列腺癌原位细胞移植动物模型的建立

目的 建立一种C57BL/6小鼠前列腺癌原位细胞移植动物模型.方法 C57BL/6小鼠30只,用微量注射器分别将0.5×106个RM-1细胞注射入前列腺左、右背侧叶包膜下.每3 d随机处死5只小鼠,动态观察小鼠前列腺癌局部生长、盆腔淋巴结转移和器官转移;术后15 d处死小鼠后,剩余5只常规饲养直至死亡,观察小鼠的平均荷瘤生存期.结果 C57BL/6小鼠前列腺原位移植RM-1细胞后第3、6、9、12、15天前列腺体积组间差异有统计学意义(P＜0.01);术后第12天开始,出现明显尿潴留、双侧或单侧输尿管扩张、肾脏体积增大、肾盂扩张;组织学观察发现术后前列腺癌细胞逐渐取代正常的前列腺组织,术后第12天组可见肿瘤侵犯周围肌肉,术后第15天组可见肿瘤侵犯精囊和膀胱.术后第3、6、9天未见明显盆腔淋巴结转移,第12、15天盆腔淋巴结转移率均为80%.各组均未发现明显的远处器官转移.各组小鼠成瘤率均为100%.小鼠平均荷瘤生存期为(15.60±0.89)d.结论 虽然未见明确的器官转移情况,但该模型能够较好的模拟人类前列腺癌的发生、发展、局部侵袭及淋巴转移的过程,是一种较理想的前列腺癌动物模型.

Abstract：

Objective To investigate the regularity in establishing the prostate cancer orthotopic transplantation model in C57BL/6 mice. Methods RM-1 cells (0.5×106)were injected into the right and left dorsal lateral prostate capsules of 30 C57BL/6 male mice respectively using micro-syringe. Five mice were sacrificed every three days to observe the local growth, the occurrence and development of prostate cancer, and the remaining five mice were fed to death to calculate the average survival period of tumorbearing mice. Results The volume of prostates was significantly different among the five groups. From the 12th day, significant retention of urine, ureterectasia (bilateral or unilateral ), increased kidney volume and pelviectasis were observed. The rate of tumor formation in the five groups which included the 3rd, 6th,9th, 12th d and 15th day was all 100%. HE staining showed that prostate cancer cells gradually replaced the normal prostate tissue. At the 12th day, muscle tissue around prostate was invaded by prostate cancer.In some samples there was metastasis of seminal vesicles and bladder at the 15th day. The rate of metastasis in pelvic lymph nodes at the 12th or 15th day was 80%. The average survival period of tumor-bearing mice was (15.60±0.89) days. Conclusion The prostate cancer orthotopic transplantation model in C57BL/6 mice can better simulate the process of occurrence, development, local invasion and lymph node metastasis of human prostate cancer and be suitably used as a model of prostate cancer research.     

原位肠代膀胱术95例报告

目的寻求理想的原位尿流改道术式。方法回顾性分析我院自1986—2005年四种原位肠代膀胱术95例临床资料和随访结果。结果术后随访77例。3个月时回肠袋膀胱在膀胱容量、囊内压及可控率方面优于去带盲升结肠膀胱（P〈0．01），12月后无差别（P〉0．05）。保留神经组白天和夜间可控率优于非保留神经组，二者差别有显著意义（P〈0．01）。去带盲升结肠膀胱组平均输血量、建囊时间及与囊有关的并发症明显少于回肠袋膀胱组（P〈0．01）。去带盲升结肠膀胱组和回肠袋膀胱组术后近远期并发症为（10．0％；18．4％）和（14．3％；21．4％）。结论去带盲升结肠贮尿囊具有手术操作相对简单，并发症少的特点。保留神经膀胱全切原位去带盲升结肠膀胱术可以提高术后控尿功能，是一种较理想的尿流改道术式。     

腹腔镜下原位回肠新膀胱术后并发症的护理

膀胱肿瘤是泌尿系统最常见的肿瘤，在我国发病率居泌尿系肿瘤首位。目前腹腔镜膀胱全切除原位回肠新膀胱术已成为无远处转移的浸润性膀胱癌的首选治疗方法。患者在进行根治性切除后，用其回肠段制成一个新膀胱，让患者保留经原尿道排尿的功能，使患者术后能从尿道自控排尿。