Comparison Between Living Donor Liver Transplantation Recipients Who Met the Milan and UCSF Criteria After Successful Downstaging Therapies

Background and Aims

Various downstaging therapies were introduced to liver recipients who could not meet the relative criteria for liver transplantation, and many endpoints were reported. The most common criteria used were the Milan criteria and the University of California, San Francisco (UCSF) criteria. However, no comparison was made between them, and we attempted to find possible differences between the living donor liver transplantation (LDLT) patients who met the Milan criteria and those who met the UCSF criteria after accepting preoperative downstaging therapies.

Materials and Methods

We performed a retrospective study of all 72 patients at our center from January 2003 to March 2009 who were diagnosed with advanced hepatocellular carcinoma but accepted various downstaging therapies. Some patients met the Milan criteria (group 1), and some met the UCSF criteria (group 2) but not the Milan criteria. We collected the data from the two groups and then compared the preoperative demographic data, downstaging therapies, intraoperative data from LDLT, and the recovery and complications after LDLT. Survival rates were compared using Kaplan?CMeier analysis.

Results

Only 44 patients (61.1?%) met the criteria for liver transplantation, 21 cases met the Milan criteria (group 1), and 23 cases met the UCSF criteria (group 2) but not the Milan criteria. All of the 44 patients accepted right lobe living liver donor liver transplantation in our center. The difference in the baseline characteristics between the two groups did not reach statistical significance. The mean number of downstaging treatments per patient was 1.81?±?0.35 in group 1 and 1.83?±?0.41 in group 2 (P?=?0.928). Most of the patients received only one downstaging treatment, and transcatheter arterial chemoembolization (TACE) was the most common downstaging therapy. Four patients suffered complications after downstaging therapies: intra-abdominal hemorrhage after right hepatectomy, upper gastrointestinal hemorrhage after TACE, biliary fistula after resection, and hand?Cfoot syndrome after taking sorafenib. All complications after LDLT, classified according to the Clavien?CDindo system, were compared within the two groups, and the calculated score of the complications in group 1 was 1.48?±?1.63, which was greater than that of group 2 (1.39?±?1.64), but this difference did not reach statistical significance (P?=?0.865). The 1-, 3-, and 5-year survival rates were 90.4, 76.2, and 71.4?% in group 1 and 91.3, 73.9, and 69.6?% in group 2, respectively (P?>?0.05). Seven patients (three in group 1 and four in group 2) had tumor recurrence after a median follow-up period of 72?months. The pathology findings were not different between the two groups.

Conclusion

Recipients who meet the Milan or UCSF criteria after accepting successful preoperative downstaging therapy in LDLT can achieve the same result.     

单鼻孔直入经筛骨垂直板后段经蝶入路切除垂体腺瘤

目的 介绍、推广单鼻孔直入经筛骨垂直板后段经蝶入路切除垂体腺瘤的手术经验，探讨该术式的优越性。方法 2001年10月以来对43例垂体腺瘤采用单鼻孔直入经筛骨垂直板后段经蝶入路手术。结果 本组无手术死亡，平均住院时间1周。随访3～25个月。MR复查示肿瘤全切除32例，近全切除9例，大部分切除2例。有内分泌症状的37例中．10例恢复正常，15例改善，12例同术前。结论 单鼻孔直入经筛骨垂直板后段经蝶手术最大限度地利用了鼻腔的自然间隙，入路直接．手术时间短．创伤轻微．并发症较少．是目前最为理想的经蝶手术术式．     

多联袋无菌制备脐带血间质干细胞的方法及效果

目的:分析人脐带血间质干细胞分离培养方法及临床应用的安全性。方法:实验于2005-04/12在河南省红十字血液中心和郑州市第二人民医院完成。实验方法:①无菌条件下将脐带血液采集到无菌采血袋内,产妇及其家属均知情同意,并经医院伦理委员会批准。随机抽查62份样本,单份采集量80～160mL,计数有核细胞。②以1:1体积比将Ficoll-Hypaque混合溶液加入四联袋主袋内,将四联袋与脐带血收集袋相连,再将样本血液沿袋壁缓慢加入四联袋主袋内的液面上。离心后将四联袋主袋放在分浆夹上,袋内液体自上而下分为血浆血小板层、单个核细胞层、淋巴细胞分离液层、多核细胞层、红细胞层5层。将血浆血小板层上2/3液体挤压入四联袋一空袋内,将剩余的血浆血小板层、单个核细胞层、淋巴细胞分离液层上部挤压入四联袋另一空袋内,即为富含有核细胞液体。③随机选择本院2005-04/12收治脑卒中后遗症患者10例。男9例,女1例,35～75岁,病程3个月～7年。诊断均由CT、MRI检查证实,符合第四届全国脑血管病学术会议修订的脑卒中诊断标准,患者均对治疗方案知情同意。将脐带血间充质干细胞经静脉输注入患者体内,每次输注1份,每例患者平均输注6份,每份间隔时间平均4d。于治疗前和治疗3个月后评价患者神经功能状态、肢体运动功能及日常生活活动能力。采用脑卒中患者临床神经功能缺损程度评分标准评估神经功能,分数越低,神经功能状态越好;采用Fugl-Meyer评估患侧肢体运动功能,分数越高,肢体运动功能越好;采用Barthel指数评估日常生活活动能力,分数越高,日常生活活动能力越高。结果:①分离的62份脐血间质干细胞,每份含有有核细胞(3.62±2.39)×109,红细胞残余量为(1.64±1.25)×109,CD34 细胞的比率为(2.31±0.93)%,CD133 的比率为(1.36±1.23)%。培养7d后贴壁细胞为(3.27±1.85)×107,CD133 比率为(8.21±2.46)%。②患者治疗前与治疗3个月后相比,神经功能状态、肢体运动功能及日常生活活动能力评分均明显升高(治疗前:25.40±6.09,31.90±21.85,36.20±19.41;治疗后:1.90±5.09,80.9±25.00,81.10±15.93,P<0.01)。未发现免疫排斥及不良反应。结论:①利用多联袋无菌制备脐血间质干细胞分离效果良好,分离过程在密闭系统进行,单个核细胞和间质干细胞能满足临床需要,适合患者静脉输注和局部直接应用,方法简便安全可靠。②经静脉输注后,疗效确切,能明显改善脑卒中后遗症作用。     

The collection and evaluation of peripheral blood progenitor cells sufficient for repetitive cycles of high-dose chemotherapy support

BACKGROUND: The development of an optimized peripheral blood progenitor cell (PBPC) harvest protocol to provide support for repetitive chemotherapy cycles is described. STUDY DESIGN AND METHODS: PBPCs mobilized by cyclophosphamide plus granulocyte-colony-stimulating factor (G-CSF) were studied in 163 leukapheresis harvests from 26 lymphoma patients. Harvested cells were transfused with two chemotherapy cycles and with an autologous bone marrow transplant. Progenitor cell content was examined in the context of hematopoietic engraftment. RESULTS: Mobilization allowed the harvest of large numbers of PBPCs. Peak harvests tended to occur after the recovering white cell count exceeded 10 × 10(9) per L. CD34+ lymphomononuclear cell (MNC) and colony-forming units-granulocyte-macrophage (CFU-GM) counts correlated poorly, but both measures peaked within 24 hours of each other in 21 of 26 patients, which demonstrated PBPC mobilization. Engraftment of platelets (> 50×10(9)/L) and granulocytes (> 500×10(6)/L) was achieved in a median of 20.5 and 16 days, respectively. A minimum number of progenitors necessary to ensure engraftment could be derived. CONCLUSION: Cyclophosphamide and G-CSF allowed the harvest of sufficient PBPCs to support multiple rounds of chemotherapy. Harvest should commence when the recovery white cell count exceeds 10×10(9) per L. PBPC harvest CD34+MNC counts are as useful as CFU-GM results in the assessment of PBPC content, and they may allow harvest protocols to be tailored to individual patients.     

雄激素受体基因第一外显子区CAG缺失的构建及其在HEK293细胞中的表达

目的：构建雄激素受体基因第一外显子区CAG重复序列缺失的突变重组体，观察CAG重复序列的有，无对雄激素受体转录及表达的调控作用。方法：实验于2006—05／2007—05在解放军总医院老年医学研究所完成。按照重叠延伸反应的原理扩增CAG重复序列两端的基因片段，再将两片段混合，在加入一个引物的情况下进行8个PCR循环以有效完成重叠延伸，然后再加入另一引物进行22个循环，完成目的片段指数扩增，将目的片段克隆至真核表达载体PAR-IRES2-EGFP，转染HEK293细胞，采用Western blot法检测HEK293细胞雄激素受体蛋白。结果：构建的CAG重复序列缺失的突变重组体经酶切鉴定和DNA测序证实构建正确，转染真核细胞可检测到雄激素受体基因的表达。结论：重叠延伸PCR是进行体外基因拼接、体外缺失突变的简单、快速的基因重组技术；雄激素受体基因第一外显子区CAG重复序列缺失的突变重组体的成功构建可为今后的相关研究提供实验基础。     

A randomized trial on the efficacy of an autologous blood drainage and transfusion device in patients undergoing elective knee arthroplasty

The purpose of the study reported here was the determination of the efficacy of a postoperative autologous blood drainage and transfusion device in reducing allogeneic red cell requirements in patients undergoing elective knee arthroplasty. The study was a randomized controlled trial with adult patients undergoing unilateral elective arthroplastic knee surgery. Patients underwent suction drainage, attached to an autologous blood drainage and transfusion device, or standard suction drainage. Allogeneic red cells were given according to strict transfusion guidelines based on blood loss and postoperative hemoglobin values. Outcome measures included the mean number of allogeneic red cell concentrates required and the number of patients in each group who required no transfusion. Patients assigned to standard suction drainage had a mean allogeneic red cell utilization of 1.2 units (SD 1.0), as compared to a mean of 0.4 units (SD 0.8) in the group undergoing drainage with the autologous blood drainage and transfusion device (p = 0.0007). The percentage of patients not requiring allogeneic red cells was significantly higher in the latter group (74.3% vs. 32.5%; p = 0.002). The postoperative drainage and transfusion device was efficacious in reducing the amount of allogeneic red cells required by patients undergoing knee arthroplasty, and its use resulted in a 42 percent reduction in the number of patients requiring allogeneic transfusion.