SIDE-TO-SIDE MESOCAVAL SHUNT IN PORTAL HYPERTENSION

Eighty-five consecutive patients underwent sideto.side mesocaval shunt with a success rate of 98.8'7。and 30day hospital mortality of 2.5"/o. Of 80 casesfollowed up for 3 months t0 8 years, 8 died, 3 hadencephalopathy, 5 rebleeding, 2 ascites and 3 lowerleg edema. A long history of hepatitis and liverfunction impairment were common features of dyingpatients. Rebleeding rate was 8.7'70. Liver functionplayed an important role in the determination of thetherapeutic effect.     

IMMUNOLOGICAL STUDIES ON THROMBOANGIITIS OBLITERANS

Using humoral immunity (gamma-globulin 18 cases, IgG, IgA, IgM each 30 cases, CH50, C3, C4 each 29 cases and CIC 31 cases), cellular immunity (E-RFC 68 cases, As 30 cases, SmIg, SmIgG each 18 cases, IMIT 30 cases) and immunopathological manifestations (light microscope, fluorescence microscope, transmitted electron microscope each 7 cases) as indices, we studied the immunological changes of "progressing", "remittent" and "stabilized" groups of patients with thromboangiitis obliterans (TAO) in different stages. Humoral immunity indicated that gamma-globulin, immune complex and IgG were all increased; cellular immunity indicated that the rate of T cells and suppressor cells was declined, while that of B cells was elevated. Immunopathologically, under light microscope all the layers of involved vessels were infiltrated with neutrophils, lymphocytes and monocytes; under fluorescence and electron microscope, immune complexes were found in the involved vessel walls. Our preliminary results suggest that TAO is an autoimmune disease relevant to antigen-antibody complex.     

CLINICOPATHOLOGICAL CONFERENCE A 51-YEAR-OLD MAN WITH PALPITAT10N, SHORT BREATH, CYANOSIS AND SUFFOCATION

A 51-year-old man was admitted to our hospital on January 23, 1985 because of pal- pitation and short breath for 40 years. He was well until 7 years of age. Then he devel- oped symptoms ofpalpitation and shortbreath with cyanosisafter exercises. Relief of the symptoms would be achieved by squat- ting for a while or taking a few minutes' rest. Later, his growth was retarded. In 1960 he developed clubbing fingers. In 1965 when hospitalized for tonsillectomy, he was sus- pected of having "congenital heart disease" with ventricular septal defect, stenosis of the pulmonary artery and Eisenmengeris syndrome in question. In 1966, cardiac catheterization was performed, showing that the partial pressure of blood oxygen was l.85 vol%, higher in the right ventricle than in the left auricle. This means there exists a left to right shunt and the magnitude of shunt is 24.0% of the pulmonary circulation. The blood oxygen saturation in the f'emoral artery is a little bit low (93.5%). The hemoglubin concentration is (180g/l). Bilateral shunt could not be excluded.Since August 1969, he began to be very often troubled by nocturnal dyspnea, cough and chest distress. These symptoms could be abated by the treatment of aminophytlline. In 1976, ultrason- ocardiography revealed ventricular septal de- fect and aortic insufficiency. In May 1984. he had high fever for several days and was sus- pected of having "bacterial endocarditisu. The fever subsided with antibiotic therapy for a few db.ys. Twenty days before this hosptalization he had chest distress, short breath, palpitation, cyanosis, nocturnal dyspnea and paroxysmal precordial pain af- ter getting cold.     

TREATMENT OF HYALINEMEMBRANE DISEASE BYHUMAN AMNIOTIC FLUIDSURFACTANT

A case of hyaline membrane disease was treated successfully with pulmonary surfactant (PS) isolated from human amniotic fluid. Dosage was 150 mg phospholipid/kg. The exogenous surfactant was instilled into the airway via a tracheal cannula. Clinical symptoms, PO2 and FiO2 improved evidently 24 hours after administration. L/S ratio and phosphatidylglycerol recovered gradually in aspirates. Lung X-ray film manifested "white lung" before instillation of surfactant and showed a striking improvement 3 days after treatment. The duration of mechanical ventilation was 6 days. During the period of recovery complications of patent ductus arteriosus and bacterial pneumonia developed. However, the patient recovered completely and was discharged 32 days after admission.     

Region-specific growth properties and trophic requirements of brain- and spinal cord-derived rat embryonic neural precursor cells

To determine whether neural precursor cells have region-specific growth properties, we compared the proliferation, mitogenicity, and differentiation of these cells isolated from the embryonic day 16 rat forebrain and spinal cord. Neural precursor cells isolated from both regions were cultured in growth medium supplemented with epidermal growth factor, basic fibroblast growth factor, or epidermal growth factor+basic fibroblast growth factor. Under all three conditions, both neural precursor cell populations proliferated for multiple passages. While spinal cord-derived neural precursor cells proliferated moderately faster in epidermal growth factor-enriched growth medium, brain-derived cells proliferated much faster in basic fibroblast growth factor-enriched growth medium. When exposed to both epidermal growth factor and basic fibroblast growth factor, the two neural precursor cell populations expanded and proliferated more rapidly than when exposed to a single factor, with brain-derived neural precursor cells expanding significantly faster than spinal cord-derived ones (P<0.0001). Differentiation studies showed that both neural precursor cell populations were multi-potent giving rise to neurons, astrocytes, and oligodendrocytes. However, neuronal differentiation from brain-derived neural precursor cells was greater than spinal cord-derived ones (11.95+/-5.00% vs 1.92+/-1.13%; passage 2). Further, the two neural precursor cell populations differentiated into a similar percentage of oligodendrocytes (brain: 8.66+/-5.85%; spinal cord: 7.69+/-3.91%; passage 2). Immunofluorescence and Western blot studies showed that neural precursor cells derived from both regions expressed receptors for basic fibroblast growth factor and epidermal growth factor. However, brain-derived neural precursor cells expressed higher levels of the two receptors than spinal cord-derived ones in growth medium containing epidermal growth factor+basic fibroblast growth factor. Thus, our results showed that neural precursor cells isolated from the two regions of the CNS have distinct properties and growth requirements. Identifying phenotypic differences between these neural precursor cell populations and their growth requirements should provide new insights into the development of cell therapies for region-specific neurological degenerative diseases.     

Evaluation and selection of candidates for renal transplantation at the Clinical Hospital Center in Rijeka

On December 31, 2001, 2486 patients with terminal renal failure received dialysis treatment in Croatia. Only one third of the patients are registered on the national waiting list for cadaveric kidney transplant. In most of the others, transplantation is impossible because of comorbidity. This is mainly due to the steadily growing age of the dialytic population and therefore a higher incidence of cardiovascular disease and diabetes. Still, evaluation of the potential recipients of cadaveric kidney transplant, registered on the waiting list, often reveals contraindications for transplantation. The aim of this study was to determine the incidence and type of contraindications in transplant candidates, found during immediate preoperative evaluation. Analysis of these data should help in determining how contraindications can be early detected and prevented. Before registering onto the national waiting list transplant candidates need to be thoroughly investigated including detailed history, physical examination, routine diagnostic procedures and additional examinations, if needed, to exclude or evaluate the possibly existing contraindications for transplantation. During the period from January 1997 until June 2002, 145 potential recipients from the national waiting list were referred to the Rijeka University Hospital Center and evaluated for kidney transplantation. Eighty-eight patients underwent transplantation. Preoperative evaluation revealed contraindications for transplantation in 52 (35.9%) candidates. Twenty-two (15.2%) patients had a positive cross-match with donor lymphocytes, 6 (4.1%) patients refused transplantation, and in 24 (16.6%) patients serious comorbidity was the reason for not being accepted for transplantation and for their withdrawal from the national waiting list. Comorbidity was mainly due to cardiovascular disease (12 patients--8.3%) and infection (8 patients--5.5%). These data show a high incidence of contraindications found during the immediate preoperative evaluation of potential kidney recipients. It was the case in more than one third of patients. During the evaluation of potential candidates for kidney transplantation special attention should be addressed to the presence of cardiovascular morbidity and infection. Peripheral vascular occlusive disease, cardiac status and/or cerebrovascular disease should be evaluated. Measures used to treat or reduce the development of complications include an optimal control of blood pressure, serum phosphate, hyperparathyroidism, dyslipidemia, and renal anemia. The sites of infection must be treated and eradicated, because immunosuppressive treatment is a threat to the transplant recipient's life. The second most common cause of refusal of potential candidates was a positive cross-match with donor lymphocytes. Sensitization to human leukocyte antigens can be prevented by the avoiding of blood transfusions and use of erythopoietin in treating renal anemia. To minimize the morbidity and mortality, the potential kidney recipients should undergo rigorous selection and thorough evaluation before including them into the waiting list for kidney transplantation. Afterwards, regular examinations are obligatory to reveal contraindications, proceed to medical interventions and treat concomitant diseases in time, which can influence the patient's survival. In case that contraindications for transplantation arise, the patient must be temporarily or definitely removed from the waiting list.     

Evaluation of anti-parvovirus B19 activity in sera by assay using quantitative polymerase chain reaction

Human parvovirus B19 (B19) infects cells of erythroid lineage. Production of neutralizing antibodies (Abs) is indispensable for recovery from B19-related disease state. In this study, we used a convenient method to measure neutralizing activities in human sera by using a real-time quantitative PCR based assay. Erythroid cell line KU812Ep6 was incubated with test sera before infection with B19 virus. The copy number of B19-DNA in cultures was decreased in the presence of the sera from patients who recovered from acute B19 infection, whereas no decrease in B19-DNA was in cultures incubated with sera from healthy volunteers who had no B19 infection. The decrease in B19-DNA copy number was calculated and the inhibition percentage was expressed as neutralizing activity to B19. A clinical study showed that the levels of neutralizing ability were high in patients who recovered soon after acute B19 infection, but were low in some patients with a prolonged clinical course for recovery from B19 infection. This method is simple and convenient compared with methods described previously, showing its usefulness to evaluate the neutralizing activity to B19.     

Analysis of the HLA-A,-B allele polymorphism in 5844 umbilical cord blood samples taken from Han population of Shandong province

To investigate the HLA-A, -B allele polymorphism in Han population of Shandong province and to explore the possibility to find out the HLA-A, -B-matched cord blood donors for stem cell transplantation to be used in other area in China, 5844 umbilical cord blood samples were taken from Han population donors of Shandong province, and assayed with PCR-sequence-oligonucleotide (PCR-SSO) assay. In Shandong Han donors, 20 alleles at HLA-A locus and 46 alleles at HLA-B locus could be detected as revealed in the present study. Among the 20 alleles at HLA-A locus, the most prevalent five alleles included A * 02(0.3041), A * 11(0.1443), A * 24(0.1434), A * 30(0.0975) and A * 33(0.0859), while, the alleles with lower gene frequencies included A * 34(0.0006), A * 25 (0.0005), A*66(0.0005), A* 74(0.0004) and A* (0.0001). Of the 46 HLA-B alleles detected, the most prevalent five alleles were B * 13(0.1348), B * 51(0.0713), B * 62(0.0712), B * 61 (0.0676) and B * 60(0.0642); while alleles with lower gene frequencies included B * 77(0.0001), B * 76(0.0002), B * 47(0.0003), B * 42(0.0003) and B * 72(0.0004). In comparison with those of the other Han population in China, the HLA-A, -B gene frequencies in the umbilical cord blood of Shandong province possess unique distribution features among the investigated populations from various regions of the same race origin, and the differences in various regions of the same race were less than those among the different race. It is evident that the HLA-A,-B alleles of the umbilical cord blood taken in Shangdong province show high degree of polymorphism, and it might be part of those of Northern Han population in China. So, it is reasonable for patients of Northern Chinese to receive HLA class I -match transplant of cord blood stem cells for tissue and organ transplantation from Shangdong umbilical cord blood bank.     

Genome-scale reconstruction of the Saccharomyces cerevisiae metabolic network

The metabolic network in the yeast Saccharomyces cerevisiae was reconstructed using currently available genomic, biochemical, and physiological information. The metabolic reactions were compartmentalized between the cytosol and the mitochondria, and transport steps between the compartments and the environment were included. A total of 708 structural open reading frames (ORFs) were accounted for in the reconstructed network, corresponding to 1035 metabolic reactions. Further, 140 reactions were included on the basis of biochemical evidence resulting in a genome-scale reconstructed metabolic network containing 1175 metabolic reactions and 584 metabolites. The number of gene functions included in the reconstructed network corresponds to approximately 16% of all characterized ORFs in S. cerevisiae. Using the reconstructed network, the metabolic capabilities of S. cerevisiae were calculated and compared with Escherichia coli. The reconstructed metabolic network is the first comprehensive network for a eukaryotic organism, and it may be used as the basis for in silico analysis of phenotypic functions.