BACKGROUND: Transplantation of organs is a well-known and accepted life-saving procedure for end-stage kidney, liver, heart and lung diseases. The insufficient number of donor organs limits the application of this technique and leads to unnecessary loss of life. Experimental techniques such as xenotransplantation are extremely important to determine new methods of creating organ availability.
DATA SOURCES: A literature search of Pubmed database was conducted and research articles reviewed.
RESULTS: Xenotransplantation is a progressive field of research. Human complement regulatory protein (hDAF)transgenic pigs and new immunosuppressive strategies that reduce xenoreactive αgal antibodies, have decreased rates of acute vascular rejection. Transplantation of α-1, 3-galactosyltransferase knock-out pig organs into baboons has resulted in the longest graft survival to date. Coagulation pathways have been identified as having a role in graft rejection. In vitro studies of porcine endogenous retroviruses (PERVs) show encouraging results that zoonosis will be less hindering to xenotransplantation than once thought.
CONCLUSIONS: Several recent advances in xenotransplantation research have brought this technique closer to clinical application. The Ethics Committee of the International Xenotransplantation Association has made recommendations to ensure maintenance of ethical standards. Advancement will depend on the development of pig models, novel immunosuppressive strategies to target the innate immune system, and new ways to create donor specific tolerance. Prevention of rejection and transmission of infectious agents remain unresolved issues. In the future, it is feasible that xenotransplantation will be used to resolve this medical dilemma.

Orthotopic liver transplantation (OLT) has evolved over the last forty years from an experimental endeavor to standard of care therapy for many patients with end stage hepatic disease.  Many technical advances have contributed to the current success of OLT, but surgical complications, especially involving the biliary reconstruction, remain a morbid problem.  Biliary complications after OLT include leaks and strictures.  Strictures may be anastomotic or intrahepatic and diffuse, as seen in cases of hepatic artery thrombosis.
Current efforts to expand the limited donor pool include the use of non-heart beating donors.  The organ procurement process in these donors entails an increased period of warm ischemia and results with non-heart beating donor grafts have been mixed.  It is now appreciated that there is an increased incidence of subsequent diffuse biliary stricturing or “ischemic cholangiopathy” in recipients of these organs.  Animal models of this phenomenon and potential therapeutic strategies targeted at ischemic cholangiopathy are being developed with potential applicability to non-heart beating donation and will be the focus of this review.

BACKGROUND: In recent years, liver transplantation (LT) has been acknowledged as an acceptable option for patients with hepatitis B virus（HBV）related end-stage liver diseases. However, HBV reinfection is an important event affecting the long-term survival of recipients. This paper was to review the risk factors related to HBV reinfection after LT.
DATA SOURCES: English literature was reviewed based on MEDLINE focusing on the potential factors related to HBV reinfection after LT.
RESULTS: HBV reinfection attributes to the unfavorable prognosis after LT. Many related factors may be responsible for it, including recipent factors (ethnical background, preoperative HBV replication status, extrahepatic HBV existence status), donor factors (compromised donor liver, HLA-A, -B compatibilities), perioperative treatment (use of antiviral agents, drug resistance, virus mutation, immunosuppressants protocol, blood transfusion) and others.
CONCLUSIONS: The successful management of HBV reinfection will only be achieved by perfect clarification of its mechanism. The new strategies include new antiviral agents, gene therapy and immune intervention, reliable use of the compromised donor livers, and so on.

BACKGROUND: In the 1990s, liver transplantation for hepatitis B virus (HBV) related-liver diseases was a very controversial issue because the graft was inevitably recurrent after liver transplantation. Significant progress has been made in the prophylaxis and treatment of recurrent hepatitis B after liver transplantation. This review covers the mechanisms, prophylaxis, and treatment of hepatitis B recurrent after liver transplantation. DATA SOURCES:  Searching MEDLINE (1995-2004) for articles on liver transplantation.
RESULTS: HBV reinfection after liver transplantation results from HBV particles in circulation or other extrahepatic sites. Hepatitis B immune globulin (HBIG) was effective in reducing HBV reinfection and improving graft survival after liver transplantation. Lamivudine has also dramatically reduced the recurrence of HBV in the patient undergoing liver transplantation.
CONCLUSIONS: Combination HBIG and lamivudine is the most effective porphylatic regimen. Lamivudine and adefovir are highly effective in treatment of HBV recurrence. HBV-related liver disease is no longer a contraindication for liver transplantation.

BACKGROUND: Most physicians in China may neglect portal vein thrombosis (PVT) in clinical practice. In fact, portal vein thrombosis is an important cause of non-cirrhotic portal hypertension. As the diversity of its clinical manifestations, misdiagnosis is common if we don’t bear PVT in mind during differential diagnosis. Therefore, we systematically reviewed PVT in terms of etiology, pathophysiology, pathology, clinical manifestations, and management.
DATA SOURCES: An English-language literature search (from 1980 to 2004) was performed using Medline and Medscape, and articles closely related to PVT were selected.
RESULTS: PVT is the second cause of portal hypertension after liver cirrhosis in western countries. Liver cirrhosis and hepatocellular carcinoma, intra-abdominal infection, thrombophilic disorders including myeloproliferative diseases are strongly associated with the development of PVT. Liver transplantation is an emerging etiological factor of PVT with the development and wide use of this technique. Gastrointestinal bleeding resulted from esophageal varices, abdominal pain, splenomegaly and hypersplenism and ascites are common manifestations of PVT. However there are differences in etiological and clinical presentations between children and adults. Diagnosis of PVT depends on imaging-studies including Doppler ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and portography. Endoscopic therapy is recommended for variceal bleeding in PVT. Anticoagulant treatment for acute PVT is widely accepted in western countries.
CONCLUSIONS: PVT may be unrecognized as the clinical manifestations are unspecific. Misdiagnosis and delayed treatment can lead to poor prognosis. Systematical collection of epidemiological and clinical data about PVT is necessary in China.

BACKGROUND: The number of split liver transplantations (SLT) has increased in the last 5 years. Regeneration after the loss of hepatic tissue is a fundamental response to liver injury. Because partial-liver grafts may not be an optimal size for recipients，the purpose of this study was to investigate the regeneration of graft liver after SLT.
METHODS: Four recipients have undergone SLT at our hospital since 2002. The graft liver volume (GLV) in the postoperative day (POD) was measured by computed tomography (CT) and the serum levels of aspartate amino-transferase (AST), alanine aminotransferase (ALT), total bilirubin (TB), prealbumin(PA)and albumin (ALB) were monitored. The GLV at different postoperative times was compared to the recipient’s standard liver volume (SLV) and the liver volume regeneration ratio (LVRR) was calculated. In order to compare SLV in recipient 2, we measured the total liver volume including the graft and the residual native liver as the GLV.
RESULTS: The GLV/SLV at POD120 and POD360 of recipient 1 was measured 114% (1159.32 cm3/1016.95 cm3), 97% (986.44 cm3/1016.95 cm3) with the LVRR being-11.0%, -24.3%, respectively. For recipient 2, it was measured 96%(927.32 cm3/965.96 cm3) and 100% (968.98 cm3/965.96 cm3), with the LVRR being 24.4%，30.0%, respectively. The initial graft volume of segment Ⅱ, Ⅲ was 265.36 cm3 and increased to 335.24 cm3 and 360.56 cm3 at POD120 and POD360, respectively, with the LVRR being 26.3% and 35.9%, respectively. The GLV/SLV at POD60 of recipient 3 was 86% (893.04 cm3/1038.42 cm3) and the LVRR was 12.0%. For recipient 4, it was 90% (567.48 cm3/630.54 cm3) whereas the LVRR was 20.0%. The serum levels of ALT, AST and TB in all recipients declined gradually and returned to normal while the serum levels of PA and ALB increased to normal. The serum levels of ALT and AST peaked within 3 days after SLT. The neurological symptoms of Wilson’s disease in recipient 2 were improved markedly. The levels of serum copper and copper-protein decreased to 30 mg/L, 120 mg/L at POD120 and the Kayser-Fleischer rings began to obliterate.
CONCLUSIONS: The size of the transplanted liver after SLT tends to converge to the standard liver volume with time and it is adequate clinically for SLT to meet the need of the body’s metabolic demands. The functional recovery of the graft liver occurs earlier than the morphological restoration.

BACKGROUND: The ability to maintain isolated human islet preparation in tissue culture has recently been adopted by most islet transplant centers to improve the safety and practicality of islet transplantation. However, maintaining islet viability and recovery remains a challenge in clinical setting. Extracellular matrix (ECM) is one of the most important components of islet microenvironment. The reconstruction of the cell-matrix relationship seems to be effective in improving the loss of differentiated islet structure and function. Small intestinal submucosa (SIS), a naturally occurring ECM, has been investigated to be able to promote wound healing, tissue remodeling, and cell growth. The purpose of this study was to evaluate the recovery and function of isolated rat pancreatic islets after in vitro culture with SIS.
METHODS: Pancreatic islets were isolated from Wistar rats by using standard surgical procurement followed by intraductal collagenase distension, mechanical dissociation, and EuroFicoll purification. Groups of purified islets were cultured in plates which were coated with multilayer SIS （SIS-treated group）or without (standard cultured group) for 7 days and 14 days in standard islet culture conditions of RPMI 1640 tissue culture media in humidified atmosphere containing 95% air and 5% CO2 at 37 ℃. The mean recovery of islets after the culture period was determined by sizing duplicate counts of a known volume and their viability was assessed by static incubation with low glucose (2.7 mmol), high glucose (16.7 mmol) and high glucose solution supplemented with 50 μm 3-isobutyl-1-methylxanthine (IBMX) solution.
RESULTS: After 7 days and 14 days of in vitro tissue culture, the SIS-treated group showed a significantly higher recovery compared with those cultured under standard conditions. The recovery in the SIS-treated group was about two times of the control group cultured in standard conditions after 14 days culture. In the SIS-treated group, there was no statistically difference between the short and long periods of culture(95.8±1.0% vs. 90.8±1.5%, P＞0.05). During incubation in high glucose (16.7 mmol) solution, there was a 2-3 fold increase in insulin secretion from both groups，but the SIS-treated group showed a higher increase than the standard cultured group after 14-day culture (20.7±1.1 mU/L vs. 11.8±1.1 mU/L, P<0.05). When islets were placed in the high glucose solution supplemented with IBMX, the stimulated insulin response in the SIS-treated group was higher than that in the standard cultured group in spite of the duration of the culture. The stimulation index of the SIS-treated group was about 2-3 times of the standard cultured group. In addition, after a long period of culture, the stimulation index of the SIS-treated group was statistically equivalent with that of the short period of culture (9.5±0.2 vs. 10.2±1.2, P＞0.05).
CONCLUSIONS: The co-culture of isolated rat islets with native sheet-like SIS can provide an excellent extracellular matrix, possible biotrophic and growth factors that promote the recovery and subsequent function of islets after in vitro tissue culture. In view of results of this study and rapid degradation of SIS in vitro, future studies will investigate the extended duration of culture and the effect of SIS on islets in vitro.

BACKGROUND: The pathogenesis of severe hepatitis B remains unknown. Reports have indicated that hepatitis B virus（HBV）mutations are important factors in the pathogenesis of this disease. This study was to investigate the genetic heterogeneity of HBV strains from serum samples of patients with fulminant hepatitis B.
METHODS: Full-length HBV genomes from 4 patients with severe hepatitis B were cloned and sequenced to observe mutations in every open reading-frame (ORF). Se-rum samples of another 25 patients with severe hepatitis B, 30 patients with chronic hepatitis B, and 25 HBV carriers were collected for sequencing and comparison of mutations in preS2, preC and core promoter regions.
RESULTS: Of 4 HBV full-length genome sequences, 3 had a G to A mutation at nucleotide A1896 in the preC region and 1 had double mutations of T1762-A1764 in the core promoter region. The 4 sequences showed mutations in the known B or T cell epitopes of the preS2 and C regions. For the other 3 groups, more mutations were seen in the preS2 region in the HBV isolates from the patients with severe hepatitis B than those from the patients with chronic hepatitis B and HBV carriers (P<0.01). There was a significant difference of mutations in the T cell epitope region of preS2 between the patients with severe hepatitis B and those with chronic hepatitis B or HBV carriers (P<0.01). In the preC and core promoter regions, the mutation frequencies of T1653 and C1753 were 48.0% and 24.0% respectively in the patients with severe hepatitis B, but none of these mutations were observed in the patients with chronic hepatitis B group or HBV carriers (P<0.01). The mutation frequency of T1762-A1764 was 76.0% in the patients with severe hepatitis B, 40.0% in the patients with chronic hepatitis B (P<0.01), and 16.0% in the HBV carriers (P<0.01). There was a significant difference in A1896 mutation between the patients with severe hepatitis B and the patients with chronic hepatitis B (P<0.05) or the HBV carriers (P<0.05).
CONCLUSION: Our observations suggest that the accumulation and persistence of high frequency mutations or complex mutations may be associated with the development and deterioration of HBV infection.

BACKGROUND: There are 8 well-documented genotypes of hepatitis B virus (HBV) at this time point. Genotyping can be accomplished based on a partial sequence of hepatitis B virus (HBV) genome such as the pre-S or S gene. Several methods have been developed and used for HBV genotyping including direct sequencing, restriction fragment length polymorphism, line probe assay and enzyme-linked immunoassay. Recently, a novel, rapid and cost-effective genotyping method based on PCR amplification assay using type-specific primers that can identify all six major genotypes has been developed. This study was undertaken to characterise HBV genotypes and investigate the association between the prevalence of different genotypes and the severity of HBV-induced liver diseases.
METHODS:  Serum samples from carriers of HBV and patients with HBV-related liver diseases from Zhejiang Province were screened for viral serological markers using commercially available radioimmunoassay (RIA) and enzyme linked immunosorbent assay (ELISA) kits. Serum HBV DNA load was determined by real-time detection PCR. A type-specific primer based the nested-PCR method was employed in the HBV genotyping. The genotype results obtained were confirmed by direct sequencing of nested PCR amplicons of the pre-S region. Ten samples of each genotype (B and C) were sequenced.
RESULTS: The survey on a cohort of 125 HBV carriers in and around Hangzhou City, Zhejiang Province showed the existence of HBV genotypes A (0.8%), B (48%), C (40.8%), D (0.8%), mixed B and C (9.6%) and an absence of E and F genotypes. Distribution of HBV genotypes in patients with liver diseases revealed a statistically insignificant higher prevalence of genotype B in mild chronic hepatitis (CH). Among the three genotypes B, C and mixed B/C infections 11 (73.3%), 3 (20%) and 1 (6.7%), (P< 0.05), respectively in subjects with moderate CH, genotype B was significantly predominant. The infection patterns for genotypes B, C and B/C mixed in (i) liver cirrhosis (LC) 4 (23.5%), 10 (58.8%) and 3 (17.7%) and (ii) hepatocellular carcinoma (HCC) 2 (28.6%), 5(71.4%) and 0 (0.0%) respectively revealed a marked association of C genotype with liver disease; however, the association was statistically insignificant (P>0.05).  Differences in positive rate of HBeAg for the three genotypes B, 16(30.8%), C, 27(51.9%), and mixed B/C, 9(17.3%) were significant (P<0.05), with genotype C showing predominance.
CONCLUSIONS: These findings show an interesting distribution of HBV A-D genotypes in Zhejiang Province. Furthermore, our results indicate a novel and markedly high prevalence of mixed B/C genotype infections in subjects with severe CH and LC, and a possible association of mixed B/C infections with the severity of liver diseases in this region of Mainland China.

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most common malignant tumours worldwide. Telomerase is reactivated in various types of malignant tumors and may contribute to the development of HCC. To evaluate the role of telomerase in formation and development of HCC, we analyzed its expression status in different parts of HCC tissues and peripheral blood mononuclear cells (PBMCs), and explored its clinical implications for diagnosis of HCC.
METHODS: Total RNAs and telomerase were extracted from HCC and their non-cancerous tissues, and both relationships were analyzed between them. The expression of telomerase reverse transcriptase (hTERT) mRNA and telomerase activities in liver tissues and PBMCs were detected by RT-PCR and telomeric repeat amplification protocol (TRAP)-ELISA, respectively. The diagnostic values of telomerase in PBMCs were investigated in the diagnosis and differentiation of HCC.
RESULTS: The specific activities of telomerase were 18.25±15.02 A/μg RNA in HCC tissues, and significantly higher than those in their non-cancerous tissues (8.16±6.22 A/μg RNA, P<0.05). But total RNA levels in HCC were 12.40±7.34 μg/mg wet liver and lower than 53.77±52.02 μg/mg wet liver in their non-cancerous parts (P<0.01). The different telomerase levels could be detected in PBMCs from patients with chronic liver diseases and control group. The enzyme activities were significantly higher in HCC than in any other groups (P<0.01). However, circulating telomerase levels were more obviously decreased in HCC patients after transcatheter arterial embolization treatment than before the treatment (P<0.01). The analysis of combined serum alpha-fetoprotein level and PBMCs telome-rase was more sensitive and specific for the diagnosis of HCC.
CONCLUSION: The abnormal expression of telomerase in HCC tissues and circulating PBMCs could be a useful marker to the diagnosis and prognosis of HCC.

BACKGROUND: Local ablative procedures such as cryosurgery and thermo-ablation are increasingly employed as a supplement to liver resection for the therapy of primary and secondary liver tumors. It is still unclear if the survival time can be extended through local ablative procedures. This prospective study shows operative actions, complications and long-term follow-up of 19 patients undergoing cryotherapy.
METHODS: Between 1997 and 1998, 19 patients underwent cryotherapy due to a non-resectable malignant liver tumor (17 patients with metastases of a colon carcinoma, 2 patients with a hepatocellular carcinoma). Twelve patients (63.2%) received cryotherapy only and seven patients (36.8%) received a combination of resection and cryotherapy. The median follow-up period was 23 months.
RESULTS: In a total of 59 liver tumors (18 were resected and 41 received cryotherapy), 12 had cryotherapy only, and 7 had a combination of cryotherapy and resection. The 30-day lethality was 0%, and the rate of major complications was 21%. After one year, 27.3% of the patients were still recurrence-free. The recurrence rate for all tumors treated was 58.8%. The median survival time for all patients was 21 months. The one-and three-year survival rates were 62.5% and 15.8%, respectively.
CONCLUSIONS: The mortality for cryotherapy is low, but there is a high rate of complications and long-term tumor control is not sufficient. If local ablative procedures of hepatic lesions are to be performed,not laparotomy but percutaneous, percutaneous thermoablation should be discussed as an alternative therapeutic measure.

BACKGROUND: The life expectancy of a patient with primary hepatic carcinoma (PHC) is hard to predict, and it is related to many prognostic factors. The Chinese classification system including five parameters: tumor, vascular thrombosis, lymph node metastasis, distant metastasis and Child-Pugh stage developed in 1999 was adopted by the 8th National Conference on Liver Cancer of the Chinese Anti-Cancer Association in 2001. In this study, the discriminatory ability of the Chinese classification system was compared with that of the TNM staging in patients for resection of PHC, in addition to the evaluation of prognostic value.
METHODS: The data of 246 patients who had undergone resection of PHC from January 1986 to December 2000 (average age, 51 years; male/female ratio, 213/33) were retrospectively studied. Among the 246 patients, 227 were followed up for at least 3 years.
RESULTS: The 1-, 3-, 5-, 7-, and 10-year tumor-free survival rates were 55%, 30%, 25%, 20% and 18%, respectively. The Chinese classification system was better than the TNM staging system in predicting survival rate of patients with PHC, as confirmed by survival curves shown by the Kaplain-Meier method. The mean survival time was 155, 70, 39, 16, and 4 months in patients with the Chinese classification stages Ⅰa, Ⅰb, Ⅱa, Ⅱb, and Ⅲ, respectively. The 1-, 3-, 5-, 7-, and 10-year tumor-free survival rates of the Chinese classification system and TNM staging were statistically significant and had a slightly positive relationship. The predictive capacity of the Chinese classification system was confirmed in any two subgroups of patients undergoing operation. COX proportional hazards regression analysis showed that the Chinese classification system was the only independent prognostic factor for survival.
CONCLUSIONS: Taking both tumor extension and liver function into account, we consider that the Chinese classification system making up for the deficiency of UICC TNM staging is more precise in predicting the prognosis of patients with resection of PHC.

BACKGROUND: This study was designed to explore the preoperative diagnosis and surgical modality of patients with hepatic tuberculous pseudotumor.
METHODS: Of 682 patients who had undergone liver resection from January 1988 to December 2004, 8 were confirmed pathologically as having hepatic tuberculous pseudotumor after operation. Their clinical features, laboratory findings, results of preoperative imaging and surgical modality of the 8 patients were analyzed.
RESULTS: In these patients, 5 were misinterpreted as having other types of liver tumor and 3 were confirmed as having liver tuberculous pseudotumor preoperatively. All the 8 patients underwent hepatic segmentectomy and local hepatic resection. Seven had no tumor recurrence after follow-up for 4 years.
CONCLUSIONS: Hepatic tuberculous pseudotumor was highly suspected for the patients with hepatic occupying-space lesions who had a history of tuberculosis. Fine needle aspiration liver biopsy guided by B-mode ultrasound and CT scan could confirm the diagnosis. They are of vital importance in the pathological diagnosis of the tumor. Therapeutic modalities included all kinds of hepatic segmentectomy and postoperative administration of antituberculous agents for the enhancement of the therapeutic effects.

BACKGROUND: Interstitial collagenase has been considered as an essential enzyme for collagenolysis in liver fibrosis, because type Ⅰand Ⅲ collagens increase predominantly in liver fibrosis. The present study aimed to demonstrate the gene expression of matrix metalloproteinases-13 (MMP-13) in the progressive phases of ethanol induced experimental liver fibrosis in rats.
METHODS: Thirty-four Sprague-Dawley rats were randomly divided into two groups. The experimental group (24 rats) was given ethanol (44%, 7 g/kg) every day and the control group (10) was given normal saline. Liver samples were harvested from experimental rats at 4, 12 and 24 weeks respectively. The kinetics of MMP-13 mRNA expression was assayed by semi-quantity reverse transcriptase polymerase chain reaction (RT-PCR).
RESULTS: In normal rat liver, a faint band for MMP-13 mRNA was observed by RT-PCR (0.24±0.41). The gene expression of MMP-13 was increased in the liver of the rats treated with ethanol for 4 weeks (0.62±0.54), but it was not considered statistically significant (P>0.05). And the livers from 12-week-treated rats showed a marked mRNA expression (1.65±0.47, P<0.01). Once fibrosis became prominent (24 weeks), a faint band of MMP-13 mRNA was observed (0.39±0.25).
CONCLUSION: MMP-13 participates in the degradation of newly-formed matrix in the early phase of rat liver fibrosis induced by ethanol, and it was induced in a distinct time frame.

BACKGROUND: 10-23 DNA enzyme is one kind of deoxyribozymes for RNA cleavage. The inhibition effects of 10-23 DNA enzyme on the expression of the HBV C gene in HepG2.2.15 cells were demonstrated previously. The aim of this study was to further explore the cleavage activities of 10-23 DNA enzyme targeting at HBV C gene mRNA in vitro.
METHODS: 10-23 DNA enzyme named Drz-HBV-C-9 specific to HBV C gene ORF A1816UG was designed and synthesized. HBV C gene mRNA was obtained by the in vitro transcription method. Cleavage activities of Drz-HBV-C-9 were observed in vitro. Values of kinetic parameters including Km，Kcat and Kcat/Km were calculated accordingly.
RESULTS: Under the certain cleavage conditions, Drz-HBV-C-9 could efficiently cleave target mRNA at specific sites in vitro. Cleavage products of 109nt plus 191nt were obtained. The kinetic parameters, Km，Kcat and Kcat/Km for Drz-HBV-C-9, were 1.4×10-9 mol, 1.6 min-1 and 1.1×109 mol-1•min-1, respectively.
CONCLUSIONS: 10-23 DNA enzyme targeting at HBV C gene mRNA possesses specific cleavage activities in vitro. This would be a potent antiviral strategy with respect to HBV gene therapy.

BACKGROUND: Fructose is cytoprotective during bile salt-induced apoptosis of hepatocytes by regulating protein kinase C (PKC). This study was undertaken to explore the regulating mechanism of hepatic injury in rats with obstructive jaundice, and to detect the PKC signal pathway.
METHODS: Rat hepatocytes were isolated by in situ collagenase perfusion and primary culture, and pretreated with various concentrations of PKC agonist phorbol myristate acetale (PMA) and inhibitor chelerythrine for 20 minutes. After pretreatment, 50 μmol/L glycochenodeoxycholate (GCDC) was added for additional 24 hours. Subsequently, the cells were detected by FCM and TUNEL. After adding with different concentrations of fructose and 100 μmol GCDC, the hepatocytes were evaluated by FCM and TUNEL. Experimental obstructive jaundice was induced with fructose and without fructose via double ligation of the bile duct for 3, 7, 14, and 21 days. Apoptotic status in the liver of all rats was detected with TUNEL, and PKC protein in the liver of obstructive jaundice (OJ) with the immunohistochemistry method.
RESULTS: PMA increased GCDC-induced apoptosis and chelerythrine decreased GCDC-induced apoptosis in a concentration-dependent manner. Adding with different concentration of fructose and 100 μmol GCDC, the decreased apoptotic rate was related to the concentration of fructose. The apoptotic rate of the liver was related to times of OJ. PKC and apoptosis index (AI) were the highest after a 14-day ligation of the bile duct without use of fructose. AI and PKC were decreasing from a 14-day ligation of the bile duct with fructose.
CONCLUSIONS: PKC takes part in the regulation, occurrence, and progression of hepatic injury in OJ. Fructose is cytoprotective during bile salt-induced apoptosis of hepatocytes by regulating PKC.

BACKGROUND: The configuration and course of liver blood vessels (LBVs) are involved in the study of pathogenesis of hepatic diseases including liver cirrhosis, tissue engineering of the liver and surgical treatment of diseases of the liver and gallbladder. In the study of vascularization in tissue engineering of the liver in particular, the work we should do is to get the anatomy data of LBVs for computer-aided reconstruction of digital model of LBVs. In doing so, the casting sample of rat liver blood vessels (RLBVs) is fabricated and the data of each section of the sample is harvested.
METHODS: Liquid polymer preparation (8%-10%), which was made of chlorinated poly vinyl chloride (CPVC) as a solute, acetone as solvent and pigment, was injected into the RLBVs of 40 rats. Once acetone evaporated, the preparation solidified. When the cells and connective tissue were dissolved by hydrochloric acid, a casting sample of RLBV was left. The sample was embedded in paraffin and cut into sections. The data of each section of RLBVs was collected by digital camera.
RESULTS: In 36 rats, the casting sample of RLBVs was made successfully by this method. The diameter of the hepatic arteries varied from 0.8 to 0.2 mm, the portal veins from 2.0 to 0.1 mm, and the hepatic veins from 2.2 to 0.2 mm. In each rat, about 150 photographs of the sections of RLBVs were taken.
CONCLUSION: The method described above is feasible for getting experimental data for computer-aided reconstruction of the digital model of RLBVs.

BACKGROUND: The outcome of patients with cholangiocarcinoma is poor. To evaluate the experience in the diagnosis and surgical treatment of cholangiocarcinoma, we investigated the status quo of diagnosis and treatment of cholangiocarcinoma in China.
METHOD: The clinical data of 680 patients with cholangiocarcinoma treated at 8 hospitals from 1995 to 2001 were retrospectively analyzed with SPSS software package.
RESULTS: The incidence of the tumor was the highest in the age group of 60-65 years. Meanwhile, the incidence was higher in aged men than in aged women, with a male to female ratio of 1.39:1. Proximal cholangiocarcinoma was the commonest (41.6%)and distant cholangiocarcinoma the second (28.7%) in the 680 patients. B-mode ultrasonography for cholangiocarcinoma was performed in 80.3% of the patients.Non-traumatic examinations such as computed tomography (CT), magnetic resonance image (MRI) and magnetic resonance cholangiopancreatography (MRCP) were more widely used than that of traumatic examinations such as percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP). The low- and middle-differentiation cancer of the proximal bile duct accounted for about 50%. Most of the patients suffered from late-stage cholangiocarcinoma. The resection rate of the tumor was low, and the rate of radical operation was only 21.6%（147/680）.
CONCLUSIONS: Cholangiocarcinoma is common in the aged men. Its diagnosis and treatment have been improved, but little. Most patients are diagnosed as having late-stage cholangiocarcinoma at the time of outpatient clinic, and the rate of radical operation is low. Thereforce, it is necessary to reinforce the early diagnosis and treatment of cholangiocarcinoma to improve the outcome after operation.

BACKGROUND: The role of aggressive surgery for end-stage gallbladder carcinoma is controversial. This retrospective study was designed to evaluate the outcome of surgical treatment for Nevin stage IV and V gallbladder carcinoma at a single institution.
METHODS: A retrospective analysis was made on 70 patients with Nevin stage IV and V gallbladder carcinoma undergoing surgical treatment from January 1993 to June 2004.
RESULTS: There were 22 cases of stage IV and 48 of stage V. Cholecystectomy was performed in 37 cases with a resection rate of 53%, 9 cases received radical resection, 13 extended radical resection, and 15 palliative resection. The curative resection rate was 31% and the morbidity rate was 36%. Postoperative 1-, 3-, 5-year survival rates of curative and palliative resection were 69%, 33%, 8% and 27%, 13%, 0, respectively (P<0.01). The 1- and 3-year survival rates of patients undergoing exploratory laparotomy only were 3% and 0, respectively.
CONCLUSIONS: Nevin stage IV and V gallbladder carcinoma should be treated by aggressive surgery. Curative resection is promising in the improvement of long-term survival rate.

BACKGROUND: The high choledocholithiasis recurrence rate after choledocholithotomy plus T-tube drainage is related to biliary bacterial infection. These bacteria are from the intestine, either via the major duodenal papilla, or the penetrating intestinal mucosa. It is therefore possible that duodenobiliary reflux and increased intestinal permeability exist in patients who have undergone choledocholithotomy. This study was undertaken to find the evidence of duodenobiliary reflux and to assess intestinal permeability in these patients.
METHODS: Twenty-one patients who underwent choledocholithotomy plus T-tube drainage 2 months ago, and 11 healthy volunteers (controls) took orally 185MBq of 99mTc-DTPA.The patients’ bile was collected in the next 2 hours via a T-tube and the 99mTc-DTPA radioactivity in the bile was counted. Intestinal permeability was evaluated by measuring the 24-hour urinary excretion rate of ingested 99mTc-DTPA in both patients and controls.
RESULTS: In 6 of the 21 patients, radioactivity in the bile was detected. The intestinal permeability was significantly higher in patients (11.45%±6.16%) than that in controls (3.61%±1.63%, t=3.28, P<0.05).
CONCLUSIONS: Duodenobiliary reflux exists in patients who have undergone choledocholithotomy plus T-tube drainage. The intestinal permeability is higher in these patients than in healthy subjects. Duodenobiliary reflux and increased intestinal permeability may be factors of cholelithiasis recurrence.

BACKGROUND: Roux-en-Y choledochojejunostomy is routinely performed in patients with regional hepatolithiasis. However, some of these patients, who have a normal gallbladder and normal Oddi’s sphincter, are unnecessarily undergoing bilio-intestinal drainage. Alternatively, reconstruction can be achieved by subcutaneous tunnel and hepatocholangioplasty with the utilization of the gallbladder (STHG). This method is effective to potential endoscopic tunnel and intervention during follow-up, and prevention of reflux cholangitis as well as the disorders of the GI tract.
METHODS: The middle and long-term complications of 46 patients who underwent STHG were analyzed. With B-ultrasonography and biochemical assay, the contraction and concentration function of the gallbladder were also studied.
RESULTS: Follow-up showed that all patients survived with a relatively normal life. One patient experienced right epigastric pain, chills and fever because of a stone which impacted in the left hepatic bile duct. Another patient had cholangitis because of biliary ascariasis. The two patients were treated by endoscopic therapy within the subcutaneous gallbladder under local anesthesia.
CONCLUSIONS: This operation not only keeps the normal physical functional of the gallbladder, Oddi’s sphincter and gastrointestinal tract, but also prevents reflux cholangitis and the disorder of the digestive tract. Hence STHG is a novel operation dealing with regional hepatolithiasis.

BACKGROUND: Measurement of total serum amylase (AMY) is the most widely used biochemical test for the diagnosis of acute pancreatitis, but it is commonly considered a nonspecific marker. To improve the biochemical diagnosis of acute pancreatitis, lipase(LIP) and pancreatic amylase(PAMY) have been tested in recent years. The present study was designed to evaluate whether serum LIP and pancreatic PAMY tests could replace total amylase test to improve diagnostic efficiency in the evaluation of acute pancreatitis in patients with hyperamylasemia.
METHODS: LIP and PAMY values were determined in serum samples from 92 patients with hyperamylasemia. Reference values for each enzyme were derived from serum samples of 147 healthy subjects. The activities of LIP and PAMY in patients with various diseases were shown directly by the boxplot graph. The diagnostic accuracy of LIP and PAMY was defined as the area under the receiver operating characteristic (ROC) curve.  Their sensitivity and specificity in detecting acute pancreatitis at varying cutoff points were shown by the curve, and the best cutoff value for each enzyme was shown by the modified ROC curve. The diagnostic values of LIP, PAMY and LIP+AMY with each upper limit of reference range (ULR) were compared with the corresponding best cutoff values.  
RESULTS: The references values of LIP and PAMY were 12.2-47.6 U/L and 28-95 U/L, respectively. These values in patients with acute pancreatitis were higher than those patients with other diseases. The areas under the ROC curve (AUC) of LIP and PAMY were 0.799 and 0.792, respectively. With the best diagnostic cutoff point of maximum (sensitivity + specificity) -100%, we obtained values of 97.9 U/L(LIP97.9=2.06×ULR) for LIP and 209 U/L(PAMY209=2.20×ULR) for PAMY. The best cutoff values for LIP, PAMY and LIP+AMY demonstrated the specificity, positive predictive value, and diagnostic efficiency higher than the corresponding ULRs.
CONCLUSIONS: Serum LIP and PAMY are specific for the pancreas and might replace total amylase for the diagnosis of acute pancreatitis in hyperamylasemia patients. LIP97.9 is more efficient than PAMY209 in the diagnosis of acute pancreatitis. A combined test of both enzymes is not superior to single test of either enzyme in diagnostic accuracy.

BACKGROUND: The high mortality of patients with severe acute pancreatitis (SAP) is due to multiorgan dysfunction. The mechanisms of SAP are still obscure. The aim of this study was to investigate the role of nuclear factor-kappa B (NF-κB) activation in rats with SAP associated with liver injury and the protection effect of triptolide against liver injury in rats with SAP.
METHODS: Ninety Wistar rats were randomly divided into three groups (n=30 each group): severe acute pancreatitis (group P), treatment with triptolide (group T), and sham operation (group S). SAP models were induced by retrograde injection of 5% sodium taurocholate to the pancreatic duct. After the model was successfully established, no treatment was given to group P. In group T, triptolide (0.05 mg/ml) was injected intraperitoneally (0.2 mg/kg). In group S, the abdominal walls of rats were opened, sutured, but not treated. The rats were sacrificed after operation at 2, 6, and 12 hours, respectively. The serum levels of amylase (AMY), alanine aminotransferase (ALT), tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) were determined at three time points (10 rats for each time point). Liver tissues were obtained to detect the activity of NF-κB and to observe their pathological changes with light and electron microscopes.
RESULTS: The serum levels of AMY and ALT were higher in groups P and T than in group S. The serum AMY levels were significantly lower in group T than in group P at 12 hours after operation. The serum ALT levels were significantly lower in group T than in group P at 6, 12 hours after operation. At the three time points, the levels of TNF-α and IL-6 in groups P and T increased more significantly than in group S. In group T they were decreased more significantly than in group P at the three time points. In groups P and T, NF-κB activity in liver tissue increased more significantly than in group S at the three time points. The activity of NF-κB was higher in group P than in groups S and T at the three time points. Liver pathological damages were milder in group T than in group P under light and electron microscopes.
CONCLUSIONS: NF-κB plays an important role in the pathogenesis of liver injury in rats with SAP. Triptolide can reduce pathological damage to the liver. Its mechanism is to inhibit the activity of NF-κB and to decrease the release of inflammatory mediators.

BACKGROUND: Toll-like receptor (TLR) 2/4 might play important roles in mediating proinflammatory cytokine synthesis and release. And nitric oxide (NO) has been used to treat acute respiratory distress syndrome (ARDS). This study aimed to investigate the changes in TLR2/4 gene expression in the lungs of rats with acute lung injury (ALI) complicated by acute hemorrhage necrotizing pancreatitis (AHNP) and the effect of NO on the TLR2/4 gene expression.
METHODS: One hundred and ten SD male rats were randomly divided into sham-operated group (n=10), AHNP group (n=30), chloroquine-treated group (n=30), and L-Arg-treated group (n=40). The lungs were dissected for lung histological scoring, and bronchoalveolar lavages were harvested for lung injury indexing. TLR2/4 mRNA expression in the lungs was measured by RT-PCR.
RESULTS: TLR2/4mRNA was detected in the lungs with low values in the sham-operated group (0.016±0.210E-2, 0.112±0.750E-2), but it was markedly increased at 3 hours in the AHNP group (0.787±0.751E-2, 1.512±1.794E-2), peaking at 12 hours (1.113±6.141E-2, 2.957±2.620E-2; P<0.05 or P<0.01). When lung injuries were aggravated, TNF-α concentrations in the lungs were increased, but NO concentrations were decreased (P<0.05 or P<0.01). When TLR2/4mRNA was inhibited by CQ (3h: 0.313±5.491E-2, 0.005±1.419E-3; 6h: 0.488±7.442E-2, 0.010±1.518E-3; 12h: 0.883±8.911E-2, 0.024±2.760E-3; P<0.05 or P<0.01), lung injuries were relieved. NO concentrations in the lungs were increased but TNF-α concentrations were decreased (P<0.05 or P<0.01). When the rats with AHNP were treated with L-Arg, TLR2/4mRNA expression in the lungs could be effectively inhibited (50mg-T: 0.656±3.977E-2, 1.501±6.111E-2; 100mg-T: 0.260±0.891E-2, 0.732±5.135E-2; 200mg-T: 0.126±0.914E-2, 0.414±1.678E-2; 400mg-T: 0.091±0.399E-2, 0.287±0.176E-2; P<0.05 or P<0.01) and lung injuries were relieved. At the same time, NO concentrations in the lungs were markedly increased, but TNF-α concentrations were decreased (P<0.05 or P<0.01).
CONCLUSIONS: The expression of TLR2/4mRNA is increased in the lungs in rats with AHNP and lung injuries are aggravated. TLR2/4mRNA gene expression of the lungs of rats with AHNP could be markedly inhibited by NO, leading to the relief of lung injuries.

Including the middle hepatic vein in the right lobe liver graft has the advantage of providing direct venous drainage of the right anterior segment. To allow unimpeded passage of blood flow, we previously designed venoplasty of the middle and right hepatic veins. We found that venoplasty is also feasible when the inferior right hepatic vein is near to the right hepatic vein, or when multiple segment 8 hepatic vein orifices are exposed adjacent to the middle hepatic vein at the graft transection surface. By joining the hepatic vein orifices into a single opening, the anastomosis into the inferior vena cava is much facilitated. The technique is simple, yet versatile, and able to cope with variation of the configurations of the hepatic vein.

BACKGROUND: Primary pancreatic lymphoma is a rare but treatable malignancy (less than 1% of pancreatic tumors) that may be clinically confused with pancreatic adenocarcinoma.
METHODS: In a patient with upper abdominal pain, ultrasonography and CT detected a mass in pancreatic head, which compressed the common bile duct. The patient received a Whipple’s operation and intraoperative frozen sections of the mass showed an anaplastic carcinoma. Immunohistochemical staining was used to indicate the origin and prognosis of tumor.  
RESULTS: Grossly the tumor involved the pancreatic head, soft in consistence and invaded part of the gastric wall. Histologically, the tumor was composed mainly of large and moderate neoplastic cells, which were diffusely positive for CD20 and Bcl-6 antigens, indicating the features of diffusely large B cell lymphoma.
CONCLUSIONS: The proper diagnosis of the tumor should be made with CD20 and Bcl-6 immunohistochemical study. Radical surgery is indicated for resectable carcinoma but not for a chemosensitive lymphoma.