ObjectiveTo summarize progress of 25-hydroxycholesterol (25-OHC), 27-hydroxycholesterol(27-OHC), and 7α,25-hydroxycholesterol (7α,25-OHC) three oxidized cholesterols in inflammation and immunology and to provide evidence for related basic researches and diseases treatments.MethodThe relevant literatures about these three important oxidized cholesterols in the inflammation and immunology in recent years were reviewed.ResultsThe 25-OHC and 27-OHC could exert the antiviral effects by interfering with various viruses invading the host via various mechanisms. Moreover, the 25-OHC and 27-OHC also played the important regulatory roles in a variety of inflammatory processes and inflammatory diseases. The 7α,25-OHC played the important role in a variety of inflammatory processes by acting on the inflammatory and immune cell membrane receptor G-protein coupled receptor 183 (also known as Epstein-Barr virus-inducible receptor 2).Conclusion25-OHC, 27-OHC and 7α,25-OHC play an important roles in occurrence and development of various inflammatory and immune responses and diseases of inflammatory and immune by acting on a variety of nuclear receptors and membrane receptors.
Objective To summarize the mechanism and research progress of Kruppel-like factor 2 (KLF2) in various liver diseases and related drug development, providing theoretical basis for further mechanism exploration and clinical application. Method The literatures on the mechanism of KLF2 in liver diseases at home and abroad were collected and summarized. Results KLF2 was widely distributed and had various functions in human body, mainly regulating the growth, differentiation and function of endothelial cells, inhibiting pro-inflammatory and pro-thrombotic gene expression, and participating in important physiological processes such as liver inflammation, oxidative stress and thrombosis, and affecting the occurrence and development of various liver diseases. The regulation of KLF2 expression by statins had been widely used in the treatment of liver diseases. Conclusion KLF2 regulates the expression of related molecules through a variety of pathways and affects the functions of various cells in the liver, which is the focus of research on improving liver injury.
ObjectiveAfter establishing the rabbit brain death model, TUNEL, western blotting, and immuno-histochemical methods were used to detect hepatocyte apoptosis to study hepatocyte apoptosis level from rabbit donors after brain death. MethodsSixty healthy male New Zealand rabbits were divided into brain death group (n=30) and sham group (n=30). The rabbits of brain death group were established by increasing intracranial pressure in a modified, slow, and intermittent way, collecting liver tissues after corresponding treatment respectively, using TUNEL to detect apoptosis rate, western blotting and immunohistochemical methods to detect the expression of Cleaved-caspase 3. ResultsThe hepatocyte apoptosis rate at each time point of brain death group were higher than those of the corresponding time point of sham group (P<0.05), and the rate of hepatocyte apoptosis increased gradually with the extension of brain death time (P<0.05). The results of Western blot assay and immunohistochemistry assay showed that the relative expression amount of Cleaved-caspase 3 protein increased gradually with the extension of brain death time (P<0.05), and relative expression amount of Cleaved-caspase 3 protein at each time point of brain death group were higher than those of the corresponding time point of sham group (P<0.05). ConclusionsThe relationship between brain death donor liver and cell apoptosis is closely related. Along with the extension of the brain death time in rabbits, the level of apoptosis of liver cells gradually increased, which affects the quality of liver donors after brain death.
Objective To study the anatomy and variations of hepatic veins draining into inferior vena cava （IVC）， and to classify the surgical techniques of piggyback liver transplantation （PBLT） based on the view of hepatic veins anatomy with IQQA liver image analysis system so as to provide the important basis for the perioperative clinical decision making. Methods Two hundred and forty-eight cases of PBLT were preformed in the Zhongnan Hospital of Wuhan University and the 3rd Xiangya Hospital of Central South University from May 2000 to August 2007， the types of hepatic veins were summarized according to the anatomy of hepatic veins and short hepatic veins draining into IVC at the second and third hepatic hilars. Forty cases of PBLT were preformed in the Zhongnan Hospital of Wuhan University from March 2010 to April 2013， and the anatomy of hepatic veins was reviewed with IQQA liver image analysis system. The anatomy of hepatic veins and technological type of liver transplantation were recorded respectively. Results Of these 248 livers studied in our center， type Ⅰ（the left and middle hepatic vein joined as one trunk ） was found in 142 cases （57.25%）， type Ⅱ （the right and middle hepatic vein joined as one trunk） was 54 cases （21.77%）， type Ⅲ （three hepatic veins joined as one trunk） in 14 cases （5.64%）， type Ⅳ （the left， middle， and right hepatic veins were all unique）in 34 cases （13.71%）， and type Ⅴ （no hepatic veins but short hepatic veins） in 4 cases （1.61%）. The data of 40 cases of PBLT from IQQA liver image analysis system showed that type Ⅰwere found in 24 cases （60.00%）， type Ⅱin 9 cases（22.50%）， type Ⅲ in 2 cases （5.00%）， type Ⅳ in 4 cases （10.00%）， and type Ⅴ in 1 case （2.50%）， which were matched with hepatic vein classification standard of the author. Conclusions Studying the anatomy and variations of hepatic veins draining into IVC with IQQA liver image analysis system and classifying the surgical techniques of PBLT （type Ⅰ，Ⅱ，Ⅲ，andⅣA patients can be performed classical PBLT；Type ⅣB and Ⅴ patients can only be performed ameliorative PBLT） could provide an important basis for clinical preoperative decision.
目的探讨肝移植术后胆道并发症的病因及内镜在肝移植并发症中的治疗。 方法笔者所在单位1995年9月至2010年3月期间共施行尸体肝移植516例，将其分为2个阶段，即1995～2001年的技术摸索阶段和2001～2010年的技术成熟阶段。第1阶段125例，有17例（13.60%）发生胆道并发症；第2阶段391例，有15例（3.84%）发生胆道并发症。对这32例患者行内镜诊治的相关临床资料进行回顾性分析。 结果32例中单纯胆瘘5例，单纯胆管结石2例，单纯胆管狭窄11例，胆管狭窄伴结石9例，胆管狭窄合并胆瘘2例，胆管扭曲2例，十二指肠乳头狭窄1例。针对不同的胆道并发症，采取了胆管扩张、乳头切开取石、胆道支架置放、鼻胆管引流等不同的治疗方式，32例患者共行内镜治疗56例次，治疗成功27例（84.38%）；发生内镜相关并发症4例（12.50%）。 结论内镜治疗肝移植术后胆道并发症的疗效是值得肯定的。
Objective To explore the protective effect and mechanism of Astragalus polysaccharides (APS) on liver injury in the state of brain death in New Zealand rabbits. Methods Twenty-four New Zealand rabbits were randomly divided into 3 groups (n=8): the blank control group, the brain death group, and the APS group. We obtained blood and liver tissue specimens from rabbits of three groups at 4 h and 8 h after treatment respectively (n=4). The rabbits of blank control group simulated the procedures of anesthesia and surgery of the brain death, without the Foley balloon catheter being pressurized, and maintained anesthesia. The brain death group: brain-dead models were established. The APS group: injection of APS (12 mg/kg) via the femoral vein bolus immediately after anesthesia, brain-dead models were established as same as rabbits of brain death group. The blood and liver tissue samples were taken at 4 h and 8 h after treatment to detect aminotrans-ferase (AST), alanine amino-transferase (ALT) and tumor necrosis factor α (TNF-α), and to observe the change of liver tissue by HE staining and immunohistochemical staining〔expression level of nuclear transcription factor p65 protein (NF-κB p65) could be detected by immunohistochemical staining〕. Results ① ALT and AST. Compare with the blank control group at the same time (4 h and 8 h), levels of ALT and AST in brain death group and APS group were significantly increased (P<0.05), and the levels of ALT and AST in brain death group were higher than those of APS group at each time point (P<0.05). In the same group, compared with 4 h, there was no significant difference in the levels of ALT and AST in blank control group at 8 h (P>0.05); the levels of ALT and AST in brain death group at 8 h were both higher than those of 4 h (P<0.05); the levels of ALT at 8 h in APS group was higher than that of 4 h, but there was no significant difference in the level of AST between 4 h and 8 h (P>0.05). ② TNF-α. Compare with the blank control groups at same time (4 h and 8 h), levels of TNF-α in brain death group and APS group were significantly increased(P<0.05), and level of TNF-α in brain death group was higher than that of APS group at 4 h and 8 h (P<0.05). ③ The HE results. The liver tissue structure of blank control group, brain death group, and APS group at 4 h had no obvious change. The liver tissue structure of brain death group at 8 h showed the evident tissue damage: liver cells showed the balloon samples, disordered arrangement, cytoplasmic loose light dye net-like, and inflammatory cells infiltrated in portal area. The liver tissue structure of APS group at 8 h showed that, liver cells showed mild edema, normal arrangement, and a small amount of inflammatory cells infiltrated in portal area. The liver tissue structure damage of APS group at 8 h was milder than that of brain death group. ④ Immunohistochemical staining results. There was no significant difference in expression levels of NF-κB p65 protein among blank control group, brain death group, and APS group at 4 h (P>0.05). But at 8 h, the expression levels of NF-κB p65 protein in brain death group and APS group were higher than that of blank control group (P<0.05), and the expression level of NF-κB p65 protein in brain death group was higher than that of APS group (P<0.05). The expression levels of NF-κB p65 protein in brain death group and APS group at 8 h was higher than that of 4 h in the same group (P<0.05), but there was no significant difference between 4 h and 8 h in blank control group (P>0.05). Conclusions Brain death will cause liver damage and the injury degree may be related to the continuous time. The damage at 8 h was more serious than that of 4 h. APS has a protective effect on liver of brain-dead rabbits' and its mechanism may be closely related to inhibit TNF-α and NF-κB by diverse ways to reduce the inflammation of the liver injury.
ObjectiveTo investigate the decision of combined liver and kidney transplantation (CLKT) after renal transplantation, provide surgical therapeutic experience for those patients with liver and renal insufficiencies and hepatorenal syndrome and summarize the risk factors, demerits and merits, and operative indications of CLKT. MethodsThe data of three successful CLKT cases of our centre from Feb. 2014 to Jan 2015 were retrospectively analyzed, and these three patients had kidney transplantation before. We also reviewed the latest associated literatures. ResultsThree patients got successful operations of CLKT and had very good recovery of renal function several days ofter operaton. Two of them discharged a few weeks after surgery, and one of these two patients got severe pulmonary infection of fungus two month after CLKT but recovered under proper therapy finally. The third patient died of severe mixed infection one month after CLKT. ConclusionsThe surgical techniques and rejection are not the main impact factor to the prognosis of CLKT after renal transplantation. Infection is the biggest trouble to which we should pay most of our attention. We should decide whether to do synchronous or nonsynchronous CLKT according to the situation before surgery. Moreover, the systematic therapy administration after CLKT is very necessary for the patients' long-term survival.