Critical considerations for the management of acute abdomen in transplant patients

The number of solid organ transplantations performed annually is increasing and are increasing in the following order:Kidney,liver,heart,lung,pancreas,small bowel,and uterine transplants.However,the outcomes of transplants are impro-ving(organ survival>90%after the 1st year).Therefore,there is a high probability that a general surgeon will be faced with the management of a transplant patient with acute abdomen.Surgical problems in immunocompromised patients may not only include graft-related problems but also nongraft-related problems.The perioperative regulation of immunosuppression,the treatment of accompanying problems of immunosuppression,the administration of cortisol and,above all,the realization of a rapidly deteriorating situation and the accurate evaluation and interpretation of clinical manifestations are particularly important in these patients.The perioperative assessment and preparation includes evaluation of the patient’s cardiovascular system and determining if the patient has hypertension or suppression of the hypothalamic-pituitary-adrenal axis,or if the patient has had any coagulation mechanism abnormalities or thromboembolic episodes.Immunosuppression in transplant patients is associated with the use of calci-neurin inhibitors,corticosteroids,and antiproliferation agents.Many times,the clinical picture is atypical,resulting in delays in diagnosis and treatment and leading to increased morbidity and mortality.Multidetector computed tomo-graphy is of utmost importance for early diagnosis and management.Transplant recipients are prone to infections,especially specific infections caused by cytomegalovirus and Clostridium difficile,and they are predisposed to intraop-erative or postoperative complications that require great care and vigilance.It is necessary to follow evidence-based therapeutic protocols.Thus,it is required that the clinician choose the correct therapeutic plan for the patient(conservative,emergency open surgery or minimally invasive surgery,including laparoscopic or even robotic surgery).

Local Expression of Vaginal Th1 and Th2 Cytokines in Murine Vaginal Candidiasis under Different Immunity Conditions

To investigate the expression of vaginal Th1 and Th2 cytokines in rats with experimental vaginal candidiasis under different immune conditions, ICR murine vaginal candidiasis model was established and immno-suppressed murine models of vaginal cadidiasis were established in estrogen-treated mice. Non-estrogen-treated mice were used as controls. The mRNA level of Th1 （IL-2）/Th2 （IL-4, IL-10, TGF-β1） cytokines in murine vaginal tissues was determined by RT-PCR. The cykotine in local tissues was increased to different extent under normal immune condition. IL-2 mRNA was increased during early stage of infection, while IL-10 was increased transiently during late stage of infection. TGF-β1 production was found to be increased persistently. At same time, the expression of IL-2 mRNA was suppressed in immno-suppressed group, and the level of IL-4, IL-10, and TGF-β1 were higher than the normal immunity group to different degree during infection. The high level of IL-2 mRNA during early stage of infection was associated with clearance of mucosal Candidia albicans （C. albicans）, and its expression suppressed leading to decreased clearance of mucosal C. albican in immuno-suppression. The over-expression of IL-4 and IL-10 could significantly enhance the susceptibility to C. albicans infection in mice.

Solitary pulmonary metastasis arising thirteen years after liver transplantation for HBV-related hepatocellular carcinoma

We described a 59-year-old male patient who underwent liver transplantation in 1989 for hepatocellular carcinoma （HCC） complicating hepatitis B virus （HBV） cirrhosis. In 2001 （12 years after liver transplantation）, he developed a lung metastasis of HCC without intrahepatic recurrence and the resection was done. In July 2003, he was symptom free without any recurrence. HCC metastasis can develop even after a very long time of liver transplantation. Many HCCs grow slowly, and the growth rate of recurrent tumors in patients receiving immunosuppressive therapy is significantly greater than that of those who do not receive immunosuppressive therapy.

EXPERIMENTAL INVESTIGATION OF THREE IMMUNO-SUPPRESSIVE DRUGS IN XENOTRANSPLANTATION

Organ transplantation between phylogenetically disparate animals are subject to hyperacute rejection that is thought to be mediated by the reaction of natural and

Effective time of immuno-suppressive protein in serum

Immuno-suppressive protein was generated in spleen and lymph node and released into serum in mice and rats under stress, which had strong suppressive effects on T and B lymphocyte proliferation. The present study showed that the serum from stressed mice presented a significant decrease in lymphocyte proliferation at 1, 12, 24, and 48 h after stress. There was not significant suppressive effect at 96 h. The half life of biological effect was 21.6

Effect of Emodin in Suppressing Acute Rejection Following Liver Allograft Transplantation in Rats

Objective：To investigate the mechanism of action of emodin for suppressing acute allograft rejection in a rat model of liver transplantation.Methods：Brown Norway（BW） recipient rats of orthotopic liver transplantation（OLT） were divided into three groups,Group A receiving isografting（with BW rats as donor）, Group B receiving allografting（with Lewis rats as donor）,Group C receiving allografting and emodin treatment （50 mg/kg daily）.They were sacrificed on day 7 of post-transplantation,and their hepatic histology,plasma cytokine levels,and T-cell subset expression were detected.Results：Compared with those in Group A,rats in Group B exhibited severe allograft rejection with a rejection activity index（RAI） of 7.67±0.98,extensive hepatocellular apoptosis with an apoptosis index（Al） of 35.83±2.32,and elevated plasma levels of interleukin-2 （IL-2）,interleukin-10（IL-10）,tumor necrosis factor-α（TNF-α）,CD4^＋ and CD4^＋/CD8^＋ ratio.However,recipients in Group C showed a decrease in histological grade of rejection and hepatocellular apoptosis,as well as a decrease in plasma levels of IL-2,TNF-α,CD4^＋ and CD4^＋/CD8^＋ ratio,but elevated levels of IL-10 as compared with the allograft group.Conclusion：Post-OLT acute rejection could be attenuated by emodin,its mechanism of action may be associated with protecting hepatocytes from apoptosis,polarizing the Th 1 paradigm to Th2,and inhibiting the proliferation of CD4^＋ T cell in plasma.

Clinical features of patients with pituitary stalk thickening: a review of 159 cases from one medical center

Background:Pituitary stalk thickening (PST) used as an imaging diagnosis plays a major role in diagnosis and treatment of the hypothalamus and pituitary disease at an early stage.Up until now,several lines of systematic investigations have been conducted among adolescents,and the results indicated that PST is possibly one of the principal early manifestations of sellar region tumor.To characterize the major clinical features of PST and to identify the most effective treatments we conducted this study.Methods:This was a retrospective review of patients with PST evaluated at Huashan Hospital over an eight-year period between 2007 and 2014.One hundred fifty nine patients who were diagnosed PST were included.The data including demographics,clinical presentations,imaging examinations,laboratory results and surgery were thoroughly reviewed and carefully analyzed.According to their clinical presentations and examinations,relevant treatments were adopted and different prognosis were observed.Results:Of the 159 patients,57 were males and 102 were females (median age was 29 and 43.4％ were under the age of 21 years).And of the patients in the age group between 30 and 35 years,84％ were females.'Polydipsia and polyuria' was the most common clinical manifestation observed in 90 cases (＞50％).49.5％ of the patients were diagnosed to have at least one anterior pituitary dysfunction.The sellar region MRI (SR-MRI) data showed that patients who had different clinical presentations or pituitary function showed different SR-MRI appearance.Over 60％ patients who performed followup MRI showed shrunken PST.Fourteen cases who received radiotherapy appeared to be improved as shown by MRI.Conclusions:PST is most commonly seen in the teenagers and the women of reproductive age.Distinct etiology may be identified based on the clinical manifestations,age and SR-MRI,which would help to make the final decision for treatments.Radiotherapy and immuno-suppressed therapy are effective in alleviating clinical symptoms and shrinking the stalk thickening.

Effect of the extract of intestine from stressed rat on lymphocyte proliferation in vitro

Immuno-suppressive protein, with a molecular weight of 155 and 370 ku, was generated in spleen and lymph node in stressed rats. It strongly inhibited lymphocyte proliferation. The results of activity assay, molecular weight determination and histological localization all demonstrated that under stress the immuno-suppressive protein was also generated in intestinal mucosa of rats.