Effect of perioperative blood transfusion on clinical outcomes in hepatic surgery for cancer

Allogeneic blood transfusion during liver resection for malignancies has been associated with an increased incidence of different types of complications: infectious complications, tumor recurrence, decreased survival. Even if there is clear evidence of transfusion-induced immunosuppression, it is difficult to demonstrate that transfusion is the only determinant factor that decisively affects the outcome. In any case there are several motivations to reduce the practice of blood transfusion. The advantages and drawbacks of different transfusion alternatives are reviewed here, emphasizing that surgeons and anesthetists who practice in centers with a high volume of liver resections, should be familiar with all the possible alternatives.

Transplantation in autoimmune liver diseases

Liver transplantation remains an effective treatment for those with end-stage disease and with intractable liver-related symptoms.The shortage of organs for transplantation has resulted in the need for rationing.A variety of approaches to selection and allocation have been developed and vary from country to country.The shortage of donors has meant that new approaches have to be adopted to make maximal use of the available organs;these include splitting grafts,use of extended criteria livers,livers from non-heart-beating donors and from living donors.Post transplantation,most patients will need life-long immunosuppression,although a small proportion can have immunosuppression successfully withdrawn.Newer immunosuppressive drugs and different strategies may allow a more targeted approach with a reduction in side-effects and so improve the patient and graft survival.For autoimmune diseases,transplantation is associated with significant improvement in the quality and length of life.Disease may recur after transplantation and may affect patient and graft survival.

Present and future cell therapies for pancreatic beta cell replenishment

If only at a small scale,islet transplantation has successfully addressed what ought to be the primary endpoint of any cell therapy:the functional replenishment of damaged tissue in patients.After years of less-thanoptimal approaches to immunosuppression,recent advances consistently yield long-term graft survival rates comparable to those of whole pancreas transplantation.Limited organ availability is the main hurdle that stands in the way of the widespread clinical utilization of this pioneering intervention.Progress in stem cell research over the past decade,coupled with our decades-long experience with islet transplantation,is shaping the future of cell therapies for the treatment of diabetes.Here we review the most promising avenues of research aimed at generating an inexhaustible supply of insulin-producing cells for islet regeneration,including the differentiation of pluripotent and multipotent stem cells of embryonic and adult origin along the beta cell lineage and the direct reprogramming of non-endocrine tissues into insulin-producing cells.

Orthotopic heart transplantation with prolonged donor ischemic time:report of 3 cases and literature review

Heart transplantation has become an effective therapy for patients with end stage heart failure. The preservation of the donor heart is an important factor that affects the results of the operation. We performed 3 cases of orthotopic heart transplantation and obtained some experience in the preservation of the donor heart. Methods： Three male patients with end stage heart failure received the operation in our department successfully. Doppler echocardiography showed left ventrieular end diameter （LVED） of the patients were 91, 87, and 83 mm, and ejection fraction （EF） were 24%, 20%, 12.9%, respectively. Once the declaration of brain death had been made, the median stemotomy was performed with a sternal saw. Haparin at a dose of 300 U/kg of body weight was administered. After at least 2-min heparin circulation, the procurement proceeded. The superior vena cava and the inferior vena cava were nearly completely divided. When the heart was empty, the ascending aorta was cross-clamped and the St. Thomas solution was infused by gravity. The heart was excised by transection of the inferior vena cava, the superior vena cava and all pulmonary veins. After donor heart was removed, it was infused with University of Wisconsin （UW） solution by gravity at a temperature of 4-6℃, then placed in UW solution for storage during transportation. The temperature of solution was maintained at about 4-6℃. The ischemic times of donor heart were 9, 8 and 6 h, respectively. The bicaval anastomotic heart transplantation was adopted. The left atrial anastomoses were constructed using 3.0 polypropylene. The inferior vene cava anastomosis was constructed, the donor and native aorta were cut to an appropriate length. Then the aorta and main pulmonary artery anastomosis were performed respectively. The superior vene cava anastomosis was usually constructed during the rewarming phase. The intraoperative course with a cardiopulmonary bypass of the 3 patients was 96, 44 and 49 min, respectively. Standard triple immunosuppression therapy was commenced in the immediate post-operative period. Results： The operation procedure was smooth and no perioperative death occurred. The follow-up was carried out carefully. The patient＇s condition was fine in 25, 30 and 32 months after operation. The blood pressure was 130/90, 140/95 and 120/80 mmHg, respectively, and LVED was 51, 49 and 53 mm; EF was 50%, 54% and 60%, respectively. Cardiothoracic ratio was 0.63, 0.55, and 0.64, respectively. Conclusion： Preservation time of donor heart with St. Thomas solution infusion and UW solution storage at 0-4℃ may exceed 6 h, and receive comparable middle-term outcomes.

举办朝阳移植论坛通知

朝阳移植论坛为中华医学会继续教育项目。论坛特别约请国内外著名移植专家进行专题讲座，追踪器官移植领域国际最新进展，力求从深层次探讨器官移植基础和临床问题。论坛安排较多讨论时间，让与会者能与国内外专家面对面互动交流。本次论坛主题为于细胞移植疗法诱导移植免疫耐受、胰岛细胞移植和临床免疫抑制药物监测。与会人员可授予国家级I类继续医学教育学分6分。欢迎全国器官移植相关专业医技人员和临床药物分析药技人员参加。

举办朝阳移植论坛通知

朝阳移植论坛为中华医学会继续教育项目。论坛特别约请国内外著名移植专家进行专题讲座，追踪器官移植领域国际最新进展，力求从深层次探讨器官移植基础和临床问题。论坛安排较多讨论时间，让与会者能与国内外专家面对面互动交流。本次论坛主题为干细胞移植疗法诱导移植免疫耐受、胰岛细胞移植和临床免疫抑制药物监测。与会人员可授予国家级I类继续医学教育学分6分。欢迎全国器官移植相关专业医技人员和临床药物分析药技人员参加。

举办朝阳移植论坛通知

朝阳移植论坛为中华医学会继续教育项目。论坛特别约请国内外著名移植专家进行专题讲座，追踪器官移植领域国际最新进展，力求从深层次探讨器官移植基础和临床问题。论坛安排较多讨论时间，让与会者能与国内外专家面对面互动交流。本次论坛主题为干细胞移植疗法诱导移植免疫耐受、胰岛细胞移植和临床免疫抑制药物监测。与会人员可授予国家级Ⅰ类继续医学教育学分6分。欢迎全国器官移植相关专业医技人员和临床药物分析药技人员参加。

Effect of soothing-liver and nourishing-heart acupuncture on early selective serotonin reuptake inhibitor treatment onset for depressive disorder and related indicators of neuroimmunology:a randomized controlled clinical trial

OBJECTIVE:To observe the effect of soothing-liver and nourishing-heart acupuncture on selective serotonin reuptake inhibitor(SSRIs) treatment effect onset in patients with depressive disorder and related indicators of neuroimmunology.METHODS:Overall,126 patients with depressive disorder were randomly divided into a medicine and acupuncture-medicine group using a random number table.Patients were treated for 6 consecutive weeks.The two groups were evaluated by the Montgomery-Asberg Depression Rating Scale(MADRS) and Side Effects Rating Scale(SERS) to assess the effect of the soothing-liver and nourishing-heart acupuncture method on early onset of SSRI treatment effect.Changes in serum 5-hydroxytryptamine(5-HT) and inflammatory cytokines before and after treatment were recorded and compared between the medicine group and the acupuncture-medicine group.RESULTS:The acupuncture-medicine group had significantly lower MADRS scores at weeks 1,2,4,and 6 after treatment compared with the medicine group(P < 0.01).The acupuncture group had significantly lower SERS scores at weeks 1,2,4,and 6 after treatment compared with the medicine group(P < 0.01).At 6 weeks after treatment,serum 5-HT in the acupuncture-medicine group was significantly higher compared with the medicine group(P <0.01).lnterleukin-6(IL-6) in the acupuncture-medicine group was significantly lower than that in the medicine group(P < 0.01),whereas there was no significant difference in IL-1(3 between the groups(P > 0.05).Anti-inflammatory cytokines IL-4 and IL-10 were significantly higher in the acupuncture-medicine group compared with the medicine group(P < 0.01,P < 0.05,respectively).CONCLUSION:The soothing-liver and nourishing-heart acupuncture method can effectively accelerate the onset of SSRI effects when treating depressive disorder and can significantly reduce the adverse reactions of SSRIs.Moreover,acupuncture can enhance serum 5-HT and regulate the balance of pro-inflammatory cytokines and anti-inflammatory cytokines.