Copolymerization of chitosan selectively grafted by polyethylene glycol was prepared. Chitosan was selectively grafted by monomethoxy polyethylene glycol（mPEG-OH）, which contained a hydroxyl group combining with hex...Copolymerization of chitosan selectively grafted by polyethylene glycol was prepared. Chitosan was selectively grafted by monomethoxy polyethylene glycol（mPEG-OH）, which contained a hydroxyl group combining with hexamethylene diisocyanate（HDI） to form a novel macromonomer namely monomethoxy polyethylene glycol isocyanate（mPEG-NCO） containing a isocyanate group with higher chemical activity in ethyl glyoxalate solution absolutely without water. The selective grafted copolymerization of Chitosan with mPEG-NCO was conducted under heterogeneous conditions as suspension in dimethylformamide. The hydrophilic copolymers of chitosan were prepared by condensation reaction of isocyanate group on mPEG- NCO with hydroxy groups on chitosan chains because amino groups on chitosan chains were protected by complexion formation with copper ions. The effect of reaction condition on the grafting extents was discussed. Swelling properties of mPEG-g-CS were researched. The graft copolymer mPEG-g-CS was characterized by the infrared spectra. The experimental result showed that the copper ions were very effective to protect amino groups from condensation reaction. The swelling degree in water increases with adding of grafting ratio. The maximum swelling degree was up to above 132% when the grafting ratio was about 270%. The graft copolymer can be soluble partially in pure water.展开更多
BACKGROUND: The low graft-to-recipient weight ratio(GRWR) in adult-to-adult living donor liver transplantation(LDLT) is one of the major risk factors affecting graft survival. The goal of this study was to evaluate wh...BACKGROUND: The low graft-to-recipient weight ratio(GRWR) in adult-to-adult living donor liver transplantation(LDLT) is one of the major risk factors affecting graft survival. The goal of this study was to evaluate whether the lower limit of the GRWR can be safely reduced without portal pressure modulation in right-lobe LDLT. METHODS: From 2005 to 2011, 317 consecutive patients from a single institute underwent LDLT with right-lobe grafts without portal pressure modulation. Of these, 23 had a GRWR of less than 0.7%(group A), 27 had a GRWR of ≥0.7%, 【0.8%(group B), and 267 had a GRWR of more than and equal to 0.8%(group C). Medical records, including recipient, donor, operation factors, laboratory findings and complications were reviewed retrospectively. RESULTS: The baseline demographics showed low model for end-stage liver disease score(mean 16.3±8.9) and high percentage of hepatocellular carcinoma(231 patients, 72.9%). Three groups by GRWR demonstrated similar characteristics except recipient body mass index and donor gender. For smallforsize syndrome, there were 3(13.0%) in group A, 1(3.7%) in group B, and 2 patients(0.7%) in group C(P【0.001). Hepatic artery thrombosis was more frequently observed in group A than in groups B and C(8.7% vs 3.7% vs 1.9%, P=0.047). However, among the three groups, graft survival rates at 1 year(100% vs 96.3% vs 93.6%) and 3 years(91.7% vs 73.2% vs 88.1%) were not different(P=0.539). In laboratory measurements,there was no group difference in total bilirubin and albumin. However, prothrombin time was longer in group A within postoperative 1 week and platelet count was lower in groups A and B within postoperative 1 month. CONCLUSION: A GRWR lower to 0.7% is safe and does not need to modulate portal pressure in adult-to-adult LDLT using the right-lobe in favorable conditions including low model for end-stage liver disease score.展开更多
AIM:To investigate the outcome of living donor liver transplantation(LDLT)recipients transplanted with small-for-size grafts(SFSGs).METHODS:Between November 2001 and December2010,196 patients underwent LDLT with right...AIM:To investigate the outcome of living donor liver transplantation(LDLT)recipients transplanted with small-for-size grafts(SFSGs).METHODS:Between November 2001 and December2010,196 patients underwent LDLT with right lobe liver grafts at our center.Recipients were divided into 2 treatment groups:group A with an actuarial graft-to-recipient weight ratio(aGRWR)<0.8%(n=45)and group B with an aGRWR≥0.8%(n=151).We evaluated serum liver function markers within 4 wk after transplantation.We also retrospectively evaluated the outcomes of these patients for potential effects related to the recipients,the donors and the transplantation procedures based upon a review of their medical records.RESULTS:Small-for-size syndrome(SFSS)developed in 7 of 45 patients(15.56%)in group A and 9 of 151patients(5.96%)in group B(P=0.080).The levels of alanine aminotransferase and aspartate aminotransferase in group A were higher than those in group B during early period after transplantation,albeit not significantly.The cumulative 1-,3-and 5-year liver graft survival rates were 82.22%,71.11%and 71.11%for group A and 81.46%,76.82%,and 75.50%for group B patients,respectively(P=0.623).However,univariate analysis of risk factors associated with graft survival in group A demonstrated that the occurrence of SFSS after LDLT was the only significant risk factor affecting graft survival(P<0.001).Furthermore,multivariate analysis of our data did not identify any additional significant risk factors accounting for poor graft survival.CONCLUSION:Our study suggests that LDLT recipients with an aGRWR<0.8%may have liver graft outcomes comparable to those who received larger size grafts.Further studies are required to ascertain the safety of using SFSGs.展开更多
Background: Small-for-size graft(SFSG) has emerged as one of the very contentions in adult-to-adult living donor liver transplantation(LDLT) as a certain graft size is related to recipients’ prognosis. Graftto-recipi...Background: Small-for-size graft(SFSG) has emerged as one of the very contentions in adult-to-adult living donor liver transplantation(LDLT) as a certain graft size is related to recipients’ prognosis. Graftto-recipient weight ratio(GRWR)≥0.8% was considered as a threshold to conduct LDLT. However, this also has been challenged over decades as a result of technique refinements. For a better understanding of SFSG in practice, we conducted this meta-analysis to compare the perioperative outcomes and long-term outcomes between patients adopting the grafts with a lower volume(GRWR < 0.8%, SFSG group) and sufficient volume(GRWR ≥ 0.8%, non-SFSG group) in adult-to-adult LDLT. Data sources: The studies comparing recipients adopting graft with a GRWR < 0.8% and ≥ 0.8% were searched by three authors independently in Pub Med, Web of Science, Embase, the Cochrane Library, MEDLINE and Google Scholar databases until September 2018 and data were analyzed by RevMan 5.3.5. Results: Sixteen studies with a total of 3272 subjects were included in this meta-analysis. In terms of small-for-size syndrome(SFSS), no significant difference was found in subjects enrolled after year 2010(before 2010, OR = 3.00, 95% CI: 1.69–5.35, P = 0.0002;after 2010, OR = 1.23, 95% CI: 0.79–1.90, P = 0.36;P for interaction: 0.02). There was no significant difference in operative duration, blood loss, cold ischemia time, biliary complications, acute rejection, postoperative bleeding, hospitalization time, perioperative mortality, and 1-, 3-and 5-year overall survival rates between two groups. Conclusions: This meta-analysis suggested that adopting SFSG in adult LDLT has comparable outcomes to those with non-SFSG counterparts since 2010.展开更多
AIM:To describe a condition that we define as early graft dysfunction(EGD)which can be identified preoperatively. METHODS:Small-for-size graft dysfunction following living-related liver transplantation(LRLT)is charact...AIM:To describe a condition that we define as early graft dysfunction(EGD)which can be identified preoperatively. METHODS:Small-for-size graft dysfunction following living-related liver transplantation(LRLT)is characterized by EGD when the graft-to-recipient body weight ratio(GRBWR)is below 0.8%.However, patients transplanted with GRBWR above 0.8%can develop dysfunction of the graft.In 73 recipients of LRLT(GRBWR>0.8%),we identified 10 patients who developed EGD.The main measures of outcomes analyzed were overall mortality,number of re-transplants and length of stay in days(LOS).Furthermore we analyzed other clinical pre-transplant variables,intraoperative parameters and post transplant data.RESULTS:A trend in favor of the non-EGD group(3-mo actuarial survival 98%vs 88%,P=0.09;3-mo graft mortality 4.7%vs 20%,P=0.07)was observed as well as shorter LOS(13 d vs 41.5 d;P=0.001)and smaller requirement of peri-operative Units of Plasma (4 vs 14;P=0.036).Univariate analysis of pre- transplant variables identified platelet count,serum bilirubin,INR and Meld-Na score as predictors of EGD. In the multivariate analysis transplant Meld-Na score (P=0.025,OR:1.175)and pretransplant platelet count(P=0.043,OR:0.956)were independently associated with EGD. CONCLUSION:EGD can be identified preoperatively and is associated with increased morbidity after LRLT. A prompt recognition of EGD can trigger a timely treatment.展开更多
目的探讨患者术前中性粒细胞/淋巴细胞比值(NLR)对非体外循环下冠状动脉旁路移植术(OPCABG)后心肌损伤以及临床预后的影响。方法选取2014年1月—2019年12月我院收治的314名行OPCABG的患者,依据患者术前NLR的三分位数分为高比值组(NLR>...目的探讨患者术前中性粒细胞/淋巴细胞比值(NLR)对非体外循环下冠状动脉旁路移植术(OPCABG)后心肌损伤以及临床预后的影响。方法选取2014年1月—2019年12月我院收治的314名行OPCABG的患者,依据患者术前NLR的三分位数分为高比值组(NLR>2.8,n=102)、中比值组(2.8≥NLR≥1.6,n=106)以及低比值组(NLR<1.6,n=106)。分别检测患者术前基线、术后8 h及术后24 h肌酸激酶同工酶(CKMB)及肌钙蛋白(CTnI)水平。结果高比值组患者术后心肌损伤发生率显著高于中比值组及低比值组(P<0.05)。高比值组术后CKMB峰值显著高于中比值组[2.1(1.2~13.0)ng/mL vs 2.0(1.0~7.3)ng/mL,P=0.047]及低比值组[2.1(1.2~13.0)ng/mL vs 1.1(0.9~1.6)ng/mL,P<0.001]。且高比值组患者术后CTnI峰值同样显著高于中比值组[0.075(0.010~0.185)ng/mL vs 0.020(0.000~0.103)ng/mL,P=0.011],以及低比值组[0.075(0.010~0.185)ng/mL vs 0.010(0.000~0.030)ng/mL,P<0.001]。术前NLR较高是术后患者CTnI升高的独立危险因素(OR:2.809;95%CI:1.326~5.954;P=0.007)。高比值组患者1年不良心血管事件发生率显著高于中比值组及低比值组(HR:1.80;95%CI:1.16~2.79;Log Rank P=0.021)。结论患者术前中性粒细胞/淋巴细胞比值升高是非体外循环冠状动脉旁路移植术后心肌损伤的独立危险因素,而且会增加患者不良心血管事件。展开更多
基金Funded by the Program of Beijing Municipal Commission of Education
文摘Copolymerization of chitosan selectively grafted by polyethylene glycol was prepared. Chitosan was selectively grafted by monomethoxy polyethylene glycol（mPEG-OH）, which contained a hydroxyl group combining with hexamethylene diisocyanate（HDI） to form a novel macromonomer namely monomethoxy polyethylene glycol isocyanate（mPEG-NCO） containing a isocyanate group with higher chemical activity in ethyl glyoxalate solution absolutely without water. The selective grafted copolymerization of Chitosan with mPEG-NCO was conducted under heterogeneous conditions as suspension in dimethylformamide. The hydrophilic copolymers of chitosan were prepared by condensation reaction of isocyanate group on mPEG- NCO with hydroxy groups on chitosan chains because amino groups on chitosan chains were protected by complexion formation with copper ions. The effect of reaction condition on the grafting extents was discussed. Swelling properties of mPEG-g-CS were researched. The graft copolymer mPEG-g-CS was characterized by the infrared spectra. The experimental result showed that the copper ions were very effective to protect amino groups from condensation reaction. The swelling degree in water increases with adding of grafting ratio. The maximum swelling degree was up to above 132% when the grafting ratio was about 270%. The graft copolymer can be soluble partially in pure water.
文摘BACKGROUND: The low graft-to-recipient weight ratio(GRWR) in adult-to-adult living donor liver transplantation(LDLT) is one of the major risk factors affecting graft survival. The goal of this study was to evaluate whether the lower limit of the GRWR can be safely reduced without portal pressure modulation in right-lobe LDLT. METHODS: From 2005 to 2011, 317 consecutive patients from a single institute underwent LDLT with right-lobe grafts without portal pressure modulation. Of these, 23 had a GRWR of less than 0.7%(group A), 27 had a GRWR of ≥0.7%, 【0.8%(group B), and 267 had a GRWR of more than and equal to 0.8%(group C). Medical records, including recipient, donor, operation factors, laboratory findings and complications were reviewed retrospectively. RESULTS: The baseline demographics showed low model for end-stage liver disease score(mean 16.3±8.9) and high percentage of hepatocellular carcinoma(231 patients, 72.9%). Three groups by GRWR demonstrated similar characteristics except recipient body mass index and donor gender. For smallforsize syndrome, there were 3(13.0%) in group A, 1(3.7%) in group B, and 2 patients(0.7%) in group C(P【0.001). Hepatic artery thrombosis was more frequently observed in group A than in groups B and C(8.7% vs 3.7% vs 1.9%, P=0.047). However, among the three groups, graft survival rates at 1 year(100% vs 96.3% vs 93.6%) and 3 years(91.7% vs 73.2% vs 88.1%) were not different(P=0.539). In laboratory measurements,there was no group difference in total bilirubin and albumin. However, prothrombin time was longer in group A within postoperative 1 week and platelet count was lower in groups A and B within postoperative 1 month. CONCLUSION: A GRWR lower to 0.7% is safe and does not need to modulate portal pressure in adult-to-adult LDLT using the right-lobe in favorable conditions including low model for end-stage liver disease score.
基金Supported by National Science and Technology Major Project of China,No.2008ZX10002-025 and No.2008ZX10002-026
文摘AIM:To investigate the outcome of living donor liver transplantation(LDLT)recipients transplanted with small-for-size grafts(SFSGs).METHODS:Between November 2001 and December2010,196 patients underwent LDLT with right lobe liver grafts at our center.Recipients were divided into 2 treatment groups:group A with an actuarial graft-to-recipient weight ratio(aGRWR)<0.8%(n=45)and group B with an aGRWR≥0.8%(n=151).We evaluated serum liver function markers within 4 wk after transplantation.We also retrospectively evaluated the outcomes of these patients for potential effects related to the recipients,the donors and the transplantation procedures based upon a review of their medical records.RESULTS:Small-for-size syndrome(SFSS)developed in 7 of 45 patients(15.56%)in group A and 9 of 151patients(5.96%)in group B(P=0.080).The levels of alanine aminotransferase and aspartate aminotransferase in group A were higher than those in group B during early period after transplantation,albeit not significantly.The cumulative 1-,3-and 5-year liver graft survival rates were 82.22%,71.11%and 71.11%for group A and 81.46%,76.82%,and 75.50%for group B patients,respectively(P=0.623).However,univariate analysis of risk factors associated with graft survival in group A demonstrated that the occurrence of SFSS after LDLT was the only significant risk factor affecting graft survival(P<0.001).Furthermore,multivariate analysis of our data did not identify any additional significant risk factors accounting for poor graft survival.CONCLUSION:Our study suggests that LDLT recipients with an aGRWR<0.8%may have liver graft outcomes comparable to those who received larger size grafts.Further studies are required to ascertain the safety of using SFSGs.
文摘Background: Small-for-size graft(SFSG) has emerged as one of the very contentions in adult-to-adult living donor liver transplantation(LDLT) as a certain graft size is related to recipients’ prognosis. Graftto-recipient weight ratio(GRWR)≥0.8% was considered as a threshold to conduct LDLT. However, this also has been challenged over decades as a result of technique refinements. For a better understanding of SFSG in practice, we conducted this meta-analysis to compare the perioperative outcomes and long-term outcomes between patients adopting the grafts with a lower volume(GRWR < 0.8%, SFSG group) and sufficient volume(GRWR ≥ 0.8%, non-SFSG group) in adult-to-adult LDLT. Data sources: The studies comparing recipients adopting graft with a GRWR < 0.8% and ≥ 0.8% were searched by three authors independently in Pub Med, Web of Science, Embase, the Cochrane Library, MEDLINE and Google Scholar databases until September 2018 and data were analyzed by RevMan 5.3.5. Results: Sixteen studies with a total of 3272 subjects were included in this meta-analysis. In terms of small-for-size syndrome(SFSS), no significant difference was found in subjects enrolled after year 2010(before 2010, OR = 3.00, 95% CI: 1.69–5.35, P = 0.0002;after 2010, OR = 1.23, 95% CI: 0.79–1.90, P = 0.36;P for interaction: 0.02). There was no significant difference in operative duration, blood loss, cold ischemia time, biliary complications, acute rejection, postoperative bleeding, hospitalization time, perioperative mortality, and 1-, 3-and 5-year overall survival rates between two groups. Conclusions: This meta-analysis suggested that adopting SFSG in adult LDLT has comparable outcomes to those with non-SFSG counterparts since 2010.
文摘AIM:To describe a condition that we define as early graft dysfunction(EGD)which can be identified preoperatively. METHODS:Small-for-size graft dysfunction following living-related liver transplantation(LRLT)is characterized by EGD when the graft-to-recipient body weight ratio(GRBWR)is below 0.8%.However, patients transplanted with GRBWR above 0.8%can develop dysfunction of the graft.In 73 recipients of LRLT(GRBWR>0.8%),we identified 10 patients who developed EGD.The main measures of outcomes analyzed were overall mortality,number of re-transplants and length of stay in days(LOS).Furthermore we analyzed other clinical pre-transplant variables,intraoperative parameters and post transplant data.RESULTS:A trend in favor of the non-EGD group(3-mo actuarial survival 98%vs 88%,P=0.09;3-mo graft mortality 4.7%vs 20%,P=0.07)was observed as well as shorter LOS(13 d vs 41.5 d;P=0.001)and smaller requirement of peri-operative Units of Plasma (4 vs 14;P=0.036).Univariate analysis of pre- transplant variables identified platelet count,serum bilirubin,INR and Meld-Na score as predictors of EGD. In the multivariate analysis transplant Meld-Na score (P=0.025,OR:1.175)and pretransplant platelet count(P=0.043,OR:0.956)were independently associated with EGD. CONCLUSION:EGD can be identified preoperatively and is associated with increased morbidity after LRLT. A prompt recognition of EGD can trigger a timely treatment.
文摘目的探讨患者术前中性粒细胞/淋巴细胞比值(NLR)对非体外循环下冠状动脉旁路移植术(OPCABG)后心肌损伤以及临床预后的影响。方法选取2014年1月—2019年12月我院收治的314名行OPCABG的患者,依据患者术前NLR的三分位数分为高比值组(NLR>2.8,n=102)、中比值组(2.8≥NLR≥1.6,n=106)以及低比值组(NLR<1.6,n=106)。分别检测患者术前基线、术后8 h及术后24 h肌酸激酶同工酶(CKMB)及肌钙蛋白(CTnI)水平。结果高比值组患者术后心肌损伤发生率显著高于中比值组及低比值组(P<0.05)。高比值组术后CKMB峰值显著高于中比值组[2.1(1.2~13.0)ng/mL vs 2.0(1.0~7.3)ng/mL,P=0.047]及低比值组[2.1(1.2~13.0)ng/mL vs 1.1(0.9~1.6)ng/mL,P<0.001]。且高比值组患者术后CTnI峰值同样显著高于中比值组[0.075(0.010~0.185)ng/mL vs 0.020(0.000~0.103)ng/mL,P=0.011],以及低比值组[0.075(0.010~0.185)ng/mL vs 0.010(0.000~0.030)ng/mL,P<0.001]。术前NLR较高是术后患者CTnI升高的独立危险因素(OR:2.809;95%CI:1.326~5.954;P=0.007)。高比值组患者1年不良心血管事件发生率显著高于中比值组及低比值组(HR:1.80;95%CI:1.16~2.79;Log Rank P=0.021)。结论患者术前中性粒细胞/淋巴细胞比值升高是非体外循环冠状动脉旁路移植术后心肌损伤的独立危险因素,而且会增加患者不良心血管事件。
