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.

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.

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.