Liver transplantation is suitable for acute and chronic liver diseases that cannot be cured by other methods. Immunosuppressants such as azathioprine, methylprednisolone, cyclophosphamide, cyclosporine A, and tacrolimus have been applied to prevent rejection after liver transplantation. Among them, tacrolimus is generally effective in resisting rejection, and its main adverse reaction is nephrotoxicity. Tacrolimus-induced seizures are rarely reported. The present report describes trismus, restlessness, and generalized muscle twitching in a 44-year-old man and a 59-year-old man who received tacrolimus after liver transplantation. Tacrolimus-induced epilepsy was diagnosed by clinical symptoms and video-electroencephalography. After the patients developed epileptic symptoms, they received intramuscular injections of diazepam and phenobarbital. When the symptoms were relieved, the patients were treated with oral levetiracetam tablets. The tacrolimus was immediately stopped, and the epilepsy symptoms gradually disappeared after treatment with sedatives and levetiracetam. The patients continued taking the levetiracetam for approximately 2 weeks. No evidence of seizures occurred during the next 8 months. Although tacrolimus is reportedly effective against rejection after liver transplantation, tacrolimus-induced epilepsy should be carefully managed to prevent death. Additionally, epilepsy may rarely occur in patients with a normal blood concentration of tacrolimus. Further study on the mechanism of such neurological complications is needed.
Central vein catheters, which are used in the treatment of cancer patients, are prone to thrombotic complications of the catheter or adjacent vein. Previous studies suggest that 1 mg warfarin daily (minidose) can significantly reduce that risk.This, study aims to establish whether minidose warfarin could reduce catheter-related thrombosis in adult patients with haematological malignancies.Patients were randomly selected to receive warfarin or not. The end-points studied were: (i) occlusion by thrombus, (ii) removal of catheter for other reasons or (iii) 90 days free of thrombus.There was no significant difference in the incidence of catheter thrombosis or venous thrombosis and no significant variation in catheter survival between the study and control groups.This study found no benefit of the routine use of minidose warfarin for prophylaxis of central vein' catheter thrombosis in patients with haematological malignancies and therefore does not support the routine use of minidose warfarin for prophylaxis in such patients.
Adequate hepatopetal portal vein blood flow is obligatory to ensure proper liver function after liver transplantation. Large collateral veins as shunts impair portal vein flow and even cause hepatofugal blood flow and portal steal syndrome. In particular, splenorenal shunts in liver transplant recipients can lead to allograft dysfunction and possible allograft loss or hepatic encephalopathy. Restoration of portal flow through left renal vein ligation ( LRVL ) is a treatment option, which is much easier compared to splenectomy, renoportal anastomosis and shunt closure, but bears the risk of moderate and temporary impairment of renal function. In addition, a patent portal vein is mandatory for LRVL . However, although LRVL has been reported to be an effective, safe and easy method to control portacaval shunts and increase hepatopetal flow in some studies, indications and safety are still not clear. In this review, we summarize existing studies on LRVL during liver transplantation.
microRNAs (miR/miRNAs) have been demonstrated to function as tumor suppressors and oncogenes, and miRNA polymorphisms may have a role in cancer development. The present study aimed to investigate the association between the miR‑146aG>C, miR‑149C>T, miR‑196a2C>T and miR‑499A>G polymorphisms and the risk of hepatocellular carcinoma (HCC) and hepatitis B virus (HBV) infection. A total of 271 patients with HCC and 532 healthy control participants were enrolled in the present study. miR‑146aG>C, miR‑149C>T, miR‑196a2C>T and miR‑499A>G polymorphisms were genotyped using the polymerase chain reaction‑restriction fragment length polymorphism method. A significant difference was identified in the genotype frequency of miR‑196a2C>T in the patients in the case group compared with the control group (χ2=6.88; P=0.032). Compared with the CC genotype, the miR‑196a2 TT genotype was associated with a significantly reduced risk of HCC [odds ratio (OR), 0.62; 95% confidence interval (CI), 0.38‑0.99], and a significantly reduced risk was also found in the dominant (OR, 0.69; 95% CI, 0.49‑0.98) and recessive (OR, 0.70; 95% CI, 0.46‑1.02) models. Moreover, individuals with HBV who were carrying the miR‑196a2 CT and TT genotypes had a significantly reduced risk of HCC (OR, 0.62; 95% CI, 0.41‑0.95; and OR, 0.39; 95% CI, 0.20‑0.73, respectively). In conclusion, the present study found that the miR‑196a2C>T polymorphism has a protective effect in patients with HCC, particularly in those with HBV infection.
Objective
To explore the managements for intraoperative thrombosis in liver transplant patients complicated with portal vein thrombosis (PVT) and its efficacy.
Methods
Clinical data of 10 patients complicated with PVT who underwent liver transplantation between February 2018 and October 2018 in Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 7 patients were male and 3 female, aged 37-66 years old with a median age of 54 years old. PVT was classified based on Yerdel classification. Among them, 4 cases were classified as grade Ⅰ, 4 grade Ⅱ and 2 grade Ⅲ. The managements for intraoperative thrombosis were summarized and clinical efficacy was evaluated.
Results
For patients with grade Ⅰ thrombosis, the thrombi were removed directly or treated by dissecting the portal vein trunk at the high end. According to the progression of thrombi, grade Ⅱ and Ⅲ thrombi were removed directly, or vascular anastomosis was performed after the removal. The large shunt vessels were ligated and dissected. After the operation, intravenous or subcutaneous injection of heparin was given for anticoagulation. The portal vein blood flow was monitored by ultrasound periodically after operation. During 6-month follow-up, postoperative ultrasound demonstrated normal portal vein blood flow in all patients. No portal vein-related complications, such as new PVT, stenosis and insufficient blood flow, occurred.
Conclusions
For patients complicated with PVT, assessment of range and severity of PVT should be performed before operation to obtain sufficient portal vein blood flow of the graft, and to design a precise surgical plan. PVT can be treated according to individual conditions to guarantee the well blood flow of portal vein and to reduce the postoperative complications.
Key words:
Liver transplantation; Portal vein; Thromboembolism
Objective
To investigate the application value of artery approach in the lower colon region combined with portal vein (PV) resection and allograft vascular grafts in radical pancreaticoduodenectomy for pancreatic cancer combined with vascular invasion.
Methods
The retrospective descriptive study was conducted. The clinicopathological data of 13 patients with pancreatic cancer involving in PV, splenic vein or junction who were admitted to the Beijing Chao Yang Hospital of Capital Medical University from March 2014 to June 2015 were collected. The superior mesenteric artery (SMA), tumors and soft tissues (including involved vessels) in the right of the celiac trunk were resected after exploring SMA and evaluating resectability of tumors. Patients underwent PV-splenic vein resection and reconstruction with allogenic vein. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up situation. Follow-up using outpatient examination and telephone interview was performed to detect survival of patients and tumor recurrence and metastasis up to April 2016. Measurement data with normal distribution were represented as ±s.
Results
(1) Surgical situations: 13 patients successfully underwent radical pancreaticoduodenectomy via artery approach in the lower colon region combined with PV, splenic vein resection and allograft vascular grafts. Operation time and volume of intraoperative blood loss were respectively (489±31)minutes and (407±96)mL, without intra- and post- operative deaths. (2) Postoperative situations: of 13 patients, 3 and 1 patients were respectively complicated with pancreatic fistula (2 in grade A and 1 in grade B) and gastroplegia, and cured by conservative treatment.There was no occurrence of bleeding, intraperitoneal infection, diarrhea, anastomotic stenosis and thrombus. The median duration of postoperative hospital stay was 12 days. Results of postoperative pathological examination: of 13 patients, high-, moderate- and low-differentiated adenocarcinoma was detected in 2, 7 and 4 patients respectively. Three patients had negative vascular margin, 2 had tunica intima invasion and 8 had tumor cell invasion in vascular adventitia.One, 2, 6, 4 patients were detected in ⅠB, ⅡA, ⅡB and Ⅲ staging, respectively. The negative margin rate by postoperative pathological examination was 11/13. (3) Follow-up situation: 13 patients were followed up 10 months postoperatively, with good survival and without tumor recurrence or metastasis.
Conclusion
The radical pancreaticoduodenectomy via artery approach in the lower colon region combined with PV/SMV resection and allograft vascular grafts is safe and feasible for pancreatic cancer involving in PV, splenic vein or junction, it can also evaluate early resectability of tumors, with good operative efficacy.
Key words:
Pancreatic neoplasms; Pancreaticoduodenectomy; Artery approach; Vascular grafts
Abstract Efficient energy storage systems are crucial for the optimal utilization of renewable energy. Sodium‐ion batteries (SIBs) are considered potential substitutes for next‐generation low‐cost energy storage systems due to the low cost and abundance of sodium resources. However, the industrialization of SIBs faces a great challenge in terms of the anode. Hard carbon could be a promising anode material due to its high capacity and low cost which originates from biomass. This study used pre‐treatment and template carbonization methods to extract a hard carbon material from a large amount of discarded biomass in bamboo powder waste. This material has a good initial Coulombic efficiency of 78.6 % and good cycling stability when applied to sodium ion batteries.Typically, the optimal hard carbon material is used as the anode to prepare sodium ion battery prototypes to demonstrate their potential applications. The anode exhibited excellent sodium storage performance with a reversible capacity of 303 mAh ⋅ g −1 at 1 C rate and good cycling performance, retaining 92.0 % of its capacity after 100 cycles. These results demonstrate that BPPHC is a promising candidate for anode material in sodium‐ion batteries. This work suggests that bamboo powder could be a low‐cost anode material for SIBs.
Objective To evaluate the feasibility and efficacy of ex-vivo liver resection combined liver autotransplantation for patients with massive primary liver cancer who underwent complex liver resection.Methods The clinical data of 4 patients suffering from massive primary liver cancer who were admitted to the Beijing Chaoyang Hospital from January 2008 to May 2010 were retrospectively analyzed.Regular liver resection could not be carried out because the first,second and third hepatic hilum of the 4 patients were invaded by the tumors,so ex-vivo liver resection combined liver autotransplantation were performed.Results The operation was successfully carried out for the 4 patients.The operation time,the duration of anhepatic phase and the volume of operative blood loss were 690-840 minutes,250-300 minutes and 400-1400 ml,respectively.Portacaval bypass operation was not performed.After ex-vivo liver resection,the inferior vena eava or hepatic vein and portal vein of the 4patients were repaired,and the allogenous blood vessels were kept to extend the superior vena cava of the remnant liver so as to facilitate the anastomosis of blood vessels and reconstruction of the first hepatic hilum. After operation,the hepatic function of 1 patient was back to normal; 1 patient who stfffered from abdominal hemorrhage received reoperation for hemostasia; 1 patient was found with hepatic dysfunction; 1 patient died of hepatorenal dysfunction at postoperative day 5.Compensatory hypertrophy was observed in the 3 patients who survived at postoperative months 1-2.Of the 3 patients,2 were found with multiple pulmonary metastases at postoperative months 8 and 9,and they died at postoperative mouths 13 and 15.Until April 2012,1 patient survived for 37 months with no tumor recurrence or metastasis. Conclusions Ex-vivo liver resection combined liver autotransplantation provides the technical feasibility for performing complex liver resection for patients. The incomplete compensation of liver function and the short-term recurrence of tumors after operation are still the main issues which hinder the development of this technique.
Key words:
Liver neoplasms; Ex-vivo liver resection; Liver autotransplantation
The middle hepatic veins are often infiltrated by intrahepatic cholangiocarcinoma. Reconstruction of the hepatic vein plays a critical role in preserving more of the residual liver volume and reducing the risk of postoperative liver failure in extreme hepatectomy. We here report a novel way to reconstruct middle hepatic vein by using vessel grafts from wasted liver.Case 1: A 64-year-old man was diagnosed with intrahepatic cholangiocarcinoma. The bifurcation and left branch of the portal vein were stenosed, and the root of the middle hepatic vein was infiltrated by the tumor. An extended left hepatectomy was performed, the portal vein was resected and reconstructed, and the middle hepatic vein was reconstructed by anastomosing the proximal left hepatic vein to the distal middle hepatic vein. Case 2: A 69-year-old woman was diagnosed with intrahepatic cholangiocarcinoma. The tumor was located in the left lobe of the liver and the left and middle hepatic veins were infiltrated by the tumor. An extended left hepatectomy was performed, and the left portal vein was used as a vein graft to reconstruct the middle hepatic vein. Both of the two patients' postoperative ultrasound showed vessel graft patency.Using a vein graft from the resected portion of the liver to reconstruct the middle hepatic vein was a useful technique and showed good result.
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