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BACKGROUND:Autologous bone marrow mesenchymal stem cel s can treat decompensated liver cirrhosis, however, little evidence has addressed the control ed clinical research in hepatitis B patients with decompensated live cirrhosis. OBJECTIVE:To evaluate the clinical efficacy and safety of autologous bone marrow mesenchymal stem cel s in the treatment of hepatitis B with decompensated live cirrhosis. METHODS:A total of 67 hepatitis B patients with decompensated live cirrhosis were divided into two groups according to their wishes to receive stem cel transplantation. The control group (34 patients) only received oral administration of nucleoside analog antivirus and supportive treatment. The treatment group (33 patients) received autologous bone marrow mesenchymal stem cel s transplantation via hepatic artery plus antivirus and supportive treatment. The liver functional index, clinical signs and symptoms, adverse reactions were observed and compared at 4, 12, 24 weeks after treatment. RESULTS AND CONCLUSION:After treatment, al patients’ symptoms were improved to varying degrees. After 4 weeks of treatment, the liver functional indexes were al significantly improved compared with before treatment, the levels of alanme aminotransferase, cholinesterase and prothrombin activity in treatment group were significantly ameliorated compared with control group (P<0.05). At 12 and 24 weeks of treatment, the alanme aminotransferase, albumin, total bilirubin, cholinesterase and prothrombin activity in control group and treatment group showed statistical y significant differences compared with before treatment (P<0.05). At the same time point, al the indicators in the treatment group were significantly ameliorated compared with control group (P<0.05). The Child-pugh score and model for end-stage liver disease score declined at 4, 12, 24 weeks after treatment, showing significant differences compared with before treatment. The difference was also significant at the same time point between two groups. The treatment of nucleoside analogue antivirus combined with autologous bone marrow mesenchymal stem cel s transplantation on hepatitis B patients with decompensated liver cirrhosis is an effective method to improve liver function and blood coagulation function, with symptom improvement, safety and low risk.
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BACKGROUND: Acute renal insufficiency (ARI) usually occurred following liver transplantation due to the surgical trauma and the application of immunosuppressant, which lack of unified diagnostic criteria. OBJECTIVE: To investigate the experience of diagnosis and treatment of ARI following liver transplantation.DESIGN, TIME AND SETTING: The experiment was performed at the 458 Hospital of Chinese PLA from January 2004 to December 2006.PARTICIPANTS: A total of 37 cases received liver transplantation, including 35 males and 2 females, aged 37-67 years, mean aged (48.5±8.9) years. All cases were divided into the liver cancer group (n=16) and liver cirrhosis group (n=21). The liver cirrhosis group included 16 cases with posthepatitic type B cirrhosis, 4 with posthepatitic type C cirrhosis, and 1 with alcoholic cirrhosis. All these cases were in decompensation stage. The final diagnosis was performed by pathological examination. METHODS: The removal of kidney and construction of blood outflow tract was achieved by modified piggy-back liver transplantation. The arterial blood gas analysis, blood routine examination, renal function and liver function were examined more than twice per day. The cephalosporins, Fluconazole and ganciclovir or vancomycin were used for 5-7 days to prevent infections.MAIN OUTCOME MEASURES: The incidence rate of acute ARI, clinical features and outcomes of patients were observed.RESULTS: ARI developed in 19 patients with liver transplantation, 5 patients died, 14 patients recovered in 2-3 weeks. The incidence of ARI following liver transplantation was associated with infection, bleeding shock, respiratory failure and acute respiratory distress syndrome (P < 0.05). CONCLUSION: The incidence of ARI following liver transplantation was 51.35%, with 26.32% mortality rate. The early diagnosis and treatment are the key steps for increasing successful rate of ARI treatment following liver transplantation.
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Objective To study the application of pressure regulated volume control ventilation in respiratory support after liver transplantation.Methods Twenty patients underwent liver transplantation were randomly averagely divided into two groups: pressure regulated vlume control ventilation(PRVCV) group and volume control(VC) group.The parameters of respiratory mechanics,hemodynamics and blood gas analysis of patients in two groups were compared,such as oxygen delivery(DO2),oxygen consumption(VO2),oxygen incepation ratio(O2ER),arteriovenous oxygen content difference(C(a-v)O2),cardiac output(CO),mean arterial pressure(mABP),mean pulmonary arterial pressure(mPAP),alveolar-arterial PO2 difference(P(A-a)O2),gas exchange index(PaO2/FiO2),ratio of shunted blood to total perfusion(Qs/Qt),peak inspiratory pressure(PIP) and mean airway pressure(mAP).Results The P(A-a)O2 and Qs/Qt were significantly decreased in PRVCV group than those in VC group(P(A-a)O2:(101.42?28.07) mm Hg vs.(136.76?39.13) mm Hg;Qs/Qt:(1.78?0.86)% vs.(3.28?0.99)%),P
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Objective To explore the effects of dendritic cells(DCs) pulsed by hepatitis B surface antigen(HbsAg) on the proliferation and function of cytokine-induced killer(CIK) cells.Methods The peripheral blood mononuclear cells(PBMCs) were isolated by the conventional method,pulsed by HbsAg,and added into the CIK cells.The ~3H-TdR incorporation was used to determine the proliferation of CIK cells and lactate dehydrogenase(LDH) release was used to measure the specific killer activity of CIK cells induced by HBsAg-pulsed DCs.Results The HBsAg-pulsed DCs could induce the proliferation of CIK cells and strengthen the killer activity of CIK cells induced by HBsAg-pulsed DCs(P
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AIM: To evaluate the specific cellular immune response in mice inoculated with the recombinant hepatitis B virus (HBV) surface vaccine (rHBs). METHODS: Spleen T lymphocyte reactivity to rHBs was assessed by a proliferation assay and cytokine secretion. BALB/c mouse were intraperitoneally inoculated with rHBs at doses of 0.65, 1.25, 2.5 or 5 ?g for once or twice. 4 weeks later, spleen lymphocytes were harvested and restimulated with rHBs in experimental group or with PBS as control. The spleen lymphocytes were labeled with [~3H]-thymidine for 3 days. The [~3H]-thymidine incorporation was measured, which expressed as the incorporation of [~3H] (counts?min~ -1 ) and stimulation index (SI) was calculated by the method of dividing the cpm obtained in the experimental group by that in control group. The content of IL-2 and IFN-? secreted from the spleen lymphocyte were measured by the method of ELISA. RESULTS: 2 weeks after primary vaccination, the SI in 0.65, 1.25, 2.5 and 5 groups was 1.55, 1.93, 2.41, 2.81 ng/L, respectively. IL-2 was 5.48?8.88, 9.28?6.98, 28.53?14.32, 64.69?20.88 ng/L, respectively. IFN-? was 8.22?8.61, 9.89?9.34, 20.27?15.50, 30.77?22.12 ng/L, respectively. 2 weeks after boost vaccination, the SI in 0.65, 1.25, 2.5 and 5 groups was 1.61, 2.05, 3.74, 3.62 ng/L, respectively. The IL-2 was 5.75?5.04, 102.53?67.52, 177.13?91.12, 332.10?124.31 ng/L, respectively. IFN-? was 3.63?4.42, 28.33?13.04, 59.66?25.75, 80.73?19.30 ng/L, respectively. CONCLUSION: Specific proliferation activity and IL-2, IFN-? secretion from the spleen lymphocytes of the mouse inoculated with rHBs are produced,that the strength is dependent on the dose of vaccination.