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Objective To summarize clinical experience of transabdominal pericardial anastomosis of suprahepatic vena cava of the donor and right atrium of the recipient in liver transplantation for Budd-Chiari syndrome (BCS) complicated with liver cancer. Methods Clinical data of a BCS patient complicated with liver cancer undergoing transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium in liver transplantation were retrospectively analyzed. Results The hepatic vein and suprahepatic vena cava were partially occluded in the patient. Liver transplantation was completed by transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium with beating-heart. In addition, due to pathological changes of the recipient's hepatic artery, splenic artery of the recipient was cut off, distal ligation was performed, and the proximal end was reversed and anastomosed with the common hepatic artery of the donor liver, and the reconstruction of hepatic artery was completed. The surgery was successfully performed. At approximately postoperative 1 week, the function of the liver allograft was gradually restored to normal, and no major complications occurred. The patient was discharged at postoperative 25 d. No signs of BCS recurrence was reported after 8-month follow-up. Conclusions It is safe and feasible to treat BCS by liver transplantation with transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium. BCS patients complicated with liver cancer obtain favorable prognosis.
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Objective:To evaluate the clinical characteristics and identify potential factors of the early-stage hip involvement in patients with ankylosing spondylitis (AS) based on the magnetic resonance imaging (MRI).Methods:A retrospective group control study was carried out in 570 AS patients who were consecutively admitted to our hospital from 2014 to 2018. Patients with hip pain or hip function limitation but lacking definitive evidence of hip involvement on radiography were underwent hip MRI. Patients were divided into three groups: no hip involvement, early-stage hip involvement (hip involvement detected by MRI but with negative radiographs) and advanced-stage hip involvement (Bath Ankylosing Spondylitis Radiology Index-hip score ≥2). The study factors included demographic, laboratory, clinical and radiographic data. Simple and multiple ordinal logistic regression analysis were used to identify factors associated with the early-stage hip involvement and advanced-stage hip involvement.Results:A total of 236 patients (41.4%) presented with hip involvement, in which 146 cases (25.6%) were diagnosed with early-stage hip involvement, while 90 cases (15.8%) were diagnosed with advanced-stage hip involvement. Multivariate logistic regression analysis demonstrated that older age at onset [ OR=0.80, 95% CI (0.72, 0.90), P<0.01], more active inflammation in the sacroiliac joints [ OR=1.13, 95% CI(1.07, 1.18), P<0.01] and worse BASMI score [ OR=3.06, 95% CI(2.14, 4.13), P<0.01] were associated with the occurrence of early-stage hip involvement. Conclusion:MRI is superior to radiography in detecting early-stage hip involvement. MRI is more suitable for hip involvement assessment in AS patients with suspected symptoms or risk factors of hip involvement.
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Objective To investigate the risk factors of disease progression and adverse pregnancy outcome in patients with systemic lupus erythematosus (SLE) during pregnancy.Methods Clinical data of 118 pregnant women with SLE admitted from June 2004 to October 2015 were retrospectively analyzed.The patients were divided into selective pregnant group (group A,n =72 cases) and non-selective pregnant group (group B,n =46) according to the disease activity of SLE.The disease progression and pregnancy outcomes were compared between two groups.Results The various system damages occurred in group B,including hematological damage in 16 cases,kidney damage in 19 cases,erythra in 10 cases,arthritis in 10 and serositis in 12 cases;while the corresponding cases in group A were 10,14,6,4 and 4(x2 =7.133,P=0.008;x2 =6.658,P =0.010;x2 =4.304,P =0.038;x2 =7.030,P =0.008;x2 =10.095,P =0.001).SLE exacerbation occurred in 28 cases (74％) of group B and 12 cases (17％) of group A (x2 =34.944,P =0.000).The logistic regression analysis showed that hypocomplementemia,proteinuria,SLEDAI score before pregnancy and positive anti-dsDNA antibody were the risk factors of SLE disease exacerbation during pregnancy.The maternal complications occurred in group B,including pregnancyinduced hypertension in 7 cases,preeclampsia in 10 cases and infections in 11 cases/times;while the corresponding cases (case/time) in group A were 2,6 and 4 (x2 =4.526,P =0.033;x2 =4.304,P =0.038;x2 =8.525,P =0.004).There were 14 cases of therapeutic induced labor,7 case of stillbirth and 27 cases of total fetal loss in group B,while the corresponding cases in group A were 2,0 and 4 (x2=18.317,P =0.000;x2 =9.080,P =0.003;x2 =40.920,P =0.0300).The logistic regression analysis showed that positive anticardiolipin antibody,proteinuria,SLEDAI score before pregnancy and renal dysfunction during pregnancy were risk factors of fetal loss.There were 87 cases of successful delivery (73.7％),the successful delivery rates were 41.3％ (19/46) in group B and 94.4％ (68/72) from group A,respectively.The infant complications occurred in group B,including premature birth in 15 cases,low birth weight in 13 cases,neonatal jaundice in 5 cases and mild asphyxia in 5 cases;while the corresponding cases in group A were 24,18,4 and 2 (x2 =11.442,P =0.001;x2 =11.395,P =0.001;x2 =4.664,P =0.031;x2 =8.035,P =0.005).Conclusion SLE patients whose disease conditions are not well controlled would lead to higher percentage of disease deterioration during pregnancy and worse pregnancy outcomes.
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Objective To detect the serum 25- OH-D levels in patients with systemic lupus erythematosus (SLE) and investigate the function of vitamin D in the pathogenesis of SLE. Methods Eighty SLE patients including 40 healthy donors and 40 RA (rheumatoid arthritis) patients were enrolled in this study. Serum 25-OH-D levels were detected with ECL method. Results (1)Serum 25-OH-D levels in patients with active SLE were lower than those with inactive SLE patients and healthy controls. (2)Serum 25-OH-D levels were negatively correlated with SLEDAI (Systemic Lupus Erythematosus Disease Activity Index) scores (r = -0.45,P < 0.01) and 24-hours urinary protein excretion (r = -0.32,P < 0.05). Conclusion Serum 25-OH-D levels in SLE patients decrease and have close relationship with disease activity and renal lesions.
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Objective To investigate the expression and significance of B lymphocyte stimulator (Blys) and its receptor BAFF (BAFF-R) in peripheral blood mononuclear cells (PBMCs) from patients with systemic lupus erythematosus (SLE). Methods The expression of Blys and BAFF-R was measured by flow cytometry in 90 pa-tients with SLE,which was compared with that of 45 healthy controls. The relationships between the expression of Blys, BAFF-R and other laboratory parameters as well as disease activity were analyzed. Results The expression of Blys and BAFF-R in PBMCs from patients with SLE was significantly elevated compared to healthy controls (P <0.001), so did the active group (P < 0.001) and inactive group (P < 0.001 and P < 0.01). The expression of Blys in PBMCs from active SLE patients was higher than that of inactive patients (P <0.05). However,there was no statisti-cal difference of BAFF-R between the two groups. The expression of Blys in PBMCs was positively related to SLEDAI (r =0.728,P <0.001) ,IgG and IgM(r=0.691,P<0.001 and r =0.453,P<0.01) ,but negatively related to C3 and CA (r = -0.510, P < 0.001 and r = -0.312, P < 0.05). The expression of Blys in dsDNA positive group was higher than those of dsDNA negative group (P < 0.01). The expression of Blys and BAFF-R in Cl qAb positive group was higher than those of ClqAb negative group as well (P <0.01). Conclusion The expression of Blys and its receptor BAFF-R in PBMCs from SLE is elevated ,which may reflect the disease activity and is related to the pro-duction of autoantibody. They might be involved in the pathogenesis of SLE.