ABSTRACT
Objective To investigate the correlation between plasma soluble CD14 (sCD14)level and disease progression in patients with acute phase of acquired immunodeficiency syndrome (AIDS). Methods Forty-one human immunodeficiency virus (HIV)-infected patients were followed up from June 2007 to June 2010 in Beijing You′an Hospital,including 20 patients with CD4 + T lymphocyte counts more than 350/μL,and 21 less than 350/μL after 3 years of HIV infection.Twenty healthy blood donors were recruited as controls.Enzyme-linked immunosorbent assay (ELISA)was employed to test the plasma sCD14 level of healthy controls and patients infected with HIV at 1 -30 d,31 -90 d,91 - 180 d and 181 -360 d.Student t test was used to compare the means between two groups.ANOVA analysis was used to compare the means among more than two groups.Results The mean plasma sCD14 level in control group was (1 654±904)μg/L.Three years after HIV infection,the sCD14 level of patients with CD4 + T lymphocyte counts less than 350/μL group was (4 214±2 635)μg/L,which was higher than that of patients with CD4 + T lymphocyte counts more than 350/μL ([2 275 ±1 457 ]μg/L).The difference was statistically significant(t=-5 .41 ,P <0.01).The plasma sCD14 level in patients infected with HIV 181 -360 d was significantly higher than that in patients infected with HIV 1 - 30 days ([4 485 ± 2 779]μg/L vs [2 577 ±1 635 ]μg/L;t = -3.39,P <0.05 ).The plasma sCD14 level was positively correlated with HIV viral load (r =0.35,P =0.000 1 ),and negatively correlated with CD4 + T lymphocyte counts (r=-0.28,P =0.001 ).Conclusions The plasma sCD14 level in patients with acute phase of HIV infection is higher than that of healthy people,which increases with prolonged HIV infection.Plasma sCD14 level in of HIV infection acute phase may be closely related to HIV/AIDS progression.
ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the influence of sirolimus on the long-term survival of patients after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>Clinic data of 165 consecutive patients who underwent OLT for HCC from February 2005 to March 2012 was analyzed retrospectively. Among them, 94 patients were treated with a sirolimus-based immunosuppressive protocol after OLT, while the other 71 patients with a FK506-based protocol. Postoperative survival time, survival, disease-free survival (DFS) and tumor recurrence rates between the two groups were compared.</p><p><b>RESULTS</b>The 2 groups were comparable in all clinicopathologic parameters. The sirolimus-based group had higher patient survival rates than the control group at 1-year (87% vs. 97%, P = 0.03), 2-year (80% vs. 88%), 3-year (76% vs. 85%) and 5-year (63% vs. 75%). The 1-year, 2-year, 3-year and 5-year recurrence rates were 12% vs. 3%, 17% vs. 9%, 21% vs. 9% (P = 0.04) and 31% vs. 16% (P = 0.03). Early and mid-HCC (I - II stage) of 131 cases (control group 61 cases, sirolimus-based group of 70 patients). The 1-year, 2-year, 3-year and 5-year survival rates were 90% vs. 97% , 80% vs. 90%, 78% vs. 86% and 65% vs. 82% (P = 0.04) and recurrence rates were 10% vs. 3%, 16% vs. 8%, 18% vs. 8% and 29% vs. 11% (P = 0.01).</p><p><b>CONCLUSION</b>The sirolimus-based immunosuppressive protocol reduce long-term postoperative recurrence rate and improve the survival rate of patients after OLT for HCC significantly (especially early-mid HCC).</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Carcinoma, Hepatocellular , Drug Therapy , Mortality , General Surgery , Immunosuppressive Agents , Therapeutic Uses , Liver Neoplasms , Drug Therapy , Mortality , General Surgery , Liver Transplantation , Neoplasm Recurrence, Local , Retrospective Studies , Sirolimus , Therapeutic Uses , Survival Rate , Tacrolimus , Therapeutic UsesABSTRACT
Objective To evaluate the influence of hepatitis B surface antigen positive or antihepatitis B core positive donors on HBV allograft re-infection or de novo hepatitis B and recipients and grafts survival after liver transplantation.Methods Between June 2004 and December 2011,510 liver transplants were performed at our department while 387 patients were followed up.Among them,9 patients received hepatitis B surface antigen positive grafts,50 patients received anti-hepatitis B core positive grafts,and 328 patients received HBV marks negative grafts.The rate of HBV allograft reinfection or de novo hepatitis B and accumulative recipients as well as grafts survival were compared.Results All recipients with hepatitis B surface antigen positive donors remained hepatitis B surface antigen carriers after operation.HBV allograft re-infection occurred in one recipient of anti-hepatitis B core positive donor group. Five recipients with HBV marks negative donors appeared hepatitis B surface antigen positive,including two cases of Lamivudine resistance leading to HBV allograft reinfection and three cases of de novo hepatitis B from non-related diseases. The 1-,3-,5-year accumulative survival rate in anti-hepatitis B core positive grafts group,hepatitis B surface antigen positive grafts group and HBV marks negative grafts group was 100％,86％,43％; 87％,79％,57％; and 87％,80％,79％,respectively (Log-rank =1.287,P =0.525).And the 1-,3-,5-year accumulative grafts survival rate in these three groups was 100％,86％,43％; 85％,77％,56％;and 86％,79％,77％,respectively (Log rank=1.288,P =0.525).During the follow-up period,no graft loss or death was found to be related to the HBV allograft re-infection or de novo hepatitis B.Conclusion Liver grafts from anti-hepatitis B core positive donors do not increase the risk of graft loss or recipient death due to HBV allograft re-infection or de novo hepatitis B under effective antiviral therapy.Hepatitis B surface antigen positive donors are feasible to save lives or prolong life in emergency situation.
ABSTRACT
Objective To compare the curative results of three different therapies for earlyintermediate stage primary liver cancer. Methods The data of 428 patients with early-intermediate stage primary liver cancer treated with one of three curative therapies from April 2004 to July 2010 in our center were analyzed retrospectively. The patients were divided non-randomly into three groups: group A liver-cancer resection (n = 231), group B radio-frequency ablation (RFA) (n = 63), and group C liver transplantation (n=134). The 1-, 3-, 5-year accululative survival and recurrence rate in each group were compared. Results The accumulative 1-, 3-, 5-year survival rates were 93.3%, 71.9%, 57.2% for group A; 86.7%, 46.5%, 38.8% for group B; 95.7%, 78.3%, 72.1% for group C,respectively. The 1-, 3-, 5-year recurrence rates were 30. 3% , 49. 7%, 68. 6% for group A; 39. 3% , 58. 7% , 79. 3% for group B; 7. 0% , 12. 1% , 12. 1% for group C,respectively. There was a highly significant difference between groups A, B and C in the survival rates and the recurrence rates. The 5-year survival rate was significantly higher for group C than group A and group B (P<0. 01, P<0. 001), and the recurrence rate of 1, 3, 5-years were significantly lower for group C than for group A and B (P<0. 001). Conclusion Liver transplantation was the most effective therapy for the early-intermediate stage primary liver cancer.
ABSTRACT
Objective To review the techniques used in biliary reconstruction for adult-adult living donor liver transplantation using a right lobe graft. Methods The clinical data of 21 pairs of donor and recipient who underwent right lobe living donor liver transplantation from April 2007 to May 2009 at Beijing Youan Hospital were analyzed retrospectively. Biliary anastomoses consisted of 10 single right hepatic duct to common hepatic duct anastomoses, 5 donor double branched ducts to recipient double branched ducts anastomoses, 5 single anastomoses between a donor double branched duct which had been converted to a single duct by ductoplasty to a single recipient bile duct, and 1 hepaticojejunostomy. A T-tube was inserted through the anterior wall of the common hepatic duct and splinted across the anastomosis in 2 recipients and a Y-tube was used in 1 recipient. Results 4 recipients died during the first post-transplant month. Another recipient received a retransplantation for acute liver necrosis. The remaining recipients were alive. The 1-year survival rate of the recipients was 77.65 %.5 patients developed biliary leakage and 2 patients developed biliary stricture. The 7 biliary complications were treated and cured by further surgical procedures. There was no significant difference in the biliary complications among the three different types of biliary anastomotic groups (x2 = 0. 659,P=0. 719). Conclusion The different types of biliary anastomoses can be used in living donor liver transplantation depending on the situations found in the donors and recipients. Continuous suturing on the posterior wall of the bile duct, interrupted suturing on the anterior wall and microsurgical techniques in biliary reconstruction are effective modalities to minimize biliary complications.
ABSTRACT
Objective To investigate technical skills on outflow reconstruction in right lobe graft adult-adult living donor liver transplantation for avoiding of venous congestion. Methods The clinical data of 21 donors and recipients who underwent right lobe living donor liver transplantation were analyzed retrospectively. Donor's standard liver volume was between 1150. 1 and 1629. 8 cm3,graft weight was between 585 and 920 g, the ratio of graft volume to recipient's estimated standard liver volume (GV/ESLV) was between 43 % and 67 %, graft-recipient weight ratio (GRWR) was between 0. 82 % and 1.59 %, the ratio of remnant liver volume to donor's standard liver volume(RLV/SLV) was between 32 % and 55 %, all graft macrosteatosis was less than 10 %. For graftwith middle hepatic vein (MHV), a triangle large orifice was made by joining MHV to right hepatic vein (RHV), then anastomosed to recipient' s enlarged orifice of RHV. For graft without MHV, if tributary of MHV＞5 mm, autologous or allogenic blood vessel was used as interposition graft to connect to IVC, and if no large MHV tributary, graft RHV was anastomosed to IVC directly. Graft's right portal vein was anastomosed to main trunk of recipient's portal vein, graft's right hepatic artery to recipient's hepatic artery, and graft's right hepatic duct to recipient's right hepatic duct. Results Among the 21 right lobe grafts, 4 right lobe grafts had MHV, 17 right lobe grafts had no MHV.Autologous greater saphenous veins were adopted in 2 cases, cryopreserved iliac arteries were adopted in 5 cases, and RHV was anastomosed directly to IVC in 10 cases. Outflow was all patent in 7 cases having reconstruction of MHV tributaries one month after operation. One-year survival rate was 75 %, 85. 7 % and 70 % respectively in MHV group, MHV tributaries reconstructed group and RHV directly anastomosed to IVC group with the difference being not significance among these three groups (P＞0. 05). Biliary complications occurred in 7 cases during the follow-up period. One case developed small-for-size syndrome, which was cured by splenic artery embolization. No severe complication occurred in donors. All donors returned to normal life during a follow-up period of 6 to 31 months. Conclusion If outflow tract was reconstructed properly, right lobe graft without MHV has equivalent clinical outcomes to right lobe graft with MHV. Using of autologous or allogenic blood vessel as interposition vessel graft for right lobe graft without MHV is an effective modality to prevent hepatic congestion and secure functional graft volume to meet recipients metabolic demand.
ABSTRACT
Objective: To construct a questionnaire of attitude towar ds aging Method: Open questionnaire was applied to young and age d to collect stereotype phrases The initial questionnaire was applied to 140 el d erly in Beijing and then did item analysis, reliability and validity tests Results: The final questionnaire had two factors: positive and negat ive Consistency reliability and repeated reliability were greater than 0 9, t he split reliability was 0 77 Conclusion: The reliability and v al idity of the self-compiled "questionnaire of attitude towards aging" are satis fying
ABSTRACT
Objective:To develop a mental status scale in non psychiatric settings (MSSNS) and to test its reliability and validity.Methods:Based on the common negative emotions in non psychiatric settings confirmed by nursing specialists and international scales, the MSSNS was constructed with psychological testing and statistical techniques. The reliability and validity were examined with 1 010 patients in non psychiatric settings.Results: The MSSNS consisted of 38 items. The reliability coefficients were 0.932 9 for internal consistence(Cronbach ?) and 0.894 0 for split half. Using the principle component analysis with varimax rotation, we got 4 factors: anxiety, depression, anger and loneliness. The correlation between MSSNS and related factors of HAD were 0.652 and 0.533 respectively. Conclusion: With its good reliability and validity, MSSNS is an ideal rating scale for total and convenient rating of patients' mental status in non psychiatric settings.