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Objective To investigate a reasonable threshold of total bilirubin for the diagnosis of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF), and to realize accurate early diagnosis. Methods A retrospective analysis was performed for the clinical data of 1232 patients with HBV-ACLF who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from September 2008 to September 2018, and according to the baseline serum level of total bilirubin (TBil), the patients were divided into group A (TBil 15%) in patients with acute-on-chronic liver failure (ACLF). Although there was a difference in long-term mortality rate between the two groups, there was no significant increase in transplant-free mortality rate after 90 days in either group. Conclusion Under the premise of international normalized ratio ≥1.5, it is not recommended to increase the threshold of TBil to 205.2 μmol/L in the diagnostic criteria for HBV-ACLF, so as to ensure the early diagnosis of more ACLF patients and bring more opportunities for treatment and cure.
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ObjectiveTo investigate the clinical features of infection in patients with acute-on-chronic liver failure (ACLF) and bacterial infection and the influencing factors for 90-day survival rate. MethodsThe patients with ACLF who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from January 2014 to December 2015 were enrolled, and related clinical data were collected and analyzed, including infection time and site, microbial culture, biochemical parameters and inflammatory markers, and 28- and 90-day prognosis after infection. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. The life-table method was used to plot survival curves. The indices affecting prognosis in the univariate analysis were further included in the multivariate logistic regression analysis. ResultsA total of 1074 patients with ACLF were admitted, among whom 609 had bacterial infection, and the incidence rate of bacterial infection was 567%. Among these 609 patients, 16 underwent liver transplantation within 90 days and related data statistics were obtained for the remaining 593 patients. As for infection site, among the patients with infection, 70.15% had abdominal infection, 41.15% had pulmonary infection, 11.97% had sepsis, 5.40% had urinary system infection, 4.89% had thoracic infection, and 8.6% had infection at other sites. Among the patients with infection, 64.76% had infection at a single site. The positive rates of microbial culture of ascites, phlegm, urine, and pleural effusion were 22.70%, 52.82%, 40.63%, and 35.71%, respectively. Escherichia coli was the most common bacterium in ascites and accounted for 43.82%; Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii accounted for 22.67%, 2400%, and 22.67%, respectively, in phlegm; Escherichia coli, Klebsiella pneumoniae, and Staphylococcaceae accounted for 33.80%, 29.58%, and 15.49%, respectively, in blood culture. The 90-day survival rate after infection was 38.11% (226/593) in the patients with ACLF, and the multivariate logistic regression analysis showed that age (P=0.006), stage of hepatic encephalopathy (HE) (P＜0001), stage of liver failure (P＜0.001), and acute kidney injury (AKI) (P＜0.001) were independent risk factors for 90-day survival in patients with ACLF and infection. ConclusionThere is a high incidence rate of infection in patients with ACLF. The 90-day survival rate is relatively low, and the presence of AKI, HE stage III or above, and advanced liver failure may indicate poor prognosis.
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As lactate is elevated due to lactate metabolic disorder in liver failure, recent studies have shown that blood lactate has a high value in predicting the prognosis of liver failure. With reference to the research findings in recent years, this article introduces the prediction model of LiFe score and reviews the advances in the clinical application of blood lactate level in patients with liver failure in China and foreign countries. It is believed that a high lactate level is an independent risk factor for poor prognosis of liver failure patients, and it is proposed that lactate can be used as an important indicator to evaluate the severity and prognosis of liver failure and further optimize the scoring system for the prognosis of related liver diseases.
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BACKGROUND: Multipotent differentiation ability enables mesenchymal stem cells from autologous bone marrow to differentiate into osteoblasts and chondroblasts, thereby promoting the formation of bones and cartilage. However, the osteogenic ability differs from each other, and whose osteogenic ability is the best still needs to be studied further. OBJECTIVE: To compare the osteogenic ability of fascia- and muscle-derived stem cells in rats. METHODS: Fascia- and muscle-derived cells were isolated from 20 rats, followed by flow cytometry sorting, and were then cultured. FDC-LacZ cells were transfected with retro-BMP4 virus twice. Afterwards, the transfection efficiency of fascia-derived cells was detected through LacZ and alkaline phosphatase staining. RESULTS AND CONCLUSION: Compared with fascia-derived cells, muscle-derived cells showed stronger chondrogenic ability and produced more calcium deposition. These findings indicate that the osteogenic ability of muscle-derived cells is superior to that of fascia-derived cells in rats.
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Anterolateral thigh flap is perfect for reconstructing maxillofacial soft tissue defects. This tissue has been widely used by clinicians, but often causes operation difficulties because of vascular variation. In this paper, we report a case where anteromedial thigh was used as new donor site when the vascular anatomic variation of anterolateral thigh perforator flap induced a failure in the flap harvest. Moreover, this paper discusses the anatomy and application of anteromedial thigh flap.
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Humans , Maxillofacial Abnormalities , General Surgery , Perforator Flap , Plastic Surgery Procedures , Methods , Thigh , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>Cell-free DNA (cfDNA) was shown to be a prognostic marker for diverse pathological states in the Intense Care Unit, but little is known of the role of cfDNA in HBV-related acute-on-chronic liver failure (ACLF). We hypothesize that cfDNA can also be a promising prognostic as well as a diagnostic marker in patients with HBV-related ACLF.</p><p><b>METHODS</b>Thirty-eight patients with HBV-related ACLF admitted in the Intense Care Unit were enrolled in the study. The patients were divided, according to the improvement of liver function at discharge, into favorable prognosis group (group 1, n=17) and poor prognosis group (group 2, n=19). Plasma samples were collected from each patient at hospitalization and at discharge to measure cfDNA by real-time quantitative PCR. MELD score was calculated at the same time points.</p><p><b>RESULTS</b>The average level of cfDNA of group 1 was lower than that of group 2 both at the time of hospitalization (P=0.044) and at discharge (P<0.001). There was no difference in MELD score between the two groups at hospitalization. Significant correlations were found of cfDNA levels with the MELD score, TBIL, CRE and INR both at hospitalization (γ=0.662, P<0.001; γ=0.356, P=0.033; γ=0.360, P=0.031; γ=0.570, P<0.001, respectively) and at discharge (γ=0.854, P<0.001; γ=0.821, P<0.001; γ=0.650, P<0.001; γ=0.638, P<0.001, respectively). The ROC curve showed that cfDNA level at discharge was optimal in diagnosing ACLF with an area under curve (AUC) value of 0.96, followed by δcfDNA (AUC value of 0.923) and cfDNA level at hospitalization (AUC value of 0.667). The MELD scores had an AUC value of only 0.545 at the time of hospitalization.</p><p><b>CONCLUSION</b>cfDNA may serve as a promising prognostic and diagnostic marker for predicting in-hospital prognosis of HBV-related ACLF within 2 to 8 weeks.</p>
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Adult , Female , Humans , Male , Middle Aged , Acute-On-Chronic Liver Failure , Diagnosis , Virology , DNA, Viral , Blood , End Stage Liver Disease , Diagnosis , Hepatitis B , Hepatitis B virus , Genetics , Pilot Projects , Plasma , Chemistry , Prognosis , Severity of Illness IndexABSTRACT
BACKGROUND:Prolonged therapy with lamivudine has been associated with tyrosine-methionine-aspartate-aspartate mutation, which results in hepatitis B recurrence. Recently, antiviral agents, such as entecavir, have high efficacy and low resistance rate in hepatitis B-related liver disease. However, the researches on the effect of entecavir in preventing hepatitis B recurrence after liver transplantation are rare. OBJECTIVE:To investigate the effect of entecavir combined with low-dose hepatitis B immunoglobulin in preventing hepatitis B recurrence after liver transplantation. METHODS:The fol ow-up data of 253 patients who had liver transplantation for hepatitis B virus related liver disease were retrospectively analyzed. Al patients received nucleoside analogues therapy formal y before liver transplantation. The effects of entecavir+hepatitis B immunoglobulin and lamivudine+hepatitis B immunoglobulin were compared in al the patients and the patents with hepatitis B recurrence risk factors (positive preoperative HBeAg, DNA-positive hepatitis B virus, hepatoma and tyrosine-methionine-aspartate-aspartate mutation). RESULTS AND CONCLUSION:A total of 253 patients received hepatitis B virus-related liver transplantation, and 29 patients died. There were 202 patients in lamivudine group in which 26 patients were dead and 16 patients had hepatitis B virus recurrence, and the recurrence rate was 7.92%(16/202). However, entecavir group had 51 patients without hepatitis B virus recurrence in which three patients were dead. There were significant differences in the mortality rate and recurrence rate between two groups. Compared with the lamivudine+hepatitis B immunoglobulin, entecavir+hepatitis B immunoglobulin could effectively reduce the recurrence rate of the patients with hepatitis B virus-related risk factors. Hepatitis B immunoglobulin was terminated and nucleoside analogues were modulated when recurrence appeared. Al patients hepatitis B virus DNA were control ed less than 500 IU/mL and liver function returned to normal level. Log-rank test showed that there was no significant difference in the long-term survival rate after timely treatment of hepatitis B virus recurrence. With the prevention of nucleoside analogues combined with hepatitis B immunoglobulin therapy, timely treatment of hepatitis B recurrence has little influence on the prognosis. Entecavir combined with hepatitis B immunoglobulin can effectively prevent the hepatitis B recurrence. For the patients with hepatitis B virus-related risk factors, entecavir combined with hepatitis B immunoglobulin can better reduce the recurrence rate of hepatitis B than lamivudine+hepatitis B immunoglobulin after liver transplantation.
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OBJECTIVE To study the feature of liver disease and liver failure complicated with fungous infection. METHODS The patients with liver disease complicated with fungous infection were collected form 1986 to 2005. The time was divided into four stages:from 1986 to 1990,from 1991 to 1995,from 1996 to 2000 and from 2001 to 2005. All patients with liver failure complicated with fungous infection in different stages were investigated for the incidence,the use of antibiotics and corticosteroids,the category and site of fungous infection and prognosis. RESULTS End-stage liver disease accounted for 82.6% and HBV infection was the main etiology in 475 cases of fungous infection. Fungous infection occurred mainly in hospital. Hospital acquired infection and community acquired infection were similar in different stages. The use of antibiotics and corticosteroids accounted for 88.8% and 48% in all patients before fungous infection,respectively. The use of antibiotics had no difference and the use of corticosteroids decreased in different stages. Candida were the main infection strains and the lungs and pharynx oralis were the main infection sites. The rate of healing and improvement of fungous infection and underlying diseases increased year by year. Healing and improvement rate of underlaying disease positively correlated with that of fungous infection. CONCLUSIONS End-stage liver disease patients are susceptible to fungous infection and Candida are the common infection strains. Lungs and pharynx oralis are the common infection sites. Anti-fungous therapy is important in the treatment of liver failure complicated with fungous infection.
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OBJECTIVE To study clinical characteristics of liver failure with fungal infections in the elderly patients and risk factors associated with treatment failure.METHODS Eighty four elderly patients with liver failure followed by fungal infections since 1986 were divided into two groups: effective group and ineffective group.RESULTS The common pathogens were Candida albicans(58.33%),Aspergillus fumigatus(9.52%) and Candida tropicalis(8.33%).The lungs(43.88%),mouth(32.65%),intestinal tract(9.18%) and blood(5.10%) were the main sites of fungal infection.Among them after treatment,35 cases(41.67%) were effective compared with 49 cases(58.33%) ineffective.The risk factors for treatment failure included age,complication with multiple organ dysfunction syndrome(MODS) and aspergillosis.In multivariate analysis,we found MODS in patients was an independent factor in predicting the prognosis.CONCLUSIONS To improve the treatment outcome,important measures include preventing infection,enhancing the treatment of liver failure,monitoring and supporting multiple organs: heart,brain,lungs and kidneys,and promptly rational administration of antifungal agents in elderly patient with liver failure.
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<p><b>BACKGROUND</b>To evaluate the inhibitive effect of combination of 3TC with Ara-AMP against HBV in vitro.</p><p><b>METHODS</b>Used 2.2.15 cell as target cell. With radioimmunological technique and blot slot, the inhibitive effect of 3TC, Ara-AMP and the combination of both against the HBsAg, HBeAg and intracellular HBV DNA were investigated.</p><p><b>RESULTS</b>The inhibitive ratio of Ara-AMP against HBsAg, HBeAg was 45.48% and 41.46% respectively when its concentration was 400.0 microgram/ml. Although 3TC also has inhibitive effect in its experimental concentration, its effect is weaker. When Ara-AMP 50.0 microgram/ml was combined with 3TC 1.25 and 5.00 microgram/ml respectively, the inhibitive ratio against HBsAg were 19.92% and 17.32% respectively. Compared with using same concentration 3TC alone, the difference of results was significant (P<0.05). But when compared with using the same concentration Ara-AMP alone, the difference of results had no statistical significance (P <0.05). Remarkable inhibitive effects of combination of 3TC with Ara-AMP against HBeAg were n ot found. When 3TC 5.00 microgram/ml was combined with Ara-AMP 12.5 and 50.0 microgram/ml respectively, the inhibitive ratio against HBV DNA was 45.90% and 50.36% respectively. Comparing the content of HBV DNA in these groups with that of control group and the groups using the same concentration 3TC and Ara-AMP alone, the differences were significant (P <0.05).</p><p><b>CONCLUSIONS</b>Combination of 3TC with Ara-AMP could enhance the inhibitive effects against HBV DNA.</p>
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Humans , Antiviral Agents , Pharmacology , DNA, Viral , Metabolism , Dose-Response Relationship, Drug , Drug Synergism , Hepatitis B virus , In Vitro Techniques , Lamivudine , Pharmacology , Vidarabine Phosphate , PharmacologyABSTRACT
Objective Retrospective observating the diminishing inflammation and lowering enzymatic effect with diammonium glycyrrhizinate (ganlixin injectionfluid) on hepatitis, such as chronic hepatitis, hepatocirrhosis, drug induced hepatitis and alcoholic hepatitis. Methods The 629 case hepatitis sufferers, including chronic hepatitis with light to middle degree, hepatocirrhosis, drug induced hepatitis and alcoholic hepatitis, were treated with 150 mg diammonium glycyrrhizinate added into 250 ml 5 % to 10 % glucose injection liquid. Another 127 chronic hepatitis sufferers treated with injecho potenl ini were seen as contrast. When the treatment was over, the level of alanine aminotransferase (ALT) and serum bilirubin (SB) and symptom of patients in two groups were analysed. Results The level of ALT and SB dropped more rapidly than that in contrast group, but there were no marked difference in symptoms recover. After 17 days therapy, there are 93.3 % patients with ALT normal level in treating group, but 73.3% in contrast group (P
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Objective To investigate the pathogen spectrum and analyze the associated risk factors of pulmonary moniliasis in the patients with liver failure.Methods A retrospective analysis of pulmonary moniliasis complicating liver failure(n=150) was performed by case-control study on the data of patients admitted to PLA 302 Hospital from Jan.1986 to Nov.2007.A cohort of 154 patients with liver failure but without fungi infection(n=154) served as the control group.By analyzing the epidemiological and clinical data,the spectrum of fungi was identified,and the risk factors in pulmonary moniliasis pneumonia inpatients with liver failure were identified.Results The number of patients with acute on chronic liver failure(69/150,46.0%) were greater than patients with chronic liver failure(78/150,52.0%),while the number of patients suffering from moniliasis pneumonia was smaller than that of control group(20/154,13.0% and 129/154,83.8%,respectively,P