Analysis of risk factors of high-level BK viruria after renal transplantation / 器官移植

Objective To analyze the risk factors of high-level BK viruria after renal transplantation and the significance in preventing BK virus-associated nephropathy (BKVAN). Methods Clinical data of 262 renal transplant recipients with regular follow-up data were retrospectively analyzed. According to the DNA load of BK virus, all recipients were divided into the high-level BK viruria group (n=35) and non-high-level BK viruria group (n=227). The incidence of high-level BK viruria after renal transplantation was summarized. The risk factors of high-level BK viruria after renal transplantation were analyzed by univariate analysis and multivariate analysis. Survival curve was delineated by Kaplan-Meier method, and survival analysis of recipients was performed. Results Among 262 renal transplant recipients, 35 cases developed high-level BK viruria with an incidence of 13.4%. The median time of occurrence of high-level BK viruria was 181 (126, 315) d. The incidence was the highest within 6 months after renal transplantation, gradually decreased from 6 months to 2 years, and then increased after 2 years. Univariate analysis showed that the history of antithymocyte globulin (ATG) treatment, acute rejection (AR), donation type and delayed graft function (DGF) were the risk factors of high-level BK viruria after renal transplantation (all P < 0.05). Multivariate Cox regression analysis demonstrated that donation after brain death followed by cardiac death (DBCD), AR and DGF were the independent risk factors of high-level BK viruria after renal transplantation. The 1-, 3- and 5-year survival rates of recipients with ATG treatment history, AR, DGF and donation type of DBCD were significantly lower than those with non-ATG treatment history, non-AR, non-DGF and other donation types [donation after brain death (DBD), donation after cardiac death (DCD) and living organ donation] respectively (all P < 0.05). Conclusions DBCD, AR and DGF are the independent risk factors of high-level BK viruria after renal transplantation. Strengthening the postoperative monitoring of these recipients and delivering early intervention may effectively prevent BKVAN.

Clinical application of ECMO in protecting donor liver in organ donation after citizen's death / 器官移植

Objective To explore the feasibility of extracorporeal membrane oxygenation (ECMO) in protecting the donor liver in donation after citizen's death. Methods Clinical data of 16 donors and recipients undergoing liver transplantation using ECMO to protect the donor liver were retrospectively analyzed. The effect of ECMO on different indicators of the donors was evaluated. The liver function and clinical prognosis of the recipients after liver transplantation were observed. Results Compared with the time before ECMO, the heart rate, total bilirubin (TB), alanine transaminase (ALT) and aspartate transaminase (AST) of the donors after ECMO were significantly reduced, whereas the systolic blood pressure, diastolic blood pressure and partial pressure of arterial oxygen (PaO2) were remarkably increased (all P < 0.05). The liver function of the recipients was properly recovered after liver transplantation, and gradually restored normal at postoperative 7 to 28 d. Postoperative complications occurred in 3 recipients, including delayed liver function recovery in 1 case, biliary tract stenosis in 1 case and portal vein thrombosis in 1 case. Among them, the patient with portal vein thrombosis died after secondary operation, and the other 2 patients were recovered and discharged after symptomatic treatment. Conclusions The hemodynamics, liver function and other indicators of donors from donation after citizen's death are significantly improved after ECMO, and the liver function of the recipients also recover well.

Clinical effects of renal replacement therapy for kidney transplantation from donation after citizen's death / 实用医学杂志

Objective To explore the clinical application of renal replacement therapy in renal transplan-tation from donation after citizen's death(DCD).Methods A total of 41 cases of the patients with renal replace-ment therapy after renal transplantation from DCD from January 2013 to December 2016 were involved,of which 14 cases received peritoneal dialysis,21 intermittent hemodialysis(IHD)and 6 continuous renal replacement ther-apy(CRRT).The therapeutic effect and complications of three renal replacement therapies were retrospectively ana-lyzed. Results After dialysis treatment,the concentration of blood BUN,Crea,and potassium was significantly lower than that before the treatment(P<0.05);the difference of Crea and BUN before and after the treatment in IHD and CRRT group was higher than that in peritoneal dialysis group(P<0.05)but there was no statistically sig-nificant difference between IHD and CRRT group(P > 0. 05). Conclusion The renal replacement after kidney transplantation from DCD should be based on the patient's condition,which is the key to protect their kidneys even to save patients'lives.

A study on distribution characteristics of traditional Chinese medical syndromes of emergency sepsis / 中国中西医结合急救杂志

Objective To explore the distribution characteristics and regularity of traditional Chinese medical (TCM) syndromes in patients with sepsis in Department of Emergency of our hospital by enalyzed their clinical data and TCM four clinical diagnostic information so as to provide the basis for TCM standardized diagnosis and treatment of sepsis. Methods From July 2016 to October 2017, 135 patients with sepsis were admitted to the Department of Emergency and Department of Emergency Intensive Care Unit (EICU) of the First Affiliated Hospital of Zhejiang Chinese Medical University, 110 cases in sepsis group, 25 cases in sepsis shock group. An unified questionnaire was developed to collect the patients' general data, infection site and TCM four clinical diagnostic information (TCM syndromes, tongue coating, pulse signs, etc.) for dialectical typing on the day of admission with definite diagnosis, the relevant laboratory examinations were completed within 24 hours after the confirmative diagnosis was made, and the quick sequential organ failure assessment (qSOFA) and SOFA scores were calculated. Results In 135 cases of sepsis, pulmonary infection (51.9%) was the main one, followed by abdominal infection (25.9%). The distribution of TCM syndromes: the toxic heat syndrome was the main syndrome in sepsis group (61.8%) and acute deficiency syndrome was the main syndrome in sepsis shock group (68.0%), the difference between the two groups being statistically significant (P < 0.001). There were no statistical significant differences in comparisons of infection related indicators between sepsis and septic shock groups, different TCM syndromes of sepsis (all P > 0.05), such as white blood cell count (WBC), percentage and absolute value of neutrophils, C-reactive protein (CRP), procalcitonin (PCT). the lactic acid in patients of the acute deficiency syndrome was significantly higher than those in patients of the toxic heat syndrome, the stoppage of the qi of the bowels syndrome and blood stasis syndrome [mmol/L: 2.8 (1.5, 4.2) vs. 1.3 (1.0, 1.8), 1.6 (1.3, 3.8), 1.6 (1.2, 2.9), P < 0.001], and in septic shock group was significantly higher than that in the sepsis group [mmol/L: 4.0 (2.7, 5.7) vs. 1.4 (1.1, 1.9), P = 0.000]. The rate of qSOFA ≥ 2 score was 25.5% (28/110) in sepsis group, and 80.0% (20/25) in sepsis shock group, the difference being statistically significant (P < 0.001); while the rate of qSOFA ≥ 2 score was 69.4% (25/36) in patients of acute deficiency syndrome, 42.1% (8/19) in patients of the stoppage of the qi of the bowels syndrome, 19.1% (13/68) in patients of toxic heat syndrome and 16.7% (2/12) in patients of blood stasis syndrome, the differences also being statistically significant (all P < 0.001). The scores of SOFA in septic shock group [7.0 (5.0, 10.0)] and acute deficiency syndrome group [6.0 (4.0, 9.0)] were significantly higher compared with those in sepsis group [3.0 (2.0, 4.0)] and other syndrome types patients [toxic heat syndrome 3.0 (2.0, 4.0), the stoppage of the qi of the bowels syndrome 4.0 (2.0, 6.0) and blood stasis syndrome 4.5 (3.0, 5.0)], the differences being statistically significant (all P < 0.001). Conclusions The distribution of TCM syndromes of sepsis is related to the severity degree of sepsis, in TCM dialectical typing of sepsis, from toxic heat syndrome developing into the stoppage of the qi of the bowels syndrome, and from blood stasis syndrome to acute deficiency syndrome, the SOFA score and lactic acid level were gradually increased as the disease condition was continuously aggravating, so the SOFA score and lactic acid could be used as the reference indicators for the severity degree of sepsis; in septic patients with different TCM syndromes, the rates of qSOFA ≥ 2 were different, and the qSOFA score combined with patient's TCM syndrome can enhance the early diagnosis of sepsis.

Clinical analysis on donor liver protection and function evaluation for organ donation after citizen's death / 器官移植

Objective To summarize the preliminary experience of donor liver protection and function evaluation for organ donation after citizen's death. Methods Clinical data of 35 donors from organ donation after citizen's death and 33 recipients were retrospectively analyzed. Donor liver procurement and clinical prognosis of the recipients were summarized. According to serum level of sodium ion (serum sodium) before organ procurement, all recipients were divided into the serum sodium <155 mmol/L, 155-160 mmol/L and 161-180 mmol/L groups. The incidence of liver graft dysfunction early after liver transplantation was statistically compared among three groups. Results In 35 donors,27 cases were Chinese type Ⅱ and 8 cases were Chinese type Ⅲ. Thirty-three donor livers were used for liver transplantation, and the remaining 2 cases of donor livers were excluded due to congestive cirrhosis. In 33 liver transplantation recipients, 30 cases were successfully recovered. The liver function was gradually restored at postoperative 7-14 d, and normal liver function was obtained during long-term follow-up. Postoperatively, 3 recipients died including 2 cases dying from portal vein thrombosis and 1 case from pulmonary infection complicated with multiple organ failure. The incidence of early liver graft dysfunction of the recipients after liver transplantation was 18%, 23% and 4/5 in the serum sodium <155 mmol/L, 155-160 mmol/L and 161-180 mmol/L groups, respectively. Statistical significance was observed between the 161-180 mmol/L and <155 mmol/L groups (P<0.05). Conclusions Timely protection of donor liver, accurate evaluation and maintenance of liver function play a pivotal role in enhancing the utilization rate of donor liver, maintaining liver function and yielding good efficacy for transplantation.

Effect of recombinant hIL-10 on lymphocytes and IL-17A of an AA rat model / 中国免疫学杂志

Objective:Adjuvant arthritis(AA)rats interfered with recombinant hIL-10,methotrexate(MTX)separately,we detected the changes of T cell subsets in rat′s blood and IL-17 A in rat′s serum.Methods:AA rats interfered with recombinant hIL-10, MTX and IL-10 plus MTX.The changes of the CD4+and CD8+T cell subsets were detected by flow cytometry;the Levels of IL-17A in serum of rats were measured by ELISA method.Results:Compare to normal control group ,the CD4+T cell total quantity and CD4+/CD8+T cell Proportion was significantly decreased , there were significant differences between the treatment group and the untreated group(P<0.05 ), the IL-17A of treatment group was significantly decreased , there was a significant differences ( P<0.05 ).The combination group had significant difference compared with IL-10 group.Conclusion:Recombinant hIL-10 can down-regulate the blood of AA rats in the number of CD4 +T cells and CD4+/CD8+ratio,reduce serum levels of IL-17A.The combination group compared with the IL-10 group effect on serum IL-17A more significantly,the results displayed recombinant hIL-10 plus MTX in the treatment of rheumatoid arthritis can better play the role.

Expressions of toll-like receptor 4 mRNA and nuclear factor-κB mRNA in lung tissue of rats with acute paraquat poisoning / 中华急诊医学杂志

Objective To investigate the expressions of toll-like receptor 4 mRNA and nuclear factor-κB (TLR4-NF-κB) mRNA in lung tissue of rats with acute paraquat poisoning.Methods Thirty male SD rats were randomly divided into two groups,namely normal saline group (NS group,n =6) and the PQ groups (n =24).The rats of PQ group were administered with 20 mg/kg PQ by intraperitoneal injection to establish the models of PQ induced lung injury.The saline was administered once instead in normal saline group.The rats of PQ group were sacrificed separately at 6 h,12 h,24 h,48 h and 72 hours after modeling,while at 6 hours the rats of normal saline group was sacrificed.The expressions of TLR4 mRNA,NF-κB mRNA,and the levels of tumor necrosis factor-α and interleukin-6 in lung (serum) of rats were detected.Meanwhile,pathological changes of the lung tissue were examined under optical microscope.Results There were no histopathological changes such as alveolar edema,hemorrhage and inflammatory cell infiltration found in NS group other than in PQ group.At the 72 h,the expressions of TLR4 mRNA (9.61 ±0.21),NF-κB mRNA (5.62 ± 0.24),and the levels of TNF-α (153.08 ± 5.02) pg/ml,and interleukin-6 (230.08 ± 10.64) pg/mL in lung tissue of rats were significantly higher in PQ group than those in control group (P ＜ 0.01).Conclusions In rats after PQ poisoning,the expressions of TLR4 mRNA,NF-κB mRNA,and the levels of TNF-αand IL-6 were higher than those in normal rats,and the TLR4-NF-κB pathway could play an important role in lung injury of rats with PQ poisoning.

Clinical analysis of liver transplant from a child of brain death to an adult / 中华肝胆外科杂志

Objective To explore clinical feasibility of liver transplant from child of brain death to adult, to summarize the clinical experiences that a child of brain death transplants liver to an adult. Methods The recipient was a 39-year-old woman patient with primary hepatic carcinoma and posthepatitis cirrhosis (decompensation stage); while the donor was a 8-old-year child of brain death because of brain neoplasms. Donated liver was gained by the method of en bloc multivisceral procurement in a short time; the operative method was classic orthotopic liver transplantation. The postoperative managements included immunosuppression, prevention of infection, hepatic protection, and other relevant supports etc. Results The transplantation operative duration was 6 hours, after which not only did the recipient survive but also her body functioned well including the liver part, with no severe postoperative complications. Conclusions The technology of transplanting livers from children to adults is feasible. The key to ensure the success of transplant operation is systematic preoperative evaluation, excellent operative technique, and perfect postoperative treatment.