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Staphylococcus epidermidis can exhibit both protective and opportunistic pathogenic effects on the skin: on the one hand, it suppresses pathogenic bacteria and inflammation, assists the innate immune system of the skin, and maintains homeostasis of skin microenvironment; on the other hand, it exhibits pathogenic potential. How Staphylococcus epidermidis affects human skin conditions depends not only on itself, but also on the communication among it, the host immune system, other microorganisms and environment factors. The balance of this interaction is the symbiotic homeostasis of Staphylococcus epidermidis, and when the homeostasis is disrupted, a variety of skin diseases such as acne vulgaris, atopic dermatitis, rosacea and melanoma can occur. Factors affecting the symbiotic homeostasis of Staphylococcus epidermidis include environmental conditions such as temperature, oxygen content and nutrition, antibiotics, the number of other microorganisms, microecological diversity, etc. This review summarizes recent research progress in symbiotic homeostasis of Staphylococcus epidermidis.
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【Objective】 To investigate the association between HLA-A, B, DRB1 alleles and chronic renal failure (CRF) in Han population of Shandong Peninsula. 【Methods】 Sequence specific oligonucleotide probe-polymerase chain reaction (PCR-SSO) was used to genotype 880 patients with CRF in the Han population of Shandong Peninsula. The allele frequencies of HLA-A, B and DRB1 were compared with 865 hematopoietic stem cell voluntary donors, and the association between HLA gene polymorphism and CRF was analyzed. 【Results】 A total of 33 HLA-A alleles, 76 HLA-B alleles and 39 HLA-DRB1 alleles were detected in the study group. DRB1*11∶01 (6.70% vs 4.45%) and DRB1*12∶02 (8.69% vs 5.90%) in CRF group were significantly higher than those in the control(Pc<0.05), and B*15∶11 (1.82% vs 3.64%) among CRF group was significantly lower compared with the control(Pc<0.05). The frequency of three loci haplotypes A*30∶01 -B*13∶02 -DRB1*07∶01 (16.61% vs 7.61%), A*33∶03 -B*58∶01 -DRB1*03∶01 (4.57% vs 1.62%) and A*02∶07 -B*46∶01 -DRB1*09∶01 (4.06% vs 1.09%) in CRF patients were significantly higher than that of the control(Pc<0.05), which were strongly correlated with CRF. 【Conclusion】 The data on the association of HLA-A, B, DRB1 alleles and haplotype polymorphisms with CRF in Shandong Peninsula has been obtained in this study. DRB1*11∶01 and DRB1*12∶02 may be the susceptibility risk factors for development of CRF, and B*15∶11 may be protective genes against development of CRF, and A*30∶01 -B*13∶02 -DRB1*07∶01, A*33∶03 -B*58∶01 -DRB1*03∶01 and A*02∶07 -B*46∶01 -DRB1*09∶01 may be the susceptible haplotypes in Han population of Shandong Peninsula.
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Objective:To investigate the effect of resveratrol on the expression of inflammatory cytokines and related genes in human SZ95 sebocytes induced by benzo (a) pyrene.Methods:Human SZ95 sebocytes were cultured in vitro, and divided into 4 groups: control group treated with 1‰ dimethyl sulfoxide for 27 hours, resveratrol group treated with 1 × 10 -5 mol/L resveratrol for 24 hours, benzo (a) pyrene group treated with 1 × 10 -5 mol/L benzo (a) pyrene for 3 hours, resveratrol+benzo (a) pyrene group treated with 1 × 10 -5 mol/L resveratrol for 24 hours followed by 1 × 10 -5 mol/L benzo (a) pyrene for 3 hours. Real-time fluorescence-based quantitative PCR was performed to determine the mRNA expression of interleukin (IL) -1α, IL-6, aryl hydrocarbon receptor (AhR) , cytochrome P4501A1 (CYP1A1) and cytochrome P4501B1 (CYP1B1) in SZ95 sebocytes in the above groups; Western blot analysis was conducted to determine the phosphorylation level of p38 mitogen-activated protein kinase (p38 MAPK, expressed as the ratio of phosphorylated to total p38 MAPK) and AhR protein expression; enzyme-linked immunosorbent assay (ELISA) was conducted to detect levels of IL-1α and IL-6 in the cell culture supernatant in each group. One-way analysis of variance was used for comparison of means among multiple groups, and least significant difference- t test was used for multiple comparisons. Results:The mRNA and protein expression of IL-1α in SZ95 sebocytes significantly differed among the control group, resveratrol group, benzo (a) pyrene group and resveratrol+benzo (a) pyrene group (mRNA: 2.045 ± 0.272, 2.058 ± 0.154, 3.124 ± 0.094, 2.185 ± 0.337, protein: 9.132 ± 1.181, 9.429 ± 0.771, 20.361 ± 0.907, 9.917 ± 0.897, F=14.662, 101.705, P < 0.01, < 0.001, respectively) , and were significantly lower in the resveratrol+benzo (a) pyrene group than in the benzo (a) pyrene group (both P < 0.01) . In addition, the phosphorylation level of p38 was significantly higher in the benzo (a) pyrene group than in the control group, resveratrol group and resveratrol+benzo (a) pyrene group ( F=303.129, P < 0.000 1) . The mRNA expression of AhR, CYP1A1 and CYP1B1 was significantly lower in the resveratrol+benzo (a) pyrene group than in the benzo (a) pyrene group ( t=10.64, 33.599, 18.327, respectively, all P < 0.001) . The benzo (a) pyrene group showed significantly decreased protein expression of AhR compared with the resveratrol+benzo (a) pyrene group ( P < 0.001) . Conclusion:Resveratrol can inhibit the environmental pollutant benzo (a) pyrene-induced expression of inflammatory factor IL-1α in SZ95 sebocytes, which is likely mediated by the AhR and p38MAPK pathways.
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Acne is a chronic inflammatory dermatosis of pilosebaceous units. Increased sebum content is the precondition of acne occurrence, and changes of sebum components promote inflammatory reactions in acne. Imbalance of sebum homeostasis is one of the key factors for acne occurrence. Due to the complex composition and diverse structure of sebum, it is difficult to analyze all lipid compounds in sebum by using a single experimental method. Lipidomics can be used to qualitatively and quantitatively analyze hundreds of lipids with different properties and biological activities, which provides a potential insight into the role of sebum in the pathogenesis of acne. This review summarizes application of lipidomics in the analysis of sebum in acne patients.
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Objective:To propose a Chinese diagnostic criterion for rosacea on the basis of clinical feature analysis of rosacea, and to assess its sensitivity and specificity.Methods:A total of 3 350 Chinese patients with newly diagnosed rosacea were collected from Department of Dermatology, Xiangya Hospital, Central South University between December 2017 and July 2018, their phenotypes and clinical features were retrospectively analyzed, and a Chinese modified diagnostic criterion for rosacea was put forward. A national multi-center clinical observational trial, which included 2 269 patients with rosacea and 2 408 patients with other facial skin diseases from 28 centers, was conducted to verify this diagnostic criterion. Then, the sensitivity and specificity of the modified diagnostic criterion were evaluated by comparing with the 2017 standard classification of rosacea developed by the National Rosacea Society Expert Committee (NRSEC) .Results:Fixed centrofacial erythema occurred in 3 350 (100%) patients with rosacea. Flushing occurred before or simultaneously with fixed erythema in 1 850 (99.4%) of the 1 861 patients with erythema on the cheeks; among the 1 489 patients with erythema on the nose or perioral area, only 52 (3.5%) had flushing; all the 342 patients presenting with phymatous changes had fixed erythema before phymatous changes. Based on the above clinical findings, it was proposed that patients with periodically aggravated fixed erythema on the cheeks accompanied with flushing could be diagnosed with rosacea; patients with fixed erythema on the nose and perioral area accompanied with at least one of selective phenotypes (flushing, telangiectasia, papules and pustules, phymatous changes, or ocular manifestations) could be diagnosed with rosacea. The national multi-center clinical observational trial revealed that the sensitivity of the Chinese modified diagnostic criterion for rosacea was 99.6%, which was close to the sensitivity (100%) of the NRSEC standard, and its specificity was 91.9%, higher than the specificity (73.3%) of the NRSEC standard.Conclusion:The Chinese modified diagnostic criterion for rosacea has good sensitivity and specificity, and can facilitate the early diagnosis of phymatous rosacea.
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Objective To evaluate the effect of isotretinoin on expression of ache-associated inflammatory genes induced by peptidoglycan in human SZ95 sebocytes,and to explore the molecular mechanism underlying the treatment of acne with isotretinoin.Methods Cultured SZ95 sebocytes were divided into 3 groups:control group receiving no treatment,peptidoglycan group treated with 20 mg/L peptidoglycan alone,and costimulation group treated with 20 mg/L peptidoglycan combined with 10-5 mol/L isotretinoin.After 3-hour treatment,real-time fluorescence-based quantitative PCR was performed to determine the mRNA expression of pro-inflammatory cytokines including interleukin (IL)-1α,IL-1β,IL-6,IL-8,tumor necrosis factor (TNF)-α,Toll-like receptor 2 (TLR2) and MyD88 (a downstream gene of TLR2) in SZ95 sebocytes in the above groups.After 24-hour treatment,enzyme-linked immunosorbent assay (ELISA) was performed to detect levels of IL-1α,IL-1β,IL-6,IL-8 and TNF-α in the cell culture supernatant in the above groups.After 48-hour treatment,Western blot analysis was conducted to determine the protein expression of TLR2 and MyD88.Statistical analysis was carried out with SPSS 23 software by one-way analysis of variance (ANOVA) for the comparison among the 3 groups,and by Bonferroni method for multiple comparisons.Results The mRNA and protein expression of pro-inflammatory cytokines including IL-1α,IL-1β,IL-6,IL-8 and TNF-α all significantly differed among the 3 groups (all P ＜ 0.01),and was significantly higher in the peptidoglycan group than in the control group and costimulation group (both P ＜ 0.016 7).The mRNA expression of MyD88 also significantly differed among the control group,peptidoglycan group and costimulation group (6.707 ± 0.950,10.270 ± 0.477,7.892 ± 0.900 respectively,F =10.17,P ＜ 0.01),and was significantly higher in the peptidoglycan group than in the control group and costimulation group (t =4.740,3.298 respectively,both P ＜ 0.016 7).The mRNA and protein expression of TLR2 were markedly higher in the peptidoglycan group than in the control group,but did not differ between the peptidoglycan group and the costimulation group.Conclusion Isotretinoin can inhibit peptidoglycan-induced expression of inflammatory factors possibly associated with the occurrence of acne in human SZ95 sebocytes,likely by inhibiting the expression of MyD88,but not TLR2,in the innate immune response,which may be one of the mechanisms underlying the treatment of acne with isotretinoin.
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<p><b>OBJECTIVE</b>To investigate the effects of YOD1 overexpression on the proliferation and migration of human oral keratinocytes (HOKs), and to clarify whether the mechanisms involve transforming growth factor-β (TGF-β) signaling.</p><p><b>METHODS</b>HOKs were transfected with the plasmid pEGFP-N3-YOD1 containing YOD1. The mRNA levels of YOD1 and TGF-β were determined by qPCR. The protein expressions of YOD1, TGF-β, Smad2/3, Smad4, and phospho-Smad2/3 were determined by western blotting. Cell proliferation and migration were evaluated by Cell Counting Kit-8 assay and wound healing assay, respectively.</p><p><b>RESULTS</b>The mRNA and protein levels of YOD1 were higher in HOKs transfected with YOD1. YOD1 overexpression significantly enhanced the migration of HOKs. The mRNA and protein levels of TGF-β3 were increased by YOD1 overexpression. HOKs transfected with YOD1 exhibited increased phospho-Smad2/3 levels.</p><p><b>CONCLUSION</b>YOD1 overexpression enhances cell migration by promoting TGF-β3 signaling which may play an important role in lip and palate formation. YOD1 mutation may contribute to aberrant TGF-β3 signaling associated with decreased cell migration resulting in NSCLP.</p>
Subject(s)
Humans , Cell Movement , Physiology , Cell Proliferation , Cells, Cultured , Endopeptidases , Genetics , Metabolism , Keratinocytes , Physiology , Signal Transduction , Physiology , Smad Proteins , Genetics , Metabolism , Thiolester Hydrolases , Genetics , Metabolism , Transforming Growth Factor beta3 , Genetics , MetabolismABSTRACT
<p><b>OBJECTIVE</b>To validate the performance of Mycob. T Stainer and Scanner (MTSS) for detecting acid-fast bacilli (AFB).</p><p><b>METHODS</b>A total of 3,816 sputum samples from 1,515 tuberculosis (TB) suspects were tested at the Anhui Provincial Chest Hospital and the Linyi People's Hospital from April-August, 2016. Each specimen was placed on two smear slides. One slide was stained by the ziehl-neelsen (ZN) method to be read by conventional microscopy (CM). The other slide was stained and scanned by MTSS. All specimens were decontaminated with 4% NaOH, and then inoculated into solid culture. The performance of MTSS was assessed.</p><p><b>RESULTS</b>MTSS produced higher average positivity rate (27.96%) as compared with the CM (26.83%). The overall sensitivity and specificity of MTSS were 78.9% and 93.9%, respectively. The sensitivity and specificity of CM was 77.4% and 95.0%, respectively.</p><p><b>CONCLUSION</b>MTSS exhibited a favorable performance in the detection of AFB. It may be an alternative to CM for screening TB.</p>
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Objective To investigate the relationship between clinical types and related risk factors in female patients with post-adolescent acne.Methods Female outpatients with post-adolescent acne aged more than 25 years were enrolled from Department of Dermatology of Renji Hospital between January and October 2016.A questionnaire survey was conducted to investigate related risk factors for post-adolescent acne in the females.Skin lesions and clinical types were evaluated by dermatologists.Statistical analysis was carried out by t test for comparison of means between two groups and by chi-square test for comparison of ratios.Results A total of 312 female patients with post-adolescent acne completed the survey,including 268 (85.9％) with mild to moderate acne and 44 (14.1％) with severe acne,241 (77.2％) with persistent acne and 71 (22.8％) with late-onset acne,or 102 (32.7％) with comedonal post-adolescent acne (CPAA) and 210 (67.3％) with papular post-adolescent acne (PPAA).Survey on related risk factors showed that 121 patients reported seasonal factors and 59 (18.9％) patients became worse in summer,and spicy,sweet and fried foods can aggravate the condition in 131 (42％),93 (29.8％) and 85 (27.2％) patients respectively.Other risk factors such as premenstrual period (62.8％,196/312),psychological factors (51.6％,161/312) and exogenous chemical exposures (43.6％,136/312) were complained of by the patients.Furthermore,premenstrual period,diet and constipation were found to be more associated with PPAA compared with CPAA (x2 =4.523,4.068,3.910,respectively,all P ＜ 0.05).Exogenous chemical exposures,such as the use of cosmetics,exposure to polluted air environment and occupational hazards,were more associated with CPAA compared with PPAA,as well as with late-onset acne compared with persistent acne (x2 =6.579,9.057,both P ＜ 0.05).In addition,premenstrual exacerbation occurred more frequently in patients with persistent acne compared with those with late-onset ache (x2 =4.512,P ＜ 0.05).Conclusions The risk factors for the occurrence of female post-adolescent acne are very complex.Premenstrual exacerbation plays a major role in the aggravation of papular and persistent post-adolescent acne,diet and constipation are more associated with PPAA,and exogenous chemical exposures are still be considered in the aggravation of comedonal and late-onset post-adolescent acne.Thus,clinical types should be considered in the diagnosis and treatment of post-adolescent acne in females.
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In this study, we sought to determine the association between environmental factors and nonsyndromic cleft of the lip and/or palate (NSCLP) to understand the etiology of the disease. A total of 200 NSCLP cases and 327 controls were recruited at the Maternal and Child Health Hospital of Xuzhou City. We conducted face-to-face interviews with the mothers of both cases and controls. The factors increasing the risk of NSCLP were a positive family history [odds ratio (OR)=56.74], pesticide exposure (OR=8.90), and indoor decoration pollution (OR=4.32). On the other hand, the factors decreasing the risk of NSCLP were a high education level (OR=0.22) and supplementation of folic acid (OR=0.23) and multivitamins (OR=0.16). Positive family history, pesticide exposure, and indoor decoration pollution are associated with the risk of NSCLP. In contrast, high education level and folic acid and multivitamin supplementation are protective factors against NSCLP.
Subject(s)
Female , Humans , Infant, Newborn , Pregnancy , Case-Control Studies , China , Epidemiology , Cleft Lip , Epidemiology , Cleft Palate , Epidemiology , Environmental Pollutants , Toxicity , Folic Acid , Therapeutic Uses , Logistic Models , Maternal Exposure , Risk Factors , Socioeconomic Factors , Surveys and QuestionnairesABSTRACT
Donation after brain death followed by circulatory death (DBCD) is a unique practice in China. The aim of this study was to define the pathologic characteristics of DBCD liver allografts in a porcine model. Fifteen male pigs (25-30 kg) were allocated randomly into donation after brain death (DBD), donation after circulatory death (DCD) and DBCD groups. Brain death was induced by augmenting intracranial pressure. Circulatory death was induced by withdrawal of life support in DBCD group and by venous injection of 40 mL 10% potassium chloride in DCD group. The donor livers were perfused in situ and kept in cold storage for 4 h. Liver tissue and common bile duct samples were collected for hematoxylin and eosin staining, TUNEL testing and electron microscopic examination. Spot necrosis was found in hepatic parenchyma of DBD and DBCD groups, while a large area of necrosis was shown in DCD group. The apoptosis rate of hepatocytes in DBD [(0.56±0.30)%] and DBCD [(0.50 ± 0.11)%] groups was much lower than that in DCD group [(3.78±0.33)%] (P0.05)). The structures of bile duct were intact in both DBD and DBCD groups, while the biliary epithelium was totally damaged in DCD group. Under electron microscope, the DBD hepatocytes were characterized by intact cell membrane, well-organized endoplasmic reticulum, mild mitochondria edema and abundant glycogens. Broken cell membrane, mild inflammatory cell infiltration and sinusoidal epithelium edema, as well as reduced glycogen volume, were found in the DBCD hepatocytes. The DCD hepatocytes had more profound cell organelle injury and much less glycogen storage. In conclusion, the preservation injury of DBCD liver allografts is much less severe than that of un-controlled DCD, but more severe than that of DBD liver allografts under electron microscope, which might reflect post-transplant liver function to some extent.
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Donation after brain death followed by circulatory death (DBCD) is a unique practice in China. The aim of this study was to define the pathologic characteristics of DBCD liver allografts in a porcine model. Fifteen male pigs (25-30 kg) were allocated randomly into donation after brain death (DBD), donation after circulatory death (DCD) and DBCD groups. Brain death was induced by augmenting intracranial pressure. Circulatory death was induced by withdrawal of life support in DBCD group and by venous injection of 40 mL 10% potassium chloride in DCD group. The donor livers were perfused in situ and kept in cold storage for 4 h. Liver tissue and common bile duct samples were collected for hematoxylin and eosin staining, TUNEL testing and electron microscopic examination. Spot necrosis was found in hepatic parenchyma of DBD and DBCD groups, while a large area of necrosis was shown in DCD group. The apoptosis rate of hepatocytes in DBD [(0.56±0.30)%] and DBCD [(0.50 ± 0.11)%] groups was much lower than that in DCD group [(3.78±0.33)%] (P<0.05). And there was no significant difference between DBD group and DBCD group (P>0.05)). The structures of bile duct were intact in both DBD and DBCD groups, while the biliary epithelium was totally damaged in DCD group. Under electron microscope, the DBD hepatocytes were characterized by intact cell membrane, well-organized endoplasmic reticulum, mild mitochondria edema and abundant glycogens. Broken cell membrane, mild inflammatory cell infiltration and sinusoidal epithelium edema, as well as reduced glycogen volume, were found in the DBCD hepatocytes. The DCD hepatocytes had more profound cell organelle injury and much less glycogen storage. In conclusion, the preservation injury of DBCD liver allografts is much less severe than that of un-controlled DCD, but more severe than that of DBD liver allografts under electron microscope, which might reflect post-transplant liver function to some extent.
Subject(s)
Animals , Humans , Allografts , Apoptosis , Brain Death , China , Death , Heart Arrest , Hepatocytes , Pathology , In Situ Nick-End Labeling , Liver , Pathology , Liver Transplantation , Methods , Microscopy, Electron , Organ Preservation , Methods , Swine , Tissue Donors , Tissue and Organ Procurement , MethodsABSTRACT
Objective To estimate the effect of the enviromental pollutant 2,3,7,8-tetrachlorodibenzo-pdioxin (TCDD),a representative of the dioxin family,on the expression of cytochrome P4501A1 (CYP1A1) in cultured human immortalized SZ95 sebocytes in vitro,so as to improve understanding of the pathogenesis of chloracne.Methods SZ95 sebocytes were cultured with or without the presence of 10 nmol/L TCDD for two hours or three days.Real time fluorescence-based PCR was performed to quantify the mRNA expression of CYP1A1,immunohistochemistry and Western blot to determine the expression level of CYP1A1 protein,in the SZ95 cells.Chi-square test was done to compare the protein and mRNA expressions of CYP1A1 between untreated and treated SZ95 cells.Results Real time PCR showed that the mRNA expression of CYP1A1 was low in SZ95 sebocytes,and increased by 5.622 times after 2-hour treatment with TCDD(P ＜ 0.05).Immunohistochemistry revealed a weak expression of CYP1A1 protein in the cytoplasm and nuclei of untreated SZ95 sebocytes,which was also significantly enhanced by the TCDD treatment.Western blot results showed that the relative expression level of CYP1A1 protein was 4.233 ± 0.252 in SZ95 sebocytes treated by TCDD for three days,significantly higher than that in untreated sebocytes(0.123 ± 0.208,P ＜ 0.05).Conclusions There is a low expression of CYP1A1 mRNA and protein in SZ95 sebocytes,which can be upregulated by TCDD,suggesting that the CYP1A1 gene is a downstream target of the aryl hydrocarbon receptor responsible for the abnormal differentiation of human sebocytes.
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<p><b>OBJECTIVE</b>To evaluate the outcomes of liver transplant recipients who received liver allografts from hepatitis B surface antigen (HBsAg)-positive donors.</p><p><b>METHODS</b>The medical records of 23 male patients (median age, 42.5 years; range: 29-61) who received HBsAg-(+) liver allografts in our organ transplant center were retrospectively analyzed. All patients had confirmed diagnosis of end-stage liver disease (ESLD) secondary to hepatitis B virus (HBV) infection, including 13 HBsAg(+)/HBeAg(-)/HBcAb(+) cases and 10 HBsAg(+)/HBeAb(+)/HBcAb(+) cases. After transplantation, all patients were administered oral entecavir and intravenous anti-hepatitis B immunoglobulin (HBIG) (2000 IU/d during the first week), along with a steroid-free immune suppression regimen. HBV-related antigen and antibody and HBV DNA were detected on post-transplantation days 1, 7, 14, 21, and 30. The liver allografts were monitored by ultrasound imaging. After discharge, monthly follow-up recorded liver function, renal function, acute rejection, infections, vascular complications, biliary complications, HBV recurrence, cancer recurrence, and patient survival.</p><p><b>RESULTS</b>Two of the recipients died from severe perioperative pneumonia. The remaining 21 recipients were followed-up for 10 to 38 months, and all 21 patients remained HBsAg(+). One recipient developed biliary ischemia and required a second liver transplantation at five months after the primary transplantation. Three recipients (all primary) died from tumor recurrence at 9, 14, and 18 months post-transplantation, respectively. All other recipients survived and had acceptably low HBV DNA copy levels. Color Doppler imaging showed good graft function and normal texture. The patient and graft survival rates were 78.3% (18/23) and 73.9% (17/23), respectively. The recurrence rate of HBV infection was 100% (23/23). In surviving patients, no liver function abnormality, graft loss, or death was found to be related to the recurrence of HBV infection.</p><p><b>CONCLUSION</b>Liver transplantation using HBsAg(+) liver grafts was safe for patients with ESLD secondary to HBV infection.</p>
Subject(s)
Adult , Humans , Male , Middle Aged , End Stage Liver Disease , General Surgery , Virology , Hepatitis B Surface Antigens , Allergy and Immunology , Liver Transplantation , Allergy and Immunology , Methods , Recurrence , Retrospective Studies , Tissue DonorsABSTRACT
<p><b>OBJECTIVE</b>To investigate the clinical characteristics, diagnosis and treatment of digestive tract leakage after orthotopic liver transplantation (OLT).</p><p><b>METHODS</b>Sixty-one recipients had digestive tract leakage in early stage after OLT among 1173 cases from January 2000 to December 2010. There were 55 male and 6 female patients, aging from 36 to 61 years, with a median of 45 years. Digestive tract leakage included bile leakage (46 cases), gastric leakage (5 cases), duodenal leakage (1 case), jejunal leakage (4 cases), ileal leakage (1 case) and colon transversum leakage (4 cases). Ten of recipients with gastrointestinal leakage had 1 to 3 times of abdominal surgery before OLT. Abdominal drainage was used in 28 cases with bile leakage, and additionally, endoscopic retrograde cholangiopancreatography, endoscopic nasobiliary drainage and stenting were performed for 8 of them, and surgical neoplasty for another 18 patients with bile leakage. Simple surgical neoplasty of perforation was performed for 13 patients with gastrointestinal leakage, and diverticulectomy and neoplasty for 1 case with duodenal leakage, and partial jejunostomy for one severe jejunal leakage. Nutritional support was administered for all of cases.</p><p><b>RESULTS</b>The incidence rate of digestive tract leakage in early stage after OLT was 5.20% (61/1173). Intra-operative iatrogenic injury of gastrointestinal tract was occurred in 6 cases with gastrointestinal leakage. After treatment, 11 cases died of multiple organ failure resulted from severe infection, with mortality of 18.0% (11/61), including 4 cases with bile leakage, with the mortality of 8.6% (4/46), and 7 cases with gastrointestinal tract leakage, with the mortality of 46.6% (7/15). The remanent 50 cases through comprehensive treatment with a span of 1 to 3 months recovered and discharged healthily. No digestive tract leakage reoccurred in the follow-up of 6 to 84 months.</p><p><b>CONCLUSIONS</b>The morbidity of digestive tract leakage in early stage after OLT is low, but its mortality is high, especially for gastrointestinal tract leakage. High dose corticosteroids therapy, history of abdominal operation and intra-operative iatrogenic injury may be high risk factor. Comprehensive treatment is crucial for improving prognosis.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Digestive System Fistula , Diagnosis , Therapeutics , Drainage , Liver Transplantation , Postoperative Complications , Diagnosis , TherapeuticsABSTRACT
<p><b>OBJECTIVE</b>To investigate the effect of Campath-1H induction on immunosuppression in small intestine transplantation.</p><p><b>METHODS</b>Clinical data of a patient who underwent small intestine transplantation were retrospectively summarized.</p><p><b>RESULTS</b>Intraoperative Campath-1H induction by intravenous injection was administered. Triple immunosuppression(FK506, MMF and methylprednisolone) was used postoperatively. The lymphocyte and leukocyte decreased significantly following Campath-1H induction, and returned to normal after adjusting the dose of immunosuppressant and use of colony stimulating factor. There were no acute rejection, graft versus host disease, or severe infection during the immediate postoperative period. The patient recovered and discharged.</p><p><b>CONCLUSION</b>Intraoperative Campath-1H induction and postoperative triple immunosuppression using FK506, MMF, and methylprednisolone may prevent rejection and graft versus host disease in the early stage after small intestine transplantation.</p>
Subject(s)
Adult , Humans , Male , Alemtuzumab , Antibodies, Monoclonal, Humanized , Therapeutic Uses , Graft Rejection , Immunosuppression Therapy , Immunosuppressive Agents , Therapeutic Uses , Intestine, Small , Transplantation , Retrospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To summarize the treatment outcomes after combined en bloc liver and pancreas transplantation.</p><p><b>METHODS</b>Five patients with end-stage liver disease and type 2 diabetes mellitus received combined en bloc liver and pancreas transplantation after hepatectomy.</p><p><b>RESULTS</b>Five operations were performed successfully. The operative time ranged from 9 to 16 hours and blood loss from 1600 to 3000 ml. Postoperatively, one patients developed pulmonary infection, one died of graft-versus-host disease(GVHD), and one experienced acute renal failure. No intestinal fistula, anastomotic leakage, biliary complications, chronic and acute rejection and pancreatitis were seen. Liver function index including alanine aminotransferase, aspartate aminotransferase and total bilirubin returned to normal levels a week after surgery, while levels of C peptide and blood glucose resumed within 1 to 2 weeks. Apart from 1 case died of GVHD, the other 4 maintained normal liver function during the follow up ranging from 2 to 23 months and no insulin was required for the diabetes.</p><p><b>CONCLUSION</b>Combined en bloc liver and pancreas transplantation is technically feasible and an effective treatment for multi-organ diseases.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Diabetes Mellitus, Type 2 , General Surgery , Liver Failure , General Surgery , Liver Transplantation , Pancreas Transplantation , Retrospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To investigate the safety and feasibility of steroids minimization immunosuppressive regimen in liver transplantation.</p><p><b>METHODS</b>One hundred and sixteen patients in line with the selecting criteria from January 2005 to June 2008 were divided into three groups according to the withdrawal of steroids: 40 cases in 3 months withdrawal group, 40 cases in 7 d withdrawal group and the other 36 cases in 24 h withdrawal group. The difference of recipients' survival, infection, acute rejection and steroids resistant acute rejection, wound healing, recurrence of HBV and hepatocellular cell (HCC), new on-set of diabetes, hyperlipidemia and hypertension between the three groups were compared.</p><p><b>RESULTS</b>The difference of recipients' survival, acute rejection including steroids resistant acute rejection, recurrence of HBV and HCC, hyperlipidemia between the three groups were not significant (P > 0.05), the incidence of wound un-healing and hypertension in 24 h withdrawal group was significantly lower than that in the other 2 groups (P < 0.05), the incidence of infection and new on-set diabetes in 24 h withdrawal group and 7 d withdrawal group was significantly lower than that in 3 months withdrawal group (P < 0.05).</p><p><b>CONCLUSION</b>Steroids minimization immunosuppressive strategy is safe and feasible in liver transplantation field, it will significantly reduce the steroids related complications without increasing the risk of rejection.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Follow-Up Studies , Graft Survival , Immunosuppression Therapy , Methods , Immunosuppressive Agents , Therapeutic Uses , Liver Transplantation , Postoperative Care , Prognosis , Retrospective Studies , Steroids , Therapeutic UsesABSTRACT
<p><b>OBJECTIVE</b>To investigate the causes and treatment of postoperative gastrointestinal bleeding after orthotopic liver transplantation (OLT).</p><p><b>METHODS</b>Clinical data of 776 patients after OLT between January 2000 and December 2006 were analyzed retrospectively.The experiences in diagnosis and treatment of postoperative gastrointestinal bleeding after OLT were reviewed.</p><p><b>RESULTS</b>Gastrointestinal bleeding occurred in 18 patients (2.3%) after OLT, among whom 8 (44.5%) were from peptic ulcer, 3 (16.7%) from gastric and esophageal varices, 3 (16.7%) from gastroduodenitis, 3 (16.7%) from hemobilia, and 1 (5.6%) had diverticular bleeding in the jejunum. These 18 patients with gastrointestinal bleeding were managed with conservative treatment, endoscopic treatment, radiological interventional embolism,or exploratory laparotomy. Five patients died of gastrointestinal bleeding and the gastrointestinal bleeding-related mortality rate was 27.8%. After a mean follow up of 3.5 years, only 1 patient died of recurrence of hepatic cellular carcinoma while others survived disease-free.</p><p><b>CONCLUSIONS</b>Gastrointestinal bleeding may occur from different sites after OLT and the mortality is high. Prompt identification of the source of bleeding and correct management are required to improve the prognosis.</p>
Subject(s)
Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Young Adult , Gastrointestinal Hemorrhage , Liver Transplantation , Postoperative Hemorrhage , Retrospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To evaluate the influence of simultaneous pancreas-kidney (SPK) transplantation on the quality of life of diabetic recipients with end-stage renal disease.</p><p><b>METHODS</b>We performed a retrospective analysis of the data of diabetic patients with end-stage renal disease and evaluated the quality of life of the recipients using SF-36 health survey.</p><p><b>RESULTS</b>One patient died of cerebrovascular accident, and 7 patients recovered smoothly. During the follow-up lasting for a mean of 23.3 months, the blood glucose, C-peptide and creatine levels of the patients remained stable. The score of 8 domains of SF-36 of the diabetic recipient at 2 years after SPK transplantation showed a significant improvement compared with that before the operation, similar to that of Chinese normal population(P > 0.05).</p><p><b>CONCLUSIONS</b>SPK transplantation can achieve a significant improvement of the quality of life of diabetic patients with end-stage renal disease.</p>