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Clinical data were retrospectively reviewed for one case of penicillium marneffei infection after renal transplantation (RT) to explore a proper management of peniciliosis marneffei (PSM)transplantation.This case had a history of pulmonary tuberculosis and underwent RT due to uremia.After discharging, postoperative recovery was excellent.Recurrent cough occurred at Month 7 post-operation.Fiberoptic bronchoscopy and pulmonary CT indicated a possibility of pulmonary tuberculosis.However, a definite diagnosis of PSM was confirmed by next generation sequencing (NGS) and pathogenic bacteria culture of alveolar lavage fluid.After adjusting immunosuppressive agents and regular antifungal treatment with voriconazole, respiratory symptoms improved and pulmonary CT hinted at a resorption of lesion.Features of pulmonary CT and bronchoscopic examination were nearly similar to those of tuberculosis.Thus early bacterium culture and NGS may aid an definite diagnosis.Voriconazole is an effective treatment of the disease.
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Objective:To explore the diagnosis and treatment of pure red cell aplastic anemia (PRCA) caused by parvovirus B19 (HPV-B19)infection after liver transplantation (LT).Methods:Three adult PRCA patients caused by parvovirus B19 infection after LT were reviewed retrospectively.The relevant literatures were collected to sort out the detection methods and treatment of parvovirus B19 infection after LT.Results:All three patients received liver transplantation due to end-stage liver disease with massive intraoperative blood transfusion and smooth postoperative recovery.Severe anemia occurred at 1-2 Months after discharge.Hemorrhagic anemia was excluded after re-admission and PRCA was diagnosed by bone marrow aspiration and next generation sequencing (NGS). After tapering the intensity of immunosuppressive therapy, intravenous immunoglobulin (IVIG) was administered for 7-10 days and hemoglobin soon normalized.A review of 15 recent literatures on HPV-B19 infection after LT revealed that the diagnosis and treatment of parvovirus B19 infection after LT gradually were became same.Conclusions:HPV-B19 infection causes PRCA after LT in adults.Diagnosing with NGS, intravenous injection of immunoglobulin and modification of immunosuppressant regimen may achieve excellent therapeutic efficacies.
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Objective:To study the predictive value of systemic immune-inflammation index (SII), alpha-fetoprotein (AFP) and tumor diameter on microvascular invasion (MVI) in patients with resectable hepatocellular carcinoma (HCC), with an aim to establish a preoperative prediction model.Methods:The clinical data of 283 patients who underwent hepatectomy at the First Affiliated Hospital of Nanchang University from September 2017 to September 2020 were retrospectively analyzed. In the 283 patients with HCC who were included into this study, 249 were males and 34 were females, aged (53.7±11.0) years. Using postoperative pathology findings, these patients were divided into two groups: the MVI negative group ( n=140) and the MVI positive group ( n=143). Correlation between MVI and related indicators was analyzed using logistic regression analysis. The prediction model of MVI was then established by selecting independent risk factors. Univariate and multivariate analysis of recurrence-free survival (RFS) were performed using the Cox proportional hazards regression model. Results:Multivariate logistic regression analysis showed that AFP>400 ng/ml ( OR=2.304, 95% CI: 1.329-3.995, P=0.003), SII>376.30×10 9/L ( OR=2.249, 95% CI: 1.299-3.894, P=0.004) and tumor diameter>5 cm ( OR=2.728, 95% CI: 1.587-4.687, P<0.001) were independent risk factors for MVI. The Cox proportional hazards regression model showed that AFP ( HR=1.663, 95% CI: 1.063-2.602, P=0.026) and SII ( HR=1.851, 95% CI: 1.173-2.920, P=0.008) were independent risk factors for RFS in HCC patients. The sensitivity and specificity of the model based on SII, AFP and tumor diameter were 59.4% and 75.7%, respectively. Conclusions:SII, AFP and tumor diameter were closely related to occurrence of MVI in patients with HCC. AFP and SII were independent prognostic factors of RFS. This prediction model has certain predictive values for occurrence of MVI and prognosis of HCC patients.
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Objective:To explore the clinical diagnosis and treatment of invasive gastrointestinal fungal infection plus pulmonary infection after renal transplantation.Methods:Clinical data were analyzed retrospectively for one patient with invasive fungal infection plus pulmonary infection after renal transplantation. The middle-aged female recipient underwent allogeneic kidney transplantation due to end-stage uremia. After successful kidney transplantation, there was postprandial epigastric pain not relieved by proton pump inhibitor. Gastroscopy after admission suggested that the nature of gastric mucosal lesions was to be determined. Pathological examination and special staining confirmed mucor.Results:After clarifying her conditions, the doses of such immunosuppression as tacrolimus, mycophenolate mofetil and prednisone were tapered and discontinued when necessary and using amphotericin B liposome plus posaconazole alleviated the digestive tract symptoms. Chest tightness, fever, shortness of breath after activities hinted at pulmonary infection after renal transplantation. Treatment was guided by the results of sputum culture.Conclusions:Mucor infection is rare in digestive tract complicated with pulmonary infection after renal transplantation. Clinicians should actively search for etiological evidence, seek multidisciplinary consultations for a definite diagnosis and provide empirical anti-infection treatments. Due attention is to be paid for double infection caused by anti-infection treatments and anti-infection treatment strategy should be timely adjusted and the dosage of immunosuppressant based upon immune monitoring.
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Objective To explore the relationship between the expression of HBx protein in HBV-related HCC samples and the clinical implications.Methods Elivision two-step was used in this study to detect the expression level of HBx protein in 40 HCC tissues,corresponding para-tumorous tissues from patients with HBV-related HCC undergoing curative hepatectomy.The relationship between HBx protein and clinical parameters (such as gender,age,TNM stage,HBV-DNA load,AFP,liver cirrhosis,a merger of vascular invasion,tumor infiltrating lymphocytes,Edmondson-Steiner histopathological grading,with or without relapse within 24 months) were analyzed.Results (1) The expression of HBx protein in the tumorous tissues was significantly lower than that of para-tumorous tissues (P ＜ 0.05).(2) In the tissues of para-tumorous,the expression of HBx protein in group HBV-DNA ＜ 500 IU/ml was significantly lower than that of group HBV-DNA≥500 IU/ml (P ＜0.05).There were no significant differences in the expression of HBx protein irrespective of gender,age,cirrhosis and the AFP level.(3) In the tissues of tumorous,the expression of HBx protein in group with vascular invasion was significantly higher than that of group without vascular invasion (P ＜ 0.05).However,there were no significant differences in the expression of HBx protein among the factors of TNM stage and Edmondson-Steiner histopathology grading.(4) In para-tumorous tissues,the expression of HBx protein in group of lymphocytic infiltration was significantly higher than that without lymphocytic infiltration (P ＜ 0.05).In the tissues of tumorous,the expression of HBx protein in disease-free survival (DFS) ＜ 24M patients was significantly higher than DFS ≥ 24M (P ＜ 0.05).Conclusions High HBx expression in tumor tissues indicates poor prognosis while that in para-tumorous tissues predicts a better prognosis.
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Objective To summarize the experience of individualized treatment for hepatic artery thrombosis after liver transplantation.Methods From October 2002 to January 2015,5 patients with hepatic artery thrombosis after liver transplantation were treated with surgical exploration,interventional therapy or thrombolytic therapy according to the reasons.Results All the 5 patients were cured without serious complications.Conclusions There are many reasons for the occurrence of hepatic artery thrombosis after liver transplantation.Early diagnosis is the key point,and individual treatment highlights the concept of precision medicine.