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Objective To investigate the effect of human umbilical cord mesenchymal stem cells (HUC-MSCs) on CD4+T cells in liver after hepatic ischemia-reperfusion injury (HIRI) in mice. Methods Two hundred and twenty-five mice were randomly divided into sham group, control group and MSC group, with 75 mice in each group. HIRI model mice were used in MSC group and control group. HUC-MSCs were injected in MSC group through inferior vena cava. Normal saline was injected in control group through inferior vena cava. Only laparotomy and abdominal closure were performed in sham group without blood vessel clipping. At 6, 12 and 24 h after operation, 15 mice of each group were randomly selected to sample eyeball blood and liver tissues, and the 30 mice left in each group were used to extract intrahepatic mononuclear cells. The number of intrahepatic mononuclear cells, percentage, number and positive rate of CD4+T cells in the mice of various groups at different time points were compared. The content of interleukin (IL)-17 in serum and liver tissue as well as expression levels of costimulatory molecules B7-1 and B7-2 messenger RNA (mRNA) in liver tissues of the mice at different time points were compared. Results At 12 and 24 h after operation, the number of intrahepatic mononuclear cells of control group was significantly higher than that of sham group, while the number of intrahepatic mononuclear cells of MSC group was significantly lower than that of control group (P<0.01-0.05). At 6, 12 and 24 h after operation, the percentage, number and positive rate of CD4+T cells of control group were significantly higher than those of sham group (all P<0.01), while the percentage of CD4+T cells of MSC group was significantly lower than that of control group (P<0.01-0.05). At 12 and 24 h after operation, the number and positive rate of CD4+T cells of MSC group were significantly lower than those of control group (P<0.01-0.05). At 6, 12 and 24 h after operation, the IL-17 contents in serum and liver tissues of control group were higher than those of sham group (all P<0.01), while the IL-17 contents in serum and liver tissues of MSC group were lower than those of control group (all P<0.01). At 6 h after operation, the mRNA expression level of B7-2 of control group was higher than that of sham group (P<0.05). At 12 and 24 h after operation, the mRNA expression levels of B7-1 and B7-2 of control group were higher than those of sham group (all P<0.01), while the mRNA expression levels of B7-1 and B7-2 of MSC group were lower than those of control group (all P<0.01). Conclusions HUC-MSCs inhibits the number of CD4+T cells and the secretion of IL-17 in liver after HIRI, as well as decreases the number of intrahepatic mononuclear cells and the mRNA expression of B7-1 and B7-2, thereby alleviating HIRI.
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Objective To infer its transmission origin and route through studying the feature of molecular epidemiology of an HCV outbreak in Guangzhou.Methods Serum samples 192 cases in an HCV outbreak incident were analyzed for 2a and 6a subtypes.Appropriate genotypes were selected as control group.Informatics software were used in the evolutionary analysis to construct time scale trees and infer the origin time of HCV infection.Results Of 119 patients in the HCV outbreak,66 cases were 2a and 110 cases were 6a subtype.No other genotypes were found.The evolutionary analysis indicated the isolates of 2a group and 6a group both originated from 2 ～ 5 years ago.Both of 2a group and 6a group were in line with the characteristics of iatrogenic infection.Conclusion 2a and 6a were the main sub-genotypes in the Guangdong HCV outbreak investigation and they were originated from 2 to 5 years ago,which were in line with the characteristics of iatrogenic transmission.With the extension of time,a large number of cases accumulated and led to outbreak.
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[Objective] To investigate the mesenchymal stem cells (MSC) in treating acute lung injury (ALI) via ALI mouse model.[Methods] By monoclonal antibody Anti-GD2 of specific antigen ganglioside (GD2) only expressed on MSC as a carrier,new fluorescent molecule probe were synthesized through covalently coupling Anti-GD2 and fluorescent group CyDye mono-reactive NHS Esters (Cy7).Synthetic Anti-GD2-Cy7 and MSC were labeled by the specific binding of antigen and antibody in vitro.Total 84 balb/c male mice were selected and randomly selected 48 mice were divided into three groups:sham group (n =16),MSC+ ALI group (n =16),NS + ALI group (n =16).The lung histopathology and scores,lung W/D ratio and permeability of lung microvasculature were examined at 24 h,48 h after ALI mouse model.Other 36 mice were randomly divided into three groups:normal group (n =12),sham group(n =12),MSC +ALI group(n =12).Labeled MSC-GD2-Cy7 were transplanted into MSC+ALI group and sham group mice via tail vein injection.At 30 min,1 d,3 d,and 7 d post-MSC-GD2-Cy7 injection,the mice were sacrificed after anesthesia and then the lung was removed.Excised lung was detected on small animal fluorescent imager.[Results] Contrast to NS+ ALI group,the lung histopathology and scores,lung W/D ratio and permeability of lung microvasculature of MSC +ALI group were more greatly improved at both 24 h and 48 h.Fluorescent results showed that the signal intensity in thc lung of MSC +ALI group was significantly higher than that of sham group at each time point [(3.37 ± 0.02)× 10-4 vs (2.05 ± 0.04) × 10-4 scaled counts/s;(35.54 ± 0.47)× 10-4 vs (25.29 ± 1.48) × 10-4 scaled counts/s;(11.17 ± 0.75)×10-4 vs (6.09 ± 0.62)× 10-4 scaled counts/s;(3.10 ± 0.14) vs (0.00 ± 0.00)× 10-4 scaled counts/s;all P ＜ 0.05].[Conclusion] Our study showed that a proportion of cells migrated into normal and injured lungs 30 min after cell transplantation,and the cells started to recruit and largely gather in injured lungs at day 1 and persisted to day 7,these results suggest that MSC possess the ability to home into injured tissues.
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Objective To investigate the application effect of nasojejunal feeding tube nutrition in patients with severe traumatic brain injury. Methods The clinical data of 54 patients with severe traumatic brain injury admitted to the Department of Surgical Critical Care Medicine,the Third Affiliated Hospital,Sun Yatsen University between June 2012 and December 2014 were analyzed retrospectively. They were divided into either a nasojejunal feeding tube nutrition support group (nasojejunal group,n = 26)or an asogastric feeding tube nutrition support group (asogastric group,n = 28)according to the different ways of enteral nutrition. All patients began to receive nasal feeding whole protein preparations (enteral nutritional emulsion,TPF-D)from the second day after admission to intensive care unit (ICU). The time to reach the enteral nutrition support target,the time of parenteral nutritional support,nutritional index (albumin and hemoglobin),the time admission to ICU,and the incidences of infection and gastrointestinal complications in both groups were observed. Results (1)According to the body weight to calculate calorie demand, the nasojejunal group reaching the time of enteral nutrition support target was faster than that of the asogastric group (3. 0 ± 0. 8 d vs. 7. 7 ± 2. 5 d). There was significant difference between the 2 groups (P 0. 05). Conclusion Nasojejunal feeding tube nutrition support may be faster to achieve the target of enteral nutrition supports and shorten the time in ICU.
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Objective To investigate the cause,prevention and treatment of intra-abdominal hemorrhage after liver transplantation. Methods Clinical data of 82 patients undergoing liver transplantation were retrospectively analyzed. All participants were divided into the intra-abdominal hemorrhage (n =12)and control groups (n =70). Preoperative parameters including age,model for end-stage liver disease (MELD)score,prothrombin time (PT),prothrombin time international normalized ratio (PT-INR),fibrinogen (FIB),activated partial thromboplastin time (APTT),platelet (Plt) were statistically compared between two groups. Intraoperative hemorrhage volume,cold ischemia time of donor liver, anhepatic phase time and operation time were also compared between two groups. Postoperatively,the mortality rate was compared between two groups. Results Among 82 patients,1 2 (1 5%)presented with intra-abdominal hemorrhage and required twice surgical hemostasis. In the intra-abdominal hemorrhage group,4 cases (33%)died,and 8 (1 1%)died in the control group. No statistical significance was documented between two groups (P>0. 05 ). Age,MELD score,PT-INR, FIB,APTT and PLT did not significantly differ between two groups (all P>0. 05 ). Compared with patients in the control group,those in the intra-abdominal hemorrhage group yielded significantly more blood loss intraoperatively,longer operation time and longer cold ischemia time of donor liver (all P<0. 05 ). Anhepatic phase time did not significantly differ between two groups (P>0. 05 ). Conclusions After liver transplantation,intra-abdominal hemorrhage is associated with longer cold ischemia time of donor liver,more intraoperative blood loss and longer operation time. In order to decrease the incidence of postoperative intra-abdominal hemorrhage,coagulation function should be completely corrected prior to surgery and the surgical skills should also be enhanced.
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Objective To summarize the treatment experience of sepsis after liver transplantation.Methods The clinical features and treatment methods of 1 patient developing sepsis after liver transplantation, who was admitted and treated in the Surgical Intensive Care Unit of the Third Affiliated Hospital of Sun Yat-sen University in September 201 4,were retrospectively studied.The interpretation of International Guidelines for Management of Severe Sepsis and Septic Shock (SSC Guidelines)and relevant literature were reviewed.Results One male patient at the age of 50 years old developed high fever and decrease of blood pressure at 1 d after liver transplantation,and was diagnosed as septic shock.The symptoms were relieved after the appropriate treatment like goal-directed fluid resuscitation,anti-infection and blood purification,etc.And the patient was discharged in stable conditions.Conclusions It is easy to develop infection after liver transplantation and the fatality rate of sepsis caused by infection is high.Once the sepsis occurs,clinicians must perform early goal-directed therapy and bundle therapy according to the SSC Guidelines positively,and select the appropriate drugs according to the pathogen culture results in order to reduce the fatality rate.
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Objective To study the related factors associated with the reversal of posttransplant diabetes mellitus (PTDM) following liver transplantation. Methods The clinical data of 62patients with PTDM in 232 patients receiving liver transplantation (26. 7 %) were retrospectively analyzed and the patients were divided into two groups: patients with transient PTDM (34 cases) and those with persistent PTDM (28 cases). Pre-operative and post-operative variables, including sex,age, body mass index, family history of diabetes, hepatitis B virus infection, pretransplantation fasting plasma glucose, the immunosuppressant regime, FK506 concentration and duration of steroid usage, were analyzed retrospectively. Results The variables, including sex, age, body mass index,family history of diabetes, hepatitis B virus infection, pretransplantation fasting plasma glucose,FK506 concentration at month 1, 3 and 6 after operation, rate of cyclosporine usage and duration of steroid usage had no significant difference between the two groups (P＞0. 05). Compared with the persistent PTDM patients, the transient PTDM patients were characterized by younger age at the time of transplantation (54 ± 8 vs. 42 ± 6 years, P＜0. 05), longer time before the development of PTDM (18 ± 23 vs. 35 ± 42 days, P＜0. 05), and higher rate of mycophenolate mofetil or sirolimus usage (0vs. 8. 9 %, P＜0. 05). Based on a multivariate analysis, age at the time of transplantation was determined as the single independent predictive factor associated with reversal of PTDM following liver transplantation (odds ratio: 1. 312, 95 % confidence interval: 1. 005 - 1. 743). Conclusion Age at the time of transplantation, duration before the development of PTDM and rate of mycophenolate mofetil or sirolimus usage are associated with reversal of PTDM following liver transplantation. Among these factors, age at the time of transplantation is only the single independent predictive factor.
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ObjectiveTo evaluate the effect of mycophenolate mofeil (MMF) combined with dose-decreased calcineurin inhibitors (CNIs) in patients who received liver transplanation with chronic kidney malfunction.Methods28 liver transplant patients with chronic kidney malfunction were prospectively included in this study.MMF was initiated and the dose of the original immunosuppressive drug CNIs decreased.The change in renal function and adverse events were evaluated.ResultsOne patient was discontinued with MMF treatment because of serious myelosuppression.The other 27 patients were treated with MMF with a median of 30.8 months.The basal creatinine values and the basal creatinine clearance were ( 134.26 ± 27.25) μmol/1 and (57.70 ± 16.93) ml/min,respectively.The basal glomerular filtration rate was (53.91±11.63) ml/min.The creatinine values at 1,3,6,12,24 and 36 months were 124.30±28.27 (P=0.006),130.19±29.29 (P=0.174),125.49±38.18 (P=0.194),119.71±31.36 (P=0.010),137.43±42.55 (P＝0.804),and (139.04±39.80) μmol/L (P=0.916).And the creatinine clearance values at 1,3,6,12,24 and 36 months were 62.57±19.29 (P=0.008),61.18± 19.70 (P=0.086),64.27±22.82 (P=0.018),67.48±22.59 (P=0.002),57.18±19.55 (P=0.405),and (54.56±23.48) ml/minute (P=0.708),respectively.The glomerular filtration rate at 1,3,6,12,24 and 36 months were 59.20 ± 14.05 (P=0.006),56.61±14.01 (P=0.04),60.47±17.33 (P=0.016),63.59±17.66 (P=0.002),53.75±13.60 (P=0.369),and (51.70±16.07) ml/min (P＝0.703).One patient (3.7％) had mild acute rejection.5 patients (18.5 ％ ) had mild abdominal distention or diarrhea.2 patients (7.4％) had ischemic cholangitis.No patient had cytomegalo virus infection or tumor recurrence.ConclusionIn liver transplant recipients with chronic renal dysfunction,MMF allowed CNIs dose reduction or discontinuation,improved or stabilized renal function in most patients and it had only mild adverse events.