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Objective To evaluate the diagnostic value of quantitative detection of cytomegalovirus (CMV) DNA from different sources [plasma, sputum and bronchoalveolar lavage fluid(BALF)] for CMV pneumonia after allogeneic hematopoietic stem cell transplantation. Methods Clinical data of 405 recipients undergoing allogeneic hematopoietic stem cell transplantation were retrospectively analyzed. Among them, 19 recipients diagnosed with CMV pneumonia were assigned into the CMV pneumonia group, and 229 recipients with CMV viremia alone, 11 recipients without CMV pneumonia who received fiberoptic bronchoscopy and 16 recipients diagnosed with bacterial or fungal pneumonia based on pathogenic evidence receiving sputum culture were assigned into the control A, B and C groups, respectively. The incidence of CMV pneumonia was summarized. The CMV DNA load of specimens from different sources (plasma, sputum and BALF) of recipients with CMV pneumonia was analyzed. The clinical prognosis of recipients with CMV pneumonia was evaluated. Results Among 405 recipients undergoing allogeneic hematopoietic stem cell transplantation, 19 cases developed CMV pneumonia, and the overall incidence of CMV pneumonia was 4.7%(19/405). The CMV DNA load in the plasma, sputum and BALF of recipients with CMV pneumonia was higher than those in the control A, B and C groups (all P < 0.05). In the 19 recipients, 12 cases were cured after antiviral treatment and 7 died from treatment failure(3 cases abandoned treatment). The fatality was 37%(7/19). Conclusions Quantitative detection of CMV DNA in the plasma, sputum and BALF may increase the diagnostic rate of CMV pneumonia, thereby improving clinical prognosis of recipients undergoing allogeneic hematopoietic stem cell transplantation.
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Objective To investigate the clinical efficacy of pretreatment regimen containing idarubicin (IDA) in allogeneic hematopoietic stem cell transplantation (allo-HSCT) for high-risk refractory leukemia. Methods A total of 116 patients with high-risk refractory leukemia who received allo-HSCT treated with 7 types of IDA-containing pretreatment regimes were enrolled in this study. The implantation rate of 116 recipients was summed up. The 2-year overall survival (OS), 2-year disease free survival (DFS), cumulative recurrence rate, recurrent mortality, transplantation related mortality (TRM), cumulative incidence of acute graft-versus-host disease (aGVHD) and chronic graft-versus-host disease (cGVHD) were statistically analyzed by Kaplan-Meier survival curve. Results All 116 recipients successfully implanted. The median follow-up time was 28 (7-70) months. Among them, 64 recipients survived, the 2-year OS was 55.2%, 2-year DFS was 51.7%, 2-year recurrent mortality was 23.3% and 2-year TRM was 18.1%. Among 116 recipients, 72 cases suffered from aGVHD. The 2-year cumulative incidence rate of aGVHD was 62.1% including 20 cases of grade Ⅲ-Ⅳ aGVHD, the 2-year cumulative incidence rate was 17.2%. Among 116 recipients, 59 cases presented with cGVHD. The 2-year cumulative incidence rate was 55.4%, of which the 2-year cumulative incidence rate of extensive cGVHD was 14.7%. Among 116 recipients, 30 cases recurred with a 2-year cumulative recurrence rate of 25.9%. Conclusions IDA-containingpretreatment regime has high safety and effectiveness, and can be used as an effective pretreatment regime for transplantation preprocessing in patients with high-risk refractory leukemia.
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Objective To evaluate the value of DEB-TACE before liver transplantation for hepatocellular carcinoma patients.Methods From Jan.2016 to Jan.2018,23 patients received DEB-TACE before liver transplantation for hepatocellular carcinoma were induced.Complications evaluation was followed up after interventional therapy.4 weeks after the intervention,the imaging examination was performed to examine the tumor response rate depond on mRECIST,the pathological conditions and tumor free survival were studied in the patients who received liver transplantation.Results The achievement ration of operation was 100％ in 23 patients.23 patients received 24 times successfully,1 patient received DEB-TACE twice,and the remaining 22 patients received DEB-TACE once.No serious complications occurred.Eighteen patients (78.3％,18/23) had postembolic syndrome after interventional therapy,mainly fever and pain.Four weeks after DEB-TACE,the complete response rate was 47.8％ (11/23),partial response rate was 30.4％ (7/23),disease stability rate was 21.7％ (5/23).All the 23 patients were included in the waiting list for transplantation.Among them,15 cases received liver transplantation.Pathological results showed that the total necrosis rate was 53.3％ (8/15),and the tumour necrosis rate in 4 of them was less than 50％.The average tumour necrosis rate of the neoplasm was 75.0％.The 15 patients who received liver transplantation were alive with no tumor recurrence.Conclusion DEB-TACE is a safe and effective treatment for patients suffered from hepatocellular carcinoma in waiting for liver transplantation.However,due to the short time of DEBs in China,further research is needed.
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Objective To evaluate the drug-eluting-beads (DEB)-TACE as down-stage therapy for hepatocellular carcinoma before liver transplantation.Methods Inclusion criteria:the hepatocellular carcinoma exceeding the standard of Milan criteria.From Jan 2016 to Jan 2018,30 patients received DEB-TACE as down-stage therapy for hepatocellular carcinoma before liver transplantation.4 weeks after DEB-TACE,the imaging examination was performed.The patients who received the liver transplantation,the pathological conditions were recorded and the tumor free survival of the patients was followed up.Results 30 patients received 30 times DEB-TACE successfully.76.7％ (23/30) patients was down-staged to meet UCSF criteria,53.3％ (16/30) patients was down-staged to meet Milan criteria.13 patients had being given liver transplantation,pathology showed that DEB-TACE achieved complete necrosis in 30.8 ％ (4/13)cases.No significant treatment related complications were observed.After liver transplantation 12 patients are alive with no tumor recurrence.The tumor recurrence rate after liver transplantation was 7.7％.Conclusion DEB-TACE is safe and effective as down-stage therapy for hepatocellular carcinoma before liver transplantation.
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This article presented our experience on transcatheter arterial chemoembolization (TACE) and portal vein embolization (PVE) before hepatic resection for huge hepatocellular carcinoma with cirrhosis.The preoperative future liver remnant/total estimated liver Volume (FLR/TELV) ratios of 5 patients were less than 40％,and preoperative TACE was implemented 3 weeks after PVE.In all these patients,right hepatectomy was successfully implemented.Preoperative TACE and PVE expanded the indication of hepatectomy,increased the safety of surgery and improved the curative rate.
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Objective To evaluate the therapeutic effectiveness of percutaneous endovascular treatment of hepatic venous outflow obstruction (HVOO)after pediatric liver transplantation(LT).Methods From January 2008 to January 2013,10 children with obstruction of hepatic vein (HV) or inferior vena cava (IVC) anastomosis underwent percutaneous transluminal angioplasty (PTA) with balloon dilation or stent placement.The hepatic venous outflow obstruction occurred 10-455 days (median,125 days) after pediatric liver transplantation.According to the time of obstruction,the obstruction was divide into early onset (＜1 month) and late onset(＞1 month).The effectiveness of PTA was analyzed.Results Twenty-one procedures were performed.One treatment was ineffective,and technical and initial clinical success ratio was 95.2％ (20/21) and 70.0％ (7/10),respectively.In 3 cases with early onset after LT,operation was performed after unsuccessful PTA in 1 case.One patient who developed recurrent stenosis was treated with PTAS.The other patient died of acute rejection.Late onset after LT was found in 7 cases,who were treated with PTA or stent successfully.Conclusions In cases of venous outflow obstruction resulting from HV and/or IVC lesions after pediatric liver transplantation,percutaneous endovascular treatment with balloon dilation or stent placement is a safe and effective alternative treatment that results in midterm and long-term patency.Early-onset or hepatic veins combined with superior vena cava obstruction should be implanted with stents as early as possible.Late-onset or hepatic veins obstruction alone can be get better results with Balloon Dilatation.
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Objective To evaluate the medium and long-term therapeutic results of percutaneous transhepatic angioplasty for portal vein stenosis (PSV) following pediatric liver transplantation.Methods From Jan.2008 to Dec.2012,5 cases with PVS after pediatric liver transplantation received percutaneous transhepatic angioplasty.There were 3 male and 2 female cases ranging from 7 months to 8 year-old with the median age of 2 years and 10 months.The protopathy included 1 Carolis disease and 4 congenital biliary atresia.The therapeutic results were monitored by clinical follow-up and imaging examination.The clinical data,imaging examination and therapeutic results were analyzed.Results All interventions were performed successfully,and the treatment efficacy was 100％.One patient was diagnosed with earl-onset PVS at 0.5 month after liver transplantation.Four patients were diagnosed with late-onset PVS at 3-30 months after liver transplantation.The prestenotic portal venous average diameter was (2.3 ± 0.6) mm (1.2-3.0 mm),the degrees of stenosis were 70％-95％.The poststenotic portal venous average diameter was (9 ± 1) mm (8-10 mm) (t =32.560,P ＜ 0.05).The prestenotic portal venous average pressure gradient was (11.0 ± 3.2) mmHg (8-16 mmHg),and the poststenotic portal venous pressure gradient was(2.2 ± 1.5) mmHg(0-4.0 mmHg) (t =8.242,P ＜ 0.05).Postoperative follow-up was 10-66 months,the portal veins of all cases were patent,and patency rate was 100％.Conclusions Percutaneous transhepatic stent angioplasty is an effective and safe method for treatment of PVS following liver transplantation.Its medium and long-term patency rates are high.
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Objective To study the role of cover-stent and embolization in the treatment of hepatic artery pseudoaneurysm following liver transplantation.Methods 5 patients with hepatic artery pseudoaneurysm after liver transplantation were treated with cover-stent and embolization between May 2010 and July 2013.The clinical features,imaging findings and complications were reviewed.Results All the 5 patients with hepatic artery pseudoaneurysm were successfully treated.2 patients with intrahepatic pseudoaneurysm received embolization.Of the 3 patients with extrahepatic pseudoaneurysm,2 received cover-stent treatment,and 1 patient received embolization.No complications related to the interventional treatment were encountered.2 patients died from multi-organ failure one month after the interventional treatment.Conclusion Cover-stent and embolization were effective and safe to treat patients with hepatic artery pseudoneurysm following liver transplantations.
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Objective To evaluate the therapeutic results of percutaneous transhepatic stent angioplasty in patients with portal vein stenosis following liver transplantation.Methods From 2005 to 2013,38 patients developed portal vein stenosis following liver transplantation.Percutaneous transhepatic angioplasty of the portal vein stenosis was performed on these patients.The results were monitored by clinical follow-up and imaging studies.Results Percutaneous transhepatic angioplasty was successful in these patients.Self-expanding metallic stents (n=7),balloon-expandable coronary stent (n=29),and membranous stent (n=1) were used.The follow-up period ranged from 3 to 90 months.Portal venous patency was maintained in 34 patients (one patient died due to multi organ failure,1 patient accepted a third liver transplantation because of biliary tract complication,and 1 patient received a repeat placement of a membranous tent because the portal vein stent was blocked by a tumor thrombus,and 1 patient developed stent restenosis).There was 1 patient who developed hemorrhage in the early postoperative period (2.63％).A diagnosis of hepatic artery hemorrhage was made by hepatic artery angiography and the patient was treated by interventional embolization.Conclusion Percutaneous transhepatic stent angioplasty is an efficacious and safe method to treat portal vein stenosis following liver transplantation.
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ObjectiveTo observe the activity and safety of a novel combination therapy for patients with recurrent or refractory aggressive non-Hodgkin lymphoma (NHL).MethodsSix consecutive patients with recurrent or refractory aggressive NHL were treated with B-VIP regimen,boanmycin (5 mg/m2 on Days 1,4,8,12 and 15),vincristine (1.4 mg/m2 on Days 1,8 and 15),ifosfamide (1.2 g/m2 on Days 1,2,3 and 15,16,17) and prednisone (50 mg on Days 1 to 10),every 21 days.All the patients had received ≥5 cycles (average 8.3 cycles) of previous chemotherapy.ResultsSix patients (100 ％) were evaluable for response.The overall objective response rate was 66.7 ％ (4 patients),including 1 case complete (CR) and 3 cases partial responses.Myelosuppression was the most frequent serious complication of this regimen.ConclusionIn the current study,B-VIP was a highly active and safe combination therapy for patients with refractory disease with a poor prognosis or for patients with multiply recurrent aggressive NHL.
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Objective To evaluate the role of protein kinase C (PKC) in reduction of hypoxia-reoxygenation (H/R) injury by hypoxic preconditioning or norepinephrine preconditioning in cultured neonatal rat cardiomyocytes. Methods Primary cultured neonatal rat cardiomyocytes were randomly divided into 6 groups (n = 25 each): control group (group Ⅰ), H/R group (group Ⅱ), hypoxia preconditioning group (group Ⅲ), norepinephrine preconditioning group (group Ⅳ), H7 + hypoxia preconditioning group (group Ⅴ) and H7 + norepinephrine preconditioning group (group Ⅵ). In group Ⅱ , the cardiomyocytes were exposed to 3 h of hypoxia followed by 1 h of reoxygenation. In group Ⅲ, the cells were subjected to 20 min of hypoxia followed by 20 min of reoxygenation before H/R. Norepinephrine was added to the culture medium with a final concentration of 10- 7 mol/L,and then the cells were cultured for 30 min before H/R in group Ⅳ. H7 was added to the culture medium with a final concentration of 5 × 10-5 mol/L, the cells were then cultured for 10 min, and the following procedures before H/R were the same as thase described in group Ⅴ . H7 was added to the culture medium with a final concentration of 5 × 10-5 mol/L, the cells were then cultured for 10 min, and the following procedures were the same as those described in group Ⅵ. The cell survival rate, the activities of LDH and CK in the supernatant, and the content of MDA and activity of SOD in cardiomyocytes were determined. Results The cell survival rate and activity of SOD were significantly lower, while the LDH and CK activities and MDA content higher in group Ⅱ than in group Ⅰ ,in group Ⅴ than in group Ⅲ, and in group Ⅵ than in group Ⅳ (P ＜ 0.01). The cell survival rate and activity of SOD were significantly increased, while the LDH and CK activities and MDA content decreased in group Ⅲ and Ⅳ compared with group Ⅱ (P＜0.01).Conclusion The activiation of PKC is involved in the reduction of H/R injury by hypoxic preconditioning or norepinephrine preconditioning in cultured neonatal rat cardiomyocytes.
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Objective: To observe the clinical effect of tuina plus medications on infantile diarrhea induced by rotavirus infection. Methods: After 55 cases of confirmed sick infants were divided into two groups by the order of their visits, 30 cases in the medication group were treated by intravenous infusion of Ribavirin and oral administration of Smecta; 25 cases in the tuina plus medication group were treated by the manual techniques of tonifying Pijing(脾经) and clarifying Dachangjing (大肠经), rubbing the abdomen and kneading the navel clockwise, pushing Shangqijiegu (上七节骨), kneading Guiwei (龟尾), and pinching the skin of the spine, in combination with same medications used as in the medication group. Results: The total effective rate was 96% in the tuina plus medication group, P < 0.01, in comparison with the medication group. Conclusion: tuina has a good therapeutic effect in the treatment of infantile diarrhea induced by rotavirus infection and is importantly significant for shortening the course, enhancing the therapeutic effect and lowering down the medical cost.
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Objective: To study the effect of flavonoids from seed residues of Hippophae rhamnoides L.( FSH) and Hippophae rhamnoides L. oil(HRO)on serum lipid in female rats with obesity. Methods Female aged rats with obesity were given FSH and HRO by oral administration for 6 w. Serum triglyceride(TG) and cholesterol(TC) were determined every 2 w. The serum free fatty acid (FFA), high-density lipoprotein cholesterol (HDL-C),body weight and Lee’s index were measured after 6 w. Results: Serum TG and FFA level decreased significantly in rats given FSH. At the same time, FSH could inhibit the increase in body weight and Lee’s index. HRO could regulate the lipid metabolism and decrease serum TG level significantly in female aged rats with obesity. Conclusion: Both FSH and HRO can improve lipid metabolism in female aged rats with obesity.