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Objective:To analyze the clinical manifestations and laboratory features of brucellosis patients in order to provide help for clinical diagnosis.Methods:The medical records of confirmed brucellosis patients ( n=81) in Kunming Third People's Hospital from 2015 to 2019 were collected. The occupation, contact history, clinical manifestations, laboratory examination characteristics and treatment of the patients were retrospectively analyzed. Results:The 81 cases of brucellosis were mainly farmers (64 cases), most of who had a history of raising sheep or contacting sheep manure or secretions (71 cases). The clinical manifestations were fever (68 cases), low back pain (42 cases), joint pain (22 cases), including 72 cases in acute stage and 9 cases in chronic stage. Laboratory examination showed that liver function index total bilirubin (TB) and direct bilirubin (DB) were generally normal, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma glutamyltransferase (GGT) were increased in about half of the patients; high sensitivity C-reactive protein (HsCRP), procalcitonin (PCT), interleukin-6 (IL-6) and serum amyloid A (SAA) were increased in more than 80% of the patients, and erythrocyte sedimentation rate (ESR) was increased in 64.6% (42/65) of the patients. Doxycycline plus rifampicin was the first-line treatment program.Conclusion:The clinical manifestations of patients with brucellosis are diverse and atypical, and patients with nonspecific clinical manifestations such as fever should be combined with their occupation, contact history, indicators of infection detection, timely blood culture examination to make a clear diagnosis, and patients with abnormal liver function should pay attention to asking about occupation and contact history, so as to reduce misdiagnosis and mistreatment of brucellosis.
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Objective To analyze the donor specific antibody (DSA) in liver transplantation,and discuss the therapeutic schemes.Methods We retrospectively analyzed prospectively collected samples from 139 cases of liver transplantation from September 1,2013 to July 1,2015.Luminex assays were applied to determine human leukocyte antigen,panel reactive antibody (PRA).For PRA positive cases,DSA,C1q and C4d were detected,and liver biopsy was done.Results Of 139 cases enrolled,there were 12 cases positive for DSAs,including 2 cases of PreDSA:1 case of Ⅰ DSA (HLA-A mismatch),and 1 case of Ⅱ DSA (HLA-DQ mismatch).Ten cases of de novo DSA (including 1 case of PreDSA) all were HLA-DQ mismatch.The liver biopsy on 5 cases showed hepatic fibrosis,early rejection and intrahepatic cholestasis,and only 2 cases showed positive C4d.Of 6 cases of DSA,5 cases showed positive C1q.In the patients positive for DSA,tacrolimus dose was adjusted postoperatively,adding mycophenolatemofetil or increasing its dose,or methylprednisolone and immunoglobulin given.Conclusion DSAs are important indicators of sensitized recipients in liver transplantation,associated with trends toward worse outcomes in patients or allografts.The monitoring of DSA is requisite in order to adjust the immunosuppressant.
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Objective To Analyze the clinical outcomes of pediatric liver transplantation (LT) for liver-based metabolic disorders.Methods We conducted a retrospective analysis on 42 pediatric patients with liver-based metabolic disorders from June 2013 to March 2017,and analyzed the pediatric end stage liver disease model (PELD),growth and development,type of transplant,postoperative complications and prognosis of patients.Results There were 42 children with liver-based metabolic disorders (15.56%) out of all the 270 children who underwent LT.The median age was 51.0 months (range,3.4-160.9 months).Of the 42 children,19 received living donor liver transplantation (LDLT),18 cases received deceased donor liver transplantation (DDLT) and 5 cases received domino liver transplantation.1-,2-and 3-year cumulative survival rate of 42 recipients was 97.7%,93.6% and 93.6%,and that of the grafts was 95.3%,91.4% and 91.4%,respectively.As compared with the 194 children with biliary atresia who underwent LT,significant difference was found in PELD and weight Z-score between the two groups.Conclusion Liver transplantation is a valuable option for children with metabolic disorders,and it has gained a better prognosis.