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Objective To investigate the cell composition and the transcriptional characteristics in microenvironments of hepatic tissues in mice at late stage of Echinococcus multilocularis infection at a single-cell level. Methods Peri-lesion and paired distal hepatic specimens were collected from two BALB/c mice (6 to 8 weeks old) infected with E. multilocularis for single-cell RNA sequencing. The Seurat package in the R software was employed for quality control of data, multi-sample integration and correction of batch effects, and uniform manifold approximation and projection (UMAP) algorithm was used for cell clustering. Cell types were annotated using classical marker genes. Differentially expressed genes were screened in each cell type through differential gene expression analysis, and the biological roles of cells were predicted using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses. Results A total of 43 710 cells from peri-lesion and distal hepatic tissues of E. multilocularis-infected mice were analyzed, and were classified into 11 cell types, including neutrophils, T cells, macrophages, granulocyte-monocyte progenitor cells, B cells, plasma cells, basophils, hepatic stellate cells, endothelial cells, hepatocytes, and platelets. T cells were the largest population of immune cells in the microenvironment of hepatic tissues, including five CD4+ T cell subsets, two CD8+ T cell subsets and phosphoantigen-reactive γδT cells. The proportions of CD4+ helper T cells and cytotoxic CD4+ T cells decreased and the proportion of T helper 2 (Th2) cells increased in peri-lesion tissues relative to distal hepatic tissues. In addition, the differentially expressed genes in Th2 cells were associated with negative regulation of the immune system, and the highly expressed genes in cytotoxic CD4+ T cells correlated with activation of the immune system. Conclusions Single-cell RNA sequencing deciphers the cell composition and distribution in microenvironments of hepatic tissues from mice infected with E. multilocularis, and the increased proportion of Th2 cells in peri-lesion hepatic tissues may be associated with formation of immunosuppressive microenvironments.
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OBJECTIVE To evaluate the effect of “Cloud Pharmacy Service System” electronic management platform in medication therapy management （MTM） of chronic airway diseases. METHODS MTM module setting of “Cloud Pharmaceutical Service System” was introduced. Totally 371 patients with chronic airway disease admitted to our hospital from January 2021 to March 2022 were selected for MTM based on the “Cloud Pharmacy Service System”. The standardization of inhalation device mastery and compliance of patients before and after intervention were compared with self-made inhalation device evaluation scale and Morisky medication adherence scale-8 （MMAS-8）. The satisfaction of patients with pharmacist after intervention was investigated. RESULTS “Cloud Pharmaceutical Service System” is mainly divided into 4 modules， such as medication therapy review， pharmacist intervention， personal medication record and the medication-related action plan， other functions. Among 371 patients， there were 237 outpatients （142 cases of asthma， 95 cases of chronic obstructive pulmonary disease） and 134 inpatients （19 cases of asthma and 115 cases of chronic obstructive pulmonary disease）. The score of the patients using inhalation device increased from 74.76±24.71 before intervention to 99.45±2.12 after intervention （P＜0.05）. MMAS-8 score increased from 7.14± 1.15 before intervention to 7.88±0.44 after intervention （P＜0.05）. The degree of patients’ satisfaction with pharmacists reached 100% after intervention. CONCLUSIONS “Cloud Pharmacy Service System” is helpful to improve the effects of pharmaceutical service for patients with chronic airway disease by providing whole-process， online， visual and immediate MTM.
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Objective To investigate the postoperative complications of ex vivo liver resection combined with autologous liver transplantation in the treatment of end-stage hepatic alveolar echinococcosis at high altitude and related prevention and treatment strategies. Methods Surgical data and follow-up data were collected from 11 patients with end-stage hepatic alveolar echinococcosis who underwent autologous liver transplantation in Qinghai People's Hospital from January 2013 to March 2019, and intraoperative and postoperative conditions were analyzed. Results All 11 patients underwent autologous liver transplantation successfully, without intraoperative death, among whom 2(18.18%) underwent hemi-extracorporeal hepatectomy and 9 (81.82%) underwent total extracorporeal hepatectomy. For the reconstruction of the retrohepatic inferior vena cava, 2 patients (18.18%) underwent reconstruction with the autologous great saphenous vein, 4 patients (36.36%) underwent reconstruction with artificial vessels, and the autologous retrohepatic inferior vena cava was preserved in 5 patients (45.45%). For biliary reconstruction, 8 patients (72.73%) underwent choledochoenterostomy and 3 (27.27%) underwent choledochocholedochostomy. The main postoperative complications of the 11 patients included bleeding in 2 patients (18.18%), bile leakage and abdominal infection in 4 patients (36.36%), bilioenteric anastomotic stenosis in 1 patient (9.09%), thrombus in 2 patients (18.18%), pulmonary infection and pleural effusion in 2 patients (18.18%), and echinococcosis recurrence in 1 patient (9.09%). Of all 11 patients, 2 (18.18%) died during the perioperative period, and the other 9 patients (81.82%) were improved and discharged. Conclusion Bleeding, biliary complications, and infection are the main causes of death in patients undergoing autologous liver transplantation at high altitude. An accurate understanding of surgical indication, careful multidisciplinary evaluation before surgery, superb operation during surgery, standardized surgical procedures, and fine perioperative management are the key to reducing perioperative mortality, avoiding and reducing postoperative complications, and achieving good long-term survival in patients undergoing autologous liver transplantation.
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Hepatic alveolar echinococcosis is a zoonotic parasitic disease. The therapeutic options of advanced hepatic alveolar echinococcosis mainly include: operation combined with drug treatment, percutaneous transhepatic biliary drainage, focus puncture drainage, drug treatment, liver transplantation. The individualized and comprehensive treatment mainly based on surgery is an ideal treatment method for advanced hepatic alveolar echinococcosis. This paper summarized the related literature at home and abroad, combined with clinical practice, and summarized the current situation and progress of the treatment of advanced hepatic alveolar echinococcosis.
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Objective@#To evaluate the efficacy and safety of reduced volume hepatectomy in treatment of advanced hepatic alveolar echinococcosis.@*Methods@#The clinical data of 90 patients with advanced hepatic alveolar echinococcosis treated at the Qinghai Provincial People's Hospital from January 2017 to January 2019 were retrospectively analyzed. There were 41 males and 49 females, with an average age of 32 (range 11 to 58) years. The locations of the lesions, operations, complications and follow-up were analyzed.@*Results@#90 patients were treated with reduced volume focal hepatectomy, 38 with radical resection and 52 with quasi radical resection. The operation time was (361±22) min. The hospital stay was (22±2) day, and the blood loss was (781±37) ml. Red blood cells were transfused in 19 patients and plasma in 39 patients. Pringle’s maneuver was used in 12 patients, regional hepatic blood flow occlusion in 42 patients, and Glisson sheath occlusion in 26 patients. The total bilirubin, alanine aminotransferase and aspartate aminotransferase returned to normal in 3 to 14 days after operation. There were 12 patients who developed bile leakage, 41 pleural effusion and 26 effusion in the operation sites. A total of ninety patients were followed up for 2 to 24 months. There was no recurrence of echinococcosis after radical resection and no enlargement of residual lesions after quasi-radical resection.@*Conclusion@#Reduced-volume hepatectomy reduced the risk and difficulty of operation. The follow-up results were good. This approach provides a feasible scheme for treatment of advanced hepatic alveolar echinococcosis.
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Objective@#To compare the changes in liver function in patients with different types of hepatic alveolar echinococcosis after radiofrequency ablation.@*Methods@#The data of 32 patients with hepatic alveolar echinococcosis treated by radiofrequency ablation from December 2016 to December 2018 at the Qinghai Provincial People's Hospital were retrospectively analyzed. There were 12 males and 20 females. The patients were divided into the single lesion group (n=17) and the multiple lesions group (n=15) according to the number of hydatid lesions. The lesions were further divided into the small lesion group (n=12) and the large or medium lesion group (n=20). The operation time, changes in AST and ALT were compared among these groups.@*Results@#The operation time of the single lesion group was 1.5 (1.0, 1.8) hour, and that of the multiple lesions group was 3.0 (1.5, 3.5) hour. The difference was statistically significant (P<0.05). On the 1st and 3rd day after treatment, ALT in the multiple lesions group was significantly higher than that in the single lesion group (P<0.05). Compared with the 1st day after operation, ALT of the two groups decreased on the 5th day after treatment, and the difference was statistically significant (P<0.05). The changes in AST in the two groups were basically the same as that of ALT. The operation time of the small lesion group was 1.0 (1.0, 1.9) hour, and of the large and medium lesion group was 2.5 (1.5, 3.0) hour. The difference was statistically significant (P<0.05). On the 1st, 3rd and 5th day after treatment, ALT in the small lesion group was significantly lower than the large or medium lesion group (P<0.05). Compared with the 1st day after treatment, ALT of the two groups decreased on the 5th day after treatment, and the difference was statistically significant (P<0.05). There was a significant difference in AST between the small lesion group and the large or medium lesion group only on the 1st day after operation (P<0.05).@*Conclusion@#Radiofrequency ablation for hepatic alveolar echinococcosis with a single lesion and a small lesion had shorter operation time with less changes in liver function after treatment.
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Objective To compare the changes in liver function in patients with different types of hepatic alveolar echinococcosis after radiofrequency ablation.Methods The data of 32 patients with hepatic alveolar echinococcosis treated by radiofrequency ablation from December 2016 to December 2018 at the Qinghai Provincial People's Hospital were retrospectively analyzed.There were 12 males and 20 females.The patients were divided into the single lesion group (n =17) and the multiple lesions group (n =15)according to the number of hydatid lesions.The lesions were further divided into the small lesion group (n =12) and the large or medium lesion group (n =20).The operation time,changes in AST and ALT were compared among these groups.Results The operation time of the single lesion group was 1.5 (1.0,1.8)hour,and that of the multiple lesions group was 3.0 (1.5,3.5) hour.The difference was statistically significant (P ＜ 0.05).On the 1st and 3rd day after treatment,ALT in the multiple lesions group was significantly higher than that in the single lesion group (P ＜ 0.05).Compared with the 1 st day after operation,ALT of the two groups decreased on the 5th day after treatment,and the difference was statistically significant (P ＜ 0.05).The changes in AST in the two groups were basically the same as that of ALT.The operation time of the small lesion group was 1.0 (1.0,1.9) hour,and of the large and medium lesion group was 2.5 (1.5,3.0) hour.The difference was statistically significant (P ＜0.05).On the 1st,3rd and 5th day after treatment,ALT in the small lesion group was significantly lower than the large or medium lesion group (P ＜ 0.05).Compared with the 1 st day after treatment,ALT of the two groups decreased on the 5thday after treatment,and the difference was statistically significant (P ＜ 0.05).There was a significant difference in AST between the small lesion group and the large or medium lesion group only on the 1 st day after operation (P ＜ 0.05).Conclusion Radiofrequency ablation for hepatic alveolar echinococcosis with a single lesion and a small lesion had shorter operation time with less changes in liver function after treatment.