Allogeneic bone marrow-derived mesenchymal stromal cells for hepatitis B virus-related acute-on-chronic liver failure: A randomized controlled trial.

Mortality from hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) is high due to limited treatment options. Preclinical and clinical investigations have proved that treatment with mesenchymal stromal cells (MSCs) is beneficial for recovery from liver injury. We hypothesized that the outcome of HBV-related ACLF would be improved by MSC treatment. From 2010 to 2013, 110 patients with HBV-related ACLF were enrolled in this open-label, nonblinded randomized controlled study. The control group (n = 54) was treated with standard medical therapy (SMT) only. The experimental group (n = 56) was infused weekly for 4 weeks with 1.0 to 10 × 105 cells/kg allogeneic bone marrow-derived MSCs and then followed for 24 weeks. The cumulated survival rate of the MSC group was 73.2% (95% confidence interval 61.6%-84.8%) versus 55.6% (95% confidence interval 42.3%-68.9%) for the SMT group (P = 0.03). There were no infusion-related side effects, but fever was more frequent in MSC compared to SMT patients during weeks 5-24 of follow-up. No carcinoma occurred in any trial patient in either group. Compared with the control group, allogeneic bone marrow-derived MSC treatment markedly improved clinical laboratory measurements, including serum total bilirubin and Model for End-Stage Liver Disease scores. The incidence of severe infection in the MSC group was much lower than that in the SMT group (16.1% versus 33.3%, P = 0.04). Mortality from multiple organ failure and severe infection was higher in the SMT group than in the MSC group (37.0% versus 17.9%, P = 0.02). CONCLUSION: Peripheral infusion of allogeneic bone marrow-derived MSCs is safe and convenient for patients with HBV-related ACLF and significantly increases the 24-week survival rate by improving liver function and decreasing the incidence of severe infections. (Hepatology 2017;66:209-219).

Microscopic Replantation of Complete Penile Amputation With Video Demonstration.

BACKGROUND: Penile amputation is an extremely rare genital injury. To the best of our knowledge, there are only about 200 cases reported in Chinese and English literature, most of them are case reports. So far, there is not any video demonstration of microscopic replantation of complete penile amputation with meticulous surgical skills. OBJECTIVE: To provide a successful example of penile replantation after complete penile amputation through video presentation of the application of meticulous microsurgical techniques and optimized procedures. MATERIALS AND METHODS: The 25-year-old patient was admitted to our hospital 3.5 hours after his penis was completely amputated due to self-mutilation. Microscopic penile replantation was immediately performed after preoperative preparation. After the surgical procedure, the patient was treated with broad-spectrum antibiotics, analgesia, antithrombotics and anxiolytic. RESULTS: The total ischemic time was about 10 hours. The duration of surgery was about 7 hours. On the 14th day post-surgery, the wound healed smoothly, the glans was ruddy in color, and the appearance returned to normal without obvious complications. The patient urinates normally with a maximal urinary flow rate of 25 ml/s after removing the catheter. Three months after surgery, the local sensation of foreskin and glans recovered significantly, which showed that slight needling could lead to obvious pain, and the penis erection hardness score was 3 during morning erection or urinary bladder distention. Six months after surgery, the patient reported that he was completely satisfied with the result, which showed that the sensation of the penis and glans surface returned to almost normal and the optimal erection hardness score was 4. CONCLUSION: Careful microsurgical anastomosis of the dorsal arteries, deep dorsal vein, superficial dorsal vein and multiple dorsal nerves could obtain ideal recovery of penile appearance and function and avoid any obvious complications.

Efficacy of cytokine-induced killer cell-based immunotherapy for hepatocellular carcinoma.

In attempts to delay tumor progression after surgery or minimally invasive local treatments, multidisciplinary strategies have been broadly studied in patients with hepatocellular carcinoma (HCC). The objective of this present study was to evaluate the efficacy of autologous transplantations of cytokine-induced killer (CIK) cells as an adjuvant therapy for patients with HCC. A total of 264 patients with HCC were enrolled in this retrospective study. Of these patients, 165 received either CIK cell therapy alone or as adjuvant therapy to surgery, transcatheter arterial chemoembolization (TACE), or TACE-based comprehensive treatments (CT). The remaining 99 patients received only surgery or TACE. Kaplan-Meier analysis and the Chi-squared test were used to analyze the overall survival (OS), progression-free survival (PFS), and clinical characteristics of the patients in the different treatment subgroups. Kaplan-Meier analysis suggested that patients in the Surgery+CIK group had a significantly improved OS compared with those in the other three groups (P < 0.001). Furthermore, patients who developed a fever after the CIK cell treatments manifested a likely better OS (P = 0.028). Subgroup analysis indicated that patients in the Surgery+CIK group likely had an improved PFS but a similar OS compared with the patients in the Surgery-alone group (P = 0.055 for PFS, and P = 0.746 for OS). Further subgroup analysis showed that the OS in both the TACE+CIK and CT+CIK groups was prolonged significantly compared with that in the TACE-alone group (P = 0.015 and P = 0.018, respectively). However, similar OS was observed between the TACE+CIK and CT+CIK groups (P = 0.686). Autologous transplantation of CIK cells as an adjuvant therapy was associated with better survival for patients with HCC, especially for those who had also undergone TACE. A fever reaction might be a potential event for assessing the curative effect of the CIK treatment.