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Objective To investigate the clinical efficacy of basiliximab-induced glucose-free corticosteroid immunosuppressive regimen after liver transplantation.Methods The retrospective cohort study was conducted.The clinicopathological data of 227 patients with liver transplantation who were admitted to Bayi Hospital affiliated to Nanjing University of Traditional Chinese Medicine from January 2010 to October 2016 were collected.Of the 227 patients,125 who postoperatively received a glucose-free corticosteroid immunosuppressive regimen using a monoclonal antibody + tacrolimus + mycophenolate mofetil tablets were allocated into the hormone-free group,and 102 who were postoperatively treated with the immunosuppressive regimen using glucocorticoid steroid + tacrolimus + mycophenolate mofetil tablets were allocated into the hormone group.Observation indicators:(1) comparison of follow-up and survival;(2) comparison of postoperative infection,rejection and biliary stenosis between groups.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival,infection,rejection and biliary stenosis up to June 2017.The measurement data with normal distribution were represented as (x) ± s,and comparison between groups was done by the t test.Measurement data with skewed distribution were described as M (P25,P75) and M (range),and comparison between groups was analyzed using the rank sum test.The count data were compared by the chi-square test.Kaplan-meier method was used to draw survival curve and calculated survival rate.Log-rank test was used for survival analysis.Results (1) Comparison of follow-up and survival:patients between groups were followed up for 9-89 months,with a median time of 45 months.The 1-and 3-year overall survival rates were respectively 93.25％,85.24％ in the hormone-free group and 89.89 ％,74.22％ in the hormone group,with a statistically significant difference (x2 =8.450,P＜0.05).(2) Comparison of postoperative infection,rejection and biliary stenosis between groups:① The total cases with postoperative infections,cases with infection of Klebsiella pneumoniae,Staphylococcus aureus,Candida,Acinetobacter baumannii and Stenotrophomonas maltophilia were 25,18,3,2,2,0 in the hormone-free group and 40,26,6,3,3,2 in the hormone group,respectively,showing a statistically significant difference between groups (x2 =10.149,P＜0.05).The patients between groups with postoperative infection were treated with active anti-infective symptomatic treatment.Three patients in the hormone group died of severe pulmonary infection,and the remaining patients in both groups were improved.② The cases with postoperative rejection in the hormone-free group and hormone group were 6 and 5,respectively,with no statistically significant difference (x2 =0.950,P＞ 0.05).The rejection of both groups occurred within 1 week postoperatively.Two patients in the hormone group were treated with glucocorticoid hormonal shock.The other patients in the 2 groups were improved by adjusting the amount of tacrolimus and mycophenolate mofetil tablets.③ The cases with postoperative biliary stenosis in the hormone-free group and the hormone group were 32 and 8 respectively,with a statistically significant difference (x2 =12.200,P＜0.05).In the hormone group,biliary stenosis occurred after stopping glucocorticoids.The patients with biliary stenosis were improved after biliary stent implantation by endoscopic retrograde cholangio pancreatography (ERCP).Conclusion The basiliximab-induced glucose-free corticosteroid immunosuppressive regimen after liver transplantation is safe and feasible,and it can significantly reduce the incidence of postoperative infection and improve long-term overall survival compared with the conventional glucocorticoid immunosuppressive regimen,but increased postoperative biliary stenesis.
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Objective To approach the effect of telbivudine for preventing recurrence of virus and improving renal function in patients with hepatitis B cirrhosis after liver transplantation with renal insufficiency,and observe the mid-and long-term efficacy.Methods We prospectively researched 17 cases of hepatitis B cirrhosis after liver transplantation with renal insufficiency.Maintenance irnmunosuppression protocol at our centre mainly included calcineurin inhibitor (tacrolimus for 12 cases,and sirolimus for 5 cases).These recipients (n =17) remained under the entecavir (n =10),tenofovir (n =4),lamivudine + adefovir (n =3) for at least 6 months before transformation to telbivudine.We detected HBV-DNA level in serum and ensured no rejection during study,necessarily punctured the graft liver for biopsy to determine if there was rejection.The basal values of blood serum creatinine (Scr) and estimated glomerular filtration rate (eGFR,CKD-EPI formula) were recorded.The Scr and eGFR at 6th month before research and basal values and at 6th and 12th month after telbivudine administration were detected,at the same time the general state and adverse reactions were evaluated.Results During the average follow-up period of 20.2 months,1 patients died.The Ser levels detected in the rest 16 patients were 105.74± 18.24,112.26± 18.67,96.48±22.0 and 89.17± 19.56μμmol/L respectively at 6th month before,basal time and 6th,12th month after telbivudine administration.The eGFR values were 72.56 ± 14.39,66.23 ± 16.61,79.77 ± 20.15 and 83.93 ± 23.67 mL/(minute,m2) at different time points respectively.As compared with the basal value,the Scr and eGFR levels were improved obviously (P＜0.05) at 6th and 12th month after telbivudine administration.The proportion of patients with eGFR ＜60 mL/(min·m2) in 16 cases was 25％,37.5％,12.5％ and 6.3％ respectively at 6th month before,basal time and 6th,12th month after telbivudine administration.The serum creatine phosphokinase level was increased (1 023 IU/L) in 1 patient (6.3％),and decreased after transformation of telbivudine to tenofovir at 3rd month after end of research.No rejection and HBV occurred.Conclusion The telbivudine improves renal function in patients with hepatitis B cirrhosis after liver transplantation with renal insufficiency.Meanwhile,telbivudine prevents hepatitis virus B recurrence.However,large samples of long-term clinical data are needed to further confirm.
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BACKGROUND:The characteristics of condylar morphology should be first understood in patients with unilateral cleft lip and palate. OBJECTIVE:To investigate the bilateral condylar morphology in adult patients with unilateral cleft lip and palate. METHODS:This study included 25 patients with unilateral cleft lip and palate (study group), and 25 normal volunteers (control group). The upper condylar height, ramal height, condylar height and condylar width were measured on panoramic radiographs. The ratio of the upper condylar height to the ramal height and the ratio of the condylar height to the condylar width were calculated. RESULTS AND CONCLUSION:Compared with the control group, upper condylar height, condylar width, condylar height and the ratio of the upper condylar height to the ramal height were reduced in the study group between the normal and affected sides (P0.05). No significant difference in upper condylar height, ramal height, condylar width, condylar height, the ratio of the upper condylar height to the ramal height, the ratio of the condylar height to the condylar width, and condylar morphology was detectable between the normal and affected sides in the experimental group (P>0.05). These data show that adult patients with unilateral cleft lip and palate presented short condylar process and narrow neck, and the condylar process is shorter than ramus, which provides clinical evidence for patients with unilateral cleft lip and palate.
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BACKGROUND:Fluorouracil sustained-release agent is a commonly used anti-cancer sustained-release drug, which has a good anti-tumor effect. OBJECTIVE:To explore the effect of fluorouracil sustained-release agent in the treatment of gastric cancer. METHODS:Literatures concerning the effect of fluorouracil sustained-release agent in the treatment of gastric cancer were retrieved and analyzed. In the paper, we investigated the preventive effect of fluorouracil sustained-release agent against tumor recurrence and metastasis after radical resection, and fol owed up the patients who underwent clinical peritoneal implantation of fluorouracil sustained-release agent. We could determine the effect of fluorouracil sustained-release agent in the treatment of advanced gastric cancer by observing the patient’s symptoms and signs, expression of tumor markers, tumor size and survival rate. RESULTS AND CONCLUSION:After combination therapy of fluorouracil sustained-release agent and arterial infusion chemotherapy adjuvant therapy, the patient’s symptoms and tumor resection rate were significantly improved. The levels of CEA, CA19-9, CA72-4 in the serum of patients significantly reduced, while the apoptosis and necrosis of tumor cells significantly increased. Fluorouracil sustained-release agent could also reduce tumor metastasis and local recurrence, and improve patient survival.
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Objective To observe the curative effect of sirolimus conversion for liver transplantation patients with chronic renal injury.Methods In 23 recipients of liver transplantation using CNI (19 cases using tacrolimus,and 4 cases using cyclosporine A) with chronic renal injury,the immunosuppressant was converted to sirolimus (SRL).The initial dose of SRL was 4 mg per day and 2 mg at the next day.The blood SRL concentration was determined by using high pressure liquid chromatography.When the valley value of SRL concentration reached a range between 5 to 8μg/L,CNI was withdrawn and MMF (1 g/day) was given simultaneously.The basal values of serum creatinine (Scr),creatinie clearance rate (Ccr) and glomerular filtration rate (GFR) were recorded in the recipients before study,and at 1st,3rd,6th,12th,and 24th month after using SRL,blood SRL concentration,Scr,Ccr and GFR,as well as body weight,blood pressure,blood cells count,liver function (serum bilirubin,albumin and prothrombin time),liver biochemistry (AST,ALT,γ-GT and AKP),blood fat (cholesterol and triglyceride) and urine protein were monitored.At the 12th month after using SRL,the graft liver was biopsied to diagnosis rejection.Results During an average followup period of 29.4 months,there were two deaths.In the remaining 21 cases,the Scr values were (147.40 ± 23.36),(152.60 ± 20.08),(150.20 ± 22.64),( 137.60 ± 18.09) and (138.30 ± 17.04)μmol/L,respectively at 1st,3rd,6th,12th,24th month after using SRL.As compared with basal Scr values [(158.91 ± 29.13) μmol/L],there were statistically significant differences at 1at,12th,24th month (P＜0.05).The Ccr values were (0,97 ± 0.18),(0.99 ± 0.1 4),( 1.00 ± 0.17),(1.07 ±0.29) and (1.14±0.12) ml/s,respectively at 1st,3rd,6th,12th,24th month after using SRL.As compared with basal Ccr value [(0.91 ± 0.14) ml/s],there were statistically significant differences at 1st,12th,24th month (P＜0.05).The GFR values were (0.80 ± 0.15),(0.78 ± 0.11),(0.75 ±0.12),(0.84 ± 0.10) and (0.94 ± 0.13) ml/s,at 1st,3rd,6th,12th,24th month after using SRL.As compared with basal GFR value [(0.71 ± 0.11) ml/s],there were statistically significant differences at 1st,12th,24th month (P＜0.05).The proportion of patients with Scr≤123 μmol/L in 21 cases was 38.1％,33.3 ％,28.6 ％,47.6 ％ and 52.4 ％,respectively at 1 st,12th,24th month (P＜0.05).No rejection cases were observed.Conclusion The immunosuppressant conversion to SRL improves renal function of liver transplantation patients with chronic renal injury,and the conversion cure can not cause rejection.
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Objective To identify the blood perfusion characteristics of different kinds of liver cancer and individualize interventional treatment models by color Doppler ultrasound(CDUS) and contrast-enhanced ultrasonography (CEUS). Methods The blood perfusion characteristics of 315 patients with liver cancer comfirmed by pathology were analyzed and classified using CDUS and CEUS. Individual interventional therapy models were selected based on the classification. Therapeutic effects were evaluated by EUS,contrast-enhanced CT(CECT) and DSA simultaneously. Results Liver cancer can be classified by the blood perfusion characteristics from CEUS examination. The individualized interventional treatment models were selected and evaluated according to the characteristics:①Solitary small HCC of diameter ≤3 cm group were treated via percutaneous ethanol injection(PEI),radiofrequency(RF) or percutaneous microwave coagulation therapy(PMCT). Necrosis rates of the lesions were 95.0% - 97.9%, 1 and 3 years survival rates were 98.0% and 87.8% ,respectively. ②Diameter ≤5 cm and lesions ≤3 group were treated with RF or PMCT combined PEI. Necrosis rates of the lesions were 93.7% - 94.8% ,1 and 3 years survival rates were 89.8% and 81.4% ,respectively. ③Diameter ＞5 cm and hypervascular tumor main fed by the hepatic artery group were treated with TACE,PEI combined RF or PMCT. Necrosis rates of the lesions were 71.4% - 73.8%, 1 and 3 years survival rates were 66.2% and 47.6%, respectively. ④ Diameter ＞5 cm and hypervascular tumor fed by double blood supply or accompanied by portal vein tumor thrombus group were treated with selective portal vein embolization(SPVE) based on the above treatments. Necrosis rates of the lesions were 53.3% - 55.6%, 1 and 3 years survival rates were 64.7% and 40.0%, respectively. Conclusions Classifying the blood perfusion characteristics and choosing individualized interventional treatment models by CEUS are of important clinical significance in non-surgical treatment of liver cancer.
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BACKGROUND: It is an important subject that how to relieve liver injury during perfusion preservation, and the pretreatment for donated liver is considered to be an effective method in this process, however, most studies are limited in animal experiment. Atomolan is a kind of reduced glutathione, which possess bidirection regulation of metabolism and detoxication. OBJECTIVE: To study the protective effect of reduced glutathione Atomolan on donor liver injury.METHODS: Totally 80 patients received liver transplantation in the Liver Transplantation Center, 81 Hospital of Chinese PLA, from May 2003 to August 2006, were divided into the control (n = 42), and Atomolan (n = 38) groups. The perfusion preservation conditions were similar, except 2.4 g glutathione was added into solutions in later group. Adenosine triphosphate (ATP) and malonaldehyde levels in liver tissues were measured, meanwhile, the liver tissues were observed under a light microscope and an electron microscope. Recipient plasma alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin concentrations were assessed at 1 day post-operation.RESULTS AND CONCLUSION: Compared with the control group, the liver ATP level of the Atomolan group was markedly increased (P < 0.01), MDA was decreased (P < 0.01), and the concentrations of ALT, AST, as well as total bilirubin were notably decreased (P < 0.01). Under a light microscope, it showed that the degrees of liver swelling histopathologic hepatic alterations were significantly lessened in the Atomolan group. While under an electron microscope, the structure of liver cells of the Atomolan group was clearer and included a higher number of mitochondria (P < 0.01). Results suggested that reduced glutathione has protective effect on donor liver injury during the procedure of hot and cold ischemia and perfusion.
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BACKGROUND: Early enteral nutrition (EEN) following liver transplantation can benefit to recover and guarantee the normal gastrointestinal tract function,which plays an important role on post-operational immunosuppressive therapy.OBJECTIVE: To conduct EEN on the patients undergoing liver transplantation,and observe the post-operation recovery of intestinal function.DESIGN: Case analysis.SETTING: The 81 Hospital of Chinese PLA.PARTICIPANTS: From April 2003 to June 2006,86 patients undergoing liver transplantation in Liver Transplantation Center at the 81 Hospital of Chinese PLA were enrolled,including 57 males and 29 females.They aged 21-68 years,with a mean of 48 years.Among them,there were 37 cases of primary hepatic carcinoma and 49 cases of posthepatitic cirrhosis; 8 cases graded in Child A (all hepatic carcinoma),34 cases in Child B,and 44 cases in Child C.And 5 cases were complicated with serious hepatitis liver function failure and hepatic coma.Informed consents were obtained from all the patients and relatives.Transplantation operation was approved by the hospital ethical committee.METHODS: Surgical approach was orthotopic liver transplantation through caval vein in 80 cases,typical orthotopie liver wansplantation without veno-venous bypass in 4 cases,and piggyback orthotopic liver transplantation in 2 cases.The average warm ischemia time was (4.8±2.4) minutes,and average cold ischemia time was (8.6±3.2) hours.Anhepatic phase was (84±28)minutes.Post-operational trigeminy immunity and anti-rejection therapy consisted of tacrolimus (Fujisawa product) +mycophenolate mofetil (Roche product) + prednisone (Pred).According to the presence of nasogastric feeding tube,the patients were divided into control group (n=49) and EEN group (n =37).There were no significant differences in the sex,age and general data of patients between the two groups.Control group adopted EEN mainly,while EEN group was fed with EEN via a nose-intestine nutritional tube,and they received short-peptide enteral nutrition (Pepti-2000) at 24 hours post-operation at the initial dose of 63-126 g/d,which was gradually increased to 372 g/d.Liquid diet was allowable by 3-5 days.MAIN OUTCOME MEASURES: ①Clinical recovery and complications of patients.②Liver function recovery indices such as total serum protein,albumin and prealbumin,as well as C reactive protein at days 1,3,5 post-operation.③Level of serum immune globulin at day 7 post-operation.RESULTS: Totally 86 patients were involved in the result analysis.①Clinical recovery and complications: In EEN group,abdominal distension occurred in 10 cases,diarrhea in 5 cases,and blocking or slippage of feeding tube in 3 cases; No emesia,back flow or aspirated pneumonia was found; In control group,2 cases appeared bile leakage,which was not detected in the EEN group.②Indices of liver function recovery: Compared with control group,the prealbumin level was significantly rised and C reactive protein was significantly decreased in the EEN group at days 3 and 5 (P ＜ 0.05).③Levels of serum immune globulin: Blood IgA and IgM of EEN group were significantly higher than those of control group at day 7 (P ＜ 0.05).CONCLUSION: EEN in post-operation patients can reduce stress,promote synthesize metabolism,improve the recovery of liver cells,and decrease the infection rate.
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Objective: To explore the effect of early enteral nutrition on post-operation recovery of patients undergone liver transplantation.Methods:86 patients undergone liver transplantation were enrolled,among which 37 cases undertook early enteral feeding and 49 cases were mainly giren parenteral nutrition.The infection rate,metabolism condition and immunol function of post-operation were compared.Results:Patients in EN group had a high lever of blood globulin and a lower infection rate,and their liver function recovery,rise of pre-albumin and decrease of CRP were much quick than those of PN group.Conclusion:Early enteral nutrition in post-operation patients can reduce stress reaction,promote synthesis metabolism,improve the recovery of liver cell and decrease the chances of infection.