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1.
Organ Transplantation ; (6): 239-2021.
Article in Chinese | WPRIM | ID: wpr-873737

ABSTRACT

Heart transplantation can save the life and improve the quality of life of patients with end-stage heart failure. Nevertheless, it is not suitable for all patients with end-stage heart failure. As a common complication of end-stage heart failure, pulmonary artery hypertension may increase the incidence of right heart failure after heart transplantation, which is associated with the short- and long-term fatality risk in the recipients after heart transplantation. In clinical practice, different transplant centers have different criteria for heart transplantation indications in patients with end-stage heart failure complicated with pulmonary artery hypertension. Accurate preoperative evaluation of surgical indications plays a critical role in determining the success of heart transplantation. In this article, the definition, pathogenesis and effects on heart transplantation, diagnostic methods and reversibility judgment of pulmonary artery hypertension, diagnostic treatment of reversible pulmonary artery hypertension and indications of heart transplantation in patients with end-stage heart failure complicated with reversible pulmonary hypertension were reviewed.

2.
Organ Transplantation ; (6): 450-2021.
Article in Chinese | WPRIM | ID: wpr-881530

ABSTRACT

Objective To analyze the early outcomes of heart transplantation in critical patients and its significance in donor allocation decision. Methods Clinical data of 449 recipients undergoing heart transplantation were retrospectively analyzed. According to preoperative status, all patients were divided into the critical status group (n=64) and general status group (n=385). The incidence of critical status was summarized. Clinical data of recipients were statistically compared between two groups. Postoperative survival and causes of death in recipients between two groups were analyzed. Perioperative results of critical recipients undergoing different mechanical circulation support as a bridge to heart transplantation were compared. Results Critical patients accounted for 14.3% of the total number of transplant recipients. The proportion of critical patients gradually increased in recent 5 years. Compared with the general status group, the recipients in critical status group had a lower proportion of smoking history, a higher proportion of cardiac surgery history, a higher serum level of creatinine, and a higher proportion of primary diseases of heart failure before heart transplantation(all P≤0.01). The proportion of undergoing mechanical circulation support was higher, the incidence of complications was higher, the stay time in intensive care unit (ICU) was longer and the in-hospital fatality was higher after heart transplantation in the critical status group (all P≤0.01). The 1-year survival rate of recipients in critical status group was significantly lower than that in general status group (83% vs. 95%, P < 0.01). The fatality of recipients due to infection and multiple organ failure in critical status group was higher than that in general status group. Among 64 critical recipients, 1 recipient received ventilator alone, and 63 recipients underwent mechanical circulation support devices as a bridge to heart transplantation. Among them, intra-aortic balloon pump (IABP) alone was applied in 49 cases (77%), 8 cases (13%) of extracorporeal membrane oxygenation (ECMO) combined with IABP, 4 cases (6%) of ECMO alone, and 2 cases (3%) of left ventricular assist device (LVAD) alone. Critical patients who received preoperative ECMO and ECMO combined with IABP bridging to heart transplantation have a higher proportion of postoperative complications, a longer ICU stay time, a longer mechanical ventilation time, and a higher proportion of hospital deaths. Conclusions The overall prognosis of critical patients undergoing heart transplantation is relatively poor. Effective preoperative management may reverse the high-risk status of critical patients in a certain extent. The limited quantity of donor heart should be allocated to the most urgent patients who can obtain the greatest benefit from heart transplantation.

3.
Article in Chinese | WPRIM | ID: wpr-823430

ABSTRACT

@#Objective    To summarize the clinical characteristics and the long-term results of pulmonary thromboendarterectomy (PTE) in the chronic thromboembolic pulmonary hypertension (CTEPH) patients with unilateral main pulmonary artery occlusion. Methods    We retrospectively analyzed the clinical data of 15 CTEPH patients with unilateral main pulmonary artery occlusion in Fuwai Hospital between 2004 and 2018. There were 11 males and 4 females aged 34.1±12.0 years at operation. Results    The mean circulatory arrest was 31.1±12.1 minutes. The ICU stay was 5 (2-29) d. The hospital stay was 15 (8-29) d. There was no hospital death. There was a decline in systolic pulmonary artery pressures (sPAP, 69.9±27.9 mm Hg to 35.1±9.7 mm Hg, P=0.020) after surgery. On postoperative V/Q scan, only 6 patients (40.0%) had significant improvement in reperfusion (≥75% estimated) of the occluded lung. There was no death during the median observation period of 49 months follow-up, while 2 patients had recurrence of pulmonary embolism. Conclusion    CTEPH patients with unilateral main pulmonary artery occlusion represent a challenging cohort. PTE is a curative resolution in both early- and long- term results, although there is a high requirement of perioperative management and a high risk of postoperative complications and rethrombosis.

4.
Article in Chinese | WPRIM | ID: wpr-751730

ABSTRACT

Objective To compare the clinical efficacy of empirical therapy and diagnostic-driven the-rapy in the treatment of the hematological malignancies patients complicated with invasive fungal disease (IFD). Methods The clinical data of patients with hematological malignancies undergoing antifungal treat-ment in the Department of Hematology and Lymphoma of Cancer Hospital & Shenzhen Hospital,Chinese Aca-demy of Medical Sciences and Peking Union Medical College from August 2017 to August 2018 were analyzed retrospectively. A total of 68 patients met the inclusion criteria,of which,28 received the empirical therapy and 40 received the diagnostic-driven therapy. Then the differences of the incidence of IFD,IFD-related mor-tality,days of hospitalization and antifungal treatment between the two groups were compared. Results The incidence of IFD in the diagnostic-driven therapy group was higher than that in the empirical therapy group [27. 5% (11 / 40)vs. 7. 1% (2 / 28),χ2 = 4. 414,P = 0. 036]. While the rates of IFD-related mortality were 7. 5% (3 / 40)and 3. 6% (1 / 28)respectively,with no statistically significant difference (χ2 = 0. 459,P =0. 498). The number of antifungal treatment days in the diagnostic-driven therapy group was greater than that in the empirical therapy group [(15. 9 ± 3. 3)d vs. (13. 1 ± 2. 5)d,t = - 3. 654,P = 0. 001]. While the num-bers of hospitalization days were similar in the two groups [(20. 1 ± 2. 1)d vs. (19. 4 ± 2. 3)d],with no sta-tistically significant difference (t = - 1. 273,P = 0. 208). Conclusion Both diagnostic-driven therapy and empirical therapy are helpful to early antifungal treatment,and they should be performed properly combined with the actual clinical conditions.

5.
Article in Chinese | WPRIM | ID: wpr-772121

ABSTRACT

OBJECTIVE@#To investigate the association of genetic polymorphisms of norepinephrine metabolizing enzymes with postpartum depression and analyze the risk factors for postpartum depression in women following cesarean section.@*METHODS@#A total of 591 Chinese woman of Han Nationality undergoing caesarean section were enrolled in this study. The diagnosis of postpartum depression was established for an Edinburgh Postnatal Depression Scale (EPDS) score ≥9. For all the women without antepartum depression, the genotypes of catechol-O-methyltransferase (COMT; at 5 sites including rs2020917 and rs737865) and monoamine oxidase A (rs6323) were determined using Sequenom Mass Array single nucleotide polymorphism (SNP) analysis. We analyzed the contribution of the genetic factors (SNPs, linkage disequilibrium and haplotype) to postpartum depression and performed logistic regression analysis to identify all the potential risk factors for postpartum depression and define the interactions between the genetic and environmental factors.@*RESULTS@#The incidence of postpartum depression was 18.1% in this cohort. Univariate analysis suggested that COMT polymorphism at rs2020917 (TT genotype) and rs737865 (GG genotype) were significantly correlated with the occurrence of postpartum depression ( < 0.05). Logistic regression analysis showed that COMT polymorphism at rs2020917 (TT genotype) and rs737865 (GG genotype), severe stress during pregnancy, and domestic violence were the risk factors for postpartum depression ( < 0.05); no obvious interaction was found between the genetic polymorphisms and the environmental factors in the occurrence of postpartum depression.@*CONCLUSIONS@#The rs2020917TT and rs737865GG genotypes of COMT, stress in pregnancy, and domestic violence are the risk factors for postpartum depression.


Subject(s)
Catechol O-Methyltransferase , Genetics , Cesarean Section , Depression, Postpartum , Diagnosis , Genetics , Domestic Violence , Psychology , Female , Gene-Environment Interaction , Genotype , Haplotypes , Humans , Linkage Disequilibrium , Monoamine Oxidase , Genetics , Norepinephrine , Metabolism , Polymorphism, Single Nucleotide , Postoperative Complications , Diagnosis , Genetics , Pregnancy , Pregnancy Complications , Psychology , Risk Factors , Stress, Psychological
6.
Article in Chinese | WPRIM | ID: wpr-594607

ABSTRACT

Objective To research the trichomonacidal effect of secnidazole benzoate in vitro.Methods Trichomonas vaginalis was cultured in liver extract medium in 96-well microplate.The culture suspension of Trichomonas vaginalis was divided into four groups:secnidazole benzoate, secnidazole, metronidazole and control, with medium as blank control.MTT colorimetric assay was applied to determine the inhibitory effect of secnidazole benzoate on the proliferation of Trichomonas vaginalis.The culture suspension was transfered into test tubes and divided into same groups to observe inhibitory effect by the classical microscopic counting method.Results After 24 h incubation, the proliferation of the parasites was concentration-dependent by secnidazole benzoate(t=9.02, P

7.
Article in Chinese | WPRIM | ID: wpr-534735

ABSTRACT

The anti-DNP and anti-OA IgE antibody responses of six strains of mice immunizedwith DNP-OA conjugate in presence of A1(OH)_3 adjuvant was investigated.Signifi-cant differences of the magnitude of serum IgE were found in anti-hapten and anti-carrier responses among strains.The primary and secondary anti-DNP and anti-OAIgE antibodies were elicited in NIH,BALB/c and DBA/2 mice after immunizationwith 1?g of DNP-OA.Among them NIH mice was the highest responder,whereasLACA,C3H and B6D2F1 mice were poor or nonresponders.In comparison the IgEresponse in BALB/c mice immunized with 1?g and 10?g of DNP-OA,the former de-monstrated a latency of primary response,but two groups had a very similar PCAtiters after 4 weeks of immunization.On the other hand,LACA mice gave a dose de-pendent IgE response.Profound primary and secondary IgE antibody responses can beonly seen in mice injected with 10?g of DNP-OA and PCA titer of anti-DNP washigher than that of anti-OA IgE antibody.However,no difference of IgE antibodylevels in NIH mice can be found between groups immunized with different doses.DNP_(4.7)-OA primed mice gave higher IgE response than that of mice immunized withDNP_3-OA.A prevailing anti-hapten IgE response was observed when higher dose ofDNP-OA conjugates was injected.

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