[Massive hemorrhage caused by fungal infections after donation-after-cardiac-death kidney transplantation: clinical features, prevention and treatment experience].

OBJECTIVE: To study the characteristics and prevention and treatment strategies of massive hemorrhage caused by fungal infections after donation-after-cardiac-death (DCD) kidney transplantation. METHODS: A total of 91 cases of DCD kidney transplantation between August 25, 2013 and June 30, 2015 in Third Affiliated Hospital of Sun Yat-sen Univservity were retrospectively analyzed. The characteristics of and prevention and treatments strategies for postoperative massive hemorrhage caused by fungal infections were summarized. RESULTS: Ninety-one cases of DCD kidney transplantation were divided into 2 groups based on regimens for preventing postoperative fungal infections: fluconazole prophylaxis group: a total of 26 cases of renal transplant before June 11, 2014 received fluconazole regimen, from postoperative day 0 to 2 weeks; micafungin prophylaxis group: a total of 65 cases of renal transplant after June 11, 2014 received micafungin regimen, also for 2 weeks from postoperative day 0. Two cases in fluconazole group developed postoperative massive hemorrhage. In case 1, the hemorrhage occurred at 2 weeks after transplantation. Graft nephrectomy was performed during surgical exploration for hemostasis, yet the massive hemorrhage relapsed 2 weeks later. Endoluminal exclusion of external iliac artery using endovascular covered stent-graft at the anastomosis site was performed and the massive bleeding was successfully stopped. The patient was restored to hemodialysis and waited for second kidney transplantation. Candia albicans was detected in the culture of blood and drainage liquid from incision. The other case of hemorrhage occurred at 3 weeks after transplantation. Graft nephrectomy plus endovascular exclusion using covered stent-graft were also performed to stop the massive bleeding. Massive fungal hyphae and spores were observed at the stump of renal graft artery under microscope. The patient received second kidney transplantation after 6 months successfully. No massive hemorrhage caused by fungal infections occurred in micafungin prophylaxis group. CONCLUSIONS: Massive hemorrhage cased by fungal infections after DCD kidney transplantation is usually characterized by delayed and recurrent course, and may result in graft nephrectomy or even death of patients. Endovascular exclusion using covered stent can successfully stop bleeding and rescue life of patients. Two-week preemptive prophylaxis of fungal infections using micafungin can effectively prevent delayed fungal massive hemorrhage in DCD kidney transplantation.

Health care utilization as a function of subjective health status, job satisfaction and gender among health care workers in Guangzhou, southern China.

Job satisfaction, subjective health and health care utilization was studied on 72 doctors and 127 nurses working at two hospitals in Guangzhou in the People's Republic of China (P.R.C.), along with medication use and consultations with physicians over the 14 days preceding data collection. Female doctors were, on average, ten years older than male doctors. Nurses (all female) were comparable to male doctors in terms of age. Current and general subjective health, and job satisfaction differed between doctors and nurses. Nurses were less satisfied than doctors and reported poorer perceived health, until gender and age were controlled. Female doctors had poorer ratings of general and current subjective health and lower job satisfaction than their male colleagues. Path analysis tested whether lower job satisfaction leads to decrements in perceived current health which in turn increased consultation with a physician and medication use. When male and female subjects were examined separately, job satisfaction was inversely related to consultation behaviour among males and positively related to perceived current health in both genders. Among females job satisfaction and consultation behaviour related to current perceived health but were not related to each other. The hypothesized path was upheld for nurses. Lack of power prevented the same path being significant for male or female doctors. In combination, doctors showed significant relationships between the four main variables studied.