Objective To investigate the expression of peripheral blood (PB) CD4+ CD25+ Foxp3+ regulatory T cells (Tregs) in patients with benign end-stage liver disease after liver transplantation and the relationship between levels of PB Tregs and acute rejection. Methods A prospective analysis was performed on 55 consecutive patients who underwent liver transplantation.Fourteen out of 55 cases suffered from acute rejection after liver transplantation were defined as rejection group,while the rest patients were classified into no acute rejection group. PB was obtained from liver transplant patients at different time points longitudinally: pre-transplant, post-transplant within one year and acute rejection. The circulating CD4+ CD25+ Foxp3+ Tregs in PB were measured by flow cytometry. Blood samples were drawn during acute rejection, at the same time, liver biopsies were performed. The circulating CD4+ CD25+ Foxp3+ Tregs were compared between two groups.Results There was no difference between two groups in levels of circulating CD4+ CD25+ Foxp3 + Tregs cells pre-transplant. However, the levels of circulating CD4+ CD25+ Foxp3+ Tregs in rejection group were decreased significantly as compared with no-rejection group (2. 23 % ± 0. 54 % vs. 2. 99 % ±0. 86 %,P＜0.01). The frequency of CD4+ CD25+ Foxp3+ T cells was negatively correlated with rejection activity index (RAI) (r = - 0. 80, P＜0. 01 ). Conclusion Monitoring PB CD4+ CD25+ Foxp3+ Tregs levels may be helpful in evaluating the immune state and act as a more sensitive marker for acute rejection diagnosis in the patients following liver transplantation.

Objective To investigate the infection characteristics and drug resistance of methicillin resistant Staphylococcus aureus after liver transplantation.Methods Retrospectively analyzed the clinical data of 170 patients who underwent liver transplantation in Beijing Chaoyang Hospital,Capital Medical University between January 2011 and April 2016.The incidence,pathogenic characteristics,distribution and drug resistance of methicillin resistant Staphylococcus aureus were analyzed.Results In this research,the methicillin resistant Staphylococcus aureus infection occurred in 23 cases after liver transplantation,and the incidence rate was 13.53％ (23/170).There were 27 strains of pathogens had been isolated,and 74.07％ (20/27) of pathogens were isolated from peritoneal drainage fluid.The most common methicillin resistant Staphylococcus aureus were Staphylococcus haemolyticus,Staphylococcus epidermidis and Staphylococcus hominis,accounting for 29.63％ (8/27),22.22％ (6/27) and 14.81％ (4/27).Drug sensitivity results indicated that the methicillin resistant Staphylococcus aureus were completely resistant to Penicillin,Oxacillin and Methicillin antibiotics.And the pathogens were extensively drug-resistant to Ciprofloxacin,Levofloxacin and Moxifloxacin,the resistance rates were 63％ (15/24),63％ (15/24) and 58％ (14/24).But the pathogens were sensitive to Teicoplanin,Vancomycin and Linezolid,and there have not been detected drug-resistant bacteria.Conclusions The infection of methicillin resistant Staphylococcus aureus is one of the most common pathogens after liver transplantation.Routine prophylactic antibiotics are not useful for the treatment,however,Teicoplanin,Vancomycin and Linezolid can be used as the first choice of treatment.

OBJECTIVETo observe the therapeutic effects of continuous plasma filtration absorption (CPFA) treatment on burn sepsis.

METHODSThirty burn patients with sepsis hospitalized in Beijing Fengtai You'anmen Hospital from July 2009 to October 2012 were treated by CPFA for twice besides routine treatment. The blood samples were collected at five sites (A, B, C, D, and E, respectively) of blood purification equipment before and after CPFA, before and after hemoabsorption, and before hemofiltration. The plasma levels of TNF-α, IL-1β, IL-6, IL-10, interleukin-1 receptor antagonist (IL-1RA), soluble tumor necrosis factor receptor (sTNFR) I , and sTNFR-II from sites A, C, and E were determined with ELISA before CPFA was performed for the first time, and those from sites B and D were determined with ELISA after CPFA was performed for the first time. Plasma levels of the above-mentioned cytokines from sites A and B were determined with ELISA before CPFA and after CPFA was performed for the second time. The data of plasma levels of IL-1βP3, IL-1RA, sTNFR-I, sTNFR-II, and TNF-α before CPFA and after CPFA was performed for the second time were collected for calculation of the ratios of IL-1RA to IL-1β and sTNFR-I plus sTNFR-II to TNF-α. The expression rate of human leukocyte antigen DR (HLA-DR) on the CD14 positive monocytes, acute physiology and chronic health evaluation (APACHE) II score, body temperature, pulse, respiratory rate, and leukocyte count of patients were evaluated or recorded before CPFA and after CPFA was performed for the second time. Patients'condition was observed. Data were processed with paired t test.

RESULTSThe plasma levels of TNF-α, IL-1β, IL-6 and IL-10 from site B after CPFA was performed for the second time were significantly lower than those from site A before CPFA was performed for the first time (with t values respectively 7.05, 5.23, 4.73, 2.37, P values below 0.01). After CPFA was performed for the first time, the plasma levels of TNF-α, IL-1β, and IL-6 from site D were significantly lower than those from site C before CPFA was performed for the first time (with t values respectively 5.48, 2. 17, 1.78, P < 0.05 or P <0.01). The plasma levels of all cytokines were close between site B after CPFA was performed for the first time and site E before CPFA was performed for the first time (with t values from 0.04 to 1.05, P values above 0.05). The plasma levels of TNF-α, IL-1β, and IL-6 from site B after CPFA was performed for the second time were significantly lower than those from site A before CPFA was performed for the second time (with t values from 1.87 to 5.93, P <0.05 or P <0.01). The ratios of IL-1RA to IL-1β and sTNFR-I plus sTNFR-II to TNF-α, and expression rate of HLA-DR were increased significantly after CPFA was performed for the second time as compared with those before CPFA (with t values from 3.99 to 7. 80, P values below 0.01). APACHE II score after CPFA was performed for the second time was 11 ± 6, which was lower than that before CPFA (22 ± 7, t =4.63, P <0.01). After CPFA was performed for the second time, body temperature, pulse, and respiratory rate of patients were improved (with t values from 1.95 to 3.55, P values below 0.05) , and the leukocyte count was significantly decreased (t =4.36, P <0.01) as compared with those before CPFA. All patients survived and were discharged with length of stay of (27 ± 31) d, and no adverse effects occurred during CPFA treatment.

CONCLUSIONSCPFA, which combines hemoabsorption and hemofiltration, can facilitate the treatment of burn sepsis by decreasing the level of pro-inflammatory cytokines efficiently, alleviating systemic inflammatory response, and improving the immune status.

Adsorption ; Aged ; Biomarkers ; blood ; Burns ; blood ; complications ; immunology ; Cytokines ; blood ; Fluid Therapy ; Hemofiltration ; methods ; Hospitalization ; Humans ; Inflammation Mediators ; blood ; Interleukin 1 Receptor Antagonist Protein ; blood ; Interleukin-10 ; blood ; Interleukin-6 ; blood ; Sepsis ; blood ; immunology ; therapy ; Treatment Outcome ; Tumor Necrosis Factor-alpha

Objective To evaluate the effect of ADV-TK gene in its inhibition of the recurrence and metastasis of hepatocellular carcinoma after curative resection in a nude mouse model. Methods In the two experimental groups, GFP-labelled ADV-TK gene transfection was determined 24 h after injection in one-each mouse. Nude mice with inplanted intrahepatic hepatocellular carcinoma underwent curative tumor resection, in the end of the operation ADV-TK gene was injected in incisional margin (11 mice) or retroperitoneally (11 mice). Ganciclovir at a dosage of 50 μg/10 g bw was given in the next day after resection. Mice in control group did not receive ADV-TK gene injection. After six weeks, mice were sacrificed. Results 1. It was showed that organs were all transfected by ADV-TK gene.2. Compared with the control group in which the recurrent tumor number of (8.7±6.5) ,tumor volume of (2933±597) mm3, and recurrence involved liver lobes of (4.3±2.2), that was (0.0±0.0), (0.0±0.0) mm3, and (0.0±0.0)(X2 = 3.05 all P<0.01) in incisional margin gene injection group, and (2.2±1.3), (265±109) mm3, and (2.1±1.3) (X2= 5.32, all P<0.01 ) respectively in intraperitoneally gene injection group.3. Compared with the control group in which the lung metastasis rate of (10/10)、number of distant organ involved by metastasis of (7.2±5.3 ), and serum AFP level of (1322±702), that was (2/10) , (3.2±1.5) and (322±102), (X2=4.33, all P<0.01) in incisional margin group, and ( 1/10)、( 1.8±1.2 ), and (268±133 ) ( X2=7.15, all P<0.01 ) in retroperitoneal group, respectively. Conclusions ADV-TK gene inhibits recurrence and metastasis of HCC after curative resection in this nude mouse model.

Objective To analyse the experience and prognosis of surgical treatment of hilar cholangiocarcinoma.Methods Clinical data of 49 patients of hilar cholangiocarcinoma underwent surgical treatment were analyzed retrospectively from January 2011 to December 2017 in Department of Hepatobiliary Surgery,Beijing Chaoyang Hospital affiliated to Capital Medical University.Of the 49 patients,29 patients underwent R0 resection and 10 patients underwent R1 resection according to the patient's condition.The overwall prognosis and R0 resection rate were analyzed.All patients were followed up by outpatient or telephone.The follow-up deadline was December 2017.The long-term prognosis of R0 and R1 resection were compared.Normal distribution data were expressed as (Mean ± SD),while non-normal distribution data were expressed as M(P25,P75).Survival curve was depicted by Kaplan-Meier method,and survival rate was compared by Log-Rank test.Results All patients underwent surgical treatment.There were 5 complications (10.2％) during the perioperative period,and no deaths occurred.Radical resection was performed in 39 patients,with a radical resection rate of 79.6％.The overall median survival time was (27.0± 1.2) months.The survival rates in 6 months,1,3 and 5 years were 95.9％,85.6％,34.5％,6.6％ respectively.The total median survival time of R0 resection and R1 resection was (28.0 ± 6.5) months and (16.0 ± 0.7) months respectively.The 6 months,1,2,and 3 years survival rates were 94.9％,89.7％,43.5％,8.3 ％ and 80.0％,68.6％,0,0 respectively.Conclusion Surgical treatment is safe and effective,and it can improve the prognosis of patients.

Objective To study the impact on the use of branched vascular allografts in the prevention of left regional portal hypertension after pancreatic cancer operations.Methods This retrospective study included 25 patients who underwent pancreaticoduodenectomy for pancreatic head cancer which involved the portal vein,superior mesenteric vein and splenic venous confluence between January 2011 to December 2017 in the Beijing Chao Yang Hospital,Capital Medical University.These patients underwent "en bloc" resection of the spleno-mesenterio-portal (SMS) venous axis with replacement of a branched vascular allografts.They were studied to see whether gastroesophageal varices were found on gastroscopy and whether there were any changes in leukocyte,platelet and splenic volume before and after the operation to determine the incidence of left regional portal hypertension after operation.Results During the follow-up period,all the portal vein,superior mesenteric vein and splenic vein anastomoses were unobstructed and without any thrombosis.No new varices were found on gastroscopy.There were no significant differences in the white blood cell count,platelets count and splenic volume before and after the operations (all P＞0.05).The 25 patients had no left regional portal hypertension.Survival time and one year survival rate of the patients were (20.2±3.7) months and 44.0％.Conclusion Branched vascular allografts effectively prevented the occurrence of left regional portal hypertension after radical pancreaticoduodenectomy with resection of SMP.

Objective To evaluate the prognosis and related risk factors in patients with primary liver cancer after liver transplantation. Methods We retrospectively analyzed the clinical data of 298 patients who underwent liver transplantation between January 2013 and December 2017 at Beijing Chaoyang Hospital of Capital Medical University. 121 patients with primary liver cancer on postoperative pathological diagnosis were included into this study. The patients included 108 males and 13 females, aged from 31 to 70 years, with an average of (52. 7 ± 8. 7) years. The prognosis and the related risk factors on prognosis were analyzed. The survival curve was drawn by the Kaplan-Meier method, and the survival rate was compared by the log-rank test. Multivariate Cox regression was used to analyze the prognostic factors. Results Of the 121 patients who were enrolled in this study, 5 patients died during the perioperative period, making a perioperative mortality rate of 4. 1% (5/121). The remaining 115 patients were followed up and the followed up rate was 95. 0% (115/121). The overall 1-, 2- and 3-year survival rates were 81. 0% , 74. 6% and 70. 2% , respectively. The median survival was 41. 5 months. Multivariate analysis showed that preoperative Child grading (RR=3. 028, 95% CI: 1. 625～5. 643) and microvascular invasion (RR=7. 165, 95% CI: 2. 237～22. 951) were independent risk factors of prognosis. The worse the preoperative Child grading, the worse was the prognosis. The prognosis of patients with microvascular invasion was also poor. Conclusions The overall prognosis of patients with primary liver cancer after liver transplantation was good. Preoperative Child grading and pathological microvascular invasion were the main risk factors of prognosis after liver transplantation carried out for primary liver cancer.

Objective To investigate the clinical characteristics and the related risk factors of pulmonary infection in patients after liver transplantation.Methods The clinical data of 298 patients who underwent liver transplantation in the Beijing Chaoyang Hospital between January 2013 and December 2017 were retrospectively stndied.The patients were divided into the infection group (n =58) and the control group (n =240) according to whether they had pulmonary infection.The characteristics,diagnosis,treatment,prognosis and risk factors of pulmonary infection were analyzed.Results Pulmonary infection occurred in 58 patients (19.5％) after liver transplantation.Eight patients died in the infection group of pulmonary infection.The mortality rate was 13.8％.The most common pathogenic bacteria were Acinetobacter bauman,Pseudomonas aeruginosa and Klebsiella pneumoniae,which accounted for 28.8％,20％ and 13.8％,respectively for the pulmonary infection.Multivariate analysis showed that the neutrophil ratio,and intensive care unit (ICU) hospitalization time were independent risk factors of pulmonary infection (P ＜ 0.05).Conclusions Pulmonary infection was common after liver transplantation.The treatment strategy should be the use of rational antibiotics and intensive pulmonary management.The neutrophil ratio and ICU hospitalization time were the risk factors of pulmonary infection.

Objective To analyze the application effect of non-penetrating vascular closure system in portal vein reconstruction of allogenic liver transplantation in adults. Methods Clinical data of 222 patients undergoing allogeneic liver transplantation were retrospectively analyzed. According to whether vascular closure system was used in portal vein reconstruction during operation, all patients were divided into vascular clip group (n=137) and traditional suture group (n=85). Perioperative conditions, clinical prognosis and complications were statistically compared between two groups. Results All patients successfully completed the surgery. The success rate of one-time portal vein anastomosis was 93.4% (128/137) in the vascular clip group. A total of 14 patients died during perioperative period in this study with a mortality rate of 6.3% (14/222). No portal vein-related complications occurred during perioperative period in both groups. The time of portal vein anastomosis in the vascular clip group was (5.6±1.7) min, which was significantly shorter than (10.7±3.6) min in the traditional suture group (P<0.05). The incidence and grade of perioperative complications did not significantly differ between two groups (all P>0.05). Conclusions It is safe and feasible to utilize vascular closure system to reconstruct the portal vein during liver transplantation. Compared with traditional suture, it can effectively shorten the time of portal vein anastomosis.