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 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.

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 evaluate the prognosis and related risk factors of distal cholangiocarcinoma after surgical treatment.Methods:The clinical data of 123 patients of distal cholangiocarcinoma in Beijing Chaoyang Hospital between January 2011 and December 2019 were retrospectively analyzed, which including 72 males and 51 females, the average age was (64.9±9.2) years (range from 29 to 84 years). All patients underwent pancreatoduodenectomy. The observation measures contains: (1) Perioperative outcomes; (2) Follow-up outcomes; (3) Risk factors for long-term survival of distal cholangiocarcinoma. Follow-up was carried out to understand the long-term survival of patients, and follow-up method contains the outpatient reexamination and telephone. The deadline of follow-up date was March 2020. The normal distribution data were expressed by ( Mean± SD), and the non-normal distribution data were expressed by M ( P25, P75). Count data were expressed by cases and percentage. Kaplan-Meier method was used to calculate and draw the survival curve. Log-rank test was used to compare the survival rate. Cox proportional risk model was used in multivariate factor analysis. Results:(1) Perioperative outcomes: In our research, all of 123 patients were successfully completed the operations, and 6 patients dead during the perioperative. (2) Follow-up outcomes: The incidence of postoperative complications was 27.6%(34/123). One hundred and twenty-one patients were followed up, the follow-up rate was 98.4%, and the median follow-up time was 41.0 months.The overall 1-year, 2-year, 3-year and 5-year survival rates were 71.8%, 50.5%, 35.5% and 30.2%. And the median survival time was 42.7 months. (3) Risk factors for long-term survival of distal cholangiocarcinoma: Multivariate analysis showed that preoperative CA19-9 ( RR=1.470, 95% CI: 1.028-2.101), portal venous system invasion ( RR=2.020, 95% CI: 1.012-4.035) and tumor differentiation ( RR=1.735, 95% CI: 1.195-2.520) were independent risk factors for the prognosis. Conclusions:Radical pancreatoduodenectomy is the best treatment for distal cholangiocarcinoma. Preoperative CA19-9 level, portal venous system invasion and tumor differentiation are independent risk factors for the prognosis.

Objective:To analyze the risk factors of lymph node metastasis of distal cholangiocarcinoma.Methods:We retrospectively analyzed the clinical data of 123 patients of distal cholangiocarcinoma in Beijing Chaoyang Hospital between Jan 2011 and Dec 2019. All patients underwent pancreatoduodenectomy. The prognosis was evaluated according to the follow-up results. The survival rate was compared by log-rank test. Logistic regression was used to analyze the risk factors for lymph node metastasis.Results:One hundred and twenty-three patients successfully underwent the operations, 6 patients died during the perioperative time. The overall 1-year, 3-year and 5-year survival rates were 75.2%, 41.9% and 31.5%. The median survival time was 44.7 months. Fifty-one patients had lymph node metastasis, and the rate of lymph node metastasis was 41.5%. The median survival time was 55.5 months and 27.5 months for patients without and with lymph node metastasis, respectively. Correspondingly, the survival rates of 1-year, 3-year, 5-year were 83.0%, 50.7%, 42.5% vs. 63.5%, 19.0%, 19.0% ( P=0.000). Multivariate analysis showed that preoperative CA19-9 ( RR=7.064, 95% CI: 2.489-20.051) and portal venous system invasion ( RR=4.610, 95% CI: 1.252-16.972) were independent risk factors for lymph node metastasis. Conclusions:Lymph node metastasis is an important factor affecting the long-term survival of patients with distal cholangiocarcinoma. Preoperative CA19-9 level and portal venous system invasion are independent risk factors for lymph node metastasis.

Objective:To analyze the value and significance of surgical operation in the treatment of pancreatic carcinoma with portal venous system invasion.Methods:The clinical data of 66 patients of pancreatic carcinoma with portal venous system invasion admitted in Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2011 to December 2018 were retrospectively analyzed. Vascular resection and reconstruction was used on all patients who underwent radical resection for pancreatic carcinoma (portal vein system invasion group). The operation procedure was made according to the location of the pancreatic carcinoma, and the vascular reconstruction procedure was made according to the type and location of portal venous system invasion. The intraoperative and perioperative situation of the patients were analyzed. Then 129 patients of pancreatic carcinoma without portal venous system invasion in the same period were selected as the control group, and the long-term prognosis between the two groups was compared.Results:The operation was successfully in 66 patients. According to the location of the pancreatic carcinoma, 55 patients underwent pancreatoduodenectomy, 8 patients underwent total pancreatoduodenectomy and 3 patients underwent distal pancreatectomy. According to the type and location of portal venous system invasion, 43 patients underwent allogeneic vascular replacement, 16 patients underwent segmental resection with end-to-end anastomosis, and 7 patients underwent wedge resection with primary closure. There was no perioperative death in this group. The incidence of postoperative complications was 28.8%(19/66), and the incidence of biochemical fistula was 9.1%(6/66), intraperitoneal infection was 7.6%(5/66), intraperitoneal hemorrhage was 4.5%(3/66), delayed gastric emptying was 4.5%(3/66), pancreatic fistula of Grade C was 1.5%(1/66) and biliary fistula was 1.5%(1/66). All the patients were discharged successfully, and the postoperative hospital stay was (20.8±9.7) days. 65 patients were followed up, and the follow-up rate was 98.5%. The median survival time of portal venous system invasion group and control group was 13 months and 22 months, respectively. The overall 1-year, 2-year and 3-year survival rates of portal venous system invasion group and control group were 53.3%, 30.4%, 23.4% and 73.1%, 45.8% and 40.1%, respectively ( P=0.006). Conclusions:Prognosis of pancreatic carcinoma patients with portal venous system invasion was poor, but it was safe and feasible to perform surgery for such patients. During the operation, different ways of venous reconstruction can be used according to the specific situation of venous invasion.

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.