OBJECTIVE To analyze the characteristic of vancomycin-resistant Enterococcus(VRE) infection after orthotopic liver transplantation, and provide a basis to improve prophylaxis and therapy. METHODS A retrospective survey in 136 patients who underwent orthotopic liver transplantation was carried out to define the incidence, clinical feature and therapeutic outcome of VRE infection. RESULTS Eleven patients were infected by VRE in this study and the incidence of infection by VRE was 8.1% following liver transplantation. Totally 31 of the VRE isolates were isolated, including 26 Enterococcus faecium strains and 5 E. faecalis strains. Sites of VRE infection included abdomen(n=4), blood(n=2), and respiratory tract(n=2). In the other 3 patients, VRE was cultured from multiple sites. Among 11 patients with VRE infection, 4 were sensitive to teicoplanin, and 7 resistant to teicoplanin. So 4 patients received antibiotics with teicoplanin and 7 patients with linezolid. In this study, 10 patients were cured and 1 patient died of sepsis. CONCLUSIONS VRE has become an nosocomial pathogen of increasing importance in liver transplantation patients. The risk factor of VRE infection should be paid attention. Infection prophylaxis of VRE should be emphasized.

Objective To investigate effect of probiotics in the treatment of patients with severe hepatitis and its influence on inflammatory cytokines.Methods A retrospective analysis of the data of patients with severe hepati-tis were maded.There were 100 patients,which including 50 cases of the observation group and 50 cases of control group,the control group was given conventional treatment,the observation group was given Bacillus viable capsule (Zhengchangsheng) for 4 weeks,2 granule a time and three times a day.The clinical symptoms were observed before and after treatment,the blood was exsanguinated for detecting bowel flora,total bilirubin,liver function and inflamma-tory cytokines.Results The total effective rate of the observation group was 86%,which was significantly higher than 56% of the control group(χ2 =11.409,P <0.01).The enterobacter of the observation group after treatment was (6.71 ±1.30)lgn/g,which was lower than before treatment(t =3.602,P <0.05),the bifidobacterium,lactobacillus, bacteroides were (7.88 ±1.18)lgn/g,(8.08 ±1.65) lgn/g,(8.30 ±1.20)lgn/g,respectively,which were higher than before treatment(t =3.772,3.707,3.523,all P <0.05).The intestinal flora in the control group had no differ-ence before and after treatment.After treatment,the total bilirubin,ALT,plasma endotoxin of the observation group and the control group were (195.0 ±25.4)μmol/L and (307.6 ±40.5)μmol/L,(58.2 ±11.5)U/L and (90.2 ± 10.5)U/L,(0.18 ±0.06)EU/mL and (0.29 ±0.08)EU/mL,respectively,which were lower than before treatment (t =16.307,9.408,10.157 and 4.032,8.075,5.076,all P <0.01).The serum TNF -α,IL -6 levels of the obser-vation group were (106.2 ±12.5)pg/mL,(82.3 ±18.9)pg/mL,which were lower than before treatment(t =3.732, 4.017,all P <0.05),which of the control group were (130.5 ±20.6)pg/mL,(110.2 ±17.8)pg/mL,there was no difference before and after treatment.The IL -2,IL -10 levels of the observation group were (60.7 ±10.0)pg/mL, (31.7 ±6.6)pg/mL,which were significantly higher than before treatment(t =3.757,3.877,all P <0.05),which of the control group were (46.2 ±5.8)pg/mL,(23.4 ±5.1)pg/mL,which had no difference before and after treat-ment.The total bilirubin,ALT,plasma endotoxin,serum TNF -α,IL -6 levels of the observation group were lower than the control group(t =7.653,8.104,3.309,3.511,3.787,all P <0.05).The IL -2,IL -10 levels of the obser-vation group were higher than the control group(t =3.487,3.428,all P <0.05).Conclusion Probiotics can correct intestinal flora,reduce plasma endotoxin,inhibit inflammatory mediators,reduce inflammation of the liver damage, improve liver function and clinical symptoms and should be introduced in the treatment of severe hepatitis.

Objective To evaluate the treatment and prevention measure for intrahepatie diffuse biliary stricture after orthotopic liver transplantation. Methods The clinical data of 21 patients with intrahepatic diffuse biliary stricture after orthotopic liver transplantation from January 2002 to December 2007 in Beijing Center for Organ Transplantation were retrospectively analyzed. A prospective clinic study was launched in order to prevent microthrombosis in the microcireulation of bile duct during warm and cold iscbemia in non-heart-beating donor since January 2006. Urokinase perfusion of the artery system was conducted during graft harvesting and reperfusion at the end of graft trimming to reduce the incidence of intrahepatic diffuse biliary stricture. Results Among 21 patients with intrahepatie diffuse and mixed type biliary stricture, 16 patients underwent liver retransplantation, and the other 5 patients died of primary graft failure while waiting for retransplantation. The incidence of intrahepatic diffuse biiiary stricture was 5.9% in non-urokinase perfusion group. On the contrary, the incidence rate of intrahepatie diffuse biliary stricture was 1.4% in urokinase perfusian group (x2 = 5.98, P < 0. 05). Conclusions Liver retransplantation is effective for refractory biliary stricture in liver transplant recipients. The incidence of intrahepatic diffuse biliary stricture is reduced in non-heart-beating donor by using urokinase perfusian.

Objective To summarize the experience of emergency orthotopic liver transplantation (EOLT) in fulminant hepatic failure (FHF).Methods The clinical date of 4 cases of FHF successfully subject to EOLT were retrospectively analyzed.Results Four patients’ consciousness completely recovered in 12 to 48 h after operation, no surgical complication occurred; Acute rejection postoperatively occurred in 2 patients and reversed after treatment. Now 4 patients were survived for 38, 17, 11, 7 months respectively with good liver function, and 3 of them went to work again.Conclusion EOLT is an effective means to cure FHF. Choosing appropriate perioperative management and (operative) timing is essential to improve the successful rate of EOLT.

Objective To investigate the clinical efficacy and the influence on T cell subsets of telbivudine in the treatment of HBeAg -positive chronic hepatitis B , guide clinical treatment .Methods 70 patients HBeAg -positive chronic hepatitis B in our hospital were randomly divided into the telbivudine group which were received telbi -vudine 600mg/d and lamivudine group which were received lamivudine 100mg/d,35 cases of each group ,both group had been treated for 48 weeks,the liver function (ALT,AST) were detected for making a statistics of ALT normaliza-tion,the serum were extracting for detecting HBV -DNA and making a statistics of HBV -DNA negative rate by PCR,the HbeAg were detected for making a statistics of HBeAg seroconversionby ECLIA ,T cell subsets ( CD3+,CD4+, CD8+,CD4+/CD8+) were detected by flow cytometry ,observed adverse events .Results The ALT,AST,HBV-DNA of the telbivudine group and lamivudine group after treatment were (36.04 ±7.62)U/L and (63.53 ±14.13)U/L, (34.26 ±8.51)U/L and (55.31 ±15.48)U/L,(2.22 ±0.73)copies/mL and (3.28 ±0.95)copies/mL,all indi-cators significantly lower than before treatment (t =24.826,18.564,7.495 and 17.413,13.331,5.442,all P<0.05),and the ALT,AST of the telbivudine group were significantly lower than the lamivudine group ( t=3.867, 3.774,3.498,all P<0.05).The ALT normalization,HBV-DNA negative rate,HBeAg seroconversion rate of the telbivudine group and lamivudine group were 97.14%and 74.29%,94.29%and 68.57%,62.86%and 37.14%, telbivudine group,the telbivudine group were significantly higher than that of lamivudine group (χ2 =7.467,7.652, 4.629,all P<0.05).The CD3+,CD4+,CD4+/CD8+of telbivudine group and lamivudine group after treatment were (66.3 ±3.8)%and (60.6 ±3.5)%,(38.8 ±5.4)% and (35.2 ±4.4)%,(1.33 ±0.16)% and (0.95 ±0.11)%,all indicaitons significantly higher than before treatment ( t =5.442,6.173,3.753 and 3.404,3.635, 3.222,all P <0.05),the telbivudine group were significantly higher than lamivudine group (t =3.473,3.207, 3.422,all P<0.05).Conclusion The telbivudine has better efficacy than the lamivudine in the treatment of HBeAg-positive chronic hepatitis B because of enhancing immune function ,can improves ALT normalization ,HBV-DNA negative rate and HBeAg seroconversion rate ,inhibit HBV replication .

Objective To investigate the fall-related knowledge and behaviors and ways after injury by chief caregivers of inpatients with neurological disease.Method We designed a questionnaire of fall-related knowledge,behaviors and ways after injury and used it among 208 chief caregivers of inpatients with neurological disease.Results On fall-related knowledge,the three items with the lowest scores about fall-related knowledge included fall-related medicine,postural hypotension and abnormal excretion.Of fall-prevented behaviour score,the lowest 3 items were three steps for getting up,placing things correctly and using wheelchair protection derive.Of the inquiry and fall measures score,the lowest 3 item were helping the patient up,observation and prevention after fall.There were significant differences in the total scores on education,time for taking care of the patients,history of fall and health education on fall (P＜0.05).The scores of those with education of senior middle school,college or above were significantly higher than those with education of junior middle school or lower (P＜0.001).The following time for taking care of the patients were compared with statistics significant:＜1month and 3～6 month,＜1month and ＞6 months,1～3 months and 3～6 months (P＜0.001).Conclusion The caregivers of the patients with neurological disease are short of knowledge in fall-related knowledge,normal behaviors and should carry out individualized health education to them.

BACKGROUND: Immunonutrition therapy can increase the synthesis of proteins with shorten half-life, regulate the local and whole body cytokines production, make the intestinal structure and functional integrity, up-regulate the immunity-inhibiting after operation through the improvement of cellular immune function. It has been proved that the appropriate nutritional therapy during perioperative period can improve the patients' immune function; however, enteral immunonutrition (EIN) in patients undergoing liver transplantation is rarely reported. OBJECTIVE: To evaluate the safety and effectiveness of EIN therapy during liver transplantation.METHODS: Eighty-four patients undertaking liver transplantation were randomly divided into two groups, namely EIN group and regular enteral nutrition (EN) group (given EIN and common EN respectively). The liver function, cellular immunity, humoral immunity, infection and the incidence of rejection were monitored in order to compare the therapeutic efficacy of two kinds of nutrition therapies. RESULTS AND CONCLUSION: The serum prealbumin and cholinesterase levels were impressively higher in the EIN group at 1 day before operation than before nutritional therapy. The expressions of CD3+ and CD4+ were significantly higher in the EIN group than the EN group at 1 day before operation (P < 0.05). The recovery of cell immunity was delayed 1 week in the EN group as compared with the EIN group; at 1-28 days after operation, IgA level was higher in the EIN group than in the EN group (P < 0.05). No increase in the incidence of infections occurred in the two groups. The results suggest that the EIN can improve the cell immunity and humoral immunity with a better effect than the EN. The EIN therapy is necessary for the rehabilitation of patients undergoing liver transplantation at the perioperative stage.

Objective To evaluate short-term clinical effects of modified total pelvic floor reconstruction surgery in treatment of severe pelvic organ prolapse.Methods Thirty-nine cases with severe pelvic organ prolapse including vault prolapse diagnosed by pelvic organ prolapse quantification (POP-Q) system received modified total pelvic floor reconstruction surgery.Clinical parameters associated peri-operative period and 12 months after surgery and complications were analyzed Results Median operation time was 70 minutes (30-240 minutes),median blood loss was 100 ml (10-200 ml).Seventy-seven percent (30/39) patients were able to micturate spontaneously in the next morning after surgery with postvoid residual volume less than 100 ml (0-650 ml).No severe intra-operative complications were recorded and the rate of postoperative morbidity was 20% (8/39 ).Median post-operative hospital stay was 4 days (1-11 days).The patients were followed up at median 24 months(13-29 months).According to POP-Q system evaluation,the successful rate of operation reached 100% .Two cases (5%,2/39) were recorded as symptomatic recurrence which manifested as posterior wall prolapse within 24 months after operation.During follow-up,8% (3/39) patients were found to have erosion within 7 months after surgery,and urgent urinary incontinence was observed in 5% (2/39) cases,while constipation occurred in 8% (3/39) cases.The most remarkable complication was dyspareunia (36%,5/14); while 50% (7/14) experienced better sexual life after surgery.Conclusions Modified total pelvic reconstruction is a safe,efficient and micro-invasive surgery in treatment of severe pelvic organ prolapse.However,its influence on post-operative sexual life should be concerned.

Objective To compare everolimus (EVR) with calcineurin inhibitor (CNI) minimization or withdrawal on renal function of liver transplant patients with standard CNI therapy.Methods A search was conducted on databases which included the PubMed,Embase and Cochrane library for randomized controlled trials (RCTs) comparing EVR with CNI with minimization or withdrawal (the EVR group) with standard CNI therapy (the standard CNIs group) on renal function of liver transplant patients.A metaanalysis was performed using RevMan 5.3 software.Results Five RCTs which included 1 264 patients were selected into this study.There were 790 patients in the EVR group and 474 patients in the standard CNIs group.On meta-analysis,the EVR group had significantly better renal function (SMD =0.36,95％ CI 0.09 ～ 0.64,P ＜ 0.05),but higher rates of infection (RR =1.37,95％ CI 1.08 ～ 1.74,P ＜ 0.05),dyslipidemia (RR =2.46,95％ CI 1.79 ～ 3.38) and leukopenia (RR =2.37,95％ CI 1.32 ～ 4.26).No significant differences were found on the mortality and the acute rejection rates between the two groups (all P ＜ 0.05).Conclusions EVR with CNI minimization or withdrawal after liver transplantation provided effective immunosuppression and improved patients' renal function.The treatment increased the rates of infection,dyslipidemia and leukopenia.

Objective To discuss the feature of transient intrahepatic cholestasis in early stage of orthotopic liver transplantation. Methods Based on the review of early (within 1 month) postoperative hyperbilirubinemia in consecutive 200 patients undergoing liver transplantation, we summarized the occurrence, development and outcome of early postoperative intrahepatic cholestasis. Results Early transient intrahepatic cholestasis was identified in 112 patients. The characteristic of early intrahepatic cholestasis is that DBIL and?-GT increasingly elevated from the second or third day postoperatively, with a peak on the 7 - 14th d, then descended to normal level on approximately 21 -28th day. The average peak level of DBIL and?-GT were( 157. 32?82. 08)?mol/L and (172?80) IU/L respectively. During the period of DBIL and?-GT ascending, AST and ALT kept descending, and within 1 week it could fall to normal level. Acute rejection, drug toxicosis and bile duct obstruction were excluded. Conclusions Postoperative early transient intrahepatic cholestasis associated with ischemia-reperfusion injury has its special clinical process and most patients recover themselves without the need for special therapy.