Adult ; Cytomegalovirus ; Cytomegalovirus Infections ; complications ; Drug Hypersensitivity Syndrome ; complications ; virology ; Eosinophilia ; complications ; virology ; Fatal Outcome ; Female ; Gout ; drug therapy ; Hepatitis ; complications ; virology ; Humans ; Liver ; physiopathology ; Viremia

OBJECTIVETo evaluate the efficacy and safety of Chinese medicine (CM) in treating infantile cytomegalovirus hepatitis (ICH).

METHODSA total of 100 infant ICH patients were randomly assigned to two groups, 60 in the treatment group and 40 in the control group. Ganciclovir was administered to all patients via intravenous dripping at dose of 5 mg/kg every 12 h for 2 weeks, followed by 5 mg/kg once a day for 5 days every week; the whole treatment course lasted 8 weeks. Besides, the patients in the treatment group were treated with CM of Qinggan Lidan Decoction (, QLD) during icteric stage, and Yigan Jiangmei Decoction (, YJD) in non-icteric hyper-aminotransferase stage by oral medication, while for those in the control group, glucurolactone 50 mg was given three times per day. The efficacy of treatment was evaluated at the ends of 2nd, 4th and 8th weeks, respectively. And a follow-up study was carried out for 6-24 months.

RESULTSThe total effective rate was 95.0% (57/60) in the treatment group and 77.5% (31/40) in the control group; the overall curative effect in the former was superior to that in the later, showing a significant difference (P=0.021). Cholestasis and liver function were improved in both groups, and the effect of reducing serum bilirubin level in the treatment group was more rapid and extensive than that in the control group, which could reduce the post-hepatitis cirrhotic risk caused by long-term cholestasis and liver cell damage.

CONCLUSIONThe therapeutic efficacy of integrated CM and Western medical drug therapy, by using QLD during icteric stage and YJD in nonicteric hyper-aminotransferase stage, was significantly higher than that of routine Western medical treatment alone; it was an ideal project for the treatment of infantile cytomegalovirus hepatitis.

Alanine Transaminase ; Bilirubin ; blood ; Cytomegalovirus Infections ; drug therapy ; enzymology ; physiopathology ; virology ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; adverse effects ; therapeutic use ; Female ; Follow-Up Studies ; Ganciclovir ; therapeutic use ; Hepatitis ; drug therapy ; enzymology ; physiopathology ; virology ; Humans ; Infant ; Liver Function Tests ; Male ; Medicine, Chinese Traditional ; Treatment Outcome

OBJECTIVETo study the significance of plasma D-dimer and von Willebrand factor (vWF) and the therapeutic effect of compound glycyrrhizin in children with cytomegalovirus (CMV) hepatitis.

METHODSTwenty healthy children, 16 asymptomatic cases with CMV infection and 52 cases of CMV hepatitis (21 cholestatic and 31 non-cholestatic) were enrolled. The 52 children with CMV hepatitis were randomly administered with conventional treatment alone or conventional treatment plus compound glycyrrhizin treatment. Plasma D-dimer and vWF levels were measured before and after treatment.

RESULTSPlasma D-dimer and vWF levels in the CMV hepatitis group were markedly higher than those in the healthy control and asymptomatic CMV infection groups (P<0.01). The cholestatic hepatitis group had more increased plasma D-dimer and vWF levels compared with the non-cholestatic hepatitis group (P<0.01). Plasma D-dimer and vWF levels in the CMV hepatitis group were markedly reduced after conventional or compound glycyrrhizin treatment (P<0.01). Compound glycyrrhizin treatment decreased more significantly plasma D-dimer and vWF levels compared with the conventional treatment in children with CMV hepatitis (P<0.01).

CONCLUSIONSThe detection of plasma D-dimer and vWF is useful in the early assessment of liver damage in children with CMV hepatitis. Compound glycyrrhizin can decrease obviously plasma D-dimer and vWF levels and might thus provide protective effects against liver damage.

Child, Preschool ; Cytomegalovirus Infections ; blood ; drug therapy ; physiopathology ; Female ; Fibrin Fibrinogen Degradation Products ; analysis ; Glycyrrhizic Acid ; pharmacology ; therapeutic use ; Hepatitis, Viral, Human ; blood ; drug therapy ; physiopathology ; Humans ; Infant ; Liver Circulation ; Male ; von Willebrand Factor ; analysis

Despite the prophylaxis and preemptive strategies using potent antiviral agents, cytomegalovirus (CMV) remains a major infectious cause of morbidity and mortality in allogeneic stem cell transplantation (SCT) recipients. Delayed immune reconstitution after SCT, such as cord blood and T-cell depleted SCT with the use of alemtuzumab, has been associated with an increased frequency of CMV disease as well as CMV reactivation. CMV disease involving central nervous system is an unusual presentation in the setting of SCT. We report a case of CMV ventriculoencephalitis after unrelated double cord blood SCT with an alemtuzumab-containing preparative regimen for Philadelphia-positive acute lymphoblastic leukemia.
Antibodies, Monoclonal/pharmacology/*therapeutic use ; Antibodies, Monoclonal, Humanized ; Antibodies, Neoplasm/pharmacology/*therapeutic use ; Antineoplastic Agents/pharmacology/*therapeutic use ; Cord Blood Stem Cell Transplantation/*adverse effects ; Cytomegalovirus/drug effects ; Cytomegalovirus Infections/*drug therapy/*etiology/physiopathology ; *Encephalitis/etiology/pathology/virology ; Fatal Outcome ; Humans ; Male ; *Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications/drug therapy/virology ; Transplantation Conditioning/methods

Cytomegaloviral hepatitis is an infantile liver disease commonly encountered in China, which could be differentiated into 4 patterns with different clinical conditions. Along with the progress of laboratory diagnostic techniques, multiple diagnostic approaches are available for this disease, but accurate diagnosis can only be made when individual patients' realities are taken into consideration. Clinical treatments are various, and the Western medicine used is mainly anti-viral agents such as Ganciclovir, and so far no unified therapeutic program has been formed. More and more ways of regarding Chinese medicine treatment of cytomegaloviral hepatitis have been published increasingly in recent years, though further research to seek preferable treatment programs is still expected.
Cytomegalovirus Infections ; complications ; diagnosis ; immunology ; therapy ; Diagnostic Techniques and Procedures ; trends ; Drugs, Chinese Herbal ; therapeutic use ; Hepatitis, Viral, Human ; diagnosis ; etiology ; immunology ; therapy ; Humans ; Immune System ; physiology ; physiopathology ; Infant ; Medicine, Chinese Traditional ; methods ; trends ; Professional Practice ; Western World

OBJECTIVETo evaluate the effect of cytomegalovirus (CMV) infection following kidney transplantation on long-term renal function and its mechanism.

METHODSNinety-six patients undergoing kidney transplantation between March 2000 and December 2005, who completed a 3-year follow-up investigation, were divided into 3 groups according CMV-pp65 antigenemia and clinical symptoms. Group A consisted of 33 recipients with symptomatic active CMV infection, group B included 33 with asymptomatic active CMV infection and group C included 30 with inactive infection. The relation of CMV infection, transforming growth factor-beta1 (TGF-beta1) mRNA in the peripheral blood mononuclear cells (PBMCs) and serum creatinine (Scr) were analyzed, and the grafts in 6 cases with renal dysfunction were biopsied.

RESULTSThe expression of TGF-beta1 mRNA in PBMCs was significantly higher in group A than in the other two groups 6 months after the transplantation (P<0.01), while Scr levels showed no significant difference between the 3 groups (P>0.05). Three years later, Scr levels in group A were significantly increased as compared with those in the other two groups (P<0.01), and the rate of renal dysfunction in group A (10/33) was significantly higher than those in group B (3/33) and C(3/30) (P<0.05). In the 16 with renal dysfunction, the expression of TGF-beta1 mRNA in PBMCs significantly higher than that in the other 80 patients with normal renal function (P<0.01). Renal allograft biopsies demonstrated mild or severe interstitial fibrosis, tubular atrophy and mononuclear cell infiltration in the 6 patients with renal graft dysfunction, supporting the diagnosis of chronic allograft nephropathy (CAN).

CONCLUSIONSymptomatic active CMV infection in renal allograft recipients is an important factor contributing to the occurrence of CAN. Monitoring of TGF-beta1 mRNA expression in PBMCs proves useful in identifying patients at risk of CAN.

Adult ; Creatinine ; blood ; Cytomegalovirus Infections ; blood ; metabolism ; physiopathology ; Female ; Humans ; Kidney ; metabolism ; physiopathology ; virology ; Kidney Transplantation ; Leukocytes, Mononuclear ; metabolism ; Male ; RNA, Messenger ; genetics ; metabolism ; Transforming Growth Factor beta1 ; genetics ; Transplantation, Homologous

INTRODUCTIONThe status of heart transplantation in Singapore is reviewed in this article.

MATERIALS AND METHODSThe database of 40 consecutive heart transplantations from July 1990 through December 2007 is reviewed retrospectively. The data is compared with the 2008 registry data of the International Society for Heart and Lung Transplantation (ISHLT).

RESULTSThe average age of recipients was 45.3 years. Ages ranged from 14 to 64 years. Ischaemic cardiomyopathy (52.5%) and dilated cardiomyopathy (42.5%) were the major indications. From 1990 to 1999, 50% of the donors sustained brain death from road traffic accident, 25% from cerebrovascular accident and 25% from falling from height, whereas the cause of brain death in the donors from 2000 to 2007 was 33%, 47% and 9.5%, respectively. The average donor age increased from 28.3 to 38.1 years. The significant morbidities in the recipients were hypertension, cytomegalovirus (CMV) infection, cardiac allograft vasculopathy and renal dysfunction. Thirtytwo required treatment for hypertension. 67.5% developed CMV disease requiring treatment. Cardiac allograft vasculopathy was diagnosed in 10. Rising creatinine levels reaching over 2.5 mg/dL was seen in 7. Three required renal dialysis. Epstein-Barr virus related lympho proliferative disorder occurred in 2 patients. One patient developed adenocarcinoma of stomach. The 30-day mortality was 10% and half life was 10 years. Cardiac allograft vasculopathy and sepsis caused 41.7% of mortality each. 11.7% of the mortality was due to cerebrovascular accident.

CONCLUSIONThe status of heart transplantation in Singapore is comparable to the ISHLT registry data. Transplant provides excellent early survival of 80%; however, the expected half life is around 10 years after cardiac transplantation. The late mortality is mainly caused by cardiac allograft vasculopathy (CAV) and renal failure. More effort and research needs to be directed towards these issues to improve the long-term results.

Adolescent ; Adult ; Cytomegalovirus Infections ; Female ; Graft Rejection ; epidemiology ; Heart Failure ; etiology ; physiopathology ; surgery ; Heart Transplantation ; mortality ; utilization ; Humans ; Immunosuppression ; Male ; Middle Aged ; Retrospective Studies ; Singapore ; epidemiology ; Tissue and Organ Procurement ; Transplantation, Homologous ; Young Adult

Acute Disease ; Child ; Cytomegalovirus Infections ; drug therapy ; physiopathology ; Humans ; Liver ; physiopathology ; Liver Diseases ; drug therapy ; physiopathology ; Measles ; drug therapy ; physiopathology ; Prognosis ; Rotavirus Infections ; drug therapy ; physiopathology ; Virus Diseases ; drug therapy ; physiopathology

Cytomegalovirus Infections ; physiopathology ; Female ; Hepatitis, Viral, Human ; physiopathology ; Humans ; Infant ; Kidney ; physiopathology ; Male

OBJECTIVETo study the changes of p38MAPK expressions, the frequency of apoptosis and the distribution of cell cycle of hunan Glioma U251 cells after HCMV infection.

METHODSThe expression of total p38 (both phosphorylated and nonphosphorylated p38) and phosphorylated p38 in U251 cells were detected by Western blotting at 15 min, 30 min, 1 h, 6 h, 10 h, 16 h, 24 h, 36 h and 48 h after HCMV infection. The apoptosis percentage and the cell cycle distribution of U251 cells at 2 d, 5 d and 7 d after HCMV infection were detected by flow cytometry (FCM).

RESULTSThe results of Western blotting demonstrated that a strong increase in phosphorylated p38 was detected from 6 h to 10 h after HCMV infection, with mean gray scales 186.33 +/- 7.51 (t = 5.37, P < 0.01) and 188.00 +/- 7.02 (t = 5.26, P < 0.01 for all) at 6 h and 10 h, respectively, and p38 phosphorylation decreased to the basic level at 16 h after HCMV infection. But the overall levels of p38 protein were not significantly altered during the course of infection. FCM analysis showed that HCMV could significantly increase the apoptotic rates of U251 cells compared with controls (t = 10.84, P < 0.01), and the apoptotic percentages of the cells reached to peak [(10.18 +/- 1.24)%] at 5 d after HCMV infection. The data of FCM showed that HCMV could decrease the number of U251 cells in G1 phase and arrest the cells in S and G2 phase. The numbers of G1 phase U251 cells were significantly lowered to (56.50 +/- 2.57)% (t = 26.45, P < 0.01), (62.33 +/- 2.64)% (t = 21.20, P < 0.01) and (67.45 +/- 4.44)% (t = 10.61, P < 0.01), respectively at 2 d, 5 d and 7 d after infection.

CONCLUSIONHCMV could activate p38MAPK pathway and trigger apoptosis and interfere cell cycle in U251 cells.

Apoptosis ; Blotting, Western ; Cell Cycle ; Cell Line, Tumor ; Cytomegalovirus ; isolation & purification ; Cytomegalovirus Infections ; metabolism ; physiopathology ; Flow Cytometry ; Glioma ; metabolism ; microbiology ; pathology ; Humans ; MAP Kinase Signaling System ; Phosphorylation ; p38 Mitogen-Activated Protein Kinases ; metabolism