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Chun-Hua Yang,
Xiao-Shun He,
Juan Chen,
Bin Ouyang,
Xiao-Feng Zhu,
Min-Ying Chen,
Wen-Feng Xie,
Li Chen,
Dong-Hua Zheng,
Yun Zhong,
Xue-Xia Chen,
Xiang-Dong Guan
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ABSTRACT: Background: Fungal infections after liver transplantation have received considerable interests because of their association with substantial morbidity and mortality. This study investigated risk factors of fungal infection after liver transplantation. Material/Methods: Retrospective analysis was performed based on clinical data from 120 patients with fungal infection after liver transplantation from January 1, 2003 to May 30, 2012. 2 test was used to analyze risk factors for fungal infections. Results: The fungal infection rate after liver transplantation is 13.5% (120/886) and the case fatality rate reaches 70.8%; most are infected by Candida albicans (67.5%), with infection located in the lung (73.3%). Acute physiology and chronic health evaluation scores of the infected group are higher than those of the control group 24 hours after the surgery (27.1±5.2 vs. 21.9±5.0). The percentage of primary liver cancer patients in the infected group was lower than in the control group (26.7% vs. 45.8%). Compared to the control group, the infected group had a higher percentage of patients with HBV, gestational diabetes mellitus, and multiple organ dysfunction syndrome. Percentages of patients with long continuous parenteral nutrition time, poorly controlled high blood sugar, long-term mechanical ventilation, and antibiotics use were higher in the infected group than in the control group. Conclusions: Preoperative original attack, postoperative critical condition, chronically high blood sugar, long-term use of antibiotics, and mechanical ventilation are probably vital risk factors for fungal infection after liver transplantation.
Annals of transplantation: quarterly of the Polish Transplantation Society 12/2012; 17(4):59-63. · 2.02 Impact Factor
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Chun-hua Yang,
Xiao-shun He,
Juan Chen,
Bin Ouyang,
Xiao-feng Zhu,
Min-ying Chen,
Wen-feng Xie,
Li Chen,
Dong-hua Zheng,
Yun Zhong,
Xue-xia Chen,
Xiang-dong Guan
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ABSTRACT: To explore the risk factors of fungal infection so as to provide rationales for the prevention of fungal infection after liver transplantation.
The clinical data of 94 cases of fungal infections after liver transplantation from January 1, 2003 to November 30, 2010 at our hospital were collected as the infective group. A total of 603 liver transplant patients without fungal infections during the same period were selected as the control group. χ(2) test and t test were utilized for the analysis of possible risk factors for fungal infection.
Fungal infection rate was 13.5% (94/697) after liver transplantation and mortality rate of fungal infection 86.2% (81/94). Candida albicans was the majority infective fungi. And the main site of infection was the lungs. The postoperative acute physiology and chronic health evaluation III (APACHE III) score of the infective group was significantly higher than that of the control group (26.0 ± 5.4 vs 21.5 ± 4.7, P < 0.01). The number of patients with primary liver cancer was lower than that of the control group (26.6% vs 45.8%, P < 0.01). The number of decompensated HBV cirrhosis and diabetics in the infective group was higher than that of the control group at pre-operation (23.4% vs 11.6%, 9.6% vs 2.8%, both P < 0.01). The number of patients with postoperative mechanical ventilation over 10 days, postoperative antibiotics over 14 days, postoperative cardiopulmonary dysfunction and liver function recovery time over 7 days, parenteral nutrition over 12 days and hyperglycemia over 7 days in the infective group were significantly higher than that in the control group (all P < 0.01).
Preoperative primary disease, postoperative disease severity, postoperative organ dysfunction, long-term mechanical ventilation, antibiotics and hyperglycemia, etc. may be the important risk factors of fungal infection after liver transplantation.
Zhonghua yi xue za zhi 04/2012; 92(14):980-1.
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ABSTRACT: To investigate the efficacy of immunotherapy on septic patients with Ulinastatin plus Thymosin-alpha(1).
Seventy postoperative septic patients were divided into two groups at random: the immunotherapy group (n equal to 36) and the conventional therapy group (n=34). Patients in the immunotherapy group received intravenous Ulinastatin of 200 000 U, 3 times per day for 3 days, Ulinastatin of 100 000 U, 3 times per day for 4 days, and subcutaneous injection of Thymosin-alpha(1) of 1.6 mg, twice per day for 3 days, then once per day for 4 days. While conventional therapies such as antibiotics and fluid resuscitation were undertaken in both groups. The expression levels of serum tumor necrosis factor-alpha (TNF-alpha), interleukin-10 (IL-10), IgG, C3, T lymphocyte subsets, CD14+ monocyte human leukocyte antigen (locus) DR (HLA-DR) and patients'28-day survival rate of the two groups were observed and evaluated.
The survival rate was significantly higher in the immunotherapy group (63.9%; 23/36) compared with the conventional therapy group (41.2%; 14/34). The serum TNF-alpha levels [(1.38+/-0.50) ng/ml in the immunotherapy group vs (1.88+/-0.53) ng/ml in the conventional group, P less than 0.05] and the serum IL-10 levels [(217.52+/-15.71) ng/ml vs (101.53+/-16.57) ng/ml, P less than 0.05] were significantly different between the two groups. The serum IgG levels in the immunotherapy group [(17.65+/-6.81) g/L] were significantly higher than in the conventional group [(11.94+/-5.32) g/L]. There were also significant differences in the expression levels of CD4+ T lymphocyte (35%+/-13% in the immunotherapy group vs 21%+/-7% in the conventional group, P less than 0.05) and CD14+ monocyte HLA-DR (50%+/-5% in the former vs 35%+/-4% in the latter, P less than 0.05).
Immunotherapy with Ulinastatin plus Thymosin-alpha(1) can enhance the inflammatory response, improve the immune homeostasis, and increase the survival rate of septic patients.
Chinese Journal of Traumatology (English Edition) 12/2009; 12(6):344-9.
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ABSTRACT: To study the effects of curcumin on TNF-alpha and TGF-beta1 in serum and lung tissue of SiO2-induced fibrosis in mice.
75 mice were divided into five groups. After treated with curcumin 6 and 9 mice of each group were sacrificed on day 14 and 42 respectively to take their blood and lung tissue. The level of TNF-alpha and TGF-beta1 was observed by ELISA.
The infection reaction of lung tissue and fibrosis in model group was obvious. Compared with sham operation group, TNF-alpha and TGF-beta1 in serum and lung tissue increased significantly(P<0.01), but decreased in different degrees after treated with curcumin(P<0.05).
Curcumin can decrease the level of TNF-alpha and TGF-beta1 in serum and lung tissue of SiO2-induced fibrosis in mice and have the anti-fibrosis role by deregulating cytokine level.
Xi bao yu fen zi mian yi xue za zhi = Chinese journal of cellular and molecular immunology 05/2009; 25(5):399-401.
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ABSTRACT: To assess the role of heparin administration in the early stage of sepsis and its mechanism of action.
This was a prospective study. One hundred and nineteen patients were enrolled in the study and were randomly divided into control group (64 cases) and therapy group (55 cases). Except the basic therapy of sepsis given to patients in both groups, the patients in the control group received normal saline, while the patients in the therapy group received heparin 2 mg.kg(-1).d(-1) with the aid of intravenous pump continuously after the onset of sepsis. The platelet count (PLT), D-dimer, and lactic acid in the blood were analyzed before therapy and on the 1st, 3rd, 5th and 10th day. The bleeding tendency was also observed. In every patient an acute physiology and chronic heath evaluation II (APACHE II) score was made.
Patients in both groups had a similar APACHE II score. The pathogenetic and therapeutic condition were similar in both groups. The rate of the active bleeding in the therapy group was lower significantly than that of the control group (12.5% vs. 5.4%, P < 0.05). The PLT of the therapy group decreased on the 1st day, but began to rise on the 3rd day gradually, and up to the same level of the admission day on the 10th day. The PLT of the control group decreased progressively every day (P < 0.05 or P < 0.01). D-dimer in the therapy group raised significantly on the 1st day, but lowered to normal level after 3 days. D-dimer in the control group went up progressively every day (all P < 0.01). Lactic acid in the therapy group went up significantly on the 1st day (P < 0.01), but it no longer rose after 3 days (all P > 0.05). The lactic acid level in the control group rose progressively every day (all P < 0.01). There were no significant differences for the PLT, D-dimer, and lactic acid between the two groups before therapy and on the 1st day (all P > 0.05). However, on the 3rd, 5th and 10th day, the PLT in the therapy group was significant higher than that of the control group, the D-dimer and the lactic acid level in the therapy group were significantly lower than that of the control group (P < 0.05 or P < 0.01).
The use of heparin at the earlier period of sepsis can inhibit the lowering of PLT and increase of D-dimer and lactic acid significantly, prevent microvascular thrombosis, improve the tissue perfusion, and decrease active bleeding.
Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue 10/2008; 20(9):550-2.
