ObjectivesTo assess the quality of clinical practice guidelines for transplantation in 2017. MethodsPubMed, NICE, NGC, NCCN, SIGN, CMA Infobase and GIN databases were searched online to collect guidelines for transplantation published in 2017. Guidelines were then assessed by using the AGREE Ⅱ instrument. ResultsA total of 10 guidelines were included. The result of assessments by the AGREE Ⅱ instrument showed a clear discrepancy among domains (P=0.001). Satisfactory scores were found in domains of " scope and purpose”, " clarity of presentation” and " overall score”, where the average scores were 90.8% (95%CI 83.5% to 98.1%), 82.5% (95%CI 72.7% to 92.3%) and 75.6% (95%CI 66.6% to 84.6%), respectively. Low scores were found in domains of " stakeholder involvement” and " applicability”, in which a score of 40.0% (95%CI 32.4% to 47.6%) and a score of 27.8% (95%CI 11.2% to 44.5%) were achieved, respectively. ConclusionsThere is a clear discrepancy among domains of global clinical practice guidelines for transplantation in 2017. Guidelines in this field should be improved in " stakeholder involvement” and " applicability”.
Objective To investigate the mechanism of AMP-activated protein kinase (AMPK) in hepatic ischemia-reperfusion injury (HIRI). Methods ① Grouping. Forty-two mice were randomly divided into Sham group, 4 ischemia reperfusion (IR) group of different times (2, 6, 12, and 24 h), Compound C group, and Compound C+repamycin (Rapa) group, each group enrolled in 6 mice. Compound C group: mice were modeled at 1 h after intraperitoneal injection of Compound C (25 mg/kg). Compound C+Rapa group: mice were modeled at 1 h after intraperitoneal injection of rapamycin (1 mg/kg) and Compound C (25 mg/kg). Mice of 4 IR groups, Compound C group, and Compound C+Rapa group were used to prepare HIRI model. Mice of Sham group were treated only for laparotomy, freeing the first portal hepatis and closing peritoneal. ② To filter the best IR time. The levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the serum of mice in Sham group and IR groups of 4 different reperfusion time points were measured. The pathological changes of liver tissues were observed by HE staining, and the expressions of related proteins in liver tissue of mice were detected by Western blot. Considering the results of blood biochemical test, HE staining, and Western blot together to determine the best IR point. ③ The exploration of signal pathway for AMPK. The expressions of proliferating cell nuclear antigen (PCNA) were observed by immunohistochemical staining in the liver tissues of IR-12 h group, Compound C group (12 h after IR) and compound C+Rapa group (12 h after IR). The mitochondrial damage was observed by rhodamine 123 staining, and the apoptotic status of liver cells was detected by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling assay (TUNEL). Results ① The 12 h after IR was the best observation time point. Compared with IR-12 h group, the levels of ALT and AST in Sham group, IR-2, 6, and 24 h groups were lower (P<0.05). HE staining showed that liver tissue destruction in IR-12 h group was the most severe. Western blot showed that, expressions of AMPKα, phosphorylated adenylate activated protein kinase α (p-AMPKα), Nip3-like protein X (Nix), BCL-2 homologous water-soluble protein (Bax), as well as ratio of autophagy microtubule-associated protein light chain 3 (LC3)Ⅱto LC3Ⅰof Sham group, IR-2, 6, and 24 h group were all lower than those of IR-12 h group (P<0.05), but the expressions of phosphorylated mammalian target of Rapa (p-mTOR) of Sham group, IR-2, 6, and 24 h group were all higher (P<0.05). Therefore, 12 h after IR was the best time to observe. ② Compared with IR-12 h group, the expression level of PCNA protein in liver tissue of Compound C group was lower (P<0.05), the mitochondrial luminescence intensity was weaker and the apoptotic cells were more. Compared with Compound C group, the expression of PCNA protein in the liver tissue of the Compound C+Rapa group was higher (P<0.05), the mitochondrial intensity was stronger and the apoptotic cells were less. ③ Compared with IR-12 h group, the expressions of Nix and p-AMPKα, and ratio of LC3Ⅱ to LC3Ⅰ in liver tissue of Compound C group decreased (P<0.05), while the expressions of p-mTOR, Caspase-3, and Cleaved Caspase-3 increased (P<0.05). Compared with Compound C group, the expressions of p-AMPKα and Nix in the liver tissue of Compound C+Rapa group increased (P<0.05), while the expressions of p-mTOR, Caspase-3, and Cleaved Caspase-3 decreased (P<0.05). Conclusion During the HIRI in mouse, AMPK regulates mitophagy and apoptosis through the mTOR/Nix pathway.
Objective To analyze the clinical characteristics of adverse drug reaction (ADR) caused by 3 kinds of coronavirus disease 2019 drugs, and provide a reference for clinical safe medication. MethodsA total of 33 patients with coronavirus disease 2019 admitted to Xiangtan Central Hospital from January 20 to March 5, 2020 were selected as the research objects. The clinical data of patients with ADR during the antiviral process were analyzed retrospectively. The patients’ gender, age, type of medication, combination medication, organs or systems involved, and clinical manifestations were summarized and analyzed. Results A total of 33 patients were enrolled. A total of 21 cases of ADR were reported. The incidence of ADR is higher in patients older than 60 years (80.0%). The most common clinical manifestations are digestive tract symptoms (66.7%). The incidence of ADR is highest in the combination of lopinavir/ritonavir+arbidol+ribavirin (100.0%), followed by the combination of lopinavir/ritonavir+arbidol (85.7%). Abidol and ribavirin each caused 1 case of severe ADR. Conclusion For patients with coronavirus disease 2019, the combination of two or more antiviral drugs should be avoided, and pharmaceutical monitoring should be strengthened for elderly, severe/critical and allergic patients.
Objective To observe the recovery of recipients with complex portal vein thrombosis (CPVT) underwent “multiple to one” anastomosis and patency of portal vein blood flow during liver transplantation, and to ensure the reliability of this method. MethodsThe clinicopathologic data of the recipients with CPVT underwent “multiple to one” anastomosis in the Beijing Friendship Hospital, Capital Medical University were collected retrospectively. The “multiple to one” portal vein reconstruction was defined as the anastomosis of multiple vessels of portal venous system with the portal vein of graft, or the anastomosis that connected the blood vessel of portal venous system and the left renal vein/inferior vena cava to the portal vein of graft. ResultsA total of 5 patients were collected, including 1 patient with Yerdel grade 3 thrombosis and 4 patients with Yerdel grade 4 thrombosis. In 3 cases, the left renal vein, inferior vena cava, left renal vein were combined with the parabiliary vein, respectively, in the anastomosis to the donor portal vein. In another 2 cases, portal vein and left renal vein were combined with gastric coronary vein, respectively, in the anastomosis to the donor portal vein. During the follow-up period of 162–865 d, all patients had the stable portal vein blood flow without any symptom of portal hypertension. One patient had thrombosis at the anastomosis with varicose vein, while the anastomosis with left renal vein was unobstructed, which did not affect the donor liver function. ConclusionMultiple blood supply of portal vein is established after “multiple to one” anastomosis, and stability of portal vein blood flow can be maintained after a blood redistribution of portal venous system following liver transplantation.
Objective To analyze the clinical data of patients with Tropheryma whipplei pneumonia, and summarize the clinical characteristics, diagnosis, and treatment methods of Tropheryma whipplei pneumonia. Methods The data of Tropheryma whipplei pneumonia patients from three hospitals in Hunan Province between January 1, 2021 and October 1, 2022 were retrospectively collected. The clinical symptoms, laboratory examination, metagenomics next-generation sequencing (mNGS), CT imaging features, diagnosis and treatments of the included patients were analyzed. Results A total of 4 patients were included. Among them, there were 2 males and 2 females. The main manifestations were cough, expectoration, fever, and shortness of breath. There were 2 cases of diffuse ground glass opacity in both lungs, 1 case of pulmonary nodule, 1 case of pulmonary cavity, 1 case of pleural disease, 2 cases of pulmonary exudative lesions, and 1 case of mediastinal lymphadenectasis. The mNGS results showed that Tropheryma whipplei was detected in all 4 patients, and the median number of serial number (lower quartile, upper quartile) was 1 528 (1 480, 1 576). After anti infection treatment, 3 cases were treated effectively, and 1 case had poor treatment effect. Conclusions mNGS is an effective method to diagnose Tropheryma whipplei pneumonia. The measurement of serum lactate dehydrogenase level is helpful to evaluate the disease and determine the prognosis. Piperacillin tazobactam, meropenem and doxycycline are effective for this disease, while moxifloxacin and trimethoprim / sulfamethoxazole are not recommended because they may be naturally resistant. Without active etiological treatment, the disease may persist in migration and lead to extrapulmonary involvement.
Objective To explore the causes and prognosis of liver retransplantation. Methods The clinical data of 215 cases who had underwent liver retransplantation in Tianjin First Central Hospital between Nov. 26th 2003 and May. 26th 2012 were analyzed retrospectively for its causes and prognosis. Results Two hundreds and fifteen cases were enrolled， including 200 cases of 2 times liver transplantation， 14 cases of 3 times liver transplantation， and 1 case of 4 times liver transplantation. The major causes of the second liver transplantation were biliary complication （53.5%， 115/215） and primary non-function or dysfunction of liver graft （8.4%， 18/215）， and the major causes of the third liver transplantation were biliary complication （5/14） and hepatocellular carcinoma recurrence （2/14）. The liver graft survival rate of late liver retransplantation （at least 1 month after operation） was significantly higher than that of early liver retrans-plantation （less than 1 month after operation） for the second liver transplantation （P=0.005）. The liver graft survival rate of the second liver transplantation was significantly higher than that of the third liver transplantation （P=0.043）. Compared with biliary complication， cases of hepatocellular carcinoma recurrence （P=0.001） and primary non-function or dysfunction of liver graft （P=0.033） had lower graft survival rates， while cases of chronic failure of liver graft had a higher survival rate （P=0.037）. Conclusions Biliary complication is the main cause of liver retransplantation. The liver retransplantations which are performed less than 1 month after prior liver transplantation result in a relative low survival rate in reason of the increase of perioperative death. The prognosis of liver retransplantation for hepatocellular carcinoma recurrence is unacceptable， while cases of chronic failure of liver graft have optimal prognosis.
ObjectiveTo investigate the effect of perioperative intravenous immunoglobulin (IVIG) on the reduction of blood group antibody titer and prognosis in children with ABO incompatible (ABO-I) liver transplantation.MethodsA retrospective study was conducted in 20 children undergoing ABO-I liver transplantation in Beijing Friendship Hospital Affiliated to Capital Medical University from July 2017 to March 2020. The changes of blood group antibody titer, alanine aminotransferase, and total bilirubin before and after operation, as well as survival rate were analyzed after intravenous IVIG during perioperative period.ResultsAfter ABO-I liver transplantation, the 1-year survival rate of 20 patients was 100%, and 1 case (5%) developed immune rejection. Compared with before operation, on the day of operation, IgM blood group antibody titer did not change in 4 cases (20%), increased in 1 case (5%), and decreased in 15 cases (75%); in one week after operation: 12 cases (60%) decreased, 5 cases (25%) increased, and 3 cases (15%) remained unchanged; in one month after operation: 18 cases (90%) decreased , 2 cases (10%) remained unchanged. Compared with before operation, the titer of IgG blood group antibody increased in 2 cases (10%), remained unchanged in 6 cases (30%), and decreased in 12 cases (60%); in one week after operation: 4 cases (20%) increased, 4 cases (20%) remained unchanged, and 12 cases (60%) decreased; in one month after operation: 3 cases (15%) increased, 4 cases (20%) remained unchanged, and 13 cases (65%) decreased. The levels of alanine aminotransferase and total bilirubin in 1 month after operation were lower than those on the day of operation.ConclusionThe effect of IVIG on reducing blood group antibody titer in children after ABO-I liver transplantation is not obvious, and its actual clinical effect needs to befurther confirmed.