Objective: To investigate the variation of functions of the heart and lung during orthotopic liver transplan- tation (OLT). Methods: Pulmonary artery cannula and right radial artery cannula were indewelled before anae...Objective: To investigate the variation of functions of the heart and lung during orthotopic liver transplan- tation (OLT). Methods: Pulmonary artery cannula and right radial artery cannula were indewelled before anaesthesia and the parameters of hemodynamics in different pe- riods were monitored. Analysis of variance was used to reveal the variation among the groups. T hypothe- sis test in paired data was used to compare the preop- erative parameters with those in each period during operation and after operation respectively, and to compare the parameters immediately after operation with those in each period after operation respective- ly. Results: During the operation, heart rate increased, but blood pressure decreased significantly at the be- ginning of no-liver period, increased again in a short period and then increased progressively 12 h after op- eration. Pulmonary artery pressure (PAP) increased from before the no-liver period to 60 h after opera- tion. Pulmonary wedge pressure changed in accord- ance with the variation of PAP. Cardiac output was maintained at a high-output level from before opera- tion to 60 h after operation. Systemic vascular resist- ance (SVR) was within the normal limits before op- eration, whereas pulmonary vascular resistance (PVR) was lower than normal. In the no-liver peri- od during the operation, SVR decreased significant- ly. Both SVR and PVR increased progressively and returned to normal postoperatively. Conclusions: The patients undergoing OLT have a high cardiac output and Iow resistance obstacle be- fore and during the operation, and will recover grad- ually after operation. Monitoring hemodynamics during the peri-operative period is of significance in the prevention and treatment of pneumonedema and cardiac functional insufficiency.展开更多
Objective: To sum up the experience in liver trans- plantation in a period of ten years at a single center. Methods: We retrospectively reviewed the clinical re- cords of 120 patients receiving liver transplantation f...Objective: To sum up the experience in liver trans- plantation in a period of ten years at a single center. Methods: We retrospectively reviewed the clinical re- cords of 120 patients receiving liver transplantation from April 1993 to October 2002. The patients' cli- nical characteristics, surgical techniques, complica- tions and survival were compared in the phases of 1993-1997 (phase Ⅰ), 1999 (phase Ⅱ), and 2000- 2002 (phase Ⅲ). Results: Malignant liver diseases were major indica- tions for liver transplantation in phase Ⅰ(100%) and Ⅱ(53. 3%), but decreased markedly in percentage in phase Ⅲ(34. 0%). When compared with recipi- ents in phase Ⅰ and Ⅱ, the survival of recipients with benign liver diseases in phase Ⅲ was significantly im- proved with the 3-month, 6-month and 1-year sur- vival rates of 85. 7%, 84. 5% and 83. 1%, respec- tively. For patients with malignant liver diseases, the 3-month, 6-month and 1-year survival rates were 87. 4%, 81. 1% and 46. 0%, respectively. The rein- fection rate of hepatitis B virus was 24% 12 months after transplantation. With technical refinements, the incidence of postransplantation vascular compli- cations has significantly decreased from 29. 4% in phase Ⅰ and Ⅱ to 4. 9% in phase Ⅲ. Biliary compli- cations remained one of the major obstacles to long- term survival. No reno-venous bypass was applied in phase Ⅲ, providing a promising outcome. Conclusion: Strict selection of potential recipients, technical refinement, appropriate management of vascular and biliary complications, and prophylaxis of recurrences of hepatitis B and malignant liver dis- eases are important to obtain long-term survival of patients receiving liver transplantation in China.展开更多
Novel non-/minimally-invasive and effective approaches are urgently needed to supplement and improve current strategies for diagnosis and management of hepatocellular carcinoma(HCC).Overwhelming evidence from publishe...Novel non-/minimally-invasive and effective approaches are urgently needed to supplement and improve current strategies for diagnosis and management of hepatocellular carcinoma(HCC).Overwhelming evidence from published studies on HCC has documented that multiple molecular biomarkers detected in body fluids and feces can be utilized in early-diagnosis,predicting responses to specific therapies,evaluating prognosis before or after therapy,as well as serving as novel therapeutic targets.Detection and analysis of proteins,metabolites,circulating nucleic acids,circulating tumor cells,and extracellular vesicles in body fluids(e.g.,blood and urine)and gut microbiota(e.g.,in feces)have excellent capabilities to improve different aspects of management of HCC.Numerous studies have been devoted in identifying more promising candidate biomarkers and therapeutic targets for diagnosis,treatment,and monitoring responses of HCC to conventional therapies,most of which may improve diagnosis and management of HCC in the future.This review aimed to summarize recent advances in utilizing these biomarkers in HCC and discuss their clinical significance.展开更多
OBJECTIVE: To investigate the gene expression of 4-1BB in peripheral blood mononuclear cells (PBMCs) and its possible significance in clinical liver transplantation. METHODS: Reverse transcription-polymerase chain rea...OBJECTIVE: To investigate the gene expression of 4-1BB in peripheral blood mononuclear cells (PBMCs) and its possible significance in clinical liver transplantation. METHODS: Reverse transcription-polymerase chain reaction (RT-PCR) was used to determine the gene expression of 4-1BB in PBMCs from 22 patients receiving liver transplantation, 13 patients with primary liver carcinoma (PLC), and 12 healthy controls. To determine whether 4-1BB molecule is also expressed on the surface of CD4^+ and CD8^+ T cell, flow cytometry was used to analyse the phenotype of T cell subsets from the blood of liver transplantation patients. RESULTS: 4-1BB mRNA was detected in PBMCs from stable survivors after liver transplantation, but almost not deteeted in PBMCs from PLC patients and healthy controls. Meanwhile, 4-1BB was almost not expressed on the surface of CD4^+ and CD8^+ T cells in healthy controls and PLC patients. A low level of 4-1BB expression, however, was found on the surface of CD4^+ and CD8^+ T cells from the stable survivors after liver transplantation. CONCLUSIONS: This study demonstrates that although patients are stable after liver transplantation, effector T-cells can also be activated through the signal of 4-1BB molecule and persistent irmmune response to grafts. Blockage of 4-1BB/4-1BBL pathway may benefitially reduce the clinical dosage of immunosuppressive agents and prolong the survival of grafts.展开更多
Hepatocellular carcinoma(HCC)is the fourth leading cause of cancer-related deaths worldwide.The prognosis of patients with HCC remains poor largely due to the late diagnosis and lack of effective treatments.Despite be...Hepatocellular carcinoma(HCC)is the fourth leading cause of cancer-related deaths worldwide.The prognosis of patients with HCC remains poor largely due to the late diagnosis and lack of effective treatments.Despite being widely used,alpha-fetoprotein serology and ultrasonography have limited diagnostic performance for early-stage HCC.The emergence of omics strategies has contributed to significant advances in the development of non-invasive biomarkers for the early diagnosis of HCC including proteins,metabolites,circulating tumor deoxyribonucleic acid,and circulating non-coding ribonucleic acid.Early diagnosis is beneficial to patients as it increases the proportion who can be treated with curative treatment,thus prolonging survival outcomes.Currently,multiple clinical trials involving locoregional,systemic therapies,and combinations of these modalities are changing therapeutic strategies for different stage HCC.Success in several preclinical trials that involve immunotherapeutic innovations has created the potential to complement and enforce other treatment strategies in the future.This review summarizes the most recent advances in noninvasive early molecular detection,current therapy strategies,and potential immunotherapeutic innovations of HCC.展开更多
Objective: To sum up the preliminary experience in living related liver transplantation (LRLT). Methods: A 9-month-old male infant with biliary atresia (BA) who had undergone an unsuccessful Kasai operation was define...Objective: To sum up the preliminary experience in living related liver transplantation (LRLT). Methods: A 9-month-old male infant with biliary atresia (BA) who had undergone an unsuccessful Kasai operation was defined as a candidate for LR- LT. The donor was his 30-year-old mother. Her la- teral lobe of the left liver was transplanted into the infant's body as the graft. The left branches of the portal vein, left hepatic artery and left hepatic vein of the graft were end-to-end anastomosed to the por- tal vein, hepatic artery proper and hepatic vein of the recipient respectively. Biliary drainage was re- established via Roux-en-Y operation. Results: The donor retained her liver function within 2 weeks after the operation. Steroid and FK506 were prescribed in immunosuppressive therapy for the re- cipient. The blood bilirubin level of the infant de- creased to normal 2 weeks after operation. No acute rejection occurred. Biliary leakage in the early peri- od after the transplantation was controlled by drain- age, and E. coli infection was effectively treated with antibiotics. The donor and recipient are in satisfacto- ry condition to the present. Conclusion: LRLT is advisable for children with bili- ary atresia.展开更多
I am Dr. Yi Zhang, from the Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University,Beijing, China. I would like to describe the metastasis in the left parotid and cervical lymph nodes of a pati...I am Dr. Yi Zhang, from the Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University,Beijing, China. I would like to describe the metastasis in the left parotid and cervical lymph nodes of a patient with bilateral retinoblastoma 72mo after the initial successful globe-preserving therapies, which included chemotherapy, laser photocoagulation, and cryotherapy.展开更多
BACKGROUND Because of atypical clinical symptoms,lymphoma is easily confused with infectious diseases.Extranodal nasal-type natural killer/T-cell lymphoma(NKTL)is more common,and there are few cases of eyelid site ons...BACKGROUND Because of atypical clinical symptoms,lymphoma is easily confused with infectious diseases.Extranodal nasal-type natural killer/T-cell lymphoma(NKTL)is more common,and there are few cases of eyelid site onset and intracranial infiltration,which increases the difficulty of diagnosis.This disease usually has a very poor prognosis and there are few reports of recovery.CASE SUMMARY A 3-year-old boy was admitted to our hospital due to an initial misdiagnosis of"eyelid cellulitis"and failed antibiotic treatment.He was characterized by fever,right eyeball bulging,convulsions,and abnormal liver function.His blood Epstein-Barr virus(EBV)DNA was positive(8.798×10^4 copies/mL),and remained positive for about half a year.The cranial imaging examination suggested a space-occupying lesion in the right eyelid,with the right temporal lobe and meninges involved.The boy underwent ocular mass resection.The pathological diagnosis was NKTL.He was diagnosed as having NKTL with intracranial infiltration,combined with chronic active EBV infection(CAEBV).Then he underwent systemic chemotherapy and intrathecal injection.The boy suffered from abnormal blood coagulation,oral mucositis,diarrhea,liver damage,and severe bone marrow suppression but survived.Finally,the tumor was completely relieved and his blood EBV-DNA level turned negative.The current follow-up has been more than 2 years and his condition is stable.CONCLUSION This case suggests that chemotherapy combined with intrathecal injection may have a good effect on intracranial infiltrating lymphoma and CAEBV,which deserves further study and discussion.展开更多
Objectives: To prevent and early diagnose hepatitis B virus reinfection and recurrent hepatitis B following liver transplantation, and to discuss the further treat- ment of recurrent hepatitis B. Methods: Liver transp...Objectives: To prevent and early diagnose hepatitis B virus reinfection and recurrent hepatitis B following liver transplantation, and to discuss the further treat- ment of recurrent hepatitis B. Methods: Liver transplantation recipients received lamivudine for prophylaxis of HBV reinfection. Viro- logical and biochemical data, serum HBV-DNA, and immunohistological staining for HBsAg and HBcAg in liver biopsy specimens were tested in due time. Results: Five patients with hepatitis B virus reinfection and two patients with hepatitis B recurrence were ob- served after liver transplantation. One patient with re- current hepatitis B developed chronic severe hepatitis B despite treatment. One patient improved after a se- ries of treatment. Conclusions: Hepatitis B virus reinfection or recurrent hepatitis B following liver transplantation occurs most- ly 6-12 months after operation. The diagnosis of hepa- titis B recurrence should be taken into account when liver biochemical data becomes poor during this pe- riod. The treatment for recurrent hepatitis B after liv- er transplantation includes increased dosage of lamivu- dine, application of famciclovir, and other liver pro- tection measures.展开更多
Objective: To investigate the expression relationship between nuclear transcription factor kappa B1 (NFκB1) and long non-coding RNA PACER (LncRNA-PACER) in peripheral blood mononuclear cells (PBMCs) of patients with ...Objective: To investigate the expression relationship between nuclear transcription factor kappa B1 (NFκB1) and long non-coding RNA PACER (LncRNA-PACER) in peripheral blood mononuclear cells (PBMCs) of patients with pulmonary tuberculosis. Methods: From February 2018 to March 2019, 40 patients with pulmonary tuberculosis (tuberculosis group) and 40 healthy persons (control group) were collected, the levels of TNF-α, IL-6 and IL-8 in serum were detected by enzyme-linked immunosorbent assay (ELISA);the expressions of LncRNA-PACER and NFκB1 mRNAs in PBMCs were detected by real-time fluorescence quantitative PCR;Western blot was used to detect the expressions of NFκB1 and COX 2 in PBMCs;Pearson method was used to analyze the expressions of LncRNA-PACER and NFκB1 in PBMCs of patients with pulmonary tuberculosis, and the expressions of LncRNA-PACER and NFκB1 in PBMCs of patients with pulmonary tuberculosis were analyzed. Results: Compared with the control group, the expressions of TNF-α, IL-6 and IL-8 in the serum of patients with pulmonary tuberculosis was significantly increased (P<0.05), and the expressions of LncRNA-PACER, NFκB1 mRNAs, proteins and COX-2 protein in PBMCs were significantly increased (P<0.05). The expressions of LncRNA-PACER and NFκB1 proteins in PBMCs were related to the number of pulmonary lesions and pulmonary cavity (P<0.05), and there was a positive correlation between the expression of LncRNA-PACER and the expression of NFκB1 mRNA in PBMCs of patients with pulmonary tuberculosis (r = 0.873, P<0.05). Conclusions: The expressions of NFκB1 and LncRNA-PACER in PBMCs of patients with pulmonary tuberculosis are significantly increased, they are positively correlated and both of them are related to the occurrence and development of pulmonary tuberculosis.展开更多
Background In this study,we aimed to analyze the clinical characteristics and prognosis of children with retinoblastoma(RB)in a single center in China with a large sample collection spanning 17 years.Methods The clini...Background In this study,we aimed to analyze the clinical characteristics and prognosis of children with retinoblastoma(RB)in a single center in China with a large sample collection spanning 17 years.Methods The clinical data of 2790 children with RB treated in Beijing Tongren Hospital from 2005 to 2021 were collected,and a retrospective analysis was conducted.Results The median age of the participants was 28.3 months.There were 3624 affected eyes,12.4%of which were in groups A–C,67.1%in groups D–E and 16.2%were not specified.The primary symptom observed in most cases was a white pupil,accounting for 66.5%,followed by strabismus(12.8%).The median follow-up time was 59.7 months.The enucleation rate was 71.3%(703/986)in a single left eye and 72.5%(702/968)in a single right eye.The overall survival(OS)rate was 95.8%(2444/2552)because 237 patients dropped out,and 109 died.Kaplan‒Meier survival analysis showed that the median survival time(MST)was 125.92 months[95%confidence interval(CI)=124.83–127.01].Cox multivariate survival analysis showed that trilateral RB(P=0.017),metastasis site(P=0.001),and combined distant tissue metastasis(P=0.001)were independent prognostic factors for RB.The OS of 44 cases of familial RB was 93.2%(41/44),with an MST of 80.62 months(95%CI=67.70–93.54).Conclusions The timing of eye protection treatment and enucleation should be comprehensively judged to avoid worsening prognosis due to operation time delay.More importantly,the promotion and popularization of diagnosis and treatment technologies are necessary to further improve RB prognosis.展开更多
Undifferentiated embryonal sarcoma of the liver (UESL) very rarely presents clinically.Approximately 1% to 4% of all solid tumors in children are malignant liver tumors,and UESL accounts for 9% to 15% of the liver tum...Undifferentiated embryonal sarcoma of the liver (UESL) very rarely presents clinically.Approximately 1% to 4% of all solid tumors in children are malignant liver tumors,and UESL accounts for 9% to 15% of the liver tumor.The onset of UESL usually occurs at 6 to 10 years of age and there is no obvious difference based on sex.[1] The first symptoms of UESL are abdominal distention and abdominal pain without jaundice,while a physical examination commonly reveals no positive vital signs except the palpable liver tumor.[1] The serum alphafetoprotein (AFP) test is not sensitive for UESL.[2] Preoperative diagnosis of UESL is very difficult.展开更多
Background: Cardiotoxicity is one of the most serious chronic complications ofanthracyclines therapy. Assessment of the left ventricular ejection fraction (LVEF) fails to detect subtle cardiac dysfunction of left v...Background: Cardiotoxicity is one of the most serious chronic complications ofanthracyclines therapy. Assessment of the left ventricular ejection fraction (LVEF) fails to detect subtle cardiac dysfunction of left ventricular (LV). This study aimed to detect and evaluate new parameters of subclinical anthracyclines' cardiotoxicity in children with solid tumor. Methods: A detailed echocardiographic examination was performed in 36 children with hepatoblastoma or rhabdomyosarcoma after receiving anthracyclines' chemotherapy and 36 healthy controls from January 2015 to December 2016. The LVEF, ratio of early diastolic peak velocity of transmitral flow (E) and septal diastolic e' mitral annular peak velocity (e'), tricuspid annular plane systolic excursion (TAPSE), and LV global longitudinal strain (GLS) were evaluated using M-mode, tissue Doppler imaging (TDI), and two-dimensional speckle tracking echocardiography (2D-STE), respectively. Echocardiographic parameters were compared between patient group and healthy controls. All patients were divided into two subgroups based on their anthracyclines' cumulative dosage (〈300 mg/m^2 subgroup and ≥300 mg/m^2 subgroup). Results: All patients had no presentation of heart failure and LVEF within normal range (65.7 ± 5.1%). Compared with healthy controls, the mean E/e' increased significantly (7.9 ±0.7 vs. 10.2 ± 3.5, t = 3.72, P 〈 0.01 ), mean TAPSE decreased significantly ( 17.2 ± 1.3 mm vs. 14.2 ± 3.0 mm, t = -4.03, P 〈 0.01), and mean LV GLS decreased significantly (-22.2% ± 1.9% vs. -17.9% ± 2.9%, t = -5.58, P 〈 0.01) in patient group. Compared with subgroup with anthracyclines' cumulative dosage 〈 300 mg/m^2, mean LV GLS decreased significantly (- 18.7 + 2.7% vs. - 16.5 ~ 2. 1%, t = 2.15, P = 0.04), the mean E/e' increased significantly (9.1 ±1.5 vs. 11.5 ± 4.9, t = -2.17, P = 0.04), and mean TAPSE decreased significantly (14.2±2.1 mm vs. 12.5±2.2 mm, t = -2.82, P = 0.02) in subgroup with anthracyclines' cumulative dosage 〉300 mg/m^2. Conclusions: LV GLS is helpful in the early detection of subclinical LV dysfunction using 2D-STE. E/e' and TAPSE are other sensitive parameters in detecting subclinical cardiac dysfunction of both ventricles by TD1. These parameters show significant change with different anthracyclines' cumulative dosage, so cumulative dosage should be controlled in clinical treatment.展开更多
Reperfusion is the key strategy in acute ST-segment elevation myocardial infarction(STEMI) care,and it is time-dependent.Shortening the time from symptom to reperfusion and choosing the optimal reperfusion strategy fo...Reperfusion is the key strategy in acute ST-segment elevation myocardial infarction(STEMI) care,and it is time-dependent.Shortening the time from symptom to reperfusion and choosing the optimal reperfusion strategy for STEMI patients are great challenges in practice.We need to improve upon the problems of low reperfusion rate,non-standardized treatment,and economic burden in STEMI care.This article briefly reviews the current status of reperfusion strategy in STEMI care,and also introduces what we will do to bridge the gap between the guidelines and implementation in the clinical setting through the upcoming China STEMI early reperfusion program.展开更多
To the Editor:Alveolar rhabdomyosarcoma(ARMS)of nasalwingwith distant metastasis has a very poor prognosis.Because it is difficult to achieve complete surgical excision of the primary site of the nasal wing,distant me...To the Editor:Alveolar rhabdomyosarcoma(ARMS)of nasalwingwith distant metastasis has a very poor prognosis.Because it is difficult to achieve complete surgical excision of the primary site of the nasal wing,distant metastasis is not easy to control.Here,we present an unusual case of a 29-month-old boy with ARMS in the left nasal wing accompanied by bone metastasis who was treated with systemic chemotherapy as well as 125I interstitial brachytherapy,and this special multidisciplinary management resulted in a perfect prognosis and mild long-term side effects.展开更多
文摘Objective: To investigate the variation of functions of the heart and lung during orthotopic liver transplan- tation (OLT). Methods: Pulmonary artery cannula and right radial artery cannula were indewelled before anaesthesia and the parameters of hemodynamics in different pe- riods were monitored. Analysis of variance was used to reveal the variation among the groups. T hypothe- sis test in paired data was used to compare the preop- erative parameters with those in each period during operation and after operation respectively, and to compare the parameters immediately after operation with those in each period after operation respective- ly. Results: During the operation, heart rate increased, but blood pressure decreased significantly at the be- ginning of no-liver period, increased again in a short period and then increased progressively 12 h after op- eration. Pulmonary artery pressure (PAP) increased from before the no-liver period to 60 h after opera- tion. Pulmonary wedge pressure changed in accord- ance with the variation of PAP. Cardiac output was maintained at a high-output level from before opera- tion to 60 h after operation. Systemic vascular resist- ance (SVR) was within the normal limits before op- eration, whereas pulmonary vascular resistance (PVR) was lower than normal. In the no-liver peri- od during the operation, SVR decreased significant- ly. Both SVR and PVR increased progressively and returned to normal postoperatively. Conclusions: The patients undergoing OLT have a high cardiac output and Iow resistance obstacle be- fore and during the operation, and will recover grad- ually after operation. Monitoring hemodynamics during the peri-operative period is of significance in the prevention and treatment of pneumonedema and cardiac functional insufficiency.
文摘Objective: To sum up the experience in liver trans- plantation in a period of ten years at a single center. Methods: We retrospectively reviewed the clinical re- cords of 120 patients receiving liver transplantation from April 1993 to October 2002. The patients' cli- nical characteristics, surgical techniques, complica- tions and survival were compared in the phases of 1993-1997 (phase Ⅰ), 1999 (phase Ⅱ), and 2000- 2002 (phase Ⅲ). Results: Malignant liver diseases were major indica- tions for liver transplantation in phase Ⅰ(100%) and Ⅱ(53. 3%), but decreased markedly in percentage in phase Ⅲ(34. 0%). When compared with recipi- ents in phase Ⅰ and Ⅱ, the survival of recipients with benign liver diseases in phase Ⅲ was significantly im- proved with the 3-month, 6-month and 1-year sur- vival rates of 85. 7%, 84. 5% and 83. 1%, respec- tively. For patients with malignant liver diseases, the 3-month, 6-month and 1-year survival rates were 87. 4%, 81. 1% and 46. 0%, respectively. The rein- fection rate of hepatitis B virus was 24% 12 months after transplantation. With technical refinements, the incidence of postransplantation vascular compli- cations has significantly decreased from 29. 4% in phase Ⅰ and Ⅱ to 4. 9% in phase Ⅲ. Biliary compli- cations remained one of the major obstacles to long- term survival. No reno-venous bypass was applied in phase Ⅲ, providing a promising outcome. Conclusion: Strict selection of potential recipients, technical refinement, appropriate management of vascular and biliary complications, and prophylaxis of recurrences of hepatitis B and malignant liver dis- eases are important to obtain long-term survival of patients receiving liver transplantation in China.
基金Supported by National Natural Science Foundation of China,No.81972726,No.81871949 and No.81572345.
文摘Novel non-/minimally-invasive and effective approaches are urgently needed to supplement and improve current strategies for diagnosis and management of hepatocellular carcinoma(HCC).Overwhelming evidence from published studies on HCC has documented that multiple molecular biomarkers detected in body fluids and feces can be utilized in early-diagnosis,predicting responses to specific therapies,evaluating prognosis before or after therapy,as well as serving as novel therapeutic targets.Detection and analysis of proteins,metabolites,circulating nucleic acids,circulating tumor cells,and extracellular vesicles in body fluids(e.g.,blood and urine)and gut microbiota(e.g.,in feces)have excellent capabilities to improve different aspects of management of HCC.Numerous studies have been devoted in identifying more promising candidate biomarkers and therapeutic targets for diagnosis,treatment,and monitoring responses of HCC to conventional therapies,most of which may improve diagnosis and management of HCC in the future.This review aimed to summarize recent advances in utilizing these biomarkers in HCC and discuss their clinical significance.
文摘OBJECTIVE: To investigate the gene expression of 4-1BB in peripheral blood mononuclear cells (PBMCs) and its possible significance in clinical liver transplantation. METHODS: Reverse transcription-polymerase chain reaction (RT-PCR) was used to determine the gene expression of 4-1BB in PBMCs from 22 patients receiving liver transplantation, 13 patients with primary liver carcinoma (PLC), and 12 healthy controls. To determine whether 4-1BB molecule is also expressed on the surface of CD4^+ and CD8^+ T cell, flow cytometry was used to analyse the phenotype of T cell subsets from the blood of liver transplantation patients. RESULTS: 4-1BB mRNA was detected in PBMCs from stable survivors after liver transplantation, but almost not deteeted in PBMCs from PLC patients and healthy controls. Meanwhile, 4-1BB was almost not expressed on the surface of CD4^+ and CD8^+ T cells in healthy controls and PLC patients. A low level of 4-1BB expression, however, was found on the surface of CD4^+ and CD8^+ T cells from the stable survivors after liver transplantation. CONCLUSIONS: This study demonstrates that although patients are stable after liver transplantation, effector T-cells can also be activated through the signal of 4-1BB molecule and persistent irmmune response to grafts. Blockage of 4-1BB/4-1BBL pathway may benefitially reduce the clinical dosage of immunosuppressive agents and prolong the survival of grafts.
基金Supported by the National Natural Science Foundation of China(General Program),No.81972726.
文摘Hepatocellular carcinoma(HCC)is the fourth leading cause of cancer-related deaths worldwide.The prognosis of patients with HCC remains poor largely due to the late diagnosis and lack of effective treatments.Despite being widely used,alpha-fetoprotein serology and ultrasonography have limited diagnostic performance for early-stage HCC.The emergence of omics strategies has contributed to significant advances in the development of non-invasive biomarkers for the early diagnosis of HCC including proteins,metabolites,circulating tumor deoxyribonucleic acid,and circulating non-coding ribonucleic acid.Early diagnosis is beneficial to patients as it increases the proportion who can be treated with curative treatment,thus prolonging survival outcomes.Currently,multiple clinical trials involving locoregional,systemic therapies,and combinations of these modalities are changing therapeutic strategies for different stage HCC.Success in several preclinical trials that involve immunotherapeutic innovations has created the potential to complement and enforce other treatment strategies in the future.This review summarizes the most recent advances in noninvasive early molecular detection,current therapy strategies,and potential immunotherapeutic innovations of HCC.
文摘Objective: To sum up the preliminary experience in living related liver transplantation (LRLT). Methods: A 9-month-old male infant with biliary atresia (BA) who had undergone an unsuccessful Kasai operation was defined as a candidate for LR- LT. The donor was his 30-year-old mother. Her la- teral lobe of the left liver was transplanted into the infant's body as the graft. The left branches of the portal vein, left hepatic artery and left hepatic vein of the graft were end-to-end anastomosed to the por- tal vein, hepatic artery proper and hepatic vein of the recipient respectively. Biliary drainage was re- established via Roux-en-Y operation. Results: The donor retained her liver function within 2 weeks after the operation. Steroid and FK506 were prescribed in immunosuppressive therapy for the re- cipient. The blood bilirubin level of the infant de- creased to normal 2 weeks after operation. No acute rejection occurred. Biliary leakage in the early peri- od after the transplantation was controlled by drain- age, and E. coli infection was effectively treated with antibiotics. The donor and recipient are in satisfacto- ry condition to the present. Conclusion: LRLT is advisable for children with bili- ary atresia.
基金Supported by Beijing "215" High-Level Medical Talent Development Program(No.2015-3-018)
文摘I am Dr. Yi Zhang, from the Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University,Beijing, China. I would like to describe the metastasis in the left parotid and cervical lymph nodes of a patient with bilateral retinoblastoma 72mo after the initial successful globe-preserving therapies, which included chemotherapy, laser photocoagulation, and cryotherapy.
基金Supported by the Beijing Hospital Authority"DengFeng"Talent Training Plan,No.DFL20180201.
文摘BACKGROUND Because of atypical clinical symptoms,lymphoma is easily confused with infectious diseases.Extranodal nasal-type natural killer/T-cell lymphoma(NKTL)is more common,and there are few cases of eyelid site onset and intracranial infiltration,which increases the difficulty of diagnosis.This disease usually has a very poor prognosis and there are few reports of recovery.CASE SUMMARY A 3-year-old boy was admitted to our hospital due to an initial misdiagnosis of"eyelid cellulitis"and failed antibiotic treatment.He was characterized by fever,right eyeball bulging,convulsions,and abnormal liver function.His blood Epstein-Barr virus(EBV)DNA was positive(8.798×10^4 copies/mL),and remained positive for about half a year.The cranial imaging examination suggested a space-occupying lesion in the right eyelid,with the right temporal lobe and meninges involved.The boy underwent ocular mass resection.The pathological diagnosis was NKTL.He was diagnosed as having NKTL with intracranial infiltration,combined with chronic active EBV infection(CAEBV).Then he underwent systemic chemotherapy and intrathecal injection.The boy suffered from abnormal blood coagulation,oral mucositis,diarrhea,liver damage,and severe bone marrow suppression but survived.Finally,the tumor was completely relieved and his blood EBV-DNA level turned negative.The current follow-up has been more than 2 years and his condition is stable.CONCLUSION This case suggests that chemotherapy combined with intrathecal injection may have a good effect on intracranial infiltrating lymphoma and CAEBV,which deserves further study and discussion.
文摘Objectives: To prevent and early diagnose hepatitis B virus reinfection and recurrent hepatitis B following liver transplantation, and to discuss the further treat- ment of recurrent hepatitis B. Methods: Liver transplantation recipients received lamivudine for prophylaxis of HBV reinfection. Viro- logical and biochemical data, serum HBV-DNA, and immunohistological staining for HBsAg and HBcAg in liver biopsy specimens were tested in due time. Results: Five patients with hepatitis B virus reinfection and two patients with hepatitis B recurrence were ob- served after liver transplantation. One patient with re- current hepatitis B developed chronic severe hepatitis B despite treatment. One patient improved after a se- ries of treatment. Conclusions: Hepatitis B virus reinfection or recurrent hepatitis B following liver transplantation occurs most- ly 6-12 months after operation. The diagnosis of hepa- titis B recurrence should be taken into account when liver biochemical data becomes poor during this pe- riod. The treatment for recurrent hepatitis B after liv- er transplantation includes increased dosage of lamivu- dine, application of famciclovir, and other liver pro- tection measures.
基金Shenzhen Science and Technology Plan(No.JCYJ20180306172419505).
文摘Objective: To investigate the expression relationship between nuclear transcription factor kappa B1 (NFκB1) and long non-coding RNA PACER (LncRNA-PACER) in peripheral blood mononuclear cells (PBMCs) of patients with pulmonary tuberculosis. Methods: From February 2018 to March 2019, 40 patients with pulmonary tuberculosis (tuberculosis group) and 40 healthy persons (control group) were collected, the levels of TNF-α, IL-6 and IL-8 in serum were detected by enzyme-linked immunosorbent assay (ELISA);the expressions of LncRNA-PACER and NFκB1 mRNAs in PBMCs were detected by real-time fluorescence quantitative PCR;Western blot was used to detect the expressions of NFκB1 and COX 2 in PBMCs;Pearson method was used to analyze the expressions of LncRNA-PACER and NFκB1 in PBMCs of patients with pulmonary tuberculosis, and the expressions of LncRNA-PACER and NFκB1 in PBMCs of patients with pulmonary tuberculosis were analyzed. Results: Compared with the control group, the expressions of TNF-α, IL-6 and IL-8 in the serum of patients with pulmonary tuberculosis was significantly increased (P<0.05), and the expressions of LncRNA-PACER, NFκB1 mRNAs, proteins and COX-2 protein in PBMCs were significantly increased (P<0.05). The expressions of LncRNA-PACER and NFκB1 proteins in PBMCs were related to the number of pulmonary lesions and pulmonary cavity (P<0.05), and there was a positive correlation between the expression of LncRNA-PACER and the expression of NFκB1 mRNA in PBMCs of patients with pulmonary tuberculosis (r = 0.873, P<0.05). Conclusions: The expressions of NFκB1 and LncRNA-PACER in PBMCs of patients with pulmonary tuberculosis are significantly increased, they are positively correlated and both of them are related to the occurrence and development of pulmonary tuberculosis.
文摘Background In this study,we aimed to analyze the clinical characteristics and prognosis of children with retinoblastoma(RB)in a single center in China with a large sample collection spanning 17 years.Methods The clinical data of 2790 children with RB treated in Beijing Tongren Hospital from 2005 to 2021 were collected,and a retrospective analysis was conducted.Results The median age of the participants was 28.3 months.There were 3624 affected eyes,12.4%of which were in groups A–C,67.1%in groups D–E and 16.2%were not specified.The primary symptom observed in most cases was a white pupil,accounting for 66.5%,followed by strabismus(12.8%).The median follow-up time was 59.7 months.The enucleation rate was 71.3%(703/986)in a single left eye and 72.5%(702/968)in a single right eye.The overall survival(OS)rate was 95.8%(2444/2552)because 237 patients dropped out,and 109 died.Kaplan‒Meier survival analysis showed that the median survival time(MST)was 125.92 months[95%confidence interval(CI)=124.83–127.01].Cox multivariate survival analysis showed that trilateral RB(P=0.017),metastasis site(P=0.001),and combined distant tissue metastasis(P=0.001)were independent prognostic factors for RB.The OS of 44 cases of familial RB was 93.2%(41/44),with an MST of 80.62 months(95%CI=67.70–93.54).Conclusions The timing of eye protection treatment and enucleation should be comprehensively judged to avoid worsening prognosis due to operation time delay.More importantly,the promotion and popularization of diagnosis and treatment technologies are necessary to further improve RB prognosis.
文摘Undifferentiated embryonal sarcoma of the liver (UESL) very rarely presents clinically.Approximately 1% to 4% of all solid tumors in children are malignant liver tumors,and UESL accounts for 9% to 15% of the liver tumor.The onset of UESL usually occurs at 6 to 10 years of age and there is no obvious difference based on sex.[1] The first symptoms of UESL are abdominal distention and abdominal pain without jaundice,while a physical examination commonly reveals no positive vital signs except the palpable liver tumor.[1] The serum alphafetoprotein (AFP) test is not sensitive for UESL.[2] Preoperative diagnosis of UESL is very difficult.
文摘Background: Cardiotoxicity is one of the most serious chronic complications ofanthracyclines therapy. Assessment of the left ventricular ejection fraction (LVEF) fails to detect subtle cardiac dysfunction of left ventricular (LV). This study aimed to detect and evaluate new parameters of subclinical anthracyclines' cardiotoxicity in children with solid tumor. Methods: A detailed echocardiographic examination was performed in 36 children with hepatoblastoma or rhabdomyosarcoma after receiving anthracyclines' chemotherapy and 36 healthy controls from January 2015 to December 2016. The LVEF, ratio of early diastolic peak velocity of transmitral flow (E) and septal diastolic e' mitral annular peak velocity (e'), tricuspid annular plane systolic excursion (TAPSE), and LV global longitudinal strain (GLS) were evaluated using M-mode, tissue Doppler imaging (TDI), and two-dimensional speckle tracking echocardiography (2D-STE), respectively. Echocardiographic parameters were compared between patient group and healthy controls. All patients were divided into two subgroups based on their anthracyclines' cumulative dosage (〈300 mg/m^2 subgroup and ≥300 mg/m^2 subgroup). Results: All patients had no presentation of heart failure and LVEF within normal range (65.7 ± 5.1%). Compared with healthy controls, the mean E/e' increased significantly (7.9 ±0.7 vs. 10.2 ± 3.5, t = 3.72, P 〈 0.01 ), mean TAPSE decreased significantly ( 17.2 ± 1.3 mm vs. 14.2 ± 3.0 mm, t = -4.03, P 〈 0.01), and mean LV GLS decreased significantly (-22.2% ± 1.9% vs. -17.9% ± 2.9%, t = -5.58, P 〈 0.01) in patient group. Compared with subgroup with anthracyclines' cumulative dosage 〈 300 mg/m^2, mean LV GLS decreased significantly (- 18.7 + 2.7% vs. - 16.5 ~ 2. 1%, t = 2.15, P = 0.04), the mean E/e' increased significantly (9.1 ±1.5 vs. 11.5 ± 4.9, t = -2.17, P = 0.04), and mean TAPSE decreased significantly (14.2±2.1 mm vs. 12.5±2.2 mm, t = -2.82, P = 0.02) in subgroup with anthracyclines' cumulative dosage 〉300 mg/m^2. Conclusions: LV GLS is helpful in the early detection of subclinical LV dysfunction using 2D-STE. E/e' and TAPSE are other sensitive parameters in detecting subclinical cardiac dysfunction of both ventricles by TD1. These parameters show significant change with different anthracyclines' cumulative dosage, so cumulative dosage should be controlled in clinical treatment.
基金Project (No.2003CB5500) supported by the National Natural Science Foundation of China
文摘Reperfusion is the key strategy in acute ST-segment elevation myocardial infarction(STEMI) care,and it is time-dependent.Shortening the time from symptom to reperfusion and choosing the optimal reperfusion strategy for STEMI patients are great challenges in practice.We need to improve upon the problems of low reperfusion rate,non-standardized treatment,and economic burden in STEMI care.This article briefly reviews the current status of reperfusion strategy in STEMI care,and also introduces what we will do to bridge the gap between the guidelines and implementation in the clinical setting through the upcoming China STEMI early reperfusion program.
文摘To the Editor:Alveolar rhabdomyosarcoma(ARMS)of nasalwingwith distant metastasis has a very poor prognosis.Because it is difficult to achieve complete surgical excision of the primary site of the nasal wing,distant metastasis is not easy to control.Here,we present an unusual case of a 29-month-old boy with ARMS in the left nasal wing accompanied by bone metastasis who was treated with systemic chemotherapy as well as 125I interstitial brachytherapy,and this special multidisciplinary management resulted in a perfect prognosis and mild long-term side effects.