Clinical Characteristics and Risk Factors of Early-Onset Tuberculosis After Liver Transplantation

BackgroundWe encountered some cases of early-onset tuberculosis (TB) after liver transplant (LT), leading to further transmission to other immunocompromised patients. Therefore, we investigated the clinical characteristics and risk factors of early-onset TB after LT.MethodsAll adult patients with TB after LT from 1996 to 2019 were retrospectively enrolled. Our hospital did not screen for latent TB infection (LTBI) in LT recipients because of concerns regarding the potential hepatotoxicity of anti-TB medication. Patients were categorized into 2 groups based on the TB onset time after LT: early-onset TB (≤2 months) and late-onset TB (>2 months).ResultsOf 4301 LT recipients, 91 patients developed TB after LT (2.1%). The median time from LT to TB development was 9.4 months. Of these 91 patients, 11 were classified as having early-onset TB (12.1%). Patients with early-onset TB had a greater pretransplant TB history than patients with late-onset TB (36.4% vs 11.3%, P = .048).ConclusionThis unusual early-onset TB was more common in patients with a pretransplant TB history, suggesting the possibility of missed TB or full manifestation of the indolent course of TB after LT. Therefore, LT recipients with a pretransplant TB history should undergo thorough screening for active TB and consider prophylaxis.     

The Prevalence,Risk Factors,and Prognosis of Acute Kidney Injury After Lung Transplantation: A Single-Center Cohort Study in China

PurposeThe aim of this study is to evaluate the incidence, risk factors, and prognosis of acute kidney injury (AKI) after lung transplantation (LTx).MethodsRecords of patients who underwent LTx in a single center were retrospectively reviewed. The prevalence of post-transplant AKI, the use of continuous renal replacement therapy (CRRT), and the risk factors for AKI were investigated. The effects of AKI and CRRT on short-term outcomes and long-term survival were measured.ResultsThis study included 148 patients, 67 of which developed postoperative AKI. Of these, 31 patients underwent CRRT; the percentage of cases with no AKI was 6.2%, and the percentage of cases with stage 1, 2, and 3 who used CRRT was 0%, 10%, and 86.2%, respectively. Patients with AKI had significantly higher intensive care unit mortality and in-hospital mortality. The 1-year post-LTx survival rate of patients with AKI was 47.8%, significantly lower than those without AKI (74.1%). There was no difference in 1-year survival rate of those with stage 1 and stage 2 AKI, but patients with stage 3 AKI showed the worst survival. Patients who underwent CRRT had an inferior survival outcome (9.7% vs 76.1%, P < .05). We found that higher acute physiologic assessment and chronic health evaluation (APACHE) II scores (odds ratio [OR] 1.082, P = .009) and higher intraoperative fluid balance (OR 1.001, P = .012) were independent risk factors, and female sex (OR 2.539) and pulmonary hypertension (OR 2.869) were potential risk factors for post-LTx AKI. A prediction model integration of the above factors showed a good concordance with actual risks and had a concordance index (C-index) of 0.76 (95% confidence interval [CI], 0.66-0.87).ConclusionSevere AKI requiring CRRT had a negative impact on the short-term and long-term outcomes of patients.     

肝脏血管周上皮样细胞肿瘤的临床及影像学特征

回顾性分析4例经病理证实的肝脏血管周上皮样细胞肿瘤(PEComa)患者影像资料,总结其影像特点并复习相关文献。4例患者均为体检发现,无乙肝病史。3例患者病变密度/信号均匀,1例病变密度/信号混杂,内见脂肪密度/信号。4例患者病变动脉期明显强化,2例包膜样延迟强化,3例强化特点呈快进快出。肝脏PEComa动脉期均为明显强化,门静脉期及延迟期表现多样,部分为包膜样延迟强化,患者临床病史不支持肝癌等诊断时,应考虑肝脏PEComa的可能。     

Neuroprotective effects of Longxue Tongluo Capsule on ischemic stroke rats revealed by LC-MS/MS-based metabolomics approach

Objective: The present study aimed to evaluate the therapeutic effect and explore the underlying mechanisms of Longxue Tongluo Capsule (LTC) on ischemic stroke rats. Methods: Twenty-six rats were randomly divided into four groups, including sham group, sham + LTC group, MCAO group, and MCAO + LTC group. Ischemic stroke rats were simulated by middle cerebral artery occlusion (MCAO), and LTC treatment group were orally administrated with 300 mg/kg of LTC once daily for seven consecutive days. LTC therapy was validated in terms of neurobehavioral abnormality evaluation, cerebral infarct area, and histological assessments. The plasma metabolome comparisons amongst different groups were conducted by UHPLC-Q Exactive MS in combination with subsequent multivariate statistical analysis, aiming to finding the molecules in respond to the surgery or LTC treatment. Results: Intragastric administration of LTC significantly decreased not only the neurobehavioral abnormality scores but also the cerebral infarct area of MCAO rats. The interstitial edema, atrophy, and pyknosis of glial and neuronal cells occurred in the infarcted area, core area, and marginal area of cerebral cortex were improved after LTC treatment. A total of 13 potential biomarkers were observed, and Youden index of 11 biomarkers such as LysoPC, SM, and PE were more than 0.7, which were involved in neuroprotective process. The correlation and pathway analysis showed that LTC was beneficial to ischemic stroke rats via regulating glycerophospholipid and sphingolipid metabolism, together with nicotinate and nicotinamide metabolism. Heatmap and ternary analysis indicated the synergistic effect of carbohydrates and lipids may be induced by flavonoid intake from LTC. Conclusion: The present study could provide evidence that metabolomics, as systematic approach, revealed its capacity to evaluate the holistic efficacy of TCM, and investigate the molecular mechanism underlying the clinical treatment of LTC on ischemic stroke.     

北京地区老年髋部脆性骨折患者术后抗骨质疏松症药物治疗现状及影响因素分析

目的 评估北京地区老年髋部脆性骨折患者术后抗骨质疏松症药物（AOM）治疗现状并探讨其影响因素。方法 横断面研究。纳入2018年11月—2019年11月北京积水潭医院、北京医院、北京安贞医院、北京市昌平区医院、北京市顺义区医院、北京市房山区良乡医院收治的髋部脆性骨折患者1 963例,总结其人口学特征,并收集患者入院后30、120、365 d的临床资料,AOM治疗及健康基本补充剂使用情况。通过单因素和多因素logistic回归分析AOM治疗的影响因素。结果 1 963例老年髋部脆性骨折患者,住院时年龄65~102（79.3±7.2）岁,≥80岁患者占56.7%（1 113/1 963）;男性患者占30.8%（604/1 963）,女性患者占69.2%（1 359/1 963）;股骨颈骨折846例,股骨粗隆间骨折1 077例,股骨粗隆下骨折40例。综合3个时间点,在髋部骨折后1年内,33.0%（648/1 963）的患者接受过AOM治疗,71.0%（1 394/1 963）的患者使用过健康基本补充剂。入院后30、120、365 d患者AOM治疗率分别为23.0%（451/1 963）、17.9%（353/1 963）、21.0%（412/1 963）,健康基本补充剂使用率分别为59.0%（1 158/1 963）、45.0%（883/1 963）、38.0%（746/1 963）。单因素分析结果显示,年龄≥80岁[粗比值比（OR）=0.645,95%可信区间（CI） 0.495~0.840]、男性（粗OR=0.760,95% CI 0.581~0.996）、共管模式（粗OR=3.025,95% CI 0.973~9.405）、居住地农村（粗OR=0.523,95% CI 0.388~0.704）、AOM服用史（粗OR=7.612,95% CI 2.227~26.020）、既往骨质疏松症史（粗OR=5.065,95% CI 3.149~8.147）、骨质疏松评估（粗OR=1.379,95% CI 1.105~2.451）是AOM治疗的影响因素。多因素分析结果显示,年龄≥80岁（调整后OR=0.618,95% CI 0.488~0.781）、男性（调整后OR=0.716,95% CI 0.565~0.908）、居住地农村（调整后OR=0.492,95% CI 0.375~0.645）是AOM治疗的危险因素;共管模式（调整后OR=2.632,95% CI 1.004~6.897）、AOM服用史（调整后OR=4.870,95% CI 2.080~11.402）、既往骨质疏松症史（调整后OR=4.804,95% CI 3.253~7.096）、骨质疏松评估（调整后OR=1.393,95% CI 1.041~1.862）是AOM治疗的保护因素。结论 北京地区老年髋部脆性骨折患者的AOM治疗率偏低。年龄≥80岁、男性、在农村居住的髋部脆性骨折患者治疗率较低,可采取共管模式,术前进行骨质疏松诊断与评估,提高骨质疏松治疗率。     

尺骨截骨位置不同对手术治疗儿童陈旧性孟氏骨折预后的影响

目的 探讨手术治疗儿童陈旧性孟氏骨折尺骨截骨点位置不同对疗效的影响。方法 回顾性队列研究。纳入2015年6月—2021年6月安徽省儿童医院骨科收治的68例儿童陈旧性孟氏骨折患者的临床资料,其中男42例、女26例,年龄3~12（6.6±2.4）岁。受伤至手术时间1~60个月,平均8.6个月。BadoⅠ型骨折60例,Ⅲ型8例。患儿均采用尺骨近端截骨矫形治疗,术中选择尺骨畸形最明显处截断尺骨,按照截骨点至尺骨近端间距占尺骨全长的比例不同分为3组,A组（占比≤25%）27例、B组（25%<占比<30%）20例、C组（占比≥30%）21例。观察指标：（1）对比3组患儿临床基线资料。（2）对比3组患儿手术时间,观察术后患肘肱桡关系恢复情况,尺骨截骨处愈合情况,以及并发症发生情况。（3）术后定期随访。取出内固定前,测量对比3组患儿肘关节旋前、旋后、伸肘、屈肘角度,采用Kim肘关节功能评分表评估并对比3组患儿肘关节功能;拆除内固定后,采用影像学Nakamura分级标准评估并对比3组患儿肘关节功能。结果 （1）3组患儿性别、年龄、患肢侧别、骨折分型、受伤至手术时间、术前患肢肘关节活动度等基线资料比较,差异均无统计学意义（P值均>0.05）。（2）3组患儿均顺利完成手术,A组手术时间为（100.6±31.7）min,B组为（133.0±24.2）min,C组为（94.9±28.6）min,差异无统计学意义（F=1.02,P=0.367）。术后第3天肘关节正侧位X线片示肱桡关系均恢复正常。A组有1例术后切口感染,予以抗感染治疗后愈合。68例患儿均获得随访,随访时间6~36个月,平均8.7个月。A组术后发生肱桡关节再脱位3例、半脱位3例,B组发生半脱位3例,C组发生半脱位2例、尺骨延迟愈合1例;3组间并发症发生情况比较,差异均无统计学意义（P值均>0.05）。3组患儿尺骨截骨处愈合时间比较,差异无统计学意义（F=0.01,P=0.989）。（3）3组患儿取出内固定前,肘关节旋前、旋后、伸肘、屈肘角度,以及Kim肘关节功能评定比较,差异均无统计学意义（P值均>0.05）。拆除内固定后,影像学Nakamura分级评定肘关节功能比较,3组间差异无统计学意义（Z=1.73,P=0.422）。结论 儿童陈旧性孟氏骨折采用尺骨近端截骨矫形治疗,术中选择尺骨畸形最明显处截断尺骨,尺骨截骨点位置的不同对患儿预后无明显影响。     

长链非编码RNA KLHL7-DT对人退变髓核细胞增殖和凋亡的影响及其相关机制

目的 探讨长链非编码RNA KLHL7-DT对人退变髓核细胞增殖和凋亡的影响及其相关机制。方法 选取2018年1月—2019年10月南京江北医院骨科脊柱骨折患者手术切除的正常椎间盘标本18例,其中男11例、女7例,年龄为22~46 （38.3±4.3）岁,PfirrmannⅠ级6例、Ⅱ级12例。取椎间盘标本常规分离、培养髓核细胞,使用10 ng/mL IL-1β处理髓核细胞获得退变髓核细胞。将退变髓核细胞分为沉默对照组、KLHL7-DT沉默组、过表达对照组、KLHL7-DT过表达组。4组细胞分别对应转染沉默对照序列、siRNA-KLHL7-DT沉默序列、过表达对照序列、KLHL7-DT过表达序列。取转染后4组退变髓核细胞采用5-乙炔基-2’脱氧尿嘧啶核苷（EdU）法检测细胞增殖情况,流式细胞术检测细胞凋亡情况,Western blot检测聚集蛋白聚糖（Aggrecan）、Ⅱ型胶原（Col Ⅱ）蛋白的表达情况。结果 （1）KLHL7-DT过表达组EdU染色阳性细胞/DAPI染色阳性比值（0.147±0.002）低于过表达对照组（0.203±0.007）,而KLHL7-DT沉默组比值（0.428±0.050）高于沉默对照组（0.240±0.032）,差异均有统计学意义（t=14.25、-5.44,P值均<0.05）。（2）KLHL7-DT过表达组细胞凋亡率（19.01%±0.41%）高于过表达对照组（14.38%±0.31%）,KLHL7-DT沉默组细胞凋亡率（16.08%±0.59%）低于沉默对照组（17.42%±0.36%）,差异均有统计学意义（t=15.69、3.36,P值均<0.05）。（3）Western blot结果显示,KLHL7-DT过表达组细胞Aggrecan和Col Ⅱ蛋白的相对表达量（分别为0.34±0.29、0.57±0.11）均低于过表达对照组（1.00±0.22、1.05±0.10）,KLHL7-DT沉默组Aggrecan和Col Ⅱ蛋白的相对表达量（分别为1.77±0.14、1.63±0.12）均高于沉默对照组（1.10±0.18、0.98±0.08）,差异均有统计学意义（t=3.10、5.54、-5.05、-7.66,P值均<0.05）。结论 上调KLHL7-DT的表达可抑制退变髓核细胞的增殖,促进退变髓核细胞的凋亡,其机制可能是通过调节细胞外基质Aggrecan、Col Ⅱ蛋白的合成,进而参与椎间盘退变的发展。     

腹股沟区膜解剖与全腹膜外疝修补术的初步探讨

目的探讨全腹膜外疝修补术(totally extraperitoneal herniorrhaphy,TEP)的游离层面,寻找疝膜解剖的标准模型。方法回顾性分析118例男性单侧原发疝临床资料,结合文献及临床实践,对腹股沟区的局部解剖进行再认识。结果手术均获成功,术中出血少,5例腹膜破裂,23例血清肿,3例阴囊血肿,无补片感染,无复发,手术过程清楚显示各个重要结构,以膜解剖理念完成各个间隙的进入与贯通,有三个重要的间隙,位于腹壁中央的R间隙(Retzius间隙),位于侧方的B间隙(Bogros间隙)以及两者中间的D间隙,即危险三角(Doom三角)间隙,通过器械贯通,形成一个连续的层面,达到补片植入、修补缺损的目的。结论通过对腹股沟区各种筋膜、各个间隙的认识,增加手术流畅性,减少手术并发症,形成疝修补膜解剖的标准模型,对临床工作产生积极的促进作用。     

完全右半肝-左半肝劈离式肝移植的临床应用:附四例报告

目的探讨完全右半肝-左半肝劈离式肝移植在成人-成人或成人-大体重儿童中的临床应用。方法回顾2019年1月至12月间首都医科大学附属北京友谊医院完成的4例完全右半肝-左半肝劈离式肝移植的供受者临床资料,分析劈离式肝移植的手术方式、冷缺血时间、手术时间、术中输血量,观察患者术后并发症及相关预后。结果4例完全右半肝-左半肝劈离式肝移植的受者包括3例成人和1例大体重儿童(45 kg),年龄范围14~48岁,体重范围45~61 kg,终末期肝病模型评分分别为21、12、41和30分。移植物质量与受者体质量比为0.85%~1.35%。冷缺血时间457~650 min,手术时长460~575 min。4例患者移植术后早期肝功能恢复顺利,均未出现小肝综合征。随访至术后6个月,其中1例出现胆道吻合口漏,经内镜逆行胰胆管造影术治疗后治愈;1例出现胆道狭窄,经皮肝穿刺胆道引流术治疗后反复胆道感染;1例术后6个月死于肺部感染。结论在严格病例选择的情况下,可以开展完全右半肝-左半肝劈离式肝移植。