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Purpose Although immune dysfunction has been investigated in adult septic patients, early immune status remains unclear. In this study, our primary aim was to assess early immune status in adult patients with sepsis stratified by age and its relevance to hospital mortality. Patients and Methods A post hoc analysis of a multicenter, randomized controlled trial was conducted; 273 patients whose immune status was evaluated within 48 hours after onset of sepsis were enrolled. Early immune status was evaluated by the percentage of monocyte human leukocyte antigen-DR (mHLA-DR) in total monocytes within 48 hours after onset of sepsis and it was classified as immunoparalysis (mHLA-DR ≤30%) or non-immunoparalysis (>30%). Three logistic regression models were conducted to explore the associations between early immunoparalysis and hospital mortality. We also developed two sensitivity analyses to find out whether the definition of early immune status (24 hours vs 48 hours after onset of sepsis) and immunotherapy affect the primary outcome. Results Of the 181 elderly (≥60yrs) and 92 non-elderly (

Postembolization syndrome (PES) is the most common complication in patients with hepatocellular carcinoma (HCC) who had undergone transcatheter arterial chemoembolization (TACE). PES was defined as fever, nausea and/or vomiting, and abdominal pain and these symptoms develop within 1-3 days after TACE. However, few studies have explored the factors influencing PES in patients with TACE for the first time.We explored the factors influencing PES in patients with HCC undergoing TACE for the first time.The present study was a hospital-based study conducted in the tertiary care hospital of Guangzhou with a retrospective study design.In this single-center retrospective study, a total of 242 patients with HCC were included in the first TACE program between November 1, 2018 and November 31, 2019.T-test and Chi-square test revealed the factors affecting the occurrence of PES. Correlation analysis (Spearman) explored the relationship between these factors and PES. Binary logistics analyzed the predictive factors of PES.The probability of PES in patients with HCC undergoing TACE for the first time was 55.45%. Types of embolic agents (r = 0.296), types of microspheres (r = 0.510), number of microspheres (r = 0.130), maximum diameter of microspheres used (r = 0.429), type of drug (r = 0.406), and drug loading (r = 0.433) were positively correlated with PES (P0.05). Serum albumin was negatively correlated with PES (P = 0.008, r = -0.170). Binary logistic regression analysis revealed that drug loading microspheres (odds ratio [OR] = 0.075, 95% confidence interval [CI] = 0.031-0.180) and serum albumin (OR = 0.182, 95% CI = 0.068-0.487) were the protective factors influencing PES, while drug loading was the risk factor of PES (OR = 1.407, 95% CI = 1.144-1.173).Drug loading microspheres, serum albumin, and drug loading were the predictors of PES after the first TACE.

Autophagy, part of the innate immune defense mechanisms, is activated during the initial phase of septic insult. Previous studies indicated that micro (mi)RNAs are additionally involved in the host response to sepsis; however, the association between miRNAs and autophagy during this process is not fully understood. To study the role of miRNA (miR)‑23a in autophagy initiated by sepsis, macrophages treated with lipopolysaccharides, in addition to blood samples from patients, were evaluated for miR‑23a expression levels. Cell viability, inflammatory mediators and autophagic markers were investigated following overexpression or inhibition of miR‑23a. The results suggested that miR‑23a was suppressed subsequent to septic insult, promoting autophagy and suppressing a hyper inflammatory response, leading to enhanced cell viability. A luciferase assay and western blot analysis confirmed ubiquitin‑like protein ATG12 to be the target of miR‑23a. The present study revealed that the downregulation of miR‑23a regulates an inflammatory response during septic insult via autophagy promotion.

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. χ2 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.

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, P0.01). The number of patients with primary liver cancer was lower than that of the control group (26.6% vs 45.8%, P0.01). 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 P0.01). 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 P0.01).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.

To investigate the vertical bone height and the bone density of the palate for implants placement using cone beam CT(CBCT) and to provide references to the safe and stable placement of palatal implants.Three-dimensional reformatting images were reconstructed with the selected CBCT scanning data of 34 patients aged 18 to 35 yeras, by means of EZ implant software. The vertical bone height was measured at 20 interesting sites of palate. Bone density was measured at 10 sites that could support 3.0 mm long implants. The data of the vertical bone height and bone density were analyzed by K-means cluster analysis.According to the cluster analysis results, the 10 sites were classified into 3 clusters. There were statistical differences among these three clusters in bone height and bone density (P0.05). The LSD result showed that the greatest mean value of vertical bone height was obtained in cluster 2, followed by cluster 1 and cluster 3; the highest bone density was founded in cluster 3, followed by cluster 1 and cluster 2.Evaluation of the sites for palatal implant placement with cone beam CT would be helpful in safe and stable implantation.

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.

This study was undertaken to evaluate the influence of labial surface contours and collum angles of the maxillary anterior teeth on torque.206 extracted maxillary teeth were selected, including 77 central incisors, 68 lateral incisors and 61 canines. All specimens were scanned by cone beam dental computed tomography (CT). Three-dimensional reconstructed images were made by using the CT software. The median sagittal planes of all teeth were selected and then analyzed by the Auto CAD software. For each tooth, the angles between tangent lines to the labial surface at four different heights along the surface and the longitudinal axis of the crown were measured. The collum angle was also measured.Between 3.5 mm and 5.0 mm level of bracket heights, for the variation of 0.5 mm, the torque differed by 1.5 degrees for the maxillary central incisors and 2 degrees for the maxillary lateral incisors and canines. The mean collum angle values for the maxillary central incisors, lateral incisors and canines were 0.88 degree, 3.87 degrees and -3.30 degrees.The biological variation in tooth morphology would influence the torque after orthodontic treatment in different ways.

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%, P0.05). 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 (P0.05 or P0.01). 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 P0.01). Lactic acid in the therapy group went up significantly on the 1st day (P0.01), but it no longer rose after 3 days (all P0.05). The lactic acid level in the control group rose progressively every day (all P0.01). 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 P0.05). 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 (P0.05 or P0.01).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.

To investigate the drug resistance of pathogenic bacteria of nosocomial infections in the surgical intensive care unit.The drug resistance of pathogenic bacteria of nosocomial infections in the SICU in our hospital from January 2001 to December 2004 were analyzed.The average nosocomial infections rate was 11.3%. The major sites of nosocomial infections were respiratory tract (30.9%), abdominal cavity (29.0%), bloodstream (9.7%) and biliary ducts (7.2%). The most common pathogens were pseudomonas aeruginosa (11.6%), methicillin-resistant coagulase negative staphylococci (11.1%) and candida albicans (9.7%). ESBLs-producing strains accounted for 66.2% and 58.5% of escherichia coli and klebsiella spp. respectively. Methicillin-resistant staphylococcus aureus accounted for 94.7% and methicillin-resistant coagulase negative staphylococci accounted for 88.2% in staphylococcus aureus and coagulase negative staphylococci. Carbapenems were the most powerful antibiotics against enterobacteriaceae. The non-fermenters were high resistant to antimicrobial agents. Vancomycin was the most potent antimicrobial against gram positive cocci. Amphotericin B was the most active antibiotic against fungi.Most strains of pathogens were antibiotic resistant in SICU. The main pathogenic bacteria of each infection site were different. So it is essential to establish nosocomial infections surveillance system in order to prevent, control and treat nosocomial infections effectively.