Postoperative CD4 Research Articles

CD4+CD25+ regulatory T cells decreased future liver remnant after associating liver partition and portal vein ligation for staged hepatectomy

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is an innovative surgical approach for the treatment of massive hepatocellular carcinoma (HCC), the key to successful planned stage 2 ALPPS is future liver remnant (FLR) volume growth, but the exact mechanism has not been elucidated. The correlation between regulatory T cells (Tregs) and postoperative FLR regeneration has not been reported.To investigate the effect of CD4+CD25+ Tregs on FLR regeneration after ALPPS.Clinical data and specimens were collected from 37 patients who developed massive HCC treated with ALPPS. Flow cytometry was performed to detect changes in the proportion of CD4+CD25+ Tregs to CD4+ T cells in peripheral blood before and after ALPPS. To analyze the relationship between peripheral blood CD4+CD25+ Treg proportion and clinicopathological information and liver volume.The postoperative CD4+CD25+ Treg proportion in stage 1 ALPPS was negatively correlated with the amount of proliferation volume, proliferation rate, and kinetic growth rate (KGR) of the FLR after stage 1 ALPPS. Patients with low Treg proportion had significantly higher KGR than those with high Treg proportion (P = 0.006); patients with high Treg proportion had more severe postoperative pathological liver fibrosis than those with low Treg proportion (P = 0.043). The area under the receiver operating characteristic curve between the percentage of Tregs and proliferation volume, proliferation rate, and KGR were all greater than 0.70.CD4+CD25+ Tregs in the peripheral blood of patients with massive HCC at stage 1 ALPPS were negatively correlated with indicators of FLR regeneration after stage 1 ALPPS and may influence the degree of fibrosis in patients' livers. Treg percentage was highly accurate in predicting the FLR regeneration after stage 1 ALPPS.

Influence of Psychological Nursing Intervention on Psychological State, Treatment Compliance, and Immune Function of Postoperative Patients with Rectal Cancer.

In order to explore the clinical effect of psychological nursing intervention on postoperative chemotherapy for rectal cancer, 120 cases of rectal cancer patients were selected as the research subjects. The control group received conventional nursing treatment after operation, and the research group received comprehensive psychological nursing intervention on this basis. The self-rating anxiety scale (SAS) scores, self-rating depression scale (SDS) scores, hope level scores, nursing satisfaction, mental state changes, treatment compliance, and immune function of two groups were analyzed and compared. There was no significant difference between the two groups of patients in the preoperative SAS, SDS, and hope level scale scores. After the intervention, postoperative SAS and SDS scores and CD8+ value of the research group were significantly lower than those of the control group. In contrast, the postoperative hope level score, treatment compliance, and postoperative CD4+/CD8+ of the research group were significantly higher, and the nursing satisfaction was better than that of the control group. The application of psychological nursing intervention in postoperative chemotherapy for patients with rectal cancer can effectively relieve anxiety and depression of patients, promote patients to establish a healthy and coordinated mental state, improve treatment compliance, improve immune function, and promote disease recovery.

The clinical relevance of performing a day seven post-operative absolute CD4 count in elective brain tumor surgery – A prospective cohort study from a single South African neurosurgical center

IntroductionThe co-morbid presence of a neoplastic brain tumor, in a patient who is HIV positive, is not uncommon in South Africa. The day-7 post-operative absolute CD4 count offers a unique window into the immunological status of an individual post elective brain tumor surgery. Materials and methodsWe performed a prospective cohort study consecutively enrolling all elective adult patients admitted tom our wards from the 01 July 2018–30 March 2020, with neoplastic brain tumors. In total 19 subjects that underwent elective operative intervention had a day seven post-operative absolute CD4 count performed. Data collected and analyzed in this study included age, HIV status, pre-operative corticosteroid therapy, pre-operative day CD4 count, timing of prophylactic antibiotic administration, craniotomy type, blood loss, duration of surgery, extent of resection, day seven post-operative CD4 count, post-operative corticosteroid therapy, histology, day-7 nosocomial infection incidence, Gram-stain result, and Glasgow Outcome Score. ResultsSignificance was demonstrated between the pre-operative day CD4 count and the day 7 post-operative CD4 count (p = 0.03). This allowed us to conclude the immunological impact of the surgery to have been insignificant. Significance was demonstrated between craniotomy type and day-7 post-operative CD4 count (p = 0.04). Significance was also demonstrated between extent of resection and the day-7 post-operative absolute CD4 count (p = 0.0018). A clinical trend was demonstrated for subjects with a lower day-7 post-operative CD4 count to have an increased risk of acquiring a day-7 nosocomial infection and a trend that this would be a Gram- negative infection. ConclusionAs per a PubMed review of the literature we are the first to report the relationship of the skull base surgical approaches, and a subtotal resection, and the statistically significantly delirious effect that these have on a day-7 absolute CD4 count. We further exclude increased intra-operative blood loss as an underlying cause behind the significance of these relationships.

The clinical value of a day one post-operative absolute CD4 count in elective neoplastic brain tumor surgery – A prospective cohort study from a single South African neurosurgical center

IntroductionMultiple simultaneously occurring intra-operative immune modulating interventions make it impossible to compare, the pre-operative day and day one post-operative absolute CD4 counts, and assume one has a measure of the pure surgical impact on this variable. Materials and methodsWe conducted a prospective cohort study by consecutively enrolling 41 elective subjects, with neoplastic brain tumours, in which we obtained a pre-operative day CD4 count and a day one post-operative CD4 count. Data collected included age, HIV status, pre-operative corticosteroid therapy, pre-operative day CD4 count, type of craniotomy, blood loss, duration of surgery, extent of resection, day one post-operative CD4 count, histological diagnosis, day-7 nosocomial infection incidence and Gram-stain result, and Glasgow Outcome Score. ResultsRegarding HIV status 29/41 (71%) subjects were HIV negative and 12/41 (29%) subjects were HIV positive. High significance was demonstrated between the pre-operative day CD4 count and the post-operative day CD4 count (p = 0.0001). While no significance was demonstrated (p = 0.51), a clinical trend was suggested where more than 1000 ml of blood loss had a detrimental effect on the day one post-operative CD4 count, which was often below 500 cells/mm. Again, while no significance was demonstrated (p = 0.13), a clinical trend was suggested where the longer the duration of surgery, the lower the day one post-operative CD4 count would be. No significance was demonstrated between day one post-operative CD4 count and day 7 nosocomial infection incidence (p = 0.35). A clinical trend was however demonstrated where a lower day one post-operative CD4 count suggested an increased risk of incurring this complication. Finally, significance was demonstrated between the day one post-operative CD4 count and the nosocomial infection gram stain result (p = 0.0058). ConclusionThe highly significantly similar pre-operative day CD4 count, to the day one post-operative CD4 count indicated that overall, the elective surgical procedures considered, had an insignificant effect.

Predictive Value of Postoperative Peripheral CD4+ T Cells Percentage in Stage I-III Colorectal Cancer: A Retrospective Multicenter Cohort Study of 1028 Subjects.

ObjectiveAssociation of postoperative peripheral CD4+ T cells percentage and recurrence in colorectal cancer (CRC) remains to be explored. Therefore, we aimed to investigate the association between the postoperative peripheral CD4+ T cells percentage and recurrence in CRC patients.Patients and MethodsConsecutive stage I–III CRC patients without neoadjuvant treatment undergoing curative resection from January 2010 to July 2016 were identified in two Chinese centers. The association between the postoperative CD4+ T cells percentage, measured within 12 weeks after surgery, and recurrence-free survival (RFS) was analyzed.ResultsA total of 1028 patients were identified (training set: 913 patients, validation set: 115 patients). In the training set, the 5-year RFS rate of the 441 patients with abnormal postoperative CD4+ T cells percentage was significantly lower than that of those with normal percentage (70.3% [95% CI 65.7–75.2%] vs 77.6% [95% CI 73.7–81.7%] and unadjusted hazard ratio [HR] 1.36 [95% CI 1.04–1.78], P=0.02). The result was confirmed in the validation set. Multivariable Cox regression analysis demonstrated that the association of postoperative CD4+ T cells percentage with 5-year RFS was independent both in the training and validation sets. In propensity score matching analysis, patients with normal postoperative CD4+ T cells percentage were found to have a favourable response to adjuvant chemotherapy (HR 0.29 [95% CI 0.12–0.72], P=0.008).ConclusionPostoperative peripheral CD4+ T cells percentage is a predictive biomarker for RFS in patients with CRC, which can identify those who will benefit from adjuvant chemotherapy.

Predictive Value of Postoperative Peripheral CD4+ T Cells Percentage in Stage I-III Colorectal Cancer: A Retrospective Multicenter Cohort Study of 1028 Subjects

Background: Association of postoperative peripheral CD4+ T cells percentage and recurrence in colorectal cancer(CRC) remains to be explored. Therefore, we aimed to investigate the association between the postoperative peripheral CD4+ T cells percentage and recurrence in CRC patients. Patients and Methods: Consecutive stage I-III CRC patients without neoadjuvant treatment undergoing curative resection from January 2010 to July 2016 were identified in two Chinese centers. The association between the postoperative CD4+ T cells percentage, measured within 12 weeks after surgery, and recurrence-free survival (RFS) was analyzed. Results: A total of 1028 patients were identified (training set: 913 patients, validation set: 115 patients). In the training set, the 5-year RFS rate of the 441 patients with abnormal postoperative CD4+ T cells percentage was significantly lower than that of those with normal percentage (70.3%[95 %CI 65.7%–75.2%] vs. 77.6%[95%CI 73.7%–81.7%]; unadjusted hazard ratio[HR] 1.36[95%CI 1.04–1.78], P=0.02). The result was confirmed in the validation set. Multivariable Cox regression analysis demonstrated that the association of postoperative CD4+ T cells percentage with 5-year RFS was independent both in the training and validation sets. In propensity score matching analysis, patients with normal postoperative CD4+ T cells percentage were found to have a favourable response to adjuvant chemotherapy (HR 0.29 [95% CI 0.12–0.72], P=0.008). Conclusion: Postoperative peripheral CD4+ T cells percentage is a predictive biomarker for RFS in patients with CRC, which can identify those who will benefit from adjuvant chemotherapy. Funding Statement: This work was supported by grants from the National Key Research and Development Program of China [2017YFC1309100], the National Natural Scientific Foundation of China [81771912], and the Applied Basic Research Projects of Yunnan Province, China [2018FE001- 065 and 2018FE001-251]. Declaration of Interests: The authors declare that they have no potential conflicts of interest. Ethics Approval Statement: This retrospective study was approved by the institutional review board of each participating hospital. The requirement for informed consent was waived by the board, owing to the study's retrospective nature. All the patient data in the survey were anonymized.

Independent prognostic value of HIF-1α expression in radiofrequency ablation of lung cancer.

Radiofrequency ablation (RFA) is widely used in the treatment of lung cancer. Hypoxia-inducible factor-1α (HIF-1α) is a crucial transcription factor regulating oxygen homeostasis that is involved in tumor cell metastasis. The present study investigated the impact of HIF-1α expression and other factors, such as postoperative blood CD4+/CD8+ ratio, on the prognosis of patients with lung cancer who had received RFA treatment. A total of 80 patients with lung cancer were recruited between January 2011 and October 2016 at The Shenzhen People's Hospital. Lung cancer was confirmed following pathological or histological examination. All patients underwent RFA treatment. Patients were followed up for 6–66 months. HIF-1α expression in lung cancer tissues was assessed by immunohistochemistry. Multivariate survival analysis was performed using Cox proportional hazards model. The results demonstrated that HIF-1α level was low in 36 patients and overexpressed in 44 patients with lung cancer. Kaplan-Meier (KM) curve analysis demonstrated that the overall survival time of patients with high HIF-1α expression was significantly shorter compared with patients with low HIF-1α expression (P<0.05). Furthermore, the results from the KM model and log-rank test revealed that age, Union for International Cancer Control stage, primary or metastatic cancer, chemotherapy, postoperative blood CD4+/CD8+ ratio, Eastern Cooperative Oncology Group performance status and HIF-1α expression had significant effects on overall survival of patients with lung cancer. The results from Cox analysis demonstrated that high HIF-1α expression, advanced age, clinical staging and chemotherapy were independent risk factors for the prognosis of lung cancer following RFA treatment, and that high HIF-1α expression was associated with the increased risk (5.91-fold) of mortality. In conclusion, the present study demonstrated that HIF-1α expression was increased in lung cancer tissues and was associated with the prognosis of patients with lung cancer who were treated with RFA. These findings suggest that HIF-1α expression may be considered as a marker for evaluating the prognosis of these patients.

The impact of perioperative enteral immunonutrition on frequent clinical outcome in patients with digestive system cancer

Background: Forepassed trials have indicated that perioperative enteral immunonutrition can improve the clinical outcome for patients with digestive system cancer. The purpose of this study was to evaluate the effect of perioperative enteral immunonutrition on immunity and postoperative complications in patients with digestive system cancer. Methods: A group of 64 patients with digestive system cancer was randomly assigned for perioperative enteral immunonutrition (n=32) or standard enteral nutrition (n=32). The postoperative clinical outcome was assessed based on a clinical index, including postoperative complications, and systemic inflammatory response syndrome (SIRS) duration. Also, the postoperative cellular immunity was compared and evaluated between the two groups. Results: The nutritional therapy of both groups were completed. The occurrence of postoperative infectious complications in the immunonutrition group (6%) was significantly (P=0.020) lower than that of the standard nutrition group (28%). The duration of SIRS in the immunonutrition group (0.77±0.91 days) was significantly shorter than that in the standard nutrition group (1.34±1.46 days) (P=0.012). The postoperative lymphocyte counts and CD4+ T-cells counts significantly declined (P Conclusions: In comparison to standard enteral nutrition, perioperative enteral immunonutrition with glutamine (Gln), ω-3 fatty acids, nucleotide and arginine (Arg) improved the immune status of the patients, reduced the occurrence of postoperative infectious complications and decreased the duration of SIRS. CD4+ T-cells immunity possibly played a vital role in the inflammatory response and the modulation of postoperative immunity after surgery with digestive system cancer.

Bariatric surgery in individuals with human immunodeficiency virus and type 2 diabetes: a case series

BackgroundThe efficacy and safety of bariatric surgery have not been fully elucidated in patients affected with human immunodeficiency virus. Although adjustable gastric banding and sleeve gastrectomy are starting to be used in patients with human immunodeficiency virus, there are limited descriptions of the outcomes of type 2 diabetes mellitus in individuals who are human immunodeficiency virus positive and undergoing these procedures.Case presentationWe have evaluated retrospectively three patients who underwent adjustable gastric banding or sleeve gastrectomy, the effect in weight reduction and glycemic control as well as its impact on human immunodeficiency virus management. Case 1 (adjustable gastric banding), a 58-year-old Caucasian male, achieved 19% total weight loss, Case 2, a 33-year-old Caucasian male (sleeve gastrectomy) lost 25%, and Case 3, a 48-year-old Caucasian female (sleeve gastrectomy), lost 14% postoperation. In terms of type 2 diabetes mellitus, Case 2 achieved complete remission according to American Diabetes Association criteria, while Case 1 would also have achieved remission were it not for the continuation of metformin postoperatively. Insulin requirements and pill burden were markedly reduced in Case 3 after sleeve gastrectomy, although lack of remission was predictable given the longevity of type 2 diabetes mellitus and preoperative insulin dosage. In all three cases, human immunodeficiency virus status did not appear to be affected by the bariatric surgery which was supported by the postoperative stable CD4 count and undetectable viral load.ConclusionsBariatric surgery is a safe and effective treatment modality in patients who are human immunodeficiency virus positive with obesity and type 2 diabetes mellitus.

Effect of three kinds of anaesthetic drugs on postoperative recovery, regulatory T cells and T lymphoid cells in elderly patients

Purpose: To investigate the effect of three anaesthetic drugs on postoperative recovery, regulatory T cells and T cell subset levels in elderly patients. Methods: The patients were randomly divided into groups A, B and C (42 patients per group). Group A received intravenous remifentanil, dexamethasone, dexmedetomidine and propofol, followed by continuous intraoperative inhalation of sevoflurane and continuous intravenous pumping of remifentanil. Group B was given intravenous propofol and midazolam, followed by continuous intraoperative inhalation of sevoflurane, while Group C received intravenous etomidate and rocuronium, with continuous intraoperative inhalation of sevoflurane. The preoperative or 24-h postoperative T regulatory cells (CD4 + CD25 + ) and T cell subsets (CD4 + and CD8 + ) were determined for each group. Results: MMSE scores in the three groups were lower than their pre-operation scores ( p < 0.05). There were significant reductions in 24-h postoperative serum CD4 + CD25 + and CD4 + levels, with higher reductions in group B ( p < 0.05). In contrast, CD8 + increased in all groups, but was lower in group B than in the other two groups ( p < 0.05). Conclusion: These findings strongly suggest that propofol, midazolam and sevoflurane have rapid onset of action and recovery, which improves the comfort of patients while decreasing negative impact on the function of the immune system. Furthermore, these anaesthetic agents enhance the recovery of elderly patients. Keywords: Anaesthesia, Cognitive function, Regulatory T cells, T cell subsets

Surgical site infection after penetrating abdominal trauma with bowel involvement: a comparison between HIV-seropositive and seronegative patients

The influence of HIV-infection on surgical site infection (SSI) after surgery for penetrating abdominal trauma is not investigated and therefore not as yet elucidated. This prospective study was performed with the aim to compare the SSI rate in human immunodeficiency virus (HIV)-seropositive and HIV-negative patients and to identify other risk factors for this abdominal wound complication. 98 patients who underwent small or large bowel resection and subsequent anastomosis due to penetrating abdominal trauma were included in the study. Injury related factors as well as demographical and physiological parameters, including HIV-status were analysed and superficial and deep SSI incidence rates were evaluated. Of the 98 patients, 23 patients (23%) were HIV-seropositive. The overall superficial SSI rate was 45% and the deep SSI rate was 15%. No significant difference in SSI (superficial or deep) in the HIV-seropositive and -negative group was demonstrated (superficial SSI HIV-pos vs HIV-neg: 61% vs 40%; p=0.172, deep SSI 22% vs 13%, p=0.276). Multivariate analysis identified five independent risk factors for SSI: postoperative CD4 count < 250 cells/μl, postoperative albumin < 30 g/L, relook operation, anastomotic leak and colonic anastomosis. HIV-infection is not an independent risk factor for developing SSI after penetrating abdominal trauma. Low postoperative CD4 count, irrespective of HIV status, low postoperative albumin, relook operation, anastomotic leak and colonic anastomosis are predictors for SSI irrespective of the HIV-serostatus. These factors should be considered in unison during the decision-making process of abdominal wound closure; planned secondary wound treatment or immediate application of negative pressure dressings in patients with a high-risk profile may decrease the hospital stay and the financial burden on the health care system.

Postoperative CD4 counts predict anastomotic leaks in patients with penetrating abdominal trauma

IntroductionThe influence of trauma- and surgical stress-induced decrease of CD4 count on anastomotic leaks after penetrating abdominal trauma has to date not been investigated. A prospective study was performed to explore the effect of CD4 count 24 h after surgery on the anastomotic leak rate and to identify risk factors for anastomotic leaks. MethodsThis was a prospective study including 98 patients with small or large bowel resection and subsequent anastomosis due to penetrating abdominal trauma. Univariate analysis identified risk factors for the development of anastomotic leak and also investigated the predictive value of the CD4 count for this complication. ResultsOf the 98 patients 23 patients (23%) were HIV-infected. The overall leak rate was 13%. Univariate analysis including all potential risk factors with p-values<0.05 identified six factors leading to a significantly higher rate of anastomotic complications: postoperative CD4 count<250 cells/μl, postoperative albumin <30 g/L, penetrating abdominal trauma index≥25, gunshot wound as mechanism of injury, blood transfusion requirement >6units and delayed anastomosis after damage control surgery. Survival rates were analysed with the χ2 test and did not show a significantly higher mortality rate in patients with low CD4 count. The negative impact of trauma and subsequent surgery on the cell mediated immunity was demonstrated by the fact that 55 (73%) of the HIV-negative patients had a CD4 count less than 500 cells/μl 24 h postoperatively. HIV-infection had no significant influence on the leak rate, however all HIV infected patients that developed an anastomotic leak died. ConclusionA low post-operative CD4 count is a predictor for anastomotic leaks irrespective of HIV-serostatus. Low postoperative serum albumin, high injury severity, gunshot wound as mechanism of injury, blood transfusion requirement >6 units and delayed anastomosis were further risk factors for anastomotic complications. Postoperative CD4 count and serum albumin should be considered in the decision making process of performing an anastomosis or diverting stoma for patients after “clip and drop” of the bowel as part of damage control surgery.

HIV Infection Is Not a Contraindication to Laparoscopic Sleeve Gastrectomy for Morbid Obesity.

The efficacy of antiretroviral therapy has made HIV a chronic condition. The prevalence of obesity in HIV positive patients has subsequently risen and is present in 6-34% of men and 21-30% of women (Keithley et al. J Assoc Nurses AIDS Care 20(4):260-74, 2009). Sleeve gastrectomy is a safe and effective procedure for weight loss in the general population, but having HIV may bring hesitation to performing bariatric surgery for some practitioners. The aim of this study is to evaluate the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) in patients with HIV. A retrospective analysis of prospectively collected data of patients with HIV who underwent LSG at a community hospital by a single surgeon was performed. Nine patients with HIV underwent LSG. Primary outcomes include weight loss at 6 and 12months and postoperative CD4 count and viral load. Secondary outcomes include alteration to antiretroviral therapy (ART). Our patients had a mean BMI of 46 (range 35-66) and were all well controlled on ART preoperatively. Mean weight loss at 12months was 40kg (range 21-55), with mean excess body weight loss 69% (range 42-112). There were no significant changes in CD4 counts, and all patients continued to have undetectable viral loads at 1year postoperatively. One patient had a change in ART, which was unrelated to bariatric surgery. There were no complications in our patient group. This is the largest series to date evaluating sleeve gastrectomy in HIV-positive patients and further supports the safety and efficacy of sleeve gastrectomy in this patient population.

Effect of Peripheral Blood CD4 + CD25 + Regulatory T Cell on Postoperative Immunotherapy for Patients with Renal Carcinoma.

To investigate the effect of peripheral blood CD4 + CD25 + regulatory T cell on postoperative immunotherapy in patients with renal carcinoma. 38 patients with renal cell carcinoma were recruited, and 20 patients from the operation group purely underwent the radical nephrectomy therapy, 18 patients from the combined group successively underwent the radical nephrectomy therapy and IFN-α adjuvant immunotherapy. Additionally, 12 healthy subjects were recruited in the same period of time and regarded as the control group. Flow cytometry was used to detect CD4 +, CD8 +, CD4 + CD25+ T lymphocyte subset content and the ratio of all parts in the pre-operative period, in the first post-operative week and in the third post-operative month, compare and analyze its variation trend. The CD4+CD25+ T lymphocyte subset content of individual renal carcinoma patients was significantly higher than that of the control group, also increases with the progression in the tumor stage (<0.05). The post-operative CD4 + CD25+T lymphocytes of individual operation group and combined group patients showed different degrees of increment, but the increment of the combined group was significantly lower than that of the operation group (<0.05). For the combined group patients with less pre-operative CD4 + CD25+T lymphocytes, their levels would increase after the immunotherapy, while the pre-operative patients with more CD4 + CD25+ T lymphocytes were the opposite situation. The detection of peripheral blood CD4+CD25+ regulatory T lymphocyte subset can reflect the anti-tumor immune status of renal cell carcinoma patient body. It can contribute to predict the prognosis of immunotherapy and provide reference for the choice of renal carcinoma post-operative adjuvant immunotherapy.

Treatment of postoperative infectious complications in patients with human immunodeficiency virus infection.

Antibiotics are widely given for surgical patients to prevent infection. Because of the lack of study on the rational use of antibiotics in patients with human immunodeficiency virus (HIV) -infected during surgical procedures, we analyzed the risk factors affecting postoperative infectious complications in HlV-infected patients and explore the rational use of perioperative antibiotics. This retrospective study consisted of 308 HlV-infected patients, 272 males and 36 females, who had undergone operation at the Shanghai Public Health Clinical Center from November 2008 to April 2012. The patients were divided into postoperative infection and non-infection groups. Their age and clinical variables were compared. The correlation between surgical incision, surgical site infection (SSI) and postoperative sepsis was analyzed. Prophylactic antibiotics were used for patients with type I and II incisions for less than 2 days. Patients with type III incisions were given antibiotics until the infection was controlled. Antiretroviral therapy (ART) was prescribed preoperatively for patients whose preoperative CD4 count was <350 cells/μL. For those patients whose preoperative CD4 count was <200 cells/μL, sulfamethoxazole and fluconazole were given preoperatively as prophylactic agents controlling Pneumocystis carinii pneumonia and fungal infection. A total of 196 patients developed postoperative infectious complications, and 7 patients died. Preoperative CD4 counts, ratio of CD4/CD8 cells, hemoglobin level, and postoperative CD4 counts, hemoglobin and albumin levels were risk factors of perioperative infection in HIV-infected patients. Patients with a preoperative CD4 count <200 cell/μL, anemia, a postoperative CD4 count <200 cell/μL or albumin levels <35 g/L were correlated with a higher rate of perioperative infection. There was a significant correlation between SSI and the type of surgical incision. The rate of SSI in patients with type I surgical incision was 2% and in those with type II surgical incision was 38%. All the patients who received type III surgical incision developed SSI, and they were more likely to develop postoperative sepsis. HIV-infected patients are more likely to develop postoperative infectious complications. The rational use of antibiotics in HIV-infected patients could help to reduce the rate of postoperative infectious complications in these patients.

Clinical and Immunological Impact of Early Postoperative Enteral Immunonutrition After Total Gastrectomy in Gastric Cancer Patients: A Prospective Randomized Study

Enteral immunodiet has been gaining increasing attention, but experimental data of its clinical effects in patients with gastric cancer are inconsistent, contradictory, and poorly investigated. The aim of this study was to assess the impact of early postoperative enteral immunonutrition on clinical and immunological outcomes in a homogeneous group of gastric cancer patients submitted to total gastrectomy. A total of 109 patients with gastric cancer were randomized to receive early postoperative enteral immunonutrition (formula supplemented with arginine, omega-3 fatty acids and ribonucleic acid [RNA]), or an isocaloric-isonitrogenous control. The postoperative outcome was evaluated based on clinical variables, including postoperative infectious complications, anastomotic leak rate, and length of hospitalization. In addition, state of cellular immunity was evaluated and compared between the 2 groups. The incidence of postoperative infectious complications in the immunodiet group (7.4%) was significantly (p < .05) lower than that of the control group (20%), as well as the anastomotic leak rate (3.7% in immunodiet group vs 7.3% in standard nutrition group, p < .05). Mortality rate did not show any significant differences; patients of the immunodiet group were found to have a significantly reduced length of hospitalization (12.7 ± 2.3 days) when compared with standard diet group (15.9 ± 3.4 days, p = .029). The data on cellular immunity showed that the postoperative CD4(+) T-cell counts decreased in both groups, but the reduction in the IED group was significantly higher (p = .032) compared with the SND group. Early postoperative enteral immunonutrition significantly improves clinical and immunological outcomes in patients undergoing gastrectomy for gastric cancer.

Restricted intravenous fluid regimen reduces the rate of postoperative complications and alters immunological activity of elderly patients operated for abdominal cancer: a randomized prospective clinical trail.

Perioperative fluid restriction can lead to better clinical outcomes and reduced complications. However, whether perioperative fluid restriction can alter the patient's postoperative cellular immunity is unknown. Therefore, a randomized, prospective clinical study was designed to determine whether fluid restriction improves immunological outcome in elderly patients who undergo gastrointestinal surgery for cancer removal. A total of 179 patients aged 65 years or older were recruited for the study and were randomly assigned to receive the restricted fluid regimen (R group) or the standard fluid regimen (S group). Postoperative T-lymphocyte subpopulations (CD3(+), CD4(+), and CD8(+)) frequencies and monocyte HLA-DR expression was investigated. Perioperative complications and cellular immunity changes were analyzed comparatively between the two groups. The restricted intravenous fluid regimen was associated with significantly less postoperative complications (1.5 complications/patient vs. S group: 2.2 complications/patient), especially for infection complications (15% vs. S group: 27%, p = 0.04). Circulating CD3(+) T-cells were suppressed after surgery in both treatment groups, but the cell frequency (cell/μL) was higher in the R group (746 vs. S group: 480 at postoperative day (POD) 2, p = 0.022; 878 vs. 502 at POD 3, p = 0.005; 892 vs. 674 at POD 5, p = 0.042). Similarly, the HLA-DR expression (% of all T cells) in monocytes were decreased in both groups, but the expression remained higher in the R group (66.20 vs. S group: 51.97 at POD 1, p = 0.029; 68.19 vs. 51.26 at POD 2, p = 0.039; 72.19 vs. 57.45 at POD 3, p = 0.014; 73.92 vs. 60.46 at POD 5, p = 0.036). Multivariate analysis suggested that perioperative CD3(+) T cell changes were associated with the development of postoperative complications [odds ratio (OR) = 1.963; 95% confidence interval (CI) 1.019-3.782; p = 0.044] and postoperative infections (OR = 3.106; 95% CI 1.302-7.406; p = 0.011). In elderly gastrointestinal cancer patients, cellular immunity is better preserved by the perioperative fluid restriction regimen. The better preserved cellular immunological function is correlated with a reduced perioperative complications rate.

Preoperative CD4 Count or CD4/CD8 Ratio as a Useful Indicator for Postoperative Sepsis in HIV-Infected Patients Undergoing Abdominal Operations

CD4 count or CD4/CD8 ratio has been found to be a valuable marker of disease progression in HIV and AIDS. Our objective was to evaluate preoperative CD4 count or CD4/CD8 ratio as a useful indicator for postoperative sepsis in HIV-infected patients undergoing abdominal operations. Retrospective analysis of 35 HIV-infected patients (four females, 31 males) undergoing abdominal operations. All patients were divided into postoperative sepsis group (A) and non-sepsis group (B). Demographic and clinical information were entered into a database and included: type of surgical procedure, age, peripheral blood cells, plasma albumin, CD4 counts, and CD4/CD8 ratios. Furthermore, we stratified and compared the incidence of postoperative sepsis according to the preoperative CD4 counts with breakpoint value of 200 cells/μL and preoperative CD4/CD8 ratios with breakpoint value of 0.15. Overall postoperative sepsis morbidity in our study was 51.43% (18/35). In sepsis group, the mean preoperative and postoperative CD4 counts, CD4/CD8 ratios, and postoperative platelet count were found significantly lower, respectively, than those in non-sepsis group (P < 0.05). The incidence of postoperative sepsis in the patients with preoperative CD4 counts ≤ 200 cells/μL was markedly higher than those with CD4 counts > 200 cells/μL (83.3% versus 17.65%; P = 0.000). Likewise, the incidence of postoperative sepsis in the patients with preoperative CD4/CD8 ratios ≤ 0.15 was dramatically higher than those with CD4/CD8 ratios > 0.15 (90% versus 36%; P = 0.007). Our preliminary study showed that HIV-infected patients with preoperative CD4 count ≤ 200 cells/μL or CD4/CD8 ratio ≤ 0.15 had overall higher postoperative sepsis morbidity. Preoperative CD4 count or CD4/CD8 ratio may be used as a useful indicator for postoperative sepsis in HIV-infected patients undergoing abdominal operations.

Predictive value of immunological parameters on sepsis following abdominal operation for patients with HIV infection

To study postoperative sepsis in HIV/AIDS patients who underwent abdominal operations. A retrospective analysis was performed to study 34 HIV/AIDS patients treated between January 2009 and December 2010 at the Shanghai Public Health Clinical Center Affiliated to Fudan University. There were 31 males and 3 females in this cohort with a mean age of 45±13 years. Nineteen patients developed postoperative sepsis. The levels of preoperative CD4, postoperative CD4, preoperative CD4/CD8, and postoperative platelet were significantly lower than those without sepsis (all P<0.05). Among 19 patients with a preoperative CD4 cell count less than or equal to 200×10(6)/L, the incidence of postoperative sepsis rate was 84.2%(16/19), and for those with a preoperative CD4 cell count greater than 200×10(6)/L, the incidence of postoperative sepsis rate was 20.0%(3/15), the difference was statistically significant(P<0.05). There were 3 postoperative deaths. CD4 cell count can be used as a predictive marker for the development of postoperative sepsis in patients with HIV/AIDS.

Attenuation of the Systemic Inflammatory Response and Infectious Complications After Gastrectomy with Preoperative Oral Arginine and ω‐3 Fatty Acids Supplemented Immunonutrition

Past trials have shown perioperative immunonutrition to improve the outcome for patients with gastric cancer. The present study was designed to evaluate the effect of preoperative oral immunonutrition on cellular immunity, the duration of the systemic inflammatory response syndrome (SIRS), and detailed postoperative complications in patients with gastric cancer. Sixty patients with gastric cancer were randomly assigned to two groups: one group received immune-enhanced formulas supplemented with arginine and omega-3 fatty acids (immune-enhancing diet (ID) group, n = 30); the other received standard formulas (conventional diet (CD) group, n = 30) for 7 days before the operation. These groups were well matched in terms of age, sex, operations, cancer stages, and intraoperative variables. The postoperative outcome was evaluated based on clinical variables, including postoperative infectious complications, noninfectious complications, and SIRS duration. In addition, the perioperative state of cellular immunity was evaluated and compared between the two groups. The incidence of postoperative infectious complications in the ID group (6%) was significantly (p < 0.05) lower than that of the CD group (28%). The duration of SIRS in the ID group (0.77 +/- 0.9 days) was significantly (p < 0.05) shorter than that in the CD group (1.34 +/- 1.45 days). The postoperative lymphocyte and CD4(+)T-cell counts significantly decreased (p < 0.05) in both groups. However, the number of CD4(+)T-cells on preoperative day 1 and postoperative day 7 was significantly (p < 0.05) higher in the ID group than in the CD group. Preoperative oral immune-enhanced formulas supplemented with arginine and omega-3 fatty acids enhanced the immune status of the patients, reduced the duration of SIRS, and decreased the incidence of postoperative infectious complications. CD4(+)T-cell immunity likely played an important role in the modulation of the postoperative immune and inflammatory response after gastrectomy.