Objective To study the effect of genomic HLA-DR compatibility on long-term survival in renal transplantation.Methods A retrospective study was performed on 518 first-cadaver renal transplants by using genotyping technique.Results More than 10%recipients shared HLA-DR matching at DNA level.half of 1 DR mismatches.The recipients with HLA-DR matched transplants showed a significant decrease of acute rejection episodes and a smooth recovery of early renal function as compared with those of DR mismatching kidneys.The 1 to 5 year-person survival rate was increased by 17%to 37.7% (P＜0.01)respectively.Multivariate analysis of 10 variables by Cox regression model revealed that DR mismatching was the most important factors influencing the long-term graft survival.Conclusion Genomic HLA-DR compatibility had a significant impact on long-term survival of first-cadaver kidney transplantation.

This work observed on isolated perfused rat hearts, that 10~(-9)mol/L endothelin (ET) induced myocardial contracture, decrease of heart function and coronary flow, intramyocardial Ca~(2+) accumulation and Mg~(2+) loss and etc. These cardiac action of ET were obviously more prominent when Mg~(2+) in the perfusion fluid was lowered to 0.12 mmol/L, and were significantly alIeviated when Mg~(2+) content was increased to 4.8mmol/L (normal plasma Mg~(2+) content is about 1.2 mmol/L). The mechanism of the Mg~(2+) effect on the cardiac action of ET may be related to its inhibition of Ca~(2+) influx into the myocytes. These results suggested that without magnesium defficiency, suitable replenishment of Mg~(2+) probably have practical clinical significance in the prevention and therapy of myocardial injury occurred during diseases with elevated circulatory ET level.

Objective To explore the single point target concentration for Neoral at 2 h postdose (C2) in Chinese renal transplantation recipients for the first 3 months following surgical procedures. Methods Neoral trough levels (C0) and C2 monitoring were measured by fluorescence polarization immunoassay (TDX) in 114 cases of cadaver renal transplants treated with Neoral (6～7 mg?kg -1 ?d -1 ), mycopherolate mofetil (MMF,1.0～1.5 g/d) and steroids for the first 3 months after renal transplantation.The effectiveness of the new monitoring method in predicting the acute rejection and side effects was retrospectively analyzed. Results The acute rejection rate of 114 transplants for the first 3 months was 15.8%(18/114).The incidence of side effects was 30.7% (35/114),including hepatoxicity(26.3%) and nephrotoxicity(7.0%).The results of 234 pairs of Neoral C0, C2 monitoring showed that the difference was not statistically significant between C0 levels of rejection and non rejection,while the difference between C2 levels [(921.55 ?431.31) vs (1 185.17?358.86)ng/ml) ] was significant.There was also no statistically significant between C0 levels of the recipients with side effects and those without side effects,but statistically significant difference was found between C2 levels [(1 302.59?450.21) vs (1 105.23? 371.64 )ng/ml].Analysis of the relationships between C2 levels and the incidences of acute rejection and side effects showed that no acute rejection and side effects rate of 4.3% were observed in the Neoral C2 interval from 1 250 ng/ml to 1 500 ng/ml. Conclusions Neoral C2 monitoring is a more sensitive predictor not only for acute rejection but also for side effect rate.The optimal C2 target level of Chinese renal transplantation recipients is 1 250 ～1 500 ng/ml for the first 3 months post transplantation.

Objective To observe the application effect of the Iodophors hygro-gauze on tracheotomy wound dressing. Methods Fifty patients who underwent tracheotomy with Ⅲ incision, were chosen to be divided into the control group and the observation group with 25 in each group. With saline water cleaning incision and surrounding skin, then disinfection with 0.5% iodophors sanitizers tampon. The observation group applied 0.5% Iodophors hygro-gauze on the wound, the control group used vaseline oil yarn. 24 hours after sample inspection, again samples were sent for bacteria analysis, bacterial colonies number, pathogenic bacteria growth and local situation of wound were observed and analyzed. Results The first results upon disinfection showed that bacterial colonies number, pathogenic bacteria growth between the two groups had no difference. After 24 hours sampling showed that the colony count and pathogenic bacteria growth of the observation group was obviously less than the control group. Local wound infection of the observation group was lighter than the control group. Conclusions 0.5% Iodophors hydro-gauze applied for tracheotomy wound dressing can effectively kill various pathogenic microorganism, prevent secondary infection, and also can prevent and treat wound infection.

To investigate the effects of granulocyte macrophage colony stimulating factor (GM-CSF) which was secreted from the fresh leukemic cells of patients with acute myeloid leukemia (AML) and recombinant human GM-CSF(rhGM-CSF) on the apoptosis of the primary incubative AML cells,the level of GM-CSF was measured by means of radioimmunoassay,the DNA ladder was detected by using DNA electrophoresis,and the percentage of apoptotic cells,percentage of expression and the mean fluorescence intensity(MFI) of bcl-2 were respectively assayed by means of flow cytomtric analysis.After the fresh leukemic cells from 5 cases were incubated for 24 hours,GM-CSF in 3 of 5 cases were seen,their percentage of apoptotic cells was less than the other 2 cases,and the MFI of bcl-2 in the 3 of 5 cases was obviously enhanced.After the fresh leukemic cells were treated with cytarabine (Ara-C) 5?g/ml in combination with rhGM-CSF 5?g/ml for 24 hours,the percentage of apoptotic cells was more than the cells treated with Ara-C alone and it upward to (56 4?7 4)%(p

Objective To observe the dynamic change of cytokines and effect of different stimulating combinations on dominant regulation, and describe the microenviroment character of local immune response. Methods PBMCs were separated from peripheral blood of healthy donors with density gradient centrifugation. The expression levels of cytokine genes under different stimulating combinations, including IL-2, IFN-?, IL-12, IL-4, IL-10 and TGF-?1, were detected by ELISA and RT-PCR. Results ELISA results indicated that secretion level of IL-2, IL-4, IL-12 and IFN-? were inhibited by IL-10. There were significant differences in IL-4 and IL-12 between control group and stimulating groups under the stimulation by anti-CD3 monoclonal antibody (McAb) or anti-CD3 McAb + anti-CD28 McAb combination. Significant differences in IL-2 only appeared in anti-CD3 antibody stimulating group. The concentrations of IFN-? were decreased moderately. At the mean time, IL-10 significantly promoted the secretion of TGF-?1 under the anti-CD3 McAb stimulation. There were similar results on the genes level for the studied cytokines. Conclusion The induction and maintenance of dominant regulation were dependent mainly on IL-10, which inhibits the overexpression of IL-4 and IL-12. It is the vital step for dominant regulation to avoid the mono-polarization development at the beginning of immune response.

Objective To investigate the effect of recipient dendritic cells (DC) loaded with donor-derived apoptotic cells on inducing murine cardiac allograft tolerance. Methods Apoptosis of donor-derived splenocytes (SC) was induced by ultraviolet B irradiation(UVB). UVB-irradiated allogenic SC were co-cultured with recipient bone marrow-derived DC that maturation was inhibited by NF-?B ODN Decoy, so that could acquire tolerogenic-immature DC loaded with donor-derived apoptotic cells (Decoy Apo-SC DC). A heterotopic vascularized heart transplantation was performed from BALB/c to C57BL/6 mice, and recipients were given one injection of recipient immature (Decoy Apo-SC DC) or mature (Apo-SC DC) DC engulfed donor-derived apoptotic cells (2?10 6 cells) through the portal vein at 7 days before the heart transplantation in the absence of immunosuppression. The cardiac survival and the expression of intragraft cytokines (IL-2, IL-10 and IFN-?) were evaluated.Results DC had potent phagocytosis of allogenic apoptotic SC (Apo-SC). NF-?B ODN Decoy inhibited engulfment of apoptotic cells-induced maturation of DC and then induced recipient tolerogenic DC. Recipient tolerogenic DC loaded with donor-derived apoptotic cells were able to cross-tolerate recipient T cells, which revealed by alloantigen-specific T-cell hyporesponsiveness in primary and secondary mixed leukocyte reaction. Injection of recipient tolerogenic DC loaded with Decoy Apo-SC DC through the portal vein at 7 days before the heart transplantation significantly prolonged vascularized heart allograft survival (MST 36.4 days versus 7 days in control group, P

The effect of HLA-DR matching was retrospectively examined at DNA level on rejection and graft survival of cadaver renal transplantation. HLA-DR matching was typed by PCR-SSP technique in 318 cyclosporine-treated primary cadaveric renal recipients. The recipients were divided into three groups:no DR mismatching (0MM), one DR mismatching (1MM) and two DR mismatching (2MM). The effect of genomic HLA-DR compatibility on early kidney function, acute rejection, steroid pulses and 1 year graft survival was retrospectively analyzed. HLA-DR alleles in all samples were successfully genotyped by PCR-SSP. The overall time of DNA typing was 4 hours. The patients well-matched(0MM),moderately-matched(1MM) and poorly-matched(2MM) were 11.6%, 51.9% and 36.5%, respectively. The total rejection rate, 1 year patient survival and graft survival in 318 recipients were 49.1%, 94.3% and 90.3%. Early graft function, acute rejection episodes, steroid pulses and graft survival in well-matched recipients were better than those in poorly-matched patients. In particular, significant difference was found in acute rejection episodes and 1 year graft survival,suggesting genomic compatibility of HLA-DR has effect on acute rejection and graft survival in cadaver kidney transplantation.

Case based learning/problem-based learning ( CBL/PBL ) is a new teaching method based on traditional medical education methods.In order to conquer the deficiency of traditional education methods in autonomous study motivation and ability of knowledge integration, CBL/PBL has been introduced into vascular surgery teaching procedure since 2006.The quality and effort of CBL/PBL compared with lecture-based learning ( LBL ) were evaluated and scored. The outcome of this teaching innovation shows CBL can arouse students' desire in autonomous study and enhance their ability in clinical analysis.But, its superiority is difficult to develop in the current medical education system.

BACKGROUND: Using low-intensity pulsed ultrasound (LIPU) to promote the repair of articular cartilage injury is very common,and we also have more options to choose the cytoskeleton, but the application conditions of LIPU and the appropriate cytoskeleton have not reached any consensus yet.OBJECTIVE: To investigate the feasibility of establishing tissue-engineered cartilage by cell-free allograft demineralized bone matrix (CFDBM) co-cultured with rabbit cartilage cells and bone marrow mesenchymal stem cells (BMSCs) in vitro, and to investigate the effect of LIPU on the cells in CFDBM.DESIGN, TIME AND SETTING: Multiple sample observation was performed at the Institute of Biomedical Engineering, Second Military Medical University of Chinese PLAfrom May to August 2009.MATERIALS: The CFDBM was prepared as modified Urist's method; the cartilage cells were obtained using mechanical disintegration and enzyme digestion; the BMSCs were separated using whole bone marrow rinsing method, purified, and amplified layer by layer.METHODS: As CFDBM With a composite of different cellular components, and whether applying LIPU stimulation, the samples were divided into four groups: chondrocyte group, BMSCs group, compound group (CFDBM was compounded with chondrocytes,BMSCs, and chondrocytes/BMSCs, respectively, without LIPU stimulation), and LIPU group (CFDBM was compounded with chondrocytes/BMSCs, and then the samples were stimulated with LIPU on the second day, 1.0 MHz frequency, 10 mW/cm~2 transient spatial intension, 20 min/d).MAIN OUTCOME MEASURES: ① the 2~(nd)-generation of cartilage cells and BMSCs were examined by immunohistochemical method; ② The CFDBM prepared as modified Urist's method was examined as HE staining; ③ The samples of four groups were examined by collagen II immunohistochemical staining on the 21~(st) day.RESULTS: ① The collagen II immunohistochemical staining of the second generation of the articular cartilage cells showed that the morphostructure was polygon, star or round, and pseudopodia extended, and the cells were rich in cytoplasm; the cytoplasm was brownish yellow, and the cell nuclear was round. ② The result of immunohistochemical staining of BMSCs showed that,CD34 was negative, CD44 and CD105 were positive. ③ In the center of CFDBM prepared as modified Urist's method, there was no obvious cell-like structure and the gap size was uniform. ④ On the 21~(st) day after combining CFDBM with cells, collagen II immunohistochemical staining demonstrated that BMSCs group was negative, chondrocyte group was weak positive, compoundgroup was positive, and the LIPU group was strongly positive.CONCLUSION: ① Biological property of the 1~(st)-3~(rd)-passage chondrocytes and BMSCs was similar to primary-cultured cells. ②Both chondrocytes and BMSCs had a highly proliferative ability in CFDBM. ③ 10 mW/cm~2 LIPU could not affect activity of BMSCs but could promote differentiation Into articular cartilage cells, and it also could not promote celt proliferation.