AIM: To investigate the role of catecholamine, angiotensin converting enzyme(ACE) and adenosine triphosphatase in ischemic preconditioning in isolated rat hearts. METHODS: Isolated perfused rat heart was subjected to global ischemia for 40 min followed by reperfusion for 10 min (I/R). Preconditioning (PC) was induced by 5 min of ischemia and 10 min of reperfusion. The tissue concentrations in NE, and ACE, ATPase activities were determined in left ventricle in the PC and I/R groups by fluorometry and spectrophotometry. RESULTS: There were no significant difference in NE and ACE between PC and I/R groups. PC hearts showed improved recovery of the contractile function after 40 min ischemia/10 min reperfusion, but activities of the myocardial total ATPase, Mg2＋-ATPase, Na＋K＋-ATPase were inhibited markedly compared with I/R group. CONCLUSION: The inhibited myocardial ATPase may be involved in the mechanism of ischemic preconditioning protection in the isolated rat heart. Endogenous myocardial norepinephrine and ACE activation are not essential for ischemic preconditioning in the isolated rat heart.

Objective To investigate whether the amount of blood transfusion affects the lengths of stay (LOS),costs,and outcomes of hospital patients or not,and to prepare for the execution of patient blood management.Methods The data of hospital patients,who had been administrated with blood in our hospital during 2016,were collected.And the influence of blood transfusion volume on LOS,costs and outcomes of patients was analyzed retrospectively.Results LOS,costs and outcomes of patients vary significantly with the amount of blood transfusion (P＜0.01).There were positive correlations between the total amount of blood transfusion and LOS,costs,and outcomes of patients.The Spearman correlation coefficient was 0.317,0.497,0.290,respectively (P＜0.01).Plasma preparation transfusion volume has a great influence on LOS,costs,and outcomes than red blood cell (P＜0.05).The transfusion volume of death patients was significantly higher than that of the survival (P＜0.01).In particular,the amount of transfused plasma and precipitation was distinctly higher than that in death patients(P＜0.01).Conclusion Blood transfusion volume affects LOS,costs and outcomes of hospital patients.The administration of plasma preparations should deserve more attention.

Objective: To compare the application of Sofren injection in respiratory department before and after the intervention to provide reference for clinical application and pharmacy management.Methods: A retrospective study was conducted on the medical records of inpatients treated with Sofren injection, and then intervene the found problems.Comparative study of Sofren injection in respiratory department before and after the intervention was performed.Results: Among the 584 cases in the retrospective study, those with off-indications were 438 ones (75%), those with inappropriate solvents were 555 ones (95.03%), and those with improper course were 196 ones (33.56%).After the intervention in the clinical practice, the improvement rate of improper solvents was 98.70%, that of off-indications was 29.85%, and that of unsuitable course was 77.71%.Conclusion: Through comparative study on the main problems before the intervention and the effective performance of specific solutions, the application of Sofren injection in respiratory department is greatly improved, which provides reference for the special management of other drugs.

Objective BK virus-associated nephropathy ( BKVAN) after kidney transplantation is a key factor that influence the prognosis of transplant kidney .To our knowledge , it is believed to be associated with immune suppression .We observed the cura-tive effect and influencing factorsof anti-rejection scheme that Leflunomide was administered instead of Mycophenolate Mofetil ( MMF) on transplant kidney BKVAN .. Methods This study included 15 kidney transplant recipients with pathologically confirmed BKVAN in Nanjing General Hospital of Nanjing Military Region form March 2007 to March 2013 .Leflunomide was administered instead of Myco-phenolate Mofetil ( MMF) .Serum creatinine level , renal allograft loss rate and side effects of leflunomide were monitored after medica-tion switch.The patients were divided into two groups , which were renal allograft loss group and renal allograft survival group , for fur-ther analyses . The differences between each groups in clinical characteristics as well as histochemical features of the transplanted kidneys were analyzed to determine the cause of renal allograft loss in patients with BKVAN . Results Six patients experienced renal al-lograft loss after switching to leflunomide and needed hemodialysis , and 9 patients had stable renal allograft function , renal allograft loss rate was 40.0%.Hyperuricemia occurred in 8 patients in the period before the medication switch and in 5 patients after the switch;a decrease in blood white cell orplateletcount was found in 2 patients during both periods;an increase in Alanine aminotransferase ( ALT) level occurred in one patient after the medication switch .There were no statistically significant differences in any of the above parame-ters before and after the medication switch.Compared to allograft survival group, serum creatinine level[(1.80 ±0.53)mg/dL vs (2.74 ±0.58)mg/dL, P=0.007], the number of B lymphocytes [(206.44 ±144.96) vs (439.67 ±267.77), P=0.047] and CD68[(588.44 ±271.80) vs (944.67 ±259.32), P=0.025] in renal allograft tissue were significantly higherin the allograft loss group. ConclusionLeflunomide is a safe and effective medication for BKVAN .Patients with significantly increased serum creatinine level might have a poorer prognosis .Significantly increased B lymphocytes and CD 68 cells in renal allograft tissue might indicate a poor prognosis.

Objective Sirolimus ( SRL) is a potent immunosuppressive drug used to prevent acute allograft rejection after re-nal transplantation.Nevertheless, the occurrence of proteinuria has recently been recognized among patients treated with SRL-based therapy.The aim of this study was to investigate the therapeutic effect of tripterygium wilfordii hook F ( T II) on proteinuria caused by SRL in renal transplant recipients who were treated by trilogy immunosuppressive therapy of sirolimus combined with mycophenolate and hormone. Methods 52 recipients were divided into 2 groups randomly:TⅡgroup (n=27) and valsartan group (n=25).The TⅡgroup was administered 1 mg/kg/d, and the valsartan group 80-160 mg/d for consecutive 12 months.Based on primary trilogy immu-nosuppressive therapy of sirolimus combined with mycophenolate and hormone, the dosage of sirolimus was adjusted according to the target concentration 6-10 ng/ml( ELASA approach) and mycophenolate was administered 750 mg twice per day, adjusting dosage ac-cording to the mycophenolate AUC 0-12 level(35-45 mg· h/L).The evaluation of therapeutic effect includes: complete remission, proteinuria decreased by>50%; partial remission, proteinuria decreased by 20% to 50%; ineffective, proteinuria decreased by<20%. Results During the 12 month follow-up, the total effective rates in the TⅡgroup and the valsartan group were 95.2%and 86.7%respectively, in which the TⅡ group decreased more significantly (P<0.01).The total cholesterol level and triglyceride level in TⅡgroup were obviously lower than those in valsartan group(P<0.01). The total cholesterol level and triglyceride level in valsartan group increased ([6.60±0.2]mmol/L vs [7.11±1.13]mmol/L, [2.47± 1.48]mmol/L vs [2.49±0.32] mmol/L).The serum protein level in TⅡ group was obviously higher than that in valsartan group ([41.1±1.2]g/L vs [37.9±4.2]g/L, P<0.05).At 3 month, 6 month and 12 month follow-up, the average serum creatinine levels in TⅡgroup were obviously lower than those in valsartan group ([1.5±0.4]mg/dl vs [1.6±0.3]mg/dl, P<0.05), ([1.3±0.3]mg/dl vs [1.8±0.5]mg/dl, P<0.05), ([1.1±0.4]mg/dl vs [2.1±0.5]mg/dl, P<0.05).The incidence rate of adverse reaction in valsartan group was obviously greater compared with TⅡgroup( P<0.05) . Conclusion Both tripterygium wilfordii multiglycosides and valsar-tan can reduce proteinuria caused by SRL in renal transplant patients,while the application of TⅡhas more remarkable effect.

Objective:To investigate the expression pattern of microRNA-146a in Brucella patients and its correlation with antibody titers.Methods: By using real time PCR assay, expression levels of microRNA-146a in sera samples from 20 brucellosis patients and 20 healthy volunteers were analyzed.The correlation between expression level of microRNA-146a and serum antibody titers were analyzed with SPSS17.0.Results: A quantification curve of microRNA-146a was constructed with synthesized standard.Expression levels of microRNA-146a among brucellosis patients were significantly lower than those in 20 healthy volunteers (P<0.001).For brucellosis patients,the expression level of microRNA-146a was negatively related with antibody titers (P<0.05). Conclusion:Expression of miRNA-146a in brucellosis patients was significantly inhibited and negatively related with antibody titer.

Objective To explore the infection rate,the correlated risk factors and knowledge of Helicobacter Pylori infection among the outpatients with 13C-urea breath test (13C-UBT).Methods 13C-UBT was performed to evaluate the HP infection status.Self-designed questionnaires were adopted to conduct investigation among 500 outpatients with 13C-UBT and then the results were analyzed.Results The HP infection rate was 46％ in our research.Demographic factors of ages in different groups,on the job or not,HP testing times and different education degree as well as having susceptible factors of family history of HP infection or not,using the public chopsticks or not,sitting up late,history of digestive disease were statistically significant.Positive HP infection was statistically significant different in people with different knowledge of HP infection.71.8％ of the patients had never heard of the HP could cause none digestive system diseases,61.4％ of the patients didn't know how to use drug combination,64.6％ of patients didn't know the review time and 53.4％ of patients did not know how to prevent and control HP infection.Conclusions There is high HP infection rate in outpatients receiving 13C-UBT.The infectious sources of HP commonly exist in population,and the route of transmission was various.We should focus on the susceptible people and strengthen health education,advocate eating separately,improve sanitary consciousness,add HP-test in the health test and enhance the reasonable intervention about HP infection.

Objective Little research has been done on the risk factor analysis of BK virus(BKV) infection in renal transplant recipients in Chinese population.The article aimed to investigate BKV infection and analyze its risk factors in renal transplant recipients in China.Methods Renal transplant recipients who had received the detection of BKV DNA in urine and blood samples in Nanjing General Hospital from June 2015 to July 2016 were selected, while the patients with uremia hemodialysis and healthy living donors were included as control group.According to the detection results of BKV DNA in urine and blood samples, renal transplant recipients were divided into BKV DNA positive group(n=89, positive urine or blood and urine BKV DNA) and BKV DNA negative group(n=359, negative blood and urine BKV DNA).Analysis was made on BKV infection in renal transplant recipients in order to investigate the effects of factors including clinical condition, postoperative complications and immunosuppressive regimen on BKV infection.Results The positive rate of BKV DNA in urine samples of renal transplant recipients was 19.9%, which was higher than those of patients with dialysis and healthy living donors(6.3% and 4.2% respectively, P<0.001).Multivariate logistic regression analysis showed BKV infection was associated with pulmonary infection(OR[95%CI], 3.468[1.227-9.802];P=0.019) , acute rejection (OR[95%CI], 2.645[1.142-6.127];P=0.023), and FK506 (OR[95%CI], 2.408[1.104-5.254];P=0.027).Conclusion The incidence of BKV infection in renal transplant recipients increases significantly.Pulmonary infection, acute rejection and FK506-based immunosuppressive regimen are risk factors leading to BKV infection.

Objective To investigate the renal pathologic changes in both donors and transplant recipients with delayed graft function (DGF).Methods The clinical and laboratory data were retrospectively analyzed in 144 renal recipients with DGF.All the patients received renal biopsy,and donors' biopsy was performed on 131 recipients.The pathological changes were examined under the light microscopy (LM),immunofluorescence (IF) and electron microscopy (EM).Results (1) The incidence of DGF was 10.16%-7.48% during 1994 to 2005,and decreased to 5.35 % during 2006 to 2009.(2) Anuria occurred in 24 cases (16.67 %),oliguria in 24 (16.67%) and hypertension in 68 cases (47.22 %).The enlargement of transplanting kidney and the increased vascular resistance was detected in 79.67 % (98/123 cases) and 45.53 % (56/123 cases) respectively by ultrasound examination.(3) The level of serum creatinine was ranged from 451 to 707 μmol/L.The high level of urinary NAG enzyme was found in 102 cases (70.83 %),proteinuria in 79 recipients (54.86 %) and hematuria in 77 cases (53.47 %).(4) The acute rejection was observed in 66 cases (45.83 %),toxicity of CNI in 22 (15.28 %),IgA nephropathy in 18 (12.50 %),acute tubular necrosis in 8 (5.56 %),and recurrent FSGS in 2 cases (1.39 %).(5) In most recipients (66/109 cases,60.55 %)immunosuppressive regimen altered and renal replacement therapy was given.Conclusion The causes of DGF are complicated.The quality of donors' kidney and early histological changes of recipients are contributed to the development of DGF.It is necessary to perform renal biopsy not only in donors but also in recipients with DGF.And kidney biopsy in transplanted patients was also beneficial to the treatment.

Objective To discuss the clinicopathological characteristics and prognosis of the recurrence of IgA nephropathy (IgAN)after renal transplantation.Methods A total of 1 48 patients,pathologically diagnosed with IgAN which progressed into end-stage renal failure,undergoing renal transplantation in National Clinical Medical Research Center of Kidney Diseases,Nanjing General Hospital of Nanjing Military Command from January 1 996 to April 2009,were included in this study.According to whether IgAN recurred,all patients were assigned into recurrence (n =46)and non-recurrence groups (n =1 02).Urinary red blood cell (U-RBC)count,24 h urinary protein level,renal function including serum creatinine (Scr)and glomerular filtration rate (GFR)at 0,1 ,2,3 and 5 years after renal transplantation were statistically compared between two groups.The incidence of histopathological renal injury and survival rate of transplant kidneys was compared between two groups.Results In recurrence group,U-RBC count and 24 h urinary protein level were gradually elevated and renal function steadily declined.Compared with non-recurrence group,U-RBC count at 2-,3-and 5-year after renal transplantation significantly increased,and renal function was significantly aggravated at postoperative 5 years (all in P<0.01 -0.001 )in recurrence group.Renal pathological findings revealed that compared with non-recurrence group,the incidence of cellular crescent formation,glomerulus adhesion,mesangial cell proliferation,increased mesentery matrix, glomerulosclerosis,segmental glomerulosclerosis,glomerular dysfunction and tubulointerstitial fibrosis was significantly higher in recurrence group (all in P <0.001 ).After renal transplantation,chronic kidney injury index in recurrence group was 7.7 ±2.3,which was significantly higher than 4.6 ±1 .4 in non-recurrence group (P <0.01 ).Compared with non-recurrence group,the incidence of chronic rejection,glomerulopathy of transplant kidney (without IgAN)and positive C4d deposition was significantly higher in recurrence group (P <0.01 -0.001 ).At 1 -and 3-year after renal transplantation, survival rates of transplant kidney did not significantly differ between recurrence and non-recurrence groups (93.8% vs.86.7%,95.6% vs.88.3%,both in P >0.05).However,the survival rate at 5 years after transplantation was 51 .4% in recurrence group,significantly lower compared with 83.8% in non-recurrence group (P <0.001 ).In recurrence group,1 0 patients (22%)presented with renal failure after renal transplantation,and 9 patients (9%)in non-recurrence group.Conclusions After renal transplantation,the recurrence of IgAN characterized by asymptomatic microscopic hematuria, albuminuria and progressive aggravation of renal function reduce long-term survival rate of renal graft and indicate poor prognosis.