To study the diagnosis of cytomegalovirus (CMV) infection after renal transplantation and the effects and side effects of preventive use of foscarnet (PFA). ELISA assay was used to determine active CMV infection (IgM+,IgG+) and inactive CMV infection (IgM-,IgG+). Seventy four cases of active CMV infection and 25 of inactive CMV infection were selected to receive PFA treatment. Besides, 10 cases of inactive CMV infection without PFA treatment served as a control group. The results showed that the serological tests turned negative in subclinical patients in active stage after 12 5 days of treatment. In those patients with clinical symptoms, infection was controlled in 34 patients after 15 days of treatment. In another 2 patients, serology turned negative after 1 month of treatment, and no recurrence found one year later. In patients in inactive stage, IgM became positive, but with no symptoms, one year after treatment. At the same time, 3 patients in the control group turned into active infection after 1, 2 and 3 months. The results suggested ELISA assay was a good method to determine serum CMV IgG and IgM at present; PFA could definitively control active CMV infection quickly, and no recurrence was found during 1 year follow up; PFA might prevent reversion of serological indexes in patients with inactive infection. Moreover, PFA did not impose damage to the function of the renal graft, and nor interfered with the metabolism of blood calcium and cyclosporine A. Thus, PFA is a safe and effective drug to treat CMV infection.

Objective To retrospectively analyze the effectiveness and safeness of tension-free vaginal tape(TVT) as a treatment for female stress urinary incontinence (SUI) with minimal injury. Methods A longitudinal incision of 1.5cm was made through vaginal mucosa at the midsection of the urethra, and a suspension tape was inserted in 40 SUI patients. Results Thirty four out of 40 patients recovered completely without urinary retention and SUI. Two patients experienced mild urinary retension 2 weeks postoperative, and another patient with similar complaint 3 months after the operation. The symptom was totally alleviated by urethral dilatation. SUI symptom was improved markedly in 1 patient. In 4 patients, bladder perforation occurred during the operation. One patient experienced vaginal mucosa desquamation, and it healed spontaneously. One patient died of myocardial infarction 5 days after the operation. Conclusion TVT seemed to be a good method with minimal injury, with little pain, good result, less complications and high safety.

Objective To study the therapeutic effects and side effects of foscarnet in the treatment of active(IgG+,IgM+)and inactive(IgC+,IgM-)cytomegalovirus(CMV)infection after cadaver renal transplantation.Methods Forty-one cases of active cytomegalovirus infection and 22 of inactive cytomegalovirus were selected to receive foscarnet treatment.Besides,10 cases of inactive cytomegalovirus infection served as control group without receiving foscarnet.The usage of foscarnet was 40 mg/kg,iv.,2 ～3 weeks in the active stage,50 mg/kg,iv.,3～4 weeks in the inactive stage.Results Clinical symptoms of patients in the active stage were controlled,and serologic CMV IgG turned negative.Moreover,no positive infection was found after 3-month follow-up for those who received foscarnet.At the same time, 3 patients in the control group turned into active infection. Only one receiving foscarnet appeared urine volume cutting down temporarily,and the renal function had a reversible change;2 patients had skin red reaction.Conclusion Foscarnet could control CMV active infection quickly,markedly and firmly.and no recurrence was found during a 3-month follow-up.Foscarnet may protect the inactive patients from turning positive.And foscarnet had no obvious damage to the renal graft function and didn't interfere with the metabolism of blood calcium and cyclosporine A.Foscarnet is a safe and effective drug to treat CMV infection.

Objective To investigate the role of HMGB1 in the pathogenesis of organ injury of acute necrotizing pancreatitis (ANP).Methods Male ICR mice were randomly allocated into control group,ANP group and HMGB1 monoclonal antibody group.ANP model was induced by intraperitoneal injection of 20％ L-arginine.Mice in HMGB1 monoclonal antibody group were given intraperitoneal injection of 200 μg of HMGB1 monoclonal antibody immediately after the induction of the ANP model.All the mice were sacrificed at 12,24,and 48 h after ANP induction.Serum level of amylase and liver,renal function were determined,level of serum HMGB1 was measured by using enzyme-linked immunosorbent assay,and then the pathologic changes of pancreas and liver were routinely observed and scored.The HMGB1 mRNA levels in the liver and pancreas were studied by real time fluorescence quantitative PCR.Results The serum levels of HMGB1 at 12 h in control group,ANP group and HMGB 1 monoclonal antibody group were (9.09 ± 1.03),(25.04 ± 4.30),(16.84 ± 4.27) μg/L; and pathological scores of pancreatic tissue were (1.50 ± 0.55),(4.33 ± 0.52),(3.03 ± 0.32) points ; and HMGB1 mRNA expressions in pancreas were 0.48 ± 0.18,7.53 ± 2.71,3.26 ±2.33 ; HMGB1 mRNA expressions in liver were-1.23 ± 0.37,0.15 ± 0.65,－ 1.27 ± 0.72.The corresponding values in ANP group were significantly higher than those in control group (P ＜ 0.05).While the corresponding values in HMGB1 monoclonal antibody group were significantly lower than those in ANP group (P ＜0.05).There was a positive linear relationship between serum HMGB1 level and pancreatic pathological scores 24 h after ANP induction (r =0.768,P ＜ 0.05).In addition,the serum levels of AMY,AST,ALT,LDH,BUN,Cr showed a similar trend as that of serum level of HMGB1,and the serum level of HMGB1 was positively associated with serum levels of Cr,BUN and ALT (r =0.824,0.719,0.590,P＜0.05).Conclusions HMGB1 may be a key factor of inflammatory response and organ dysfunction of ANP in mice,and extrinsic supply of its monoclonal antibody may decrease the injuries of pancreas and other organs during ANP.

Objective To observe the serum levels of high mobility group box-1 protein (HMGB1)in patients with acute cholangitis (AC) and to investigate contributions of HMGB1 in AC.Methods Serum HMGB1 concentrations were determined by an enzyme-linked immunosorbent assay in 30 patients with AC of severe type (ACST) and 42 patients with mild acute cholangitis at the time of admission (within 72 h after the onset).A total of 50 healthy subjects were recruited as the control group.Fluorescent quantitative PCR (FQPCR) was used to detect the HMGB1 mRNA expression and the relationship between serum HMGB1 levels and clinical factors was analyzed.Results The serum HMGB1 levels in healthy control group,mild group and ACST group were (1.82 ± 0.64) μg/L,(10.46 ± 3.75) μg/L,(18.89 ± 6.86) μg/L,respectively.The mean value of serum HMGB1 level in mild group was significantly higher than that in control group,while significantly lower than that in ACST group (P ＜ 0.05).Compared to the control group,the HMGB1 mRNA level in patients of AC increased significantly and the level of ACST group was higher than that of mild group.The serum HMGB1 levels of patients with positive bile or/and blood cultures were higher than that of negative.After emergency endoscopic nasal biliary drainage,the serum HMGB1 levels of patients significantly decreased compared to preoperational (P ＜ 0.05).The HMGB1 levels were significantly positively correlated with white cell counts,C-reactive protein (CRP),total serum bilirubin,direct bilirubin and alkaline phosphatase (ALP).By logistic regression analysis,serum HMGB1 levels had correlation with severity of disease.Conclusion Serum HMGB1 levels significantly increased in patients with AC and the serum concentrations of ACST group were higher than those of mild group.Serum HMGB1 level has a correlation with sepsis.ENBD could lower its serum levels.Serum HMGB1 has predictive value to severity of disease.

Objective: To probe into the etiology of the sever e post-renal transplantation infection and its diagnosis and t reatment. Methods: A retrospective analysis was made on the seve re infected cases among 1 504 renal transplantation cases. Results: (1)The infected rate in the whole group was 23.74%,and 14.01% of the infecti on cases was severely involved. (2) About 86% of the severe infection occurred within 6 months after operation and as high as 82% of the patients were successf ully rescued by various etiological treatment. (3) The main etiological causes according to their frequency and type were: Bacteria(Mycobacterium tub erculosis, Pseudomonas, Aureus staphylococcus, Bacillus cloacae, etc.); Fungus (Candida albians, Candida tropicals, Penicillum patulum). Cytomegalo virus also often appeared. Conclusion: (1) Infection is one of t h e common complications after renal transplantation and severe infection is an im portant cause of death. (2) Correct diagnosis and combined therapy in time may improve its success rate. (3) Characterized germ spectrum exists in severe post -renal transplantation infection and its role is of great importance to clinica l management.

Objective To investigate the value of three-dimensional digital subtraction angiography (3D-DSA)in the diagnosis and interventional treatment of Budd-Chiari syndrome caused by the obstruction of inferior vena cava(IVC).Methods Twenty-one patients with complex Budd-Chiari syndrome caused by the obstruction of IVC underwent 3D-DSA after two-dimensional-DSA(2D-DSA)was performed with posterior-anterior view.The images of 2D-DSA and 3D-DSA were independently reviewed by two senior interventional radiologists iu a double-blinded way.Percutaneous transluminal angioplasty or stent placement of IVC were performed according to the results of 2D-DSA and 3D-DSA.Results Different aspects of the IVC in all patients were demonstrated on the 3D-DSA images,including the mowhology and the location of obstructions,the origins of collateral vessels and their relationships to the IVC.Collateral vessels originated from the site of IVC occlusions in 9 patients were detected by the 3D-DSA.However.the 2D-DSA provided excellent visualization of the vascular structures of the IVC in 7 patients.and the collateral vessels origihated from the site of IVC occlusions were shown in 2 patients.The 3D-DSA was significantly superior to the 2D-DSA in detecting the IVC obstructions and the collateral vessels(P＜0.05).The virtual angioscopy of the 3D-DSA was able to visualize free IVC thrombosis in 3 paitents.and mural IVC thrombosis in 1 patient.The procedures were successful in all patients.There were no other complications except the rupture of IVC in 1 patient.Conclusion The 3D-DSA can offer valuable informations in diagnosis of IVC obstruction.and it may play an important role in interventional treatment of Budd-Chiari syndrome.

Objective:To perform trans-peritoneal laparoscopic adrenalectomy via a single incision in treatment of adrenal tumors,and to discuss its clinical outcome and safety.Methods:Single incision trans-peritoneal laparoscopic adrenalectomy was used in treatment of three patients with adrenal tumors.The incision was made 3 cm below the costal margin of anterior axillary line; three Tocars were placed in the cut.The instruments used included single port access,CUSA,Hem-o-lok,etc..Results:The three operations were all successful,and there were no conversion to open procedure or a need for extra Ttrocars.The operating time periods were 75,116,and 135 min,with a mean of (108.7?30.7)min.The perioperative blood losses were 10,20,and 30 ml,with a mean of (20?10)ml.The gastric canal and ureteral catheter were withdrew one day after operation,and the drainage tube was withdrew 3 d after operation.The mean postoperative hospital stay was 4 d.Conclusion:Single incision trans-peritoneal laparoscopic adrenalectomy has the advantage of little trauma,less blood loss,satisfactory safety,and prompt postoperative recovery,but is difficult to manage.

OBJECTIVETo review kidney transplantation in the center and analyze the risk factors affecting long-term allograft survival.

METHODSThirty-two relative variables were analyzed with SAS statistical software. Using Log-rank method, we investigated influence of these variables on short-and long-term survival of grafts. Kaplan-Meier analysis was used to estimate the 1-, 3-, 5-, 10-years graft survival rates and half-life. Proportional hazards regression analysis (Cox model) was used to assess and rank the relative risk of potential variables.

RESULTSThe 1-, 3-, 5-, 10-years graft survival rates were 83%, 75%, 66% and 48%. After excluding the patients died with functioning grafts, the 1-, 3-, 5-, 10 years grafts survival rate increased to 89%, 82%, 75% and 69%, respectively. The mean half-life was 8.78 +/- 0.14 and 14.09 +/- 0.20 years, respectively. By Log-rank analysis, factors affecting short- and long-term graft survival were identified as: renal function, duration of graft function became normal, cold-ischemia time, presence of acute rejection, delayed graft function, immunosuppressive regimen, complication, infection, anti-rejection therapy. Cox model multivariate analysis showed that there were 18 factors affecting graft survival.

CONCLUSIONSNew immunosuppressive agents not only significantly increase short-term graft survival, but also have the better long-term outcome tendency. Making assurance to get high quality donor organ and minimizing the death with graft function may be the most feasible way to prolong graft survival at present.

Adult ; Cadaver ; Female ; Graft Survival ; drug effects ; Humans ; Immunosuppressive Agents ; pharmacology ; Kidney Transplantation ; Male ; Multivariate Analysis ; Transplantation, Homologous

In the paper, the study was reviewed on the infrared temperature characteristics of acupoints in recent 10 years. CNKI, WANFANG, VIP, SciVerse ScienceDirect and Springer databases were retrieved, with"infrared thermal imaging" and "acupoint" as the key words. The retrieving time was from January 1, 2006 to December 31, 2016. Totally, 468 relevant papers were searched and 169 papers of them were read carefully on acupoint infrared temperature. In terms of physiological condition, pathological condition and the stimulation methods such as acupuncture, moxibustion,, embedding therapy and cupping therapy, the general situation was reviewed on the infrared temperature characteristics of acupoints separately. It was found that the study on infrared temperature characteristics of acupoints in physiological condition was limited and the characteristics discovered were not enough to systematically review the physiological and physical properties of acupoints. The study in terms of the pathological condition objectively reflected the effects and rules of diseases. It was showed in the study of acupoint infrared temperature characteristics after stimulation that the changes of infrared thermal imaging tempe-rature at some specific region induced by different therapies and parameters might be used to deduce the potential mechanism and optimal parameters or schemes of intervention method and contributed to the formation and deve-lopment of quantitative diagnosis and treatment. The authors believe that the study on infrared temperature characteristics of acupoint provides the active significance in the exploration on the physiological and physical characteristics of acupoint, the effects and rules of diseases as well as the quantitative diagnosis and treatment.