Objective:To study the fit of pure titanium single crown fabricated by electron beam melting(EBM).Methods:Pure titanium crowns were fabricated by EBM,selective laser melting(SLM),CAD/CAM(R +K and DMG)and conventional lost wax technique(LW)respectively(n =5).Marginal and internal gap was copied by light-body silicone and measured using a digital mi-croscope .The data of marginal gap(MG)and internal gap(IG)were statisticaly analysed by ANOVA and SPSS statistical package version 17.0.Results:The MG and IG(μm)of pure titanium crowns in EBM group were 38.42 ±6.72 and 105.54 ±33.18,in SLMgroup 38.63 ±6.82 and 114.63 ±52.18,in DMG CAD/CAMgroup 26.18 ±4.36 and 102.18 ±40.81,in R +K CAD/CAM group 26.98 ±4.44 and 102.24 ±25.30,in LW group were 42.61 ±5.73 and 102.98 ±45.67,respectively.The marginal fit of the EBMgroup was significantly smaller than 120 μm of the generally accepted clinical standards.In the 2 CAD/CAM groups the MG was smaller than that of other 3 groups(P <0.05).The IG of the 5 groups were not statisticaly different(P >0.05).Conclu-sion:The marginal fit of titanium single crown fabricated by EBMis similar to that by SLM,better than that of LW and inferior than that of CAD/CAM.The internal fit of the crowns made by the 5 systems is similar.

Objective To study the effectiveness and safety of intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis therapy for acute ischemic stroke in patients with atrial fibrillation (AF).Methods A total of 94 patients treated with intravenous rt-PA thrombolysis within 4.5 hours after cerebral stroke onset were analyzed and divided into two groups:a non-AF group (n =64) and an AF group (n =30).Another 30 acute ischemic stroke patients with AF without thrombolytic therapy were selected as a control group.The prognosis of the three groups was compared.The National Institute of Health Stroke Scale (NIHSS) was used for comparison among the three groups before therapy and 7 days after therapy.The incidences of intracerebral hemorrhage (ICH) and symptomatic ICH (SICH) were recorded.The patients were followed up for 90 days and their clinical outcomes were assessed by using the modified Rankin scale (mRS).Results There were no significant differences in the NIHSS scores among three groups before treatment (P ＞ 0.05).The NIHSS scores were significantly lower in the AF and non-AF groups 7 days after thrombolysis therapy than those before thrombolysis therapy (P ＜0.05 and P ＜0.01),and no significant difference in the NIHSS scores was found in the control group before and after therapy (P ＞ 0.05).The incidence of ICH was significantly higher in the AF group than in the non-AF group (26.7％ vs.9.4％,P ＜ 0.05).No significant difference in the incidence of SICH was found between the AF and non-AF groups (13.3％ vs.6.3％,P ＞ 0.05).The favorable prognosis rate was higher in the AF and nonAFgroups than in control group (40.0％ vs.16.7％,P＜0.05; 45.3％ vs.16.7％,P＜0.01).No significant difference in very unfavorable prognosis rate was found between the AF and non-AF groups (20.0％ vs.18.8％,P ＞0.05).Conclusions It is effective and safe of rt-PA thrombolysis therapy for acute ischemic stroke patients with AF.

Objective To analyze the causes,neuroimaging and clinical manifestations of isolated unilateral pontine infarction and to discuss its relationship to progressive motor deficit(PMD).Methods All 58 patients with isolated acute unilateral pontine infarction confirmed by magnetic resonance imaging (MRI) were recruited in this study for retrospective review.Thirty-one patients of them had brain and neck multi-slice spiral CT angiography(CTA) within 1 week after admission.PMD severity was accessed using the dynamic National Institutes of Health Stroke Scale (NIHSS) within 5 days after onset.All 58 patients were divided into two groups:patients with PMD (23 cases) in group 1 and patients without PMD (35 cases) in group 2.Two groups were compared for the risk factors,initial NIHSS scores,modified Rankin Scale (mRS) scores at 1 month after onset,clinical manifestations,infarction distribution,size and morphology of infarctions and basilar artery lesions.Results The major cause was pathologic changes in basilar artery branch in both groups(6/12 in group 1 and 10/19 in group 2).The proportion of patients with infarction extending to the pontine surface in group 1 was higher than that in group 2 (21/23,91.3％ vs 20/35,57.1％,x2 =7.817,P =0.005).Initial NIHSS score in group 1 was higher than that in group 2(6.7 ±2.9 vs 4.5 ± 2.4,t =3.121,P =0.003).mRS score at 1 month after onset in group 1 was higher than that in group 2(2.2 ± 1.1 vs 1.5 ± 0.8,t =2.909,P =0.004).The Logistic regression analysis showed that isolated unilateral pontine infarction extending to the pontine surface was positively related to PMD (odds ratio 9.670,95％ confidence interval 1.171-79.856,P =0.035).Conclusions Progressive isolated unilateral pontine infarction is mostly caused by pathologic changes in basilar artery branch.Patients with PMD have a more severe initial clinical manifest and they have a worse short-term prognosis than patients without PMD.Isolated unilateral pontine infarction extending to the pontine surface may be a risk predictor in stroke evolution.

Objective:To compare the marginal and internal fit of selective laser melting(SLM)titanium crowns with lost-wax cast (LW)titanium crowns.Methods:Titanium crowns of 10 subjects were fabricated by SLM and conventional LW respectively(n =10).The marginal and internal gaps of the crowns were recorded with silicon film using a replica technique.Each silicon film was cut into 2 parts and the thickness of silicon layer was measured at ×100 magnification using a stereomicroscope,the data of marginal gap (MG)and internal gap(IG)were statistically analysed by ANOVA and SPSS statistical package version 17.0.Results:The MG (μm)of the titanium crowns of SLMgroup and LMgroup were 90.67 ±14.7 and 94.77 ±21.9(P <0.05),IG were 213.73 ±90.4 and 217.00 ±97.7(P >0.05),respectively.Conclusion:The marginal fit of the SLMcrowns is better than that of the LW ones,and is significantly smaller than 120 μm of the clinical generally accepted standards.

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 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.

A comparative observation about histological and histochemical study were made onthe preservating methods of local ischemic kidney of dogs.The methods of this exp-eriment were divided into five groups:A.Local hypothermia;B.Hypothermic perfu-sion solution 500ml,4℃,containing Procaine 450 mg and Heparin 100 mg,infusedinto renal artery;C.Hypothermic perfusion solution 500ml,4℃,containing 20% Ma-nniton 32ml,25% MgSO_4 0.36 ml,Heparin 100 ml,infused into renal artery;D.Localhypothermia and heparin 30 mg injected into the same vessel.E.Local room tem-perature.The specimens were taken from the kidneys of the experimental dogs atvarious period after treated with every method.The results were as follows;A,D and E group presented irreversible histological changes within 4 hoursaftertreatment.Four hours later,the reaction of SDH,ATPase,AlPase werenegative.It suggested that the kidney damage was serious,as well as expressed thatthe effect of these preservating methods for ischemic kidney are not satisfactory.In B group,the histological and histochemical alteration is very light and almostreversible,during 60 days after treatment.In C group,hypothermic perfusionsolution containing Mannitol,MgSO_4 etc either during experiment or follow observa-tion for 60 days,no histological and histochemical alterations were found.It indica-ted that this method is an ideal perservating technique for ischemic kidney.

Objective: To evaluate the efficacy and safety of bortezomib in kidney transplant recipients with chronic active antibody-mediated rejection (cABMR). Methods: A retrospective study wad conducted in patients(n=136)fulfilling the Banff 2017 criteria for cABMR from January 2004 to July 2017, including 29 patients bortezomib group and 97 patients in control group. Identified cABMR patients were dichotomized into bortezomib and control groups with a 1∶1 match using the propensity score matching method. The primary outcome was initiation of replacement therapy or an estimated glomerular filtration rate(eGFR)declined to <15 ml·min^-1·(1.73m²)^-1. The prognosis and adverse reactions of two groups were analyzed and evaluated. Results: No significant inter-group differences existed in age, sex ratio, immunosuppressive regimen, allograft age, serum creatinine, eGFR, urine protein, serum albumin, hemoglobin or HCV positive rate(all P>0.05). There were no significant inter-group differences in Banff scores (g, i, t, v, ah, mm, ci, ct, cv, ptc, c4d, all P>0.05). The median survival for bortezomib group and control group was 40.7 months and 36.9 months respectively. No statistically significant difference in graft survival between the two groups was observed(P=0.83), even after propensity score adjustment(P=0.29). The incidence of nausea, diarrhea and thrombocytopenia in bortezomib group was higher than those in control group (P<0.05). Conclusions Bortezomib does not seem to improve the prognosis of cABMR while is associated with higher incidence of adverse reactions.

Objective To characterize the clinicopathologic features,treatment efficacy and prognoses of proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) in renal allografts.Methods Electronic medical records of Jinling Hospital were searched for PGNMID that was diagnosed during January 2008 to April 2017.Clinicopathologic features,treatment regimens and prognoses information were retrieved and analyzed.Results We identified 5 cases of PGNMID with clinical symptoms of proteinuria (5/5),serum creatinine elevation (4/5) or hematuria (4/5) 5 to 19 months after kidney transplantation.Various light microscopic features were observed,with predominantly membranoprolifeative pattern.Mild mesangial proliferation pattern could be observed in early stages of disease progression.Immunofluorescence revealed monoclonal IgG3κ in 3 patients and IgG3λ in another 2 cases.One case of PGNMID with normal light microscopy but monoclonal IgG deposits was verified by IgG and light-chain subtyping.In the 4 patients treated with rituximab or bortezomib,decreased proteinuria was achieved in all treated patients while the decreases in serum creatinine decrease were only observed in 2 patients At last follow-up,one patient was in dialysis and serum creatinine levels of other 2 patients were ＞265.2 μmol/L.Conclusion Membranoprolifeative pattern is the most frequently observed microscopic findings and IgG3 is the most frequent IgG subtype in PGNMID.PGNMID recurs shortly after kidney transplantation.Rituximab and/or bortezomib is conducive to decrease proteinuria while their efficacy to decrease serum creatinine is dubious.The most effective treatment protocol for PGNMID remains to be determined in larger samples.