Objective To compare the long-term effect and safety between tacrolimus (FK506) and cyclosporine (CsA) in patients receiving cadaveric renal transplantation. Method A total of 210 patients were randomized to FK506 and CsA after cadaveric renal transplantation, and were followed up for 12-32 months for the variation of trough concentration in whole blood, the incidence of acute rejection and chronic rejection, one-year survival rate of patient/graft, variation of creatinine level, impairment of liver function and glucose metabolism and lipid metabolism, incidence of infection, and side effects. Results The variation of trough concentration of FK506 was similar to CsA. The incidence of acute rejection was significantly lower in FK506 group than in CsA group ( 16.3 % vs 33.0 % , P 0.05 ). The incidence of impaired liver function and impaired lipid metabolism and gingivitis and creatinine level three months after transplantation were significantly lower in FK506 group than in CsA group ( P

Objective To investigate the functional status of adrenal cortex status in newborn with septic shock, and explore the diagnostic criteria of relative adrenal insufficiency (RAI) and catecholamine resistance in shock. Methods Fifty newborns with septic shock, 28 males and 22 females, admitted into neonatal intensive care unit (NICU) of Hangzhou Second People's Hospital from Jan. 2005 to Jun. 2009, were involved in the present study. Serum cortisol levels of the newborn patients were measured with radio immunoassay at baseline and 30 and 60 minutes after-administration of a low-dose (1?g) of adrenocorticotrophic hormone (ACTH). The patients were divided into two groups by maximal cortisol increment levels: normal adrenal function (NAF) group and RAI group. Some clinical factors, for example, the fluid demands on 1st day, shock duration, mortality, neonatal critical illness score (NCIS) and the incidence of catecholamine resistance shock, were observed. According to prognosis these newborn patients were then divided into two groups: nonsurvivors and survivors. The serum cortisol levels were compared after ACTH test between the two groups. Results Nineteen RAI and 31 NAF were observed in the 50 cases. The fluid demands on 1st day, shock duration and mortality were higher, while NCIS was lower in RAI group than in NAF group (P

Objective To investigate the diagnosis and treatment of vascular complications after allograft kidney transplantation.Methods The clinical data of 34 patients with vascular complications after renal allograft transplantation were retrospectively studied,and the characteristics,diagnosis and therapeutics were analyzed.Results Among the 34 patients,there were 13 cases of allograft renal(artery) obstruction,8 cases of allograft renal artery hemorrhage,7 cases of arterial anastomosis(rupture),4 cases of allograft renal vein obstruction,1 case of external iliac artery aneurysm and 1 case of external iliac vein thrombosis.Diagnosis was made in 21 patients by color Doppler flow imaging(CDFI),among whom 10 received further examination of magnetic resonance angiography(MRA).In the 5 cases of allograft renal artery stenosis(TRAS),3 came out with well renal function after the placement of endovascular stents.During the follow-up duration of 8,10 and 14 months,their serum creatinine(Scr) maintained between 115 and 135 ?mol/L.TRAS patient's allograft renal artery which had been anastomosed end-to-end with internal iliac artery was shifted to end-to-side style with(external) iliac artery at the second time,and came out with normal Scr one month postoperation.One TRAS patient received conservative treatment because MRA examination indicated only mild stenosis,and his Scr has been decreasing for 21 days till now.Three patients with allograft renal vein(obstruction) was treated with surgery,in whom one died of heart failure,and the other 2 patients'(renal) function recovered well during the follow-up of respectively 13 and 36 months.One patient with external iliac vein thrombus died of allograft rupture.All the other patients underwent allograft(resection).Conclusion Vascular complications after renal transplantation progresses fast once(developed) with a poor prognosis,so early diagnosis is essential for graft as well as survival and(effective) management should be administrated accordingly.CDFI could be the first choose for screening.

Objective To observe the effect of tacrolimus vs cyclosporin A on liver function after kidney transplantation. Methods Seventy-three cases of HBV carriers received kidney transplantation. Their liver functions before operation were normal and HBV DNA was negative. After operation they were divided into two groups: FK506 group (n=40) taking FK506, mycofenolate mofetil (MMF) and prednisone to prevent rejection. CsA group (n=33) taking CsA, MMF and prednisone to prevent rejection. The cases were followed for 1 to 6 years. The incidence of liver function admage and HBV DNA positive rate were observed in two groups. When damage to liver function appeared, the doses of immunosuppresive drugs were regulated, and the drugs protecting liver function were given. Results Four cases ( 10.0 % ) in FK506 group and 16 cases ( 48.5 %) in CsA group suffered the damage to liver function. In 2 cases ( 5.0 %) of FK506 group and 9 cases ( 27.3 %) of CsA group, HBV-DNA transferred to positive (P

[Objective]To discuss the spinal single side structure illness to the spinal column stable influence characteristic and the method of treatment,and to analyze the character of comparing the traditional three-column theory with the newly three-pyramidal-column theory.[Method]Through 2001-2006 year our hospital admited preservation integrity spinal single side structure illness 42 cases,among the total single side articular process illness 21 cases,single side vertebral plate illness 10 cases,Single side pedicle of vertebral arch illness 7 cases,single side more structure illness 4 cases.Through conservatively treats 11 cases,Single stage fixed 4 cases,the single stage two-sided fixed surgery treats 27 cases,thus,to analyze and revaluate three-pyramidal-column theory essence.[Result]Forty-two cases obtained the revisit completely,average follow-up for 28 months.Evaluates according to the Shi Shushan 's standard,the excellent 31 cases;the good 8 cases,the fair 3 cases.Good and excellent rate reached above 93%.[Conclusion]The spinal single side structure illness may lead to spinal pyramid tropic or scoliosis,and very little causes spondylolisthesis.The spinal colarnn is a three-pyramidal column lives by many triangles.Any colarnn or the angle being destructed will affect its stability.

Objective To study the feasibility and safety of horseshoe kidney transplantation and avoid the waste of the donor kidney. Methods The horseshoe kidney was identified and confirmed during the organ procurement process. It was perfused in situ and procured en bloc. With an appropriate dissection and reconstruction on the beach table, the horseshoe kidney was carefully divided at the isthmus and transplanted into two separate recipients. The surgical strategies and postoperative outcomes of transplanting the cadaveric horseshoe kidneys were evaluated. Results Two recipients had a immediate return of renal function after the blood vessels were opened. One recipient had a normal renal function presented as lower post-transplant serum creatinine values with a follow-up of 12 months. There was no complications related to the horseshoe kidney. Another case died of infection 1.5 month later after the transplantation. Conclusions Cadaveric horseshoe kidney may be transplanted successfully using various individual technical strategies based on the specific renal anatomy. Considering the lack of donor horseshoe kidney transplantation is feasible and safe.

Objective To study the clinical efficacy and safety of rapamycin in combination with CsA and steroid to prevent the acute rejection of kidney transplantation. Methods In an open-label,multi-center study,there were 100 primary renal allograft recipients with cadaveric donors enrolled from 4 transplantation centers in China. The immunosuppressive regimen was the triple therapy of rapamycin in combination with CsA and steriod. Rapamycin was administered in 48 h after grafting. The first dose of rapamycin was 6 mg /day and the maintenance dose was 2 mg /day. Results Eighty-four recipients were followed up for more than 6 months. Rapamycin was discontinued in 16 patients because of the adverse events and other reasons. Eight patients experienced acute rejection and 7 patients were reversed by methyprednisolon therapy. In 6 of the 7 patients,the dose of rapamycin was maintained 2 mg /day. The remaining one was added to 3 mg /day. No recurrence of AR was observed in a continuous follow-up of more than half-year. The most common and significant adverse events were hyperlipoidemia and abnormal liver function.Conclusions The combination of rapamycin with CsA and steroid to treat recipients of kidney transplantation is safe and efficient. There was a low incidence of AR but a high incidence of hyperlipoidemia and abnormal liver function. The rational regulation of the dose may reduce the incidence of the side-effects. Further observation and study are required for long-term application.

Objective To investigate the therapeutic effect of rapamycin in the treatment of malignancies after kidney transplantation (KT).Methods Of the 23 inoperable patients with malignancies after KT, 8 (RPM group) received Rapamycin as treatment as well as there immunosuppressive regimens were modulated, and the remaining 15 (non-RPM group) were treated only by immunosuppressive regimen modulation, some of whom also received chemotherapy. The survival of the patients in the two groups was compared.Results In RPM group, the median survival time was (14.5) months and no acute rejection (AR) occurred during whole follow-up period. There are still 7 patients alive at the end of this study. One recipient with Kaposi’s sarcoma developed AR because of RPM dose reduction, and finally died of transplanted kidney failure and pulmonary infection. In non-RPM group, the median survival time was (3.0) months, and all of them died during the follow-up period. The 12- and 20-month survival rates were respectively (75.0) % and (37.5) % in RPM group, while (7.1) % and 0 in non-RPM group with the difference being statistically significant (P

Objective To investigate the therapeutic role of glucocorticoid in treating cytomegalovirus (CMV) severe pneumonia after kidney transplantation. Methods Two groups of patients with CMV severe pneumonia after kidney transplantation were analyzed. The therapeutics for 12 patients of group A included the elimination of immunosuppressive agents such as cyclosporine (or tacrolimus) and cellcept, the use of antiviral drug such as gancyclovir, measures to prevent and cure other bacterial and fungal infections, supportive therapies and suck of oxygen or mechanical ventilation by respirators. Except for the above therapies, methylprednisolone was routinely injected to those 14 patients of group B. At the beginning, the dose of methylprednisolone was 120 mg/day to 150 mg/day. Three to five days later, the dose was decreased to 80 mg/day. The dose was further decreased to 40 mg/day when patients’ signs were improved. After patients’ signs were excluded, prednisone was taken orally in place of methylprednisolone. In our patients, methylprednisolone was used for average 12 days, ranging from 8 to 21 days. Results Among the patients of group A, 9 (75 %) were treated with mechanical ventilation by respirators, 7 ( 58.33 %) died and 2 ( 16.67 %) received dialysis due to dysfunction of the transplanted kidneys. Among the patients of group B, 4 ( 28.57 %) were treated with mechanical ventilation by respirators, 2 ( 14.29 %) died and no case with the transplanted kidney loss was found. There were significant differences between the two groups on the probability of using mechanical ventilation by respirators and the mortality (P= 0.047 and P= 0.038 respectively). In the patients of group B, no severe side effects caused by methylprednisolone were found. Conclusion The treatment with proper dose of methylprednisolone may extenuate effectively the inflammatory reaction from the CMV severe pneumonia after kidney transplantation while reduce the rejection related to the absence of other immunosuppressants and decrease the mortality and the rate of transplanted kidney loss.

Shenjincao injection was prepared from the extract of Lycopodium cernuum L. by ultrafiltration or wateralcohol methods,respectively,and then injected intra-peritoneally in groups of rats contaminated with quartz powder to assess their prophylactic effects. After 5 weeks of treatment,the rats were dissected and the fresh and dried weights,collagen content and the pathologic grading of the lungs were examined. Results showed that Shenjincao injection prepared with ultrafiltration was effective for the prophylactic treatment of experimental silicnsis of rats,while that prepared with water-alcohol method was devoid of such effect. The antisilicosis active principle of Shenjincao was explored and discussed.