Objective To investigate the changes of panel reaction antibody (PRA) and the effects of HLA sensitized paths in patients waiting for renal transplantation.Methods PRA of 10 555 samples from 8926 renal transplant recipients in 51 transplant centers was analyzed.In 1991-1998 group,PRA was by using NIH-CDC technique,and in 1999-2010 group,PRA was detected by using ELISA.The effects of blood transfusion,pregnancy and transplantation on the PRA positive rate were analyzed.Results There were 1324 recipients positive for PRA in 8926 (14.83 ％ ).The average PRA positive rate in 1991 1998 group and 1999-2010 group was 18.17％ (513/2823) and 13.29％ (811/6103) repectively (P＜0.01).Among 1324 PRA positive recipients,the number of recipients with PRA of 1％-30％ and PRA of ≥30％ respectively accounted for 71.83％ and 28.17％.There were statistically significant differences in the PRA positive rate between the recipients receiving blood transfusion and those without blood transfusion (31.77％ vs 1.21％,P ＜ 0.01 ),between the recipients having pregnancy history and those without pregnancy history (24.64％ vs 7.19％,P＜ 0.01 ),and between primary transplant and re-transplant recipients (13.35 ％ vs 40.62％,P＜0.01).Conclusion In last 20 years, PRA in majority of PRA positive recipients was ＜ 30％ (low sensitized).Renal transplantation and blood transfusion were the important influencing factors that led to positive PRA,and pregnancy history was a related factor.

Objective To investigate the inhibition mechanism of gallnut on biofilm formation by MRSA 41577.Methods TTC assay was used to detect inhibitory effects of biofilms formation and mature biofilms.The of PIA on biofilm formation was studied using Congo red agar method.Micro-Ultraviolet Spectrophotometer was used to detect inhibitory effects of the release of eDNA.The influence for Baicalein on icaA and cidA gene expression were detected by RT-PCR method.Results The inhibitory concentration (MIC) and minimum bactericidal concentration (MIC) of MRSA 41577 BF were 0.5 mg/mL and 1 mg/mL, respectively.The inhibitory effect of galla on MRSA 41577BF formation and mature BF was significantly inhibited.Inhibition of MRSA 41577,the MIC and MBC of mature BF were 4 mg/mL and 16 mg/mL.Congo red test results show that Galla can inhibit the synthesis of MRSA 41577 PIA, and the concentration was dose-dependent.The results showed that gallnut could inhibit the release of MRSA 41577 eDNA, and the release amount of eDNA was 3.61μg/OD595 and 11.91μg/OD595 , respectively, when the concentration of gall was 1/2MIC.The release of eDNA was reduced by 69.7% (P<0.01).The expression of icaA and cidA genes in the control group was 9.7% and 6.67%, respectively.The expression of icaA and cidA in the control group was significantly lower than that in the control group ( icaA and cidA, and cidA gene expression were 100%, the expression of icaA and cidA genes were reduced by 90.3%and 93.3%, respectively (P<0.01).Conclusion The inhibitory effect of gallnut on the biofilm of MRSA 41577 is mainly through inhibiting the expression of icaA and cidA genes, and then affecting the synthesis of PIA and the secretion of eDNA .

Objective To study the preoperative treatment and prognosis observation? in sensitized recipients of kidney transplantation.Method Forty-one recipients positive for preoperative PRA accepted renal allograft transplantation from January 2007 to July 2012.All recipients were given immunosuppressant or immune induction by anti-CD25rnAb in advance,and plasma exchange,immunoadsorption and intravenous high-dose immune globulin were administered.Meanwhile,donor HLA antigens had to avoid all stored HLA antibodies of the recipient,and lymphocyte cytotoxicity cross test (CDC) had to be negative.Anti-human lymphocyte globulin (ATG) was used to strengthen the immune induction,and tacrolimus + mycophenolate mofetil (MMF) + corticosteroids triple immunosuppressive regimen was adopted after transplantation.Then intravenous micafungin would be given after transplanted kidney function was normal,and ganciclovir and sulfamethoxazole were taken orally to prevent infection.Result In 41 recipients positive for preoperative PRA,13 cases were positive for only HLA class Ⅰ antibodies,15 cases for only HLA class Ⅱ antibodies,and there existed 13 cases of both HLA class Ⅰ and class Ⅱ antibodies also with PRA≥50％.Fifteen patients achieved normal serum creatinine in one week,and no hyperacute rejection and accelerated rejection occurred.Fourteen recipients experienced an episode of acute rejection (34.15％,14/41): 12 recovered by steroids bolus therapy,and the other two reversed in 3-5 days by cyclophosphamide or ATG treatment.One case died of mycotic pneumonia in 4 months later.One-year recipient/kidney survival rate was 97.6％ (40/41).Conclusion The recipients positive for preoperative PRA only can accept renal allograft transplant while the donor's HLA antigens had to avoid all stored HLA antibodies of recipients themselves and CDC test was negative.After that the combination of desensitization therapy,immune induction therapy and postoperative potent immunosuppressant can prevent acute rejection effectively and increase postoperative recipient/kidney survival rate.

Objective To explore the effects of the pre-pregnant body mass index(BMI) and the pregnancy growth on the mater-nal and neonatal outcomes .Methods 250 pregnant women with the built file ,regular antenatal inspection and hospital delivery in our hospital during 2011 were selected and divided into the emaciation group ,the appropriate group and the obesity group according to the pre-pregnant BMI .The occurrence rates of cesarean section ,fetal macrosomia ,low birth weight ,postpartum hemorrhage ,ges-tational diabetes ,gestational hypertension disease ,fetal distress ,neonatal asphyxia and puerperal infection were compared among the various groups .In addition ,according to the different growth amplitudes of pregnancy BMI ,the pregnant women were re-divided in-to 3 groups(weight gain insufficient group ,weight gain appropriate group and weight gain overmuch group ) and the different ma-ternal and neonatal outcomes were compared .Results The occurrence rates of cesarean section ,macrosomia ,gestational diabetes and gestational hypertension disease in the obesity group were significantly higher than those in the emaciation group and the appro-priate group(P<0 .05) ,while the occurrence rate of the low birth weight in the emaciation group was significantly higher than that of the appropriate group and the obesity group(P<0 .05);the occurrence rates of cesarean section ,macrosomia ,gestational diabetes and gestational hypertension disease in the weight gain overmuch group were significantly higher than those in the weight gain in-sufficient group and the weight gain appropriate group(P<0 .05) ,while the occurrence rate of low birth weight in the weight gain insufficient group was significantly higher than that of the weight gain appropriate group and the weight gain overmuch group (P<0 .05) .Conclusion The maternal and neonatal outcomes in the pregnant women with pre-pregnant BMI exceeding the standard and pregnant BMI overmuch growth are very worrying .The growth of pre-pregnant BMI and pregnant BMI is one of the important indi-cators for monitoring the maternal and neonatal complications .

By means of polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay, the association between vitamin D receptor (VDR) genotypes and bone mineral density (BMD) in the patients receiving long-term glucocorticoid therapy was studied. The clinical data and blood of 71 patients with rheumatosis who received long-term glucocorticoid therapy were collected. BMD was measured by dual-energy X-ray absorptimometry. VDR gene fragment (about 185 bp) was amplified by PCR from the extracted genomic DNA, then digested with restriction endonuclease Bsm I. The genotypes were evaluated based on the fragment length following endonuclease digestion and the association between genotypes and BMD or Z-score values was analyzed. Among the 71 cases, the detected genotypes were Bb and bb with the distribution frequency being 11.3% and 88.7% respectively. The distribution frequency of the alleles was in agreement with the Hardy-Weinberg equilibrium. There was no significant difference between the two genotypes in age, gender, body mass index (BMI), disease duration, disease types, time of glucocorticoid administration and cumulative dosage (P > 0.05). Osteoporosis rate of the patients with Bb or bb genotype was 37.5% and 33.3% respectively, with the difference being not significant (chi 2 = 0.05, P = 0.8). The BMD and Z-score values at lumbar spine and femur in two genotypes were not similar, but the difference had no significant (P > 0.05). The distribution frequency of bb type of VDR genotypes in Han populations of China was more prevalent, followed by Bb and bb types in turn. In the patients receiving long-term glucocorticoid therapy, there was no significant difference in BMD between Bb and bb genotypes. The data suggest that the VDR genotypes may not be means of identifying patients at greater risk of glucocorticoid-induced osteoporosis, which await to be further confirmed by a large sample size.
Arthritis, Rheumatoid/drug therapy ; Bone Density ; Genotype ; Lupus Erythematosus, Systemic/drug therapy ; Osteoporosis/chemically induced ; Osteoporosis/*genetics ; *Polymorphism, Restriction Fragment Length ; Prednisolone/*adverse effects ; Prednisolone/therapeutic use ; Receptors, Calcitriol/*genetics

Objective To investigate the correlation between human leukocyte antigens-A,-B,-DRB1 (HLA-A,-B,-DRB1) high resolution alleles and chronic renal failure (CRF) caused by immunoglobulin-a nephropathy (IgAN).Method The polymerase chain reaction-sequence-based typing (PCR-SBT) method was used to investigate the genotypes of HLA-A,-B and-DRB1 high-resolution alleles in 191 cases of CRF caused by IgAN (experimental group) and 503 healthy blood donors (control group).The alleles frequencies between two groups were compared and the association between CRF caused by IgAN and the polyrnorphism of HLA was analyzed.Result (1) There were 25 alleles at A locus,48 alleles at B locus and 32 alleles at DRB1 locus in experimental group.(2) The genetic frequency of HLAA * 2901 [Pc =0.033,OR =10.738,95％ CI (1.193,96.691)],HLA DRB1 * 1106 [Pc =0.0001,OR =0.969,95％ CI (0.944,0.994)],HLA-DRB1 * 1202[Pc =0.002,OR =1.859,95％ CI (1.259,2.745)],HLA-DRB1 * 1401 [Pc =0.021,OR =0.984,95％ CI (0.967,0.998)],HLA-DRB1 * 1602[Pc=0.015,OR=1.915,95％ CI (1.157,3.17)] in experimental group was higher than in control group (P＜0.05).Conclusion There is susceptibility association of HLA-A * 2901,HLA-DRB1 * 1106,HLA-DRE * 1202,HLA-DRB1 * 1401,HLA-DRB1 * 1602 with CRF caused by IgAN.It is concluded that there is a close genetic and immunological correlation between HLA alleles and the pathogenesis of CRF caused by IgAN.

Objective To identify the changes of outpatients/emergency visits at Nanjing Children′s Hospital since introduction of the general pricing reform at public hospitals.Methods Fluctuations of outpatients/emergency visits at Nanjing Children′s Hospital before and after the reform in 2015 were compared,and an empirical analysis was made in view of the overall structural changes,demand price elasticity and cross-price elasticity of various outpatients/emergency visits.Results The change of total outpatients/emergency visits was minimal,yet the composition registered significant changes.Monthly average of common outpatients totaled 7 072 visits,a growth of 12.6%;that of senior specialists totaled 3 035 visits,a growth of 48.4%.The price elasticity was<1,while the demand for various outpatients/emergency visits services and cross-price elasticity appeared inelastic.Conclusions The one year reform has witnessed the hospital in smooth operations as yet.Given the sizable rise of examination prices for both outpatients/emergency visits,patient volume remains stable instead of drastic decrease,evidencing the strong demand for children′s medical services.

Objective:To compare and study coronary artery lesions characteristics of patients with non -ST -seg‐ment elevation acute myocardial infarction (NSTEMI) .Methods :A total of 66 patients diagnosed as acute NSTEMI were enrolled as NSTEMI group ,meanwhile 74 patients with unstable angina pectoris (UAP) were regarded as UAP group and 76 patients with acute ST -segment elevation myocardial infarction (STEMI ) were regarded as STEMI group .All patients received coronary angiography (CAG) and optical coherence tomography (OCT) examination . Coronary artery lesions characteristics were compared among three groups .Results:Pairwise comparison showed , that occlusion lesion (33.3% ) and serious stenosis (70% ~94% ) lesion (34.8% ) in NSTEMI group were signifi‐cantly more than those of UAP group (14.9% ,8.1% ) respectively;the occlusion lesion and serious stenosis lesion of STEMI group were no significant difference compared with those of STEMI group , P>0.05 all;type C lesion 43.9% of NSTEMI group was significantly more than that of UAP group (27.0% ) and of STEMI group (31.6% ) respectively ( P<0.05 all);vulnerable plaque of NSTEMI group (56.1% ) was significantly more than that of UAP group (23.0% ,P<0.01) ,but was no significant difference compared with STEMI group (56.6% ,P> 0.05). Conclusion :Serious stenosis lesion ,type C lesion and vulnerable plaque of NSTEMI group are significantly more than those of UAP group ;in NSTEMI group , type C lesion is significantly more than ,and occlusion lesion occlusion le‐sion significantly less than that of STEMI group .

ObjectiveTo evaluate whether post-traumatic stress disorder(PTSD)-like rats more easily to acquire the alcohol induced conditioned place preference(CPP),and its relationship with dopamine D1 receptor.Methods40 SD rats were randomly divided into four groups:PTSD + ethanol group ( PE.),control + ethanol group (CE),PTSD + saline group(PS),and control + saline group(CS).All rats of each group were trained for CPP with alternate injections of alcohol ( 2 mg/kg,i.p.) and saline ( 10 ml/kg,i.p.).PE and PS group were subjected to single prolonged stress (SPS) for PTSD model.Four groups were evaluated the performances of freezing behavior and plus maze test after SPS 24 hours and 7 days.And on SPS 7 days four groups were respectively detected D1 dopamine receptor-positive cells number in amygdale by immunohistochemistry.ResultsCompared with control group,freezing time of PTSD group was remarkable longer on 7 days after SPS not 24 hours( (89.13 ±8.60) s vs(22.25± 5.85) s,q =8.77,P ＜ 0.01 ),and number of entry into the open arms and time spent in the open arms of PTSD group were both less than control group on 7 days after SPS not 24 hours( (4.25 ± 1.26) vs ( 14.38 ± 2.18),( 12.38 ± 3.30) s vs (40.38 ± 7.29 ) s,q =4.74 and 4.08,P ＜ 0.01 ).In CPP,the CPP value of post-conditioning only in PE group was obviously higher than that of pre-conditioning ( q=31.81,P＜ 0.01 ).The CPP value of postconditioning in PE group was higher than that of CS group,CE group and PS group( q=-38.32,-22.21,-33.38,P＜0.05).There were no significant differences in the number of D1 dopamine receptor-positive cells in the amygdale region among four groups (F =0.07,P ＞0.05 ).ConclusionThe PTSD-like rats are easier to acquire the alcohol CPP,which maybe not relate to the changes of the number of D1 dopamine receptor-positive cells in amygdala.

Objective:To study the clinical outcome of lamellar keratoplasty combined with autogenous corneal stromal padding for treatment of corneal perforation.Methods:An observational case series study was conducted.A total of 14 patients (14 eyes) with corneal perforation underwent lamellar keratoplasty in Henan Provincial People's Hospital from January 2017 to August 2018 were collected.During the operation, the corneal stromal autograft was taken to pad the corneal perforation.Visual acuity, intraocular pressure, corneal epithelial healing time, infection recurrence, and the status of corneal graft and anterior chamber were recorded on the 1st, 7th, 14th day, 1st, 3rd, 6th, 9th and 12th month after operation.OCT examination of anterior segment was performed at 1 month, 6 and 12 months postoperatively to observe the interlamellar structure of corneal implantation bed and stromal graft, anterior chamber and iris.The safety and effectiveness of the operation were evaluated according to the 1-year follow-up.The study protocol adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Henan Eye Hospital (No.HNEECKY-2019[18]). Written informed consent was obtained from each patient prior to entering the study cohort.Results:The healing time of corneal epithelium was 2-4 days after operation, (3.01±0.59) days on average.At one day after surgery, all patients had normal anterior chamber depth without aqueous leak and no double chamber was observed.The corneal grafts attached to the implantation bed well and showed mild to moderate edema.There was no recurrence of corneal infection ulcer two weeks after operation, and the corneal ulcer was healed and anterior chamber was well formed in 14 patients.The corneal graft was transparent, and the anterior segment OCT image showed corneal implant bed and graft were well attached, and the anterior chamber depth was normal three months after operation.The best corrected visual acuity of 9 eyes was more than 0.3 one year after operation, and the vision acuity of the 14 patients improved obviously, and no refractory glaucoma occurred after operation.Conclusions:Lamellar keratoplasty combined with autogenous corneal stromal padding is a safe and effective surgical procedure for treating corneal perforation.