BACKGROUND:Calcineurin inhibitors reduce acute rejection rates and improve short-term graft survival in renal transplantation, but its nephrotoxicity associated with long-term use of calcineurin inhibitors remains an important issue. To both avoid exposure to calcineurin inhibitors and maintain effective immunosuppression, immunosuppressive agents such as sirolimus have emerged.
OBJECTIVE:To summarize the research progress of the two main protocols of sirolimus in kidney transplantation (de novo sirolimus-based therapy without calcineurin inhibitors and protocol conversion from a calcineurin inhibitor based therapy to sirolimus).
METHODS:With the key words of“kidney transplantation, sirolimus”in Chinese and in English, respectively, a computer-based search of articles was performed in CNKI (January 2000 to September 2013) and PubMed (January 1996 to September 2013) databases. Articles with the de novo sirolimus-based therapy without calcineurin inhibitors and protocol conversion from a calcineurin inhibitor based therapy to sirolimus were included.
RESULTS AND CONCLUSION:Sirolimus may obtain the advantages of no renal toxicity, anti-tumor and lower incidence of cytomegalovirus infections when compared with calcineurin inhibitors. But not al patients are suitable for sirolimus, and to screen patients strictly is the key of satisfactory clinical results. An appropriate treatment plan, drug monitoring of sirolimus, prevention and treatment of complications are essential features of the use of sirolimus.

Objective To evaluate the effectiveness of a major depression animal model for old man es?tablished with orchidectomized(ORX) and subsequently olfactory bulbectomized(OBX) rat. Methods Healthy Sprague?Dawley male adult rats were randomly assigned to six groups with ten rats in each group:intact,sham?oper?ated,model,vehicle,fluoxetine plus testosterone propionate(Flu+TP) and amitriptyline plus testosterone propionate (Ami+TP) groups. ORX+OBX rat model was established. Therapy of Flu or Ami (10 mg/kg,i.p.) combined with TP(25 mg/kg,s.c.) was administered. Behavioral changes of rats in each group were detected. Results Open field test: The number of rat crossing lattices in model((124.50±14.25)lattices) or vehicle group( 118.70± 10.27) was significantly larger than those of intact(38.20±6.30),sham?operated(33.70±9.58),Flu+TP (34.00± 9.82) and Ami+TP group (35.20±12.54). The rearing number of model or vehicle group was also significantly larger than those of intact,sham?operated,Flu+TP and Ami+TP group.Statistical differences in the above corre?sponding comparisons of open field test existed (P<0.01). Forced swimming test: The immobility time of model ((131.70±32.44)s) or vehicle group ((135.10±34.01)s) was significantly longer than those of intact((66.60± 12.06)s),sham?operated((62.00±13.38)s),Flu+TP((59.60±8.89)s) and Ami+TP group ((64.80±10.78)s). There were statistical differences in the above corresponding comparisons (P<0.01). Morris water maze test: The escape latency of model((62.00±26.05)s) or vehicle group ((60.52±27.00)s) was significantly longer than those of intact((24.19±9.12)s),sham?operated((21.06±8.13)s),Flu+TP((22.88±8.01)s) and Ami+TP group ((27.04±10.11)s);while the time rat swimming in the quadrant originally put a platform of model or vehicle group was significantly shorter than those of intact,sham?operated,Flu+TP and Ami+TP group. There were statisti?cal differences in the above corresponding comparisons of Morris water maze test (P<0. 01, P<0. 05 ) . Conclusion The above data demonstrates that ORX+OBX rat model is both repeatability and reliability,and can be a major depression animal model of old man for future researches.

Objective To investigate the possible abnormal changes of adult neurogenesis in the rostral migratory stream(RMS),in the olfactory bulb and in learning or memory of renovascular hypertensive rat,and to evaluate the possible efficacies produced by intervention of exogenous melatonin.Methods Renovascular hypertensive rat model was established by clamping bilateral renal arteries.Rats were randomly divided into four groups with 10 rats per group:hypertensive,sham-operated,melatonin-treated and normal groups.Morris water maze was used to detect the abilities of learning and memory,and immunohistochemistry for bromodeoxyuridine (BrdU),bromodeoxyuridine plus glial fibrillary acidic protein (BrdU + GFAP) and bromodeoxyuridine plus neurofilament (BrdU + NT) was utilized to examine the changes of the adult neurogenesis in RMS and in the olfactory bulb of each rat.Results The escape latency of hypertensive group ((29.95 ± 20.11) s) recorded in Morris water maze test was the longest in a significant comparison to those of normal group((20.58 ± 19.18)s),sham-operated group ((22.11 ± 20.28) s) and melatonin-treated group ((23.81 ± 22.25) s) (P ＜ 0.05) ; while the time spent by rats during swimming in the quadrant with being originally put platform of hypertensive ((25.51 ± 5.21) s) was the shortest by significant comparison to those of normal((34.67 ± 4.53) s),sham-operated ((33.56 ± 6.12) s) and melatonin-treated group ((36.23 ± 3.86)s) (P ＜ 0.05).Proliferation of neural stem cells (cells/field):the number of BrdU immunoreactive (BrdU-IR) cells of rats in RMS of hypertensive group(34.08 ±6.49) was the smallest,significantly compared with those of normal(43.53 ± 7.56),sham-operated (46.11 ± 4.75) and melatonintreated group (44.30 ± 8.29),(P ＜ 0.05).Differentiation of neural stem cells (cells/slice):the number of BrdU + GFAP-IR cells in olfactory bulb of hypertensive group (2.45 ± 1.32) was largest,significantly compared with those of normal (1.01 ± 0.78),sham-operated (0.68 ± 0.37) and melatonin-treated group (1.35 ± 0.88) (P ＜0.05) ; while the number of BrdU + NF-IR cells in olfactory bulb of hypertensive group (1.15 ± 0.81) was the smallest,significantly compared with those of normal (1.89 ± 0.98),sham-operated(1.63 ± 1.01) and melatonin-treated group (2.30 ± 1.22) (P ＜ 0.05).Conclusion Melatonin can ameliorate the abnormal cognitive behaviors induced by hypertension via a mechanism of reversing the progression of neurogenesis disorders both in RMS and in olfactory bulb,indicating that melatonin may prevent the development of dementia triggered by hypertension.

The fatigue of the diaphragm was determined with electromyography ir.35 patients with chronic obstructive emphysema (COPD) and in 47 nomaJ subjects serving as the control.It was found that the high/low frequency ratio (H/L) and the central frequency (Fc) of the diaphragmatic electromyogiam (EMGdi) were markedly decreased after diaphragmatic fatigue in COPD patients as well as in the controls ( P

To summarize the etiological factor and to assess the therapeutic effect for neovascular glaucoma(NVG).Methods A retrospective study of 28 cases (29 eyes) with NVG was performed. The mean age, proportion of sex and primary ocular disease, incidence of symptom, sign and postoperative complication were analyzed. Results 78 6% of the patients were over 40 years old. 62% of the patients were secondary to the ocular ischemic disease such as central retina vein occlusion and proliferative diabetic retinopathy. The clinical characters included intraocular pressure (IOP) increasing, pain, mixed conjunctival congestion and rubeosis iridis. The mean IOP reduction was 19.5 mmHg in 29 eyes after antiglaucomatous drags treatment and 19.13mmHg in 23 eyes after Hunan aqueous humor drainage (HAD) implantation. The common postoperative complications were flat anterior chamber and choroidal detachment. The success rate of HAD implantation was 87%.Conclusions NVG was commonly secondary to ocular ischemic disease. Although prevention was the principal, reducing IOP and ameliorating ischemic situation were as the same important.

Objective To investigate the application value of combined detection of enterovirus 71 type(EV71) nucleic acid and antibody in diagnosis of hand-foot-mouth disease(HFMD).Methods From Jan.to Nov.2015,a total of 180 children with suspected HFMD were divided into nucleic acid detection group,antibody detection group and combined detection group,with 36 subjects for each group.Viral nucleic acid was detected by using reverse transcription polymerase chain reaction.Antibody was detected by using enzyme linked immunosorbent assay.All detected results were analyzed.Results The positive rate of nucleic acid detection group was the highest(80.55%),while that of antibody detection group was the lowest(47.22%).Among various symptoms,the positive rates of nucleic acid,antibody and combined detection in subjects with skin rash were the highest.Conclusion Combined detection of EV71 nucleic acid and antibody could avoid the false positive result of nucleic acid detection and false negative result of antibody detection,thus could be helpful for increasing diagnostic accuracy rate of HFMD.

Objective To study the lymphatic microvessel density of keloid and correlation of invasive growth.Methods Invasive part,proliferative part and peripheral normal skin of keloid patients (n=10) were collected by surgical excision,and normal skin of keloid and non-keloid patients as control.Lymphatic vessel density of different parts of keloid and normal skin were investigated by immunohistochemical staining using the lymphatic endothelium specific marker D2-40.Results There were no significant differences between lymphatic microvessel density of peripheral normal skin of keloid (12.563 ±1.803) n/mm2 and normal skin of non-keloid patients (11.071 ± 2.645) n/mm2 (t=1.389,P＞0.05); Lymphatic microvessel density of invasive part of keloid (27.315 ± 7.430) n/mm2 was significantly higher than those of proliferative part of keloid (17.375± 6.221) n/mm2 and normal skin (12.563±1.803) n/mm2 (x2 =16.8,P＜0.01); there were significant differences between proliferative parts of keloid and normal skin (t=2.276,P＜0.05).Conclusions Lymphatic microvessel density increase in the invasive part of keloid may have a certain relationship with invasive growth.

This paper presents successful surgical treatment of a-trial fibrillation by a simplified maze procedure (SMP) in 3 patients. All of them suffered from rheumatic heart valvular diseases complicated with atrial fibrillation (AF) for 3 to 10 years. Their heart function were in class III-IV(NYHA). The diameter of the left atrium varied from 52-58 mm and the cardiothoracic ratio 0. 64-0.70. The open heart operation was performed under conventional cardiopulmonary bypass combined with systemic hypothermia and using cardio-plegia for myocardial protection. After finishing the modified maze operation,mitral valve replacement was performed in 2 cases and mitral and aortic valve replacement together with tricuspid annuloplasty in one. Sinus rhythm recovered after cardiac ressuscitation and was maintained in the early postoperative period in all 3 cases. However, with in 3 months after the operation, one patient died of cerebrovascular accident, probably a complication of anticoagulant therapy. The other 2 patients remained well with normal sinus rhythm and their heart function was in class I 3 years after the operation. The clinical results indicate that mitral valve or mitral and aortic valve replacements plus simplified maze procedure to abolish atrial fibrillation may improve the postoperative hemodynamics by recovery of the sinus rhythm.

OBJECTIVE To explore the nursing management to control hospital infection in center of the blood purification,and to improve the nursing quality.METHODS All of the nursing management measure,education and strictly administered disinfection and isolation measure were established to control the hospital infection.RESULTS After the nursing management to control hospital infection was standardized and regularted and the standardized sterilization and isolation were set up,the rate of hospital infection was decreased.CONCLUSIONS Nursing management can play a main and key role in the control of hospital infection in center of the blood purification.

The article introduces the network resource in urology surgery both at home and abroad and analyses the existing problems in carrying out online teaching uronology and puts forward some countermeasures.