Objective To analyze the outcome of allograft function of the HBsAg(+) recipients and discuss the suitable time of antiviral therapy. Methods Twenty-one HBsAg(+) recipients were randomly divided two groups: one group (11 cases) taking lamivudine orally after recovery of intestinal function, and another group (10 cases) taking lamivudine orally when liver dysfunction and increased HBV-DNA (HBV-DNA>106 copies/L) occurred during the period of follow-up. Liver function, allograft function, and hepatitis virus reactivation were followed up for 2 years after transplantation. Results Hepatitis recurrence and liver dysfunction after renal transplantation lay in viral replication after immuno-suppression. Lamivudine therapy accomplished the goals of viral suppression, and normalization of alanine aminotransferase (ALT) levels. Preemptive lamivudine therapy for recipients had a better liver and allograft function than oral administration for patients with liver dysfunction and increased HBV-DNA copies during a period of the two-years follow-up. Conclusion HBsAg (+) is not contraindication of renal transplantation. Preemptive lamivudine therapy early after operation could avoid liver dysfunction and improve the renal allograft function during the period of two-years follow-up.

AIM: To study the clinical treatments and prognosis of the severe pneumonia in 12 patients after renal transplantation. METHODS: Twelve patients with severe pneumonia following renal transplantation treated in Guangdong Provincial Hospital of Traditional Chinese Medicine were selected between May 2004 and October 2006. They all agreed to the experiment. Seven patients had pneumonia at 3 months after transplantation, 1 at 3.5 months, 3 at 4 months and 1 at 5 months. The main therapy included immunosuppressive removal at early stage, mask oxygen inhalation, bi-level airway pressure ventilation or tracheal intubation to correct the hypoxemia; the algogen was detected by many approaches, and specific treatment was carried out according to the susceptibility test; gastroenteric nutrition was supplied through nasogastric tube, and part patients were given parenteral nutrition to strengthen nutrition support. Imaging examination of lung and blood gas analysis were performed every two to three days to evaluate the curative effect; transplanted kidney function was detected to determine the acute rejection early. RESULTS: All 12 patients were involved in the result analysis without any lost. Etiological agent detection: There were three cases with fungal pneumonia, 4 with cytomegalovirus pneumonia, 3 with bacterial pneumonia, 1 with mixed infection and 2 with unclear agent. Two cases of cytomegalovirus pneumonia developed rapidly into acute respiratory distress in 1 week after hospitalization and finally died of respiratory failure; the rest 10 patients were rescued successfully, except one with pulmonary interstital fibrosis, which could affect the life quality. CONCLUSION: The key points of successful treatment for severe pneumonia are the combination of early aggressive reduction of the immunosuppressive therapy, early detection of responsible pathogen and effective control of severe hypoxemia.

[Objective]To explore the cause of the early complications of Bryan cervical disc arthroplasty and summarize the prevention experience. [Methods]From June 2006 to December 2007,60 patients(33 males and27 females) with 73 levels underwent Bryan cervical disc placement.The average age was 43.3 years(range,33-54 years).[Results]One case complained of persistent arm pain because of incomplete decompression and was treated by dehydration,but the pain was still present.The average period of follow-up was 15.6 months,JOA scores were improved from 8.34?1.22 points to 16.11?1.01 points(P

Objective A new field of organ donation after cardiac death (DCD) has been explored to create additional source to clinic transplantation in China.Methods A 33-years old male patient underwent permanent vegetation state for more than 2 years in ICU after severe head injury.His relatives gave writing consent to donate his organs in order to save his renal failure father and others,if possible,in case of cardiac death.On July 27,2005,the patient's heart arrested.Clinic death was announced.The case was immediately referred to transplant team and Maastricht-V DCD organ procurement was emergently performed and two kidneys were harvested. Estimated warm ischemic time was about 40 min followed by 8 h cold ischemic time.Two adults received the grafts.One of recipients was donor's biological father,namely it was the first case of deceased related renal transplantation (DRRTx) in China.Results Both recipients developed delayed graft function postoperatively and eventually recovered after few weeks.By submission of this article,the DRRTx patient has survived with normal renal function for 77 months (6 years and 5 months).Unfortunately,other patient died from fungus pneumonia after 56 months with normal renal function.Conclusion Non-controlled Maastricht-V DCD could be an additional source to transplantation if prompt reaction could be taken.

Objective To evaluate the role of the combination of angiotensin receptor blocker (ARB)and angiotensin corwerting enzyme inhibitor(ACEI)in functional protection and long-term survival of renal allograft. Methods Thirty-two renal transplant recipients without diabetes mellitus,whose albuminuria concentration in 24-hours collection was more than 0.5 g/d or serum Cr concentration was higher than 177 mmol/L,were randomly divided into experimental group(n=23,male 9 and female 14 cases,mean age 40 years)and control group(n=9,male 5 and female 4 cases,mean age 35 years).Combination of ARB(Valsartan,80rag Qd)and ACEI(Benazapril,20 mg Bid)theraPy was given to each patient every day for 3 years in experimental group.The recipients in control group never received this administration.The serum Cr concentration,albuminuria in 24-hours collection and survival of renal allograft were compared between the 2 groups after 3 years. Results There was significant difference(P＜0.05) of serum Cr concentration between experimental group and control group(252.2±117.9 mmol/L VS 375.3±203.0 mmol/L),especially for chronic allograft nephropathy (CAN)patieats(282.4±147.3 mmol/L vs 528.7±107.8 mmol/L,P＜0.01).There was no difference (P＞0.05)in terms of the values of alburninuria(1.0±0.6 g/d vs 1.3±0.7 g/d)and survival of renal allograft(76 months VS 71 months)after 3 years between 2 groups.Comclusion The administration of ARB+ACEI could protect function of renal allograft with different pathological changes especially for CAN.

Objective To investigate the preliminary experience of mechanical thrombectomy with a tri-axial system of the Solitaire AB stent through a Neuro delivery catheter to treat intracranial large artery occlusion. Methods A tri-axial system was used to deliver the Solitaire AB stent through a Neuro delivery catheter to provide intracranial aspiration in close proximity to the stent. This technique was used in 1 case of acute middle cerebral artery occlusion and 1 case of acute basilar artery occlusion. Results Successful revascularization was achieved in these 2 cases. Thrombolysis in cerebral infarction (TICI)score was 3. The clot length of acute middle cerebral artery occlusion was 3 cm and the modified Rankin Scale (mRS)score of this case was 3 at 90 days follow-up. Another patient with acute bilateral vertebral occlusion was revealed successful recanalization by angiography. Conclusion The results suggest that this technique of a tri-axial system used of the Solitaire stent through a Neuro delivery catheter can effectively retrieve clots from the occlusive artery and minimize the chance of antegrade blood flow dislodging the thrombus.

Objective To find out the pathogenicity of bacterial L-forms.Methods β-glucuronidase activities of both E.coli and their L-forms were determined with modified Fishman's method. The endotoxin content in 3 kinds of Gram negtive bacteria and their L-forms were measured with the limulus lysate test. Under ultrasonography, percutaneous transhepatic cholecystic punctures were performed on 2 groups of 10 healthy dogs. E.coli and their L-forms were respectively injected into the gallbladders of the 2 groups. 48 hours later, the gallbladder bile was obtained through puncture and cultured. After 6 months, all the animals were killed. Their bile was cultured and the gallbladders were pathologically analysed.Results Endotoxin existed in L-forms of Gram negtive bacteria (about 1/3-1/2 of the original forms). L-forms of E.coli also produced β-glucuronidase (58.67% activity of the original forms). A half of the E.coli which had stayed in the canine gallbladders for 48 hours have been transformed into L-forms by the action of bile and other factors. The L-forms existed in the gallbladder bile longer than 6 months. The gallbladders showed chronic infections: mild atrophy of mucosa, white blood cell and lymph cell infiltration in submucosa and slight fiberosis of the gallbladder walls. Bacterial L-forms were found in mucosa cells.Conclusions Bacterial L-forms can also produce pathogenical materials, but the amount is less than that of the original bacterial forms. Both bacterial forms and L-forms can lead to chronic infection of the canine gallbladders.

AIM: To illuminate the effect of SWI/SNF-related, matrix-associated, actin-dependent regulator of chromatin, subfamily b, member 1 (SMARCB1) in early diagnosis and prognosis of hepatocellular carcinoma (HCC) by determining the clinical expression of SMARCB1 in HCC tissue and benign liver tissue.METHODS: The specific target gene SMARCB1 was selected from these genes by using The Cancer Genome Atlas (TCGA).SMARCB1 expression in HCC tissue and benign liver tissue was measured by immunohistochemistry.Further statistical analysis of TCGA was performed to illuminate the role of SMARCB1 on HCC occurrence and progression.RESULTS: Compared with the benign liver tissue, immunohistochemical staining showed that SMARCB1 expression was significantly up-regulated in the HCC tissue (P<0.01).In addition, SMARCB1 expression was significantly associated with advanced tumor stage (P<0.05).The relation between SMARCB1 expression at mRNA level and clinical prognosis was analyzed.The results indicated that high SMARCB1 expression was an independent prognostic factor for HCC (P<0.05).CONCLUSION: SMARCB1 may play a part as a carcinogenic gene in tumorigenesis.We can distinguish primary HCC samples from non-malignant samples according to its different clinical expression.High SMARCB1 expression probably predicts poor outcome in HCC patients.

There are two kinds ofamelogeningene mutation, including mutation in primer-binding re-gion ofamelogeningene and micro deletion of Y chromosome encompassingamelogeningene, and the latter is more common. The mechanisms of mutation in primer-binding region ofamelogeningene is nu-cleotide point mutation and the mechanism of micro deletion of Y chromosome encompassingamelo-geningene maybe non-allelic homologous recombination or non-homologous end-joining. Among the population worldwide, there is a notably higher frequency ofamelogeningene mutations in Indian popu-lation, Sri Lanka population and Nepalese population which reside within the Indian subcontinent. Thoughamelogeningene mutations have little impact on fertility and phenotype, they might cause incor-rect result in gender identification. Using composite-amplification kit which including autosomal STR lo-cus,amelogeningene locus and multiple Y-STR locus, could avoid wrong gender identification caused byamelogeningene mutation.

Objective To investigate the role and mechanism of circular RNA SNRK (circSNRK) in ischemia-reperfusion injury (IRI). Methods A hypoxia-reoxygenation (IRI) cell model was established. The expression level of circSNRK after IRI treatment and the effect of overexpression of circSNRK on cell proliferation and apoptosis were detected. The targets of circSNRK were identified. HK2 cells were divided into the blank group (Mock group), IRI group, control plasmid+IRI group (IRI+NC group), human circSNRK overexpression+IRI group (IRI+circSNRK group), human circSNRK overexpression+IRI+protein kinase B (Akt) inhibitor group (IRI+circSNRK+MK2206 group) and control plasmid group (NC group). Cell proliferation and apoptosis were detected in the Mock, IRI, IRI+NC and IRI+circSNRK groups. The gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses of the target of circSNRK were carried out. The expression levels of CDKN1A, Akt, B-cell lymphoma (Bcl)-2, cysteinyl aspartate specific proteinase (Caspase)-9 messenger RNA (mRNA), and those of p21, Bcl-2, Caspase-9, Akt and p-Akt proteins were detected in the Mock, IRI, IRI+NC and IRI+circSNRK groups, respectively. Cell proliferation and apoptosis were determined in the NC, IRI+NC, IRI+circSNRK and IRI+circSNRK+MK2206 groups. Results Compared with the Mock group, the expression level of circSNRK was lower, and cell proliferation capability of HK2 cells was decreased and cell apoptosis was increased in the IRI group. In the IRI+circSNRK group, cell proliferation capability was higher, whereas cell apoptosis was lower than those in the IRI+NC group. circSNRK could act on 648 targets through 51 microRNAs (miRNAs). GO enrichment analysis revealed that the targets of circSNRK were mainly enriched in biological processes (such as cell process and biological regulation), cell components (such as cell parts, cells and extracellular parts), and molecular functions (such as binding, binding proteins and enzymes). KEGG enrichment analysis showed that the targets of circSNRK were mainly enriched in cancer signaling pathway, phosphatidylinositol 3-kinase (PI3K)-Akt signaling pathway, miRNA in cancer and other related signaling pathways. Compared with the Mock group, the relative expression levels of CDKN1A and Caspase-9 mRNA were higher, the expression level of miR-99a-5p RNA was higher and the relative expression levels of Akt and Bcl-2 mRNA were lower in the IRI group. Compared with the IRI+NC group, the relative expression levels of CDKN1A and Caspase-9 mRNA were lower, those of Akt and Bcl-2 mRNA were higher, and the expression level of miR-99a-5p RNA was lower in the IRI+circSNRK group, and the differences were statistically significant (all P < 0.05). Compared with the Mock group, the expression levels of p21 and Caspase-9 proteins were higher, while those of p-Akt, Akt and Bcl-2 proteins were lower in the IRI group. Compared with the IRI+NC group, the expression levels of p21 and Caspase-9 proteins were lower, whereas those of p-Akt, Akt and Bcl-2 proteins were higher in the IRI+circSNRK group. The miR-99a-5p binding sites were observed in circSNRK and Akt. Compared with the NC group, cell proliferation capability was declined in the IRI+NC group. Compared with the IRI+NC group, cell proliferation capability was elevated in the IRI+circSNRK group. Compared with the IRI+circSNRK group, cell proliferation capability was declined in the IRI+circSNRK+MK2206 group (all P < 0.05). The cell apoptosis level in the IRI+NC group was higher than that in the NC group. The cell apoptosis level in the IRI+circSNRK group was lower compared with that in the IRI+NC group. The cell apoptosis level in the IRI+circSNRK+MK2206 group was higher than that in the IRI+circSNRK group. Conclusions Under IRI conditions, circSNRK may affect the proliferation and apoptosis of HK2 cells probably via the Akt signaling pathway.