Advances in immunosuppressive therapy have significantly improved short-term allograft and patient survival.However,chronic allograft failure,antibody mediated rejection,recurrent diseases and immunosuppressive drug associated adverse effects remain serious barriers to long-term survival and quality of life.New immunosuppressive agents and protocols are being evaluated to combat these problems.Importantly,clinicians must work to manage post-transplant complications and avoid complex medication regimens,which will potentiate drug interactions and non.compliance.Different organs have different immunogenicities and each recipient has a unique clinical and immunologic profile.The clinician must recognize these variations and customize the immunosuppressive regimens and treatment protocols based on the individual condition.The general principles of an individualized immunosuppressive protocol should take the following factors into account:organ type,donor and recipient characteristics,quality of the donor organ,recipienVs medical history,recipient's undedying disease,immunologic risk for acute rejection,potential co-morbidity related to immunosuppression,significant druginteractions,medication costs and patient compliance.In addition,the combination of immunosuppressive drugs must have a pharmacologic rationale to achieve the desired goal of suppressing the individual's immune system to render the patient tolerant to the allograft while minimizing co-morbidities.For the past few years,many clinical strategies have been applied in an attempt to improve graft survival or to reduce immunsuppressants induced side-effects.Specific protocols include steroid or CNI avoidance,minimization or withdraw,desensitization,and treatment for antibody mediated rejection,disease specific,and pediatric specific.The short-term outcomes from these different strategies are promising but the long-term results remain to be determined.Unfortunately,current immunosuppressive agents or strategies have failed to adequately control chronic rejection in most of solid organ transplantation except liver transplantation.Eady post-transplant complications aye generally related to the operation,the severity of pre-operative illness,immunologic status,and the quality of the donor organ.Careful recipient and donor selection is paramount to minimize severity of disease and medical comorbidities.These early complications include allograft dysfunction,cardiovascular and hemodynamic instability,and immunosuppressive drug-induced adverse effects.Acute infection remains a common and serious early complication despite new and effective drug therapies,placing the responsibility on the clinician for early recognition and treatment.Emerging resistant bacteria and fungi require early and aggressive intervention.Unlike infection,early aUograft rejection is usually limited and manageable with the newer immunosuppressive agents.However,it must be distinguished from other causes of allograft dysfunction(ie.recurrent hepatitis C,ealcineurin induced nephrotoxicity,or infection).Recently approved Cylex@immune cell function assay allows clinicians to tailor and individualize immunosuppression to prevent organ rejection while minimizing infection and complications.Improved patient and allograft survival has enabled transplant recipients to reach milestones and return to productive lives provided they are compliant. It was also challenged the clinician to manage the long-term complications of immunosuppression therapy, adverse drug interaction, recurrent diseases and chronic allograft failure. Long-term immunosuppressive therapy places transplant recipients at risk for renal insufficiency, cardiovascular and metabolic diseases, de novo malignancies, and psychosocial challenges. The management of viral hepatitis C re-infection, chronic allograft nephropathy, vasculopathy, and obliterative bronchiolitis is currently the greatest challenges facing the transplant specialist. The management of immunosuppressants induced adverse effects/drug interactions, chronic allograft failure and recurrent disease is dependent on regular clinical follow-up, an accurate diagnosis and appropriate treatment.Our challenge for the future will be to develop strategies to determine the best, cost-effective regimens for an individual patient to prevent long-term graft loss. I believe the management of immunosuppression and posttransplant complications is best met with a multidisciplinary team approach. This presentation will discuss the current immunosuppressive strategies and the common post-transplant complications. It is designed to help the clinician recognize individual risk factors and provide appropriate management.

Objective:To investigate the feasibility of establishing a human renal cell carcinoma model in human peripheral blood lymphocyte-engrafted to severe combined immunodeficient(hu-PBL-SCID)mice.Methods:The biological and immunological features of mice were evaluated after intra-peritoneal injection of human peripheral blood lymphocytes(PBL)and subcutaneous implantation of human renal cell carcinoma cells(RCCCs).Results:(1)Subcutaneous tumors developed in all the mice given human PBL and RCCCs.The latency period was significantly prolonged,and the tumor size was markedly depressed,as compared with the mice given RCCCs(P

0.05).The wake-up times in above-mentioned two groups were shorter than that in X-group,and the recovery times of BR and temperature were shorter than that in X-group.SBP of XN-group were better than that of N-group at 4 and 8 h after the treatment.PaO2/FiO2 of XN-group was better than that of N-group and X-group at 8 h after the treatment.Meanwhile the symptoms after the patients came around,including dizzy and headache,nausea and vomiting,palpitation and chest distress,were fewer in XN-group than those in N-group(P

Optic neuritis and multiple sclerosis are common diseases of neuro-ophthalmolgy.It is concord for doctors in the recognition,diagnosis and therapy of optic neuritis abroad.But there is much debate on the concept,diagnosis and therapy in optic neu- ritis and multiple sclerosis in China.It is the responsibility of ophthalmologists to have correct cognition in the concept and diagnosis on optic neuritis and multiple sclerosis,and to save visual function of patients through reasonable normative therapy.Active exploration and necessary disputing are beneficial to recognize this disease,and important to obtain the best therapy program,too.(Ophthalmol CHN,2007,16:361-362,364)

Intracranial aneurysm is one of the major causes in cerebral hemorrhage and subarachnoid hemorrhage. About 20% patients with intracranial aneurysms have clinical symptoms or signs of eye in early stage. One of them is acute monocular mydriasis without other signs. Sometimes the patients would receive timely treatment and be saved if ophthalmologists can recognize this sign. This editorial reviewed some physiological and pathological factors resulting in acute mydriasis from the point of anatomy, etiology and diagnosis , and emphasized the relation and clinical significance between intracranial aneurysms and monocular mydriasis.

Objective To study the chemical constituents from the stems of Acanthopanax gracilistylus.Methods Thechemical constituents of the plant were isolated and puried by column chromatography and their structures wereelucidated on the basis of physicochemical properties and spectral data.Results A new ent-kaurane glycoside,named kaurane acid glycoside A { 16α,17-dihydroxy-ent-kauran-19-oic 19-[β-D-glucopyranosyl-(1→2)-β-Dglucopyranosyl]ester}(1),was isolated from the n-butanol part.Conclusion Compound 1 is a new one.

Objective To explore the efficacy of low-dose aripiprazole combining with citalopram on the depression. Methods A total 57 patients with depression were randomly assigned to the study group and the control group. Either group was treated with a fixed dose 20 mg citalopram per day, and the study group was simultaneously titrated to low dose (5～10mg/d) of aripiprazole at initiating dose 2.5 mg per day within two weeks. They were evaluated with Hamilton Depression Scale (HAMD).Clinical Global Impression (CGI-SI) and Treatment Emergent Symptom Scale(TESS) before treatment and at the end of 1st, 2nd, 4th and 6th week after treatment. The study lasted for 6 weeks. Results HAMD total score of either group were 11.54 ± 5.58 and 16.59 ± 6.67 respectively, which had statistically significant difference between two groups(t = 2.961, P<0.05) at the end of the study. CGI-SI score of either group was 2.12 ± 1.47 vs 3.17 ± 1.63 at treatment termination, which also had statistically significant difference (t = 2.439, P<0.05). There were mild side effects rate and no statistically significant difference between two groups (χ~2 =0.625, P>0.05). TESS scores were not statistically significant difference between two groups at each point of measure. Conclusion The results suggest low dose of aripiprazole augmentation of citalopram may be effective and safe in the treatment of depression.

Objective To learn the hotspots of study in ischemic optic neuropathy (ION).Methods Literature on ION published in January 2000 to July 2012 was identified in Pubmed database.MeSH terms that frequently appeared were identified and co-word analysis was carried out by cluster analysis.Then a network was drawn using social network analysis.Results A total of 1045 papers were included.The United States,England,Germany,France and Netherlands together accounted for 71.53％ (748) of the articles.There were 28 high-frequency MeSH terms and hot topics clustered into four fields.The appearance frequency of MeSH showed that most research focused on:(1)postoperative or arteritic ION;(2) epidemiology,pathology and diagnosis of ION ; (3) pathophysiology and therapy of ION ; (4) chemically induced ION.Conclusion The international main research focus of ION includes four fields,which may provide reference or scholars both in scientific research and clinical research.

Neuro-ophthalmology is a subspecialty of both neurology and ophthalmology concerning visual problems that are related to the nervous system. As the rapid development of computer technology, information technology and radiology, the development of neuro-ophthalmology is in the best period in history. The following important topics are worthy of attention: 1) the diagnosis and therapy of carotid artery stenosis related ophthalmopathy;2)the relationship between papilledema and cranial venous sinus thrombosis; 3) the diagnosis of optic canal fracture with high resolution computer tomography;4)the relationship between optic neuritis and multiple sclerosis.

Neuro-ophthalmological emergencies are some ocular manifestations, which are associated with the sight or life-threatening diseases if not promptly treated, including acute visual loss, sudden diplopia or anisocoria.Some severe nerve system or orbitocranial inflammatory diseases frequently present neuro-ophthalmological symptoms at the early stage.Acute visual loss is the common complaint of optic neuritis, arteritic anterior ischemic optic neuropathy, rhino-orbital-cerebral mucormycosis, and pituitary apoplexy.Diplopia usually occurs in cavernous sinus thrombosis or intracranial aneurysm because of cranial nerve palsies.Additionally, intracranial aneurysms and carotid artery dissecting aneurysm often present anisocoria initially.The clinical symptoms, signs, diagnosis and management of these disorders were reviewed from the point of emergency medicine, and the role of neuro-ophthalmological signs in the diagnosis was highlighted in this review, aiming to help ophthalmologists improve the awareness of these conditions, and emphasize the urgency of these signs.